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Cavalcante LCDC, Rodrigues GM, Ribeiro Júnior RFG, Monteiro AM, Damasceno AVBS, Couteiro RP, Yasojima EY, Brito MVH, Percário S. Ischemic perconditioning on mesenteric ischemia/reperfusion injury in rats. Acta Cir Bras 2021; 36:e360903. [PMID: 34755763 PMCID: PMC8580514 DOI: 10.1590/acb360903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/09/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose: To evaluate if the perconditioning affects the antioxidant capacity in
mesenteric ischemia and reperfusion injury. Methods: Twenty-one Wistar rats were assigned into three groups, as follows: Sham, IR
and rPER. The animals were subjected to mesenteric ischemia for 30 min. rPER
consisted of three cycles of 5-min hindlimb ischemia followed by 5 min
hindlimb perfusion at the same time to mesenteric ischemic period. After 5
minutes, blood and 5 cm of terminal ileum were harvested for thiobarbituric
acid reactive substances (TBARS) and Trolox equivalent antioxidant capacity
(TEAC) measurement. Results: rPER technique was able to reduce intestinal tissue TBARS levels
(p<0.0001), but no statistic difference was observed in blood levels
between groups, although it was verified similar results in rPER and Sham
group. rPER technique also enhanced TEAC levels in both blood (p = 0.0314)
and intestinal tissue (p = 0.0139), compared to IR group. Conclusions: rPER appears as the most promising technique to avoid IR injury. This
technique reduced TBARS levels in blood and intestinal tissue and promoted
the maintenance of antioxidant defense in mesenteric acute injury.
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Tavares-da-Silva E, Figueiredo A. Renal Procurement: Techniques for Optimizing the Quality of the Graft in the Cadaveric Setting. Curr Urol Rep 2020; 21:12. [PMID: 32166407 DOI: 10.1007/s11934-020-0963-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE OF REVIEW Kidney transplantation is the best treatment for end-stage renal disease. However, due to organ shortage, suboptimal grafts are increasingly being used. RECENT FINDINGS We carried out a review on the methods and techniques of organ optimization in the cadaveric setting. Donor care is the first link in a chain of care. Right after brain death, there is a set of changes, of which hormonal and hemodynamic changes are the most relevant. Several studies have been conducted to determine which drugs to administer, although in most cases, the results are not definitive. The main goal seems rather achieve a set of biochemical and hemodynamic objectives. The ischemia-reperfusion injury is a critical factor for kidney damage in transplantation. One of the ways found to deal with this type of injury is preconditioning. Local and remote ischemic preconditioning has been studied for various organs, but studies on the kidney are scarce. A new promising area is pharmacological preconditioning, which is taking its first steps. Main surgical techniques were established in the late twentieth century. Some minor new features have been introduced to deal with anatomical variations or the emergence of donation after circulatory death. Finally, after harvesting, it is necessary to ensure the best conditions for the kidneys until the time of transplantation. Much has evolved since static cold preservation, but the best preservation conditions are yet to be determined. Conservation in the cold has come to be questioned, and great results have appeared at temperatures closer to physiological.
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Affiliation(s)
- Edgar Tavares-da-Silva
- Urology and Renal Transplantation Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal.,Centro de Investigação em Meio Ambiente, Genética e Oncobiologia (CIMAGO), Coimbra, Portugal
| | - Arnaldo Figueiredo
- Urology and Renal Transplantation Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal. .,Faculty of Medicine, University of Coimbra, Coimbra, Portugal. .,Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal. .,Centro de Investigação em Meio Ambiente, Genética e Oncobiologia (CIMAGO), Coimbra, Portugal.
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Farooqui W, Pommergaard HC, Rasmussen A. Remote ischemic preconditioning of transplant recipients to reduce graft ischemia and reperfusion injuries: A systematic review. Transplant Rev (Orlando) 2017. [PMID: 28637593 DOI: 10.1016/j.trre.2017.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Solid organ transplantation is an accepted treatment for end-stage solid organ diseases. During the procedure, ischemia and reperfusion injury may affect graft and patient outcomes. Remote ischemic preconditioning (rIC) has been shown to reduce ischemia and reperfusion injury and can be performed safely. Thus, rIC may potentially improve outcomes after solid organ transplantation. Traditionally, the focus of rIC has been on the donor. However, preconditioning the recipient may be a more suitable approach in transplant settings. The current review analyzed previously published studies where rIC was performed on transplant recipients. METHODS PubMed and EMBASE databases were searched for eligible clinical and animal studies evaluating rIC of recipients. Articles were analyzed and compared qualitatively. Risk of bias was assessed using the Cochrane Collaboration's tool for interventional clinical studies and SYRCLEs risk of bias tool for animal studies. RESULTS A total of 12 studies were included. Overall, these studies were heterogeneous due to differences in populations and intervention set-up. Some of the studies suggested improvement of graft function, while other studies did not show any effect. The quality of the 12 included studies was predominantly low. CONCLUSION Due to the heterogeneity and quality of the included studies the result, that rIC may be beneficial in transplantation of some organs, should be interpreted with caution. The result must be confirmed by further clinical studies.
