Myocardial ischemia: the pathogenesis of irreversible cell injury in ischemia.

Cells made ischemic rapidly manifest many distinct structural and functional alterations as a consequence of the depletion of their energy stores. In attempting to determine which of these are causally related to the eventual cell death, the authors have emphasized the relationship to the reversibility of the ischemic injury. Two phenomena have consistently characterized irreversibly in contrast to reversibly injured ischemic cells: the inability to restore mitochondrial function and evidence of plasma membrane damage. Studies in the authors' laboratory are reviewed that have focused on the pathogenesis, biochemical nature, and the relationship to irreversible cell injury of both of these alterations. A number of mitochondrial abnormalities are related to changes in long-chain acyl-CoA metabolism with inhibition of adenine nucleotide translocation and potentiation of a Ca2+-dependent increase in the permeability of the inner mitochondrial membrane. These changes are reversible upon reoxygenation only when the large increase in intracellular Ca2+ content that accompanies the phospholipid depletion from other cellular membranes is prevented. This disorder in phospholipid metabolism is felt to be the critical lesion that produces irreversible cell injury in ischemia. It affects the endoplasmic and sarcoplasmic reticular membranes of liver and myocardial cells, respectively, and probably the plasma membranes of both. It is prevented by pretreatment with chlorpromazine. An activation of endogenous phospholipases by an elevated, cytosolic free Ca2+ ion concentration is suggested as the mechanism underlying this phospholipid disturbance. The central role of intracellular Ca2+ in the initiation and functional consequences of ischemic cell injury are emphasized.     

Physiopathology of cerebral ischemia

In spite of significant advances made in the technology to image the intracranial contents and to measure the metabolic activity of discrete brain sites, the factor(s) responsible for the death of ischemic neurons remains unresolved. Several potential culprits have been tried: (1) "energy failure", or depletion of high-energy phosphates, occurs very quickly after ischemia, but energy metabolites recover even in tissues where functional return does not occur; (2) "tissue lactacidosis" enhances ischemic cell necrosis, but this factor is not the indispensable cause of neuronal necrosis because acidosis is minimal or nonexistent under conditions of hypoglycemia and seizures; (3) "impairment of the microcirculation" may be a contributing factor, but such microcirculatory impairment cannot be the initiating event as it is known that irreversible neuronal injury precedes the development of microcirculatory abnormalities; (4) the effects of "excitatory neurotransmitters", especially glutamate, may explain the "delayed neuronal death" or the protracted necrosis of neurons in the CA1 sector of the hippocampus; (5) ionic pump alterations: studies of experimental myocardial ischemia tend to support a contributory role of Ca2+ in the aggravation of cell necrosis; however, lack of an experimental model in which steady-state conditions can be maintained has left unresolved the potential participation of calcium ions in ischemic cell necrosis; (6) the same statement, concerning the lack of an experimental model, can be made about the role of free-radical species; oxygen free radicals and superoxides are abundant in the reperfusion stage of ischemic injury, but it is unclear how significant their contribution might be as initiators of ischemic necrosis; and (7) the "ischemic penumbra" is a zone or portion of brain tissue that is sufficiently hypoperfused as to be functionless, but where the cells are likely to recover once normal perfusion is reestablished. Further understanding of the "penumbra" may prove crucial in future studies of brain ischemia.     

Lethal Myocardial Ischemic Injury

The biologic changes occurring in severely ischemic myocytes in vivo as the affected cells pass through the phase of reversible to the phase of lethal or irreversible injury are reviewed with special emphasis on the effect of ischemia on the production and utilization of highenergy phosphate, the destruction of the adenine nucleotide pool, and the appearance of signs of damage to the plasma membrane of the sarcolemma. Evidence is presented that indicates that the events occurring in severe ischemia in vivo are essentially identical to those found in total ischemia in vitro except that the biologic changes of ischemia develop more slowly in total ischemia in vitro than in severe ischemia in vivo. The slower time course of injury, together with the uniformity of injury provided by total ischemia in vitro, may allow for more precise identification of potential lethal cellular events in ischemic injury. The production of highenergy phosphates (HEP) from anaerobic glycolysis have been estimated in both in vivo and in vitro ischemia by the measurement of lactate accumulation, and total HEP utilization has been estimated from the depletion of stores of preformed HEP. The results show that between 80% and 90% of the HEP utilized by ischemic dog left ventricle is produced by anaerobic glycolysis. The onset of irreversibility is associated with marked depletion of the HEP and adenine nucleotide pools of the tissue and the cessation of energy production via glycolysis. The cessation of anaerobic glycolysis may be caused by the low sarcoplasmic, adenosine triphosphate (ATP) concentration of the dying myocyte. In addition to the foregoing changes, irreversibly injured tissue exhibits both ultrastructural and functional evidence of disruption of the plasmalemma of the sarcolemma. The possible relationships, causal and otherwise, between severe HEP depletion and membrane damage are discussed. Both HEP depletion (ATP < 3-8% of control) and membrane damage are considered to be objective signs of the presence of irreversible myocardial ischemic injury. However, at the present time, there is no proof that these changes are causally related either to each other or to cell death in severe in vivo ischemia.     

