1
|
Derebaşınlıoğlu H, Demİröz A, Aydin Y, Ekmekçi H, Balci Ekmekçi Ö, Aydin Ö, Cankorkmaz L. Comparison of ischemic preconditioning and BotulinumA Toxin injection for the prevention of ischemia-reperfusion injury in musculocutaneous flaps. Turk J Med Sci 2020; 50:1523-1534. [PMID: 32718122 PMCID: PMC7605091 DOI: 10.3906/sag-1904-95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/21/2020] [Indexed: 11/15/2022] Open
Abstract
Background/aim The aim of the study was to evaluate the protective effect of Botulinum A toxin injection against ischemia-reperfusion injury. Materials and methods Thirty-two Sprague-Dawley rats were divided into: control, ischemia-reperfusion, ischemic preconditioning, and botulinum groups. In all groups the musculocutaneous pedicle flap was occluded for 4 h, and then reperfused to induce ischemia-reperfusion injury. Serum and tissue myeloperoxidase (MPO) and nitric oxide (NO) levels were measured at 24 h and at 10 days. Results Tissue MPO levels did not differ significantly between the ischemic preconditioning and botulinum groups at 24 h but was significantly lower in the botulinum group at 10 days. Tissue NO levels were significantly higher in the ischemic preconditioning group compared to the botulinum group at 24 h and at 10 days. Serum MPO showed no significant difference between these two groups at 24 h but was significantly lower in the ischemic preconditioning group compared to the botulinum group at 10 days. Serum NO levels were not significantly different at 24 h but significantly higher in the botulinum group at 10 days. Conclusion Findings show that botulinum has a protective effect against the ischemia-reperfusion injury via increased NO and decreased MPO levels in tissue. Based on tissue NO levels, ischemic preconditioning was significantly higher than botulinum.
Collapse
Affiliation(s)
- Handan Derebaşınlıoğlu
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Sivas Cumhuriyet University, Sivas, Turkey
| | - Anil Demİröz
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, İstanbul University Cerrahpaşa Medical School, İstanbul, Turkey
| | - Yağmur Aydin
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, İstanbul University Cerrahpaşa Medical School, İstanbul, Turkey
| | - Hakan Ekmekçi
- Department of Biochemistry, Faculty of Medicine, İstanbul University Cerrahpaşa Medical School, İstanbul, Turkey
| | - Özlem Balci Ekmekçi
- Department of Biochemistry, Faculty of Medicine, İstanbul University Cerrahpaşa Medical School, İstanbul, Turkey
| | - Övgü Aydin
- Department of Pathology, Faculty of Medicine, İstanbul University Cerrahpaşa Medical School, İstanbul, Turkey
| | - Levent Cankorkmaz
- Department of Pediatric Surgery, Faculty of Medicine, Sivas Cumhuriyet University, Sivas, Turkey
| |
Collapse
|
2
|
Akcal A, Sirvan SS, Karsidag S, Görgülü T, Akcal MA, Ozagari A, Tatlidede S. Combination of ischemic preconditioning and postconditioning can minimise skin flap loss: experimental study. J Plast Surg Hand Surg 2016; 50:233-8. [PMID: 27072670 DOI: 10.3109/2000656x.2016.1154468] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Ischaemic preconditioning and postconditioning, which consist of one or a series of short ischaemic events. This study aimed to determine the efficiency of post-conditioning a flap in the minimisation of flap loss after a preconditioned skin flap. METHODS The rats were divided into five groups: sham group, control group, pre-con group, post-con group, and pre + post-con group. On postoperative days 3 and 7, the entire flaps along with the margins of necrosis were traced onto transparent sheets. The areas of intact skin and tissue were recorded. RESULTS The flap necrosis area and percentage of necrosis were calculated for each animal. The necrotic area percentage of the control group was found to be significantly higher than those of the other groups on Days 3 and 7 (p = 0.01 and p = 0.03, respectively). The necrotic area percentage of the pre-con group was significantly higher than the pre + post-con group on Day 7 (p = 0.01). VEGFR-3 expression was observed at a rate of more than 50% in the post-con group. The presence of a protective effect in the late period was separately investigated by immunohistochemical staining of VEGFR-3 in the proliferating vessels. The necrotic areas was reduced in the flaps of the pre-con, post-con, and pre + post-con groups and the combined preconditioning and postconditioning group has reduced necrotic area compared to preconditioning of the skin flap. CONCLUSION The protective effect was observed on day 7 for combined ischaemic preconditioning and postconditioning. The presence of a protective effect in the late period was separately investigated by immunohistochemical staining of VEGFR-3 in the proliferating vessels.
