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Vlastos D, Zeinah M, Ninkovic-Hall G, Vlachos S, Salem A, Asonitis A, Chavan H, Kalampalikis L, Al Shammari A, Alvarez Gallesio JM, Pons A, Andreadou I, Ikonomidis I. The effects of ischaemic conditioning on lung ischaemia-reperfusion injury. Respir Res 2022; 23:351. [PMID: 36527070 PMCID: PMC9756694 DOI: 10.1186/s12931-022-02288-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Ischaemia-reperfusion injury (IRI) encompasses the deleterious effects on cellular function and survival that result from the restoration of organ perfusion. Despite their unique tolerance to ischaemia and hypoxia, afforded by their dual (pulmonary and bronchial) circulation as well as direct oxygen diffusion from the airways, lungs are particularly susceptible to IRI (LIRI). LIRI may be observed in a variety of clinical settings, including lung transplantation, lung resections, cardiopulmonary bypass during cardiac surgery, aortic cross-clamping for abdominal aortic aneurysm repair, as well as tourniquet application for orthopaedic operations. It is a diagnosis of exclusion, manifesting clinically as acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). Ischaemic conditioning (IC) signifies the original paradigm of treating IRI. It entails the application of short, non-lethal ischemia and reperfusion manoeuvres to an organ, tissue, or arterial territory, which activates mechanisms that reduce IRI. Interestingly, there is accumulating experimental and preliminary clinical evidence that IC may ameliorate LIRI in various pathophysiological contexts. Considering the detrimental effects of LIRI, ranging from ALI following lung resections to primary graft dysfunction (PGD) after lung transplantation, the association of these entities with adverse outcomes, as well as the paucity of protective or therapeutic interventions, IC holds promise as a safe and effective strategy to protect the lung. This article aims to provide a narrative review of the existing experimental and clinical evidence regarding the effects of IC on LIRI and prompt further investigation to refine its clinical application.
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Affiliation(s)
- Dimitrios Vlastos
- grid.415914.c0000 0004 0399 9999Department of Vascular Surgery, Countess of Chester Hospital, Chester, UK ,grid.411449.d0000 0004 0622 4662Second Department of Cardiology, Attikon University Hospital, Athens, Greece ,Present Address: Liverpool, UK
| | - Mohamed Zeinah
- grid.415992.20000 0004 0398 7066Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK ,grid.7269.a0000 0004 0621 1570Ain Shams University, Cairo, Egypt
| | - George Ninkovic-Hall
- grid.415970.e0000 0004 0417 2395Department of Vascular Surgery, Royal Liverpool University Hospital, Liverpool, UK
| | - Stefanos Vlachos
- grid.411449.d0000 0004 0622 4662Second Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - Agni Salem
- grid.415992.20000 0004 0398 7066Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Athanasios Asonitis
- grid.413157.50000 0004 0590 2070Department of Cardiothoracic Surgery, NHS Golden Jubilee National Hospital, Glascow, UK
| | - Hemangi Chavan
- grid.421662.50000 0000 9216 5443Department of Thoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Lazaros Kalampalikis
- grid.414012.20000 0004 0622 6596Department of Minimally Invasive Cardiac Surgery, Metropolitan General Hospital, Athens, Greece
| | - Abdullah Al Shammari
- grid.421662.50000 0000 9216 5443Department of Thoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - José María Alvarez Gallesio
- grid.421662.50000 0000 9216 5443Department of Thoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Aina Pons
- grid.421662.50000 0000 9216 5443Department of Thoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Ioanna Andreadou
- grid.5216.00000 0001 2155 0800School of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Ignatios Ikonomidis
- grid.411449.d0000 0004 0622 4662Second Department of Cardiology, Attikon University Hospital, Athens, Greece
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Santos CHMD, Dourado DM, Silva BAKD, Pontes HBD, Azevedo Neto ED, Vendas GSDC, Chaves IDO, Miranda JVC, Oliva JVDG, Dias LDES, Almeida MHMD, Sampaio TL. Effect of Ischemic Postconditioning and Atorvastatin in the Prevention of Remote Lung Reperfusion Injury. Braz J Cardiovasc Surg 2018; 33:115-121. [PMID: 29898139 PMCID: PMC5985836 DOI: 10.21470/1678-9741-2017-0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 11/08/2017] [Indexed: 11/11/2022] Open
