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      Dexmedetomidine protects cardiomyocytes against hypoxia/reoxygenation injury via multiple mechanisms

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          Abstract

          <div class="section"> <a class="named-anchor" id="jcla24119-sec-0001"> <!-- named anchor --> </a> <h5 class="section-title" id="d727794e216">Background</h5> <p id="d727794e218">Myocardial infarction (MI) is a serious cardiovascular disease associated with myocardial ischemia/reperfusion (I/R) injury. Dexmedetomidine (Dex), an α2‐adrenoceptor agonist, has been reported to protect against I/R injury. We examined the cardioprotective effects of Dex on cardiomyocytes under hypoxia/reoxygenation (H/R) conditions and explored the underlying mechanisms. </p> </div><div class="section"> <a class="named-anchor" id="jcla24119-sec-0002"> <!-- named anchor --> </a> <h5 class="section-title" id="d727794e221">Materials and methods</h5> <p id="d727794e223">A H/R model was established to mimic the MI injury. The CCK‐8 assay was performed to measure cell viability. Cellular apoptosis was measured using the Annexin V fluorescein isothiocyanate (FITC)‐propidium iodide (PI) staining. The levels of interleukin (IL)‐1α and tumor necrosis factor (TNF)‐α, and the activity of lactate dehydrogenase (LDH) were measured using a commercial enzyme‐linked immunosorbent assay (ELISA) kit. Reactive oxygen species (ROS) were measured using the 2'‐7’ dichlorofluorescein diacetate (DCFH‐DA) staining assay. In addition, the levels of malondialdehyde (MDA) and the activity of superoxide dismutase (SOD), catalase (CAT), and caspase‐3 were measured using a commercial kit. siRNA was used to silence Bcl‐2, catalase, or STAT3. Western blotting was used to measure the change in the levels of proteins. </p> </div><div class="section"> <a class="named-anchor" id="jcla24119-sec-0003"> <!-- named anchor --> </a> <h5 class="section-title" id="d727794e226">Results</h5> <p id="d727794e228">Dex improved the cell viability and inhibited the inflammatory response in H9c2 cells exposed to H/R treatment. In addition, Dex inhibited apoptosis and alleviated the endoplasmic reticulum (ER) stress and oxidative stress in H9c2 cells under the H/R treatment. Mechanism investigation showed that Dex inhibited the intrinsic pathway of apoptosis. Moreover, Dex enhanced the activation of the JAK2/STAT3 signaling pathway in H/R‐treated H9c2 cells. </p> </div><div class="section"> <a class="named-anchor" id="jcla24119-sec-0004"> <!-- named anchor --> </a> <h5 class="section-title" id="d727794e231">Conclusion</h5> <p id="d727794e233">Altogether, our findings suggested Dex as a promising therapeutic agent for myocardial I/R. </p> </div><p class="first" id="d727794e236">Dexmedetomidine (Dex) is an α‐2‐adrenoceptor agonist. In the present study, we revealed that Dex is able to increase cell viability and inhibited the inflammatory response in H9c2 cells under the hypoxia/reoxygenation (H/R) treatment. Mechanistically, Dex treatment led to the activation of JAK2/STAT3 pathway which is responsible for the inhibition of the intrinsic apoptotic pathway, endoplasmic reticulum stress, and oxidative stress. Thus, Dex might be a promising agent for the treatment of myocardial I/R. <div class="boxed-text panel" id="jcla24119-blkfxd-0001"> <a class="named-anchor" id="jcla24119-blkfxd-0001"> <!-- named anchor --> </a> <div class="figure-container so-text-align-c"> <img alt="" class="figure" src="/document_file/3c61bc17-abf1-418b-beb0-ea957592da48/PubMedCentral/image/JCLA-36-e24119-g003.jpg"/> </div> <div class="panel-content"/> </div> </p>

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          Most cited references26

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          Cell biology of ischemia/reperfusion injury.

