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2024, Number 2

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Rev Mex Anest 2024; 47 (2)

Myocardial postconditioning with remifentanyl in the isolated perfused rat heart

Luna-Ortiz P, Torres JC, Pilar-Báez S, Pastelín-Hernández G, Martínez-Rosas M

Language: Spanish
References: 45
Page: 91-95
PDF size: 232.70 Kb.


ABSTRACT

Perioperative myocardial ischemia can occur during surgery in high-risk patients, which could increase postoperative morbidity and mortality. The heart can tolerate the effects of acute ischemia-reperfusion (I/R) injury if several short cycles of I/R are applied prior to sustained myocardial ischemia. This strategy is used before (ischemic preconditioning) or after (ischemic postconditioning) sustained lethal ischemia. In pharmacological conditioning, drugs are used to obtain cardioprotective effects like ischemic preconditioning. Opioids have been used in pharmacological conditioning. Remifentanyl is the most extensively studied opioid in cardioprotection. Previous studies show that remifentanyl protects against I/R damage by applying it pre, trans and post-reperfusion in experimental studies and in clinical practice. In this work we studied the postconditioning induced with remifentanyl in the Langendorff model of isolated and perfused rat heart. This model reproduces myocardial ischemia in the heart isolated from an anesthetized animal. The variables recorded were left intraventricular pressure (LVP), heart rate (HR), and heart contractile activity expressed as cardiac work (TC = LVP × HR). Ischemia occurred when the perfusion was stopped for 30 minutes. Later, reperfusion was restored for two hours, observing the response of the isolated heart under the different conditions. In control hearts with I/R, the TC decreased by 40%. On the other hand, remifentanyl recovered the basal levels of TC control without I/R. Further studies are needed to evaluate the effectiveness of remifentanyl postconditioning in daily clinical practice.


REFERENCES

  1. Biccard BM. Detection and management of perioperative myocardial ischemia. Curr Opin Anaesthesiol. 2014;27:336-343.

  2. Murry CE, Jennings RB, Reimer KA. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation. 1986;74:1124-1136.

  3. Irwin MG, Wong GT. Remifentanil and opioid-induced cardioprotection. J Cardiothorac Vasc Anesth. 2015;29:S23-26.

  4. Schultz JE, Rose E, Yao Z, Gross GJ. Evidence for involvement of opioid receptors in ischemic preconditioning in rat hearts. Am J Physiol. 1995;268:H2157-2161.

  5. Schultz JJ, Hsu AK, Gross GJ. Ischemic preconditioning and morphine-induced cardioprotection involve the delta (delta)-opioid receptor in the intact rat heart. J Mol Cell Cardiol. 1997; 29:2187-2195.

  6. Schultz JJ, Hsu AK, Gross GJ. Ischemic preconditioning is mediated by a peripheral opioid receptor mechanism in the intact rat heart. J Mol Cell Cardiol. 1997;29:1355-1362.

  7. Zhang WM, Jin WQ, Wong TM: Multiplicity of kappa opioid receptor binding in the rat cardiac sarcolemma. J Mol Cell Cardiol. 1996;28:1547-1554.

  8. Zimlichman R, Gefel D, Eliahou H, et al. Expression of opioid receptors during heart ontogeny in normotensive and hypertensive rats. Circulation. 1996;93:1020-1025.

  9. Benedict PE, Benedict MB, Su TP, Bolling SF. Opiate drugs and delta receptor-mediated myocardial protection. Circulation. 1999;100:II357-60.

  10. Headrick JP, See Hoe LE, Du Toit EF, Peart JN. Opioid receptors and cardioprotection – 'opioidergic conditioning' of the heart. Br J Pharmacol. 2015;172:2026-2050.

  11. Roth S, Torregroza C, Feige K, et al. Pharmacological conditioning of the heart: an update on experimental developments and clinical implications. Int J Mol Sci. 2021;22:2519.

