Myocardial ischemia-reperfusion injury and the influence of inflammation
Myocardial ischemia-reperfusion injury and the influence of inflammation
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DOI：
10.1016/j.tcm.2022.02.005
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发表时间：
2023-08-08
影响因子：
9.3
通讯作者：
Oosterlinck, Wouter
中科院分区：
文献类型：
--
作者：
Algoet, Michiel;Janssens, Stefan;Oosterlinck, Wouter
急性心肌梗死是由冠状动脉突然闭塞引起的，并导致相应心肌区域的缺血，这通常导致心肌坏死。如果冠状动脉灌注不中断，心肌瘢痕形成将导致心肌的不良重塑和心力衰竭。经皮冠状动脉介入治疗和外科冠状动脉旁路移植术的成功引入使得有可能实现早期血运重建/再灌注，从而限制心肌缺血区。然而，再灌注本身自相矛盾地触发心肌中的加重和加速的损伤，称为缺血再灌注（I/R）损伤。该机制部分由炎症通过多个相互作用的途径驱动。本文就I/R损伤机制及炎症改变的影响作一综述。在临床前模型中，多种药物和介入治疗策略（缺血预处理）已被证明在I/R期间是有益的，但在临床转化时却非常不成功。在这篇综述中，我们重点关注I/R损伤的常见机制，改变炎症和潜在的治疗策略。我们假设双重方法可能是有价值的，因为I/R损伤患者注定患有多种合并症和全身性低度炎症，这需要在其他策略完全有效之前进行针对性干预。副本; 2022 Elsevier Inc. All rights reserved.
Acute myocardial infarction is caused by a sudden coronary artery occlusion and leads to ischemia in the corresponding myocardial territory which generally results in myocardial necrosis. Without restora-tion of coronary perfusion, myocardial scar formation will cause adverse remodelling of the myocardium and heart failure. Successful introduction of percutaneous coronary intervention and surgical coronary artery bypass grafting made it possible to achieve early revascularisation/reperfusion, hence limiting the ischemic zone of myocardium. However, reperfusion by itself paradoxically triggers an exacerbated and accelerated injury in the myocardium, called ischemia-reperfusion (I/R) injury. This mechanism is par-tially driven by inflammation through multiple interacting pathways. In this review we summarize the current insights in mechanisms of I/R injury and the influence of altered inflammation. Multiple pharma-cological and interventional therapeutic strategies (ischemic conditioning) have proven to be beneficial during I/R in preclinical models but were notoriously unsuccessful upon clinical translation. In this review we focus on common mechanisms of I/R injury, altered inflammation and potential therapeutic strategies. We hypothesize that a dual approach may be of value because I/R injury patients are predestined with multiple comorbidities and systemic low-grade inflammation, which requires targeted intervention before other strategies can be fully effective.& COPY; 2022 Elsevier Inc. All rights reserved.