Feline intestinal ischemia and reperfusion: relation between radical formation and tissue damage

Reperfusion injury and reactive oxygen species: The evolution of a concept

Reperfusion injury, the paradoxical tissue response that is manifested by blood flow-deprived and oxygen-starved organs following the restoration of blood flow and tissue oxygenation, has been a focus of basic and clinical research for over 4-decades. While a variety of molecular mechanisms have been proposed to explain this phenomenon, excess production of reactive oxygen species (ROS) continues to receive much attention as a critical factor in the genesis of reperfusion injury. As a consequence, considerable effort has been devoted to identifying the dominant cellular and enzymatic sources of excess ROS production following ischemia-reperfusion (I/R). Of the potential ROS sources described to date, xanthine oxidase, NADPH oxidase (Nox), mitochondria, and uncoupled nitric oxide synthase have gained a status as the most likely contributors to reperfusion-induced oxidative stress and represent priority targets for therapeutic intervention against reperfusion-induced organ dysfunction and tissue damage. Although all four enzymatic sources are present in most tissues and are likely to play some role in reperfusion injury, priority and emphasis has been given to specific ROS sources that are enriched in certain tissues, such as xanthine oxidase in the gastrointestinal tract and mitochondria in the metabolically active heart and brain. The possibility that multiple ROS sources contribute to reperfusion injury in most tissues is supported by evidence demonstrating that redox-signaling enables ROS produced by one enzymatic source (e.g., Nox) to activate and enhance ROS production by a second source (e.g., mitochondria). This review provides a synopsis of the evidence implicating ROS in reperfusion injury, the clinical implications of this phenomenon, and summarizes current understanding of the four most frequently invoked enzymatic sources of ROS production in post-ischemic tissue.

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Reperfusion injury is implicated in a variety of human diseases and disorders.

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Evidence implicating ROS in reperfusion injury continues to grow.

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Several enzymes are candidate sources of ROS in post-ischemic tissue.

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Inter-enzymatic ROS-dependent signaling enhances the oxidative stress caused by I/R.

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Animal models of ischemia-reperfusion-induced intestinal injury: progress and promise for translational research

Research in the field of ischemia-reperfusion injury continues to be plagued by the inability to translate research findings to clinically useful therapies. This may in part relate to the complexity of disease processes that result in intestinal ischemia but may also result from inappropriate research model selection. Research animal models have been integral to the study of ischemia-reperfusion-induced intestinal injury. However, the clinical conditions that compromise intestinal blood flow in clinical patients ranges widely from primary intestinal disease to processes secondary to distant organ failure and generalized systemic disease. Thus models that closely resemble human pathology in clinical conditions as disparate as volvulus, shock, and necrotizing enterocolitis are likely to give the greatest opportunity to understand mechanisms of ischemia that may ultimately translate to patient care. Furthermore, conditions that result in varying levels of ischemia may be further complicated by the reperfusion of blood to tissues that, in some cases, further exacerbates injury. This review assesses animal models of ischemia-reperfusion injury as well as the knowledge that has been derived from each to aid selection of appropriate research models. In addition, a discussion of the future of intestinal ischemia-reperfusion research is provided to place some context on the areas likely to provide the greatest benefit from continued research of ischemia-reperfusion injury.

Antioxidant enzyme levels in intestinal and renal tissues after a 60-minute exercise in untrained mice

