线粒体通透性转换孔在缺血后处理中的作用和机制

心肌细胞急性缺血后,及时再灌注能够挽救缺血心肌细胞的活力、减少梗死面积、促进心肌细胞功能恢复。但是再灌注是一把“双刃剑”,它产生大量活性氧类（reactive oxygen species,ROS）和Ca2＋超载,开放线粒体通透性转换孔（mitochondrial permeability transition pore,mPTP）,使线粒体肿胀,外膜破裂导致心肌细胞坏死。mPTP是线粒体非特异性的转换孔,由电压依赖性阴离子通道（voltage-dependent anion channel,VDAC）、腺苷酸转位蛋白（adeninenucleotide translocator,ANT）和亲环蛋白D（cyclophilin D,CYPD）组成。mPTP关闭维持线粒体结构完整,是缺血心肌细胞功能恢复的先决条件。缺血后处理通过减少再灌注早期ROS大量释放和拮抗Ca^2＋超载、释放内源性介质、激活再灌注损伤补救激酶（reperfusion injury salvage kinase,RISK）、抑制mPTP开放,从而保护心肌细胞。     

大鼠心肌整体缺血及离体再灌注致生物膜的损伤作用

目的和方法：利用整体大鼠异丙肾上腺素损伤（ISO）和离体大鼠全心停灌／再灌（I／R）两种模型,观察了心肌缺血和缺血／再灌注对心肌生物膜－线粒体膜及肌纤维膜损伤的影响。结果：ISO（5mg/kg,皮下注射）和I／R（20min/20min)可导致大鼠心脏生物膜产生严重损伤,表现为心肌线粒体脂质过氧化产物明显增加,线粒体磷脂酶A2（PLA2）激活,从而导致线粒体膜磷脂（PL）含量减少,磷脂分解产物游离脂肪酸（FFA）增加,膜脂流动性（LFU）降低,线粒体Ca^2 -ATPase及肌纤维膜Na^ ,K^ -ATPase活性降低,线粒体呼吸功能降低、呼吸链氧化磷酸化解偶联,高能磷酸化合物生成减少。结论：整体ISO和离体I／R可导致大鼠心肌线粒体、肌纤维膜结构和功能损伤。     

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。     

线粒体移植改善缺血再灌注损伤的作用及机制

当心脏手术、器官移植和血管病变时，血流停止以及之后血液再灌注过程都会对组织器官造成损伤，出现相应的功能障碍，即缺血再灌注损伤（ischemia-reperfusion injury,I/RI）。其中，线粒体功能障碍被认为是器官I/RI的重要原因之一，受损线粒体会导致细胞能量供应减少、活性氧（reactive oxygen species,ROS）生成增加、钙超载等结果，从而激活细胞死亡程序。线粒体是一种高度动态的细胞器，通过不断融合、分裂维持自身稳态，并且，线粒体已被研究证明可在细胞间转移。目前，线粒体提取技术较为成熟，可以从组织中提取出完整的、有活性的线粒体。在以上背景下，出现了线粒体移植（mitochondrial transplantation,MT）技术，通过移植活性线粒体至受损组织内，帮助细胞恢复功能。然而，MT的临床应用还面临着许多挑战，如MT的规范移植程序、作用机制和安全性等仍需要深入研究。本文就近10年MT改善I/RI的作用及相关机制进行了综述。     

缺血后处理、ATP后处理减轻兔缺血再灌注损伤:与腺苷受体激活有关

目的:近期实验研究显示,在再灌注的早期给予短暂、重复的缺血再灌(缺血后处理Postconditioning)能够减轻心肌再灌注损伤。本实验旨在探明三磷酸腺苷(ATP)用于缺血后处理是否产生上述保护效应,以及了解腺苷受体在此保护作用机制中的地位。方法:家兔开胸后左前降支均给予40min结扎和180min的再灌注,并随机分为5组:(1)对照组;(2)缺血后处理组;(3)ATP后处理组;(4)缺血后处理 SPT(硫苯茶碱)组;(5)SPT对照组。于实验终点测定心肌梗死面积(TTC染色),血浆CK-MB、SOD、MDA含量。结果:和时照组相比,缺血后处理组与ATP后处理组心梗面积减少(p<0．05),CK-MB也显著降低(p相似文献   