Collapse
Affiliation(s)
- Arzu Akcal
- a Medical Faculty, Department of Plastic and Reconstructive Surgery , Akdeniz University , Antalya , Turkey
| | - Selami Serhat Sirvan
- b Department of Plastic and Reconstructive Surgery , Sisli Etfal Research and Training Hospital , Istanbul , Turkey
| | - Semra Karsidag
- b Department of Plastic and Reconstructive Surgery , Sisli Etfal Research and Training Hospital , Istanbul , Turkey
| | - Tahsin Görgülü
- c Medical Faculty, Department of Plastic and Reconstructive Surgery , Bulent Ecevit University , Zonguldak , Turkey
| | - Mehmet Akif Akcal
- d Deparment of Orthopedic and Traumatology , Ataturk State Hospital , Antalya , Turkey
| | - Aysim Ozagari
- e Deparment of Pathology , Sisli Etfal Research and Training Hospital , Istanbul , Turkey
| | - Soner Tatlidede
- b Department of Plastic and Reconstructive Surgery , Sisli Etfal Research and Training Hospital , Istanbul , Turkey
| |
Collapse
|
3
|
Kocman EA, Ozatik O, Sahin A, Guney T, Kose AA, Dag I, Alatas O, Cetin C. Effects of ischemic preconditioning protocols on skeletal muscle ischemia–reperfusion injury. J Surg Res 2015; 193:942-52. [DOI: 10.1016/j.jss.2014.09.032] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 09/11/2014] [Accepted: 09/24/2014] [Indexed: 01/03/2023]
|
4
|
Tupling AR, Bombardier E, Vigna C, Quadrilatero J, Fu M. Interaction between Hsp70 and the SR Ca2+pump: a potential mechanism for cytoprotection in heart and skeletal muscle. Appl Physiol Nutr Metab 2008; 33:1023-32. [DOI: 10.1139/h08-067] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The overexpression of heat shock protein 70 (Hsp70) provides cytoprotection to cells, making them resistant to otherwise lethal levels of stress. In this review, the role Hsp70 plays in protecting both cardiac and skeletal muscle against the pathophysiological effects of oxidative stress are examined, with a focus on the molecular basis for the cytoprotective effects of Hsp70. The ability of Hsp70 to maintain cell survival undoubtedly involves the regulation of multiple steps within apoptotic pathways, but could also involve the regulation of key upstream mediators of apoptosis (i.e., oxidative stress, Ca2+overload). Hsp70 can stabilize the structure and function of both the skeletal muscle and cardiac Ca2+pump under heat stress conditions. Given that Ca2+overload has long been implicated in cell death, Hsp70 might protect muscle cells by maintaining cellular Ca2+homeostasis, thereby preventing the initiation of apoptosis. The functional interaction between Hsp70 and Ca2+pumps might also promote improvements in muscle contractility after exposure to oxidative stress.
