缺血预处理时心肌细胞三磷酸腺苷含量和超微结构变化

采用生物发光技术，分别测定缺血预处理和对照组再灌注60min时心肌细胞三磷酸腺苷（ATP）含量，同时留取心肌标本行光镜和电镜观察，探讨缺血预处理保护心肌的作用机理。结果表明：①缺血预处理组心肌细胞ATP含量明显高于对照组，差异显著（P＜0．05）；②缺血预处理组光镜、电镜所见心肌损伤均明显比对照组轻。提示：缺血预处理可以减少心肌细胞能量消耗，保护线粒体的结构和功能，从而对缺血心肌具有一定保护作用。     

心脏和肾脏短暂缺血对心肌保护作用的比较研究

目的　明确心脏和肾脏短暂缺血预处理对心肌缺血 再灌注 (MIR)所致心肌坏死和细胞凋亡的影响。方法　在家兔MIR模型上 ,36只动物随机分为单纯MIR组、心肌短暂缺血预处理 (MIP)组和肾脏短暂缺血预处理 (RIP)组。实验过程中 ,记录血流动力学、心外膜电图 ;应用三苯硝基四氮唑红测定心肌梗死范围 ;采用末端标记和流式细胞方法检测心肌细胞凋亡等。结果　 (1)血流动力学和心外膜电图 :三组动物的血流动力学指标在MIR过程中逐渐下降 ;心外膜电图ST段在缺血期明显抬高 ,再灌注过程中恢复正常。 (2 )心肌梗死范围 :MIR组的心肌梗死范围 (坏死区占缺血区的重量百分比 )为 (5 3 83± 2 0 4 ) % ,MIP组和RIP组的心肌梗死范围分别为 (2 9 6 7± 2 16 ) %和 (33 0 0±3 4 6 ) %。与MIR组相比 ,MIP组和RIP组的心肌梗死范围明显减小 (P <0 0 1)。 (3)心肌细胞凋亡 :末端标记显示 ,MIR组、MIP组和RIP组中缺血区的心肌细胞凋亡率分别为 (10 98± 0 92 ) %、(5 93±0 81%和 (5 5 8± 0 5 0 ) % ,MIP组和RIP组缺血区中的细胞凋亡率较MIR组明显降低 (P <0 0 1)。结论　MIP和RIP均能减少MIR所致的心肌梗死范围和细胞凋亡 ,MIP和RIP对心脏的保护效应无明显差别。     

Modulation of liver oxidant-antioxidant system by ischemic preconditioning during ischemia／reperfusion injury in rats

AIM: To investigate effects of ischemic pre-conditioning on the liver endogenous oxidant-antioxidant system during ischemia/reperfusion injury. METHODS: Twenty-four male Sprague-Dawley rats were randomly divided into sham-operated (Sham), ischemia/ reperfusion (I/R), ischemic pre-conditioning plus ischemia/ reperfusion (IPC) groups. Serum ALT, AST and hyaluronic acid levels were assayed and pathologic alterations observed. Liver malondialdehyde (MDA) contents, endogenous antioxidant enzymes, superoxidase dismutase (SOD), catalase (CAT), gultathionine peroxidase (GSH-Px) activities, neutrophils accumulation marker, myeloperoxidase (MPO) activities were measured respectively. RESULTS: Compared with I/R group, sinusoidal endothelial cells as well as hepatocytes damages, as assessed biochemically and histochemically, were improved significantly in IPC group; neutrophils infiltration was also markedly reduced. In IPC group, liver peroxidation, as measured by MDA contents, was significantly decreased when compared with I/R group; endogenous antioxidant enzymes, SOD, CAT and GSH-Px activities were markedly higher than that in I/R group. CONCLUSION: Ischemic pre-conditioning exerts protective effects on both hepatic sinusoidal endothelial cells and hepatocytes during liver I/R injury. Its mechanisms may involve dimunition of neutrophils infiltration and modulation of the imbalance of endogenous oxidant-antioxidant system in the organism.     

