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

• Published in: Brain and behavior 2018-05, Vol.8 (5), p.e00959-n/a
• Main Authors: Hentia, Ciprian, Rizzato, Alex, Camporesi, Enrico, Yang, Zhongjin, Muntean, Danina M., Săndesc, Dorel, Bosco, Gerardo
• Format: Article
• Language: English
• Subjects: Animals; Apoptosis - physiology; Disease Models, Animal; Edema; Female; Gene expression; Humans; hyperbaric oxygenation; Hyperbaric Oxygenation - methods; Hypoxia; Ischemia; ischemia–reperfusion injury; Ischemic Preconditioning - methods; Male; Original Research; Oxygen - administration & dosage; preconditioning; Rats, Sprague-Dawley; Reperfusion - adverse effects; Reperfusion Injury - prevention & control; Signal transduction
• ISSN: 2162-3279; 2162-3279
• DOI: 10.1002/brb3.959

Introduction Ischemia/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. Methods In 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. Results Animal 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. Conclusion Evidence 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. Experimental evidence suggests the benefits of HBO used as a preconditioning stimulus in I/R injury. HBO seems to have certain advantages over the drugs, not only because it can act on different complementary levels, but it also offers a reservoir of oxygen that may last for a few hours and may be of great importance in case of sudden hypoxia or ischemia, improves endothelial function and rheology, and decreases local inflammation and edema. Last but not least, oxygen reaches to cellular level not only carried by blood, but als