Collapse
Affiliation(s)
- A. Russell Tupling
- Department of Kinesiology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Eric Bombardier
- Department of Kinesiology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Chris Vigna
- Department of Kinesiology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Joe Quadrilatero
- Department of Kinesiology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Minghua Fu
- Department of Kinesiology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| |
Collapse
|
5
|
Coskunfirat OK, Ozkan O, Dikici MB. The Effect of Ischemic Preconditioning on Secondary Ischemia in Skin Flaps. Ann Plast Surg 2006; 57:431-4. [PMID: 16998337 DOI: 10.1097/01.sap.0000237082.57008.33] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ischemic preconditioning is a useful manipulation to reduce the undesirable effects of ischemia. The beneficial results of this phenomenon against ischemia-reperfusion have been seen in different flap models; however, all these studies have focused on primary ischemia. In this study, we investigated the effects of ischemic preconditioning on secondary ischemia in a skin flap model. We used the 6- x 3-cm-sized epigastric skin flap in 40 Wistar rats. In all animals, primary global ischemia of 2 hours was followed by 4 hours of either arterial or venous secondary ischemia 24 hours after the primary ischemia and ischemic preconditioning (IP) was tested in this protocol. Ischemic preconditioning was performed by 2 cycles of 15 minutes of repeated ischemia/reperfusion periods. The animals were allocated into 4 groups: group 1 (n = 10 animals): primary ischemia (2 hours) + secondary arterial ischemia (4 hours); group 2 (n = 10 animals): IP + primary ischemia (2 hours) + secondary arterial ischemia (4 hours); group 3 (n = 10 animals): primary ischemia (2 hours) + secondary venous ischemia (4 hours); group 4 (n = 10 animals): IP + primary ischemia (2 hours) + secondary venous ischemia (4 hours). Flap viability was assessed 1 week after the surgical procedure, and surviving flap area was recorded as a percentage of the whole flap area. Group 1 was compared with group 2, and group 3 was compared with group 4 to evaluate the effects of ischemic preconditioning against secondary arterial and venous ischemia. t test and Mann-Whitney rank sum tests were used for statistical analysis. There were statistical differences both between groups 1 and 2 and groups 3 and 4. The results revealed that ischemic preconditioning was an effective procedure to reduce the flap necrosis as a cause of secondary ischemia in skin flaps.
Collapse
Affiliation(s)
- O Koray Coskunfirat
- Department of Plastic and Reconstructive Surgery, Akdeniz University School of Medicine, Antalya, Turkey.
| | | | | |
Collapse
|
6
|
Moses MA, Addison PD, Neligan PC, Ashrafpour H, Huang N, McAllister SE, Lipa JE, Forrest CR, Pang CY. Inducing late phase of infarct protection in skeletal muscle by remote preconditioning: efficacy and mechanism. Am J Physiol Regul Integr Comp Physiol 2005; 289:R1609-17. [PMID: 16179491 DOI: 10.1152/ajpregu.00395.2005] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We have previously demonstrated that remote ischemic preconditioning (IPC) by instigation of three cycles of 10-min occlusion/reperfusion in a hindlimb of the pig elicits an early phase of infarct protection in local and distant skeletal muscles subjected to 4 h of ischemia immediately after remote IPC. The aim of this project was to test our hypothesis that hindlimb remote IPC also induces a late phase of infarct protection in skeletal muscle and that KATP channels play a pivotal role in the trigger and mediator mechanisms. We observed that pig bilateral latissimus dorsi (LD) muscle flaps sustained 46 ± 2% infarction when subjected to 4 h of ischemia/48 h of reperfusion. The late phase of infarct protection appeared at 24 h and lasted up to 72 h after hindlimb remote IPC. The LD muscle infarction was reduced to 28 ± 3, 26 ± 1, 23 ± 2, 24 ± 2 and 24 ± 4% at 24, 28, 36, 48 and 72 h after remote IPC, respectively ( P < 0.05; n = 8). In subsequent studies, hindlimb remote IPC or intravenous injection of the sarcolemmal KATP (sKATP) channel opener P-1075 (2 μg/kg) at 24 h before 4 h of sustained ischemia (i.e., late preconditioning) reduced muscle infarction from 43 ± 4% (ischemic control) to 24 ± 2 and 19 ± 3%, respectively ( P < 0.05, n = 8). Intravenous injection of the sKATP channel inhibitor HMR 1098 (6 mg/kg) or the nonspecific KATP channel inhibitor glibenclamide (Glib; 1 mg/kg) at 10 min before remote IPC completely blocked the infarct- protective effect of remote IPC in LD muscle flaps subjected to 4 h of sustained ischemia at 24 h after remote IPC. Intravenous bolus injection of the mitochondrial KATP (mKATP) channel inhibitor 5-hydroxydecanoate (5-HD; 5 mg/kg) immediately before remote IPC and 30-min intravenous infusion of 5-HD (5 mg/kg) during remote IPC did not affect the infarct-protective effect of remote IPC in LD muscle flaps. However, intravenous Glib or 5-HD, but not HMR 1098, given 24 h after remote IPC completely blocked the late infarct-protective effect of remote IPC in LD muscle flaps. None of these drug treatments affected the infarct size of control LD muscle flaps. The late phase of infarct protection was associated with a higher ( P < 0.05) muscle content of ATP at the end of 4 h of ischemia and 1.5 h of reperfusion and a lower ( P < 0.05) neutrophilic activity at the end of 1.5 h of reperfusion compared with the time-matched control. In conclusion, these findings support our hypothesis that hindlimb remote IPC induces an uninterrupted long (48 h) late phase of infarct protection, and sKATP and mKATP channels play a central role in the trigger and mediator mechanism, respectively.
