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Kwon HM, Kang SJ, Han SB, Kim JH, Kim SH, Jun IG, Song JG, Hwang GS. Effect of dexmedetomidine on the incidence of postoperative acute kidney injury in living donor liver transplantation recipients: a randomized controlled trial. Int J Surg 2024; 110:4161-4169. [PMID: 38537086 PMCID: PMC11254204 DOI: 10.1097/js9.0000000000001331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/03/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND Acute kidney injury (AKI) is one of the most common complications after living-donor liver transplantation (LDLT) that has great impact on recipient and graft outcomes. Dexmedetomidine is reported to decrease the incidence of AKI. In the current study, the authors investigated whether intraoperative dexmedetomidine infusion would reduce the AKI following LDLT. MATERIAL AND METHODS In total, 205 adult patients undergoing elective LDLT were randomly assigned to the dexmedetomidine group ( n =103) or the control group ( n =102). Dexmedetomidine group received continuous dexmedetomidine infusion at a rate of 0.4 mcg/kg/h after the anesthesia induction until 2 h after graft reperfusion. The primary outcome was to compare the incidence of AKI. Secondary outcomes included serial lactate levels during surgery, chronic kidney disease, major adverse cardiovascular events, early allograft dysfunction, graft failure, overall mortality, duration of mechanical ventilation, intensive care unit, and hospital length of stay. Intraoperative hemodynamic parameters were also collected. RESULTS Of 205 recipients, 42.4% ( n =87) developed AKI. The incidence of AKI was lower in the dexmedetomidine group (35.0%, n =36/103) compared with the control (50.0%, n =51/102) ( P =0.042). There were significantly lower lactate levels in the dexmedetomidine group after reperfusion [4.39 (3.99-4.8) vs 5.02 (4.62-5.42), P =0.031] until the end of surgery [4.23 (3.73-4.74) vs 5.35 (4.84-5.85), P =0.002]. There were no significant differences in the other secondary outcomes besides lactate. Also, intraoperative mean blood pressure, cardiac output, and systemic vascular resistance did not show any difference. CONCLUSION Our study suggests that intraoperative dexmedetomidine administration was associated with significantly decreased AKI incidence and lower intraoperative serum lactate levels in LDLT recipients, without untoward hemodynamic effects.
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Affiliation(s)
| | | | | | | | | | | | - Jun-Gol Song
- Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul 05505, Republic of Korea
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Yavuz A, Küçük A, Ergörün Aİ, Dursun AD, Yiğman Z, Alkan M, Arslan M. Evaluation of the efficacy of silymarin and dexmedetomidine on kidney and lung tissue in the treatment of sepsis in rats with cecal perforation. Exp Ther Med 2024; 27:242. [PMID: 38655036 PMCID: PMC11036365 DOI: 10.3892/etm.2024.12530] [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: 06/28/2023] [Accepted: 10/27/2023] [Indexed: 04/26/2024] Open
Abstract
Sepsis is a systemic inflammatory response syndrome that develops in the host against microorganisms. This response develops away from the primary infection site and results in end-organ damage. The present study aimed to investigate the protective and therapeutic effects on lung and kidney tissue of silymarin (S) and dexmedetomidine (DEX) applied 1 h before and after sepsis induced by the cecal ligation and puncture (CLP) method in rats. A total of 62 rats was randomly divided into eight groups: i) Control (n=6); ii) cecal perforation (CLP; n=8); iii) S + CLP (n=8; S + CLP; S administered 1 h before CPL); iv) CLP + S (n=8; S administered 1 h after CLP); v) DEX + CLP (n=8; D + CLP; DEX administered 1 h before CLP); vi) CLP + D (n=8; DEX administered 1 h after CLP); vii) SD + CLP (n=8; S and DEX administered 1 h before CLP) and viii) CLP + SD (n=8; S and DEX administered 1 h after CLP). After the cecum filled with stool, it was tied with 3/0 silk under the ileocecal valve and the anterior surface of the cecum was punctured twice with an 18-gauge needle. A total of 100 mg/kg silymarin and 100 µg/kg DEX were administered intraperitoneally to the treatment groups. Lung and kidney tissue samples were collected to evaluate biochemical and histopathological parameters. In the histopathological examination, all parameters indicating kidney injury; interstitial edema, peritubular capillary dilatation, vacuolization, ablation of tubular epithelium from the basement membrane, loss of brush border in the proximal tubule epithelium, cell swelling and nuclear defragmentation; were increased in the CLP compared with the control group. Silymarin administration increased kidney damage, including ablation of tubular epithelium from the basement membrane, compared with that in the CLP group. DEX significantly reduced kidney damage compared with the CLP and silymarin groups. The co-administration of DEX + silymarin decreased kidney damage, although it was not as effective as DEX-alone. To conclude, intraperitoneal DEX ameliorated injury in CLP rats. DEX + silymarin partially ameliorated injury but silymarin administration increased damage. As a result, silymarin has a negative effects with this dosage and DEX has a protective effect. In the present study, it was determined that using the two drugs together had a greater therapeutic effect than silymarin and no differences in the effects were not observed any when the application times of the agents were changed.
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Affiliation(s)
- Aydin Yavuz
- Department of General Surgery, Faculty of Medicine, Gazi University, Ankara 06510, Turkey
| | - Ayşegül Küçük
- Department of Physiology, Faculty of Medicine, Kutahya Health Science University, Kutahya 43020, Turkey
| | - Aydan İremnur Ergörün
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Gazi University, Ankara 06510, Turkey
| | - Ali Doğan Dursun
- Department of Physiology, Faculty of Medicine, Atılım University, Ankara 06830, Turkey
| | - Zeynep Yiğman
- Department of Histology and Embryology, Faculty of Medicine, Gazi University, Ankara 06510, Turkey
- Neuroscience and Neurotechnology Center of Excellence, Gazi University, Ankara 06510, Turkey
| | - Metin Alkan
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Gazi University, Ankara 06510, Turkey
| | - Mustafa Arslan
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Gazi University, Ankara 06510, Turkey
- Life Sciences Application and Research Center, Gazi University, Ankara 06830, Turkey
- Laboratory Animal Breeding and Experimental Research Center, Gazi University, Ankara 06510, Turkey
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3
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Bostancı H, Erel S, Küçük A, Kip G, Sezen ŞC, Gokgoz S, Atlı M, Aktepe F, Dikmen K, Arslan M, Kavutçu M. Dexmedetomidine's Effects on the Livers and Kidneys of Rats with Pancreatic Ischemia-Reperfusion Injury. Drug Des Devel Ther 2024; 18:1785-1797. [PMID: 38828020 PMCID: PMC11141764 DOI: 10.2147/dddt.s441773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 05/13/2024] [Indexed: 06/05/2024] Open
Abstract
Objective Pancreatic surgeries inherently cause ischemia-reperfusion (IR) injury, affecting not only the pancreas but also distant organs. This study was conducted to explore the potential use of dexmedetomidine, a sedative with antiapoptotic, anti-inflammatory, and antioxidant properties, in mitigating the impacts of pancreatic IR on kidney and liver tissues. Methods A total of 24 rats were randomly divided into four groups: control (C), dexmedetomidine (D), ischemia reperfusion (IR), and dexmedetomidine ischemia reperfusion (D-IR). Pancreatic ischemia was induced in the IR and D-IR groups. Dexmedetomidine was administered intraperitoneally to the D and D-IR groups. Liver and kidney tissue samples were subjected to microscopic examinations after hematoxylin and eosin staining. The levels of thiobarbituric acid reactive substances (TBARS), aryllesterase (AES), catalase (CAT), and glutathione S-transferase (GST) enzyme activity were assessed in liver and kidney tissues. The serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN), and creatinine were measured. Results A comparison of the groups revealed that the IR group exhibited significantly elevated TBARS (p < 0.0001), AES (p = 0.004), and CAT enzyme activity (p < 0.0001) levels in the liver and kidney compared to groups C and D. Group D-IR demonstrated notably reduced histopathological damage (p < 0.05) and low TBARS (p < 0.0001), AES (p = 0.004), and CAT enzyme activity (p < 0.0001) in the liver and kidney as well as low AST and ALT activity levels (p < 0.0001) in the serum compared to the IR group. Conclusion The preemptive administration of dexmedetomidine before pancreatic IR provides significant protection to kidney and liver tissues, as evidenced by the histopathological and biochemical parameters in this study. The findings underscored the potential therapeutic role of dexmedetomidine in mitigating the multiorgan damage associated with pancreatic surgeries.
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Affiliation(s)
- Hasan Bostancı
- Gazi University Faculty of Medicine, Department of General Surgery, Ankara, Turkey
| | - Selin Erel
- Gazi University Faculty of Medicine Department of Anesthesiology and Reanimation, Ankara, Turkey
| | - Ayşegül Küçük
- Kutahya Health Sciences University Faculty of Medicine, Department of Physiology, Kutahya, Turkey
| | - Gülay Kip
- Gazi University Faculty of Medicine Department of Anesthesiology and Reanimation, Ankara, Turkey
| | - Şaban Cem Sezen
- Kırıkkale University Faculty of Medicine, Department of Histology and Embryology, Kırıkkale, Turkey
| | - Seda Gokgoz
- Gazi University Faculty of Medicine, Department of Medical Biochemistry, Ankara, Turkey
| | - Muharrem Atlı
- Kırıkkale University Faculty of Medicine, Department of Histology and Embryology, Kırıkkale, Turkey
| | - Feyza Aktepe
- Gazi University Faculty of Medicine Department of Anesthesiology and Reanimation, Ankara, Turkey
| | - Kursat Dikmen
- Gazi University Faculty of Medicine, Department of General Surgery, Ankara, Turkey
| | - Mustafa Arslan
- Gazi University Faculty of Medicine Department of Anesthesiology and Reanimation, Ankara, Turkey
- Gazi University, Life Sciences Application and Research Center, Ankara, Turkey
- Gazi University, Laboratory Animal Breeding and Experimental Research Center (GUDAM), Ankara, Turkey
| | - Mustafa Kavutçu
- Gazi University Faculty of Medicine, Department of Medical Biochemistry, Ankara, Turkey
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Gao X, Wu Y. Perioperative acute kidney injury: The renoprotective effect and mechanism of dexmedetomidine. Biochem Biophys Res Commun 2024; 695:149402. [PMID: 38159412 DOI: 10.1016/j.bbrc.2023.149402] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/10/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
Dexmedetomidine (DEX) is a highly selective and potent α2-adrenoceptor (α2-AR) agonist that is widely used as a clinical anesthetic to induce anxiolytic, sedative, and analgesic effects. In recent years, a growing body of evidence has demonstrated that DEX protects against acute kidney injury (AKI) caused by sepsis, drugs, surgery, and ischemia-reperfusion (I/R) in organs or tissues, indicating its potential role in the prevention and treatment of AKI. In this review, we summarized the evidence of the renoprotective effects of DEX on different models of AKI and explored the mechanism. We found that the renoprotective effects of DEX mainly involved antisympathetic effects, reducing inflammatory reactions and oxidative stress, reducing apoptosis, increasing autophagy, reducing ferroptosis, protecting renal tubular epithelial cells (RTECs), and inhibiting renal fibrosis. Thus, the use of DEX is a promising strategy for the management and treatment of perioperative AKI. The aim of this review is to further clarify the renoprotective mechanism of DEX to provide a theoretical basis for its use in basic research in various AKI models, clinical management, and the treatment of perioperative AKI.