缺血预处理对心肌缺血再灌注诱发凋亡的保护机制

目的：通过观察心肌细胞凋亡指数与心肌中Fas、C-fOS表达阳性率的变化,探讨缺血预处理对心肌缺血再灌注诱发细胞凋亡的保护作用及与心肌中Fas、c-fos基因表达的关系. 方法：将入选大鼠随机分为假手术对照组（A组）、缺血组（B组）、缺血再灌注组（C组）、缺血预处理组（D组）,每组15只,测定各组大鼠心肌中细胞凋亡和Fas、c-fos的表达,并分析三者之间的相关性. 结果：与A组比较,B、C及D组大鼠的心肌凋亡指数、心肌中Fas与c-fos的阳性率均升高（P＜0.01）;与C组比较,B组及D组大鼠的心肌凋亡指数、心肌中Fas与C-fOS的阳性率均降低（P＜0.01）.Pearson相关分析显示心肌凋亡指数、Fas、c-fos三者之间存在显著正相关. 结论：缺血预处理可能通过下调凋亡相关基因Fas、c-fos的表达,减少细胞凋亡而发挥心肌保护作用.     

Evidence that the acute phase of ischemic preconditioning does not require signaling by the A2B adenosine receptor

Ischemic preconditioning (IPC) is a protective phenomenon in which brief ischemia renders the myocardium resistant to subsequent ischemic insults. Here, we used A_2BAR gene knock-out (A_2BKO)/β-galactosidase reporter gene knock-in mice and the A_2BAR antagonist ATL-801 to investigate the potential involvement of the A_2BAR in IPC, focusing on the acute phase of protection. Cardioprotection provided by acute IPC elicited by two 3-min occlusion/3-min reperfusion cycles was readily apparent in an isolated, Langendorff-perfused mouse heart model in studies using hearts from A_2BKO mice. IPC equivalently improved the recovery of contractile function following 20 min of global ischemia and 45 min of reperfusion in both WT and A_2BKO hearts by ~ 30-40%, and equivalently decreased the release of cardiac troponin I during the reperfusion period (from 5969 ± 925 to 1595 ± 674 ng/g and 4376 ± 739 to 2278 ± 462 ng/g using WT and A_2BKO hearts, respectively). Similarly, the infarct size-reducing capacity of acute IPC in an in vivo model of infarction was fully manifested in experiments using A_2BKO mice, as well as in experiments using rats pretreated with ATL-801. We did observe, however, a marked reduction in infarct size in rats following administration of the selective A_2BAR agonist BAY 60-6583 (~ 25% reduction at a dose of 1.0 mg/kg). While supportive of its concept as a cardioprotective receptor, these experiments indicate that the mechanism of the early phase of IPC is not dependent on signaling by the A_2BAR. We present the idea that the A_2BAR may contribute to the later stages of IPC dependent on the induction of stress-responsive genes.     

Concepts of hypoxic NO signaling in remote ischemic preconditioning

Acute coronary syndromes remain a leading single cause of death worldwide. Therapeutic strategies to treat cardiomyocyte threatening ischemia/reperfusion injury are urgently needed. Remote ischemic preconditioning (rIPC) applied by brief ischemic episodes to heart-distant organs has been tested in several clinical studies, and the major body of evidence points to beneficial effects of rIPC for patients. The underlying signaling, however, remains incompletely understood. This relates particularly to the mechanism by which the protective signal is transferred from the remote site to the target organ. Many pathways have been forwarded but none can explain the protective effects completely. In light of recent experimental studies, we here outline the current knowledge relating to the generation of the protective signal in the remote organ, the signal transfer to the target organ and the transduction of the transferred signal into cardioprotection. The majority of studies favors a humoral factor that activates cardiomyocyte downstream signaling - receptor-dependent and independently. Cellular targets include deleterious calcium (Ca²⁺) signaling, reactive oxygen species, mitochondrial function and structure, and cellular apoptosis and necrosis. Following an outline of the existing evidence, we will furthermore characterize the existing knowledge and discuss future perspectives with particular emphasis on the interaction between the recently discovered hypoxic nitrite-nitric oxide signaling in rIPC. This refers to the protective role of nitrite, which can be activated endogenously using rIPC and which then contributes to cardioprotection by rIPC.     

肢体缺血预处理和后处理对脑缺血的保护作用及其机制

远隔缺血预处理和缺血后处理是减轻缺血再灌注损伤的2种新方法。近年来的研究显示,其对脑缺血也具有显著的保护作用。在适当时机给予适当强度的远隔缺血预处理或后处理可诱导脑组织缺血耐受,进而产生神经保护作用。肢体缺血预处理和后处理操作简单,临床应用价值较高。文章对肢体缺血预处理和后处理对脑缺血的保护作用进行了综述。     