          Disorders characterized by ischemia/reperfusion (I/R), such as myocardial infarction, stroke, and peripheral vascular disease, continue to be among the most frequent causes of debilitating disease and death. Tissue injury and/or death occur as a result of the initial ischemic insult, which is determined primarily by the magnitude and duration of the interruption in the blood supply, and then subsequent damage induced by reperfusion. During prolonged ischemia, ATP levels and intracellular pH decrease as a result of anaerobic metabolism and lactate accumulation. As a consequence, ATPase-dependent ion transport mechanisms become dysfunctional, contributing to increased intracellular and mitochondrial calcium levels (calcium overload), cell swelling and rupture, and cell death by necrotic, necroptotic, apoptotic, and autophagic mechanisms. Although oxygen levels are restored upon reperfusion, a surge in the generation of reactive oxygen species occurs and proinflammatory neutrophils infiltrate ischemic tissues to exacerbate ischemic injury. The pathologic events induced by I/R orchestrate the opening of the mitochondrial permeability transition pore, which appears to represent a common end-effector of the pathologic events initiated by I/R. The aim of this treatise is to provide a comprehensive review of the mechanisms underlying the development of I/R injury, from which it should be apparent that a combination of molecular and cellular approaches targeting multiple pathologic processes to limit the extent of I/R injury must be adopted to enhance resistance to cell death and increase regenerative capacity in order to effect long-lasting repair of ischemic tissues. Copyright © 2012 Elsevier Inc. All rights reserved.
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            Dexmedetomidine: A Review of Its Use for Sedation in the Intensive Care Setting.

            Dexmedetomidine (Dexdor(®)) is a highly selective α2-adrenoceptor agonist. It has sedative, analgesic and opioid-sparing effects and is suitable for short- and longer-term sedation in an intensive care setting. In the randomized, double-blind, multicentre MIDEX and PRODEX trials, longer-term sedation with dexmedetomidine was noninferior to midazolam and propofol in terms of time spent at the target sedation range, as well as being associated with a shorter time to extubation than midazolam or propofol, and a shorter duration of mechanical ventilation than midazolam. Patients receiving dexmedetomidine were also easier to rouse, more co-operative and better able to communicate than patients receiving midazolam or propofol. Dexmedetomidine had beneficial effects on delirium in some randomized, controlled trials (e.g. patients receiving dexmedetomidine were less likely to experience delirium than patients receiving midazolam, propofol or remifentanil and had more delirium- and coma-free days than patients receiving lorazepam). Intravenous dexmedetomidine had an acceptable tolerability profile; hypotension, hypertension and bradycardia were the most commonly reported adverse reactions. In conclusion, dexmedetomidine is an important option for sedation in the intensive care setting.
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              Dexmedetomidine: review, update, and future considerations of paediatric perioperative and periprocedural applications and limitations.

              Despite lack of paediatric labelling, contributions to the literature on paediatric applications of dexmedetomidine have increased over recent years. Dexmedetomidine possesses many properties that are advantageous for a sedative and anaesthetic; it has been reported to provide sedation that parallels natural sleep, anxiolysis, analgesia, sympatholysis, and an anaesthetic-sparing effect with minimal respiratory depression. In addition, there is increasing evidence supporting its organ-protective effects against ischaemic and hypoxic injury. These favourable physiological effects combined with a limited adverse effect profile make dexmedetomidine an attractive adjunct to anaesthesia (general and regional) for a variety of procedures in paediatric operating rooms. A comprehensive understanding of the pharmacological, pharmacokinetic, and pharmacodynamic effects of dexmedetomidine is critical to maximize its safe, efficacious, and efficient paediatric perioperative applications. This review focuses on the current paediatric perioperative and periprocedural applications of dexmedetomidine and its limitations, with a consideration for the future.
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                Author and article information

                Contributors
                Journal
                Journal of Clinical Laboratory Analysis
                Clinical Laboratory Analysis
                Wiley
                0887-8013
                1098-2825
                December 09 2021
                Affiliations
                [1 ]Department of AnesthesiologyThe Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital) Hangzhou Zhejiang China
                Article
                10.1002/jcla.24119
                ff222ef5-1a20-4572-8202-432707eed988
                © 2021

                http://creativecommons.org/licenses/by/4.0/

                http://doi.wiley.com/10.1002/tdm_license_1.1

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