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。     

氧化苦参碱对大鼠缺血再灌注心肌损伤的保护机制研究

目的:探讨氧化苦参碱(OMT)对大鼠缺血再灌注心肌损伤(MIRI)的保护机制。方法:随机将60只成年Wistar大鼠分成对照组、MIRI组和OMT组,每组20只,除对照组外,其他两组结扎30 min后松解结扎线灌注60 min。结扎前10 min,OMT组股静脉输入苦参注射液120 mg/kg,对照组、MIRI组则输入等容量生理盐水。造模后,记录两组心率(HR)、左心室收缩压(LVSP)、左室内压最大上升或下降速率(+dp/dt_(max)或-dp/dt_(min))及血清乳酸脱氢酶(LDH),检测两组心肌组织中一氧化氮(NO)、丙二醛(MDA)、一氧化氮合酶(NOS)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-PX)水平。结果:与MIRI组相比,OMT组HR、LVSP和+dp/dt_(max)、-dp/dt_(min)均显著升高(P0.05),且OMT组上述指标与对照组比较,差异均无统计学意义(均P0.05)。与MIRI组相比,OMT组的NO、NOS、SOD、GSH-PX水平均显著升高,而MDA、血清LDH水平显著降低,比较差异均有统计学意义(均P0.05),且OMT组上述指标与对照组比较,差异均无统计学意义(均P0.05)。结论:OMT对MIRI大鼠具有心肌保护作用,其机制可能与提高抗氧自由基活性、改善微循环及舒张冠脉血管有关。     

腺苷预处理对大鼠心脏移植缺血再灌注损伤心肌的保护作用

目的探讨腺苷（adenosine,Ado）预处理在心脏移植缺血再灌注损伤的保护作用。方法健康雄性Sprague．Dawley（SD）大鼠40只,建立大鼠同系异位心脏移植模型。随机分为3组：假手术组、对照组、实验组（供体心在获取前15min给予Ado预处理后4℃改良St．Thoms液10mL。主动脉根部灌注停跳）。术后5h测定血清中丙二醛（MDA）、超氧化物歧化酶（SOD）、肌酸激酶同工酶（CK-MB）含量,电镜观测心肌细胞超微结构变化。结果实验组MDA、CK-MB明显减少（P〈0．01）,SOD明显增加（P〈0．01）,心肌超微结构改变明显减轻。实验组的移植心脏存活时间较对照组明显延长[（22．1±2．9）dw（12．0±1．8）d,P〈0．01）]。结论Ado预处理对心脏移植缺血再灌注损伤有保护作用,使受者的移植心脏存活期延长。     

肾缺血预处理对心脏缺血／再灌注损伤的保护作用

目的：探讨肾缺血预处理对家兔心脏缺血／再灌注（I／R）损伤的影响及意义。方法：32只大耳白家兔随机分为假手术（SO）、心脏I／R、经典缺血预处理（CIPC）及肾缺血预处理（RIPC）4组。观察各组心肌梗塞面积、左室舒缩功能、心脏超微结构及心律失常发生率的变化。结果：CIPC、RIPC组,心肌梗塞面积、再灌性心律失常发生率较I／R组明显降低,左室舒缩功能明显恢复（P＜0.01）,心脏超微结构损伤明显减轻。结论：RIPC可诱导出与CIPC类似的心脏保护效应。     

