Enzyme, Pharmaceutical Aids, Miscellaneous Last Part of Chapter no 5th.pdf
09 ir injury
1. Dept. of PathologyDept. of Pathology
Medical CollegeMedical College
Hunan Normal UniversityHunan Normal University
(( 湖南 范大学医学院病理学教研室师湖南 范大学医学院病理学教研室师 )) 1
Chapter 9Chapter 9
Ischemia-Reperfusion InjuryIschemia-Reperfusion Injury
(缺血(缺血 -- 再灌注 )损伤再灌注 )损伤
2. 22
Ischemia-Reperfusion InjuryIschemia-Reperfusion Injury
a.a. IntroductionIntroduction
b.b. EtiologyEtiology
c.c. PathogenesisPathogenesis
d.d. Alterations of Metabolism andAlterations of Metabolism and
FunctionFunction
e.e. Pathophysiological Basis ofPathophysiological Basis of
Prevention and TreatmentPrevention and Treatment
3. Ischemia
Concept
Injury More injury
Reperfusion
“A paradox”
After prolonged ischemia, reestablishment
of blood flow (reperfusion) does not relieve
ischemic injury; On the contrary, it aggravates
the tissue injury.
6. pH Paradox
Acidosis Tissue injury
Correction of
Acidosis
Tissue injury ↑
Perfusion
Paradoxes During IR Injury
7. 1955 Sewell1955 Sewell
Ligation of dog coronary artery → restoreLigation of dog coronary artery → restore
blood flow → ventricular fibrillation → deathblood flow → ventricular fibrillation → death
1960 Jennings1960 Jennings Myocardial IRIMyocardial IRI (first to name IRI)
1968 Ames1968 Ames Brain IRIBrain IRI
1972 Flore1972 Flore Kidney IRIKidney IRI
1978 Modry Lung IRI1978 Modry Lung IRI
1981 Greenberg Intestine IRI1981 Greenberg Intestine IRI
History of Ischemia-Reperfusion Injury (IRI)
Research
8. 88
Ischemia-Reperfusion InjuryIschemia-Reperfusion Injury
a.a. IntroductionIntroduction
b.b. EtiologyEtiology
c.c. PathogenesisPathogenesis
d.d. Alterations of Metabolism andAlterations of Metabolism and
FunctionFunction
e.e. Pathophysiological Basis ofPathophysiological Basis of
Prevention and TreatmentPrevention and Treatment
12. Factors Influencing IR Injury
a.a. Duration of ischemiaDuration of ischemia
b.b. Collateral circulationCollateral circulation
c.c. Dependency on oxygen supplyDependency on oxygen supply
d.d. Condition of reperfusionCondition of reperfusion
12
13. Effect of Duration of Ischemia on IRI
Ischemia
time
(min)
Reperfusion
time
(min)
Ventricular
tachycardia
(%)
Ventricula
r
fibrillation
(%)
Mortality
(%)
2 10 0 0 0
5 10 47.6 47.6 25.8
10 10 30.0 40.0 10.0
15 10 9.0 0 0
14. 1414
Ischemia-Reperfusion InjuryIschemia-Reperfusion Injury
a.a. IntroductionIntroduction
b.b. EtiologyEtiology
c.c. PathogenesisPathogenesis
d.d. Alterations of Metabolism andAlterations of Metabolism and
FunctionFunction
e.e. Pathophysiological Basis ofPathophysiological Basis of
Prevention and TreatmentPrevention and Treatment
15. Pathogenesis of IR Injury
a.a. Role of OFR/ROSRole of OFR/ROS
b.b. Calcium overloadCalcium overload
c.c. Activation of neutrophilsActivation of neutrophils
16. Free Radicals
Highly reactive group of atoms, molecules
or radicals, which carry unpaired electron
in the outer orbit.
Free radicals that contain oxygen.
Properties of free radicalsProperties of free radicals
Chemically activeChemically active
Highly oxidativeHighly oxidative
Short half-lifeShort half-life
Oxygen Free Radicals (OFR)
17. Reactive Oxygen Species (ROS)
A group of chemically reactive molecules
containing oxygen.
Oxygen free radicals: O2
., OH ., LO .
Non-free radicals:
1
O2 , H2O2
Classification of ROS
18. Free Radicals
Oxygen Free
Radicals
Reactive Oxygen
Species
Non-Free
Radicals
(Oxygen-
containing)
Non-Oxygen
Free Radicals
O2
.
OH .
LO .
1
O2
H2O2
OONO-
L .
Cl .
CH3
.
