Translation of remote ischaemic preconditioning into clinical practice

Kharbanda, Rajesh K.; Nielsen, Thomas; Redington, Andrew N.

doi:10.1016/s0140-6736(09)61421-5

Cited by 232 publications

(156 citation statements)

References 71 publications

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“…RIPC, which can be achieved by noninvasive transient occlusion of blood flow to a limb with a blood pressure cuff, has been proven to be a valuable technique to reduce I/R injury in several organs (1,2), and newer studies also suggest RIPC-mediated protective effects on the intestine (18,19).…”

Section: Discussionmentioning

confidence: 99%

“…Several animal studies as well as clinical trials have reported RIPC as an effective, cheap and low-risk technique with remarkable clinical promise. Translation of RIPC to clinical application has recently been demonstrated by transient occlusion of blood flow to a limb with a blood pressure cuff, thereby preconditioning the myocardium before coronary artery bypass graft surgery (1)(2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

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Serum from Patients Undergoing Remote Ischemic Preconditioning Protects Cultured Human Intestinal Cells from Hypoxia-Induced Damage: Involvement of Matrixmetalloproteinase-2 and -9

Zitta

Meybohm

Bein

et al. 2011

Mol Med

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Remote ischemic preconditioning (RIPC) can be induced by transient occlusion of blood flow to a limb with a blood pressure cuff and exerts multiorgan protection from ischemia/reperfusion injury. Ischemia/reperfusion injury in the intestinal tract leads to intestinal barrier dysfunction and can result in multiple organ failure. Here we used an intestinal cell line (CaCo-2) to evaluate the effects of RIPC-conditioned patient sera on hypoxia-induced cell damage in vitro and to identify serum factors that mediate RIPC effects. Patient sera (n = 10) derived before RIPC (T0), directly after RIPC (T1) and 1 h after RIPC (T2) were added to the culture medium at the onset of hypoxia until 48 h after hypoxia. Reverse transcription-polymerase chain reaction, lactate dehydrogenase (LDH) assays, caspase-3/7 assays, silver staining, gelatin zymography and Western blotting were performed. Hypoxia led to morphological signs of cell damage and increased the release of LDH in cultures containing sera T0 (P < 0.01) and T1 (P < 0.05), but not sera T2, which reduced the hypoxia-mediated LDH release compared with sera T0 (P < 0.05). Gelatin zymography revealed a significant reduction of activities of the matrixmetalloproteinase (MMP)-2 and MMP-9 in the protective sera T2 compared with the nonprotective sera T0 (MMP-2: P < 0.01; MMP-9: P < 0.05). Addition of human recombinant MMP-2 and MMP-9 to MMP-deficient culture media increased the sensitivity of CaCo-2 cells to hypoxia-induced cell damage (P < 0.05), but did not result in a reduced phosphorylation of prosurvival kinases p42/44 and protein kinase B (Akt) or increased activity of caspase-3/7. Our results suggest MMP-2 and MMP-9 as currently unknown humoral factors that may be involved in RIPC-mediated cytoprotection in the intestine.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Serum from Patients Undergoing Remote Ischemic Preconditioning Protects Cultured Human Intestinal Cells from Hypoxia-Induced Damage: Involvement of Matrixmetalloproteinase-2 and -9

Zitta

Meybohm

Bein

et al. 2011

Mol Med

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“…Ancak, Uzak İÖ ile ilgili çalış-maların sınırlı sayıda hasta grupları üzerinde yapıldığı ve koroner arter baypas greft (KABG) cerrahilerinde hemodinamik parametrelerde düzelme sağlamadığı, böbrek ve akciğerlerde koruyucu etkiye sahip olmadığı da iddia edilmektedir (46) . Sonuç olarak, hayvan çalışmaları Uzak İÖ'nün farklı organlar üzerindeki olumlu etkilerini büyük ölçüde kanıtlasa da, klinik ortamda etkin kullanımının araştırılacağı insan çalış-malarına gereksinim olduğu ortadadır (47) . KABG ameliyatları, karaciğer transplantasyonu gibi cerrahilerde ve uygulama öncesi iskemireperfüzyonun gerçekleşeceği bilinen durumlarda İÖ uygulaması ile infarkt boyutunu sınırlamak olası gö-zükmektedir.…”

