Remote Ischemic Preconditioning in Human Coronary Artery Bypass Surgery

Rahman, Ishtiaq; Mascaro, Jorge; Steeds, Richard P.; Frenneaux, Michael; Nightingale, Peter; Gosling, Peter; Townsend, P.; Townend, Jonathan N.; Green, David; Bonser, Robert S.

doi:10.1161/circulationaha.109.926667

Cited by 228 publications

(228 citation statements)

References 26 publications

Supporting

Mentioning

211

Contrasting

Unclassified

Order By: Relevance

“…When these procedures are performed on an elective basis, it may be possible to use some form of remote IPC by induction of HIF-1 in the limb before cardiac surgery, either by transient adenoviral HIF-1α gene therapy, as demonstrated in our study, or by pharmacological inhibition of the prolyl hydroxylases that promote HIF-1α degradation (19). This approach may provide a more robust induction of IL-10 and possibly other protective secreted factors than can be achieved by blood pressure insufflation, which has given mixed results in prospective randomized placebo-controlled clinical trials (12,33).…”

Section: Discussionmentioning

confidence: 79%

Hypoxia-inducible factor 1 is required for remote ischemic preconditioning of the heart

Cai

Luo

Zhan

et al. 2013

Proc. Natl. Acad. Sci. U.S.A.

155

146

View full text Add to dashboard Cite

Both preclinical and clinical studies suggest that brief cycles of ischemia and reperfusion in the arm or leg may protect the heart against injury following prolonged coronary artery occlusion and reperfusion, a phenomenon known as remote ischemic preconditioning. Recent studies in mice indicate that increased plasma interleukin-10 (IL-10) levels play an important role in remote ischemic preconditioning induced by clamping the femoral artery for 5 min followed by 5 min of reperfusion for a total of three cycles. In this study, we demonstrate that remote ischemic preconditioning increases plasma IL-10 levels and decreases myocardial infarct size in wild-type mice but not in littermates that are heterozygous for a knockout allele at the locus encoding hypoxia-inducible factor (HIF) 1α. Injection of a recombinant adenovirus encoding a constitutively active form of HIF-1α into mouse hind limb muscle was sufficient to increase plasma IL-10 levels and decrease myocardial infarct size. Exposure of C2C12 mouse myocytes to cyclic hypoxia and reoxygenation rapidly increased levels of IL-10 mRNA, which was blocked by administration of the HIF-1 inhibitor acriflavine or by expression of short hairpin RNA targeting HIF-1α or HIF-1β. Chromatin immunoprecipitation assays demonstrated that binding of HIF-1 to the Il10 gene was induced when myocytes were subjected to cyclic hypoxia and reoxygenation. Taken together, these data indicate that HIF-1 activates Il10 gene transcription and is required for remote ischemic preconditioning.cardiac surgery | cardioprotection | coronary heart disease | myocardial infarction C oronary heart disease (CHD) is the leading cause of mortality in the US population, accounting for one in every six deaths, at a rate of one death from CHD every minute (1). Coronary artery stenosis due to atherosclerotic plaques results in reduced perfusion and myocardial ischemia. Plaque rupture results in complete arterial occlusion and the death of cardiac cells (myocardial infarction; MI) due to oxygen deprivation (2). Rapid reperfusion by thrombolytic therapy or percutaneous coronary intervention is the most important clinical factor to limit infarct size (IS), while at the same time reperfusion contributes to tissue injury by increasing intracellular reactive oxygen species and Ca 2+ levels (3, 4). Exposure of the heart to short (5-min) episodes of ischemia (I 5 ) and reperfusion (R 5 ) protects the heart against injury caused by a subsequent prolonged episode of ischemia and reperfusion (IR), a phenomenon known as ischemic preconditioning (IPC) (5).Although IPC was shown to have a powerful protective effect in animal models, the obvious difficulties involved in subjecting the heart to direct IPC restrict its potential clinical applications. However, the discovery that an IPC stimulus applied to the circumflex coronary artery reduced the size of an MI arising from sustained occlusion of the left anterior descending artery (6) was subsequently extended by the demonstration that the heart could be protected by su...

show abstract

Section: Discussionmentioning

confidence: 79%

Hypoxia-inducible factor 1 is required for remote ischemic preconditioning of the heart

Cai

Luo

Zhan

et al. 2013

Proc. Natl. Acad. Sci. U.S.A.

155

146

View full text Add to dashboard Cite

show abstract

“…67 Renal outcomes were among the secondary end points. The results showed that in patients undergoing multivessel coronary artery bypass graft (CABG) surgery, the incidence of AKI in those who received rIPC was similar to that of controls.…”

mentioning

confidence: 99%

Remote Ischemic Preconditioning and Renoprotection

Gassanov¹,

Nia

Caglayan³

et al. 2014

Journal of the American Society of Nephrology

122

106

View full text Add to dashboard Cite

There is currently no effective prophylactic regimen available to prevent contrastinduced AKI (CI-AKI), a frequent and life-threatening complication after cardiac catheterization. Therefore, novel treatment strategies are required to decrease CI-AKI incidence and to improve clinical outcomes in these patients. Remote ischemic preconditioning (rIPC), defined as transient brief episodes of ischemia at a remote site before a subsequent prolonged ischemia/reperfusion injury of the target organ, is an adaptational response that protects against ischemic and reperfusion insult. Indeed, several studies demonstrated the tissue-protective effects of rIPC in various target organs, including the kidneys. In this regard, rIPC may offer a novel noninvasive and virtually cost-free treatment strategy for decreasing CI-AKI incidence. This review evaluates the current experimental and clinical evidence for rIPC as a potential renoprotective strategy, and discusses the underlying mechanisms and key areas for future research.