The Relationship Between
Free radicals and Reactive Oxygen Species
19. RReactive specieseactive species Half-lifeHalf-lifeHalf-lifeHalf-life
Hydroxyl radical (Hydroxyl radical (••
OH)OH)
Alcoxyl radical (ROAlcoxyl radical (RO••
))
Singlet oxygen (Singlet oxygen (11
OO22))
Peroxynitrite anion (ONOOPeroxynitrite anion (ONOO--
))
Peroxyl radical (ROOPeroxyl radical (ROO••
))
Nitric oxide (Nitric oxide (••
NO)NO)
Hydrogen peroxide (HHydrogen peroxide (H22OO22))
Superoxide anion (OSuperoxide anion (O22
••
))
1010-9-9
ss
1010-6-6
ss
1010-5-5
ss
00..05 – 105 – 1..00 ss
77 ss
1 – 101 – 10 ss
hours/hours/daysdays
hours/hours/daysdays
19
Half-life ofHalf-life of Some ROSSome ROS
20. Mechanism of OFR Increase During IR InjuryMechanism of OFR Increase During IR Injury
a.a. Increased OFR productionIncreased OFR production
b.b. Decreased OFR clearanceDecreased OFR clearance
Role of ORF/ROS
Injurious Effects of OFRInjurious Effects of OFR
29. Mechanism of OFR Increase During IR InjuryMechanism of OFR Increase During IR Injury
a.a. Increased OFR productionIncreased OFR production
b.b. Decreased OFR clearanceDecreased OFR clearance
Role of ORF/ROS
Injurious Effects of OFRInjurious Effects of OFR
34. Mechanism of OFR Increase During IR InjuryMechanism of OFR Increase During IR Injury
a.a. Increased OFR productionIncreased OFR production
b.b. Decreased OFR clearanceDecreased OFR clearance
Role of ORF/ROS
Injurious Effects of OFRInjurious Effects of OFR
40. Pathogenesis of IR Injury
a.a. Role of ORF/ROSRole of ORF/ROS
b.b. Calcium overloadCalcium overload
c.c. Activation of neutrophilsActivation of neutrophils
41. Calcium Overload
During IR, the concentration of cytosolic CaDuring IR, the concentration of cytosolic Ca2+2+
increases obviously, causing cell damage andincreases obviously, causing cell damage and
dysfunction. This phenomenon is called “Calciumdysfunction. This phenomenon is called “Calcium
Overload”.Overload”.
42. Mechanisms of Calcium Overload
NaNa++
-Ca-Ca2+2+
exchanger dysfunctionexchanger dysfunction
Damage in cell membraneDamage in cell membrane
Damage in organelle (Mito or SR) membraneDamage in organelle (Mito or SR) membrane
Na+
-Ca2+
Exchanger
Ca2+
Pump
Ca2+
[Ca2+
]e : 10-3
M [Ca2+
]i : 10-7
M
Ca2+
channel
Mito
SR
Ca2+
Na +
Ca 2+
Ca 2+
SR: Sarcoplasmic reticulum
44. Mito SR
IRI
[Ca2+
]i ↑
OFR ↑
Proteinase
Destruction
Membrane
Cytoskeleton
Nuclease
Chr Damage
Na+
-Ca2+
ExchangerCa 2+
Na +
Mito dysfunction
Mito oxidation ↓
Consequences of Calcium Overload
45. Pathogenesis of IR Injury
a.a. Role of ORF/ROSRole of ORF/ROS
b.b. Calcium overloadCalcium overload
c.c. Activation of neutrophilsActivation of neutrophils
46. IR injuryIR injury
Activation of
Neutrophils
Chemokines
(LTs, PAF, Kinin)
Adhesion molecules ↑↑
(integrin, ICAM-1)(integrin, ICAM-1)
Activation of Neutrophils
Granzymes
(elastase,
collagenase)
OFR Cytokines
48. 4848
Ischemia-Reperfusion InjuryIschemia-Reperfusion Injury
a.a. OverviewOverview
b.b. EtiologyEtiology
c.c. PathogenesisPathogenesis
d.d. Alterations of Metabolism andAlterations of Metabolism and
FunctionFunction
e.e. Pathophysiological Basis ofPathophysiological Basis of
Prevention and TreatmentPrevention and Treatment
50. ArrhythmiaArrhythmia
Ventricular fibrillationVentricular fibrillation
Ventricular TachycardiaVentricular Tachycardia
Myocardial dysfunctionMyocardial dysfunction
COCO ↓↓
Myocardial stunningMyocardial stunning
Reversible reduction of the function of heartReversible reduction of the function of heart
contraction after reperfusion.contraction after reperfusion.
Restored after a few hours or days.Restored after a few hours or days.
Myocardial IR Injury
51. 5151
Ischemia-Reperfusion InjuryIschemia-Reperfusion Injury
a.a. IntroductionIntroduction
b.b. EtiologyEtiology
c.c. PathogenesisPathogenesis
d.d. Alterations of Metabolism andAlterations of Metabolism and
FunctionFunction
e.e. Pathophysiological Basis ofPathophysiological Basis of
Prevention and TreatmentPrevention and Treatment
52. Reduce ischemia
Control reperfusion conditions
Scavenge OFR
Relieve Ca2+
overload
Improve metabolism
- Energy supplementation
- Cell protectors
Prevention and Treatment of IR Injury
53. Lower pressureLower pressure
Lower flow speedLower flow speed
Lower temperatureLower temperature
Lower pHLower pH
Lower CaLower Ca2+2+
and Naand Na++
↓↓ OFR and edemaOFR and edema
↓↓ CaCa2+2+
overloadoverload
↓↓ metabolism →↓ energymetabolism →↓ energy
consumptionconsumption
Control Reperfusion ConditionsControl Reperfusion Conditions
During ischemia, ROS generation is reduced. However, during reperfusion, ROS production is greatly increased (one of the major mechanisms of IR injury).
