title: Combined enzymatic and antioxidative treatment reduces ischemia-reperfusion injury in rabbit skeletal muscle.
abstract: BACKGROUND
  Ischemia/reperfusion (I/R) injury is characterized by the production of oxygen-free radicals leading to disturbances in vasomotility (microvascular constriction) and microvascular permeability (interstitial edema formation). The objective was to evaluate the effect of the combined antioxidative and enzymatic preparation Phlogenzym on I/R injury of skeletal muscle.
  
  
  METHODS
  A rabbit hindlimb model of I/R (2.5/2 h) was used (IR group). Phlogenzym, containing rutin, trypsin, and bromelain, was applied enterally (60 mg/kg body weight) as a bolus 30 min prior to ischemia (Ph group). Sham-operated animals served as controls (CO group). Plasma malondialdehyde, potassium, and microvascular perfusion (monitored by laser flowmetry) were assessed. Histomorphometry and electron microscopy were performed from major adductor muscles.
  
  
  RESULTS
  Two hours after reperfusion, potassium levels were significantly elevated in IR compared to Ph group (6.7 +/- 1.2 versus 4.9 +/- 0.9 mmol/l, P < 0.006). Enhanced lipid peroxidation, apparent by increased plasma malondialdehyde levels, was ameliorated in the Ph group (1.0 +/- 0.1 versus 0.7 +/- 0.1 nmol/ml, P < 0.0001). No-reflow (reduction of blood flow by 62% in IR group) was not observed in the Ph group (P < 0.004). Phlogenzym treatment prevented microvascular constriction (17.6 +/- 2.3 versus 12.6 +/- 1.1 microm(2), P < 0.0001) and mollified interstitial edema (21.5 +/- 2.0 versus 26.0 +/- 3.7%, P < 0.017), resulting in mild ultrastructural alterations in contrast to pronounced sarcolemmal and mitochondrial damage in untreated rabbits.
  
  
  CONCLUSIONS
  Phlogenzym had a protective effect on skeletal muscle during I/R injury expressed by prevention of no-reflow and preservation of muscle tissue.
authors.affiliation: Department of Vascular Surgery, Medical University of Vienna, Vienna, Austria. christoph.neumayer@meduniwien.ac.at
authors.forename: Christoph
authors.initials: C
authors.lastname: Neumayer
authors.forename: Alexander
authors.initials: A
authors.lastname: Fügl
authors.forename: Josef
authors.initials: J
authors.lastname: Nanobashvili
authors.forename: Roland
authors.initials: R
authors.lastname: Blumer
authors.forename: Andreas
authors.initials: A
authors.lastname: Punz
authors.forename: Helmut
authors.initials: H
authors.lastname: Gruber
authors.forename: Peter
authors.initials: P
authors.lastname: Polterauer
authors.forename: Ihor
authors.initials: I
authors.lastname: Huk
mesh_terms: D000818:Animals; D000975:Antioxidants / Q000494:pharmacology*; D001794:Blood Pressure; D001963:Bromelains / Q000494:pharmacology*; D002196:Capillaries / Q000378:metabolism / Q000473:pathology / Q000648:ultrastructure; D004338:Drug Combinations; D006863:Hydrogen-Ion Concentration; D008054:Lipid Peroxides / Q000097:blood; D008297:Male; D008315:Malondialdehyde / Q000097:blood; D008833:Microcirculation / Q000187:drug effects; D008854:Microscopy, Electron; D018485:Muscle Fibers, Skeletal / Q000378:metabolism / Q000473:pathology / Q000648:ultrastructure; D018482:Muscle, Skeletal / Q000098:blood supply* / Q000378:metabolism / Q000473:pathology; D011188:Potassium / Q000378:metabolism; D011817:Rabbits; D015427:Reperfusion Injury / Q000188:drug therapy* / Q000378:metabolism* / Q000473:pathology; D012431:Rutin / Q000031:analogs & derivatives* / Q000494:pharmacology; D013858:Thiobarbiturates / Q000097:blood; D014357:Trypsin / Q000494:pharmacology*
chemical_list: D000975:Antioxidants; D004338:Drug Combinations; D008054:Lipid Peroxides; C119937:Phlogenzym; D013858:Thiobarbiturates; D008315:Malondialdehyde; D012431:Rutin; D001963:Bromelains; D014357:Trypsin; C029684:thiobarbituric acid; D011188:Potassium