缺血后低压灌注处理对兔脊髓缺血/再灌注损伤的保护及ERK传导通路在其中的作用

目的 评价细胞外信号调节激酶 (ERK)传导通路对低压灌注缺血后处理兔缺血/再灌注损伤脊髓的保护作用及机制.方法 84只日本大耳白兔随机分为7组,分别为C组(对照组,不给予缺血后处理)、PB组(缺血后处理组)、D、PD1、PD3、PD9组分别于腹主动脉开放前1min鞘内注射DMSO 20μl、PD98059 1μg(20μl)、PD98059 3μg(20μl)、PD98059 9μg(20μl)之后进行缺血后处理及PD组(腹主动脉开放前1min鞘内注射PD98059 3μg(20μl),之后不行缺血后处理).分别于再灌注1、3、7、28d时采用Tarlov评分评价后肢运动功能.每组于再灌注1d时处死6只动物,取L3～5节段脊髓组织,采用Western blot技术测定p-ERK1/2 及Bcl-2,Bax蛋白表达.结果 1、3、7、28d,PB组Tarlov评分明显高于其它各组(P<0.05),缺血后处理可以明显上调p-ERK1/2及凋亡抑制基因Bcl-2的表达,下调凋亡促进基因Bax的表达(P<0.05),而这些调节作用可以被ERK1/2阻断剂PD98059抑制.结论 p-ERK1/2在低压灌注缺血后处理对缺血再灌注损伤脊髓的保护中起重要作用.     

乙酰胆碱对离体大鼠缺血/复灌心脏的保护作用及其机制

目的:探讨乙酰胆碱(ACh)预处理抗心肌缺血复灌(I/R)损伤作用及其与线粒体渗透性转换孔和/或线粒体ATP敏感性钾通道的关系。方法:采用离体大鼠心脏Langendorff灌流方法进行全心停灌30min,复灌120min复制I/R模型。测定心室力学指标和复灌各时间点冠脉流出液中乳酸脱氢酶(LDH)含量。实验结束测定心肌组织formazan含量的变化。结果:与单纯I/R组相比,ACh(0.1μmol/L,5min)预处理明显提高心肌细胞的formazan含量,降低复灌期间冠脉流出液中LDH含量,明显改善I/R所致的左室发展压、左心室内压最大上升和下降速率、心率与发展压乘积和左室舒张末压力的下降,缓解冠脉流量的减少。线粒体渗透性转换孔开放剂苍术苷(20μmol/L,复灌前给药20min)和线粒体ATP敏感性钾通道抑制剂5-羟基癸酸(100μmol/L,缺血前给药20min)能明显减弱ACh的保护作用。结论:在大鼠离体心脏灌流模型上,ACh预处理具有抗心脏缺血/复灌损伤的作用,这种保护作用可能与其抑制线粒体渗透性转换孔的开放和促进线粒体ATP敏感性钾通道的开放有关。     

葛根素对离体大鼠缺血/复灌心脏的保护作用及其作用机制

目的：探讨葛根素（puerarin,Pue）预处理抗心肌缺血／复灌（ischemia／reperfusion,I／R）损伤是否与线粒体渗透性转换孔和／或线粒体ATP敏感性钾通道有关。方法：采用离体大鼠心脏Leangendorff灌流方法,全心停灌30min,复灌120min复制I／R模型。测定心室力学指标和复灌各时间点冠脉流出液中乳酸脱氢酶（LDH）含量。实验结束测定心肌组织formazan量的变化。结果：与单纯I／R组相比,Pue（0．24mmol／L,5min）预处理明显提高心肌细胞的formazan含量,降低复灌期间冠脉流出液中LDH含量,明显促进左室发展压、左心室内压最大上升和下降速率、心率与发展压乘积和左室舒张末压力的恢复,缓解冠脉流量的减少。线粒体渗透性转换孔开放剂苍术苷（20μmol／L。复灌前给药20min）和线粒体ATP敏感性钾通道抑制剂5-羟基癸酸（100μmol／L,缺血前给药20min）能明显减弱Pue的保护作用。结论：在大鼠离体心脏灌流模型上,Pue预处理具有抗心脏缺血／复灌损伤的作用,这种保护作用可能与其抑制线粒体渗透性转换孔的开放和促进线粒体ATP敏感性钾通道的开放有关。     

Mitochondrial ion channels as targets for cardioprotection

Acute myocardial infarction (AMI) and the heart failure (HF) that often result remain the leading causes of death and disability worldwide. As such, new therapeutic targets need to be discovered to protect the myocardium against acute ischaemia/reperfusion (I/R) injury in order to reduce myocardial infarct (MI) size, preserve left ventricular function and prevent the onset of HF. Mitochondrial dysfunction during acute I/R injury is a critical determinant of cell death following AMI, and therefore, ion channels in the inner mitochondrial membrane, which are known to influence cell death and survival, provide potential therapeutic targets for cardioprotection. In this article, we review the role of mitochondrial ion channels, which are known to modulate susceptibility to acute myocardial I/R injury, and we explore their potential roles as therapeutic targets for reducing MI size and preventing HF following AMI.     

