缺血预处理合并低温及晶体停搏液对兔未成熟心肌的保护作用

本文拟探讨缺血预处理(ischemic preconditioning,IP)合并低温及晶体停搏液对幼兔的离体心脏是否具有心肌保护作用.采用Langendorff离体心脏灌注模型,灌注液为Krebs-Henseleit液(K-H液).取3～4周龄幼兔心脏,在第一部分实验中分为Con、IP1、IP2、IP3组(n=6),分别给予0、1、2、3次IP,其后各组心脏均在20℃低温下停灌2 h,37℃常温下再灌注30 min.在第二部分实验中分为SConI、SCon2、SCon3、SIPl、SIP2、SIP3组(n=8),其中SIPl、SIP2、SIP3组给予2次IP后灌注St.Tho-mas Ⅱ晶体停搏液(CCS)使心脏停搏,然后分别使心脏在32℃、25℃、20℃下停灌30、90和120min,其后各组均在37℃再灌注30 min.SConl,SCon2,SCon3三组则不给予IP,继续灌注20min后灌注CCS使心脏停搏,然后分别在32℃、25℃、20℃下停灌30、90和120 min,其后各组均在37℃再灌注30 min.以Maclab/4 s生理实验系统记录平衡末、缺血前、再灌注后1、3、5、10、20、30 min时心率(HR)、左心室发展压(LVDP)以及左心室内压上升及下降最大速率(±dp/dtmax),测定再灌注末心肌组织中ATP和丙二醛(MDA)的含量,以及超氧化物歧化酶(SOD)的活性.在20℃低温停灌且停灌期间不给予CCS时,再灌注末IP2组LVDP×HR、+dp/dtmax和-dp/dtmax的恢复率分别为96%±21%、101%±19%和84%±15%,显著高于Con组和IP3组(P＜0.01,P＜0.05);心肌组织的ATP含量亦高于Con组(P＜0.01).在不同低温停灌且停灌期间给予CCS时,再灌注末SIP1、SIP2组的LVDP×HR、+dp/dtmax分别恢复到87%±14%、99%±26%(P＜0.05,vs SConl group)和87%±16%、102%±20%(P＜0.05,vs SCon2 group);心肌组织的ATP含量均分别显著高于SCon1组和SCon2组(P＜0.05),心肌组织MDA含量亦分别低于SCon1组和SCon2组(P＜0.05).上述结果提示,IP对在20℃低温停灌的兔未成熟心脏具有一定的心肌保护作用,2次IP的保护效应优于1次或3次IP.在停灌期间应用CCS,IP的心肌保护作用随停灌期间低温程度的升高而减弱.     

内源性阿片物质参与大鼠缺血预处理的心肌保护作用

实验以离体灌流的ＳＤ大鼠心脏为模型,用ｋ特异性拮抗剂的ＭＲ２２６６研究ｋ阿片受体的阻断与缺血预处理的关系,用放射免疫分析法研究ＩＰ及长时间缺血对心肌强啡肽Ａ１－１３浓度的影响,探索Ｋ阿片物质在ＩＰ过程中的作用和地位。     

缺血-再灌注损伤防治的新方法——缺血后处理的研究现状

缺血后处理(ischemic postconditioning,I-postC)是近年发现的一种重要内源性保护机制,即长时间缺血后再灌注前短时间内反复短暂再缺血处理,可明显减轻缺血组织的缺血-再灌注(ische-mia/reperfusion,I/R)损伤。I-postC可在组织器官缺血事件发生之后实施,因而具有更广阔的临床应用前景,本文对I-postC实施方法、保护作用及机制研究的现状作一总结。     

缺血（氧）预处理的普遍性及临床应用前景

预处理是机体抵抗缺血再灌注损伤的一种内源性保护现象,已在多种属动物心脏上得到证实。本文着重就心脏以外其他组织器官和细胞的预处理保护作用及预处理的临床应用前景进行综述。     

蛋白激酶C与缺血预处理心肌保护作用

蛋白激酶Ｃ（ＰＫＣ）是心肌细胞磷脂酰肌醇信号转导系统的重要组成部分,ＰＫＣ在缺血预处理（ＩＰ）过程中的移位和激活在ＩＰ的心肌保护中发挥了关键的作用。ＰＫＣ介导ＩＰ心肌保护作用的机制与其磷酸化底物蛋白有关,包括激活细胞外－５‘－核苷酸酶,激活ＡＴＰ敏感性钾通道以及维持细胞内Ｃａ＾２＋稳态。对ＰＫＣ发挥ＩＰ心肌保护作用机制的探索将为人类心血管疾病的治疗提供新的理论基础和药理手段。     