不同时期无创肢体缺血预适应对急性心肌梗死大鼠的保护作用

目的:探讨急性心肌梗死前、再灌注前及再灌注时等不同时期,无创性肢体缺血预适应在减轻大鼠缺血/再灌注损伤中的作用。方法:所有大鼠随机分为4组(每组10只):心肌缺血/再灌注损伤组(A组)、急性心肌梗死前肢体缺血预适应组(B组)、再灌注前肢体缺血预适应组(C组)和再灌注初期肢体缺血预适应组(D组)。观察各组心电、心肌缺血范围(AAR)、心肌梗死范围(IA)、心肌梗死部位质量与左心室质量(LV)的比值(IA/LV)、梗死范围与缺血范围的比值(IA/AAR)、CK-MB值。结果:与A组相比,B、C、D 3组ST段抬高幅度、CK-MB值、IA/LV和IA/AAR比值均显著降低(P<0.01)。结论:无创性肢体缺血预适应在急性心肌梗死前、再灌注前及再灌注时的各个时期应用,都能明显降低大鼠心肌缺血/再灌注时的ST段抬高幅度,明显降低心肌酶水平,明显缩小心肌坏死面积。     

Prevention of the ischemia-induced decrease in mitochondrial Tom20 content by ischemic preconditioning

Preserved mitochondrial function (respiration, calcium handling) and integrity (cytochrome c release) is central for cell survival following ischemia/reperfusion. Mitochondrial function also requires import of proteins from the cytosol via the translocase of the outer and inner membrane (TOM and TIM complexes). Since mitochondrial function following ischemia/reperfusion is better preserved by ischemic preconditioning (IP), we now investigated whether expression of parts of the import machinery is affected by ischemia/reperfusion without or with IP in vivo. We analyzed the mitochondrial content of the presequence receptor Tom20, the pore forming unit Tom40 and Tim23. Goettinger minipigs were subjected to 90 min of low-flow ischemia without or with preconditioning by 10 min ischemia and 15 min reperfusion. Mitochondria were isolated from the ischemic or preconditioned anterior wall of the left ventricle and from the control posterior wall. Infarct size was significantly reduced by IP (20.1 +/- 1.6% of area at risk (non-preconditioned) vs. 6.5 +/- 2.5% of area at risk (IP)). Using Western blot analysis, the ratio of Tom20 (normalized to Ponceau S) between mitochondria isolated from the anterior ischemic and posterior control wall was reduced (0.72 +/- 0.11, a.u., n = 8), whereas the mitochondrial Tom20 content was preserved by IP (1.17 +/- 0.16 a.u., n = 7, P < 0.05). The mitochondrial Tom40, Tim23 and adenine nucleotide transporter (ANT) contents were not significantly different between non-preconditioned and preconditioned myocardium. The preservation of the mitochondrial Tom20 protein level may contribute to the improved mitochondrial function after IP.     

Metabolic plasticity and the promotion of cardiac protection in ischemia and ischemic preconditioning

The concept of metabolic protection of the ischemic myocardium is in constant evolution and has recently been supported by clinical studies. Historically, enhanced glucose metabolism and glycolysis were proposed as anti-ischemic cardioprotection. This hypothesis is supported by the sub-cellular linkage between key glycolytic enzymes and the activity of two survival-promoting membrane-bound pumps, namely the sodium-potassium ATPase, and the calcium uptake pump of the sarcoplasmic reticulum. Moreover, improved resistance against ischemia follows the administration of glucose-insulin-potassium in a variety of animal models and in patients following acute myocardial infarction. The metabolic plasticity paradigm has now been expanded to include (1) the benefit of improved coupling of glycolysis to glucose oxidation, which explains the action of anti-ischemic fatty acid inhibitors such as trimetazidine and ranolazine; (2) the role of malonyl CoA in the glucose-fatty acid interaction; and (3) the anti-apoptotic role of insulin. Furthermore, we argue for a protective role of increased glucose uptake in the preconditioning paradigm. Additionally, we postulate an adaptive role of mitochondrial respiration in the promotion of cardioprotection in the context of ischemic preconditioning. The mechanisms driving these mitochondrial perturbations are still unknown, but are hypothesized to involve an initial modest uncoupling of respiration from the production of mitochondrial ATP. These perturbations are in turn thought to prime the mitochondria to augment mitochondrial respiration during a subsequent ischemic insult to the heart. In this review we discuss studies that demonstrate how metabolic plasticity can promote cardioprotection against ischemia and reperfusion injury and highlight areas that require further characterization.     

