远端缺血预处理对心肌的保护作用

实验发现,局部缺血预处理对远端(未预处理)心肌组织具有保护作用,而且其它器官的短暂缺血也可实现心肌保护作用,这一现象不同于经典的缺血预处理,因此被命名为远端缺血预处理。研究其机制表明,神经反射调节是机体实现远端缺血预处理保护作用的重要方式,心肌组织中蛋白激酶C激活介导了这一作用。     

辅酶Q_(10)对缺血心肌线粒体功能和形态的影响

辅酶Q_(10)(CoQ_(10))参与呼吸链及电子传递,在氧化还原系统中作为可逆的受氢体行使着催化功能。文献报道CoQ_(10)能保护或改善缺血心肌的功能、代谢和形态,临床用于治疗冠心病、充血性心衰、心肌炎、心律失常等心血管疾病。本文通过观察CoQ_(10)对缺血心肌线粒体功能和形态的影响,以探讨其保护缺血心肌的作用机制。     

高频电刺激股神经减小大鼠心肌缺血-再灌注后的梗塞范围

通过氨基甲酸乙酯麻醉大鼠观察股神经电刺激对缺血- 再灌注心肌的影响,旨在证实外周神经刺激对心肌有无保护效应,并明确其可能的作用机制。心肌缺血区和梗塞区分别用伊文思蓝和氯化硝基四氮唑蓝染色确定,心肌梗塞范围定义为心肌梗塞区重量占心肌缺血区重量的百分比。所得结果如下:(1)在心肌缺血30 min 和再灌注120 min 过程中,梗塞心肌占缺血心肌的(54.96±0.82)%。 高频电刺激(10 V,100 Hz,1ms)股神经5 min 可使心肌梗塞范围减少到(36.94±1.34)% (P<0.01), 表明 (2)高频电刺激股神经对缺血-再灌注心肌有保护作用。然而,低频电刺激(10 V, 10 Hz, 1 ms)股神经对缺血-再灌注心肌梗塞范围无影响。 预先应用非选择性阿片肽受体阻断剂纳洛酮(5 mg/kg, i.v.)或非选择性KATP 通道阻断剂格列苯脲(5 mg/kg, i.v.)均能完全 (3)取消高频电刺激股神经对缺血-再灌注心肌的保护作用。以上结果提示,高频外周神经刺激可以减小缺血- 再灌注心肌的梗塞范围,其可能的作用机制是: 高频电刺激股神经时中枢神经系统内释放的内源性阿片肽和由此激活的心肌KATP通道的开放介导了这种保护作用。     

心肌缺血预处理后Ca2+*Mg2+-ATPase及SDH活性的变化

198 6年Ｍｕｒｒｙ等首次发现实验狗心肌在经历了短暂性缺血后产生对随后持续严重缺血再灌注的保护作用 ,并称此现象为“缺血预处理 (ｉｓｃｈｅｍｉｃｐｒｏｅｏｎｄｉｔｉｏｎｉｎｇ,ＩＰＣ)。ＩＰＣ现象的发现为心肌保护提供了一条新的途径。实验及临床研究均发现其可以限制心肌梗塞范围 ,增加心肌收缩力 ,降低再灌性心律失常 ,但心肌的这一内源性保护机制不清。有人认为ＩＰＣ的产生机制与纠正细胞内外的离子紊乱和心肌能量代谢有关。Ｃａ2 ·Ｍｇ2 ＡＴＰａｓｅ在维持细胞内外的正常离子浓度中起重要作用 ,琥珀酸脱氢酶 (ＳＤＨ)是…     

迷走神经和乙酰胆碱对缺血心肌保护作用的研究新进展

缺血性心脏病是危害人类健康的主要疾病之一。新近研究发现,心肌缺血与迷走神经活性降低及交感神经活性升高密切相关。本文从缺血性心脏病时心脏迷走神经调控的改变、迷走神经及其递质乙酰胆碱对缺血心肌的保护作用和其在缺血预适应、缺血后适应中可能的信号转导途径等方面,对迷走神经及其递质保护缺血心肌的作用机制研究的新进展予以综述,将有助于深入理解缺血性心脏病的发病机制及防治措施,为该疾病的防治开辟新思路。     

