Cardioprotection by remote ischemic conditioning: Mechanisms and clinical evidences

Abstract

In remote ischemic conditioning (RIC), several cycles of ischemia and reperfusion render distant organ and tissues more resistant to the ischemia-reperfusion injury. The intermittent ischemia can be applied before the ischemic insult in the target site (remote ischemic preconditioning), during the ischemic insult (remote ischemic perconditioning) or at the onset of reperfusion (remote ischemic postconditioning). The mechanisms of RIC have not been completely defined yet; however, these mechanisms must be represented by the release of humoral mediators and/or the activation of a neural reflex. RIC has been discovered in the heart, and has been arising great enthusiasm in the cardiovascular field. Its efficacy has been evaluated in many clinical trials, which provided controversial results. Our incomplete comprehension of the mechanisms underlying the RIC could be impairing the design of clinical trials and the interpretation of their results. In the present review we summarize current knowledge about RIC pathophysiology and the data about its cardioprotective efficacy.

Randomized clinical trial of remote ischaemic preconditioning versus no preconditioning in the prevention of perioperative myocardial infarction during open surgery for ruptured abdominal aortic aneurysm

“…The RIPC treatment was initialized during surgery, similar to methods used in many elective studies, but the first set of variables was collected immediately after operation. Much of the focus of therapeutic conditioning has been on the preischaemic stage for tissue protection, but recent studies have shown that postconditioning may also play an important role, thus questioning the role of timing in RIPC intervention. The acute setting may be an ideal target for RIPC, but the varying and often extreme decompensation of patients with ruptured AAA may have limited, if any, potential gain from conditioning.…”

Remote Limb Ischemic Preconditioning Attenuates Cerebrovascular Depression During Sinusoidal Galvanic Vestibular Stimulation via α 1 ‐Adrenoceptor–Protein Kinase Cε–Endothelial NO Synthase Pathway in Rats

“…Because RIPC is currently being tested in clinical trials for many cardio‐ and cerebrovascular diseases/injuries/surgeries, RIPC can be fast‐tracked into clinical trials for preventing VVS. Furthermore, RIPC has been shown to be involved in activation of several targets that have been pharmacologically investigated for VVS: β‐adrenoceptors, α 1 ‐adrenoceptor, and NET1, (and being investigated in POST 6). Thus, RIPC seems to be superior to the current pharmacological treatments being used/investigated due to is pleiotropic effects.…”

Parallel comparison of pre-conditioning and post-conditioning effects in human cancers and keratinocytes upon acute gamma irradiation

“…The conditioning effect is perhaps best studied in vascular biology. Ischemic conditioning contributes to cardioprotection by reducing oxidative stress and thus minimizing or preventing myocardial infarction (Aimo et al, 2015).…”