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Affiliation(s)
- Xiong Gao
- Health Science Center, Yangtze University, Jingzhou, Hubei, China
| | - Yaohua Wu
- Department of Anesthesiology, Huanggang Central Hospital, Huanggang, Hube, China.
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Protective effect of fatty acid amide hydrolase inhibitor URB597 and monoacylglycerol lipase inhibitor KML29 on renal ischemia-reperfusion injury via toll-like receptor 4/nuclear factor-kappa B pathway. Int Immunopharmacol 2023; 114:109586. [PMID: 36700769 DOI: 10.1016/j.intimp.2022.109586] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/23/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Arachidonoyl ethanolamide (anandamide, AEA) and 2-arachidonoylglycerol (2-AG) are the most studies endocannabinoids. AEA and 2-AG are degraded by fatty acid amide hydrolase (FAAH) and monoacylglycerol lipase (MAGL) enzymes, respectively. FAAH and MAGL enzymes are widely expressed in many tissues, including kidney. Recent works have depicted that AEA and 2-AG levels are associated with ischemia-reperfusion (IR) injury. In this study, we investigated the effects of MAGL inhibitor KML29 and FAAH inhibitor URB597 against kidney IR injury. METHODS The kidneys of the rats underwent ischemia for 45 min and then reperfusion for 24 h. KML29 and URB597 were administered intraperitoneally with kidney IR to two different treatment groups. RESULTS IR application increased serum blood urea nitrogen (BUN), creatinine (Cre), interleukin-18 (IL-18), neutrophil gelatinase-associated lipocalin (NGAL), and kidney injury molecule-1 (KIM-1) levels, while these parameters were decreased following KML29 and URB597 administration. KML29 and URB597 administration also reduced the increased toll-like receptor-4 (TRL-4), phosphorylated-NF-κB, phosphorylated-IκB-α, tumor necrosis factor alpha (TNF-α), interleukin-1beta (IL-1β), interleukin-6 (IL-6), caspase-3 levels and histopathological damage in kidney tissue. CONCLUSIONS Our results reveal that MAGL inhibitor KML29 and FAAH inhibitor URB597 have a protective effect on kidney IR injury by preventing apoptosis and inflammation. Inhibition of MAGL and FAAH may be a new therapeutic strategy to prevent kidney IR injury.
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Khanahmad H, Mirbod SM, Karimi F, Kharazinejad E, Owjfard M, Najaflu M, Tavangar M. Pathological Mechanisms Induced by TRPM2 Ion Channels Activation in Renal Ischemia-Reperfusion Injury. Mol Biol Rep 2022; 49:11071-11079. [PMID: 36104583 DOI: 10.1007/s11033-022-07836-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/26/2022] [Accepted: 08/01/2022] [Indexed: 10/14/2022]
Abstract
Renal ischemia-reperfusion (IR) injury triggers a cascade of signaling reactions involving an increase in Ca2 + charge and reactive oxygen species (ROS) levels resulting in necrosis, inflammation, apoptosis, and subsequently acute kidney injury (AKI).Transient receptor potential (TRP) channels include an essential class of Ca2+ permeable cation channels, which are segregated into six main channels: the canonical channel (TRPC), the vanilloid-related channel (TRPV), the melastatin-related channel (TRPM), the ankyrin-related channel (TRPA), the mucolipin-related channel (TRPML) and polycystin-related channel (TRPP) or polycystic kidney disease protein (PKD2). TRP channels are involved in adjusting vascular tone, vascular permeability, cell volume, proliferation, secretion, angiogenesis and apoptosis.TRPM channels include eight isoforms (TRPM1-TRPM8) and TRPM2 is the second member of this subfamily that has been expressed in various tissues and organs such as the brain, heart, kidney and lung. Renal TRPM2 channels have an important role in renal IR damage. So that TRPM2 deficient mice are resistant to renal IR injury. TRPM2 channels are triggered by several chemicals including hydrogen peroxide, Ca2+, and cyclic adenosine diphosphate (ADP) ribose (cADPR) that are generated during AKI caused by IR injury, as well as being implicated in cell death caused by oxidative stress, inflammation, and apoptosis.
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Affiliation(s)
- Hossein Khanahmad
- Department of Genetics and Molecular biology, School of Medicine, Isfahan University of medical science, Isfahan, Iran
- Department of Genetics and Molecular biology, School of Medicine, Isfahan University of Medical sciences, Isfahan, Iran, Isfahan University of Medical sciences, Isfahan, Iran
| | - Seyedeh Mahnaz Mirbod
- Resident of Cardiology, Department of cardiology, Isfahan University of Medical Science, Isfahan, Iran
- Department of Cardiology, Isfahan University of Medical Sciences, Isfahan, Iran., Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farzaneh Karimi
- Behbahan Faculty of Medical Sciences, Behbahan, Iran.
- Behbahan Faculty of Medical Sciences, No.8, Shahid Zibaei Blvd. Behbahan city, Behbahan, Khozestan province, Iran.
- Department of Physiology, Behbahan Faculty of Medical Sciences, Behbahan, Iran., Behbahan Faculty of Medical Sciences, Behbahan, Iran.
| | - Ebrahim Kharazinejad
- Abadan University of Medical Sciences, Abadan, Iran
- Department of Anatomy, Abadan University of Medical Sciences, Abadan, Iran, Abadan University of Medical Sciences, Abadan , Iran
| | - Maryam Owjfard
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Shiraz University of Applied Science and Technology (UAST), Shiraz, Iran
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Shiraz University of Applied Science and Technology (UAST), Shiraz, Iran, Shiraz University of Applied Science and Technology (UAST), Shiraz, Iran
| | - Malihe Najaflu
- Department of Genetics and Molecular biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Genetics and Molecular biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrsa Tavangar
- Department of Genetics and Molecular biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Genetics and Molecular biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran, Isfahan University of Medical Sciences, Isfahan, Iran
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Acar M, Sayhan Kaplan H, Erdem AF, Tomak Y, Turan G, Özdin M. Effects of dexmedetomidine on new oxidative stress markers on renal ischaemia-reperfusion injury in rats: thiol/disulphide homeostasis and the ischaemia-modified albumin. Arch Physiol Biochem 2022; 128:1115-1120. [PMID: 32401057 DOI: 10.1080/13813455.2020.1754431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES This study investigated the effect of dexmedetomidine on the oxidant-antioxidant (thiol/disulphide) balance. METHODS A total of 24 rats were divided into four groups. The renal arteries in groups IR (ischaemia/reperfusion) and IR + D (ischaemia/reperfusion + dexmedetomidine) were clamped for 45 min and reperfused for 180 min. Groups D (Dexmedetomidine) and IR + D were administered 100 μg/kg dexmedetomidine. Oxidant-antioxidant (thiol/disulphide) levels were measured. Kidney tissue was examined histopathologically. RESULTS No statistically difference was found between the groups in terms of thiol-disulphide averages, while IMA, TOS and thiol-disulphide results showed a minimal decrease in Group IR + D compared to Group IR (p > 0.05). Tubular lesions and necrosis were found in 26-50% of tubules in Group IR. Tubular damage and necrosis in Group IR + D declined to 5-25% . CONCLUSIONS No statistically difference was found in the study where OSI index, thiol/disulphide balance and IMA were measured together as biochemical values.
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Affiliation(s)
- Müberra Acar
- Department of Anesthesiology and Reanimation, Ağrı State Hospital, Ağrı, Turkey
| | - Havva Sayhan Kaplan
- Department of Anesthesiology and Reanimation, Van Yuzuncu Yil University, Van, Turkey
| | - Ali F Erdem
- Department of Anaesthesiology and Reanimation, Sakarya University, Sakarya, Turkey
| | - Yakup Tomak
- Department of Anaesthesiology and Reanimation, Sakarya University, Sakarya, Turkey
| | - Gupse Turan
- Department of Pathology, Sakarya University, Sakarya, Turkey
| | - Mehmet Özdin
- Department of Biochemistry, Sakarya University, Sakarya, Turkey
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Tao WH, Shan XS, Zhang JX, Liu HY, Wang BY, Wei X, Zhang M, Peng K, Ding J, Xu SX, Li LG, Hu JK, Meng XW, Ji FH. Dexmedetomidine Attenuates Ferroptosis-Mediated Renal Ischemia/Reperfusion Injury and Inflammation by Inhibiting ACSL4 via α2-AR. Front Pharmacol 2022; 13:782466. [PMID: 35873574 PMCID: PMC9307125 DOI: 10.3389/fphar.2022.782466] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 05/23/2022] [Indexed: 12/23/2022] Open
Abstract
Ischemia-reperfusion (I/R) injury is a serious clinical pathology associated with acute kidney injury (AKI). Ferroptosis is non-apoptotic cell death that is known to contribute to renal I/R injury. Dexmedetomidine (Dex) has been shown to exert anti-inflammatory and organ protective effects. This study aimed to investigate the detailed molecular mechanism of Dex protects kidneys against I/R injury through inhibiting ferroptosis. We established the I/R-induced renal injury model in mice, and OGD/R induced HEK293T cells damage in vitro. RNA-seq analysis was performed for identifying the potential therapeutic targets. RNA-seq analysis for differentially expressed genes (DEGs) reported Acyl-CoA synthetase long-chain family member 4 (ACSL4) related to ferroptosis and inflammation in I/R mice renal, which was validated in rodent renal. Liproxstatin-1, the specific small-molecule inhibitor of ferroptosis, significantly attenuated ferroptosis-mediated renal I/R injury with decreased LPO, MDA, and LDH levels, and increased GSH level. Inhibiting the activity of ACSL4 by the Rosiglitazone (ROSI) resulted in the decreased ferroptosis and inflammation, as well as reduced renal tissue damage, with decreasing LPO, MDA and LDH level, increasing GSH level, reducing COX2 and increasing GPx4 protein expression, and suppressing the TNF-α mRNA and IL-6 mRNA levels. Dex as a α2-adrenergic receptor (α2-AR) agonist performed renal protective effects against I/R-induced injury. Our results also revealed that Dex administration mitigated tissue damage, inhibited ferroptosis, and downregulated inflammation response following renal I/R injury, which were associated with the suppression of ACSL4. In addition, ACSL4 overexpression abolishes Dex-mediated protective effects on OGD/R induced ferroptosis and inflammation in HEK293T cells, and promotion of ACSL4 expression by α2-AR inhibitor significantly reversed the effects on the protective role of Dex. This present study indicated that the Dex attenuates ferroptosis-mediated renal I/R injury and inflammation by inhibiting ACSL4 via α2-AR.