Abstract
Objective The aim of the present study was to evaluate the ability of ischemic
postconditioning, atorvastatin and both associated to prevent or minimize
reperfusion injury in the lung of rats subjected to ischemia and reperfusion
by abdominal aortic clamping. Methods We used 41 Wistar norvegic rats, which were distributed into 5 groups:
ischemia and reperfusion (I/R), ischemic postcondictioning (IPC),
postconditioning + atorvastatin (IPC+A), atorvastatin (A) and SHAM. It was
performed a medium laparotomy, dissection and isolation of the infra-renal
abdominal aorta; except for the SHAM group, all the others were submitted to
the aortic clamping for 70 minutes (ischemia) and posterior clamp removal
(reperfusion, 70 minutes). In the IPC and IPC+A groups, postconditioning was
performed between the ischemia and reperfusion phases by four cycles of
reperfusion and ischemia lasting 30 seconds each. In the IPC+A and A groups,
preceding the surgical procedure, administration of 3.4 mg/day of
atorvastatin was performed for seven days by gavage. After the surgical
procedure, the right caudal lobe was removed from the lung for histological
study, using tissue injury score ranging from grade 1 (normal tissue) to
grade 4 (intense lesion). Results The mean lung injury was 3.6 in the I/R group, 1.6 in the IPC group, 1.2 in
the IPC+A group, 1.2 in the A group, and 1 in the SHAM group
(P<0.01). Conclusion Ischemic postconditioning and atorvastatin were able to minimize lung
reperfusion injury, alone or in combination.
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dos Santos CHM, Aydos RD, Nogueira E, Miiji LNO, Cassino PC, Alves II, Calheiros NM, Garcia M. Ischemic Postconditioning Assessment in the Liver of Rats Undergoing Mesenteric Ischemia and Reperfusion. Braz J Cardiovasc Surg 2017; 31:287-290. [PMID: 27849300 PMCID: PMC5094425 DOI: 10.5935/1678-9741.20160068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 07/04/2016] [Indexed: 12/17/2022] Open
Abstract
Introduction Ischemic postconditioning is a method that shows evidence of efficacy in
minimizing reperfusion injury; however, its effectiveness in preventing
injuries in distant organs is still unknown, especially in those who have
undergone mesenteric ischemia and reperfusion. Objective To evaluate the effect of ischemic postconditioning in preventing reperfusion
injury in the liver of rats submitted to mesenteric ischemia and
reperfusion, comparing two different methods of ischemic
postconditioning. Methods 30 Wistar male rats were used, distributed into three groups: Group A: Ten
rats submitted to intestinal ischemia for 30 minutes followed by reperfusion
for 60 minutes; Group B: Ten rats subjected to ischemia and reperfusion;
after ischemia, two cycles of reperfusion (two minutes each) interleaved
with two cycles of ischemia (two minutes each); and Group C: Ten rats
subjected to ischemia and reperfusion; after ischemia, four cycles of
reperfusion (30 seconds each) interspersed with four cycles of ischemia (30
seconds each). After the experiment, the left lobe of the liver was resected
for subsequent histological analysis, using the following classification:
grade 1 - centrilobular congestion; grade 2 - centrilobular congestion with
some degeneration of hepatocytes in one or two central veins; and grade 3 -
multifocal centrilobular congestion and degeneration of portal
hepatocytes. Results The mean degree of liver damage found was 1.8 in group A, 1.7 in group B and
1.3 in group C. There was no statistically significant difference between
the groups. Conclusion Ischemic postconditioning was unable to minimize reperfusion injury in rats
undergoing mesenteric ischemia and reperfusion.
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Affiliation(s)
| | - Ricardo Dutra Aydos
- Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Ed Nogueira
- Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
| | | | - Pedro Carvalho Cassino
- Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Isadora Ishaq Alves
- Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
| | | | - Milena Garcia
- Faculdade de Medicina da Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
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