MicroRNA对缺血再灌注损伤的调控作用

MicroRNA(miRNA)是一类小的(~20个核苷酸)、非编码的单链RNA分子,能够负调控基因表达,涉及多种信号途径和病理生理过程。缺血再灌注损伤(ischemia reperfusion injury,IRI)指组织器官缺血后重新获得血液的再灌注过程,灌注后组织、器官功能不能恢复,造成功能障碍和结构损伤的现象。IRI是影响多个组织与器官复杂的、系统的生理病理过程,并能够产生很多不可逆的损伤,导致级联的多器官功能障碍。现已发现多种miRNA在组织器官IRI中发生明显的变化,表明miRNA能够直接或者间接影响组织器官IRI。本文综述了miRNA的靶基因以及在心、脑、肝和肾IRI中的调控作用。miRNA不仅参与了器官IR损伤的病理生理过程,而且作为IR损伤的特定标志物在临床诊断和干预治疗中具有广阔的前景。     

基质金属蛋白酶在心肌缺血再灌注损伤中的作用

肌缺血再灌注损伤是指缺血心肌组织在恢复血流供给后,其细胞代谢功能障碍及结构破坏反而加重的现象,主要表现在心肌收缩与舒张功能障碍、血管内皮功能障碍、微循环血流紊乱、细胞代谢失调、电解质平衡紊乱、细胞凋亡与坏死等,并伴随着氧自由基的大量产生和毒性损伤以及炎症反应的激活,是一个极其复杂的病理过程。基质金属蛋白酶（MMPs）及其组织抑制物（TIMPs）是心肌组织中多种细胞分泌的内源性细胞因子,其作用涵盖了细胞外基质降解、炎症反应激活、调节血管功能、影响细胞凋亡与存活等众多病理生理过程,而这些过程均在心肌缺血再灌注损伤中发挥着重要的作用。     

PPARγ在器官缺血再灌注损伤中的保护作用及机制

PPARγ为过氧化物酶体增殖物激活受体超家族中的一个亚型,在全身各组织均有表达。PPARγ已被证实广泛介入了机体脂肪组织的发育分化、全身糖脂代谢调控及抗炎反应等过程。缺血再灌注损伤是组织器官缺血缺氧后,血流重新恢复对组织器官造成的损伤,常继发于创伤、外科手术及休克等过程。近年来,有研究显示PPARγ在多种器官的缺血再灌注损伤过程中起保护作用。本文对PPARγ激活或抑制在多种常见器官缺血再灌注损伤中的作用及机制进行简要讨论与总结。     

富氢盐水对缺血再灌注损伤保护作用的研究进展

缺血是临床疾病中最常见原因之一,缺血再灌注损伤是脑缺血等器官缺血最重要病理生理过程,缺血性疾病通常可在早期采用溶栓和抗自由基损伤等技术来防治。氢气目前仅作为保健品使用,尚未应用于临床,富氢盐水作为一种含氢注射液,能够减少缺血再灌注损伤,减轻炎性反应,抑制细胞凋亡,减少氧化应激,从而对器官起到明确的保护作用。缺血再灌注损伤在临床发生率极高,富氢盐水作为一种能够普及、应用方便的保护剂,具有广大的应用前景。富氢盐水用于防治缺血再灌注导致的组织损伤和器官功能障碍的可能机制为降低氧化应激、减少细胞凋亡和抑制炎性因子上调。     

Kupffer细胞在肝移植后缺血再灌注损伤的作用及研究现状

缺血再灌注损伤(ischemia reperfusion injury,IRI)是肝脏手术过程中常见的并发症之一,也是肝移植后肝脏主要发生的病理生理过程。肝移植后IRI主要包括肝脏局部缺血性损伤和炎症介导的再灌注损伤两个相互关联的过程。缺氧以及再灌注过程中缺少生物刺激因子使得再灌注组织缺乏氧供被认为是这两个不同阶段主要损伤机制,并相互促进缺血及再灌注损伤的发展。Kupffer细胞(kupffer cells,KCs)是肝脏常驻巨噬细胞,被认为在缺血期由病原体相关分子受体激活的,通过不同的信号传导通路产生氧化应激和促炎因子如肿瘤坏死因α、白介素1β,白介素12等发挥作用。KCs是调节肝脏缺血再灌注损伤机制中固有免疫和适应性免疫交叉作用网络的关键因素。     