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Affiliation(s)
- Wen-hui Tao
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Soochow, China
- Institute of Anesthesiology, Soochow University, Soochow, China
| | - Xi-sheng Shan
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Soochow, China
- Institute of Anesthesiology, Soochow University, Soochow, China
| | - Jia-xin Zhang
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Soochow, China
| | - Hua-yue Liu
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Soochow, China
- Institute of Anesthesiology, Soochow University, Soochow, China
| | - Bi-ying Wang
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Soochow, China
| | - Xiang Wei
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Soochow, China
| | - Mian Zhang
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Soochow, China
- Institute of Anesthesiology, Soochow University, Soochow, China
| | - Ke Peng
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Soochow, China
- Institute of Anesthesiology, Soochow University, Soochow, China
| | - Jun Ding
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Soochow, China
| | - Shang-xian Xu
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Soochow, China
| | - Lin-gui Li
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Soochow, China
- Institute of Anesthesiology, Soochow University, Soochow, China
| | - Jun-kai Hu
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Soochow, China
- Institute of Anesthesiology, Soochow University, Soochow, China
| | - Xiao-wen Meng
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Soochow, China
- Institute of Anesthesiology, Soochow University, Soochow, China
- *Correspondence:Xiao-wen Meng, ; Fu-hai Ji,
| | - Fu-hai Ji
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Soochow, China
- Institute of Anesthesiology, Soochow University, Soochow, China
- *Correspondence:Xiao-wen Meng, ; Fu-hai Ji,
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Oxidative Stress and Ischemia/Reperfusion Injury in Kidney Transplantation: Focus on Ferroptosis, Mitophagy and New Antioxidants. Antioxidants (Basel) 2022; 11:antiox11040769. [PMID: 35453454 PMCID: PMC9024672 DOI: 10.3390/antiox11040769] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 12/11/2022] Open
Abstract
Although there has been technical and pharmacological progress in kidney transplant medicine, some patients may experience acute post-transplant complications. Among the mechanisms involved in these conditions, ischemia/reperfusion (I/R) injury may have a primary pathophysiological role since it is one of the leading causes of delayed graft function (DGF), a slow recovery of the renal function with the need for dialysis (generally during the first week after transplantation). DGF has a significant social and economic impact as it is associated with prolonged hospitalization and the development of severe complications (including acute rejection). During I/R injury, oxidative stress plays a major role activating several pathways including ferroptosis, an iron-driven cell death characterized by iron accumulation and excessive lipid peroxidation, and mitophagy, a selective degradation of damaged mitochondria by autophagy. Ferroptosis may contribute to the renal damage, while mitophagy can have a protective role by reducing the release of reactive oxygen species from dysfunctional mitochondria. Deep comprehension of both pathways may offer the possibility of identifying new early diagnostic noninvasive biomarkers of DGF and introducing new clinically employable pharmacological strategies. In this review we summarize all relevant knowledge in this field and discuss current antioxidant pharmacological strategies that could represent, in the next future, potential treatments for I/R injury.
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Kartal S, Şen A, Tümkaya L, Erdivanlı B, Mercantepe T, Yılmaz A. The effect of dexmedetomidine on liver injury secondary to lower extremity ischemia-reperfusion in a diabetic rat model. Clin Exp Hypertens 2021; 43:677-682. [PMID: 34109906 DOI: 10.1080/10641963.2021.1937204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: In this study, we aimed to evaluate the hepatic protective effects of dexmedetomidine in the lower extremity ischemia-reperfusion model in diabetic rats biochemically and histopathologically.Methods: Rats were randomly divided into 4 equal groups (n = 6); Control (C) group, diabetic control group (DM), diabetic ischemia-reperfusion group (IR), group with diabetic IR and dexmedetomidine (DEX). In the IR and DEX groups were performed 120 min reperfusion after 120 min ischemia. In group DEX, 100 µ / kg dexmedetomidine was administered intraperitoneally 30 minutes before renal IR administration. Then, various histopathological and biochemical parameters were evaluated in liver tissue.Results: After ischemia-reperfusion, aspartate amino transaminase, alanine amino transaminase, total oxidant level, and thiobarbituric acid -reactive substances were increased, total thiol group and total antioxidant level were decreased and these parameters were found to improve in the group given dexmedetomidine. It was also observed that there was histopathological deterioration after ischemia-reperfusion and histopathological deterioration was found to be less with dexmedetomidine administration.Conclusion: The effects of lower extremity ischemia-reperfusion on hepatic tissue as distant organs were evaluated in diabetic rats, histopathologically, immunologically, biochemically, and liver damage was determined after ischemia-reperfusion, and dexmedetomidine was found to decrease liver damage.
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Affiliation(s)
- Seyfi Kartal
- Department of Anesthesiology and Reanimation, Trabzon Kanuni Training and Research Hospital, University of Healthy Sciences, Trabzon, Turkey
| | - Ahmet Şen
- Department of Anesthesiology and Reanimation, Trabzon Kanuni Training and Research Hospital, University of Healthy Sciences, Trabzon, Turkey
| | - Levent Tümkaya
- Department of Medical Sciences Histology Embryology, Faculty of Medicine, University of Recep Tayyip Erdoğan, Rize, Turkey
| | - Basar Erdivanlı
- Department of Anesthesiology and Reanimation, Faculty of Medicine, University of Recep Tayyip Erdoğan, Rize, Turkey
| | - Tolga Mercantepe
- Department of Medical Sciences Histology Embryology, Faculty of Medicine, University of Recep Tayyip Erdoğan, Rize, Turkey
| | - Adnan Yılmaz
- Department of Basic Sciences Biochemistry, Faculty of Medicine, University of Recep Tayyip Erdoğan, Rize, Turkey
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Effects of dexmedetomidine on renal microcirculation in ischemia/reperfusion-induced acute kidney injury in rats. Sci Rep 2021; 11:2026. [PMID: 33479346 PMCID: PMC7820577 DOI: 10.1038/s41598-021-81288-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 12/31/2020] [Indexed: 11/25/2022] Open
Abstract
Microcirculatory dysfunction plays a crucial role in renal ischemia/reperfusion (IR)-induced injury. Dexmedetomidine was reported to ameliorate IR-induced acute kidney injury. This study investigated the effects of dexmedetomidine on renal microcirculation after IR-induced acute kidney injury in rats. In total, 50 rats were randomly allocated to the following five groups (10 in each group): Sham, Control‒IR, Dex (dexmedetomidine) ‒Sham, Dex‒IR, and IR‒Dex group. The microcirculation parameters included total small vessel density, perfused small vessel density (PSVD), proportion of perfused small vessels, microvascular flow index, and tissue oxygen saturation (StO2) were recorded. The repeated measures analysis showed that PSVD on renal surface was higher in the Dex‒IR group than in the Control‒IR group (3.5 mm/mm2, 95% confidence interval [CI] 0.6 to 6.4 mm/mm2, P = 0.01). At 240 min, StO2 on renal surface was lower in the Control‒IR group than in the Sham group (– 7%, 95% CI − 13 to − 1%, P = 0.021), but StO2 did not differ significantly among the Sham, Dex‒IR, and IR‒Dex groups. Our results showed that pretreatment with dexmedetomidine improved renal microcirculation in rats with IR-induced acute kidney injury. However, the adverse effects of low mean arterial pressure and heart rate might offset the protective effect of dexmedetomidine on organ injury.
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Selim NM, El-Hawary SS, El Zalabani SM, Shamma RN, Mahdy NES, Sherif NH, Fahmy HA, Mekkawy MH, Yasri A, Sobeh M. Impact of Washingtonia robusta Leaves on Gamma Irradiation-Induced Hepatotoxicity in Rats and Correlation with STING Pathway and Phenolic Composition. Pharmaceuticals (Basel) 2020; 13:ph13100320. [PMID: 33086669 PMCID: PMC7603372 DOI: 10.3390/ph13100320] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/25/2020] [Accepted: 09/27/2020] [Indexed: 12/23/2022] Open
Abstract
Exposure to ionizing radiation usually results in cellular oxidative damage and may induce liver toxicity. The efficiency of the ethanol extracts of Washingtonia filifera (EWF) and Washingtonia robusta (EWR) leaves in alleviating γ-radiation-induced oxidative hepatotoxicity was herein explored. Proximate and macronutrient composition of the leaves was determined to establish reliable quality control criteria. Colorimetric estimation of total phenolic (TPC) and flavonoid (TFC) contents revealed their occurrence in larger amounts in EWR. In vitro evaluation of the antioxidant capacity by 2,2-azinobis (3-ethylbenzothiazoline-6-sulfonic acid (ABTS) and ferric reducing antioxidant power (FRAP) assays confirmed higher efficiency of EWR designating a close correlation with phenolic composition. Four phenolics, viz., naringenin, kaempferol, quercetin, and gallic acid, were isolated from EWR. In vivo assessment of the extracts' antioxidant potential was performed on γ-irradiated (7.5 Gy) female rats. EWR was found more efficient in restoring the elevated liver index, ALT, albumin, cholesterol, and reactive oxygen species (ROS) levels. Both extracts ameliorated the increase in the stimulator of interferon gene (STING) expression. Bioactivity was confirmed by immuno-histochemical examination of inflammatory and apoptotic biomarkers (TNF-α, IL-6 and caspase-3) and histopathological architecture. In addition, the interactions of the isolated compounds with STING were assessed in silico by molecular docking. Therefore, Washingtonia robusta leaves might be suggested as a valuable nutritional supplement to alleviate radiotherapy-induced hepatotoxicity.
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Affiliation(s)
- Nabil M. Selim
- Department of Pharmacognosy, Faculty of Pharmacy, Cairo University, Cairo 12613, Egypt; (S.S.E.-H.); (S.M.E.Z.); (N.E.S.M.)
- Correspondence: (N.M.S.); (M.S.)
| | - Seham S. El-Hawary
- Department of Pharmacognosy, Faculty of Pharmacy, Cairo University, Cairo 12613, Egypt; (S.S.E.-H.); (S.M.E.Z.); (N.E.S.M.)
| | - Soheir M. El Zalabani
- Department of Pharmacognosy, Faculty of Pharmacy, Cairo University, Cairo 12613, Egypt; (S.S.E.-H.); (S.M.E.Z.); (N.E.S.M.)
| | - Rehab Nabil Shamma
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo 12613, Egypt;
| | - Nariman El Sayed Mahdy
- Department of Pharmacognosy, Faculty of Pharmacy, Cairo University, Cairo 12613, Egypt; (S.S.E.-H.); (S.M.E.Z.); (N.E.S.M.)
| | - Noheir H. Sherif
- Pharmacognosy Department, Faculty of Pharmacy, Nahda University, Beni-Suef 62513, Egypt;
- Drug Radiation Research Department, National Centre for Radiation Research and Technology, Egyptian Atomic Energy Authority, P.O. Box: 29 Nasr City, Cairo 11865, Egypt; (H.A.F.); (M.H.M.)
| | - Hanan A. Fahmy
- Drug Radiation Research Department, National Centre for Radiation Research and Technology, Egyptian Atomic Energy Authority, P.O. Box: 29 Nasr City, Cairo 11865, Egypt; (H.A.F.); (M.H.M.)
| | - Mai H. Mekkawy
- Drug Radiation Research Department, National Centre for Radiation Research and Technology, Egyptian Atomic Energy Authority, P.O. Box: 29 Nasr City, Cairo 11865, Egypt; (H.A.F.); (M.H.M.)
| | - Abdelaziz Yasri
- AgroBioSciences Research Division, Mohammed VI Polytechnic University, Lot 660–Hay MoulayRachid, 43150 Ben-Guerir, Morocco;
| | - Mansour Sobeh
- AgroBioSciences Research Division, Mohammed VI Polytechnic University, Lot 660–Hay MoulayRachid, 43150 Ben-Guerir, Morocco;
- Correspondence: (N.M.S.); (M.S.)
