• Rocha de Sousa Paulo Thales PT Heart Institute (InCor), LIM 11, University of São Paulo Medical School, São Paulo, São Paulo, Brazil., Ana Cristina Breithaupt-Faloppa, de Jesus Correia Cristiano C Heart Institute (InCor), LIM 11, University of São Paulo Medical School, São Paulo, São Paulo, Brazil., Raif Restivo Simão, Sueli Gomes Ferreira, Alfredo Inácio Fiorelli, Moreira Luiz Felipe Pinho LFP Heart Institute (InCor), LIM 11, University of São Paulo Medical School, São Paulo, São Paulo, Brazil., and Paulina Sannomiya.
• Heart Institute (InCor), LIM 11, University of São Paulo Medical School, São Paulo, São Paulo, Brazil.
• J. Vasc. Surg. 2018 Feb 1; 67 (2): 597-606.

ObjectiveIn surgical aortic repair or cardiac surgery with aorta occlusion, the occurrence of mesenteric ischemia and bowel injury has been associated with higher short-term mortality. The vascular protection of estrogens has been investigated and is mainly mediated by increasing the availability of nitric oxide (NO). Therefore, this study investigated the role of 17β-estradiol on visceral ischemia-reperfusion (I/R) injury after descending aorta occlusion in male rats.MethodsMesenteric ischemia was induced in male Wistar rats by placing a 2F Fogarty arterial embolectomy catheter (Edwards Lifesciences, Irvine, Calif) in the descending aorta, which remained occluded for 15 minutes, followed by reperfusion for up to 2 hours. Rats were divided into four groups: (1) rats that underwent surgical manipulation only (sham, n = 22); (2) rats that underwent I/R injury (n = 22); (3) rats treated with intravenous 17β-estradiol (280 μg/kg) 30 minutes before I/R (n = 22); (4) or at the beginning of reperfusion (n = 22). Intestinal histopathologic changes were evaluated by histomorphometry. Mesenteric microcirculatory alterations were assessed by laser Doppler flowmetry and intravital microscopy technique. Protein expression of intercellular adhesion molecule-1, P-selectin, endothelial NO synthase (eNOS), and endothelin-1 was evaluated by immunohistochemistry; in addition, eNOS and endothelin-1 gene expressions were quantified by real-time polymerase chain reaction. Serum cytokines were measured by enzyme-linked immunosorbent assay.ResultsRelative to the sham group, the I/R group exhibited a highly pronounced loss of intestine mucosal thickness, a reduction in mesenteric blood flow (P = .0203), increased migrated leukocytes (P < .05), and high mortality rate (35%). Treatment with 17β-estradiol before aorta occlusion preserved intestine mucosal thickness (P = .0437) and mesenteric blood flow (P = .0251), reduced the number of migrated leukocytes (P < .05), and prevented any fatal occurrence. Furthermore, 17β-estradiol downregulated the expression of intercellular adhesion molecule-1 (P = .0001) and P-selectin (P < .0001) on the endothelium and increased the protein expression of eNOS (P < .0001). The gene expressions of eNOS and endothelin-1 did not differ between the groups.ConclusionsThe prophylactic treatment with 17β-estradiol showed better overall repercussions and was able to prevent any fatal occurrence, increase eNOS expression, thus preserving mesenteric perfusion and intestinal integrity, and reduce inflammation.Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

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