The ether phospholipids trail: blood timing in renal ischemia-reperfusion injury

Oxidized phospholipids as modulators of inflammation in atherosclerosis

PURPOSE OF REVIEW

This review will summarize recent evidence demonstrating that biologically active phospholipid oxidation products modulate inflammatory reactions.

RECENT FINDINGS

Structural identification of new biologically active oxidized phospholipids and the finding that they can also be formed at inflammatory sites other than the atherosclerotic lesion have expanded the potential role of these compounds in inflammation beyond atherogenesis. Various signaling pathways are induced by oxidized phospholipids, leading to the expression of inflammatory genes by mechanisms that differ from those mediated by the classic inflammatory agonists tumor necrosis factor or lipopolysaccharide. Furthermore, oxidized phospholipids can bind to pattern recognition molecules and thus potently influence inflammation and immune responses during host defense.

SUMMARY

During inflammatory processes biologically active lipid oxidation products accumulate that modulate the inflammatory process and may determine the fate and outcome of the body's reaction in acute inflammation during host defense. Oxidized phospholipids may induce and propagate chronic inflammatory processes; however, evidence is accumulating that cells and tissues respond towards these oxidatively formed stress signals also by activation of anti-inflammatory, cytoprotective reactions.

Postischemic renal oxidative stress induces inflammatory response through PAF and oxidized phospholipids. Prevention by antioxidant treatment

Reperfusion injury is considered primarily an inflammatory response to oxidative stress. In vitro, oxygen free radicals induce the formation of oxidized phospholipids with platelet-activating factor (PAF) activity (PAF-like lipids). We examined the following: 1) whether PAF and PAF-like lipids are released during reperfusion; 2) the relationship between these phospholipids and oxidative damage on the one hand, and leukocyte recruitment in renal tissue on the other; and 3) whether antioxidant treatment influences the behavior of these phospholipids, the renal inflammatory response, and the outcome of postischemic acute renal failure. After 60 min of warm renal ischemia in rabbits, a release of PAF and, particularly, PAF-like lipids was seen in the first 15 min of reperfusion. In addition, the release of those phospholipids was associated with intense tissue DNA oxidation and with an increase in myeloperoxidase activity. Vitamin C was able to attenuate these postischemic oxidative changes, decrease PAF and PAF-like lipid levels, and, consequently, reduce myeloperoxidase activity. After 40 min of warm renal ischemia in rats, vitamin C treatment ameliorated renal function and structure. This is the first in vivo demonstration of the release of phospholipid oxidation products as part of an oxidative-inflammatory response after renal ischemia-reperfusion, with the release of phospholipid oxidation products significantly reduced by antioxidant treatment.

Promising effects of ischemic preconditioning in renal transplantation

BACKGROUND

Ischemic preconditioning, a phenomenon induced by brief ischemia and reperfusion periods, renders an organ tolerant to subsequent prolonged ischemia. This study evaluated different schedules of preconditioning the kidney to assess the role of nitric oxide (NO) and determine the effects of preconditioning on kidney transplantation.

METHODS

In study design A, to determine the optimum procedure of preconditioning, one-cycle schedules were assayed by occluding/releasing renal pedicles according to various warm ischemic (5, 10, 15, 20 min) and reperfusion (10, 20, 40 min) windows in Sprague-Dawley rats. Thereafter, warm renal ischemia was induced by clamping both pedicles for 40 minutes. Design B used the most suitable schedule found from the first study to obtain several groups, using either a direct nitric oxide donor (spermine NONOate) or two nitric oxide synthase (NOS) blockers (L-NAME and aminoguanidine), to determine whether NO mediates in renal preconditioning. To establish whether preconditioning reduces cold preservation damage, in Design C the optimum preconditioning schedule was used in syngeneic Lewis rats where preconditioned and non-preconditioned kidneys were transplanted after five hours of cold storage in Euro-Collins solution.

RESULTS

The best preconditioning schedule consisted of 15 minutes of warm ischemia and 10 minutes of reperfusion (Prec 15/10), since it was the only schedule that offered both functional and histological protection. The NO donor reproduced the ischemic preconditioning. Non-selective NOS blockade abolished the preconditioning and exacerbated ischemic damage, which was overcome by the addition of the NO donor. Selective blocking of inducible NOS also abolished the effects of preconditioning. Renal NO increased at the end of preconditioning in the Prec 15/10 group. Prolongation of the reperfusion window (20 or 40 min) abolished the preconditioning protection, although it was associated with a further increase in renal NO. As renal DNA oxidative injury paralleled NO, increasing with prolongation of reperfusion, it may account for the disappearance of preconditioning. Finally, the one-cycle preconditioning schedule offered an effective functional and histological protection against cold preservation damage in rat renal transplantation.

CONCLUSIONS

Fifteen minutes of warm ischemia and 10 minutes of reperfusion in the kidney is the most suitable one-cycle schedule for preconditioning since it protects from both warm and cold ischemia. The beneficial effect of preconditioning is related to the local production of NO, and we believe it has promising therapeutic value in clinical renal transplantation.