Cardioprotection Techniques: Preconditioning, Postconditioning and Remote Con-ditioning (Basic Science)

Abstract

Ischemic heart disease (IHD) is the leading cause of death and disability worldwide. The major pathological consequences of IHD arise from the detrimental effects of acute ischemia-reperfusion injury (IRI) on the myocardium. Therefore, in order to improve clinical outcomes in patients with IHD, novel therapeutic strategies are required to protect the myocardium from acute IRI and preserve cardiac function (cardioprotection). In this regard, endogenous cardioprotective strategies such as ischemic preconditioning (IPC), ischemic postconditioning (IPost) and remote ischemic conditioning (RIC) may provide novel approaches for protecting the heart in clinical settings in which the patient experiences acute myocardial IRI. In this review article, we provide an overview of these endogenous cardioprotective strategies with respect to the pre-clinical experimental literature, exploring their major characteristics and underlying signaling mechanisms. The application of these therapeutic strategies in the clinical setting for potential patient benefit is reviewed in another article in this special issue.

Molecular Mechanisms of Renal Ischemic Conditioning Strategies

“…But conceptually, the early window of protection for IPC is predominately dependent on immediate effects especially on the mitochondria, whereas the late-phase protection is mediated through modulation of key transcription factors (NF-κB, STAT1/3, HIF-1α, AP-1, Nrf2 etc.) and de novo protein synthesis (COX-2, HO-1, iNOS, MnSOD and HSPs; see Appendix for a list of molecular abbreviations) [12,26,27] (fig. 2).…”

Remote ischemic preconditioning versus intermittent hypoxia training: a comparative analysis for cardioprotection

“…Mitochondrial K ATP channels are thought to be a plausible target of the RIPC [43,44]. Other authors suggest other agents such as heat shock protein 70 (HSP 70), IL-6, IL-8, IL-10, nuclear factor kappa B (NFκB) and TNF-α [25,[45][46][47].…”

Remifentanil functions in the adaptive protection of cardiac function following ischemia

“…However, since it is difficult to accurately determine when ischemia may arise, the potential therapeutic application of IPC is greatly limited. Zhao et al (5) initially proposed the concept of ischemic postconditioning (IPO), which involves brief periods of ischemia during reperfusion (6,7), in 2003. It is thought that IPO may reduce the extent of myocardial infarction and myocardial enzyme release, and the occurrence of reperfusion arrhythmias.…”