REVIEW: Ischemia–Reperfusion Injury of the Intestine and Protective Strategies Against Injury

Abstract

Ischemia-reperfusion injury of the intestine is a significant problem in abdominal aortic aneurysm surgery, small bowel transplantation, cardiopulmonary bypass, strangulated hernias, and neonatal necrotizing enterocolitis. It can also occur as a consequence of collapse of systemic circulation, as in hypovolemic and septic shock. It is associated with a high morbidity and mortality. This article is a comprehensive review of the current status of the molecular biology and the strategies to prevent ischemia-reperfusion injury of the intestine. Various treatment modalities have successfully been applied to attenuate reperfusion injury in animal models of reperfusion injury of the intestine. Ischemic preconditioning has been found to be the most promising strategy against reperfusion injury during the last few years, appearing to increase the tolerance of the intestine to reperfusion injury. Although ischemic preconditioning has been shown to be beneficial in the human heart and the liver, prospective controlled studies in humans involving ischemic preconditioning of the intestine are lacking. Research focused on the application of novel drugs that can mimic the effects of ischemic preconditioning to manipulate the cellular events during reperfusion injury of the intestine is required.

Ischemia-reperfusion histopathology alterations of the rabbit intestinal wall with and without exclusion of the collateral mesenteric circulation supply

“…The ischemia-reperfusion lesion may complicate many clinical conditions and plays an important role in the pathogenesis and survival following mesenteric blood flow reduction [3][4][5] , and an extensive research approach have been done [6][7][8][9][10] to understand the mechanisms of ischemia-reperfusion intestinal injury to obtain the best protection. The occlusion by selective clamping of the cranial mesenteric artery and the one hour ischemic time used being the routine procedure until now in most reported research but not comparatively studied until now the importance of different collateral blood supply due to anatomic variations specie dependents.…”

Neutrophil priming by hypoxic preconditioning protects against epithelial barrier damage and enteric bacterial translocation in intestinal ischemia/reperfusion

“…[1][2][3] Intestinal I/R may trigger mucosal barrier damage and enteric bacterial translocation (BT), leading to development of septic complications. 4,5 The intestine contains over 100 trillion commensal bacteria that are normally restricted to the lumen.…”

Propofol attenuates intestinal mucosa injury induced by intestinal ischemia-reperfusion in the rat

“…1 It is well known that intestinal I/R not only leads to the injury of intestine itself, but may also cause multiple organ dysfunction owing to damage of the intestinal mucosal barrier. 2 Of particular interest, compromised peripheral perfusion during CPB and the resulting gastrointestinal mucosal injury have been shown to lead to decreased mucosal barrier function, which may allow translocation of intestinal flora and endotoxemia and subsequently increased systemic inflammation.…”