  12. Patel SS, Spencer CM. Remifentanil. Drugs. 1996;52:417-427.

  13. Egan TD, Minto CF, Hermann DJ, Barr J, Muir KT, Shafer SL. Remifentanil versus alfentanil: comparative pharmacokinetics and pharmacodynamics in healthy adult male volunteers. Anesthesiology. 1996;84:821-833. Erratum in: Anesthesiology. 1996;85:695.

  14. Michelsen LG, Salmenpera M, Hug CC Jr, Szlam F, VanderMeer D. Anesthetic potency of remifentanil in dogs. Anesthesiology. 1996;84:865-872.

  15. Beers R, Camporesi E. Remifentanil update: clinical science and utility. CNS Drugs. 2004;18:1085-1104.

  16. Fletcher D, Martinez V. Opioid-induced hyperalgesia in patients after surgery: a systematic review and a meta-analysis. Br J Anaesth. 2014;112:991-1004.

  17. Zhang Y, Irwin MG, Wong TM. Remifentanil preconditioning protects against ischemic injury in the intact rat heart. Anesthesiology. 2004;101:918-923.

  18. Xu ZD, Jin M, He WX, et al. Remifentanil preconditioning lowers cardiac troponin I levels in patients undergoing off-pump coronary artery bypass graft surgery. Nan Fang Yi Ke Da Xue Xue Bao. 2009;29:1554-1556.

  19. Wong GT, Huang Z, Ji S, Irwin MG. Remifentanil reduces the release of biochemical markers of myocardial damage after coronary artery bypass surgery: a randomized trial. J Cardiothorac Vasc Anesth. 2010;24:790-796.

  20. Greco M, Landoni G, Biondi-Zoccai G, et al. Remifentanil in cardiac surgery: a meta-analysis of randomized controlled trials. J CardiothoracVascAnesth. 2012;26:110-116.

  21. Hanouz JL, Yvon A, Guesne G, et al. The in vitro effects of remifentanil, sufentanil, fentanyl, and alfentanil on isolated human right atria. AnesthAnalg. 2001;93:543-549.

  22. Duman A. Saide Sahin A. Esra Atalik K et al. The in vitro effects of remifentanil and fentanyl on isolated human right atria and saphenous veins. J Cardiothorac Vasc Anesth. 2003;17:465-469.

  23. Ogletree ML, Sprung J, Moravec CS. Effects of remifentanil on the contractility of failing human heart muscle. J Cardiothoracic Vasc Anesth. 2005;19:763-767.

  24. Wong GT, Li R, Jiang LL, Irwin MG. Remifentanil post-conditioning attenuates cardiac ischemia-reperfusion injury via kappa or delta opioid receptor activation. Acta Anaesthesiol Scand. 2010;54:510-518.

  25. Sheng M, Zhang G, Wang J, et al. Remifentanil induces cardio protection against ischemia/reperfusion injury by inhibiting endoplasmic reticulum stress through the maintenance of zinc homeostasis. Anesth Analg. 2018;127:267-276.

  26. Yu CK, Li YH, Wong GT, Wong TM, Irwin MG. Remifentanil preconditioning confers delayed cardioprotection in the rat. Br J Anaesth. 2007;99:632-638.

  27. Zhang Y, Irwin MG, Wong TM, Chen M, Cao CM. Remifentanil preconditioning confers cardioprotection via cardiac kappa- and delta-opioid receptors. Anesthesiology. 2005;102:371-378.

  28. Mukhomedzyanov AV, Popov SV, Maslov LN. δ2-Opioid receptors as a target in designing new cardioprotective drugs: the role of protein kinase C, AMPK, and sarcolemmal KATP channels. Bull Exp Biol Med. 2022;173:33-36. doi: 10.1007/s10517-022-05487-2.