Irreversible ischemic cell injury. Prevention by chlorpromazine of the aggregation of the intramembranous particles of rat liver plasma membranes.

Ischemic rat liver tissue has been shown previously to exhibit a markedly accelerated rate of phospholipid degradation, producing a loss of almost one half the total cellular phospholipid with 3 hours of ischemia. Pretreatment of the rats with chlorpromazine completely prevented the disturbed phospholipid metabolism at the same time that it prevented the cell death associated with as much as 3 hours of ischemia. Lipid-depleted microsomal membranes were shown previously to manifest alterations in their structure and function. The present report documents that similar structural alterations are evident in ischemic liver cell plasma membranes. The technique of freeze-fracture electron microscopy was used to examine the morphology of ischemic liver cell plasma membranes. Freeze-fracture replicas of whole tissue fragments exhibited a diffuse aggregation of the intramembranous particles in the P face of the plasma membranes. The incidence of this change correlated with the duration of ischemia. Pretreatment of the rats with chlorpromazine (20 mg/kg) for 30 minutes before inducing ischemia prevented the aggregation of the membrane-associated particles. These findings establish the existence of plasma membrane alterations in ischemic liver cells. The time course of these changes, their prevention by chlorpromazine, and their similarity to the previously described structural alterations in the microsomal membranes suggest that they are related to the loss of liver cell phospholipid. The data in the present report support the hypothesis that an accelerated phospholipid degradation and its resultant membrane dysfunction are the critical alterations that produce irreversible liver cell injury and, ultimately, cell death in ischemia.     

Effects of glucose on calcium channels in neural cells.

Hyperglycemia has been reported to alter outcome following experimental and clinical cerebral ischemia, but the mechanisms involved are incompletely understood. Since glucose influences the function of dihydropyridine-sensitive, voltage-gated Ca2+ channels in some non-neural cells, and since cellular Ca2+ overload has been implicated in the pathogenesis of ischemic neuronal injury, we examined whether glucose regulates Ca2+ channel function in a cultured neural cell line. Physiologic concentrations of glucose had no effect on free intracellular Ca2+ levels in PC12 cells, but 4-fold elevation of glucose above physiologic levels reduced the dihydropyridine-sensitive, depolarization-induced increase in Ca2+. This effect would not account for exacerbation of ischemic brain injury by hyperglycemia, but may contribute to attenuation of ischemic injury by glucose in certain settings.     

Hyperthermia: effects on renal ischemic/reperfusion injury in the rat

Hyperthermia (39.5 degrees C) worsens experimental ischemic acute renal failure (ARF). We assessed whether it does so by affecting the ischemic and/or reperfusion injury phase and if its influence is mediated through changes in kidney ATP content and xanthine oxidase-mediated oxidant stress. Rats were subjected to 25 minutes of renal pedicle occlusion and hyperthermia was imposed during ischemia alone, reflow alone (0 to 30, 30 to 60, and 60 to 90 minutes), ischemia + reflow, or without ischemia. Hyperthermia's effects on ischemic/reperfusion adenylate pools lipid peroxidation (malondialdehyde), and the severity of ARF were assessed in comparison with normothermic ischemic controls. Hyperthermia confined to ischemia profoundly worsened ARF whereas during immediate reflow (0 to 30 minutes) hyperthermia had only a mild ARF-potentiating effect. During late reflow (greater than 30 minutes) or in the absence of ischemia, hyperthermia caused no damage. Hyperthermia had only a brief negative impact on ischemic ATP content, just slightly lowering it during the first 5 minutes of ischemia. Nevertheless, much greater ischemic damage resulted, reflected by increased proximal tubular brush border membrane sloughing at the end of vascular occlusion. Hyperthermia imposed only during reflow did not affect ATP concentrations. Hyperthermia increased end-ischemic purine base concentrations by 10% due to increased ATP degradation. However, reperfusion lipid peroxidation did not result and xanthine oxidase inhibition (by oxypurinol) conferred no protection. Conclusions: (a) Hyperthermia worsens ARF predominantly by affecting ischemic, not reperfusion, injury; (b) xanthine oxidase is not an important mediator of hyperthermic-ischemic ARF; and (c) hyperthermia has a quantitatively trivial impact on ischemic ATP levels. This suggests that hyperthermia principally worsens ARF by magnifying the consequences of energy depletion (e.g., membrane damage) more than by worsening energy depletion, per se.     