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Zhang YZ, Zhou ZC, Song CY, Chen X. The Protective Effect and Mechanism of Dexmedetomidine on Diabetic Peripheral Neuropathy in Rats. Front Pharmacol 2020; 11:1139. [PMID: 32848754 PMCID: PMC7406656 DOI: 10.3389/fphar.2020.01139] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/13/2020] [Indexed: 12/15/2022] Open
Abstract
Objective To investigate the role of dexmedetomidine (DEX) in the inhibition of diabetic peripheral neuropathy (DPN) and the protection in the nerve damage. Methods Eighty male Sprague-Dawley (SD) rats were randomly allocated to four groups: the control group (C group), DPN model group (DPN group), DEX-treated group (DEX group), and the yohimbine treated group (YOH group). DPN was induced by intraperitoneal administration of streptozocin (STZ) (35 mg/kg). The body weights, blood glucose level, mechanical withdrawal threshold (MWT), thermal withdrawal latency (TWL), the motor, and sensory nerve conduction velocities (MNCV and SNCV) of sciatic nerve were measured. Then the sciatic nerve was isolated for H&E staining and immunohistochemical staining. The oxidative stress makers such as malondialdehyde (MDA), superoxide-dismutase (SOD), and glutathione peroxidase (GSH-Px) and apoptosis related cytokines such as Bax, Bcl-2, and caspase-3 were estimated. Results There was no significant difference of the blood glucose and body weight among the DPN group, DEX group, and YOH group. H&E staining showed that DEX treatment can ameliorate the damage of sciatic nerve cells. In the DPN group, MWT, TWL, MNCV, and SNCV were significantly reduced compared with the C group (P < 0.05). In DEX group rats, MWT, TWL, MNCV, and SNCV were increased significantly (P < 0.05) compared with the DPN group and YOH group rats. Lower SOD and GSH-Px, and higher MDA were found in the DPN group compared with the C group (P < 0.01), and DEX treatment restored SOD, GSH-px, and MDA activity significantly (P < 0.01). The expression levels of Bax and caspase-3 were increased, while that of Bcl-2 was decreased significantly in the DPN group compared with the C group (P < 0.05). In the DEX group, the expression levels of Bax and caspase-3 were decreased significantly (P < 0.05), while that of Bcl-2 was increased significantly (P < 0.05) compared with the DPN group and the YOH group. Conclusion The results of this study demonstrated that DEX has the inhibitory and protective effects on DPN of rats. This may be associated with its antioxidative and anti-apoptosis responses.
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Affiliation(s)
- Yan-Zhuo Zhang
- Department of Anesthesiology, The Fourth Affiliated Hospital of Guangxi Medical University/Liuzhou Workers' Hospital, Liuzhou, China.,Department of Anesthesiology, China and Heilongjiang Key Laboratory for Anesthesia and Critical Care, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhong-Cheng Zhou
- Department of Anesthesiology, China and Heilongjiang Key Laboratory for Anesthesia and Critical Care, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chun-Yu Song
- Department of Anesthesiology, China and Heilongjiang Key Laboratory for Anesthesia and Critical Care, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xia Chen
- Department of Anesthesiology, The Fourth Affiliated Hospital of Guangxi Medical University/Liuzhou Workers' Hospital, Liuzhou, China
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Chen Y, Huang Y, Xiong B, Luo H, Song X. Dexmedetomidine ameliorates renal ischemia reperfusion-mediated activation of the NLRP3 inflammasome in alveolar macrophages. Gene 2020; 758:144973. [PMID: 32707303 DOI: 10.1016/j.gene.2020.144973] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/01/2020] [Accepted: 07/17/2020] [Indexed: 02/07/2023]
Abstract
Renal ischemia-reperfusion (rI/R) is a risk factor for acute lung injury (ALI). Alveolar macrophages (AMs) activation mediated by rI/R-induced ALI is one of the pathogeneses associated with the development of ALI. In rI/R, α2-adrenergic receptor agonists have been indicated to be effective in decreasing urea nitrogen concentrations. In this study, we explored the underlying pathogenesis of the clinically obtainable α2-adrenergic receptor agonist dexmedetomidine (DEX) in protecting against rI/R -mediated AMs activation. We incubated AMs with the serum of sham and rI/R rats in the presence or absence of various concentrations of DEX. We used an enzyme-linked immunosorbent assay to detect the secretion levels of GSH, LDH, IL-18, IL-1β, and HMGB1 in the culture supernatant. We employed real-time polymerase chain reaction to assess the expression of NOX-4 mRNA, and western blotting to observe the protein levels of NOX-4, the NLRP3 inflammasome, AMPK, and eNOS. In addition, we used immunofluorescence to analyze ROS and MMP activity. Incubation of AMs with DEX suppressed rI/R-mediated cellular LDH production and ROS release. DEX also abolished the rI/R-mediated decrease in the activity of GSH and increased the levels of the rI/R-related NADPH oxidase protein NOX-4. Furthermore, DEX reduced the amelioration of the mitochondrial potential induced by rI/R. Our study showed that DEX inhibits rI/R-mediated levels of the NLRP3 inflammasome proteins ASC, NLRP3, HMGB1 and p20, and ameliorates rI/R-mediated AMPK signaling inactivation. Therefore, DEX reduces the levels of two mediators that are activated by the NLRP3 inflammasome: IL-18 and IL-1β. Finally, our study established that DEX mitigates the rI/R-mediated decrease in eNOS, demonstrating its protective functions against AMs activation. In conclusion, our study demonstrated that the protective action of DEX in AMs is induced through amelioration of HMGB1-NLRP3 inflammasome-AMPK signaling. Our results suggest that the anesthetic reagent DEX exerts beneficial effects to ameliorate rI/R-induced ALI.
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Affiliation(s)
- Yingying Chen
- Department of Anesthesiology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China
| | - Ying Huang
- Department of Anesthesiology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China
| | - Bingrui Xiong
- Department of Anesthesiology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China
| | - Huan Luo
- Department of Anesthesiology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China
| | - Xuemin Song
- Department of Anesthesiology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei, China.
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AKKOÇ A, METİN A. RATLARDA BÖBREK İSKEMİ-REPERFÜZYON HASARINDA PROFLAKTİK KALSİYUM DOBESİLATIN ETKİNLİĞİ. ACTA MEDICA ALANYA 2020. [DOI: 10.30565/medalanya.643852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Organ-Protective Effects and the Underlying Mechanism of Dexmedetomidine. Mediators Inflamm 2020; 2020:6136105. [PMID: 32454792 PMCID: PMC7232715 DOI: 10.1155/2020/6136105] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/13/2020] [Accepted: 04/16/2020] [Indexed: 12/21/2022] Open
Abstract
Dexmedetomidine (DEX) is a highly selective α2 adrenergic receptor (α2AR) agonist currently used in clinical settings. Because DEX has dose-dependent advantages of sedation, analgesia, antianxiety, inhibition of sympathetic nervous system activity, cardiovascular stabilization, and significant reduction of postoperative delirium and agitation, but does not produce respiratory depression and agitation, it is widely used in clinical anesthesia and ICU departments. In recent years, much clinical study and basic research has confirmed that DEX has a protective effect on a variety of organs, including the nervous system, heart, lungs, kidneys, liver, and small intestine. It acts by reducing the inflammatory response in these organs, activating antiapoptotic signaling pathways which protect cells from damage. Therefore, based on wide clinical application and safety, DEX may become a promising clinical multiorgan protection drug in the future. In this article, we review the physiological effects related to organ protection in α2AR agonists along with the organ-protective effects and mechanisms of DEX to understand their combined application value.
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Wu F, Duan H, Xie Y. Preventive Effects of Dexmedetomidine on Renal Dysfunction and Hemodynamic Stability in Malignant Obstructive Jaundice Patients During Peri-Operative Period. Med Sci Monit 2019; 25:6782-6787. [PMID: 31498783 PMCID: PMC6752108 DOI: 10.12659/msm.916329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background This study aimed to investigate effects of intra-operative administration with dexmedetomidine (Dex) on hemodynamics and renal function in patients with malignant obstructive jaundice. Material/Methods Our randomized, double-blinded, placebo-controlled study was conducted among 40 patients with malignant obstructive jaundice between August 2009 and March 2011 in The Affiliated Hospital of Inner Mongolia Medical University. The 40 patients were randomly divided into 2 groups: the Dex group (receiving Dex 0.5 μg/kg 10-minutes before induction and then a 0.5 μg/kg/hour maintenance infusion until end of operation 30 minutes) and the Control group (receiving normal saline of same amount and at same rate). The adverse events, including incidence of cardiovascular complications and nausea and vomiting, and length of hospital stay were determined. The level of cystatin C (CysC), retinol-binding protein (RBP), creatinine (Scr), and blood urea nitrogen (BUN) were also evaluated. Results Dexmedetomidine administration significantly decreased heart rate (HR) and stroke volume variation (SVV) and significantly increased capital venous pressure (CVP) and mean arterial pressure (MAP) values compared to that in the Control group (P<0.05). Dexmedetomidine administration significantly upregulated urine volume and significantly downregulated atropine levels compared to the Control group (P<0.05). Dexmedetomidine administration significantly improved renal functions, by modulating CysC, RBP, Scr and BUN levels compared to the Control group (P<0.05). Dexmedetomidine administration demonstrated no additional side-effects. Dexmedetomidine administration significantly shortened length of hospitalization in the Dex group compared to the Control group (P<0.05). Conclusions Dexmedetomidine plays preventive effects on renal dysfunction and hemodynamic stability in malignant obstructive jaundice patients during peri-operative period.
