An overview of protective strategies against ischemia/reperfusion injury: The role of hyperbaric oxygen preconditioning

Abstract

IntroductionIschemia/reperfusion (I/R) injury, such as myocardial infarction, stroke, and peripheral vascular disease, has been recognized as the most frequent causes of devastating disorders and death currently. Protective effect of various preconditioning stimuli, including hyperbaric oxygen (HBO), has been proposed in the management of I/R.MethodsIn this study, we searched and reviewed up‐to‐date published papers to explore the pathophysiology of I/R injury and to understand the mechanisms underlying the protective effect of HBO as conditioning strategy.ResultsAnimal study and clinic observation support the notion that HBO therapy and conditioning provide beneficial effect against the deleterious effects of postischemic reperfusion. Several explanations have been proposed. The first likely mechanism may be that HBO counteracts hypoxia and reduces I/R injury by improving oxygen delivery to an area with diminished blood flow. Secondly, by reducing hypoxia–ischemia, HBO reduces all the pathological events as a consequence of hypoxia, including tissue edema, increased affective area permeability, postischemia derangement of tissue metabolism, and inflammation. Thirdly, HBO may directly affect cell apoptosis, signal transduction, and gene expression in those that are sensitive to oxygen or hypoxia. HBO provides a reservoir of oxygen at cellular level not only carried by blood, but also by diffusion from the interstitial tissue where it reaches high concentration that may last for several hours, improves endothelial function and rheology, and decreases local inflammation and edema.ConclusionEvidence suggests the benefits of HBO when used as a preconditioning stimulus in the setting of I/R injury. Translating the beneficial effects of HBO into current practice requires, as for the “conditioning strategies”, a thorough consideration of risk factors, comorbidities, and comedications that could interfere with HBO‐related protection.

Hyperbaric oxygen preconditioning and the role of NADPH oxidase inhibition in postischemic acute kidney injury induced in spontaneously hypertensive rats

“…Besides being carried through by blood, oxygen reaches to the cellular level also by diffusion from the interstitial tissue in which it reaches high concentration during HBO treatment. It improves endothelial function and decreases local inflammation and edema [14]. Also, as increased ROS is associated with enhanced RVR, we can assume that upregulated antioxidant enzyme activities [40,41] after HBO preconditioning may decreased RVR by ROS scavenging that would further improve renal hemodynamic.…”

“…HBO is used to increase blood oxygen level that can penetrate to ischemic areas and perilesioned tissue more deeply than under normobaric conditions and has found its place, as primary or adjuvant therapy in the treatment protocols for different clinical conditions [11][12][13]. Experimental studies and clinical observations support the evidence that HBO preconditioning has beneficial effect in postischemic reperfusion injury [12][13][14]. It improves oxygen delivery to an area with diminished circulation, resulting in improved endothelial function and decreased local inflammation and edema.…”

“…It improves oxygen delivery to an area with diminished circulation, resulting in improved endothelial function and decreased local inflammation and edema. Also, it may directly affect gene expression, signal transduction and cell apoptosis [14]. It affects an antioxidant enzyme expression and the time between two exposures can be observed as pseudohypoxia which is important for upregulation of antioxidative enzymes.…”

Neuroprotective effects of human amniotic fluid stem cells-derived secretome in an ischemia/reperfusion model

“…65,66 Consequently, defining the molecular mechanisms underlying the I/R injury can improve the success of reperfusion treatment and enhance the clinical advantages for patients with stroke. 67 Numerous biological processes involving calcium excess, oxidative stress, inflammatory reactions, and endoplasmic reticulum stress are closely related to the brain I/R injury. 65,68 Interestingly, each of these activities can be influenced by mitochondria.…”

DNA Methylation May be Involved in the Analgesic Effect of Hyperbaric Oxygen via Regulating FUNDC1

“…HBO which is beneficial for formation of new blood vessels and repairing the function of nerve tissue is a noninvasive treatment for I/R disease [14]. Some researchers have reported that preconditioning HBO can protect against nervous I/R injury [15].…”