远隔后处理心肌保护的基础研究和临床应用转化

背景 在远离靶器官的组织(如肢体)实施后处理产生保护性信号(即远隔后处理)是提供内源性组织保护的一种措施.目的 综述远隔后处理的心肌保护效应、作用机制和临床应用转化现状.内容 在包括鼠、兔和猪在内的多个种属动物实验研究中,远隔后处理能够明显减轻心肌缺血/再灌注(ischemia/reperfusion,I/R)损伤、组织坏死和细胞凋亡.与远隔预处理一样,远隔后处理需要通过体液或神经信号转导通路传递或交流保护性因子或信号.靶器官保护机制的触发子包括G蛋白耦联受体配体、缺血代谢物和小分子热敏物质.有关远隔后处理改善临床结果或生物标记的临床研究结果令人鼓舞.趋向 与经典缺血预处理和后处理不同,有关远隔后处理心肌保护作用生理或分子机制的研究目前仍显不足.如果进一步的临床研究证实远隔后处理可改善患者的转归,其实践价值将是巨大的.

The basic research and clinical translation of remote postconditioning

Background Generating protective signals by postconditioning performed in a tissue remote from the target organ such as the limb, i.e.remote postconditioning, is an approach to exerting endogenous tissue protection.Objective This review will focus on cardioprotective effect, mechanisms and clinical translation of remote postconditioning.Content Remote postconditioning has been observed to reduce myocardial ischemia/reperfusion(I/R) injury experimentally in multiple species, including rat, rabbit and pig.Both tissue necrosis and apoptosis are reduced.As remote preconditioning, remote postconditioning requires a transfer or communication of protective factors or signals through humoral and/or neural pathways.Triggers of target organ protection include G-protein-coupled receptor ligands, metabolites of ischemia, or small thermolabile molecules.Clinical studies investigating improvements in clinical outcomes or biomarkers with remote postconditioning are encouraging.Trend Unlike conventional ischemic preconditioning and postconditioning, physiological and molecular mechanisms underlying remote postconditioning are still poorly understood.If further studies show improved clinical outcomes of patients by remote postconditioning, the implications for practice are immense.