Protocols and Mechanisms for Remote Ischemic Preconditioning: A Novel Method for Reducing Ischemia Reperfusion Injury

Abstract

Ischemia reperfusion injury (IRI) results in damage to local and remote organs. Remote ischemic preconditioning (RIPC) is a strategy to protect against IRI by inducing a prior brief period(s) of IRI to an organ remote from that undergoing sustained injury. RIPC has been shown to protect organs against IRI; however, the protocols and mechanisms for RIPC are unclear. For this review, a Medline/Pubmed search (January 1985 to January 2007) was conducted and all relevant articles were included. RIPC protocols are organ and species specific and both humoral and neurogenic pathways are involved in triggering intracellular signal pathways for protection.

Neonatal necrotizing enterocolitis rat model attenuated by a remote ischemic preconditioning in the pregnant

“…Remote ischemic preconditioning promotes tissue protection by two ways of action: the neuronal and the humoral 8,9,20 . In the present study, the protective mechanism was probably humoral, since maternal-fetal interaction occurs through the placenta, the basic site of nutrient and gas exchanges between the mother and the fetus.…”

Hind limb ischemic preconditioning induces an anti-inflammatory response by remote organs in rats

“…Adenosine is also released after direct IPC of skeletal muscles as a physiological response in order to reduce injury to the microcirculation, and brief hind limb ischemia by the release of adenosine may protect remote organs against IRI (6).…”

“…Recently, an early and late phase of remote protection of the endothelium has been shown in humans with protection being activated immediately after rIPC and lasting 4 h. A delayed phase of protection beginning at 24 h and lasting 48 h was noted and was associated with protein expression in the vascular endothelium (6).…”

“…The delayed phase of rIPC seems to be dependent on protein synthesis. Limb rIPC protected the cerebral endothelium of rats in both the early (15 min) and late (48 h) phase of reperfusion injury (6).…”

Myocardial ischemia-reperfusion and cardioprotection: a study with microdialysis in a porcine model

“…The KATP channels are also involved in the preconditioning offered by volatile anaesthetics (Bienengraeber 2005), and probably in the phenomenon of "remote preconditioning" whereby the myocardial tissue is protected against injury during ischemia-reperfusion following short preconditioning ischemic periods in other "remote" organs as e.g. skeletal muscle (Kanoria 2007). In addition to the effect of reduced or delayed ischemic myocardial injury, there are also indications that preconditioning may reduce myocardial stunning after ischemia, as demonstrated in experimental animals (Shizukuda 1993, Urabe 1993.…”