Controlling Reperfusion Injury With Controlled Reperfusion: Historical Perspectives and New Paradigms.
Controlling Reperfusion Injury With Controlled Reperfusion: Historical Perspectives and New Paradigms.
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DOI：
10.1177/10742484211046674
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发表时间：
2021-11
影响因子：
2.6
通讯作者：
Haworth KJ
中科院分区：
文献类型：
--
作者：
Fischesser DM;Bo B;Benton RP;Su H;Jahanpanah N;Haworth KJ
心脏再灌注损伤是急性心肌梗死和其他类型缺血性心脏病治疗后的一个公认的结果。许多心脏保护方案和治疗方法已经在临床前模型中取得了成功。不幸的是，缺乏成功的大规模临床转化，部分原因可能是再灌注可导致细胞死亡的多种途径。基于过去的研究结果，新的心脏保护方案的研究仍在继续。一类仍在积极研究中的心脏保护方案是控制再灌注。本类包括以可控的方式改变再灌注液的含量或再灌注液的机械特性（如压力和流量）的方法。这篇综述文章首先提供了细胞死亡的主要途径的基本概述，这些途径有可能通过各种形式的控制再灌注来解决，包括无回流现象、离子失衡（特别是钙超载）和氧化应激。描述了各种控制再灌注方法，以及临床前和临床阶段的机制和结果导向研究的总结。这篇综述将局限于改变内源性血液成分的方法。这些方法包括缺血后适应、轻度再灌注、控制缺氧再灌注、控制高氧再灌注、控制酸性再灌注和控制离子再灌注。这篇综述最后讨论了过去方法的局限性，以及它们如何指出未来研究的潜在方向。
Cardiac reperfusion injury is a well-established outcome following treatment of acute myocardial infarction and other types of ischemic heart conditions. Numerous cardioprotection protocols and therapies have been pursued with success in pre-clinical models. Unfortunately, there has been lack of successful large-scale clinical translation, perhaps in part due to the multiple pathways that reperfusion can contribute to cell death. The search continues for new cardioprotection protocols based on what has been learned from past results. One class of cardioprotection protocols that remain under active investigation is that of controlled reperfusion. This class consists of those approaches that modify, in a controlled manner, the content of the reperfusate or the mechanical properties of the reperfusate (e.g., pressure and flow). This review article first provides a basic overview of the primary pathways to cell death that have the potential to be addressed by various forms of controlled reperfusion, including no-reflow phenomenon, ion imbalances (particularly calcium overload), and oxidative stress. Descriptions of various controlled reperfusion approaches are described, along with summaries of both mechanistic and outcome-oriented studies at the pre-clinical and clinical phases. This review will constrain itself to approaches that modify endogenously-occurring blood components. These approaches include ischemic postconditioning, gentle reperfusion, controlled hypoxic reperfusion, controlled hyperoxic reperfusion, controlled acidotic reperfusion, and controlled ionic reperfusion. This review concludes with a discussion of the limitations of past approaches and how they point to potential directions of investigation for the future.
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发表时间：
2009-04-01
影响因子：
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