胆红素对大鼠肺脏缺血再灌注损伤保护作用的研究

目的探讨胆红素对实验性大鼠肺缺血再灌注损伤的保护作用并探讨其发生的机制。方法60只健康Wistar大鼠随机分为3组：手术对照（C）组,缺血再灌注（IR）组,胆红素干预（B）组。每组分别于缺血第45min、再灌注30min、60min、120min4个时点,经左房放血处死大鼠,观察肺组织病理形态变化,检测血浆丙二醛（MDA）、超氧化物歧化酶（SOD）的含量,测定肺组织干/湿重（D/W）比值,TUNEL法测定肺组织中细胞凋亡指数（AI）。结果①肺组织病理变化：缺血再灌注后IR组肺组织损伤进行性加重,毛细血管充血、肺泡间隔炎性细胞浸润、肺泡腔内炎性细胞及炎性液体渗出显著,B组肺组织充血、水肿、炎性细胞浸润较IR组减轻。②血浆MDA含量：IR组在缺血再灌注后血浆MDA含量明显增加,较C组和B组同时点均显著增高（P〈0.01）,而B组的MDA含量在缺血再灌注过程中的变化无显著性意义;③血浆SOD含量：经缺血再灌注后,IR和B组血浆SOD含量较C组同时点均显著下降（P〈0.05）,B组减少的程度明显小于IR组（P〈0.05）;④肺组织D/W比值：经缺血和再灌注后,IR组和B组的肺组织D/W比值都呈进行性下降（再灌注60、120minvs缺血45min,P〈0.01）;B组下降幅度明显小于IR组（再灌注60、120min时,B组vsIR组,P〈0.05）;⑤肺组织细胞AI的变化：IR组及B组缺血再灌注后均可见肺组织细胞凋亡现象,但与IR组相比,B组相同时点的肺组织细胞凋亡数显著减少（P〈0.05）;结论胆红素对于实验性大鼠肺脏缺血再灌注损伤具有一定的保护作用,其作用机制与清除氧自由基、抗氧化及抗细胞凋亡有关。     

肌肽抗全身性缺血／再灌注损伤的防治作用

临床上器官移植、溶栓治疗、冠脉血管成形等治疗导致的缺血-再灌注损伤（ischemia-reperfusion injury,IRI）尚没有理想的治疗药物。肌肽（carnosine）在体内具有抗氧化、保护膜完整性、鏊合金属离子、质子缓冲、调节巨噬细胞功能等作用,能有效地减轻氧化应激导致的细胞损伤及IRI导致的脑、心、肾等器官组织损伤和功能障碍,因此,肌肽被认为是具有前景的抗IRI药物,值得通过动物实验及临床实验进一步研究探讨。     

长链非编码 RNA 在心肌生理和病理生理功能调控中的作用

长链非编码RNA(long non-coding RNA,lncRNA)是一组超过200个核苷酸的非编码转录RNA,能与DNA或RNA、miRNA结合位点和启动子的靶碱基结合,改变基因表达,或者直接调节蛋白功能,参与胚胎发生发育、器官功能稳态维持以及疾病发生发展等多种生理和病理过程。近年多项研究结果表明,lncRNA不但在生理性心脏发生发育、心脏各类型细胞分化和转化过程发挥重要作用,而且在心脏疾病,如心肌肥厚、心力衰竭、心肌梗死和心脏缺血再灌注损伤等病理性疾病中,表达谱发生动态改变。     

长链非编码RNA在心肌生理和病理生理功能调控中的作用北大核心CSCD

长链非编码RNA(long non-coding RNA,lncRNA)是一组超过200个核苷酸的非编码转录RNA,能与DNA或RNA、miRNA结合位点和启动子的靶碱基结合,改变基因表达,或者直接调节蛋白功能,参与胚胎发生发育、器官功能稳态维持以及疾病发生发展等多种生理和病理过程。近年多项研究结果表明,lncRNA不但在生理性心脏发生发育、心脏各类型细胞分化和转化过程发挥重要作用,而且在心脏疾病,如心肌肥厚、心力衰竭、心肌梗死和心脏缺血再灌注损伤等病理性疾病中,表达谱发生动态改变。     