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Affiliation(s)
- Fan Wu
- Department of Anesthesiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China (mainland)
| | - Haixia Duan
- Department of Anesthesiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China (mainland)
| | - Yaying Xie
- Department of Anesthesiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China (mainland)
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The protective effect of cannabinoid type 2 receptor activation on renal ischemia-reperfusion injury. Mol Cell Biochem 2019; 462:123-132. [PMID: 31446615 DOI: 10.1007/s11010-019-03616-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 08/17/2019] [Indexed: 12/18/2022]
Abstract
Kidney ischemia reperfusion (IR) injury is an important health problem resulting in acute renal failure. After IR, the inflammatory and apoptotic process is triggered. The relation of Cannabinoid type 2 (CB2) receptor with inflammatory and apoptotic process has been determined. The CB2 receptor has been shown to be localized in glomeruli and tubules in human and rat kidney. Activation of CB2 receptor with JWH-133 has been shown to reduce apoptosis and inflammation. In this study, it was investigated whether CB2 activation with selective CB2 receptor agonist JWH-133 was protective against renal IR injury. Male Sprague-Dawley rats were divided into 5 groups (n = 45). Bilateral ischemia was treated to the IR group rat's kidneys for 45 min and then reperfusion was performed for 24 h. Three different doses of JWH-133 (0.2, 1 and 5 mg/kg) were administered to the treatment groups at the onset of ischemia. The JWH-133 application at three different doses decreased the glomerular and tubular damage. Additionally, in the renal tissue, nuclear factor-κB, tumour necrosis factor alpha, interleukin-1beta, and caspase-3 levels decreased immunohistochemically. Similarly, JWH-133 application decreased the serum tumour necrosis factor alpha, blood urea nitrogen, creatinine, kidney injury molecule-1, neutrophil gelatinase-associated lipocalin, Cystatin C, interleukin-18, interleukin-1beta, interleukin-6, and interleukin-10 levels. We found that JWH-133 and CB2 receptor activation had a curative effect against kidney IR damage. JWH-133 may be a new therapeutic agent in preventing kidney IR damage.
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Assad OM, Aly Labib DA, Ahmed Rashed L. Dexmedetomidine protects against myocardial ischaemia/reperfusion-induced renal damage in rats. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2017.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Osama M. Assad
- Department of AnesthesiologyFaculty of Medicine, Cairo University, Egypt
| | - Dina A. Aly Labib
- Department of Medical Pharmacology, Faculty of Medicine, Cairo University, Egypt
| | - Laila Ahmed Rashed
- Department of Medical Biochemistery and Molecular Biology, Faculty of Medicine, Cairo University, Egypt
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Kim SH, Kim DH, Shin S, Kim SJ, Kim TL, Choi YS. Effects of dexmedetomidine on inflammatory mediators after tourniquet-induced ischemia-reperfusion injury: a randomized, double-blinded, controlled study. Minerva Anestesiol 2019; 85:279-287. [DOI: 10.23736/s0375-9393.18.13015-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Wang Q, Yu H, Yu H, Ma M, Ma Y, Li R. miR‑223‑3p/TIAL1 interaction is involved in the mechanisms associated with the neuroprotective effects of dexmedetomidine on hippocampal neuronal cells in vitro. Mol Med Rep 2018; 19:805-812. [PMID: 30569136 PMCID: PMC6323261 DOI: 10.3892/mmr.2018.9742] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/15/2018] [Indexed: 11/09/2022] Open
Abstract
Dexmedetomidine (DEX), an α2 adrenoceptor agonist, is a commonly used anesthetic drug in surgical procedures. Previous studies have indicated that DEX exerts neuroprotective effects. However, the molecular mechanism underlying this process remains to be elucidated. The present study investigated a potential implication of microRNA (miR)-223-3p in the DEX-induced anti-oxidative effect on neuronal cells. The results indicated that following hydrogen peroxide (H2O2)-mediated induction of oxidative stress, the viability of human hippocampal neuronal cells was markedly decreased, as determined by an MTT assay. In addition, treatment with H2O2 induced cell apoptosis, the release of lactate dehydrogenase, accumulation of intracellular calcium, phosphorylation of calmodulin-2, and production of malondialdehyde and reactive oxygen species. Furthermore, treatment with H2O2 inhibited the expression of mir-223-3p and enhanced the expression of its target cytotoxic granule associated RNA binding protein like 1 (TIAL1), and these effects were reversed by treatment with DEX. Mechanistic studies demonstrated that the 3′-untranslated region of TIAL1 is a direct target of mir-223-3p. The results of the present study demonstrated that DEX may induce its neuroprotective effects by regulating the interaction between miR-223-3p and TIAL1. Therefore, the manipulation of miR-223-3p/TIAL1 interaction may be involved in the neuroprotective effects of DEX.
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Affiliation(s)
- Qi Wang
- Department of Anesthesiology, Cangzhou Central Hospital, Cangzhou, Hebei 061001, P.R. China
| | - Hongmei Yu
- Department of Anesthesiology, Cangzhou Central Hospital, Cangzhou, Hebei 061001, P.R. China
| | - Hong Yu
- Department of Anesthesiology, Cangzhou Central Hospital, Cangzhou, Hebei 061001, P.R. China
| | - Meina Ma
- Department of Anesthesiology, Cangzhou Central Hospital, Cangzhou, Hebei 061001, P.R. China
| | - Yali Ma
- Department of Anesthesiology, Cangzhou Central Hospital, Cangzhou, Hebei 061001, P.R. China
| | - Rui Li
- Department of Anesthesiology, Cangzhou Central Hospital, Cangzhou, Hebei 061001, P.R. China
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Hassan SS, Rizk A, Thomann C, Motawie A, Abdelfattah S, Ahmad Z. Preconditioning with atorvastatin against renal ischemia-reperfusion injury in nondiabetic versus diabetic rats. Can J Physiol Pharmacol 2018; 97:1-14. [PMID: 30412424 DOI: 10.1139/cjpp-2018-0228] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Acute renal failure complicates renal ischemia-reperfusion (I/R) owing to reactive oxygen species production. Atorvastatin (ATO) has anti-inflammatory and antioxidant properties. The current study investigated whether ATO alleviated damage induced by renal I/R injury in nondiabetic versus diabetic rat models. Thirty-six rats were equally divided into 6 groups: group A1 (nondiabetic sham), group A2 (nondiabetic I/R), group A3 (nondiabetic ATO + I/R), group B1 (diabetic sham), group B2 (diabetic I/R), and group B3 (diabetic ATO + I/R). All groups experienced 45 min of bilateral renal ischemia followed by 24 h of reperfusion. Groups A3 and B3 were treated with single intraperitoneal doses of ATO (10 mg/kg) 30 min before ischemia. Histological analysis of kidney tissues, kidney function tests, and analyses of caspase-3 and CD44 expression and oxidative stress markers were performed to assess tubular injury. Histological analysis revealed marked tubular damage in groups A2 and B2 but improvement in groups A3 and B3. Improvements were also found in groups A3 and B3 for caspase-3 and CD44 expression, kidney function tests, and oxidative stress markers. Our results suggest ATO may ameliorate renal I/R injury differently between nondiabetic and diabetic rats.
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Affiliation(s)
- Sherif S Hassan
- a Department of Medical Education, California University of Science and Medicine, School of Medicine, San Bernardino, CA 92408, USA.,b Department of Anatomy and Embryology, Faculty of Medicine, Cairo University, El-Manial Street, Cairo, Egypt
| | - Ayman Rizk
- b Department of Anatomy and Embryology, Faculty of Medicine, Cairo University, El-Manial Street, Cairo, Egypt
| | - Charity Thomann
- a Department of Medical Education, California University of Science and Medicine, School of Medicine, San Bernardino, CA 92408, USA.,c School of Psychology, Fielding Graduate University, Santa Barbara, CA 93105, USA
| | - Ahmed Motawie
- b Department of Anatomy and Embryology, Faculty of Medicine, Cairo University, El-Manial Street, Cairo, Egypt
| | - Shereen Abdelfattah
- b Department of Anatomy and Embryology, Faculty of Medicine, Cairo University, El-Manial Street, Cairo, Egypt
| | - Zulfiqar Ahmad
- d Department of Biochemistry, A.T. Still University-Kirksville College of Osteopathic Medicine, Kirksville, MO 63501, USA
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Çakır M, Tekin S, Taşlıdere A, Çakan P, Düzova H, Gül CC. Protective effect of N-(p-amylcinnamoyl) anthranilic acid, phospholipase A 2 enzyme inhibitor, and transient receptor potential melastatin-2 channel blocker against renal ischemia-reperfusion injury. J Cell Biochem 2018; 120:3822-3832. [PMID: 30259992 DOI: 10.1002/jcb.27664] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 08/21/2018] [Indexed: 12/25/2022]
Abstract
The production of reactive oxygen species and inflammatory events are the underlying mechanisms of ischemia-reperfusion injury (IRI). It was determined that transient receptor potential melastatin-2 (TRPM2) channels and phospholipase A2 (PLA 2 ) enzymes were associated with inflammation and cell death. In this study, we investigated the effect of N-( p-amylcinnamoyl) anthranilic acid (ACA), a TRPM2 channel blocker, and PLA 2 enzyme inhibitor on renal IRI. A total of 36 male Sprague-Dawley rats were divided into four groups: control, ischemia-reperfusion (I/R), I/R + ACA 5 mg, I/R + ACA 25 mg. In I/R applied groups, the ischemia for 45 minutes and reperfusion for 24 hours were applied bilaterally to the kidneys. In the I/R group, serum levels of the blood urea nitrogen (BUN), creatinine, cystatin C (CysC), kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), and interleukin-18 increased. On histopathological examination of renal tissue in the I/R group, the formation of glomerular and tubular damage was seen, and it was detected that there was an increase in the levels of malondialdehyde (MDA), caspase-3, total oxidant status (TOS), and oxidative stress index (OSI); and there was a decrease in total antioxidant capacity (TAC) and catalase enzyme activity. ACA administration reduced serum levels of BUN, creatinine, CysC, KIM-1, NGAL, interleukin-18. In the renal tissue, ACA administration reduced histopathological damage, levels of caspase-3, MDA, TOS, and OSI; and it increased the level of TAC and catalase enzyme activity. It has been shown with the histological and biochemical results in this study that ACA is protective against renal IRI.
