Protective Effect of Melatonin on Infrarenal Aortic Occlusion: This Effect Is Related to Anti-inflammatory Effect and An
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Protective Effect of Melatonin on Infrarenal Aortic Occlusion: This Effect Is Related to Anti-inflammatory Effect and Antioxidant Effect Ahmet Ahsen,1,8 Yucel Gonul,2 Abdurrahman Genc,3 Memnune Sena Ulu,4 Murat Yagmurca,5 Cevdet Ugur Kocogullari,6 Sefa Celik,7 and Seref Yuksel4 KEY WORDS: melatonin; aortic ischemia–reperfusion; renal; oxidative stress parameters.
INTRODUCTION Aortic cross-clamping is frequently exerted during surgery of the abdominal aorta (AA). Ischemia–reperfusion (IR) damage, which is observed in the surgery of AA, is a complex situation and is considered not only in lower extremities but also in remote tissues and organs like the lungs, kidneys, heart, and liver [1–6]. IR damage leads to important morbidity and mortality because of its systemic complications [7, 8]. Acute renal dysfunction, which is one of the most important complications following elective surgery of AA, is still a frequently seen condition (15– 22 %), but acute kidney injury (AKI) is relatively rare (1.8– 4 %) [9, 10]. Infrarenal clamping of the aorta has been shown to decrease renal blood flow especially in patients who postoperatively developed renal failure [11–13]. This clamping procedure can cause vasoconstriction in renal arteries by forming turbulent flow in the aorta at the level of renal arteries [13].
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Department of Internal Medicine, Afyon Kocatepe University School of Medicine, Ic Hastaliklari A.D., 03200 Afyonkarahisar, Turkey 2 Department of Anatomy, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey 3 Department of Physiology, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey 4 Department of Nephrology, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey 5 Department of Histology, Turgut Ozal University School of Medicine, Ankara, Turkey 6 Department of Cardiovascular Surgery, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey 7 Department of Biochemistry, Afyon Kocatepe University School of Medicine, Afyonkarahisar, Turkey 8 To whom correspondence should be addressed at Department of Internal Medicine, Afyon Kocatepe University School of Medicine, Ic Hastaliklari A.D., 03200 Afyonkarahisar, Turkey. E-mail: [email protected]
The mechanisms underlying IR-induced organ damage are likely multifactorial and interdependent, involving hypoxia, inflammatory responses, and free radical damage [14–17]. Two of the most important factors in the pathophysiology of IR injury are reactive oxygen species (ROS) and massive secretion of systemic inflammatory mediators, which especially increase in the reperfusion phase [18–20]. The endogenous antioxidants which are responsible for protecting against ROS during reperfusion have an important role in decreasing IR injury [18]. Melatonin, the main indolamine produced by the pineal gland, has been demonstrated to be an effective antioxidant and free radical scavenger [21–24]. Additionally, it has also shown an anti-inflammatory effect, which is suppression of proinflammatory cytokines like tumor necrosis fact
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