show abstract

“…Оказалось, что ДИП в 10 раз снижает частоту возникновения острого поражения по-чек [49]. Впрочем, некоторым исследователям не удалось обнару-жить ренопротекторный эффект ДИП у пациентов с КШ [50,51]. Кардиохирурги из Великобритании ДИП осуществляли с помо-щью 3 циклов ишемии (5 мин) и реперфузии (5 мин) руки [50].…”

Section: терапевтический архив 8 2016unclassified

“…Впрочем, некоторым исследователям не удалось обнару-жить ренопротекторный эффект ДИП у пациентов с КШ [50,51]. Кардиохирурги из Великобритании ДИП осуществляли с помо-щью 3 циклов ишемии (5 мин) и реперфузии (5 мин) руки [50]. Острое поражение почек они оценивали по необходимости в диа-лизе, по уровню креатина в сыворотке крови, по соотношению альбумин/креатин в моче.…”

Section: терапевтический архив 8 2016unclassified

“…Из исследования исключили пациен-тов с СД. Установлено, что ДИП не влияет на эти показатели [50]. В более поздней работе [51] для оценки нефропротекторного эф-фекта ДИП у пациентов с КШ использовали существенно боль-ше показателей: СКФ; концентрация креатина в сыворотке кро-ви; уровень NGAL и цистатина-С в сыворотке крови; в моче определяли NGAL и молекулу повреждения почек (kidney injury molecule-1).…”

Section: терапевтический архив 8 2016unclassified

See 1 more Smart Citation

Neuroprotective and nephroprotective effects of remote postconditioning: Prospects for clinical use

Maslov

Tsibulnikov

Цепокина

et al. 2016

Terapevticheskii arkhiv

View full text Add to dashboard Cite

1 фГБну «нИИ кардиологии», Томск, россия; 2 национальный исследовательский Томский политехнический университет, Томск, россия; 3 фГБну нИИ комплексных проблем сердечно-сосудистых заболеваний, Кемерово, россия; 4 республиканский научно-прак-тический центр «Кардиология», Минск, Беларусь Аннотация результаты экспериментальных и клинических исследований убедительно свидетельствуют, что дистантное ишемическое прекондиционирование (ДИП) не оказывает нейропротекторного эффекта при кардиохирургических вмешательствах, выполняемых в условиях искусственного кровообращения. Дистантное прекондиционирование (ДК) не оказывает нейро-протекторного эффекта при геморрагическом инсульте. необходимо проведение рандомизированного многоцентрового исследования для оценки эффективности ДИП у пациентов с ишемическим инсультом. ДК снижает выраженность ишеми-ческого и реперфузионного повреждения почки при трансплантации. установлено, что ДИП предупреждает появление нефропатии, индуцированной контрастным веществом. необходимо многоцентровое исследование для оценки эффек-тивности ДИП у пациентов с протезированием аневризмы брюшной аорты. Анализ представленных данных свидетель-ствует, что ДИП не предупреждает возникновение кардиоренального синдрома у новорожденных и детей при выполнении кардиохирургических вмешательств. Данные литературы о способности ДИП оказывать нефропротекторный эффект у пациентов с коронарным шунтированием носят противоречивый характер и свидетельствуют о целесообразности про-ведения многоцентрового исследования. The results of experimental and clinical studies strongly suggest that remote ischemic preconditioning (rIP) has no neuroprotective effect during cardiac surgery performed under extracorporeal circulation. remote preconditioning (rP) has no neuroprotective effect in hemorrhagic stroke. A randomized multicenter study is needed to evaluate the efficiency rIP in patients with ischemic stroke. rP reduces the severity of ischemia/reperfusion kidney injury during transplantation. rIP has been established to prevent contrast-induced nephropathy. There is a need for a multicenter trial to evaluate the efficiency of rIP in patients with abdominal aortic aneurysm repair. Analysis of the presented data indicates that rIP fails to prevent cardiorenal syndrome in infants and children during cardiac surgery. The data available in the literature on the capacity of rIP to provide nephroprotective effect in patients after coronary artery bypass surgery are discordant and indicative of the advisability of a multicenter study. Keywords: remote ischemic preconditioning, brain, kidneys.Дистантное ишемическое прекондиционирование (ДИП) -это феномен повышения устойчивости к длительной ишемии и реперфузии одного органа после кратковременной ишемии-ре-перфузии другого органа. Полагают, что кратковременная ише-мия и реперфузия вызывают выброс в кровоток гуморального фактора(ов), которые повышают толерантность органов и тканей к ишемии и реперфузии [1][2][3][4][5][6][7]. Предполагают, что подобными факторами могут быть эндогенные каннабин...

show abstract

Remote Ischemic Preconditioning in Human Coronary Artery Bypass Surgery

Abstract: Background-We assessed whether remote ischemic preconditioning (RIPC) improves myocardial, renal, and lung protection after on-pump coronary surgery.

Cited by 228 publications

References 26 publications

Hypoxia-inducible factor 1 is required for remote ischemic preconditioning of the heart

Hypoxia-inducible factor 1 is required for remote ischemic preconditioning of the heart

Remote Ischemic Preconditioning and Renoprotection

Neuroprotective and nephroprotective effects of remote postconditioning: Prospects for clinical use

Contact Info

Product

Resources

About