Section: İskemi̇k öNkoşullamanin Kli̇ni̇k öNemi̇unclassified

“…Adenozin reseptör agonistleri (teofilin, aminofilin), opioid antagonistleri (nalokson), α1 adrenerjik reseptör antagonistleri (fentolamin), M2-muskarinik reseptör antagonistleri (atropin), kalsiyum kanal blokerleri (nifedipin), KATP kanal blokerleri (antidiyabetik ajanlar, lidokain), digoksin, aprotinin ve COX-2 inhibitörleri kardiyak önkoşullamada olumsuz etkiye sahip ajanlar olarak karşımıza çıkar (49) . Uzak İÖ'nün ise KABG uygulanan hastaların postoperatif dönemlerinde, kardiyak fonksiyon, inotrop gereksiniminin azalması, aritmi insidansının düşme-si, renal veya akciğer fonksiyonları üzerinde olumlu etkisi gösterilememiştir (47) .…”

Section: çEşitli Organlar üZerinde Uygulanan İö'nün Klinik Sonuçlarıunclassified

Clinical Importance of Ischemic Preconditioning

Oncel¹,

Dinçer²,

Cinel³

2012

GKDA Derg

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“…Over the decade, leading cardiovascular researchers have gone from great excitation to dramatic disappointment with the clinical application of rIPC [8,9]. The frustration could not be overcome by the recent metaanalyses and narrative reviews, due to their low quality or lack of objective quantitative measures of the effect, respectively [10][11][12][13]. This review and meta-analysis provides the most up-to-date and in-depth quantitative analysis of rIPC in adult and pediatric cardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

Experimental cardiovascular and lung research Remote ischemic preconditioning versus standard myocardial protection in cardiac surgery: ten years of clinical trials. A systematic review and meta-analysis

Marczak¹,

Bańkowski²,

Płonek³

et al. 2013

kitp

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StreszczenieCelem niniejszej metaanalizy jest systematyczny przegląd dowodów obrazujących wpływ odległego hartowania niedokrwiennego (rIPC) na mięsień serca pacjentów poddanych operacjom kardiochirurgicznym. Materiały i metody: Przeglądu literatury dokonano na podstawie pełnotekstowych prac publikowanych w bazach danych Medline, Cochrane itp. Włączono badania kontrolowane z randomizacją, porównujące rIPC oraz standardową ochronę mięśnia serca u pacjentów poddanych zabiegom kardiochirurgicznym, jeżeli raportowały co najmniej jeden z wyników: markery uszkodzenia mięśnia sercowego, pooperacyjne zapotrzebowanie na leki wykazujące dodatni efekt inotropowy, czas hospitalizacji na oddziale intensywnej terapii. 268 EXPERIMENTAL CARDIOVASCULAR AND LUNG RESEARCH SummaryObjectives: To systematically review and assess the existing evidence for the applicability of remote ischemic preconditioning (rIPC) in cardiac surgery. Material and methods: Major biomedical databases: Medline, Cochrane, etc. were searched. All randomized controlled trials (RCTs) comparing rIPC and standard myocardial protection in patients submitted to cardiac surgery were included if they reported at least one of the outcomes of interest: myocardial injury markers, postoperative inotropic support, or length of ICU stay. Results: 991 patients were included in the analysis. rIPC was shown to reduce myocardial injury markers postoperatively by -0.63 SMD [-0.99 to -0.28] and postoperative inotropic requirement by -0.40 SMD [-0.66 to -0.16] in the adult patients submitted to cardiac surgery. There has been significant, yet correctable, heterogeneity of the primary outcome of interest, and the available RCTs were small sample studies. Conclusions: This meta-analysis provides evidence confirming that rIPC has potential benefits with regard to myocardial protection.

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Translation of remote ischaemic preconditioning into clinical practice

Cited by 232 publications

References 71 publications

Serum from Patients Undergoing Remote Ischemic Preconditioning Protects Cultured Human Intestinal Cells from Hypoxia-Induced Damage: Involvement of Matrixmetalloproteinase-2 and -9

Serum from Patients Undergoing Remote Ischemic Preconditioning Protects Cultured Human Intestinal Cells from Hypoxia-Induced Damage: Involvement of Matrixmetalloproteinase-2 and -9

Clinical Importance of Ischemic Preconditioning

Experimental cardiovascular and lung research Remote ischemic preconditioning versus standard myocardial protection in cardiac surgery: ten years of clinical trials. A systematic review and meta-analysis

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