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Affiliation(s)
- Waqas Farooqui
- Department of Surgery, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark.
| | - Hans Christian Pommergaard
- Department of Surgical Gastroenterology and Transplantation, Abdominal Centre, Rigshospitalet, Blegdamsvej 9, 2100 Købehnavn Ø, Denmark
| | - Allan Rasmussen
- Department of Surgical Gastroenterology and Transplantation, Abdominal Centre, Rigshospitalet, Blegdamsvej 9, 2100 Købehnavn Ø, Denmark
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Pinheiro DFDC, Fontes B, Shimazaki JK, Heimbecker AMC, Jacysyn JDF, Rasslan S, Montero EFDS, Utiyama EM. Ischemic preconditioning modifies mortality and inflammatory response. Acta Cir Bras 2016; 31:1-7. [PMID: 26840349 DOI: 10.1590/s0102-865020160010000001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 12/12/2015] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To evaluate the effect of ischemic preconditioning on mortality, inflammatory mediators and oxidative stress after intestinal ischemia and reperfusion. METHODS Male Wistar rats were allocated according to the period of ischemia with or without ischemic preconditioning which consist on clamping the superior mesenteric artery for 10 minutes followed by reperfusion for 10 minutes before the sustained ischemia period. Mortality was assessed in Phase 1 study, and the CINC-1, CINC-2 and MDA levels in the lungs were analyzed in Phase 2. RESULTS Mortality was lower in the ischemic preconditioning group subjected to 90 minutes of ischemia compared to the group without ischemic preconditioning (I-90: 50% and IPC-90: 15%, p=0.018), and it was lower in the ischemic preconditioning group as a whole compared to the groups without ischemic preconditioning (IPC-14% and I=30%, p=0.006). Lower levels of MDA, CINC-1, and CINC-2 were observed in the animals that were subjected to ischemic preconditioning compared to the animals that were not (MDA: I-45=1.23 nmol/mg protein, and IPC-45=0.62 nmol/mg protein, p=0.0333; CINC-1: I-45=0.82 ng/mL and IPC-45=0.67 ng/mL, p=0.041; CINC-2: I-45=0.52 ng/mL and IPC-45=0.35 ng/mL, p=0.032). CONCLUSION Ischemic preconditioning reduces mortality, inflammatory process and oxidative stress in rats subjected to intestinal ischemia and reperfusion.
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Affiliation(s)
| | - Belchor Fontes
- Department of Surgery, Medical School, FMUSP, Sao Paulo, SP, Brazil
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Hemin Preconditioning Upregulates Heme Oxygenase-1 in Deceased Donor Renal Transplant Recipients: A Randomized, Controlled, Phase IIB Trial. Transplantation 2016; 100:176-83. [PMID: 26680374 DOI: 10.1097/tp.0000000000000770] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The enzyme heme oxygenase-1 (HO-1) degrades heme and protects against ischemia-reperfusion injury. Monocytes/macrophages are the major source of HO-1 and higher levels improve renal transplant outcomes. Heme arginate (HA) safely induces HO-1 in humans. METHODS The Heme Oxygenase-1 in renal Transplantation study was a randomized, placebo-controlled, IIb trial to evaluate HA effect on HO-1 upregulation after deceased donor kidney transplantation. 40 recipients were randomized to either 3 mg kg HA or placebo (0.9% NaCl), given preoperatively (day 0) and again on day 2. Recipient blood and urine were collected daily. Graft biopsies were taken preoperatively and on day 5. Primary outcome was HO-1 upregulation in peripheral blood mononuclear cells (PBMCs). Secondary outcomes were graft HO-1 upregulation and injury, urinary biomarkers, and renal function. RESULTS The HA upregulated PBMC HO-1 protein more than placebo at 24 hours: HA 11.1 ng/mL versus placebo 0.14 ng/mL (P = < 0.0001). The PBMC HO-1 messenger RNA also increased: HA 2.73-fold versus placebo 1.41-fold (P = 0.02). Heme arginate increased day 5 tissue HO-1 protein immunopositivity compared with placebo: HA 0.21 versus placebo -0.03 (P = 0.02) and % HO-1-positive renal macrophage also increased: HA 50.8 cells per high power field versus placebo 22.3 (P = 0.012). Urinary biomarkers were reduced after HA but not significantly. Histological injury and renal function were similar but the study was not powered for this. Adverse events were equivalent between groups. CONCLUSIONS The primary outcome was achieved and demonstrated for the first time that HA safely induces HO-1 in transplant recipients. Planned larger studies will determine the impact of HO-1 upregulation on clinical outcomes and evaluate the benefit to patients at risk of ischemia-reperfusion injury.
