Limb Ischemic Conditioning Induces Oxidative Stress Followed by a Correlated Increase of HIF-1α in Healthy Volunteers

Abstract

Local and remote ischemic preconditioning has been used as a protective intervention against ischemia/reperfusion (I/R) damage in several preclinical and clinical studies. However, its physiological mechanisms are not completely known. I/R increases the production of reactive oxygen species, which also serve as messengers for a variety of functions. Hypoxia-inducible factor 1 alpha (HIF-1α) is probably the most important transcription factor mediator of hypoxic signaling. We hypothesized that limb ischemic conditioning (LIC) induces a local oxidative/nitrosative stress and a correlated increase of HIF-1α plasma levels. An observational, prospective, and single-center study has been conducted in 27 healthy volunteers. LIC was applied: three cycles (5min of ischemia followed by 5min of reperfusion) using an ischemia cuff placed on the upper left arm. Time course of 8-isoprostane, nitrite, and HIF-1α levels was measured in blood plasma. Venous blood was sampled from the left arm before tourniquet inflation (basal) and after LIC: 1min and 2hr for 8-isoprostane and nitrite; and 1min, 2hr, 8hr, 24hr, and 48hr for HIF-1α. After LIC, we have found an early increase of 8-isoprostane and nitrite. HIF-1α increased at 2 and 8hr after LIC. We found a direct correlation between HIF-1α and 8-isoprostane and nitrite plasma levels. We concluded that LIC induces an early oxidative/nitrosative stress in the arm followed by an increase of HIF-1α plasma levels correlated with 8-isoprostane and nitrite levels, possibly as a local response.