Keap-NRF2 signaling contributes to the Notch1 protected heart against ischemic reperfusion injury via regulating mitochondrial ROS generation and bioenergetics

Myocardial ischemia/reperfusion (I/R) injury is recognized as the leading cause of death worldwide. However, the molecular mechanisms involved in this process are still not fully understood. We previously reported that the combined action of Notch1 and Keap1-NRF2 signaling pathway can significantly increase the activity of cardiomyocytes, inhibit the apoptosis of cardiomyocytes, reduce the formation of reactive oxygen species, and improve the antioxidant activity in neonate rat myocardial cells. However, the regulatory mechanism of Notch1 signaling pathway on the NRF2 signaling pathway and its actual role on I/R injury are still unclear. Herein, we found that Keap-NRF2 signaling is activated by Notch1 in RBP-Jκ dependent manner, thus protects the heart against I/R injury via inhibiting the mitochondrial ROS generation and improves the mitochondrial bioenergetics in vitro and in vivo. These results suggest that Keap-NRF2 signaling might become a promising therapeutic strategy for treating myocardial I/R injury.     

一氧化氮在乙醇后处理心肌保护中的作用

目的:探讨乙醇后处理心肌保护作用是否与一氧化氮生成有关。方法:局部结扎冠状动脉左前降支30min,复灌120 min复制离体大鼠心肌缺血/复灌模型。心肌缺血末5 min,复灌初期10min给予乙醇50mmol/L,共灌流15 min进行乙醇后处理干预。实验随机分为五组,正常组,缺血/复灌组,乙醇后处理组,乙醇后处理+L-NAME组和乙醇后处理+苍术苷组。测定心室动力学指标和复灌期间冠脉流出液中乳酸脱氢酶(LDH)含量,TTC染色法测定心肌梗死面积,硝酸还原法测定心肌组织一氧化氮(NO)含量。RT-PCR检测左心室前壁心尖组织Bc-l2和BaxmRNA的表达。结果:与单纯缺血/复灌相比,乙醇后处理明显促进了左室发展压、左室做功的恢复,降低复灌期冠脉流出液中LDH的释放和心肌梗死面积,心肌组织NO释放减少,Bc-l 2/Bax mRNA比值增高。一氧化氮合酶抑制剂L-NAME和线粒体渗透性转换孔道开放剂苍术苷均抑制了乙醇后处理心室功能的恢复、LDH释放的减少和梗死面积的降低,心肌组织NO释放进一步减少,Bc-l 2/Bax mRNA比值降低。结论:乙醇后处理的心肌保护作用可能与减少NO的释放、抑制线粒体渗透性转换孔道的开放和抑制细胞凋亡的发生有关。     

Cyclosporin A binding in mitochondrial cyclophilin inhibits the permeability transition pore and protects hearts from ischaemia/reperfusion injury

When loaded with high (pathological) levels of Ca²⁺, mitochondria become swollen and uncoupled as the result of a large non-specific increase in membrane permeability. This process, known as the mitochondrial permeability transition (MPT), is exacerbated by oxidative stress and adenine nucleotide depletion. These conditions match those that a heart experiences during reperfusion following a period of ischaemia. The MPT is caused by the opening of a non-specific pore that can be prevented by sub-micromolar concentrations of cyclosporin A (CsA). A variety of conditions that increase the sensitivity of pore opening to [Ca²⁺], such as thiol modification, oxidative stress, increased matrix volume and chaotropic agents, all enhance the binding of matrix cyclophilin (CyP) to the inner mitochondrial membrane in a CsA-sensitive manner. In contrast, ADP, membrane potential and low pH decrease the sensitivity of pore opening to [Ca²⁺] without affecting CyP binding. We present a model of pore opening involving CyP binding to a membrane target protein followed by Ca²⁺-dependent triggering of a conformational change to induce channel opening. Using the ischaemic/reperfused rat heart we have shown that the mitochondrial pore does not open during ischaemia, but does do so during reperfusion. Recovery of heart during reperfusion is improved in the presence of 0.2 µM CsA, suggesting that the MPT may be critical in the transition from reversible to irreversible reperfusion injury. (Mol Cell Biochem 174: 167–172, 1997)     

