Ischemia-reperfusion injury of the intestine and protective strategies against injury.
Ischemia-reperfusion injury of the intestine is a significant problem in abdominal aortic aneurysm surgery, small bowel transplantation, cardiopulmonary bypass, strangulated hernias, and neonatal necrotizing enterocolitis. It can also occur as a consequence of collapse of systemic circulation, as in hypovolemic and septic shock. It is associated with a high morbidity and mortality. This article is a comprehensive review of the current status of the molecular biology and the strategies to prevent ischemia-reperfusion injury of the intestine. Various treatment modalities have successfully been applied to attenuate reperfusion injury in animal models of reperfusion injury of the intestine. Ischemic preconditioning has been found to be the most promising strategy against reperfusion injury during the last few years, appearing to increase the tolerance of the intestine to reperfusion injury. Although ischemic preconditioning has been shown to be beneficial in the human heart and the liver, prospective controlled studies in humans involving ischemic preconditioning of the intestine are lacking. Research focused on the application of novel drugs that can mimic the effects of ischemic preconditioning to manipulate the cellular events during reperfusion injury of the intestine is required.
GI & Hepatobiliary Research Unit, University Department of Surgery, Royal Free and University College Medical School, University College London, London NW3 2PF, UK.
Ismail Hameed
IH
Mallick
Wenxuan
W
Yang
Marc C
MC
Winslet
Alexander M
AM
Seifalian
D000818:Animals; D015415:Biomarkers / Q000097:blood; D016232:Endothelins / Q000032:analysis / Q000378:metabolism; D006360:Heat-Shock Proteins / Q000032:analysis / Q000378:metabolism; D006801:Humans; D018836:Inflammation Mediators / Q000032:analysis / Q000378:metabolism*; D007420:Intestine, Large / Q000098:blood supply*; D007421:Intestine, Small / Q000098:blood supply*; D007511:Ischemia / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D019194:Ischemic Preconditioning / Q000379:methods*; D009569:Nitric Oxide / Q000032:analysis / Q000378:metabolism; D011379:Prognosis; D051381:Rats; D015427:Reperfusion Injury / Q000401:mortality / Q000517:prevention & control* / Q000628:therapy; D012720:Severity of Illness Index; D016019:Survival Analysis; D014969:Xanthine Oxidase / Q000032:analysis / Q000378:metabolism
D015415:Biomarkers; D016232:Endothelins; D006360:Heat-Shock Proteins; D018836:Inflammation Mediators; D009569:Nitric Oxide; D014969:Xanthine Oxidase