Sulfated glycoprotein-2 induced endogenous resistance to ischemia and reperfusion injury in the seminiferous tubules.

Evidence of increased resistance of Sertoli cells to ischemia and reperfusion injury was presented by numerous histological, morphological, and quantitative studies. In situ hybridization techniques and immunocytochemical studies demonstrated intense expression of sulfated glycoprotein-2 (SGP-2) in Sertoli cells. We propose that protective effects of SGP-2 are the core of the differential tolerance of ischemia by the various testicular cells and the morphology of the postischemic testis. We believe that suppression of ischemic damage selectively in Sertoli cells is the consequence of the ability to produce SGP-2, an endogenous inhibitor of ischemic injury. This hypothetical function of SGP-2 is supported by its immunosuppressive properties and its structural and functional identity to several types of human complement cytolysis inhibitors.     

Cytoskeletal injury and subsarcolemmal bleb formation in dog heart during in vitro total ischemia.

In previous studies a two-step hypothesis explaining the mechanism of lethal ischemic injury to cardiac myocytes has been advanced. It proposes that damage to the myocyte cytoskeleton precedes, and predisposes the cell to, mechanical injury induced by cell swelling or by ischemic contracture. This study quantitated the prevalence of breakage of the major cytoskeletal attachment between the plasmalemma and peripheral myofibers as a function of the duration (0-180 minutes) of in vitro total ischemia in dog heart papillary muscle. Breakages of Z-band, plasmalemmal attachment complexes were few before 120 minutes of ischemia, but thereafter became more prevalent; the transition between the initial rate of appearance of the breaks and the later fast rates coincided with the appearance of severe cell swelling, ischemic contracture, and ultrastructural criteria of irreversible ischemic injury. Z-band, plasmalemmal attachment complex breakage and cell swelling resulted in formation of subsarcolemmal blebs. Two major bleb types have been discerned on ultrastructural appearance using as the criteria the preservation of integrity of the plasma-lemma and subplasmalemmal leptomeres. The identification of two types of blebs suggests two independent mechanisms of injury, the first directed at Z-band attachments, and the second at the cytoskeletal structures of A- and I-band regions of the plasmalemma.     

Investigating the Role of Ischemia vs. Elevated Hydrostatic Pressure Associated with Acute Obstructive Uropathy

Obstructive uropathy can cause irreversible renal damage. It has been hypothesized that elevated hydrostatic pressure within renal tubules and/or renal ischemia contributes to cellular injury following obstruction. However, these assaults are essentially impossible to isolate in vivo. Therefore, we developed a novel pressure system to evaluate the isolated and coordinated effects of elevated hydrostatic pressure and ischemic insults on renal cells in vitro. Cells were subjected to: (1) elevated hydrostatic pressure (80 cm H₂O); (2) ischemic insults (hypoxia (0% O₂), hypercapnia (20% CO₂), and 0 mM glucose media); and (3) elevated pressure + ischemic insults. Cellular responses including cell density, lactate dehydrogenase (LDH) release, and intracellular LDH (LDH_i), were recorded after 24 h of insult and following recovery. Data were analyzed to assess the primary effects of ischemic insults and elevated pressure. Unlike pressure, ischemic insults exerted a primary effect on nearly all response measurements. We also evaluated the data for insult interactions and identified significant interactions between ischemic insults and pressure. Altogether, findings indicate that pressure may sub-lethally effect cells and alter cellular metabolism (LDH_i) and membrane properties. Results suggest that renal ischemia may be the primary, but not the sole, cause of cellular injury induced by obstructive uropathy.     

Mechanism of liver injury following ischemia.