柚皮素对心肌缺血再灌注损伤的保护作用

柚皮素(naringenin, Nari)具有抗氧化和抗动脉粥样硬化的效应,并能激活ATP敏感性钾离子通道(KATP)以给心脏提供保护。为了探究Nari对心脏保护的机制,本研究选取成年雄性SD大鼠为研究对象,并将大鼠分为4组:对照组、NARI组、NARI+格列本脲(GLI)组和NARI+5-羟基癸酸(5-HD)组。将实验小鼠的心脏分离,Langendorff灌流,缺血处理30 min,然后再灌注60 min,测定其左心室压力、冠脉流出液中乳酸脱氢酶(LDH)、心肌超氧化物歧化酶(SOD)活性、丙二醛(MDA)含量以及测量心肌梗死面积。结果发现,2.5μmol/L以上浓度的Nari能够促进左心室功能恢复,冠脉流出液中LDH降低,心肌梗死面积明显减少,说明Nari可增加心肌SOD活性,并减少心肌MDA含量,同时Nari的这种心脏保护作用可被GLI和5-HD阻断。研究证明,Nari在缺血再灌注损伤时具有心脏保护作用,其机制可能与通过激活细胞和线粒体膜KATP通道发挥增强心肌抗氧化的能力有关。     

金属硫蛋白对缺氧／复氧心肌细胞的保护作用

金属硫蛋白 (ＭＴ)是普遍存在各种生物体内、富含硫基的小分子蛋白 ,在缺血 /再灌注 (Ｉ/Ｒ)损伤中通过清除自由基减轻心肌细胞损伤 ,同时ＭＴ参与预缺血保护 (ＩＰＣ)。目前对ＭＴ在ＩＰＣ中的保护作用机制及功效仍无明确研究 ,本实验以培养的乳鼠心肌细胞缺氧 /复氧模拟缺血 /再灌注损伤 ,检测心肌细胞在ＩＰＣ处理后 2 4ｈＭＴ的含量、脂质过氧化程度及Ｎａ Ｋ ＡＴＰ酶、Ｃａ2 Ｍｇ2 ＡＴＰ酶的活力变化 ,锌诱导产生的ＭＴ作用 ,并比较ＭＴ与抗氧化剂谷胱甘肽 (ＧＳＨ)的保护作用 ,初步探讨ＭＴ的心肌保护作用机制及应用价值。1　…     

骨骼肌和心肌缺血后处理对兔缺血/再灌注心肌的保护作用

目的:观察骨骼肌缺血后处理(RPostC)、心肌的缺血后处理(MPostC)对缺血/再灌注心肌保护作用是否存在差异以及两者联合后作用是否叠加。方法:健康新西兰大白兔3O只,随机分为5组(n=6):缺血对照组(Con)、假手术组(sham)、心肌缺血后处理组(MPostC)和肢体缺血后处理组(RPostC)及心肌缺血后处理联合肢体缺血后处理组(MPostC+RPostC)。采用开胸结扎冠状动脉左室支45 min,再灌注120min方法制作缺血/再灌注模型,采用短暂结扎双侧髂外动脉固定部位5 min造成骨骼肌短暂缺血。以Evans蓝标记心肌缺血区范围,以TTC法检测梗死心肌范围,并分别于缺血前、后及再灌注1、2 h测定血浆磷酸肌酸激酶(CPK)活性和乳酸脱氢酶(LDH)含量。结果:和Con组相比,MPostC和RPostC组心肌梗死范围均明显降低(P<0.05);MPostC联合RPostC组心肌梗死范围与MPostC或RPostC组相比,均进一步降低(均P<0.05)。但MPostC组及RPostC组之间心肌坏死范围未见统计学差异。再灌注120 min末血浆CPK活性及LDH含量也显示相似趋势。结论:骨骼肌缺血后处理及心肌后处理对缺血/再灌注心肌均具有明显保护作用;且两者作用可以叠加;但骨骼肌和心肌后处理之间保护作用未显示统计学差异。     

