vtioВестник трансплантологии и искусственных органовRussian Journal of Transplantology and Artificial Organs1995-1191Academician V.I.Shumakov National Medical Research Center of Transplantology and Artificial Organs", Ministry of Health of the Russian Federation10.15825/1995-1191-2026-1-181-196vtio-2002Research ArticleТрансплантомикаTransplantomicsАктуальные проблемы профилактики и коррекции окислительного стресса при остром ишемически‑реперфузионном повреждении почкиCurrent issues in the prevention and management of oxidative stress in acute renal ischemic-reperfusion injuryПоповС. В.PopovS. V.

Санкт-Петербург

St. Petersburg

info@lucaclinic.ruГусейновР. Г.HuseynovR. G.

Санкт-Петербург

St. Petersburg

info@lucaclinic.ruСивакК. В.SivakK. V.

Санкт-Петербург

St. Petersburg

kvsivak@gmail.comЛелявинаТ. А.LelyavinaT. A.

Лелявина Татьяна Александровна

198515, Санкт-Петербург, Стрельна, ул. Декабристов, д. 6.

Тел. (981) 908-90-18

Tatiana Lelyavina

6, Dekabristov str., Strelna, St. Petersburg, 198515

Phone: (981) 908-90-18

tatianalelyavina@mail.ruМалышевЕ. А.BeshtoevA. H.

Санкт-Петербург

St. Petersburg

info@lucaclinic.ruБештоевА. Х.MalyshevE. A.

Санкт-Петербург

St. Petersburg

info@lucaclinic.ruГрушевскийР. О.GrushevskyR. O.

Санкт-Петербург

St. Petersburg

info@lucaclinic.ruАккузыевД. Ш.AkkuzyevD. Sh.

Санкт-Петербург

St. Petersburg

info@lucaclinic.ruСПб ГБУЗ «Клиническая больница Святителя Луки»; ФГБВОУ ВО «Военно-медицинская академия имени С.М. Кирова»РоссияSt. Luke’s Clinical Hospital; Kirov Military Medical AcademyRussian FederationСПб ГБУЗ «Клиническая больница Святителя Луки»; ЧОУВО «Санкт-Петербургский медико-социальный институт»РоссияSt. Luke’s Clinical Hospital; St. Petersburg Medico-Social InstituteRussian FederationСПб ГБУЗ «Клиническая больница Святителя Луки»РоссияSt. Luke’s Clinical HospitalRussian FederationСПб ГБУЗ «Клиническая больница Святителя Луки»; ФГБУ «Национальный медицинский исследовательский центр имени В.А. Алмазова» Минздрава РоссииРоссияSt. Luke’s Clinical Hospital; Almazov National Medical Research CentreRussian Federation202631032026281181196Copyright © Попов С.В., Гусейнов Р.Г., Сивак К.В., Лелявина Т.А., Малышев Е.А., Бештоев А.Х., Грушевский Р.О., Аккузыев Д.Ш., 20262026Попов С.В., Гусейнов Р.Г., Сивак К.В., Лелявина Т.А., Малышев Е.А., Бештоев А.Х., Грушевский Р.О., Аккузыев Д.Ш.Popov S.V., Huseynov R.G., Sivak K.V., Lelyavina T.A., Beshtoev A.H., Malyshev E.A., Grushevsky R.O., Akkuzyev D.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.transpl.ru/vtio/article/view/2002

Ишемически-реперфузионные повреждения почечной ткани, развивающиеся при выполнении органосохраняющих операций на почке, и в особенности при трансплантации почки, оставаясь одной из ключевых проблем урологии и трансплантологии, могут приводить к прогрессированию острого повреждения почек и хронической дисфункции органа в дальнейшем. Консервативные методы, направленные на минимизацию окислительного стресса, весьма актуальны в условиях ограниченных возможностей хирургической коррекции. Не менее актуальна проблема ИРПП в трансплантологии. Трансплантация почки является методом выбора для пациентов с терминальной стадией хронической почечной недостаточности, позволяющим значительно улучшить качество и продолжительность жизни по сравнению с заместительной почечной терапией. Ключевым этапом процедуры трансплантации является ишемия донорского органа (как тепловая, так и холодовая) и последующая реперфузия после восстановления кровотока в организме реципиента. Выраженность ИРПП напрямую влияет на функцию трансплантата, являясь одним из факторов риска отсроченной функции трансплантата (ОФТ) и реакции острого отторжения трансплантата [1, 2]. Таким образом, поиск эффективных способов профилактики и коррекции ИРПП имеет критическое значение для улучшения исходов трансплантации.