细胞膜钠钙交换蛋白在大鼠心肌缺血预适应及腺苷诱导预适应中的作用及其信号转导

目的 探讨细胞膜钠钙交换蛋白（NCX）在心肌缺血预适应及药物诱导预适应中的作用及可能的信号转导途径.方法 培养乳鼠心肌细胞随机分为缺血/再灌注组、缺血预适应组、腺苷预处理组、钙调素依赖蛋白激酶Ⅱ（CaMKⅡ）抑制剂KN-93＋缺血预适应组、KN-93＋腺苷预处理组及对照组.各组乳酸脱氢酶（LDH）漏出量用生化法测定（n=5）,钠钙交换蛋白mRNA表达以半定量RT-PCR检测（n=5）,NCX活性以液闪仪测定Na^＋依赖的^45Ca^2＋摄取率表示（n=5）.结果 （1）缺血/再灌注组LDH漏出量显著增加（P＜0.05）,缺血预适应及腺苷预处理组LDH漏出量均显著降低 （P＜0.05）;KN-93预作用后,缺血预适应及腺苷预处理组LDH漏出量均显著增加（P＜0.05）. （2）缺血/再灌注组NCX ^45Ca^2＋摄取率比对照组高（P＜0.005）.缺血预适应及腺苷预处理组较缺血/再灌注时NCX ^45Ca^2＋摄取率显著低（P＜0.05）,且腺苷预处理组NCX ^45Ca^2＋摄取率较缺血预适应组更低（P＜0.05）. KN-93＋缺血预适应组与缺血/再灌注组NCX ^45Ca^2＋摄取率差异无统计学意义, KN-93＋腺苷预处理组较缺血/再灌注组NCX ^45Ca^2＋摄取率低（P＜0.05）.（3） 缺血/再灌注组NCX mRNA的表达比对照组显著高（P＜0.05）;缺血预适应及腺苷预处理组NCX mRNA的表达均显著低（P＜0.05）;KN-93处理后缺血预适应组及腺苷预处理组NCX mRNA的表达水平显著高（P＜0.05）,且腺苷预处理组NCX mRNA的表达较缺血预适应组更高（P＜0.05）.结论 缺血预适应及腺苷预处理对心肌的保护作用与细胞膜NCX有关,缺血预适应中NCX对心肌损伤保护作用经CaMKⅡ介导,而在腺苷预处理中NCX对心肌损伤保护作用仅部分经CaMKⅡ介导.     

大鼠脑缺血后海马CA1区脑红蛋白表达的变化及肢体缺血预处理对其影响

目的 观察青年和老年大鼠脑缺血后海马CA1区脑红蛋白(Ngb)表达的变化及肢体缺血预处理(LIP)对其影响. 方法 将凝闭双侧椎动脉的青年和老年大鼠均随机分为脑缺血组和脑缺血+LIP组.采用反转录聚合酶链反应(RT-PCR)和Western blot法检测海马CA1区NgbmRNA和蛋白表达,硫堇染色观察海马CA1区锥体神经元迟发性死亡(DND)情况. 结果 青年脑缺血组、青年脑缺血+LIP组、老年脑缺血组、老年脑缺血+LIP组的Ngb mRNA和蛋白表达分别为0.16±0.02和0.32±0.07、0.52±0.04和0.91±0.06、0.09±0.01和0.22±0.08、0.21±0.01和0.66±0.06.表明老年大鼠脑缺血后海马CA1区Ngb mRNA和蛋白表达较青年脑缺血大鼠降低(P<0.05),LIP可上调青年和老年大鼠脑缺血后海马CA1区Ngb mRNA和蛋白表达(P<0.05),但对老年大鼠的上调作用低于青年大鼠(P<0.05).硫堇染色显示,海马CA1区神经元密度青年脑缺血组,青年脑缺血+LIP组、老年脑缺血组和老年脑缺血+LIP组分别为(38.8±10.9)、(171.5±16.9)、(21.2±12.2)个/mm和(102.7±15.4)个/mm.表明老年大鼠LIP预防脑缺血引起的海马CA1区锥体神经元DND的作用小于青年大鼠. 结论 老年大鼠脑缺血后Ngb的表达及LIP对其上调作用较青年大鼠明显减弱,这可能是老年大鼠脑缺血后损伤较重和LIP对老年大鼠脑缺血保护作用较弱的原因之一.     

