The effect of ischaemic postconditioning on mucosal integrity and function in equine jejunal ischaemia.
Authors: Verhaar Nicole, Breves Gerhard, Hewicker-Trautwein Marion, Pfarrer Christiane, Rohn Karl, Burmester Marion, Schnepel Nadine, Neudeck Stephan, Twele Lara, Kästner Sabine
Journal: Equine veterinary journal
Summary
# Editorial Summary: Ischaemic Postconditioning in Equine Jejunal Ischaemia Ischaemia–reperfusion injury represents a significant pathophysiological challenge in equine colic surgery, and ischaemic postconditioning (IPoC)—a technique involving brief cycles of reocclusion and reperfusion—has shown promise in other species and tissues for limiting this damage. Verhaar and colleagues conducted a randomised controlled trial in which 14 horses underwent 90 minutes of experimentally induced jejunal ischaemia; seven received standard reperfusion (control), whilst seven underwent three 30-second clamping cycles immediately following ischaemia release, with comprehensive assessment of mucosal integrity, electrophysiology and barrier function across the following 120 minutes. The IPoC group demonstrated significantly less villus denudation (21.5% reduction, P = 0.02) and reduced mucosal-to-serosal permeability to mannitol (15.2 nM/cm²/h reduction, P = 0.007) compared to controls, suggesting that the technique does afford protective effects against epithelial damage, though tight junction protein levels and electrophysiological parameters showed no significant differences between groups. Whilst the study was limited by its small sample size and lack of long-term outcome data, the preserved mucosal architecture and maintained barrier function observed with IPoC warrants further investigation as a potentially adjunctive intervention during colic surgery—particularly in cases where intestinal viability remains marginal and post-operative complications present significant clinical and economic costs.
Read the full abstract on PubMed
Practical Takeaways
- •IPoC may offer a simple, non-pharmacological protective strategy during surgical management of equine small intestinal ischaemia by reducing mucosal damage during reperfusion
- •The technique involves brief reocclusion cycles (3 × 30 seconds) immediately after releasing ischaemia and is feasible to implement during colic surgery
- •While mucosal protection was demonstrated, longer-term clinical outcomes and effects on surgical success rates remain unknown and require further investigation
Key Findings
- •Ischaemic postconditioning (IPoC) with three 30-second reocclusion cycles significantly reduced mucosal villus denudation by 21.5% compared to control (P = 0.02)
- •IPoC reduced mucosal-to-serosal flux rates by 15.2 nM/cm²/h (P = 0.007), indicating decreased paracellular permeability
- •IPoC significantly reduced intestinal microperfusion during all clamping cycles but had limited effect on oxygen saturation beyond the first cycle
- •No significant differences between groups were found for electrophysiological variables or tight junction protein levels (claudin-1, claudin-2, occludin)