The present study was designed to determine the effects of exercise on the antioxidant enzymatic system and lipid peroxidation in small intestine and kidney, during the post-exercise period in untrained mice. Two days after the last adaptation running exercise, animals were ran on the treadmill for 60 min at 18 m/min. 5 degrees slope. After the acute exercise the animals were killed by cervical dislocation, immediately (0 h), 3 hours (3 h) and 24 hours (24 h) after the exercise. Control animals were killed without running exercise. Their proximal small intestinal and renal tissues were quickly removed. Changes in the concentration of thiobarbituric acid reactive substance (TBARS), as an index of lipid peroxidation, in intestine and kidney were studied in mice after the running exercise and in unexercised control group. The activities of superoxide dismutase (SOD) and glutathione peroxidase (GPx) were determined in these tissues. Tissue SOD, GPx activities and TBARS level were not increase by the exercise in kidney. Intestinal SOD activity decreased after exercise (0 h and 3 h respectively, p<0.05, p<0.01) and retumed to control levels. Intestinal GPx activity increased after exercise (0 h, p<0.05) and returned to control levels. There was no significant difference among groups in intestinal tissue TBARS levels. These findings could suggest that submaximal exercise may not cause oxidative stress in proximal small intestinal tissue and kidney.

Free radicals are formed in the brain of fetal sheep during reperfusion after cerebral ischemia

Free radical production in the brain of acutely anesthetized, exteriorized lamb fetuses (n = 11, gestational age = 135 d) was measured using spin trap methodology. Communications between the vertebral and carotid circulations were tied, producing a two-vessel supply to the brain. Flow probes and occlusion slings were placed around each carotid. The spin trap 2-ethyl-3-hydroxy-2,4,4-trimethyloxazolidine (OXANOH) was infused intermittently into one carotid at a constant rate, and blood samples were taken at intervals from the sagittal sinus. These samples were analyzed for the stable radical OXANO. using electron spin resonance spectrometry. Six animals were subjected to 30 min of complete cerebral ischemia, and five fetuses served as sham-operated control animals. During postischemic reperfusion radical formation increased 2-fold during the first 20 min. However, the elevation of OXANO. in the venous effluent from the brain did not start until the transient hyperemia had passed. It is thus concluded that the increase of OXANO. observed is caused by an augmentation of free radical production during reperfusion. Because the spin trap agent was infused directly into the arterial supply and recovered directly from the venous effluent of the brain, the site of production could be the brain tissue, the endothelial cells of the cerebral circulation, and activated leukocytes. This is the first demonstration of increased radical production from the fetal brain. It is noteworthy that it takes place despite oxygen tension of the reperfusing blood of only 3-3.5 kPa.

Use of microdialysis for in-vivo monitoring of hydroxyl free-radical generation in the rat

Free-radicals are reported to cause the tissue-damage associated with some toxins and diseases, yet there is no suitable method for routine in-vivo monitoring of these species. This paper introduces an in-vivo microdialysis technique in which the hydroxyl radical reacts with salicylate to generate dihydroxybenzoic acids (DHBA) which are measured by HPLC with electrochemical detection. When pargyline, a monoamine oxidase inhibitor, was infused into rat brain, the levels of DHBA increased markedly. When noradrenaline was administered to animals pre-treated with pargyline, DHBA levels increased markedly compared with the group treated with noradrenaline only. When the heart was subjected to 15-min regional ischaemia by occlusion of the left anterior descending coronary artery, levels of DHBA in heart dialysate were unchanged. Electrical stimulation of the stellate ganglion resulted in marked elevation of levels of DHBA the myocardial dialysate. Infusion of Fe2+ into rat liver resulted in increased formation of DHBA. When the intestine was rendered ischaemic for 10, 20 and 30 min, the highest DHBA level was obtained after 10-min ischaemia and the lowest after 30 min. These results confirm that free-radical production might make a major contribution at certain stages in the progression of the injury.