To clarify whether ischemic liver injury is due to ischemia itself or reperfusion, histopathological and functional changes in the liver were examined before and after liver ischemia in rats with porto-systemic collateral channels. Effects of oxygen-derived free radical scavengers or an inhibitor of platelet aggregation on development of ischemic liver injury were also examined. Liver ischemia was produced by ligation of the portal vein and hepatic artery at liver hilum for 1 hr. The primary lesion of ischemic liver injury was cloudy swelling of liver cells in the periportal and midzonal regions; it developed during ischemia. The cloudy swelling of liver cells induced uneven distribution of sinusoidal blood flow after reperfusion, and consequently individual liver cell necrosis and focal hepatocellular necrosis in the midzonal regions developed later. Elevation of cytoplasmic enzyme activities in the serum after reperfusion was due to leakage across the damaged plasma membrane of liver cells. The treatment with superoxide dismutase, catalase, or heparin had not altered the liver injury that was attributed to ischemia, biochemically and histologically. These results suggest that ischemic liver injury is due to liver cell damage developed during ischemia, and that the ischemic liver injury is not alleviated or prevented by superoxide dismutase, catalase, or heparin.     

Mechanisms of oxygen glucose deprivation-induced glutamate release from cerebrocortical slice cultures

Glutamate has been recognized to mediate ischemia-induced neuronal injury in the brain, but the source of extracellular glutamate during ischemic insults remains controversial. We investigated the mechanisms of glutamate release in organotypic cerebrocortical slice cultures prepared from rat neonates, using oxygen glucose deprivation (OGD) as an in vitro ischemia model. Slice cultures were submerged in glucose-free deoxygenated buffer for 20-60 min and glutamate released into the extracellular buffer was quantified. Cell injury was assessed by uptake of propidium iodide 24 h after OGD insult. OGD-induced time-dependent glutamate release and cell injury, both of which were potently inhibited by a sodium channel blocker tetrodotoxin (1 microM). Application of voltage-dependent Ca2+ channel blockers or of an inhibitor of vacuolar-ATPase significantly reduced OGD-induced glutamate release and cell injury. On the contrary, inhibitors of glutamate transporters exacerbated OGD-induced glutamate release and cell injury. Volume sensitive organic anion channel blockers also augmented OGD-induced glutamate release and cell injury. In addition, OGD-induced glutamate release was markedly reduced in neuron-depleted slice cultures that were pretreated with 100 microM NMDA. These results suggest that vesicular release of neuronal origin constitutes a crucial component of extracellular glutamate increase during ischemic insults, which triggers neuronal injury.     

Effect of a Transient Period of Ischemia on Myocardial Cells: I. Effects on Cell Volume Regulation

The effect of temporary periods of ischemia on the electrolytes and water of myocardial cells were studied in groups of mongrel dogs. Myocardial tissue exposed to 40 minutes of ischemia induced by occlusion of the circumflex branch of the left coronary artery developed no changes in water or electrolytes when compared to nonischemic left ventricle of the same or sham-operated animals, even though this period of ischemia is known to produce irreversible injury to many of the damaged cells. However, reperfusion of the affected myocardium with arterial blood for only 2 minutes resulted in striking increases in tissue H₂O, Na^-, Cl^- and Ca^2-. These changes in electrolytes increased in severity with longer periods of reflow, and tissue K⁺ was decreased significantly after 10 minutes of reflow had passed. Analysis of the results suggested that the tissue edema was primarily the result of cellular swelling. Myocardium exposed to 15 minutes of ischemia followed by 2 minutes of reflow showed no significant changes aside from a slight increase in Na⁺. These studies demonstrate that defects in cell volume regulation occur early in severe ischemic injury.     

高血糖对树鼩脑皮层局灶性缺血时海马微环境离子稳态及神经元继发性损伤的影响

 目的：研究高血糖对树鼩脑皮层血栓性缺血时海马微环境离子稳态的影响,探讨高血糖在缺血后神经元继发性损伤中的作用及机制。方法：用链脲佐菌素复制树鼩高血糖模型,并用光化学方法诱导脑皮层局部血栓性缺血,用单泵等速微灌流系统和离子分析仪测定缺血4 h、24 h及72 h海马离子微环境（细胞外pH值、K+、Na+、Ca2+、Cl-）的动态变化,并观察脑组织的病理形态学改变及海马神经元密度变化。结果：树鼩脑皮层缺血后,其海马微环境内出现了pH值、Na+、Ca2+及Cl-含量的降低,K+含量升高,变化以缺血后4 h为著,24 h次之,72 h无显著差异;高血糖加缺血进一步加重离子稳态的紊乱,缺血后4 h的pH值、K+和Ca2+含量,以及缺血后24 h的pH值和Na+含量与正常血糖缺血组同期值相比,变化显著（P<0.05）。形态学观察显示,光化学反应后4 h照射区皮层可见梗死灶,且患侧海马CA1区也存在缺血损伤性改变;24 h病损达高峰;72 h伴随胶质细胞增生等修复性反应。相应时点高血糖加缺血组皮层及海马的损伤均大于缺血组,以缺血后24 h(P<0.01)和72 h(P<0.05)尤为显著。结论: 树鼩脑皮层血栓性缺血形成后,缺血中心区扩布所导致的微环境内酸碱平衡及离子稳态性异常可能是海马神经元继发性损伤的重要原因,高血糖可加剧缺血脑区离子微环境的紊乱。     

