Endogenous and exogenous protection from surgically induced reactive oxygen and nitrogen species
Bryan J Mathis1, Hideyuki Kato2, Yujiro Matsuishi3
1International Medical Center, University of Tsukuba Affiliated Hospital, 2-1-1 Amakubo, Tsukuba, 305-8576, Ibaraki, Japan. bmathis@md.tsukuba.ac.jp.
Abstract:
Surgical intervention creates reactive oxygen species through diverse molecular mechanisms, including direct stimulation of immune-mediated inflammation necessary for wound healing. However, dysregulation of redox homeostasis in surgical patients overwhelms the endogenous defense system, slowing the healing process and damaging organs. We broadly surveyed reactive oxygen species that result from surgical interventions and the endogenous and/or exogenous antioxidants that control them. This study assimilates current reports on surgical sources of reactive oxygen and nitrogen species along with literature reports on the effects of endogenous and exogenous antioxidants in human, animal, and clinical settings. Although exogenous antioxidants are generally beneficial, endogenous antioxidant systems account for over 80% of total activity, varying based on patient age, sex, and health or co-morbidity status, especially in smokers, the diabetic, and the obese. Supplementation of exogenous compounds for support in surgical patients is thus theoretically beneficial, but a lack of persuasive clinical evidence has left this potential patient support strategy without clear guidelines. A more thorough understanding of the mechanisms of exogenous antioxidants in patients with compromised health statuses and pharmacokinetic profiling may increase the utility of such support in both the operating and recovery rooms.
Insights
Surgery generates reactive oxygen species, impacting healing. While antioxidants help, more research is needed to guide their use in surgical patients, especially those with health issues.
Area of Science:
- Biomedical Science
- Surgical Research
- Oxidative Stress Biology
Background:
- Surgical procedures inherently generate reactive oxygen species (ROS) via inflammatory pathways crucial for wound healing.
- Imbalances in redox homeostasis during surgery can impede healing and cause organ damage.
- Endogenous and exogenous antioxidants play critical roles in managing ROS in surgical contexts.
Purpose of the Study:
- To comprehensively review the sources of ROS/RNS (reactive nitrogen species) from surgical interventions.
- To evaluate the impact of endogenous and exogenous antioxidants on surgical outcomes.
- To identify knowledge gaps regarding antioxidant supplementation in surgical patients.
Main Methods:
- Systematic assimilation of current literature on surgical ROS generation.
- Review of studies on endogenous and exogenous antioxidant effects in human, animal, and clinical settings.
- Analysis of factors influencing endogenous antioxidant activity.
Main Results:
- Endogenous antioxidant systems provide over 80% of total antioxidant activity, influenced by patient factors like age, sex, and comorbidities (diabetes, obesity, smoking).
- Exogenous antioxidants show general benefits, but clinical evidence for their efficacy in surgical patients is limited.
- Significant variability exists in endogenous antioxidant capacity based on individual health status.
Conclusions:
- Exogenous antioxidant supplementation holds theoretical promise for surgical patients but lacks robust clinical validation and clear guidelines.
- Further research into the mechanisms of exogenous antioxidants in compromised patient populations is essential.
- Pharmacokinetic profiling and targeted studies are needed to optimize antioxidant support in surgical and recovery settings.
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