Combined enzymatic and antioxidative treatment reduces ischemia-reperfusion injury in rabbit skeletal muscle.
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.
Neumayer
Christoph
C
Department of Vascular Surgery, Medical University of Vienna, Vienna, Austria. christoph.neumayer@meduniwien.ac.at
Fügl
Alexander
A
Nanobashvili
Josef
J
Blumer
Roland
R
Punz
Andreas
A
Gruber
Helmut
H
Polterauer
Peter
P
Huk
Ihor
I
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*
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