环孢菌素A对脂多糖诱导的小鼠急性肺损伤的保护作用

目的：探讨线粒体渗透性转换孔道抑制剂环孢菌素A（CsA）对脂多糖（LPS）诱导的小鼠急性肺损伤可能的保护作用。方法：LPS 4 mg/kg气管内滴入复制小鼠急性肺损伤模型,实验随机分为5组（n=24）：分别为正常对照组、LPS组、地塞米松组、CsA组和CsA＋苍术苷组。6 h后小鼠处死,测定各组支气管肺泡灌洗液乳酸脱氢酶（LDH）的含量,酶联免疫吸附法测定肺组织匀浆液TNF-α浓度,测定肺组织湿/干重比和肺毛细血管通透性指数。结果：气管内滴入LPS 6 h后,CsA组与LPS组相比,肺泡灌洗液中LDH活性降低,肺组织匀浆液TNF-α浓度下降,肺组织湿/干重比、肺毛细血管通透性指数均明显下降,但CsA＋Atr组与LPS组相比无明显区别。结论：环孢菌素A对脂多糖诱导的小鼠急性肺损伤有保护作用,其机制可能与其抑制线粒体渗透性转换孔道的开放有关。     

The mitochondrial permeability transition in toxic, hypoxic and reperfusion injury

Opening of a non-specific, high conductance permeability transition pore or megachannel in the inner mitochondrial membrane causes onset of the mitochondrial permeability transition, which is characterized by mitochondrial swelling, depolarization and uncoupling. Inducers of the permeability transition include Ca²⁺, oxidant stress and a permissive pH greater than 7.0. Blockers include cyclosporin A, trifluoperazine and pH < 7. Using laser scanning confocal microscopy, we developed techniques to visualize onset of the mitochondrial permeability transition in situ in living cells. In untreated cells, the permeability transition pore is continuously closed and does not 'flicker' open. By contrast, the pore opens in liver and heart cells after exposure to oxidant chemicals, calcium ionophore, hypoxia and ischemia/reperfusion, causing mitochondrial uncoupling and aggravation of ATP depletion. In injury to hepatocytes from tert-butylhydroperoxide, an analog of lipid hydroperoxides generated during oxidative stress, onset of the mitochondrial permeability transition is preceded by oxidation of mitochondrial pyridine nucleotides, mitochondrial generation of oxygen radicals and an increase of mitochondrial Ca²⁺, all inducers of the mitochondrial permeability transition. In ischemia, the acidosis of anaerobic metabolism protects strongly against cell death. During reperfusion, recovery of pH to normal levels is a stress that actually precipitates cell killing. Onset of the mitochondrial permeability transition may be responsible, in part, for this pH-dependent injury, or pH paradox. The mitochondrial permeability transition may also be responsible for a variety of pathological phenomena. In particular, the mitochondrial permeability transition may underlie Reye's syndrome and Reye's-like drug toxicities. In conclusion, multiple mechanisms contribute to cell injury after hypoxia, ischemia/reperfusion and toxic chemicals, but a common final pathway leading to acute cellular nec rosis may be ATP depletion after mitochondrial failure. One important mechanism causing mitochondrial failure is the mitochondrial permeability transition, which both uncouples oxidative phosphorylation and accelerates ATP hydrolysis. Interventions that block this pH-dependent phenomenon protect against onset of cell death. (Mol Cell Biochem 174: 159–165, 1997)