缺血预处理对大鼠缺血再灌注后心房肌Cx43和Cx40的影响

目的 探讨缺血预处理对大鼠缺血再灌注后的心房肌缝隙连接蛋白43(Cx43)和缝隙连接蛋白40(Cx40)表达和分布的影响。方法 30只Wistar大鼠随机分为假手术组(或对照组,n=5)：只穿线不结扎左冠状动脉前降支。缺血再灌注组(I/R组,n=5)：给予前降支结扎30 min,再灌注120 min。早期缺血预处理组(IPC组,n=5)：行IPC处理后,余处理同I/R组。延迟IPC组(L-IPC组,n=5)：在IPC处理24h后,余处理同I/R组。早期远程缺血预处理组(RIPC组,n=5)：给予RIPC后,余处理同I/R组。延迟RIPC组(L-RIPC组,n=5)：RIPC处理24h后,余处理同I/R组。测量心房组织Cx40、43的mRNA表达、Cx40、43蛋白表达以及用免疫组化法测定Cx40、43的分布。结果 I/R组Cx43和Cx40在mRNA水平和蛋白水平均明显降低,分布无规律且侧面分布相对增加。而各种IPC方式(IPC、L-IPC、RIPC、L-RIPC)在I/R后,心房Cx43和Cx40mRNA水平和蛋白水平下降不明显,其分布多于心肌细胞闰盘处,仅少量分布于心肌细胞侧面。结论 IPC能维持I/R后的心房肌Cx43和Cx40的较高表达,并维持其空间分布相对稳定。     

大鼠局灶性脑缺血耐受胶质细胞源性神经营养因子的表达

目的探讨局灶脑缺血预处理对大鼠大脑中动脉栓塞(MCAO)后神经功能的影响及胶质细胞源性神经营养因子(GDNF)的表达。方法线栓法建立大鼠MCAO及预处理模型,Bederson神经功能评分观察大鼠神经功能,免疫组织化学和原位杂交技术检测GDNF表达。结果缺血预处理(IPC)可提高大鼠局灶性脑缺血后神经功能,且梗死周边区GDNF蛋白及mRNA表达水平高于对照组(P<0.05)。结论10 min IPC可产生缺血耐受,可能通过增加GDNF的表达而起脑保护作用。     

Role of connexin 43 in ischemic preconditioning does not involve intercellular communication through gap junctions

Connexin 43 (Cx 43) has recently been implicated in protection of ischemic preconditioning. Cx 43 colocalization with protein kinase C and p38 mitogen-activated protein kinase is increased in preconditioned myocardium, Cx 43 phosphorylation is preserved in preconditioned myocardium, and hearts from Cx 43-deficient mice cannot be preconditioned. It is, however, unclear whether the important role of Cx 43 relates to intercellular communication through gap junctions or its function in volume homeostasis. To address this issue, we used isolated cardiomyocytes, which no longer-form gap junctions, from wild-type (n = 5) and heterozygous Cx 43-deficient mice (n = 8) and subjected them to 2 h simulated ischemia (hypoxia, acidosis) and an additional challenge by extracellular hypo-osmolarity (from 310 to 250 mOsm/l). Viability (trypan blue exclusion) was well maintained in normoxic wild-type cardiomyocytes (54 +/- 5% at baseline vs. 46 +/- 4 (mean +/- S.D.) % at 2 h). With simulated ischemia, viability was reduced to 17 +/- 5%. Preconditioning by a preceding exposure to 10 min simulated ischemia and 15 min reoxygenation preserved viability after 2 h simulated ischemia (36 +/- 1%, P < 0.001 vs. simulated ischemia). In Cx 43-deficient cardiomyocytes, viability was also well maintained in normoxia (56 +/- 10% vs. 44 +/- 10%). Viability was also reduced to 17 +/- 6% with 2 h simulated ischemia. In contrast to wild-type cells, preconditioning did not prevent the reduction in viability (18 +/- 8%). In conclusion, Cx 43 is essential for preconditioning in the absence of gap junctions, supporting its function through improved volume regulation.     

福辛普利晚期预处理对缺氧复氧期心室肌动作电位的影响

目的：观察福辛普利晚期预处理对缺氧复氧心室肌细胞动作电位的影响。方法：应用全细胞膜片钳方法，记录观察酶解的成年豚鼠心室肌细胞动作电位在缺氧复氧期的变化。结果：缺氧复氧的心室肌细胞膜静息电位增加，动作电位复极50时程（APD50）、APD90缩短（P均〈0．01）。福辛普利预处理可使晚期缺氧复氧的心室肌细胞膜静息电位降低，APD50、APD90延长，虽不显著（P〉0．05）。结论：福辛普利可稳定缺氧复氧心肌电生理活动，可模拟晚期预处理对心肌产生保护作用。