基质金属蛋白酶在心肌缺血再灌注损伤中的作用

肌缺血再灌注损伤是指缺血心肌组织在恢复血流供给后,其细胞代谢功能障碍及结构破坏反而加重的现象,主要表现在心肌收缩与舒张功能障碍、血管内皮功能障碍、微循环血流紊乱、细胞代谢失调、电解质平衡紊乱、细胞凋亡与坏死等,并伴随着氧自由基的大量产生和毒性损伤以及炎症反应的激活,是一个极其复杂的病理过程。基质金属蛋白酶(MMPs)及其组织抑制物(TIMPs)是心肌组织中多种细胞分泌的内源性细胞因子,其作用涵盖了细胞外基质降解、炎症反应激活、调节血管功能、影响细胞凋亡与存活等众多病理生理过程,而这些过程均在心肌缺血再灌注损伤中发挥着重要的作用。     

Biliverdin Protects against Liver Ischemia Reperfusion Injury in Swine

Ischemia reperfusion injury (IRI) in organ transplantation remains a serious and unsolved problem. Organs that undergo significant damage during IRI, function less well immediately after reperfusion and tend to have more problems at later times when rejection can occur. Biliverdin has emerged as an agent that potently suppress IRI in rodent models. Since the use of biliverdin is being developed as a potential therapeutic modality for humans, we tested the efficacy for its effects on IRI of the liver in swine, an accepted and relevant pre-clinical animal model. Administration of biliverdin resulted in rapid appearance of bilirubin in the serum and significantly suppressed IRI-induced liver dysfunction as measured by multiple parameters including urea and ammonia clearance, neutrophil infiltration and tissue histopathology including hepatocyte cell death. Taken together, our findings, in a large animal model, provide strong support for the continued evaluation of biliverdin as a potential therapeutic in the clinical setting of transplantation of the liver and perhaps other organs.     

Low‐energy shock wave pretreatment recruit circulating endothelial progenitor cells to attenuate renal ischaemia reperfusion injury

Low‐energy shock wave (LESW) has been recognized as a promising non‐invasive intervention to prevent the organs or tissues against ischaemia reperfusion injury (IRI), whereas its effect on kidney injury is rarely explored. To investigate the protective role of pretreatment with LESW on renal IRI in rats, animals were randomly divided into Sham, LESW, IRI and LESW + IRI groups. At 4, 12, 24 hours and 3 and 7 days after reperfusion, serum samples and renal tissues were harvested for performing the analysis of renal function, histopathology, immunohistochemistry, flow cytometry and Western blot, as well as enzyme‐linked immunosorbent assay. Moreover, circulating endothelial progenitor cells (EPCs) were isolated, labelled with fluorescent dye and injected by tail vein. The fluorescent signals of EPCs were detected using fluorescence microscope and in vivo imaging system to track the distribution of injected circulating EPCs. Results showed that pretreatment with LESW could significantly reduce kidney injury biomarkers, tubular damage, and cell apoptosis, and promote cell proliferation and vascularization in IRI kidneys. The renoprotective role of LESW pretreatment would be attributed to the remarkably increased EPCs in the treated kidneys, part of which were recruited from circulation through SDF‐1/CXCR7 pathway. In conclusion, pretreatment with LESW could increase the recruitment of circulating EPCs to attenuate and repair renal IRI.     

The challenge of translating ischemic conditioning from animal models to humans: the role of comorbidities

