Biomarkers in post‐reperfusion syndrome after acute lower limb ischaemia

Abstract

Ischaemia reperfusion (I/R) injury refers to tissue damage caused when blood supply returns to the tissue after a period of ischaemia. Matrix metalloproteinases (MMPs), neutrophil gelatinase-associated lipocalin (NGAL) and cytokines are biomarkers involved in several vascular complications. The aim of this study was to evaluate the role of MMPs, NGAL and inflammatory cytokines in I/R syndrome. We conducted an open label, multicentric, parallel group study, between January 2010 and December 2013. Patients with acute limb ischaemia were enrolled in this study and were divided into two groups: (i) those subjected to fasciotomy and (ii) those not subjected to fasciotomy, according to the onset of compartment syndrome. Plasma and tissue values of MMPs and NGAL as well as plasma cytokines were evaluated. MMPs, NGAL and cytokine levels were higher in patients with compartment syndrome. Biomarkers evaluated in this study may be used in the future as predictors of I/R injury severity and its possible evolution towards post-reperfusion syndrome.

Plasma MMP and TIMP evaluation in patients with deep venous thrombosis: could they have a predictive role in the development of post‐thrombotic syndrome?

“…Several papers have shown that drugs with anti‐protease activity are associated with faster and better outcomes in patients with vascular disease . In the present study, we documented that pharmacological treatment induced a decrease in MMP and NGAL levels as it has not been possible to reduce the plasma levels of MMP‐1 and MMP‐8.…”

“…TNF‐α is a pro‐inflammatory cytokine capable of inducing adhesion molecule and proteinase gene expression, and plays a role in the progression of several diseases. IL‐6 is a pro‐inflammatory cytokine with multiple functions, and is involved in inflammatory process as well as endothelial dysfunction .…”

“…DVT, deep vein thrombosis; ELISA, enzyme-linked immunosorbent assay; PTS, post-thrombotic syndrome. *P < 0⋅05 and **P < 0⋅01 versus Group C. a pro-inflammatory cytokine with multiple functions, and is involved in inflammatory process as well as endothelial dysfunction (27,31,45,46,48,49). In this study, we recorded at the time of admission high levels of TNF-α and IL-6 that decreased during the study, confirming the role of the inflammation in the development of DVT.…”

Editor's Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia

“…Recent research has concentrated on potential IRI biomarkers; these include matrix metalloproteinases, neutrophyl gelatinase associated lipocalin, and inflammatory cytokines. 182 Compartment syndrome (CS) is a serious complication following ALI revascularisation. The tissue swelling as a result of IRI raises pressure in the limb muscles which are constrained by fascial compartments.Thus, intracompartment pressure rises as a result of swelling and may be sufficiently high to reduce perfusion of already damaged tissues.…”

Traumatische Gefäßverletzungen

“…Auf zellulärer Ebene kommt es kurze Zeit nach der Gefäßverletzung und peripheren Ischämie sowie folgender Reperfusion zur Aktivierung von Monozyten und Infiltration von Makrophagen, die antigenvermittelt die frühe Immunantwort einleiten [16]. Darüber hinaus sekretieren diese Makrophagen Zytokine, wie Interleukin-1 (IL-1) und Tumor-Nekrose-Faktor-α(TNF-α), die zur Aktivierung von T-Zellen führen [17,18]. Eine Reperfusion induziert die Freisetzung von sowohl reaktiven Sauerstoffspezies (d. h. oxidativer Stress) und TNF-α aus dem Endothel, wodurch über eine NF-kB-vermittelte Transkription von Genen inflammatorische Chemokine kodiert werden [19].…”