CABG: 冠状动脉旁路搭桥术
PTCA: 经皮冠状动脉扩张术
CABG: 冠状动脉旁路搭桥术
PTCA: 经皮腔内冠状动脉成型术
用球囊或支架 (stent: stand, support)。
1977 first case in the world.
Abundance in collateral circulation (侧枝循环), not easy for IR injury.
ROS, 活性氧簇
1O2,singlet oxygen (单线态氧)
ONOO-: 过氧亚硝基阴离子
The sodium-calcium exchanger (often denoted Na+/Ca2+ exchanger, NCX, or exchange protein) is an antiporter membrane protein that removes calcium from cells. It uses the energy that is stored in the electrochemical gradient of sodium (Na+) by allowing Na+ to flow down its gradient across the plasma membrane in exchange for the countertransport of calcium ions (Ca2+). The NCX removes a single calcium ion in exchange for the import of three sodium ions.[1] The exchanger exists in many different cell types and animal species.[2] The NCX is considered one of the most important cellular mechanisms for removing Ca2+.[2]
Should be intracellular calcium.
LBT4 increase is because of breakdown of membrane lipid leading to increase of AA.
Usually it denotes the release of these chemicals from immune cells, e.g., neutrophils and monocytes, as they come into contact with different bacteria or fungi. Two enzymes are involved, NADPH oxidase and MPO.
It plays an important role in immune response. OONO-: Peroxynitrite anion.
Hypochlorous acid (NaOCl or CaOCl) is used as bleach or disinfectant.
O2-: superoxide anion; OH-: hydroxyl radical.
O2. is the basis for production of other OFR; OH. is the most active and potent endogenous OFR.
Catalase (CAT) makes H2O2 to become H2O and O2.
Mn (Manganese) (锰) [‘mæŋɡəniːz] (not to confuse with Mg (Magnesium)(镁) [mæɡ’niːziəm] ). Cu (Copper) ['kɑːpər]
Hawking (physicist and cosmologist from U of Cambridge) suffers from a rare early-onset, slow-progressing form of amyotrophic lateral sclerosis (ALS,肌萎缩性脊髓侧索硬化征), also known as motor neuron disease or Lou Gehrig's disease, that has gradually paralysed him over the decades.[20] He now communicates using a single cheek muscle attached to a speech-generating device. Hawking married twice and has three children.全身关节不能活动,不能说话。
Allopurinol inhibit the transformation from xanthine dehydrogenase to xanthine oxidase.
Reaction of GSH to GSSG requires GSH-Px (glutathione peroxidase).
Lipids, proteins, and DNA can be oxidized.
Lipid peroxidation refers to the oxidative degradation of lipids. It is the process in which free radicals "steal" electrons from the lipids in cell membranes, resulting in cell damage. This process proceeds by a free radical chain reaction mechanism. It most often affects polyunsaturated fatty acids, because they contain multiple double bonds in between which lie methylene bridges (-CH2-) that possess especially reactive hydrogens. As with any radical reaction, the reaction consists of three major steps: initiation, propagation, and termination.
DNA breakage, crosslinking will occur. 80% of DNA OFR damage is caused by .OH.
Lead to gene mutation.
Calcium overload (a pathological process) does not equal to calcium increase.
Two types of calcium channel: VOCC: Voltage-operated Ca2+ channel; ROCC: Receptor-operated Ca2+ channel.
Mito contains 500-fold more calcium than cytosol.
Intracellular IP3 increases, calcium is released from ER to the cytoplasm.
Na-Ca exchanger is not a pump, does not need energy. It depends on Na-Ca concentration. (exchange of Na vs. Ca at 3:1). This
[Ca2+]e:10-3 ~ 10-2M; [Ca2+]i:10-8 ~10-7M
Calcium overload (a pathological process) does not equal to calcium increase.
Two types of calcium channel: VOCC: Voltage-operated Ca2+ channel; ROCC: Receptor-operated Ca2+ channel.
Mito contains 500-fold more calcium than cytosol.
Intracellular IP3 increases, calcium is released from ER to the cytoplasm.
Na-Ca exchanger is not a pump, does not need energy. It depends on Na-Ca concentration. (exchange of Na vs. Ca at 3:1). This
[Ca2+]e:10-3 ~ 10-2M; [Ca2+]i:10-8 ~10-7M
Formation of Calcium Phosphate precipitation → Mito oxidation↓
Increased OFR production is because blocking Mito oxidation. (1-2 single electron reduction increases producing more OFR).
Stunning (心肌顿抑) is a protective mechanism, leading to decreased oxygen consumption.
Cell protectors: metallothionein, taurate (牛磺酸)
Lower pH to decrease the difference between extracellular and intracellular [H+], reducing Na-Ca exchange.
Lower Na will reduce the activation of Na-Ca exchanger.