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Affiliation(s)
- Murat Çakır
- Department of Physiology, Faculty of Medicine, University of Bozok, Yozgat, Turkey
| | - Suat Tekin
- Department of Physiology, Faculty of Medicine, University of Inonu, Malatya, Turkey
| | - Aslı Taşlıdere
- Department of Histology and Embryology, Faculty of Medicine, University of Inonu, Malatya, Turkey
| | - Pınar Çakan
- Department of Physiology, Faculty of Medicine, University of Inonu, Malatya, Turkey
| | - Halil Düzova
- Department of Physiology, Faculty of Medicine, University of Inonu, Malatya, Turkey
| | - Cemile Ceren Gül
- Department of Histology and Embryology, Faculty of Medicine, University of Inonu, Malatya, Turkey
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Renoprotective effects of dexmedetomidine against ischemia-reperfusion injury in streptozotocin-induced diabetic rats. PLoS One 2018; 13:e0198307. [PMID: 30114208 PMCID: PMC6095484 DOI: 10.1371/journal.pone.0198307] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/02/2018] [Indexed: 12/21/2022] Open
Abstract
Background Diabetic patients are susceptible to renal ischemia-reperfusion injury, which leads to perioperative complications. Activation of NOD-like receptor protein 3 (NLRP3) inflammasome participates in the development of diabetes, and contributes to renal ischemia-reperfusion injury. Dexmedetomidine (DEX), a highly selective α2-adrenoreceptor agonist, shows renoprotective effects against ischemia-reperfusion injury. We aimed to elucidate the effects, underlying mechanisms, and optimal timing of DEX treatment in diabetic rats. Methods Male Sprague-Dawley rats (n = 12 per group) were randomly divided into normal-sham, diabetes-sham, diabetes-ischemia-reperfusion-control, diabetes-ischemia-reperfusion-DEX-pre-treatment, and diabetes-ischemia-reperfusion-DEX-post-treatment groups. Renal ischemia-reperfusion injury was induced in diabetic rats by occlusion of both renal arteries for 45 min, followed by reperfusion for 24 h. DEX (10 μg/kg) was administered intraperitoneally 1 h before ischemia (pre-treatment) or upon reperfusion (post-treatment). After reperfusion, renal tissue was biochemically and histopathologically evaluated. Results DEX treatment attenuated ischemia reperfusion-induced increase in NLRP3, caspase-1, IL-1β, phospho-AKT, and phospho-ERK signaling. Moreover, oxidative stress injury, inflammatory reactions, apoptosis, and renal tubular damage were favorably modulated by DEX treatment. Furthermore, post-reperfusion treatment with DEX was significantly more effective than pre-treatment in modulating NLRP3 inflammasome, AKT and ERK signaling, and oxidative stress. Conclusions This study shows that the protective effects of DEX in renal ischemia-reperfusion injury are preserved in diabetic conditions and may potentially provide a basis for the use of DEX in clinical treatment of renal ischemia-reperfusion injury.
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Kovalčíková A, Gyurászová M, Vavrincová-Yaghi D, Vavrinec P, Tóthová Ľ, Boor P, Šebeková K, Celec P. Oxidative stress in the brain caused by acute kidney injury. Metab Brain Dis 2018. [PMID: 29516412 DOI: 10.1007/s11011-018-0204-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Uremic encephalopathy is a severe complication of renal failure. The underlying pathogenesis is unknown although several mechanisms have been suggested. Renal failure causes oxidative stress leading to cardiovascular complications. It has been suggested as the potential mediator of uremic encephalopathy as well, but it is largely unknown whether brain tissue itself undergoes oxidative damage in uremia. The aim of our experiment was to analyze oxidative stress markers in different brain regions in an animal model of acute kidney injury (AKI). AKI was induced by ischemia-reperfusion injury in male Wistar rats. Urine was collected in metabolic cages after 24 h. Samples of plasma and several brain regions were collected after 48 h. Markers of lipid peroxidation, protein oxidation and total antioxidant capacity were assessed. Renal failure was confirmed by high plasma creatinine, urea and urinary albumin to creatinine ratio. Our data confirmed increased systemic oxidative stress in the AKI group with plasma concentrations of markers of oxidative damage being twice as high compared to the sham-operated control group. No effect was seen in the urine. In the hippocampus, lipid and protein oxidation was higher, while antioxidant capacity was lower in the rats with AKI. Lipid oxidation markers in the frontal cortex were higher by 33%. No differences to controls were found in the cerebellum and hypothalamus. In conclusion, our results indicate that AKI leads to oxidative stress in the brain, especially in the hippocampus and in the frontal cortex. This kidney-brain crosstalk mediated by increased oxidative stress might explain some of the symptoms of uremic encephalopathy. The causes and consequences of oxidative damage observed in the brain during AKI remain to be elucidated.
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Affiliation(s)
- Alexandra Kovalčíková
- Institute of Molecular Biomedicine, Faculty of Medicine, Comenius University, Sasinkova 4, 841 01, Bratislava, Slovakia
| | - Marianna Gyurászová
- Institute of Molecular Biomedicine, Faculty of Medicine, Comenius University, Sasinkova 4, 841 01, Bratislava, Slovakia
| | - Diana Vavrincová-Yaghi
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University, Bratislava, Slovakia
| | - Peter Vavrinec
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University, Bratislava, Slovakia
| | - Ľubomíra Tóthová
- Institute of Molecular Biomedicine, Faculty of Medicine, Comenius University, Sasinkova 4, 841 01, Bratislava, Slovakia
| | - Peter Boor
- Institute of Molecular Biomedicine, Faculty of Medicine, Comenius University, Sasinkova 4, 841 01, Bratislava, Slovakia
- Institute of Pathology and Department of Nephrology, RWTH University of Aachen, Aachen, Germany
| | - Katarína Šebeková
- Institute of Molecular Biomedicine, Faculty of Medicine, Comenius University, Sasinkova 4, 841 01, Bratislava, Slovakia
| | - Peter Celec
- Institute of Molecular Biomedicine, Faculty of Medicine, Comenius University, Sasinkova 4, 841 01, Bratislava, Slovakia.
- Institute of Pathophysiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia.
- Department of Molecular Biology, Faculty of Natural Sciences, Comenius University, Bratislava, Slovakia.
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Abstract
Transcription activator-like effector nucleases (TALENs) are valuable tools for precise genome engineering of laboratory animals. Here we utilized this technique for efficient site-specific gene modification to create a fumarate hydratase (FH) gene knockout rat model, in which there was an 11 base-pair deletion in the first exon of the FH gene in 111 rats. 18 live-born targeted mutation offsprings were produced from 80 injected zygotes with 22.5% efficiency, indicating high TALEN knockout success in rat zygots. Only heterozygous deletion was observed in the offsprings. Sixteen pairs of heterozygous FH knockout (FH+/−) rats were arranged for mating experiments for six months without any homozygous KO rat identified. Sequencing from the pregnant rats embryo samples showed no homozygous FH KO, indicating that homozygous FH KO is embryonically lethal. Comparatively, the litter size was decreased in both male and female FH+/− KO rats. There was no behaviour difference between the FH+/− KO and the control rats except that the FH+/− KO male rats showed significantly higher body weight in the 16-week observation period. Clinical haematology and biochemical examinations showed hematopoietic and kidney dysfunction in the FH+/− KO rats. Small foci of anaplastic lesions of tubular epithelial cells around glomeruli were identified in the FH+/− kidney, and these anaplastic cells were comparatively positive for Ki67, p53 and Sox9, and such findings are most probably related to the kidney dysfunction reflected by the biochemical examinations of the rats. In conclusion, we have successfully established an FH+/− KO rat model, which will be useful for further functional FH studies.
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Erbatur ME, Sezen ŞC, Bayraktar AC, Arslan M, Kavutçu M, Aydın ME. Effects of dexmedetomidine on renal tissue after lower limb ischemia reperfusion injury in streptozotocin induced diabetic rats. Libyan J Med 2017; 12:1270021. [PMID: 28452604 PMCID: PMC5328322 DOI: 10.1080/19932820.2017.1270021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 12/03/2016] [Indexed: 01/22/2023] Open
Abstract
AIM The aim of this study was to investigate whether dexmedetomidine - administered before ischemia - has protective effects against lower extremity ischemia reperfusion injury that induced by clamping and subsequent declamping of infra-renal abdominal aorta in streptozotocin-induced diabetic rats. MATERIAL AND METHODS After obtaining ethical committee approval, four study groups each containing six rats were created (Control (Group C), diabetes-control (Group DM-C), diabetes I/R (Group DM-I/R), and diabetes-I/R-dexmedetomidine (Group DM-I/R-D). In diabetes groups, single-dose (55 mg/kg) streptozotocin was administered intraperitoneally. Rats with a blood glucose level above 250 mg/dl at the 72nd hour were accepted as diabetic. At the end of four weeks, laparotomy was performed in all rats. Nothing else was done in Group C and DM-C. In Group DM-I/R, ischemia reperfusion was produced via two-hour periods of clamping and subsequent declamping of infra-renal abdominal aorta. In Group DM-I/R-D, 100 μg/kg dexmedetomidine was administered intraperitoneally 30 minutes before ischemia period. At the end of reperfusion, period biochemical and histopathological evaluation of renal tissue specimen were performed. RESULTS Thiobarbituric acid reactive substance (TBARS), Superoxide dismutase (SOD), Nitric oxide synthase (NOS), Catalase (CAT) and Glutathion S transferase (GST) levels were found significantly higher in Group DM-I/R when compared with Group C and Group DM-C. In the dexmedetomidine-treated group, TBARS, NOS, CAT, and GST levels were significantly lower than those measured in the Group D-I/R. In histopathological evaluation, glomerular vacuolization (GV), tubular dilatation (TD), vascular vacuolization and hypertrophy (VVH), tubular cell degeneration and necrosis (TCDN), tubular hyaline cylinder (THC), leucocyte infiltration (LI), and tubular cell spillage (TCS) in Group DM-I/R were significantly increased when compared with the control group. Also, GV, VVH, and THC levels in the dexmedetomidine-treated group (Group DM-I/R-D) were found significantly decreased when compared with the Group DM-I/R. CONCLUSION We found that dexmedetomidine - 100 μg/kg intraperitoneally - administered 30 minutes before ischemia in diabetic rats ameliorates lipid peroxidation, oxidative stress, and I-R-related renal injury. We suggest that dexmedetomidine administration in diabetic rats before I/R has renoprotective effects.
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Affiliation(s)
- Meral Erdal Erbatur
- Department of Anesthesiology and Reanimation, Gazi University, Ankara, Turkey
| | - Şaban Cem Sezen
- Department of Histology and Embryology, Kırıkkale University, Kırıkkale, Turkey
| | | | - Mustafa Arslan
- Department of Anesthesiology and Reanimation, Gazi University, Ankara, Turkey
| | - Mustafa Kavutçu
- Department of Medical Biochemistry, Gazi University, Ankara, Turkey
| | - Muhammed Enes Aydın
- Department of Anesthesiology and Reanimation, Gazi University, Ankara, Turkey
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Jiang WW, Wang QH, Liao YJ, Peng P, Xu M, Yin LX. Effects of dexmedetomidine on TNF-α and interleukin-2 in serum of rats with severe craniocerebral injury. BMC Anesthesiol 2017; 17:130. [PMID: 28931374 PMCID: PMC5607498 DOI: 10.1186/s12871-017-0410-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 08/24/2017] [Indexed: 01/08/2023] Open
Abstract
Background Dexmedetomidine is a highly selective adrenergic receptor agonist, which has a dose-dependent sedative hypnotic effect. Furthermore, it also has pharmacological properties, and the ability to inhibit sympathetic activity and improve cardiovascular stability during an operation. However, its protective effect on patients with severe craniocerebral injury in the perioperative period remains unclear. Method Eighty adult male SD rats were used and divided into two groups (n = 40, each group): dexmedetomidine injury group (experimental group), and sodium chloride injury group (control group). Models of severe craniocerebral injury were established in these two groups using the modified Feeney’s free-fall method. As soon as the establishment of models was succeed, rat in the experimental group received 1 μg of dexmedetomidine (0.1 ml), while each rat in the control group was given 0.1 ml of 0.9% sodium chloride. Blood was sampled from an incision at the femoral vein to detect TNF-α and IL-2 levels at 1, 12, 24,36,48 and 72 h after establishing the model in the two groups. Results After severe craniocerebral injury, TNF-α levels of rats were lower in every stage and at different degrees in the experimental group than in the control group (P < 0.05), while IL-2 levels were lower in the experimental group to different extents (P < 0.05). Conclusion Dexmedetomidine protects the brain of rats with severe craniocerebral injury by reducing the release of inflammatory mediators.
