Polyethylene glycol conditioning: An effective strategy to protect against liver ischemia reperfusion injury

Abstract

Ischemia is defined by the arrest of blood flow in the organ cutting thus oxygen and metabolite supply indispensable for its survival and function. Restoration of blood flow in hypoxic tissue, called reperfusion, can paradoxically result in more destructive than beneficial effects. Ischemia reperfusion injury (IRI) is an inevitable problem in many clinical situation of liver surgery such as organ transplantation, trauma and liver resection. Therapeutic strategies against IRI have been developed during the last 60 years and great advance into the mechanisms responsible of injuries have been achieved. However, efficient therapy against IRI is still lacking and few clinical studies in phase III have proven their effectiveness. This could be due in part to the complexity of the mechanisms responsible of IRI and to the specific drugs activity and their potential adverse effects.

Polyethylene glycols (PEGs) are water soluble nontoxic polymers that have been employed in many biomedical applications such as gastrointestinal disorders and drugs pegylation. Besides its usefulness as oncotic agents in preservation solutions, it has been shown that PEGs molecules protect against cold injury and ischemic damage.

In contrast to the current pharmacological strategies used against IRI, PEG presents the advantages of being a multi-target strategy. In fact, IRI is a multifactorial disease including oxidative stress, inflammation, endoplasmic reticulum stress, mitochondrial damage, and cytoskeleton alterations which lead to cell death and organ dysfunction. PEG has been associated with the majority of these events as it has been shown that PEG reduces reactive oxygen species, prevents cell death, maintains mitochondrial integrity, and reduces inflammation and endoplasmic reticulum stress. From this perspective, it is reasonable to expect that PEG administration may be an effective therapeutic strategy against liver IRI.

The aim of this thesis was to investigate the beneficial effects of PEG 35 in different models of IRI that mimic clinical situation of liver surgery. In the first study, we investigated the impact of the administration of intravenous PEG 35 before liver warm IRI. In the second one, we investigated whether intravenously administrated PEG 35 could protect against cold IRI in steatotic rat livers. Finally, we developed a new washout solution containing PEG 35 to prevent reperfusion injury after prolonged cold preservation.

The results of the present thesis demonstrated that:

- Intravenous administration of PEG 35 at 10 mg/kg protects the liver in an experimental model of warm IRI in rats. The protective mechanisms are associated with the activation of the pro survival pathways Akt and AMPK and the inhibition of apoptosis. PEG 35 also protects the hepatocyte morphology by increasing F/G-actin ratio and activating p-p38.

- Intravenous administration of PEG 35 at 10 mg/kg protects steatotic livers in an experimental model of cold IRI in obese rats. The protective effects of PEG 35 are mediated by the preservation of mitochondrial status, the stabilisation of the cytoskeleton and the regulation of the cytoprotective AMPK and Akt signalling pathways.

- Liver graft washout with a PEG 35-containing rinse solution increases the protection against IRI in a model of isolated perfused rat liver. .Protection was due to the inhibition of metalloproteinases, the activation of cytoprotective AMPK and eNOS signalling pathways and the preservation of cytoskeleton integrity.

La lesión por isquemia reperfusión (I/R) es un proceso complejo que tiene lugar cuando un órgano se ve privado del aporte sanguíneo (isquemia) y se manifiesta de forma predominante después del posterior restablecimiento del flujo sanguíneo (reperfusión). Existen numerosas situaciones en la práctica clínica en las que el hígado se ve sometido a una situación de I/R, entre ellas, la resección hepática y el trasplante hepático.

Los polietilenglicoles (PEGs) son polímeros solubles en agua, no tóxicos y con diferentes pesos moleculares. Algunos de ellos, con un peso molecular de 20 kDa (PEG 20) y de 35 kDa (PEG 35) forman parte de la composición de soluciones de preservación de órganos (SCOT e IGL-1). Además, en varios modelos experimentales de in vivo e in vitro se ha reportado que varios PEGs ejercen efectos beneficiosos.

Atendiendo a lo anteriormente expuesto, la utilización de PEGs puede constituir una excelente herramienta para prevenir el daño hepático por I/R. El objetivo de esta tesis es investigar los efectos beneficiosos del PEG 35 en diferentes modelos de lesión por I/R, que imitan una cirugía hepática.

Nuestros resultados demuestran que:

- EL PEG 35 administrado por vía intravenosa protege eficientemente el hígado de ratas contra la I/R caliente. Los mecanismos de protección están asociados con la activación de la supervivencia vía Akt y AMPK y la inhibición de la apoptosis. El PEG 35 también protege la morfología de los hepatocitos mediante el aumento de la F/G-actina y la activación de p-p38.

- La administración intravenosa de PEG 35 protege los hígados esteatósicos en un modelo de I/R fría en ratas obesas. Los efectos protectores de PEG 35 están mediados por la preservación del estado mitocondrial, la estabilización del citoesqueleto y la regulación de las vías de señalización citoprotectoras AMPK y AKT.

- La adición de PEG 35 a una nueva solucione de lavado aumenta la protección contra la lesión por I/R en un modelo de hígado de rata aislado y perfundido a través de la inhibición de las metaloproteinasas, la activación de vías de señalización citoprotectoras AMPK y eNOS y la preservación de la integridad del citoesqueleto.