Hepato-Pancreato-Biliary and Transplant, Department of Surgery, University of Rome Tor Vergata, 00133, Rome,Italy.
Hepatology and Liver Transplant Unit, University of Tor Vergata, 00133, Rome,Italy.
Rev Recent Clin Trials. 2021;16(4):372-380. doi: 10.2174/1574887116666210729112932.
Hepatic Ischemia Reperfusion Injury (IRI) is a serious threat that characterizes the liver but also other transplantable organs. The worst effect of long-term IRI on an impaired graft could lead to irreversible damage and organ failure. Several events characterize the cascade that ultimately leads to organ failure. Among all, multiple strategies have been attempted to identify early phenomena of IRI with divergent results, and biomarkers might represent a novel approach to early detect ischemic damage.
A literature review of the current state-of-the-art on IRI was conducted in the present manuscript. Information was collected from worldwide clinical trials conducted in highly specialized institutions. Experiments conducted on IRI animal models and clinical studies were screened. The final outcomes were analyzed and reported in the present review.
Matrix Metalloproteinases (MMPs) represent an interesting example of the early detector of neutrophil invasion after acute and chronic hepatic IRI. Neutrophil Gelatinase-associated Lipocalin (NGAL) is another biomarker which seems more predictable of the IRI gravity phase. Mitochondrial flavin mononucleotide (FMN) was recently discovered and might become a reliable biomarker of hepatic IRI during Hypothermic Oxygenation Machine Perfusion (HOPE).
The available strategies to avoid IRI, despite constantly improving, are still lacking a gold standard method. Further studies are still needed to explore new options in the IRI diagnosis and treatment, and to this purpose, regenerative medicine and tissue engineering surely can play a pivotal role in the transplantation field.
肝脏缺血再灌注损伤（IRI）是一种严重的威胁，不仅会影响肝脏，还会影响其他可移植的器官。长期的 IRI 对受损移植物的最严重影响可能导致不可逆转的损伤和器官衰竭。有几个事件标志着最终导致器官衰竭的级联反应。在所有这些事件中，已经尝试了多种策略来识别 IRI 的早期现象，但结果却大相径庭，生物标志物可能代表了一种早期检测缺血损伤的新方法。
本研究对当前肝脏 IRI 研究的最新进展进行了文献回顾。信息是从全球在高度专业化机构进行的临床试验中收集的。筛选了针对 IRI 动物模型和临床研究的实验。最终结果在本综述中进行了分析和报告。
基质金属蛋白酶（MMPs）是中性粒细胞浸润急性和慢性肝 IRI 的早期检测的一个有趣的例子。中性粒细胞明胶酶相关脂质运载蛋白（NGAL）是另一种似乎更能预测 IRI 严重程度的生物标志物。线粒体黄素单核苷酸（FMN）最近被发现，可能成为低温氧合机灌注（HOPE）期间肝脏 IRI 的可靠生物标志物。
尽管不断改进，但避免 IRI 的现有策略仍然缺乏金标准方法。为了进一步探索 IRI 的诊断和治疗的新选择，仍需要进一步的研究，而再生医学和组织工程肯定可以在移植领域发挥关键作用。