Studies on the pathogenesis of ischemic cell injury XV. Reversal of ischemic cell injury in hamster trachea and human bronchus by explant culture

Hamster tracheal epithelium survived 3 hours of total ischemia at 37 degrees C as demonstrated by its ability to be maintained in organ culture for 7 days subsequent to the ischemic episode. Epithelium ischemic for longer periods did not survive in culture. Human bronchial epithelium obtained from surgically resected lungs showed the acute effects of ischemia, i.e., the cells had dilated endoplasmic reticulum and swollen mitochondria. These cellular effects of ischemia were, however, reversed by placing the bronchus in explant culture. Bronchus obtained at autopsy, 2 to 3 hours following death, showed epithelial cells suffering severe ischemic cell injury, most of which did not survive in culture, but in some cases, a few basal cells survived to form a non-keratinizing squamous epithelium.     

Depolarization-associated iron release with abrupt reduction in pulmonary endothelial shear stress in situ

This study evaluated the roles of endothelial cell membrane potential and reactive oxygen species (ROS) in the increase of tissue free iron during lung ischemia. Oxygenated ischemia was produced in the isolated rat lung by discontinuing perfusion while ventilation with O2 was maintained. We have shown previously that tissue oxygenation is maintained in this model of ischemia and that biochemical changes are the result of an abrupt reduction in endothelial shear stress. With 1 hr oxygenated ischemia, generation of ROS, evaluated by oxidation of dichlorodihydrofluorescein (H2DCF) to fluorescent dichlorofluorescein, increased 8.0-fold, lung thiobarbituric acid reactive substances (TBARS) increased 3.4-fold, and lung protein carbonyl content increased 2.4-fold. Lung tissue free iron, measured in the lung homogenate with a fluorescent desferrioxamine derivative, increased 4.0-fold during ischemia. Pretreatment of lungs with thapsigargin abolished the increase in free iron with ischemia indicating that this effect is dependent on Ca2+ release from intracellular stores. Perfusion of lungs with high (25 mM) K+ to depolarize the endothelium also led to a significant increase in tissue free iron. Pretreatment of lungs with 35 microM cromakalim, a K+-channel agonist, significantly inhibited both ischemia-induced tissue oxidant injury and the increase in free iron with ischemia or with high K+ perfusion. A similar increase in free iron was observed when lungs were ventilated with either O2 or N2 during the ischemic period or were pre-perfused with an inhibitor of ROS production (diphenyleneiodonium). These results indicate that ROS generation is not required for ischemia-mediated iron release. Thus, ROS generation and iron release with ischemia are independent although both are subsequent to endothelial cell membrane depolarization.     

Myocardial ischemia and reperfusion injury.

Myocardial ischemic injury results from severe impairment of coronary blood supply and produces a spectrum of clinical syndromes. As a result of intensive investigation over decades, a detailed understanding is now available of the complexity of the response of the myocardium to an ischemic insult. Myocardial ischemia results in a characteristic pattern of metabolic and ultrastructural changes that lead to irreversible injury. Recent studies have explored the relationship of myocardial ischemic injury to the major modes of cell death, namely, oncosis and apoptosis. The evidence indicates that apoptotic and oncotic mechanisms can proceed together in ischemic myocytes with oncotic mechanisms and morphology dominating the end stage of irreversible injury. Myocardial infarcts evolve as a wavefront of necrosis, extending from subendocardium to subepicardium over a 3- to 4-hour period. A number of processes can profoundly influence the evolution of myocardial ischemic injury. Timely reperfusion produces major effects on ischemic myocardium, including a component of reperfusion injury and a greater amount of salvage of myocardium. Preconditioning by several short bouts of coronary occlusion and reperfusion can temporarily salvage significant amounts of myocardium and extend the window of myocardial viability. Ongoing research into the mechanisms involved in reperfusion and preconditioning is yielding new insights into basic myocardial pathobiology.     

