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131
URGENTNA MEDICINA - IZBRANA POGLAVJA 2010
prostih kisikovih radikalov nastaja v poprej ishemičnem miokardu v prvih nekaj minutah reperfuzije, kjer
je molekularni kisik izpostavljen redukcijski reakciji in tvorbi prostih kisikovih radikalov kot so:
superoksidni anion, hidroksilni radikali in peroksinitrit. Prosti kisikovi radikali inaktivirajo specifične
encime ali pa sprožijo lipidno peroksidacijo.
Ishemična poškodba povzroči okvaro mitohondrija, s tem pa sproži programirano celično smrt oz.
apoptozo. Pri tem pride do aktivacije B celična levkemija/limfom 2 proteina (B cell leukemia/lymphoma
2, Bcl-2) na zunanji mitohondrijski membrani, ki aktivira protein BAX (Bcl-2 associated X protein, BAX).
Proteini BAX tvorijo pore v mitohondrijski membrani in omogočijo iztekanje citokroma c. Citokrom c se
veže na aktivacijski factor-1 apoptotske proteaze (apoptotic protease-activating factor 1, Apaf-1) in
nastane apoptosom. Apoptosom aktvira encim kaspazo 9, ki sproži kaspazno kaskado s posledično
razgradnjo proteinov, tudi proteinov v mitohondrijski membrani, ki se konča s programirano celično
smrtjo in fagocitozo celice.
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