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Affiliation(s)
- Wan-Wei Jiang
- Department of Anesthesiology II, Affiliated Zhongshan Hospital of Dalian University, No. 6 of Jiefang Street, Zhongshan District, Dalian, 116001, China.
| | - Qing-Hui Wang
- Department of Anesthesiology II, Affiliated Zhongshan Hospital of Dalian University, No. 6 of Jiefang Street, Zhongshan District, Dalian, 116001, China
| | - Ya-Jing Liao
- Department of Anesthesiology II, Affiliated Zhongshan Hospital of Dalian University, No. 6 of Jiefang Street, Zhongshan District, Dalian, 116001, China
| | - Pai Peng
- Department of Anesthesiology II, Affiliated Zhongshan Hospital of Dalian University, No. 6 of Jiefang Street, Zhongshan District, Dalian, 116001, China
| | - Min Xu
- Department of Anesthesiology II, Affiliated Zhongshan Hospital of Dalian University, No. 6 of Jiefang Street, Zhongshan District, Dalian, 116001, China
| | - Li-Xin Yin
- Department of Anesthesiology II, Affiliated Zhongshan Hospital of Dalian University, No. 6 of Jiefang Street, Zhongshan District, Dalian, 116001, China
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Uysal E, Dokur M, Altınay S, Saygılı Eİ, Batcıoglu K, Ceylan MS, Kazımoglu H, Uyumlu BA, Karadag M. Investigation of the Effect of Milrinone on Renal Damage in an Experimental Non-Heart Beating Donor Model. J INVEST SURG 2017; 31:402-411. [DOI: 10.1080/08941939.2017.1343880] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Erdal Uysal
- Department of General Surgery, Sanko University School of Medicine, Gaziantep, Turkey
| | - Mehmet Dokur
- Emergency, Dr. Necip Fazil City Hospital, Kahramanmaras, Turkey
| | - Serdar Altınay
- Department of Pathology, Bakırköy Dr Sadi Konuk Health Application and Research Center, Istanbul, Turkey
| | - Eyup İlker Saygılı
- Department of Biochemistry, Sanko University School of Medicine, Gaziantep, Turkey
| | - Kadir Batcıoglu
- Department of Biochemistry, Inonu University Faculty of Pharmacy, Malatya, Turkey
| | | | - Hatem Kazımoglu
- Department of Urology, Sanko Universitesi Tip Fakultesi, Gaziantep, Turkey
| | | | - Mehmet Karadag
- Biostatistic and Medical Informatics, Health Sciences Institute, Inonu University, Malatya, Turkey
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Akpınar O, Nazıroğlu M, Akpınar H. Different doses of dexmedetomidine reduce plasma cytokine production, brain oxidative injury, PARP and caspase expression levels but increase liver oxidative toxicity in cerebral ischemia-induced rats. Brain Res Bull 2017; 130:1-9. [DOI: 10.1016/j.brainresbull.2016.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 12/09/2016] [Indexed: 12/22/2022]
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Cakir M, Duzova H, Baysal I, Gül CC, Kuşcu G, Kutluk F, Çakin H, Şeker Ş, İlbeği E, Uslu S, Avci U, Demir S, Akinci C, Atli S. The effect of hypericum perforatum on kidney ischemia/reperfusion damage. Ren Fail 2017; 39:385-391. [PMID: 28209087 PMCID: PMC6014337 DOI: 10.1080/0886022x.2017.1287734] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
It has been revealed in recent studies that Hypericum Perforatum (HP) is influential on cancer, inflammatory diseases, bacterial and viral diseases, and has neuroprotective and antioxidant properties. In this study, we investigated the effect of HP, which is known to have antioxidant and anti-inflammatory effects, on kidney I/R damage. Male Sprague–Dawley rats were divided into three groups, and each of the groups had eight rats: The Control Group; the Ischemia/Reperfusion (I/R) Group; and the IR + HP Group which was treated with 50 mg/kg of HP. The right kidneys of the rats were removed, and the left kidney developed ischemia during the 45th min, and reperfusion occurred in the following 3rd h. The histopathological findings and also the level of Malondialdehyde (MDA), Glutathione (GSH) and superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GSH-PX) enzyme activations in the renal tissues were measured. Blood Urea Nitrogen (BUN), Creatinin (Cre) from serum samples were determined. The levels of BUN, Cre, and kidney tissue MDA increased at a significant level, and the SOD, CAT, and GSH-PX enzyme activity decreased at a significant level in the I/R group, compared with the Control Group (p < 0.05). In the I/R + HP group, the levels of MDA decreased at a significant level compared to the I/R group, while the SOD, CAT, and GSH-PX activity increased (p < 0.05). In histopathological examinations, it was observed that the tubular dilatation and epithelial desquamation regressed in the IR + HP Group when compared with the I/R Group. It has been shown with the histological and biochemical results in this study that HP is protective against acute renal I/R.
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Affiliation(s)
- Murat Cakir
- a Department of Physiology, Faculty of Medicine , Inonu University , Malatya , Turkey
| | - Halil Duzova
- a Department of Physiology, Faculty of Medicine , Inonu University , Malatya , Turkey
| | - Işil Baysal
- b Department of Histology and Embryology, Faculty of Medicine , Inonu University , Malatya , Turkey
| | - Cemile Ceren Gül
- b Department of Histology and Embryology, Faculty of Medicine , Inonu University , Malatya , Turkey
| | - Gülbahar Kuşcu
- c Faculty of Medicine , Inonu University , Malatya , Turkey
| | - Fatma Kutluk
- c Faculty of Medicine , Inonu University , Malatya , Turkey
| | - Hilal Çakin
- c Faculty of Medicine , Inonu University , Malatya , Turkey
| | - Şifanur Şeker
- c Faculty of Medicine , Inonu University , Malatya , Turkey
| | - Esranur İlbeği
- c Faculty of Medicine , Inonu University , Malatya , Turkey
| | - Seda Uslu
- c Faculty of Medicine , Inonu University , Malatya , Turkey
| | - Umut Avci
- c Faculty of Medicine , Inonu University , Malatya , Turkey
| | - Samet Demir
- c Faculty of Medicine , Inonu University , Malatya , Turkey
| | - Cihan Akinci
- c Faculty of Medicine , Inonu University , Malatya , Turkey
| | - Sercan Atli
- c Faculty of Medicine , Inonu University , Malatya , Turkey
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Erkılıç E, Kesimci E, Alaybeyoğlu F, Kılınç I, Tural R, Yazgan A, Gümüş T, Sepici Dinçel A, Dumlu EG, Kanbak O. Does remifentanil attenuate renal ischemia-reperfusion injury better than dexmedetomidine in rat kidney? DRUG DESIGN DEVELOPMENT AND THERAPY 2017; 11:677-683. [PMID: 28331287 PMCID: PMC5352155 DOI: 10.2147/dddt.s126701] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Ischemia–reperfusion (I/R) injury is a common cause of patient morbidity and mortality in the perioperative period. Patients undergoing long-lasting, abdominal, and urogenital surgeries with risk factors such as advanced age, peripheral artery disease, diabetes mellitus, renovascular disease, and congestive heart failure are candidates for acute kidney injury (AKI) due to impaired renal perfusion and decreased functional renal reserve. Pharmacological agents with multiple functions and anti-oxidative and anti-inflammation properties may be promising preventative strategies for AKI. Recently, dexmedetomidine (dex) has been postulated to have renoprotective effects. Objectives We aimed to investigate the protective effects of an intravenous anesthetic remifentanil in renal I/R injury in the rat in comparison with dex. Materials and methods A total of 30 Sprague Dawley adult rats were randomly assigned into five groups: the control group (group C, n=6), the sham group (group Sh, n=6, saline-infused rats without I/R injury), the saline group (group S, n=6, saline-infused rats with I/R injury), the remifentanil-treated group (group REM, n=6), and the dexmedetomidine-treated group (group DEX, n=6). The infusions (saline, remifentanil, and dex) were started after anesthesia induction and right nephrectomy and continued until the end of the surgical procedure. In I/R injury groups, the left renal artery and vein were occluded together by a clamp for 30 minutes and reperfusion lasted for 30 minutes. The rats were sacrificed after reperfusion, and the left kidney tissue was harvested. Blood samples were drawn from all animals to evaluate plasma neutrophil gelatinase-associated lipocalin (NGAL) at the beginning, 15 minutes after ischemia, 15 minutes after reperfusion, and 6 hours after the surgical procedure (T0, T1, T2, and T3, respectively). Results The plasma NGAL levels exhibited increase at T1, T2, and T3 compared to the levels at T0 in group S (P<0.05). In group REM, there was a significant increase in plasma NGAL levels at T3 in comparison to those at T0, T1, and T2. The plasma NGAL levels at T2 in group S were significantly higher than those at T2 in group DEX (P<0.05). The groups S and REM showed significantly higher plasma NGAL levels at T3 compared to those at T0 (P<0.05). Upon histological examination, there was no difference among the study groups when left kidneys were evaluated (P>0.05). Conclusion The NGAL levels and histopathological findings reflected protection by dex against renal I/R injury. However, the same exact results could not be mentioned for remifentanil depending on our study results.
