cardiotomskСибирский журнал клинической и экспериментальной медициныSiberian Journal of Clinical and Experimental Medicine2713-29272713-265XTSU publishing10.29001/2073-8552-2023-38-1-37-45cardiotomsk-1711Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESДистантное посткондиционирование миокарда: механизмы, эффективность при метаболическом синдроме в экспериментальных и клинических исследованиях (обзор)Remote postconditioning of myocardium: mechanisms, efficacy in metabolic syndrome in experimental and clinical studies (review)https://orcid.org/0000-0003-1808-556XМухомедзяновА. В.MukhomedzyanovA. V.

Мухомедзянов Александр Валерьевич - кандидат медицинских наук, научный сотрудник, лаборатория экспериментальной кардиологии.

634012, Томск, ул. Киевская, 111а

Alexandr V. Mukhomedzyanov - Cand. Sci. (Med.), Research Scientist, Laboratory of Experimental Cardiology, Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences.

111a, Kievskaya str, Tomsk, 634012

sasha_m91@mail.ruhttps://orcid.org/0000-0002-5966-8916СиротинаМ. А.SirotinaM. A.

Сиротина Мария Александровна - аспирант, младший научный сотрудник, лаборатория экспериментальной кардиологии.

634012, Томск, ул. Киевская, 111а

Maria A. Sirotina - Graduate Student, Junior Research Scientist, Laboratory of Experimental Cardiology, Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences.

111a, Kievskaya str, Tomsk, 634012

sirotina_maria@mail.ruhttps://orcid.org/0000-0002-9876-6957ЛогвиновС. В.LogvinovS. V.

Логвинов Сергей Валентинович - доктор медицинских наук, профессор, старший научный сотрудник, лаборатория экспериментальной кардиологии, НИИ кардиологии, Томский НИМЦ РАН; заведующий кафедрой гистологии и эмбриологии, СибГМУ МЗ РФ.

634012, Томск, ул. Киевская, 111а; 634050, Томск, ул. Московский тракт, 2

Sergey V. Logvinov - Dr. Sci. (Med.), Professor, Senior Research Scientist, Laboratory of Experimental Cardiology, Cardiology Research Institute, Tomsk National  Research Medical Center, Russian Academy  of Sciences; Head of  Department of Histology and Embryology, Siberian State Medical University.

111a, Kievskaya str, Tomsk, 634012; 2, Moskovsky trakt str., Tomsk, 634050

s_logvinov@mail.ruhttps://orcid.org/0000-0003-2264-1928НарыжнаяН. В.NaryzhnayaN. V.

Нарыжная Наталья Владимировна - доктор медицинских наук, ведущий научный сотрудник, лаборатория экспериментальной кардиологии.

634012, Томск, ул. Киевская, 111а

Natalia  V. Naryzhnaya - Dr. Sc. (Med.),  Leading  Research  Scientist, Laboratory of Experimental Cardiology, Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences.

111a, Kievskaya str, Tomsk, 634012

natalynar@andex.ruНаучно-исследовательский институт кардиологии, Томский национальный исследовательский медицинский центр Российской академии наукРоссияCardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of SciencesRussian FederationНаучно-исследовательский институт кардиологии, Томский национальный исследовательский медицинский центр Российской академии наук; Сибирский государственный медицинский университет Министерства здравоохранения Российской ФедерацииРоссияCardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences; Siberian State Medical University of the Ministry of Health of the Russian FederationRussian Federation2023090420233813745Copyright © Мухомедзянов А.В., Сиротина М.А., Логвинов С.В., Нарыжная Н.В., 20232023Мухомедзянов А.В., Сиротина М.А., Логвинов С.В., Нарыжная Н.В.Mukhomedzyanov A.V., Sirotina M.A., Logvinov S.V., Naryzhnaya N.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sibjcem.ru/jour/article/view/1711

Дистантное посткондиционирование сердца (ДПост) – проведение нескольких периодов краткосрочной ишемии-реперфузии удаленного от сердца органа после длительного периода ишемии непосредственно перед возобновлением коронарного кровотока или же в раннем реперфузионном периоде, что приводит к сокращению размера формирующегося впоследствии инфаркта – представляет большой терапевтический потенциал для клинической практики. Механизм ДПост включает триггер, на роль которого могут претендовать аденозин, опиоиды, каннабиноиды, брадикинин, CGRP и субстанция Р. Важную роль в сигнальном механизме ДПост играют протеинкиназа С, PI3-киназа, киназа Akt и JAK. В экспериментальных исследованиях обнаружено, что генетически детерминированные или вызванные диетой метаболические изменения снижают эффективность кардиопротекции при ДПост. В качестве возможных механизмов неэффективности кардиопротекции можно предположить снижение выброса гуморальных факторов, дисфункцию рецепторного и сигнального звена ДПост, влияние метаболических нарушений на работу КАТФ-каналов, mPTP и на состояние митохондриального дыхания. Однако эти предположения нуждаются в экспериментальном обосновании. Результаты клинических исследований показывают как наличие антинекротического и инфаркт-лимитирующего эффекта ДПост при остром инфаркте миокарда (ОИМ) и кардиохирургических вмешательствах, так и отсутствие его эффективности. Роль метаболических нарушений в отсутствии эффективности ДПост у пациентов требует обоснования.

Remote postconditioning of the heart (RPost) – performed several periods of short-term ischemia-reperfusion of an remote organ after a long period of ischemia immediately before the resumption or in the early reperfusion, which leads to a reduction in the size at the subsequently formed infarction – represents a great therapeutic potential for clinical practice. The mechanism of remote postconditioning includes a trigger that can be played by adenosine, opioids, cannabinoids, bradykinin, CGRP, and substance P. Protein kinase C, PI3 kinase, Akt kinase, and JAK play an important role in the signaling mechanism of remote postconditioning. Experimental studies found that genetically determined or diet-induced metabolic changes reduce the effectiveness of cardioprotection in RPost. As possible mechanisms of cardioprotection inefficiency, we can suggest a decrease in the release of humoral factors, dysfunction of the receptor and signaling link of RPost, the effect of metabolic disorders on the functioning of KATP channel, mPTP, and on the state of mitochondrial respiration. However, these assumptions need experimental substantiation. The results of clinical studies show both the antinecrotizing and infarct-limiting effect of RPost in AMI and cardiac surgery, and the lack of its effectiveness. The role of metabolic disorders in the absence of the effectiveness of RPost in patients requires substantiation.

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The authors declare that there are no conflicts of interest present.