Цель работы

Цель работы: систематизация современных представлений о возможностях консервативных методов коррекции ишемически-реперфузионных повреждений почечной ткани, вызываемых избытком активных форм кислорода (АФК) и возникающих при выполнении органосохраняющих операций на почке и трансплантации почки в условиях тепловой ишемии данного органа.

Методы

Методы. Анализ литературных данных за последние 10 лет с использованием поисковой системы PubMed, электронной базы данных по доказательной медицине Cochrane Library, единой библиографической и реферативной базы данных рецензируемой научной литературы Scopus с фокусом на рандомизированные исследования, в которых тестируются лекарственные средства или вновь синтезированные соединения, подавляющие образование АФК, восстанавливающие или усиливающие антиоксидантные способности внутренней среды организма.

Заключение

Заключение. На данном этапе развития медицинской науки в качестве возможных медикаментозных средств антиоксидантной защиты почечной ткани – пока только в рамках доклинических исследований – тестируются вещества, способные блокировать молекулярные механизмы открытия поры перехода проницаемости мембран митохондрий, а также подавлять образования АФК путем ингибирования НАДФН- и ксантиноксидазы. Изучается терапевтический потенциал экзогенных ферментативных препаратов (супероксиддисмутаза, каталаза и др.), низкомолекулярных каталитических поглотителей АФК, неферментативных антиоксидантов, таких, например, как супрафизиологические дозы аскорбиновой кислоты или митохондриально адресованные митохинон и эламипретид и др. Возможно, в будущем результаты этих исследований послужат основой для создания эффективной системы антиоксидантной профилактики и лечения ишемически-реперфузионных повреждений почечной ткани при органосохраняющих операциях на почке и трансплантации.

Renal ischemia–reperfusion injury (IRI), which develops during organ-preserving kidney surgery and particularly during kidney transplantation (KT), remains a major challenge in urology and transplantology, as it can lead to progression of acute kidney injury and chronic graft dysfunction. Conservative strategies aimed at minimizing oxidative stress are especially important in situations where surgical options are limited. In transplantology, IRI is of particular relevance, as KT is the treatment of choice for patients with end-stage renal disease, significantly improving both quality of life and survival compared with renal replacement therapy. A critical stage of the transplantation procedure involves donor organ ischemia (warm and cold), followed by reperfusion after restoration of blood flow in the recipient. The severity of IRI directly influences graft function and is a key risk factor for delayed graft function and acute rejection [1, 2]. Therefore, the search for effective the search for to prevent and correct IRI is critical to improving kidney transplant outcomes.

Objective to systematize current knowledge on the potential of conservative methods for correcting renal IRI caused by excessive reactive oxygen species (ROS) during organ-preserving kidney surgery and KT under conditions of warm ischemia.

Methods

Methods. A systematic analysis of literature published over the past 10 years was conducted using the PubMed search engine, the Cochrane Library database of evidence-based medicine, and the Scopus unified bibliographic and abstract database of peer-reviewed scientific literature. Particular emphasis was placed on randomized studies evaluating drugs or newly synthesized compounds that suppress ROS formation and restore or enhance the body’s antioxidant capacity.

Conclusion

Conclusion. At the current stage of medical science, considerable attention is focused on substances capable of blocking the molecular mechanisms involved in mitochondrial membrane pore opening, as well as on agents that suppress ROS formation through inhibition of NADPH oxidase and xanthine oxidase. The therapeutic potential of exogenous enzyme preparations (such as superoxide dismutase and catalase), low-molecular-weight catalytic ROS scavengers, and non-enzymatic antioxidants – including supraphysiological doses of ascorbic acid and mitochondria-targeted agents such as mitoquinone and elamipretide – is actively being investigated. In the future, the results of these studies may form the basis for the development of effective antioxidant strategies for the prevention and treatment of renal IRI during organ-preserving kidney surgery and transplantation. 

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