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Hypoxia and Complement-and-Coagulation Pathways in the Deceased Organ Donor as the Major Target for Intervention to Improve Renal Allograft Outcome. Transplantation 2015; 99:1293-300. [PMID: 25427168 DOI: 10.1097/tp.0000000000000500] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND In the last few decades, strategies to improve allograft survival after kidney transplantation have been directed to recipient-dependent mechanisms of renal injury. In contrast, no such efforts have been made to optimize organ quality in the donor. Optimizing deceased donor kidney quality opens new possibilities to improve renal allograft outcome. METHODS A total of 554 kidney biopsies were taken from donation after brain death (DBD) and donation after cardiac death (DCD) kidneys before donation, after cold ischemia and after reperfusion. Healthy living donor kidney biopsies served as controls. Transcriptomics was performed by whole genome microarray analyses followed by functional pathway analyses. RESULTS Before organ retrieval and before cessation of blood circulation, metabolic pathways related to hypoxia and complement-and-coagulation cascades were the major pathways enhanced in DBD donors. Similar pathways were also enriched in DCD donors after the first warm ischemia time. Shortly after reperfusion of DCD grafts, pathways related to prolonged and worsening deprivation of oxygen were associated with delayed graft function in the recipient. CONCLUSION In conclusion, this large deceased donor study shows enrichment of hypoxia and complement-and-coagulation pathways already in DBD donors before cessation of blood flow, before organ retrieval. Therefore, future intervention therapies should target hypoxia and complement-and-coagulation cascades in the donor to improve renal allograft outcome in the recipient.
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Guler L, Tavlasoglu M, Yucel O, Guler A, Sahin MA, Kurkluoglu M, Sirin Y, Eken A, Gamsizkan M, Dakak M, Gurkok S, Genc O. Taurine attenuates lung ischemia–reperfusion injury after lung transplantation in rats. J Anesth 2013; 28:347-53. [DOI: 10.1007/s00540-013-1741-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 10/19/2013] [Indexed: 10/26/2022]
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Gao M, Liu D. Ischemic preconditioning may attenuate lung ischemia-reperfusion injury partly by stimulating autophagy. J Formos Med Assoc 2013; 114:677-8. [PMID: 23902740 DOI: 10.1016/j.jfma.2013.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 05/02/2013] [Accepted: 06/17/2013] [Indexed: 11/16/2022] Open
Affiliation(s)
- Min Gao
- Intensive Care Unit, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Donglei Liu
- Department of Thoracic Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Hong SM, Yang YS. A potential role of crystallin in the vitreous bodies of rats after ischemia-reperfusion injury. KOREAN JOURNAL OF OPHTHALMOLOGY 2012; 26:248-54. [PMID: 22870022 PMCID: PMC3408528 DOI: 10.3341/kjo.2012.26.4.248] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 10/21/2011] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Ischemia-reperfusion injury (I/R injury) is known not only to induce hypoxic and oxidative stress, but also to cause retinal degeneration in rats. Crystallins, known to inhibit the formation of reactive oxygen species, reduce apoptotic cell death. Our goal was to clarify not only the role of I/R injury-mediated crystallins, but also to evaluate the correlation of these compounds to anti-inflammation in the vitreous body. METHODS Twenty-four Sprague-Dawley rats were used in this study. We induced I/R injury by clamping the optic nerve for 30 minutes and then releasing it. The vitreous bodies were obtained from the experimental and control subjects 24, 48, and 72 hours after I/R injury. Two-dimensional electrophoresis was performed, and the targeted spots were further investigated using matrix-assisted laser desorption-ionization time-of-flight mass spectrometry, spectrophotometry, Western blotting, and histological examination. RESULTS After I/R injury, 23 spots were identified as crystallins. The βB2 crystallins were transcriptionally and post-translationally regulated, whereas the αB crystallins were controlled by post-translational modifications in the vitreous bodies of the rats. The total amounts of αA and β crystallins (including isotypes of β crystalline) had increased 48 hours after injury. The phosphorylation of αB crystallin (at serine residues 19, 45, and 59) was significantly increased 48 hours later, whereas phosphorylation of ERK1/2 showed the greatest decrease. CONCLUSIONS During hypoxic and oxidation stress, our results suggest that phosphorylated αB crystalline inhibits RAS, resulting in the inactivation of ERK1/2. The phosphorylation of αB crystallin may be associated with the inflammatory suppression in the vitreous body via the I/R injury model system.
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Affiliation(s)
| | - Yun Sik Yang
- Department of Ophthalmology, Wonkwang University School of Medicine, Iksan, Korea
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Bon D, Chatauret N, Giraud S, Thuillier R, Favreau F, Hauet T. New strategies to optimize kidney recovery and preservation in transplantation. Nat Rev Nephrol 2012; 8:339-47. [DOI: 10.1038/nrneph.2012.83] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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