  29. Wong TM, Wu S. Roles of kappa opioid receptors in cardioprotection against ischemia: the signaling mechanisms. Sheng Li Xue Bao. 2003;55:115-120.

  30. Popov SV, Mukhomedzyanov AV, Maslov LN, et al. The Infarct-reducing effect of the δ2 opioid receptor agonist deltorphin II: the molecular mechanism. Membranes (Basel). 2023;13:63.

  31. Mukhomedzyanov AV, Tsibulnikov SY, Krylatov AV, Maslov LN. Comparative analysis of infarct size limiting activity of δ-opioid receptor agonists in reperfused heart in vivo. Bull Exp Biol Med. 2021;170:604-607.

  32. Mukhomedzyanov AV, Tsibulnikov SY, Maslov LN. Comparative analysis of infarct size limiting activity of κ-opioid receptor agonists in in vivo reperfused heart. Bull Exp Biol Med. 2021;170:594-597.

  33. Lecour S. Multiple protective pathways against reperfusion injury: a SAFE path without aktion? J Mol Cell Cardiol. 2009;46:607-609.

  34. Wang K, Liu Z, Zhao M, et al. κ-opioid receptor activation promotes mitochondrial fusion and enhances myocardial resistance to ischemia and reperfusion injury via STAT3-OPA1 pathway. Eur J Pharmacol. 2020;874:172987.

  35. Zhang S, Zhou Y, Zhao L, et al. κ-opioid receptor activation protects against myocardial ischemia-reperfusion injury via AMPK/Akt/eNOS signaling activation. Eur J Pharmacol. 2018;833:100-108.

  36. Zhang Y, Chen ZW, Girwin M, Wong TM. Remifentanil mimics cardioprotective effect of ischemic preconditioning via protein kinase C activation in open chest of rats. Acta Pharmacol Sin. 2005;26:546-550.

  37. Suleiman MS, Halestrap AP, Griffiths EJ. Mitochondria: a target for myocardial protection. Pharmacol Ther. 2001;89:29-46.

  38. Griffiths EJ, Halestrap AP. Mitochondrial non-specific pores remain closed during cardiac ischaemia, but open upon reperfusion. Biochem J. 1995;307:93-98.

  39. Halestrap AP, Clarke SJ, Javadov SA. Mitochondrial permeability transition pore opening during myocardial reperfusion-a target for cardioprotection. Cardiovasc Res. 2004;61:372-385.

  40. Hausenloy DJ, Duchen MR, Yellon DM. Inhibiting mitochondrial permeability transition pore opening at reperfusion protects against ischaemia-reperfusion injury. Cardiovasc Res. 2003;60:617-625.

  41. Jang Y, Xi J, Wang H, Mueller RA, Norfleet EA, Xu Z. Postconditioning prevents reperfusion injury by activating delta-opioid receptors. Anesthesiology. 2008;108:243-250.

  42. Sheng M, Zhang G, Wang J, et al. Remifentanil induces cardio protection against ischemia/reperfusion injury by inhibiting endoplasmic reticulum stress through the maintenance of zinc homeostasis. AnesthAnalg. 2018;127:267-276.

  43. Kim HS, Cho JE, Hong SW, Kim SO, Shim JK, Kwak YL. Remifentanil protects myocardium through activation of anti-apoptotic pathways of survival in ischemia-reperfused rat heart. Physiol Res. 2010;59:347-356.

  44. Li J, Hu HP, Li Y, Shao W, Zhang JZ, Wang LM. Influences of remifentanil on myocardial ischemia-reperfusion injury and the expressions of Bax and Bcl-2 in rats. Eur Rev Med Pharmacol Sci. 2018;22:8951-8960.

  45. Lewinska A, Adamczyk-Grochala J, Bloniarz D, et al. Remifentanil preconditioning protects against hypoxia-induced senescence and necroptosis in human cardiac myocytes in vitro. Aging. 2020;12:13924-13938. doi: 10.18632/aging.103604.




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