Abstract
Remote ischemic conditioning (RIC) is a therapeutic strategy for protecting organs or tissue against the detrimental effects of acute ischemia-reperfusion injury (IRI). It describes an endogenous phenomenon in which the application of one or more brief cycles of non-lethal ischemia and reperfusion to an organ or tissue protects a remote organ or tissue from a sustained episode of lethal IRI. Although RIC protection was first demonstrated to protect the heart against acute myocardial infarction, its beneficial effects are also seen in other organs (lung, liver, kidney, intestine, brain) and tissues (skeletal muscle) subjected to acute IRI. The recent discovery that RIC can be induced non-invasively by simply inflating and deflating a standard blood pressure cuff placed on the upper arm or leg, has facilitated its translation into the clinical setting, where it has been reported to be beneficial in a variety of cardiac scenarios. In this review article we provide an overview of RIC, the potential underlying mechanisms, and its potential as a novel therapeutic strategy for protecting the heart and other organs from acute IRI.
Highlights
Coronary heart disease (CHD) is the leading cause of morbidity and mortality worldwide (Lloyd-Jones et al, 2009)
Both ischemic preconditioning (IPC) and ischemic postconditioning require an intervention to be applied to the heart directly which may not be feasible in all clinical settings
Li et al (2004) demonstrated that delayed RIPC-induced cardioprotection was abrogated in mice with deficient in transcription factor NFκB p105 subunit supporting the important role of gene transcription in mediating the protective effect of remote ischemic conditioning (RIC)
Summary
Coronary heart disease (CHD) is the leading cause of morbidity and mortality worldwide (Lloyd-Jones et al, 2009). Murry et al (1986) first described the phenomenon of ischemic preconditioning (IPC) in which the application of brief cycles of non-lethal ischemia and reperfusion to the heart reduced subsequent myocardial infarct size in the canine heart The drawback of this therapeutic strategy is the requirement for the intervention to be applied prior to the index ischemic event, which in the case of an acute myocardial infarction (MI) is impossible to predict. Remote ischemic conditioning describes the cardioprotective effect elicited from applying one or cycles of non-lethal ischemiareperfusion to an organ or tissue remote from the heart It was originally described by Przyklenk et al (1993), who demonstrated that the application of brief occlusions and reperfusion of the circumflex coronary artery dramatically reduced the size of the MI arising from a sustained occlusion of the left anterior descending coronary artery. Soon after this discovery it was demonstrated that the heart could be protected by a www.frontiersin.org
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