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。     

缺血预处理及低温对幼兔心肌缺血/再灌注损伤的影响

目的：探讨缺血预处理(ischemic preconditioning,IP)及低温对幼兔心脏缺血／再灌注损伤的影响。方法：采用Langendorff离体心脏灌注模型,取3～4周龄幼兔心脏,分别给予不同次数的IP后使其在20℃低温下缺血或给予同样次数的IP后使其分别在不同低温下缺血。常温再灌注30min。记录心脏缺血／再灌注前后左心室功能指标,测定再灌注末心肌组织中ATP和丙二醛(MDA)含量,超氧化物歧化酶(SOD)及Ca^2 -ATP酶的活性。结果：再灌注末,IP2组左心室各功能指标的恢复率及心肌组织的ATP含量及Ca^2 -ATP酶的活性均显著高于Con组和IP3组;SIP1、SIP2组的左心室各功能指标的恢复率及心肌组织的ATP含量均分别显著高于SConn1组和SCon2组。其心肌组织MDA含量亦分别低于SCon1组和SCon2组。结论：IP可减轻低温缺血的幼兔心肌缺血／再灌注损伤,其效应与IP的次数和低温程度有关。     

心肌缺血预处理与β-肾上腺素受体信号转导系统的研究进展

本文综述了心脏β-肾上腺素受体信号转导系统的生理功能及其各组成部分在心肌内缺血预处理中的作用,为心肌缺血预处理的保护机制提供科学依据。     

缺血预处理对缺血/再灌注离体心脏的保护作用

目的：探讨连续多次短暂缺血预处理对缺血/再灌注损伤心肌的保护作用及机制。方法：采用大鼠离体心脏Lan-gendorff灌流模型,观察缺血预处理对心肌缺血/再灌注后不同时间点冠脉流出液中AST、CPK、UDH及冠脉流量,心肌组织中SOD、LPO以及再灌注性心律失常的影响。结果：缺血预处理可以减少缺血/再灌注损伤的心肌冠脉流出液中AST、CPK、LDH的含量,提高心肌SOD活性,降低LPO水平,并且抑制再灌注性心律失常的发生,提高再灌注期间的冠脉流量。结论：缺血预处理对心肌缺血/再灌注损伤具有一定保护作用。     

缺血预处理对缺血再灌注后兔脊髓磷酸腺苷代谢的影响

目的：研究缺血参处理对缺血再灌注后兔脊髓磷酸腺苷代谢的影响。方法：往置入腹主动脉的Swan-Ganz导管气囊内注气造成兔腰髓缺血模型。将实验兔分为假手术组、缺血组和预处理组。应用反相高效液相色谱方法（reverse phase HPLC),对缺血再灌注后不同时间点腰髓组织中磷酸腺苷（ATP、ADP、AMP）的含量进行检测。结果：和假手术组相比,缺血组兔再灌后各时间点腰髓组织ATP含量有明显下降（P＜0．01）。与缺血组相应时间点相比,预处理组兔再灌注后腰髓组织ATP含量明显提高（P＜0．01）。结论：缺血预处理显著提高缺血再灌注后兔脊髓组织ATP含量,这可能是缺血预处理对脊髓缺血再灌注损伤产生保护作用的机制之一。     

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。     

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.     

Ceramide in the antiapoptotic effect of ischemic preconditioning

Although the mechanism by which ischemic preconditioning (PC) inhibits myocardial apoptosis during ischemia-reperfusion is unclear, evidence indicates a role for the secondary messenger ceramide. We investigated in vivo whether PC may affect ceramide and sn-1,2-diacylglycerol (DAG) production, and attenuate apoptosis during ischemia. Rabbits underwent 30 min of ischemia, followed by 4 h of reperfusion. Before this, they received either no intervention (control group) or one episode of 5 min of ischemia, followed by 5 min of reperfusion (PC group), or an intravenous administration of the sphingomyelinase inhibitor D609. Myocardial content of ceramide and DAG was measured using the DAG kinase assay at different time points of the experiment. Apoptosis was detected and quantified by a sandwich enzyme immunoassay. Both AR and infarct size were measured using blue dye injection and triphenyltetrazolium chloride staining. Control hearts exhibited a peak of ceramide production at 5 min of the prolonged ischemia, with a mean value averaging 64 +/- 5 ng/mg tissue (P < 0.05 vs. 48 +/- 4 ng/mg at baseline). In contrast, ischemic PC and D609 prevented ceramide increase during the prolonged ischemia. Myocardial DAG content was increased only in PC hearts at 30 min of ischemia. Preconditioned and D609 groups developed less apoptosis, as well as a limited infarct size, compared with the control group. These results suggest that the antiapoptotic effect of PC may be due to a reduced ceramide production during sustained ischemia in the rabbit heart.     