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Affiliation(s)
- E Erkılıç
- Anesthesiology and Reanimation Department
| | - E Kesimci
- Anesthesiology and Reanimation Department
| | | | - I Kılınç
- General Surgery Department, Atatürk Training and Research Hospital
| | - R Tural
- Biochemistry Department, Faculty of Medicine, Gazi University
| | - A Yazgan
- Pathology Department, Atatürk Training and Research Hospital
| | - T Gümüş
- Anesthesiology and Reanimation Department
| | - A Sepici Dinçel
- Biochemistry Department, Faculty of Medicine, Gazi University
| | - E G Dumlu
- General Surgery Clinic, Faculty of Medicine, Yıldırım Beyazıt University, Ankara, Turkey
| | - O Kanbak
- Anesthesiology and Reanimation Department
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Sancak EB, Turkön H, Çukur S, Erimsah S, Akbas A, Gulpinar MT, Toman H, Sahin H, Uzun M. Major Ozonated Autohemotherapy Preconditioning Ameliorates Kidney Ischemia-Reperfusion Injury. Inflammation 2016; 39:209-217. [PMID: 26282390 DOI: 10.1007/s10753-015-0240-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Medical ozone has therapeutic properties as an antimicrobial, anti-inflammatory, modulator of antioxidant defense system. Major ozonated autohemotherapy (MOA) is a new therapeutic approach that is widely used in the treatment of many diseases. The objective of the present study was to determine whether preischemic application of MOA would attenuate renal ischemia-reperfusion injury (IRI) in rabbits. Twenty-four male New Zealand white rabbits were divided into four groups, each including six animals: (1) Sham-operated group, (2) Ozone group (the MOA group without IRI), (3) IR group (60 min ischemia followed by 24 h reperfusion), and (4) IR + MOA group (MOA group). The effects of MOA were examined by use of hematologic and biochemical parameters consisting of neutrophil to lymphocyte ratio (NLR), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), ischemia-modified albumin (IMA), total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI). In addition, the histopathological changes including the tubular brush border loss (TBBL), tubular cast (TC), tubular necrosis (TN), intertubular hemorrhage and congestion (IHC), dilatation of bowman space (DBS), and interstitial inflammatory cells infiltration (IECI) were evaluated. In the IR group, compared to the Sham group, biochemical parameters indicating oxidative stress, NLR, IL-6, TNF-α, IMA, TOS, and OSI have increased. MOA reduced inflammation and oxidative stress parameters. Although TAS values have decreased in the IR group and increased in the MOA-pretreated group, no significant changes in TAS values were detected between the IR and MOA groups. The total score was obtained by summing all the scores from morphological kidney damage markers. The total score has increased with IR damage when compared with the Sham group (13.83 ± 4.30 vs 1.51 ± 1.71; p = 0.002). But, the total score has decreased significantly after application of MOA (5.01 ± 1.49; p = 0.002; compared with the IR group). MOA preconditioning is effective in reducing tissue damage induced in kidney ischemia-reperfusion injury. The protective effect of MOA is mediated via reducing inflammatory response and regulating of reactive oxygen species (ROS). Renal histology also showed convincing evidence regarding MOA's protective nature against kidney injury induced renal ischemia-reperfusion. Consequently, MOA might be helpful in protecting the kidneys from IR-induced damage in humans, probably through the anti-inflammatory effect and reducing the total oxidant status.
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Affiliation(s)
- Eyup Burak Sancak
- Department of Urology, Canakkale Onsekiz Mart University, Faculty of Medicine, Canakkale, Turkey. .,Canakkale Onsekiz Mart Universitesi, Terzioglu Yerleskesi, Barbaros Mh, 17100, Canakkale, Turkey.
| | - Hakan Turkön
- Department of Biochemistry, Canakkale Onsekiz Mart University, Faculty of Medicine, Canakkale, Turkey
| | - Selma Çukur
- Department of Pathology, Abant Izzet Baysal University, Faculty of Medicine, Bolu, Turkey
| | - Sevilay Erimsah
- Department of Histology and Embryology, Abant Izzet Baysal University, Faculty of Medicine, Bolu, Turkey
| | - Alpaslan Akbas
- Department of Urology, Canakkale Onsekiz Mart University, Faculty of Medicine, Canakkale, Turkey
| | - Murat Tolga Gulpinar
- Department of Urology, Canakkale Onsekiz Mart University, Faculty of Medicine, Canakkale, Turkey
| | - Huseyin Toman
- Department of Anesthesiology, Canakkale Onsekiz Mart University, Faculty of Medicine, Canakkale, Turkey
| | - Hasan Sahin
- Department of Anesthesiology, Canakkale Onsekiz Mart University, Faculty of Medicine, Canakkale, Turkey
| | - Metehan Uzun
- Department of Physiology, Canakkale Onsekiz Mart University, Faculty of Medicine, Canakkale, Turkey
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Interventional therapy of diabetes mellitus type 2 complicated with acute cerebral hemorrhage by using dexmedetomidine. JOURNAL OF ACUTE DISEASE 2016. [DOI: 10.1016/j.joad.2016.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Bircan B, Çakır M, Kırbağ S, Gül HF. Effect of apelin hormone on renal ischemia/reperfusion induced oxidative damage in rats. Ren Fail 2016; 38:1122-8. [DOI: 10.1080/0886022x.2016.1184957] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Karahan MA, Yalcin S, Aydogan H, Büyükfirat E, Kücük A, Kocarslan S, Yüce HH, Taskın A, Aksoy N. Curcumin and dexmedetomidine prevents oxidative stress and renal injury in hind limb ischemia/reperfusion injury in a rat model. Ren Fail 2016; 38:693-8. [PMID: 26983591 DOI: 10.3109/0886022x.2016.1157746] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Curcumin and dexmedetomidine have been shown to have protective effects in ischemia-reperfusion injury on various organs. However, their protective effects on kidney tissue against ischemia-reperfusion injury remain unclear. We aimed to determine whether curcumin or dexmedetomidine prevents renal tissue from injury that was induced by hind limb ischemia-reperfusion in rats. Fifty rats were divided into five groups: sham, control, curcumin (CUR) group (200 mg/kg curcumin, n = 10), dexmedetomidine (DEX) group (25 μg/kg dexmedetomidine, n = 10), and curcumin-dexmedetomidine (CUR-DEX) group (200 mg/kg curcumin and 25 μg/kg dexmedetomidine). Curcumin and dexmedetomidine were administered intraperitoneally immediately after the end of 4 h ischemia, just 5 min before reperfusion. The extremity re-perfused for 2 h and then blood samples were taken and total antioxidant capacity (TAC), total oxidative status (TOS) levels, and oxidative stress index (OSI) were measured, and renal tissue samples were histopathologically examined. The TAC activity levels in blood samples were significantly lower in the control than the other groups (p < 0.01 for all comparisons). The TOS activity levels in blood samples were significantly higher in Control group and than the other groups (p < 0.01 for all comparison). The OSI were found to be significantly increased in the control group compared to others groups (p < 0.001 for all comparisons). Histopathological examination revealed less severe lesions in the sham, CUR, DEX, and CUR-DEX groups, compared with the control group (p < 0.01). Rat hind limb ischemia-reperfusion causes histopathological changes in the kidneys. Curcumin and dexmedetomidine administered intraperitoneally was effective in reducing oxidative stress and renal histopathologic injury in an acute hind limb I/R rat model.
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Affiliation(s)
- M A Karahan
- a Department of Anesthesiology and Reanimation, Medical Faculty , Harran University , Şanliurfa , Turkey
| | - S Yalcin
- a Department of Anesthesiology and Reanimation, Medical Faculty , Harran University , Şanliurfa , Turkey
| | - H Aydogan
- a Department of Anesthesiology and Reanimation, Medical Faculty , Harran University , Şanliurfa , Turkey
| | - E Büyükfirat
- a Department of Anesthesiology and Reanimation, Medical Faculty , Harran University , Şanliurfa , Turkey
| | - A Kücük
- a Department of Anesthesiology and Reanimation, Medical Faculty , Harran University , Şanliurfa , Turkey
| | - S Kocarslan
- b Department of Pathology, Medical Faculty , Harran University , Şanliurfa , Turkey
| | - H H Yüce
- a Department of Anesthesiology and Reanimation, Medical Faculty , Harran University , Şanliurfa , Turkey
| | - A Taskın
- c Department of Clinical Biochemistry, Medical Faculty , Harran University , Şanliurfa , Turkey
| | - N Aksoy
- c Department of Clinical Biochemistry, Medical Faculty , Harran University , Şanliurfa , Turkey
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Kiraz HA, Poyraz F, Kip G, Erdem Ö, Alkan M, Arslan M, Özer A, Şivgin V, Çomu FM. The effect of levosimendan on myocardial ischemia-reperfusion injury in streptozotocin-induced diabetic rats. Libyan J Med 2015; 10:29269. [PMID: 26649830 PMCID: PMC4673913 DOI: 10.3402/ljm.v10.29269] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective Ischemia/reperfusion (I/R) injury is an important cause of myocardial damage by means of oxidative, inflammatory, and apoptotic mechanisms. The aim of the present study was to examine the potential cardio protective effects of levosimendan in a diabetic rat model of myocardial I/R injury. Methods A total of 18 streptozotocin-induced diabetic Wistar Albino rats (55 mg/kg) were randomly divided into three equal groups as follows: the diabetic I/R group (DIR) in which myocardial I/R was induced following left thoracotomy, by ligating the left anterior descending coronary artery for 60 min, followed by 2 h of reperfusion; the diabetic I/R levosimendan group (DIRL), which underwent I/R by the same method while taking levosimendan intraperitoneal 12 µg kg−1; and the diabetic control group (DC) which underwent sham operations without tightening of the coronary sutures. As a control group (C), six healthy age-matched Wistar Albino rats underwent sham operations similar to the DC group. Two hours after the operation, the rats were sacrificed and the myocardial tissue samples were examined by light microscopy for evidence of myonecrosis and inflammatory cell infiltration. Results Myonecrosis findings were significantly different among groups (p=0.008). Myonecrosis was more pronounced in the DIR group compared with the C, DC, and DIRL groups (p=0.001, p=0.007 and p=0.037, respectively). Similarly, the degree of inflammatory cell infiltration showed significant difference among groups (p<0.0001). Compared with C, DC, and DIRL groups, the inflammatory cell infiltration was significantly higher among the DIR group (p<0.0001, p<0.0001, and p=0.020, respectively). Also, myocardial tissue edema was significantly different among groups (p=0.006). The light microscopic myocardial tissue edema levels were significantly higher in the DIR group than the C, DC, and DIRL groups (p=0.001, p=0.037, and p=0.014, respectively). Conclusion Taken together, our data indicate that levosimendan may be helpful in reducing myocardial necrosis, myocardial inflammation, and myocardial tissue edema resulting from ischemia–reperfusion injury.
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Affiliation(s)
- Hasan Ali Kiraz
- a Department of Anaesthesiology and Reanimation Onsekiz Mart University Medical Faculty , Canakkale , Turkey
| | - Fatih Poyraz
- b Department of Cardiology Kirikkale University Medical Faculty , Afyonkarahisar , Turkey
| | - Gülay Kip
- c Department of Paediatric Dentistry (Anaesthesiology and Reanimation specialist) Gazi University Dentistry Faculty , Ankara , Turkey
| | - Özlem Erdem
- d Department of Pathology Gazi University Medical Faculty , Ankara , Turkey
| | - Metin Alkan
- e Department of Anaesthesiology and Reanimation Gazi University Medical Faculty , Ankara , Turkey
| | - Mustafa Arslan
- e Department of Anaesthesiology and Reanimation Gazi University Medical Faculty , Ankara , Turkey
| | - Abdullah Özer
- f Department of Cardiovascular Surgery Gazi University Medical Faculty , Ankara , Turkey
| | - Volkan Şivgin
- e Department of Anaesthesiology and Reanimation Gazi University Medical Faculty , Ankara , Turkey
| | - Faruk Metin Çomu
- g Department of Physiology Kirikkale University Medical Faculty , Afyonkarahisar , Turkey
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