Cardioprotection 'Outside the Box' - The evolving paradigm of remote preconditioning

Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
Archiv für Kreislaufforschung (Impact Factor: 5.41). 06/2003; 98(3):149-57. DOI: 10.1007/s00395-003-0406-y
Source: PubMed


Conventional ischemic preconditioning is the phenomenon whereby brief episodes of myocardial ischemia render the ischemic territory resistant to a subsequent, sustained ischemic insult. A growing body of evidence further indicates that brief ischemia applied in distant organs and tissues can also protect naïve, virgin myocardium from ischemic injury. In this review, we describe the initial observations that provided the impetus for the study of 'remote preconditioning', and summarize our current knowledge of the three facets of 'preconditioning at a distance' --intra-cardiac, inter-organ and transferred inter-cardiac preconditioning.

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    • "Regional transient ischaemia provides protection to distant tissue or organs, a phenomenon known as remote preconditioning . Przyklenk et al. [9] reported that regional myocardial ischaemic preconditioning may protect the remote virgin myocardium. Li et al. [10] reported that cardiac ischaemic preconditioning improves lung preservation in patients undergoing valve replacement . "
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    ABSTRACT: OBJECTIVES Acute kidney injury is a common and serious complication of cardiac surgery. Because its underlying mechanisms are unclear, there is no specific therapy to prevent or treat it. A regional transient ischaemia and reperfusion (I/R) may provide protection to distant tissue or organs, a phenomenon known as remote preconditioning. In this study, we investigated whether myocardial preconditioning (MPC) would reduce kidney injury and apoptosis induced by myocardial I/R, as well as the mechanisms involved.
    Preview · Article · Dec 2014 · European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery
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    • "The first evidence that repetitive induction of ischemia and reperfusion in a remote region can provide cardioprotection was delivered in 1993 by Przyklenk et al. [21]. A conditioning protocol in the circumflex coronary artery reduced infarct size in a myocardial infarction induced by LAD occlusion. "
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    ABSTRACT: Reperfusion by means of percutaneous coronary intervention or thrombolytic therapy is the most effective treatment for acute myocardial infarction, markedly reducing mortality and morbidity. Reperfusion however induces necrotic and apoptotic damages to cardiomyocytes, that were viable prior to reperfusion, a process called lethal reperfusion injury. This process, consisting of many single processes, may be responsible of up to half of the final infarct size. A myriad of therapies as an adjunct to reperfusion have been studied with the purpose to attenuate reperfusion injury. The majority of these studies have been disappointing or contradicting, but recent proof-of-concept trials show that reperfusion injury still is a legitimate target. This overview will discuss these trials, the progression in attenuating myocardial reperfusion injury, promising therapies, and future perspectives.
    Full-text · Article · Nov 2013 · International journal of cardiology
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    • "Ischemic preconditioning has been recognized as a major cardioprotective phenomenon for many years (4). In recent years, it has been found that transient ischemia of a remote organ or limb, which is termed remote ischemic preconditioning (RIPC), could generate protection for the organ subsequently challenged by lethal ischemia (5). The discovery of this phenomenon may obviate the need to directly intervene in the heart to achieve cardioprotection. "
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    ABSTRACT: Ischemia reperfusion injury is partly responsible for the high mortality associated with induced myocardial injury and the reduction in the full benefit of myocardial reperfusion. Remote ischemic preconditioning, perconditioning, and postconditioning have all been shown to be cardioprotective. However, it is still unknown which one is the most beneficial. To examine this issue, we used adult male Wistar rat ischemia reperfusion models to compare the cardioprotective effect of these three approaches applied on double-sided hind limbs. The rats were randomly distributed to the following five groups: sham, ischemia reperfusion, remote preconditioning, remote perconditioning, and remote post-conditioning. The ischemia/reperfusion model was established by sternotomy followed by a 30-min ligation of the left coronary artery and a subsequent 3-h reperfusion. Remote conditioning was induced with three 5-min ischemia/5-min reperfusion cycles of the double-sided hind limbs using a tourniquet. A lower early reperfusion arrhythmia score (1.50 + 0.97) was found in the rats treated with remote perconditioning compared to those in the ischemia reperfusion group (2.33 + 0.71). Meanwhile, reduced infarct size was also observed (15.27 + 5.19% in remote perconditioning, 14.53 + 3.45% in remote preconditioning, and 19.84+5.85% in remote post-conditioning vs. 34.47 + 7.13% in ischemia reperfusion, p<0.05), as well as higher expression levels of the apoptosis-relevant protein Bcl-2/Bax following global (ischemia/reperfusion) injury in in vivo rat heart models (1.255 + 0.053 in remote perconditioning, 1.463 + 0.290 in remote preconditioning, and 1.461 +0.541 in remote post-conditioning vs. 1.003 + 0.159 in ischemia reperfusion, p<0.05). Three remote conditioning strategies implemented with episodes of double-sided hind limb ischemia/reperfusion have similar therapeutic potential for cardiac ischemia/reperfusion injury, and remote perconditioning has a greater ability to prevent reperfusion arrhythmia.
    Full-text · Article · Feb 2013 · Clinics (São Paulo, Brazil)
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