全基因组关联研究现状

在过去的5年中, 全基因组关联研究(Genome-wide association study, GWAS)方法已被证明是研究复杂疾病和性状遗传易感变异的一种有效手段。目前, 各国科学家在多种复杂疾病和性状中开展了大量的GWAS, 对肿瘤、糖尿病、心脏病、神经精神疾病、自身免疫及免疫相关疾病等复杂疾病以及一些常见性状(如身高、体重、血脂、色素等)的遗传易感基因研究取得了重大成果。截止到2010年9月11日, 运用GWAS开展了对近200种复杂疾病/性状的研究, 发现了3 000多个疾病相关的遗传变异。文章就GWAS的发展及其在复杂疾病/性状中的应用做一综述。     

Nitric oxide and cerebral ischemic preconditioning

Nitric oxide (NO) is an important mediator of cerebral blood flow and metabolism. As a vasodilator, NO regulates cerebral blood flow, and couples regional brain perfusion with metabolic activity. Following cerebral ischemia, NO levels rise significantly due to activation of neuronal nitric oxide synthase by NMDA receptor mediated calcium entry. Depending on its tissue and enzymatic source, NO may be protective or toxic. This article reviews the effects of NO following cerebral ischemia, the signaling pathways through which NO acts, and its potential roles in cerebral ischemic preconditioning.     

多肽类药物制剂研究现状

多肽类药物制剂研究所面临的主要问题是多肽的不稳定性、体内半衰期短和生物膜透过性差。本文综述了(1)引起多肽不稳定性的原因;(2)提高多肽稳定性的方法;(3)多肽类药物制剂货架时间的确定;(4)多肽类药物的分析手段;(5)多肽类药物的控释研究;(6)多肽的非注射途径给药研究。最后提出了多肽类药物制剂研究的展望。     

Involvement of metallothionein in the protection of lung ischemic preconditioning

The aim of the present study was to investigate whether metallothionein was involved in the protection of lung ischemic preconditioning (IP) against lung ischemia-reperfusion (I/R) injury. Adult male Sprague-Dawley rats were randomly divided into 3 groups based upon the intervention (n=8): control group (C), lung I/R group (I/R), lung I/R+IP group (IP). At the end of the experiment, the content of metallothionein was tested in lung tissue. Blood specimens collected from the arteria carotis were tested for the contents of malondialdehyde (MDA), the activities of superoxide dismutase (SOD) and myeloperoxidase (MPO). The pneumocyte apoptosis index (AI) was determined by terminal deoxynucleotidyl transferase mediated dUTP nick end labeling (TUNEL). Ultrastructural changes of lung tissue were observed by using transmission electron microscope. The results showed that in I/R group, the content of metallothionein was decreased (P<0.05), the content of MDA and MPO activity were increased (P<0.01), and SOD activity was decreased (P<0.01), compared with those in control group. IP treatment significantly increased the content of metallothionein (P<0.01), attenuated the MDA level (P<0.05) and MPO activity (P<0.01), and improved SOD activity (P<0.01) in blood serum. The number of TUNEL-positive cells in IP group was significantly reduced compared with that in I/R group (P<0.01). There were abnormal ultrastructural changes in I/R group, which were markedly reversed in IP group. In conclusion, IP may protect lung against I/R injury by inducing the expression of metallothionein.     

The role of adenylate cyclase in ischemic preconditioning in the rat heart: a cytochemical study

Using catalytic cytochemistry the AC activity was studied during ischemic preconditioning (IP) (5 min occlusion of LAD and 10 min reperfusion) followed by 30 min regional ischemia in isolated Langendorff-perfused rat heart. In controls the specific precipitate of AC reaction was found on the sarcolemma (SL) and the junctional sarcoplasmic reticulum (JSR) of cardiomyocytes. After prolonged ischemia the reaction product was absent, whereas IP followed by prolonged ischemia protected the AC activity on SL and JSR. IP-induced enhancement of AC activity in this model was accompanied by significant reduction of ischemia/reperfusion fibrillation. The results suggest involvement of AC system in mechanisms of IP.     

Autophagy in ischemic preconditioning and hibernating myocardium

Autophagy is a major protective mechanism and has been identified in response to hypoxia and more recently, myocardial ischemia, but it is not known whether it is involved in mediating ischemic preconditioning, the most powerful intervention known to protect myocardium against lethal ischemic injury. We examined autophagy in several models of preconditioning induced by 6 repetitive episodes of ischemia every 12 hours versus classical first or second-window preconditioning in swine. The results indicated that autophagy is an important mechanism mediating cardioprotection following repetitive episodes of coronary stenosis or coronary occlusion, but less for traditional first or second window preconditioning.