Remote hindlimb preconditioning and hepatoprotection: NO-table strides against liver ischaemia/reperfusion injury

Hepatic IR (ischaemia/reperfusion) injury is an important clinical problem complicating liver surgery and transplantation. IPC (ischaemic preconditioning) is a strategy whereby brief episodes of IR in an organ can induce an adaptive response to protect against subsequent prolonged IR injury. However, trauma to vessels supplying the target organ is unavoidable using the technique of direct IPC. One amenable strategy would be to apply the protective preconditioning stimulus to an organ distant or remote from the target organ of interest, a technique known as RIPC (remote IPC). In the present issue of Clinical Science, Abu-Amara and co-workers utilize hindlimb RIPC as a novel therapeutic strategy against liver IR injury and investigate the mechanistic contribution of NO to hepatoprotection by administering C-PTIO [2-(4-carboxyphenyl)-4,4,5,5-tetramethylimidazoline-1-oxyl-3-oxide potassium salt], an NO scavenger. Their experiments set the stage for more definitive studies to demonstrate a discernible benefit for the utility of RIPC in liver surgery and transplantation.