A new approach to prevent ischemia/reperfusion injury in a rat model: remote ischemic conditioning
To evaluate the effect of remote ischemic conditioning (RIC) on ovarian ischemia/reperfusion injury in a rat model.
A total of 36 Wistar albino rats with a body weight of 220–250 g were used for this study. Right adnexal torsion was performed for 180 min, and at the end of the period, the adnex was released and the abdomen was reclosed for 180 min for reperfusion. Torsion and detorsion procedures were applied to all rats except group 1 (sham, control). The right lower extremity was tied to perform remote tissue ischemia in groups 3, 4, 5, and 6. The goal of the procedure, which was purplish discoloration and pulselessness of the extremity, was maintained. After 5 min of ischemia, reperfusion was achieved for 5 min. Repeating this procedure 3 times was defined as hypoxia attacks (RIC). Retrieved ovaries were examined for tissue injury with biochemical, histopathologic, and immunohistochemical analysis.
Unlike the control group, vascular congestion, hemorrhage, edema, and inflammatory cell infiltration were observed in group 2 (only I/R [ischemia/reperfusion]). In groups 3 (I/R + RIC), 4 (I/R + RIC), 5 (I/R + RIC), and 6 (I/R + RIC), edema and inflammatory cell infiltration were not observed. However, vascular congestion and hemorrhage that were detected in these groups were higher than in group 1 (Control) and less than in group 2 (I/R). The Caspase-3 Index was found to be increased in all groups compared to group 1 (P < .001). However, the increase in the RIC-performed groups was significantly less than in group 2. The apoptotic index, which was determined by the TUNEL, was also found to be increased in all groups compared to group 1 (P < .001). When the comparison was made in relation to group 2, the decrease of AI in RIC-performed groups was statistically significant, except the decrease in group 6 (P = .29).
It is not clinically conceivable to prepare the tissue for pre-ischemia in ovarian torsion. However, the RIC application, which will be initiated if torsion is suspected when arrangements are made for surgery, might be a simple, effective, and inexpensive approach to prevent I/R injury in the clinic.
KeywordsIschemia Remote ischemia Ovarian torsion Reperfusion injury Rat model
The authors thank Vehbi Yavuz Tokgoz for coordination at the beginning of the study.
MS: 65%: Hypothesis, development of project, surgery, and statistical analyses. MG: 10%: Surgery. TK: 10%: Surgery. Murat Usta: 5%: Biochemistry. BT: 5%: Histology. CT: 5%: Histology
The study was supported by the Giresun University BAP Committee (SAG-BAP-A-160317-87).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 5.Galinier P, Carfagna L, Delsol M, Ballouhey Q, Lemasson F, Le Mandat A, Moscovici J, Guitard J, Pienkowski C, Vaysse P (2009) Ovarian torsion. Management and ovarian prognosis: a report of 45 cases. J Pediatr Surg 44(9):1759–1765. https://doi.org/10.1016/j.jpedsurg.2008.11.058 CrossRefGoogle Scholar
- 6.Borekci B, Gundogdu C, Altunkaynak BZ, Calik M, Altunkaynak ME, Unal D, Unal B (2009) The protective effect of dehydroepiandrosterone on ovarian tissues after torsion-detorsion injury: a stereological and histopathological study. Eurasian J Med 41(1):22–27Google Scholar
- 8.Limani P, Linecker M, Oberkofler CE, Barmettler G, Kaech A, Graf R, Humar B, Clavien PA (2016) Remote ischemic preconditioning: a novel strategy in rescuing older livers from ischemia-reperfusion injury in a rodent model. Ann Surg 264(5):797–803. https://doi.org/10.1097/sla.0000000000001765 CrossRefGoogle Scholar
- 9.Wang S, Li H, He N, Sun Y, Guo S, Liao W, Liao Y, Chen Y, Bin J (2017) Impact of remote ischaemic preconditioning on major clinical outcomes in patients undergoing cardiovascular surgery: a meta-analysis with trial sequential analysis of 32 randomised controlled trials. Int J Cardiol 227:882–891. https://doi.org/10.1016/j.ijcard.2016.11.278 CrossRefGoogle Scholar
- 12.Kruger E, Heller DS (1999) Adnexal torsion. A clinicopathologic review of 31 cases. J Reprod Med 44(2):71–75Google Scholar
- 16.Ozsoy AZ, Nursal AF, Arici A, Butun I, Uysal M, Irmak Sapmaz H, Kunt Isguder C, Yilmaz Dogru H, Tas U (2016) Effects of carvedilol on an ischemia/reperfusion model: biochemical, histopathological and immunohistochemical evaluation. J Obstet Gynaecol Res 42(9):1132–1140. https://doi.org/10.1111/jog.13028 CrossRefGoogle Scholar
- 21.Petrowsky H, McCormack L, Trujillo M, Selzner M, Jochum W, Clavien PA (2006) A prospective, randomized, controlled trial comparing intermittent portal triad clamping versus ischemic preconditioning with continuous clamping for major liver resection. Ann Surg 244(6):921–928. https://doi.org/10.1097/01.sla.0000246834.07130.5d (Discussion 928–930) CrossRefGoogle Scholar