The effect of pre- and post-remote ischemic conditioning reduces the injury associated with intestinal ischemia/reperfus
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ORIGINAL ARTICLE
The effect of pre‑ and post‑remote ischemic conditioning reduces the injury associated with intestinal ischemia/reperfusion Hiromu Miyake1,2 · Yuhki Koike1 · Shogo Seo1 · Carol Lee1 · Bo Li1 · Niloofar Ganji1 · Agostino Pierro1,3 Accepted: 8 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Midgut volvulus is associated with intestinal ischemia/reperfusion (IR) injury and can progress to severe intestinal damage. Remote ischemic conditioning (RIC) reduces IR-induced injury in distant organs. The aim of this study was to investigate whether RIC protects the intestine from IR injury. Methods We investigated intestinal IR injury in 3 weeks old SD rats. Animals underwent: (i) sham laparotomy, (ii) intestinal IR injury, (iii) intestinal IR + RIC during ischemia, or (iv) intestinal IR + RIC after reperfusion. Intestinal IR injury was achieved by 45 min occlusion of superior mesenteric artery followed by de-occlusion. RIC was administered via four cycles of 5 min of hind limb ischemia followed by 5 min reperfusion. Animals were sacrificed 24 h after surgery and the ileum was harvested for evaluation. Results Intestinal injury was present after IR. However, this injury was reduced in both IR + RIC groups. Expression of inflammatory cytokine IL6 was lower in IR + RIC groups compared to IR alone. Carbonyl protein was also significantly lower in IR + RIC compared to IR, indicating lower oxidative stress in both IR + RIC groups. Conclusion Remote ischemic conditioning attenuated intestinal injury, inflammation, and oxidative stress in experimental intestinal ischemia/reperfusion injury. Remote ischemic conditioning may be useful in children with midgut volvulus to reduce the intestinal injury. Level of evidence Experimental study. Type of study Animal experiment. Keywords Ischemia reperfusion injury · Remote ischemic conditioning · Inflammation · Oxidative stress
Introduction Intestinal ischemia–reperfusion (IR) injury is involved in a number of pediatric gastrointestinal diseases, such as midgut volvulus, necrotizing enterocolitis, trauma, cardio-pulmonary disease, and shock [1]. Midgut volvulus is usually one of the most severe complications of intestinal malrotation [2]. Occasionally midgut volvulus causes extensive bowel necrosis requiring massive intestinal resection. This * Agostino Pierro [email protected] 1
Division of General and Thoracic Surgery, The Hospital for Sick Children, 1526‑555 University Ave, Toronto, ON M5G1X8, Canada
2
Department of Pediatric Surgery, Shizuoka Children’s Hospital, 860 Urushiyama, Aoi‑ku, Shizuoka 4208660, Japan
3
University of Toronto, Toronto, Canada
devastating complication can result in short bowel syndrome. After derotation of the midgut volvulus, the viability of some parts of the intestine is unclear, leading to a second look laparotomy 24–48 h later [2]. Increasing the viability of “questionable” intestine could help to avoid extensive intestinal resection and minimize the risk of short bo
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