Background: Restoration of blood supply to an organ after a critical period of ischemia results in parenchymal injury and dysfunction of the organ referred to as reperfusion injury. Ischemia reperfusion injury is often seen in organ transplants, major organ resections and in shock. Ischemic preconditioning (IPC) is an adaptational response of briefly ischemic tissues which serves to protect against subsequent prolonged ischemic insults and reperfusion injury. Ischemic preconditioning can be mechanical or pharmacological. Direct mechanical preconditioning in which the target organ is exposed to brief ischemia prior to prolonged ischemia has the benefit of reducing ischemia-reperfusion injury (IRI) but its main disadvantage is trauma to major vessels and stress to the target organ. Remote (inter organ) preconditioning is a recent observation in which brief ischemia of one organ has been shown to confer protection on distant organs without direct stress to the organ.
Aim: To discuss the evidence for remote IPC (RIPC), underlying mechanisms and possible clinical applications of RIPC. METHODS OF SEARCH: A Pubmed search with the keywords "ischemic preconditioning," "remote preconditioning," "remote ischemic preconditioning," and "ischemia reperfusion" was done. All articles on remote preconditioning up to September 2006 have been reviewed. Relevant reference articles from within these have been selected for further discussion.
Results: Experimental studies have demonstrated that the heart, liver, lung, intestine, brain, kidney and limbs are capable of producing remote preconditioning when subjected to brief IR. Remote intra-organ preconditioning was first described in the heart where brief ischemia in one territory led to protection in other areas. Translation of RIPC to clinical application has been demonstrated by the use of brief forearm ischemia in preconditioning the heart prior to coronary bypass and in reducing endothelial dysfunction of the contra lateral limb. Recently protection of the heart has been demonstrated by remote hind limb preconditioning in children who underwent surgery on cardiopulmonary bypass for congenital heart disease. The RIPC stimulus presumably induces release of biochemical messengers which act either by the bloodstream or by the neurogenic pathway resulting in reduced oxidative stress and preservation of mitochondrial function. Studies have demonstrated endothelial NO, Free radicals, Kinases, Opioids, Catecholamines and K(ATP) channels as the candidate mechanism in remote preconditioning. Experiments have shown suppression of proinflammatory genes, expression of antioxidant genes and modulation of gene expression by RIPC as a novel method of IRI injury prevention.
Conclusion: There is strong evidence to support RIPC. The underlying mechanisms and pathways need further clarification. The effective use of RIPC needs to be investigated in clinical settings.
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http://dx.doi.org/10.1016/j.jss.2007.12.747 | DOI Listing |
Background And Purpose: To investigate the impact of a history of ischemic stroke or transient ischemic attack (TIA) on the effectiveness of remote ischemic conditioning (RIC) for outcomes in acute ischemic stroke patients.
Methods: We conducted a post hoc analysis of the Remote Ischaemic Conditioning for Acute Moderate Ischaemic Stroke (RICAMIS) trial. Patients in RICAMIS were categorized into two groups according to a history of stroke.
Acta Cir Bras
January 2025
Universidad Nacional de La Plata - Faculty of Medicine - Organ Transplant Laboratory - La Plata - Argentina.
Purpose: To mitigate ischemia-reperfusion injury (IRI) triggered in solid organ transplant procedures, we aimed to evaluate the effects of multi-organ abdominal ischemic preconditioning (MAIP) in the context of renal IRI.
Methods: An experimental kidney transplant model was conducted. Rats were divided into three groups: an intervention free basal group from which physiological data was collected; a control group (CT), which consisted of transplanted animals without MAIP; and a treated group, in which a MAIP protocol was implemented in the donor during the procurement of the left kidney, monitoring the recipient for 24 hours.
Exp Brain Res
January 2025
Faculty of Sport, Technology and Health Sciences, St. Mary's University, Twickenham, Middlesex, UK.
The aim of this study was to assess if ischaemic preconditioning (IPC) can reduce pain perception and enhance corticospinal excitability during voluntary contractions. In a randomised, within-subject design, healthy participants took part in three experimental visits after a familiarisation session. Measures of pressure pain threshold (PPT), maximum voluntary isometric force, voluntary activation, resting twitch force, corticospinal excitability and corticospinal inhibition were performed before and ≥10 min after either, unilateral IPC on the right leg (3 × 5 min); a sham protocol (3 × 1 min); or a control (no occlusion).
View Article and Find Full Text PDFFront Med (Lausanne)
December 2024
Department of Anesthesiology, The 988th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Zhengzhou, China.
Objective: Limb ischemia-reperfusion injury caused by repeated tourniquet application usually leads to acute kidney injury, adversely affecting patient prognosis. This study aimed to investigate the renoprotective effect of remote ischemic preconditioning (RIPC) in patients undergoing extremity surgery with repeated tourniquet application.
Methods: 64 patients were enrolled and randomly divided into an RIPC group and a control group, with 32 patients in each.
Cardiovasc Drugs Ther
January 2025
The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, London, WC1E 6HX, UK.
Purpose: Reperfusion of the ischaemic heart is essential to limit myocardial infarction. However, reperfusion can cause cardiomyocyte hypercontracture. Recently, cardiac myosin-targeted inhibitors (CMIs), such as Mavacamten (MYK-461) and Aficamten (CK-274), have been developed to treat patients with cardiac hypercontractility.
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