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The effect of pre- and post-remote ischemic conditioning reduces the injury associated with intestinal ischemia/reperfusion

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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.

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Acknowledgements

Dr. Agostino Pierro was supported by The Hospital for Sick Children and by the Canadian Institutes of Health Research (CIHR) Foundation Grant (353857).

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Authors and Affiliations

  1. Division of General and Thoracic Surgery, The Hospital for Sick Children, 1526-555 University Ave, Toronto, ON, M5G1X8, Canada

    Hiromu Miyake, Yuhki Koike, Shogo Seo, Carol Lee, Bo Li, Niloofar Ganji & Agostino Pierro

  2. Department of Pediatric Surgery, Shizuoka Children’s Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 4208660, Japan

    Hiromu Miyake

  3. University of Toronto, Toronto, Canada

    Agostino Pierro

Authors
  1. Hiromu Miyake
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  2. Yuhki Koike
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  3. Shogo Seo
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  4. Carol Lee
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  5. Bo Li
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  6. Niloofar Ganji
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  7. Agostino Pierro
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Contributions

Study conception and design: HM, AP. Acquisition of data: HM. Analysis and interpretation of data: HM. Drafting of manuscript: HM, AP. Critical revision of manuscript: YK, SS, CL, BL, NG.

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Correspondence to Agostino Pierro.

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Miyake, H., Koike, Y., Seo, S. et al. The effect of pre- and post-remote ischemic conditioning reduces the injury associated with intestinal ischemia/reperfusion. Pediatr Surg Int 36, 1437–1442 (2020). https://doi.org/10.1007/s00383-020-04762-5

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  • DOI: https://doi.org/10.1007/s00383-020-04762-5

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