Following a period of ischemia (local restriction of blood supply to a tissue), the restoration of blood supply to the affected area causes significant tissue damage. This is known as ischemia-reperfusion injury (IRI) and is a central pathological mechanism contributing to many common disease states. The medical complications caused by IRI in individuals with cerebrovascular or heart disease are a leading cause of death in developed countries. IRI is also of crucial importance in fields as diverse as solid organ transplantation, acute kidney injury and following major surgery, where post-operative organ dysfunction is a major cause of morbidity and mortality. Given its clinical impact, novel interventions are urgently needed to minimize the effects of IRI, not least to save lives but also to reduce healthcare costs. In this Review, we examine the experimental technique of ischemic conditioning, which entails exposing organs or tissues to brief sub-lethal episodes of ischemia and reperfusion, before, during or after a lethal ischemic insult. This approach has been found to confer profound tissue protection against IRI. We discuss the translation of ischemic conditioning strategies from bench to bedside, and highlight where transition into human clinical studies has been less successful than in animal models, reviewing potential reasons for this. We explore the challenges that preclude more extensive clinical translation of these strategies and emphasize the role that underlying comorbidities have in altering the efficacy of these strategies in improving patient outcomes.KEY WORDS: Comorbidities, Ischemic postconditioning, Ischemic preconditioning, Remote ischemic preconditioning     

巨噬细胞亚型转变在大鼠肾脏缺血/再灌注损伤中的作用

目的：探讨巨噬细胞在大鼠肾脏缺血/再灌注损伤过程中的亚型转变及意义。方法：将30只雄性SD大鼠随机分成假手术组（Sham,n=6）和缺血/再灌组（IRI,夹闭肾动脉45 min,n=24）。IRI组分别于术后0、6、24和72 h取肾组织,每个时相组6只大鼠。用HE染色观察肾组织损伤程度;免疫组化染色检测细胞增殖核抗原（PCNA）的表达;实时定量RT-PCR检测巨噬细胞移动抑制因子（MIF） mRNA的表达;免疫组织荧光染色检测MIF、单核巨噬细胞趋化蛋白-1（MCP-1）以及活化巨噬细胞标志物CD68的表达,流式细胞分析检测巨噬细胞M1和M2亚型的分布特征。结果：病理结果显示大鼠肾局部损伤情况和炎症细胞浸润程度在24 h时最为严重,之后逐渐恢复。PCNA在再灌后表达明显增加,6 h达峰值,72 h表达下降。相比于正常组,再灌组大鼠肾组织中MIF的mRNA和蛋白表达明显升高;MCP-1表达则在6 h达峰值,随后下降;而CD68阳性的巨噬细胞数量明显增加,24 h达峰值,72 h表达下降。更进一步研究发现缺血/再灌注6 h时,M1亚型分布达最高值;之后随着缺血/再灌注时间延长,M1亚群相对含量开始下调,M2随之升高。结论：在肾脏缺血/再灌注早期,M1巨噬细胞介导的组织损伤发挥主要作用,随后M2型表达逐渐上调,并通过促进细胞增殖修复肾组织损伤。     

NOD1 activates autophagy to aggravate hepatic ischemia-reperfusion injury in mice

Hepatic ischemia/reperfusion injury (IRI) is tissue damage resulting from return of the blood supply to the tissue after a period of ischemia or lack of oxygen. Much of the morbidity associated with liver transplantation and major hepatic resections is, in part, due to IRI. Both innate immunity and autophagy play important roles in hepatic IRI. With regard to innate immunity, one factor that plays a key role is NOD1, an intracellular pattern recognition receptor. NOD1 has recently been shown to be associated with autophagy, but the mechanisms involved with this process remain obscure. This relationship between NOD1 and autophagy prompted us to examine the role and potential mechanisms of NOD1 in regulating autophagy as related to hepatic IRI. We found that NOD1 was upregulated during hepatic IRI and was associated with an activation of the autophagic signaling pathway. Moreover, levels of Atg5, a critical protein associated with autophagy, were decreased when NOD1 was inhibited by NOD1 small interfering RNA. We conclude that NOD1 appears to exert a pivotal role in hepatic IRI by activating autophagy to aggravate hepatic IRI, and Atg5 was required for this process. The identification of this novel pathway, that links expression levels of NOD1 with Atg5-mediated autophagy, may provide new insights for the generation of novel protective therapies directed against hepatic IRI.     