Sigma-ligands and non-competitive NMDA antagonists inhibit glutamate release during cerebral ischemia

Release of glutamate from brain cells is increased during ischemia and is thought to be involved in ischemic damage. In rat hippocampal slices the release of glutamate during 'in vitro ischemia' (anoxia without glucose) is shown to be blocked by two groups of compounds: non-competitive N-methyl-D-aspartate (NMDA) antagonists and sigma ligands. The effects are selective for the ischemic glutamate release, which is independent of extracellular Ca2+. High K+, Ca2+ dependent, induced release of glutamate is not inhibited. NMDA receptor blockade normally does not prevent ischemic transmission damage in the rat hippocampal slice. However, when ischemic glutamate release is attenuated, NMDA receptor antagonists do prevent the damage. This indicates that high levels of glutamate may cause damage via non-NMDA as well as NMDA receptors.     

Cellular mechanism of ischemic acute renal failure: Role of Ca2+ and calcium entry blockers

Summary This presentation briefly reviews the cellular mechanism of ischemic acute renal failure (ARF) with particular emphasis on the role of Ca²⁺ and calcium entry blockers (CEB). Vascular consequences of an ischemic renal insult including vasoconstriction, diminished glomerular permeability, loss of autoregulation, and hypersensitivity to renal nerve stimulation may relate to increased cellular Ca²⁺ concentration in the renal afferent arteriole and glomerular mesangial cells. Evidence is also presented that the ischemic injury to tubular plasma membranes is associated with increased Ca²⁺ uptake. With an ischemic insult of a short duration, the renal mitochondria are able to buffer the increased cellular Ca²⁺. However, after an ischemic insult of long duration, the Ca²⁺ overloaded mitochondria deteriorate, adenosine triphosphate (ATP) synthesis decreases, and cell death follows. If a sufficient number of renal tubular cells undergo this cell death, tubular obstruction, i.e. the maintenance phase of ARF, occurs.     

肢体缺血后适应对小鼠脑缺血再灌注损伤的影响及机制

目的:建立小鼠脑缺血后进行短暂肢体缺血提高脑缺血耐受模型,确定肢体缺血后适应对脑缺血时程的影响及热休克蛋白70(HSP70)的作用,探讨肢体缺血后适应(LIPostC)对脑缺血/再灌注损伤抑制作用和机制。方法:复制小鼠大脑中动脉闭塞模型(MCAO),第1批实验将小鼠分为9组:假手术组、脑缺血/再灌注组(缺血时间分别0.5 h、1 h、1.5 h、2 h组),脑缺血/再灌注+短暂肢体缺血(LIPostC)组(0.5 h+LIPostC、1 h+LIPostC、1.5 h+LIPostC、2 h+LIPostC组)。分别观察小鼠运动行为变化;TTC染色测量脑梗死体积;HE染色观察脑组织损伤程度;TUNEL法检测神经元凋亡程度。第2批实验将小鼠随机分为4组:假手术组、脑缺血/再灌注组、MCAO+LIPostC组和MCAO+LIPostC+quercetin组(缺血时间为2 h)。术后24 h用Western blotting法检测脑皮质中HSP70蛋白表达和神经功能评分。结果:脑缺血时程影响小鼠运动行为和脑损伤程度,随脑缺血时间延长,小鼠的脑再灌注损伤程度加重,其行为缺陷和脑病理变化明显;缺血2 h组脑损伤程度比缺血1.5 h组和缺血1 h组严重(P0.05)。脑缺血后不同时间施加LIPostC显示不同程度的神经保护作用。LIPostC各组与相对应的I/R组比较,其脑再灌注损伤程度呈现不同程度减轻,行为学评分降低、脑梗死体积减小,脑皮质损伤减轻,TUNEL阳性凋亡细胞数目减少。脑缺血2 h再灌注损伤较重,但LIPostC仍具有明显的脑保护作用。以2 h脑缺血小鼠为模型进行机制研究,结果表明,LIPostC可提高缺血脑组织HSP70蛋白表达,改善神经功能,HSP70抑制剂quercetin可削弱LIPostC的这种脑保护作用。结论:LIPostC可抑制MCAO小鼠的脑缺血再灌注损伤,促进缺血脑区HSP70表达和改善神经功能。HSP70在LIPostC提高MCAO小鼠的脑缺血耐受机制中发挥重要作用。