Ischemia/Reperfusion Injury: Pathophysiology, Current Clinical Management, and Potential Preventive Approaches

Abstract

Myocardial ischemia reperfusion syndrome is a complex entity where many inflammatory mediators play different roles, both to enhance myocardial infarction-derived damage and to heal injury. In such a setting, the establishment of an effective therapy to treat this condition has been elusive, perhaps because the experimental treatments have been conceived to block just one of the many pathogenic pathways of the disease, or because they thwart the tissue-repairing phase of the syndrome. Either way, we think that a discussion about the pathophysiology of the disease and the mechanisms of action of some drugs may shed some clarity on the topic.

Clearance of senescent cells during cardiac ischemia–reperfusion injury improves recovery

“…Subsequent to cardiac IR, the degree to which remodeling occurs is not only dependent on the immediate detrimental processes associated with ischemia and rapid oxidative stress due to reperfusion but is also dependent on the outcomes of a complex inflammatory response (Sánchez‐Hernández et al, 2020). Tissue damage caused by IR induces an acute inflammatory response responsible for the elimination of necrotic debris (Prabhu & Frangogiannis, 2016).…”

“…We suggest that targeting senescence is a valid and clinically feasible strategy to attenuate maladaptive remodeling and promote recovery post‐IR. Major advantages of senolytic treatment over current strategies include 1) targeting senescence which occurs as a result of the cellular stress associated with IRI provides an extended therapeutic window; and 2) targeting senescence attenuates multiple components of the inflammatory responses subsequent to IR, which are detrimental to recovery (Prabhu & Frangogiannis, 2016; Sánchez‐Hernández et al, 2020). Recent studies have begun to trial senolytics in patients suffering from pulmonary fibrosis or kidney disease (Hickson et al, 2019; Justice et al, 2019), and if senolytics prove to be effective and safe, they could be transformative for cardiovascular medicine.…”

“…Sánchez-Hernández et al, 2020). While both phases of inflammation are required for successful wound healing they can also con-tribute to myocardial dysfunction.…”

Photoacoustic Imaging in Evaluating Early Intestinal Ischemia and Reperfusion Injury with Rat Models

“…In the process of ischemia and reperfusion, there is a dependence between reperfusion injury and ischemia time, and the ischemia process itself can cause injury, which is also the basis of reperfusion injury [31,32] . The essence of reperfusion injury is to further aggravate or convert the injury in ischemic phase into irreversible injury after blood ow recovery [33] .…”

Síndrome de baja gasto cardíaco en el posoperatorio de cirugía cardíaca

“…Otra complicación que ocurre en las cirugías con paro, está vinculada al fenómeno de isquemia-reperfusión, generalmente provocado por una protección miocárdica deficiente, con la cardioplejia y/o el clampeo-declampeo aórtico. El mismo se desencadena una vez restaurado el flujo sanguíneo normal, tras lo cual se genera una respuesta inflamatoria que induce mayor daño miocárdico (1,18,19) . Esto también ocurre a nivel pulmonar, al desvincularse de la CEC, situación a la que nos referimos como injuria pulmonar por isquemia-reperfusión, que se manifiesta por edema pulmonar e hipoxemia (1) .…”