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2009, Número 3

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Bioquimia 2009; 34 (3)


Mecanismos moleculares involucrados en las estrategias mecánicas para evitar el daño por reperfusión en el miocardio isquémico

Correa-Segura F, Zazueta C

Idioma: Español
Referencias bibliográficas: 53
Paginas: 137-149
Archivo PDF: 146.45 Kb.


RESUMEN

El tamaño del infarto está determinado no solamente por la duración y la severidad de la isquemia, sino también por los procesos patológicos que ocurren en la reperfusión (daño por reperfusión). Aunque existen numerosas estrategias farmacológicas en las cuales se administran fármacos antes del inicio de la reperfusión, y que logran reducir el tamaño del infarto, se han descrito dos alternativas mecánicas que han logrado también reducir notablemente la lesión por reperfusión. El pre-acondicionamiento, que consiste en la aplicación de breves ciclos de isquemia y reperfusión, antes de una isquemia prolongada, es capaz de limitar el tamaño del infarto de manera constante. La reproducibilidad de este fenómeno usando diferentes protocolos en un variado número de especies y de preparaciones experimentales, lo condujo rápidamente a ser descrito como el “patrón de oro” para la cardioprotección. Por otro lado, el post-acondicionamiento, definido como breves ciclos de reperfusión interrumpidos por la isquemia (o hipoxia) y que se aplica después de una isquemia prolongada y antes del inicio de la reperfusión, fue introducido recientemente como una estrategia mecánica para disminuir el daño por reperfusión. El post-acondicionamiento que interviene durante los primeros minutos de reperfusión ha demostrado que reduce el tamaño del infarto significativamente. Las dos maniobras reducen la activación y disfunción endotelial, la respuesta inflamatoria a la reperfusión, la necrosis y la apoptosis a corto y largo plazo. En esta revisión describiremos los mecanismos moleculares que el pre y el post-acondicionamiento activan y que se han asociado con la cardioprotección. El conocimiento de estos mecanismos es esencial para desarrollar nuevos protocolos para conseguir la protección terapéutica de pacientes con enfermedades isquémicas cardíacas.


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