肾神经在肾缺血预处理对麻醉家兔心脏保护中的作用

在氨基甲酸乙酯麻醉家兔上,观察肾脏缺血预处理(RIP)对缺血-再灌注心肌的影响,旨在证实RIP对心肌有无保护效应,并明确肾神经在其中的作用。所得结果如下(1)在心脏45min缺血和180min再灌注过程中,血压、心率和心肌耗氧量呈进行性下降;心外膜电图ST段在缺血期明显抬高,再灌注过程中逐渐恢复到基础对照值。心肌梗塞范围占缺血心肌的55.80±1.25%。(2)RIP时心肌梗塞范围为36.51±2.8%,较单纯心肌缺血-再灌注显著减少(P<0.01),表明RIP对心肌有保护作用。(3)肾神经切断可取消RIP对心肌的保护效应,但肾神经切断本身对单纯缺血-再灌注所致的心肌梗死范围无明显影响。(4)肾缺血(10min)时,肾传入神经放电活动由0.14±0.08增至0.65±0.12imp/s(P<0.01)。(5)预先应用腺苷受体拮抗剂8-苯茶碱可明显减弱肾缺血所激活的肾传入神经活动,提示肾传入活动的增强是由肾缺血产生的腺苷所介导。以上结果表明,肾短暂缺血-再灌注所诱发的肾神经传入活动在RIP心肌保护效应中起重要作用。     

大鼠肢体预缺血减小心肌缺血-再灌注后的梗塞范围

在氨基甲酸乙酯麻醉大鼠上观察肢体预缺血(limb ischemic preconditioning,LIP)对缺血-再灌注(ischemia—reperfusion,IR)心肌的影响,旨在探讨LIP对IR心肌有无保护效应,并明确腺苷和神经通路是否参与此效应。所得结果如下:(1)在心脏缺血30 min和再灌注120 min过程中,梗塞心肌占缺血心肌的51.48±0.82％。(2)LIP时心肌梗塞范围为35.14±0.88％,较单纯心肌缺血-再灌注时显著减小(P<0.01),表明LIP对心肌有保护作用。(3)事先切断股神经可取消LIP的保护效应。(4)股动脉内局部给予腺苷(10nmol/kg),可模拟LIP对心肌的保护作用;心肌梗塞范围是37.28±1.68％,而股静脉内注射同等剂量腺苷则无保护作用。(5)股动脉内预先应用腺苷A.受体拈抗剂8-环戊-1,3-二丙基嘌呤(DPCPX)(32 nmol/kg)可部分阻断LIP诱发的心肌保护效应。以上结果表明,肢体短暂预缺血可减小心肌缺血-再灌注后的梗塞范围,而局部释放的腺苷和由此所激活的相关的神经通路在LIP的心肌保护中起重要作用。     

Hypoxic preconditioning

A concept of tissue-cell adaptation to hypoxia (hypoxic preconditioning) is raised and its corresponding animal model is introduced. A significantly strengthened tolerance to hypoxia and a protective effect of the brain extracts from the preconditioned animals are presented. Changes in animals' behavior, neuromorphology, neurophysiology, neurochemistry and molecular neurobiology during preconditioning are described. Energy saving, hypometabolism, and cerebral protection in particular are thought to be involved in the development of hypoxic tolerance and tissue-cell protection. The essence and significance of the hypoxic tissue-cell adaptation or preconditioning are discussed in terms of biological evolution and practical implication.     

Non-ischemic myocardial preconditioning

The reduction of infarct size produced by brief ischemic episodes prior to a sustained occlusion of a coronary artery, called ischemic preconditioning, is a well known phenomenon that occurs in several species, but its mechanism is still under investigation. Recent reports support the idea that this protection can also be obtained by non-ischemic maneuvers like distention of the left ventricle and metabolic stimulation of myocardial cells. The features of non-ischemic preconditioning (temporal limitation, second window, tolerance development, remote preconditioning and efficiency of the protection), as opposed to those of ischemic preconditioning, are still to be determined. Neither is it known if non-ischemic preconditioning occurs in humans. From a physiological point of view the protective effect of an increase in metabolic rate of the heart means a constant feed-back mechanism in the myocardial cell that counteracts the presumptive damage consequent to the increase in metabolism. Therefore, in the presence of a sudden coronary occlusion the metabolic rate of the heart immediately before the occlusion would have a dual role of increasing the degree of ischemia and of protecting against it.     