Impact of Ginkgo Biloba Extract EGb 761 on ischemia/reperfusion - induced oxidative stress products formation in rat forebrain

Dysbalance in reactive oxygen/nitrogen species is involved in the pathogenesis of cerebral ischemia/reperfusion injury (IRI). Ginkgo biloba extract (Egb 761) pre-treatment was used to observe potential antioxidant/neuroprotective effect after global ischemia/reperfusion. Egb 761 significantly decreased the level of lipoperoxidation (LPO) in rat forebrain total membrane fraction (homogenate) induced by in vitro oxidative stress (Fe(2+)+H(2)O(2)). In animals subjected to four-vessel global ischemia for 15 min and 2-24 h reperfusion the EGb pretreatment slightly decreased LPO in forebrain homogenate. However, as detected in EGb treated group, the LPO-induced lysine conjugates are attenuated in comparison to non-treated IRI animals. EGb significantly improved parameters which indicate forebrain protein oxidative damage after IRI. The intensity of tryptophane fluorescence was increased by the 18.2% comparing to non-treated IRI group and bityrosine fluorescence was significantly decreased in ischemic (21%) and 24 h reperfused (15.9%) group in comparison non-treated IRI group. In addition, the level of total free SH- groups in pre-treated animals was significantly higher comparing to non-treated animals. Our results indicate that extract of EGb 761 has potent antioxidant activity and could play a role to attenuate the IRI-induced oxidative protein modification and lipoperoxidation in the neuroprotective process.     

Melatonin and its protective role in attenuating warm or cold hepatic ischaemia/reperfusion injury

Although the liver is the only organ with regenerative capacity, various injury factors induce irreversible liver dysfunction and end‐stage liver disease. Liver resection and liver transplantation (LT) are effective treatments for individuals with liver failure, liver cirrhosis and liver cancers. The remnant or transplanted liver tissues will undergo hepatic ischaemia/reperfusion (IR), which leads to oxidative stress, inflammation, immune injury and liver damage. Moreover, systemic ischaemia induced by trauma, stroke, myocardial ischaemia, haemorrhagic shock and other injury factors also induces liver ischaemia/reperfusion injury (IRI) in individuals. Hepatic IRI can be divided into warm IRI, which is induced by liver surgery and systemic ischaemia, and cold IRI, which is induced by LT. Multiple studies have shown that melatonin (MT) acts as an endogenous free radical scavenger with antioxidant capacity and is also able to attenuate hepatic IRI via its anti‐inflammatory and antiapoptotic capacities. In this review, we discuss the potential mechanisms and current strategies of MT administration in liver surgery for protecting against warm or cold hepatic IRI. We highlight strategies to improve the efficacy and safety of MT for attenuating hepatic IRI in different conditions. After the potential mechanisms underlying the interactions between MT and other important cellular processes during hepatic IR are clarified, more opportunities will be available to use MT to treat liver diseases in the future.     

BMAL1 regulates mitochondrial homeostasis in renal ischaemia‐reperfusion injury by mediating the SIRT1/PGC‐1α axis

The regulation of renal function by circadian gene BMAL1 has been recently recognized; however, the role and mechanism of BMAL1 in renal ischaemia‐reperfusion injury (IRI) are still unknown. The purpose of this study was to clarify the pathophysiological role of BMAL1 in renal IRI. We measured the levels of BMAL1 and mitochondrial biogenesis‐related proteins, including SIRT1, PGC‐1α, NRF1 and TFAM, in rats with renal IRI. In rats, the level of BMAL1 decreased significantly, resulting in inhibition of SIRT1 expression and mitochondrial biogenesis. In addition, under hypoxia and reoxygenation (H/R) stimulation, BMAL1 knockdown decreased the level of SIRT1 and exacerbated the degree of mitochondrial damage and apoptosis. Overexpression of BMAL1 alleviated H/R‐induced injury. Furthermore, application of the SIRT1 inhibitor EX527 not only reduced the activities of SIRT1 and PGC‐1α but also further aggravated mitochondrial dysfunction and partially reversed the protective effect of BMAL1 overexpression. Moreover, whether in vivo or in vitro, the application of SIRT1 agonist resveratrol rescued the mitochondrial dysfunction caused by H/R or IRI by activating mitochondrial biogenesis. These results indicate that BMAL1 is a key circadian gene that mediates mitochondrial homeostasis in renal IRI through the SIRT1/PGC‐1α axis, which provides a new direction for targeted therapy for renal IRI.