Reperfusion injury natural history

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [4] Associate Editor(s)-in-Chief: Shivam Singla, M.D.[5] Anjan K. Chakrabarti, M.D. [6] Kashish Goel, M.D.

Overview

Reperfusion injury mechanism is mostly studied by scientists in cats and dogs with the first experimental study done in 1955 by Sewell and later different studies were done to understand more about the reperfusion injury mechanisms. Most of the complications associated with reperfusion injury are mainly due to the formation of reactive oxygen species and neutrophil activation ultimately resulting in tissue damage-causing Ischemia, Infarction, Haemorrhage, and edema. Prognosis, in general, is poor with Ischemia-reperfusion injury resulting in tissue injury and damage. The most important determinant of prognosis is the time taken to reperfuse the ischemic tissue. More the delay in time to reperfusion, worse the prognosis is.

Natural History

Reperfusion Injury Natural History along with the different terms given by various scientists along the course of time starting from 1950's- 1980. [1]

The Ischemia-reperfusion injury was first seen in 1955 by Sewell while performing ligation of Dog's coronary arteries

Then later Jennings gave the term Myocardial IRI in 1960. He is the first person to name the term Ischemia Reperfusion Injury(IRI) on the basis of histological changes in canine myocardium.

Later various terms were given by the scientist depending upon the various organ system involved:

  • Then Modry gave the term Lung IRI in 1978

Ischemic preconditioning was first explained by Murry et al. In 1986 he performed a study in dog explaining the importance of ischemia reperfusion in dogs on infarct size reduction[1].

Natural History Of Reperfusion Injury. [2]

Ischemic post-conditioning was given by Zhao et al in 2003 and explained this with the help of an experiment showing a small episode of Ischemia or reperfusion performed immediately after the resumption of flow following a period of ischemia. They found that this helped in the reduction of infarct size in dogs by up to 40%[2].

Complications

  • Early reperfusion in the course of STEMI prevents myocardial necrosis and may lead to complete recovery of function resulting in a better prognosis as compared to a situation where there is a delay in perfusion[4].

Prognosis

Prognosis in CNS patients

References

  1. Varga G, Ghanem S, Szabo B, Nagy K, Pal N, Tanczos B, Somogyi V, Barath B, Deak A, Matolay O, Bidiga L, Peto K, Nemeth N (August 2020). "Which remote ischemic preconditioning protocol is favorable in renal ischemia-reperfusion injury in the rat?". Clin. Hemorheol. Microcirc. doi:10.3233/CH-200916. PMID 32804120 Check |pmid= value (help).
  2. Mentias A, Mahmoud AN, Elgendy IY, Elgendy AY, Barakat AF, Abuzaid AS, Saad M, Kapadia SR (December 2017). "Ischemic postconditioning during primary percutaneous coronary intervention". Catheter Cardiovasc Interv. 90 (7): 1059–1067. doi:10.1002/ccd.26965. PMID 28296005.
  3. Hausenloy DJ, Yellon DM (January 2013). "Myocardial ischemia-reperfusion injury: a neglected therapeutic target". J. Clin. Invest. 123 (1): 92–100. doi:10.1172/JCI62874. PMC 3533275. PMID 23281415.
  4. Niccoli G, Montone RA, Ibanez B, Thiele H, Crea F, Heusch G, Bulluck H, Hausenloy DJ, Berry C, Stiermaier T, Camici PG, Eitel I (July 2019). "Optimized Treatment of ST-Elevation Myocardial Infarction". Circ. Res. 125 (2): 245–258. doi:10.1161/CIRCRESAHA.119.315344. PMID 31268854.
  5. Gonzalez LM, Moeser AJ, Blikslager AT (January 2015). "Animal models of ischemia-reperfusion-induced intestinal injury: progress and promise for translational research". Am. J. Physiol. Gastrointest. Liver Physiol. 308 (2): G63–75. doi:10.1152/ajpgi.00112.2013. PMC 4297854. PMID 25414098.
  6. Yang JL, Yang YR, Chen SD (November 2019). "The potential of drug repurposing combined with reperfusion therapy in cerebral ischemic stroke: A supplementary strategy to endovascular thrombectomy". Life Sci. 236: 116889. doi:10.1016/j.lfs.2019.116889. PMID 31610199.