Molecular mechanism of preconditioning

During the last 20 years, since the appearance of the first publication on ischemic preconditioning (PC), our knowledge of this phenomenon has increased exponentially. PC is defined as an increased tolerance to ischemia and reperfusion induced by previous sublethal period ischemia. This is the most powerful mechanism known to date for limiting the infract size. This adaptation occurs in a biphasic pattern (i) early preconditioning (lasts for 2-3 h) and (ii) late preconditioning (starting at 24 h lasting until 72-96 h after initial ischemia). Early preconditioning is more potent than delayed preconditioning in reducing infract size. Late preconditioning attenuates myocardial stunning and requires genomic activation with de novo protein synthesis. Early preconditioning depends on adenosine, opioids and to a lesser degree, on bradykinin and prostaglandins, released during ischemia. These molecules activate G-protein-coupled receptor, initiate activation of K(ATP) channel and generate oxygen-free radicals, and stimulate a series of protein kinases, which include protein kinase C, tyrosine kinase, and members of MAP kinase family. Late preconditioning is triggered by a similar sequence of events, but in addition essentially depends on newly synthesized proteins, which comprise iNOS, COX-2, manganese superoxide dismutase, and possibly heat shock proteins. The final mechanism of PC is still not very clear. The present review focuses on the possible role signaling molecules that regulate cardiomyocyte life and death during ischemia and reperfusion.     

Angiotensin preconditioning of the heart

Angiotensin II (Ang II) has been found to exert preconditioning-like effect on mammalian hearts. Diverse mechanisms are known to exist to explain the cardioprotective abilities of Ang II preconditioning. The present study hypothesized, based on the recent report that Ang II generates reactive oxygen species (ROS) through NADPH oxidase, that Ang II preconditioning occurs through redox cycling. To test this hypothesis, a group of rat hearts was treated with Ang II in the absence or presence of an NADPH oxidase inhibitor, apocynin; or a cell-permeable ROS scavenger, N-acetyl cysteine (NAC). Ang II pretreatment improved postischemic ventricular recovery; reduced myocardial infarction; and decreased the number of cardiomyocyte apoptosis, indicating its ability to precondition the heart against ischemic injury. Both apocynin and NAC almost abolished the preconditioning ability of Ang II. Ang II resulted in increase in ROS activity in the heart, which was reduced by either NAC or apocynin. Ang II also increased both the NADPH oxidase subunits gp91 phox and p22phox mRNA expression, which was abolished with apocynin and NAC. Our results thus demonstrate that the Ang II preconditioning was associated with enhanced ROS activities and increased NADPH oxidase subunits p22phox and gp91phox expression. Both NAC and apocynin reduced ROS activities simultaneously abolishing preconditioning ability of Ang II, suggesting that Ang II preconditioning occurs through redox cycling. That both NAC and apocynin reduced ROS activities and abolished Ang II-mediated increase in p22phox and gp91phox activity further suggest that such redox cycling occurs via both NADPH oxidase-dependent and -independent pathways.     

SAPKs regulation of ischemic preconditioning

The role of stress-activated protein kinases (SAPKs), c-Jun NH(2)-terminal kinase (JNK) and p38 mitogen-activated protein (MAP) kinase, in preconditioning (PC) was examined with the use of isolated rat hearts subjected to four cyclic episodes of 5-min ischemia and 10-min reperfusion followed by 30-min ischemia and 2-h reperfusion (I/R). A group of hearts was preperfused with 100 microM curcumin, a c-Jun and JNK1 inhibitor, or 5 microM SB 203580, a p38 MAP kinase inhibitor. Another group of hearts was preperfused with 20 microM anisomycin, a stimulator for both JNK and p38 MAP kinases. I/R increased the protein levels of JNK1, c-Jun, and p38 MAP kinase. PC also enhanced the induction of these kinases, but subsequent I/R-mediated increase was blocked by PC. Curcumin blocked I/R- and PC-mediated increase in JNK1 and c-Jun protein levels, whereas it had no effects on p38 MAP kinase. SB 203580, on the other hand, was equally effective in reducing the p38 MAP kinase activation but exerted no effects on JNK1 and c-Jun induction. I/R-mediated increased myocardial infarction was reduced by any of the following compounds: anisomycin, curcumin, and SB 203580. The cardioprotective effects of PC were abolished by either curcumin or SB 203580. The results demonstrate that PC is mediated by a signal-transduction pathway involving both JNK1 and p38 MAP kinase. Activation of SAPKs, although transient, is obligatory for PC.     

