Propofol post-conditioning alleviates hepatic ischaemia reperfusion injury via BRG1-mediated Nrf2/HO-1 transcriptional activation in human and mice.
Ge M, Chen H, et al.Journal of Cellular & Molecular Medicine 2017; 27: 27.
Aims
To explore the effects of propofol post-conditioning (PPC) on hepatic ischaemia reperfusion injury during orthotopic liver transplantation (OLT) and to explore the mechanisms by which Heme oxygenase-1 (HO-1) is up regulated using animal and cellular models.
Interventions
Participants were randomized to receive either propofol at 2 mg/kg (PPC group) or the same volume normal saline (non-PPC group), injected by intravenous pump within 10 min following onset of reperfusion.
Participants
37 patients aged 18–65 years, scheduled for OLT.
Outcomes
Measured outcomes included liver function, Brahma-related gene-1, Nuclear-related factor 2, HO-1 and NADPH:quinone oxidoreductase-1 expression levels.
Follow-up
14 days
CET Conclusions
This is a report of a good quality clinical trial that loses something in the combined reporting of human, animal and biochemical studies together. The clinical trial randomised liver transplant recipients to receive a Propofol infusion 10 minutes after liver reperfusion and found a significant reduction in serum ALT, AST, PT and for several days after transplantation. Clinical outcomes such as graft survival and re-transplantation are not presented, although the clinical study was small. The authors present many biochemical results, which showed the upregulation of Nuclear Related Factor-2 (NRF-2) and increased expression of Haem-Oxygenase-1 (HO-1) and NADPH Quinone Oxidoreductase (NQO1). From this the authors concluded that the beneficial effect of Propofol comes via an amelioration of oxidative stress by reducing reactive oxygen species. There is a wealth of biochemical and animal data in this report, to support the clinical results, but it would have been more useful to produce two separate papers so that the clinical outcomes could be more clearly presented.
Data analysis
Per protocol analysis
Trial registration
Chinese Clinical Trial Registry - ChiCTR-OCH-12002255