Preconditioning and its clinical potential

A novel in vitro model of ischaemic preconditioning: its effect on cell viability in human skeletal muscle and a possible explanation for the 'second window of protection'

BACKGROUND

The ischaemia-reperfusion (IR) injury causes significant morbidity. Ischaemic preconditioning (IPC) is a technique for limiting the effects of the IR injury. Its potential has not yet been harnessed in orthopaedics.

AIMS

To establish a novel in vitro IR model using a human skeletal muscle cell line. Secondly, to introduce simulated IPC to the model and examine the effect of this on cell viability.

METHODS

A human skeletal muscle cell line was cultured in vitro. Placing the cells in a hypoxic buffer and a closed hypoxic environment simulated ischaemia. Reversing this process simulated reperfusion. IPC was simulated by alternate cycles of ischaemia and reperfusion. Cell viability comparisons were made between control and experimental groups of cells.

RESULTS

A reproducible in vitro IR model was established. The addition of simulated IPC is associated with increased cell death at 12 and 24 h of reperfusion. Significantly greater cell survival is seen in the IPC group when measured at 72 h reperfusion.

CONCLUSIONS

We hypothesise that IPC initially decreases cell number. The remaining cells are more robust. This selected cell line then expands over the course of 72 h and displays greater resistance to the IR injury. This theory can help explain delayed preconditioning.

The cellular and molecular origin of reactive oxygen species generation during myocardial ischemia and reperfusion

Myocardial ischemia-reperfusion injury is an important cause of impaired heart function in the early postoperative period subsequent to cardiac surgery. Reactive oxygen species (ROS) generation increases during both ischemia and reperfusion and it plays a central role in the pathophysiology of intraoperative myocardial injury. Unfortunately, the cellular source of these ROS during ischemia and reperfusion is often poorly defined. Similarly, individual ROS members tend to be grouped together as free radicals with a uniform reactivity towards biomolecules and with deleterious effects collectively ascribed under the vague umbrella of oxidative stress. This review aims to clarify the identity, origin, and progression of ROS during myocardial ischemia and reperfusion. Additionally, this review aims to describe the biochemical reactions and cellular processes that are initiated by specific ROS that work in concert to ultimately yield the clinical manifestations of myocardial ischemia-reperfusion. Lastly, this review provides an overview of several key cardioprotective strategies that target myocardial ischemia-reperfusion injury from the perspective of ROS generation. This overview is illustrated with example clinical studies that have attempted to translate these strategies to reduce the severity of ischemia-reperfusion injury during coronary artery bypass grafting surgery.

The role of oxidative stress response revealed in preconditioning heat stimulation in skeletal muscle of rats

BACKGROUND

Our previous study showed that preconditioned local somatothermal stimulation (LSTS) protected subsequent ischemia-reperfusion injury of the skeletal muscle. The exact mechanisms of LSTS preconditioning remain unknown. The aim of this study was to test the hypothesis stating that heat stimulation induces free radical production, increases enzymatic scavenging activity, and subsequently enhances the expression of heat shock protein 70 (HSP-70) in skeletal muscles.

MATERIALS AND METHODS

After LSTS was applied onto the left quarter ventral abdomen muscle of male Sprague-Dawley rats, the underling muscles were collected at the intervals of baseline, 5-, 15-, 30-, and 60-min after LSTS. The time-dependent profiles of free radical production and enzymatic scavenging activity were measured. The influence of nitric oxide (NO) on HSP-70 expression was evaluated by pretreatment of an NO synthase inhibitor.

RESULTS

The concentrations of reactive oxygen species, NO metabolites, and malondialdehyde increased significantly 5 min after LSTS, whereas the scavenging activity reduced to the lowest level 5 min (dismutase) and 15 min (catalase and glutathione) after LSTS. Expression of HSP-70 was significantly lower in the LSTS with NO synthase inhibitor group than in the LSTS group.

CONCLUSIONS

LSTS induces oxidative stress and the scavenging response in the underlying skeletal muscle, which might explain the possible mechanisms of LSTS preconditioning-induced muscle plasticity.