低氧预适应的脑机制

A concept ot tissue adaptation to hypoxia( i.e. hypoxic preconditioning) was developed and its corresponding animal models were reproduced in 1966s. The methods of model reproduction in rat, rabbit, and mouse in particular and the main results are brifly introduced in this review. The tolerance to hypoxia o{ preconditioned animals is significantly increased. Regular changes in animals‘ behavior, neurophysiology, respiratory and circulatory physiology, neuromorphology in vivo and {unction of brain and spinal cord in vitro are briefly demonstrated. The protective effects in vivo and in vitro of homogenate extract taken from the brain o{ preconditioned animals, neurochemcals and molecular neurobiolcgical alterations are briefly presented. The essence and significance of tissue adaption to hypoxia/hypoxic preconditioning are discussed in the review in terms of evolution and practical implication.     

In vivo stress preconditioning

The heat shock or stress protein response is a highly conserved defense mechanism. Activation of the stress protein response by mild hyperthermia or by pharmacological agents allows cells to withstand a subsequent metabolic insult that would otherwise be lethal, a phenomenon referred as "thermotolerance" or "preconditioning." Heat shock response is characterized by increased expression of stress proteins that provide cellular protection, e.g., via increased chaperoning activity in all organisms, from bacteria to animals and humans. Indeed, there is experimental evidence that overexpression of specific heat shock proteins or heat shock factors produce protective effects similar to those observed after stress preconditioning. The purpose of this review is first to discuss the methods used to induce in vivo thermotolerance with mild hyperthermia or pharmacological agents. Then, as an example of the organ protection provided by in vivo stress preconditioning, the second part of this paper will examine how the induction of thermotolerance modulates the lung inflammatory response associated with acute lung injury, thus providing broad organ and tissue protection against oxidative stress associated this syndrome.     

阿片样物质与心脏缺血预处理

阿片肽和外源性阿片术物质如吗啡除了能缓解心肌梗塞造成的疼痛外,还具有减小梗塞范围和降低心律失常的发生等重要作用。心脏阿片受体参与了缺血预处理（IPC）对心脏的调节作用,阿片样物质激活心脏阿片受体还可模拟IPC对心脏的作用。心脏阿片受体的激活产生的急性即第一窗口期和延迟即第二窗口期的心脏保护作用的信号途径,与IPC相似,其信号通路涉及Gi/Go蛋白、蛋白激酶C、酪氨酸激酶和ATP敏感K^ 通道等途径。     

Postischemic anti-inflammatory effects of bradykinin preconditioning

We sought to determine the mechanisms whereby brief administration of bradykinin (bradykinin preconditioning, BK-PC) before prolonged ischemia followed by reperfusion (I/R) prevents postischemic microvascular dysfunction. Intravital videomicroscopic approaches were used to quantify I/R-induced leukocyte/endothelial cell adhesive interactions and microvascular barrier disruption in single postcapillary venules of the rat mesentery. I/R increased the number of rolling, adherent, and emigrated leukocytes and enhanced venular albumin leakage, effects that were prevented by BK-PC. The anti-inflammatory effects of BK-PC were largely prevented by concomitant administration of a B(2)-receptor antagonist but not by coincident B(1) receptor blockade, nitric oxide (NO) synthase inhibition, or cyclooxygenase blockade. However, NO synthase blockade during reperfusion after prolonged ischemia was effective in attenuating the anti-inflammatory effects of BK-PC. Pan protein kinase C (PKC) inhibition antagonized the beneficial effects of BK-PC but only when administered during prolonged ischemia. In contrast, specific inhibition of the conventional PKC isotypes failed to alter the effectiveness of BK-PC. These results indicate that bradykinin can be used to pharmacologically precondition single mesenteric postcapillary venules to resist I/R-induced leukocyte recruitment and microvascular barrier dysfunction by a mechanism that involves B(2) receptor-dependent activation of nonconventional PKC isotypes and subsequent formation of NO.