Abstract
Acute mesenteric ischemia, caused by an abrupt interruption of blood flow in the mesenteric vessels, is associated with high mortality. When treated with surgical interventions or drugs to re-open the vascular lumen, the reperfusion process itself can inflict damage to the intestinal wall. Ischemia and reperfusion injury comprise complex mechanisms involving disarrangement of the splanchnic microcirculatory flow and impairment of the mitochondrial respiratory chain due to initial hypoxemia and subsequent oxidative stress during the reperfusion phase. This pathophysiologic process results in the production of large amounts of reactive oxygen (ROS) and nitrogen (RNS) species, which damage deoxyribonucleic acid, protein, lipids, and carbohydrates by autophagy, mitoptosis, necrosis, necroptosis, and apoptosis. Fluorescence-based systems using molecular probes have emerged as highly effective tools to monitor the concentrations and locations of these often short-lived ROS and RNS. The timely and accurate detection of both ROS and RNS by such an approach would help to identify early injury events associated with ischemia and reperfusion and increase overall clinical diagnostic sensitivity. This abstract describes the pathophysiology of intestinal ischemia and reperfusion and the early biological laboratory diagnosis using fluorescent molecular probes anticipating clinical decisions in the face of an extremely morbid disease.
Highlights
Acute mesenteric ischemia (AMI) is characterized by an abrupt interruption or reduction of the intestinal blood supply, either temporarily or permanently, and is a medicalsurgical emergency that requires immediate attention
The first studies related to oxygen-derived free radicals date back to 1931 when Haber and Weiss described the monovalent reduction of molecular oxygen to superoxide anion (O2−), a free radical capable of oxidizing organic structures and enzymes [9]
In 1968, McCord and Fridovich referred to xanthine oxidase (XO) as a biological source of superoxide production and found it was present in various organic tissues
Summary
Acute mesenteric ischemia (AMI) is characterized by an abrupt interruption or reduction of the intestinal blood supply, either temporarily or permanently, and is a medicalsurgical emergency that requires immediate attention. Under conditions of sustained stress, degradation of energy sources, enzyme synthesis, and activation of nuclear transcriptional factors occur, resulting in a chain reaction with significant production of ROS and/or RNS and the formation of several oxidizing substances, including lipid peroxides and carbonyl proteins Such oxidants can trigger extensive cell damage and aggravate ischemiainitiated injury in the intestinal loop [5]. Beyond their roles in processes like modulation of cell survival, differentiation, cell death, cell signaling, and inflammation-related factor production, some reactive species have clear beneficial actions, such as the containment of invading pathogens, when present in physiologically ‘normal’ levels. Abdominal computed tomography angiography with three-dimensional imaging can identify features of acute splanchnic vascular obstruction and intestinal injury It is inaccurate in assessing the extent and severity of parietal involvement [7].
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