Therapeutic delivery of hydrogen sulfide for salvage of ischemic skeletal muscle after the onset of critical ischemia

Extremity ischemia is a limb- and life-threatening clinical scenario that must be treated expeditiously. Although rapid recognition and revascularization is crucial, there are few options regarding pharmacologic means to mitigate the effect of ischemia and subsequent reperfusion (ischemia-reperfusion injury). This is particularly true in situations of unanticipated ischemia, where no interventions can be undertaken before the onset of ischemia. Hydrogen sulfide is protective of muscle cells against ischemia-reperfusion injury when delivered before the onset of ischemia, and this study evaluated the effect of hydrogen sulfide delivered after the onset of ischemia. The promising results of the in vitro and in vivo studies suggest that hydrogen sulfide may in the future be an important adjunct to prompt surgical or endovascular intervention in episodes of unanticipated extremity ischemia.