Remote ischemic conditioning: the enigmatic transfer of protection.

Abstract

This editorial refers to ‘Glucagon-like peptide-1 (GLP-1) mediates cardioprotection by remote ischaemic conditioning’ by Basalay et al. , doi: 10.1093/cvr/cvw216. Remote ischemic conditioning is the systemic response to brief non-lethal ischemia/reperfusion in various tissues or organs which provides protection to a number of target tissues or organs over a distance. These target organs, including brain, heart, liver, lungs, intestine, kidneys, skeletal muscle, and skin, are then more resistant to sustained ischemia/reperfusion.1 Remote ischemic conditioning can be elicited prior (pre-), during (per-) and following (post-conditioning) the sustained ischemia. The peripheral stimulus appears to involve the activation of sensory nerve fibers and/or vascular shear stress, and the protective signal transduction in the target organs, notably in the heart, is very similar to that of local ischemic pre- and post-conditioning. The most fascinating feature of remote ischemic conditioning, however, is the transfer of a protective signal over a larger distance. This transfer appears to mechanistically involve both humoral and neuronal pathways but is largely enigmatic in its details.1,2 On the other hand, just this transfer of protection from the periphery to central organs such as brain, heart, and kidneys has attracted clinical interest for potential translation. A number of studies in patients undergoing cardiovascular surgery have …