Enterocyte viability and mitochondrial function after graded intestinal ischemia and reperfusion in rats

Ischemia/reperfusion of the small intestine can lead to metabolic and structural alterations in the mucosa. Cellular dysfunction occurs when mitochondrial metabolism is compromised, which may ultimately lead to impaired organ function. The aims of this study were to assess the suppression of cellular and mitochondrial oxidative metabolism and involvement of mitochondria in the ischemia/reperfusion injury. The mitochondria were prepared from isolated enterocytes obtained from the small intestine of anesthetized adult rats following different time periods of ischemia and ischemia followed by 5 min reperfusion. Cellular and mitochondrial function were assessed using MTT (3-(4,5-Dimethylthiazol-2-yl) -2,5-diphenyl tetrazolium bromide) reduction assay. Ischemia of increasing time periods caused a progressive decrease in cellular and mitochondrial MTT reduction in enterocytes and reperfusion showed further decrease of MTT formazan formation. Inclusion of 1 mM succinate, as respiratory substrate, showed reversal of suppression of mitochondrial function in 30-60 min ischemia whereas 90 min ischemia or short time period ischemia followed by 5 min reperfusion indicated an irreversible damage to mitochondria. This study indicated that mitochondria are a sensitive target of damage due to oxygen deficiency and possibly due to sudden burst of oxygen free radicals. Mitochondria can withstand short periods of ischemia whereas long duration ischemia or reperfusion results in irreversible damage to mitochondrial function.

Quantification of tissue damage in the feline small intestine during ischaemia-reperfusion: the importance of free radicals

Intestinal ischaemia is accompanied by characteristic mucosal lesions, which can be graded according to a six-grade system proposed by Chiu et al. (1970). This report describes a continuous grading system which makes it possible to quantify the intestinal damage in connection with ischaemia-reperfusion. The present morphometric method is based on quantitative histological analysis of intestinal biopsies performed on 200 histological sections from 44 cat experiments. Radical formation was quantified by infusing close i.a. a spin trap, OXANOH, which produces a secondary stable radical, OXANO., after reacting with radicals in the tissue. OXANO. concentration was determined in venous blood samples with electron spin resonance. We demonstrate a highly significant correlation between the grading system of Chiu et al. (1970) and the morphometric analysis of this study. The tissue damage was located exclusively in the intestinal villi. Comparing the mucosal damage that occurs during 60 min of intestinal ischaemia (superior mesenteric artery pressure 15-25 mmHg) with that seen during the first 30 min reperfusion this study shows that the villus damage occurring during ischaemia is at least twice as large as the aggravation seen upon reperfusion. Furthermore, the authors demonstrate a significant correlation between rate of radical formation and villus tissue damage particularly during the first 30 min after ischaemia. It is concluded that the proposed quantitative morphological method represents a non-discrete grading system for evaluating tissue damage in connection with ischaemia-reperfusion in the small intestine. The ischaemia itself inflicted a more severe damage to the intestine than reperfusion. A significant correlation between damage and radical formation was demonstrated during the reperfusion. However, the results suggest that factors other than radical formation are of importance in explaining the tissue damage upon reperfusion. The nature of these factors is presently unknown.

Free radicals and pathogenesis during ischemia and reperfusion of the cat small intestine

BACKGROUND/AIM

In spite of the interest in free radicals as mediators of ischemic damage, most information on these species in biological systems is derived from indirect measurements. Our aim was to obtain more direct information concerning sources of free radical production during ischemia and reperfusion.

METHODS

We have performed simultaneous measurement of radical generation, purine metabolites, reduced glutathione, neutrophil infiltration and morphological appearance in the cat small intestine in vivo during 60 minutes of ischemia followed by 60 minutes of reperfusion.

RESULTS

Radical formation increased abruptly on reperfusion and remained elevated in untreated animals. Inhibition by a monoclonal antibody (IB4) against the neutrophil and by allopurinol treatment was paralleled by improvement of biochemical and morphological parameters. The radicals detected during reperfusion could be divided into one component arising directly from the neutrophils, one due to the xanthine oxidase reaction, and one unknown source.

CONCLUSIONS

Neutrophils are a major source of radical production during reperfusion after ischemia. Radicals formed in the xanthine oxidase reaction seem to function as a primer for the neutrophils. The nonsignificant linear correlation between radical formation and morphological appearance suggests that factors other than free radicals are important for the development of intestinal damage after a period of ischemia.