Collapse
Affiliation(s)
- Michael A Moses
- Research Institute, The Hospital for Sick Children, Toronto, ON, Canada M5G 1X8
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Harralson T, Grossi FV, Quan EE, Tecimer T, Perez-Abadia G, Anderson G, Barker JH, Maldonado C. Ischemic Preconditioning of Skeletal Muscle. Ann Plast Surg 2005; 55:216-22. [PMID: 16034256 DOI: 10.1097/01.sap.0000164578.85395.c7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The time course of the late phase of ischemic preconditioning (IPC) was determined in latissimus dorsi muscle (LDM) flaps using viability and function as the endpoints. MATERIALS AND METHODS LDM flaps from Sprague-Dawley rats were allocated into 6 groups. LDMs were preconditioned with 2 30-minute periods of ischemia separated by 10 minutes of reperfusion and subjected to a 4-hour ischemic insult after 24, 48, 72, and 96 hours from IPC. LDMs were evaluated for percent necrosis and muscle contractile function and compared with controls. RESULTS The late phase of IPC provides significant protection against necrosis up to 72 hours. Conversely, when the end point used was muscle contractile function, the protection only lasted 48 hours. CONCLUSION The time course of late-phase protection in skeletal muscle is 2-3 days. Late phase IPC appears to protect muscle flaps during the most critical time period following elevation.
Collapse
Affiliation(s)
- Thomas Harralson
- Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Kilian JG, Nakhla S, Griffith K, Harmer J, Skilton M, Celermajer DS. Reperfusion injury in the human forearm is mild and not attenuated by short-term ischaemic preconditioning. Clin Exp Pharmacol Physiol 2005; 32:86-90. [PMID: 15730440 DOI: 10.1111/j.1440-1681.2005.04163.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
1. Ischaemia-reperfusion (IR) injury is an important contributor to tissue damage and has been shown to be attenuated by preconditioning (PC) in some animal models. A recent report has suggested that the forearm can be used for the study of this phenomenon in humans. We aimed to reproduce and further characterize this model. 2. Healthy young adult volunteers (mean (+/-SEM) age 32+/-6 years) were studied on two occasions. During one visit, IR alone was induced by 10 min of upper arm cuff occlusion, whereas on another occasion a PC stimulus (three 3 min cuff inflations) preceded IR. Endothelial function in the ischaemic arm was assessed by measuring arterial flow-mediated dilatation (FMD) and by calculation of forearm blood flow at baseline and 15 and 60 min after IR. Systemic venous blood was sampled from the non-ischaemic arm at baseline, after PC and at 2, 15 and 30 min after IR to assess neutrophil/leucocyte (CD11b) and platelet (bound glycoprotein IIb/IIIa and fibrinogen) activation, as well as numbers of platelet-leucocyte complexes, which were determined by flow cytometry. Because of a lack of measurable effects, the IR experiment was repeated with 20 min ischaemia in six subjects. 3. Five females and eight males completed the study. Flow-mediated dilatation was significantly impaired 30 min after IR (4.1 vs 6.2% at baseline; P<0.05);however, this was not significantly attenuated by ischaemic PC (FMD reduction at 30 min compared with baseline was 2.1+/-0.5% with IR alone and 2.6+/-1.4% with IR after PC; NS). No significant effect was seen on the number of platelet-leucocyte aggregates or on white cell or platelet activation after IR alone or after IR with PC (P>0.6 for all comparisons). Similar results were obtained in six subjects studied subjected to 20 min ischaemia. 4. In conclusion, in healthy young adults, brief periods of skeletal muscle ischaemia lead to arterial endothelial dysfunction, but no significant platelet or white cell activation. Preconditioning does not attenuate this effect on the endothelium. Further experiments with longer ischaemia times and varying PC stimuli may be necessary to produce measurable effects; however, this may prove difficult in conscious human subjects.
Collapse
Affiliation(s)
- J G Kilian
- The Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | | | | | | | | | | |
Collapse
|