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Protecting the heart from ischemia/reperfusion injury: an update on remote ischemic preconditioning and
Martín Donato1, Pablo Evelson, Ricardo J Gelpi
1aDepartamento de Patología, Facultad de Medicina, Instituto de Fisiopatología Cardiovascular (INFICA) bFacultad de Medicina, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Instituto de Bioquímica y Medicina Molecular (IBIMOL) cFacultad de Farmacia y Bioquímica, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET). Instituto de Bioquímica y Medicina Molecular (IBIMOL), Universidad de Buenos Aires, Buenos Aires, Argentina *Members of the National Council of Scientific and Technological Research (CONICET).
Insights
Remote ischemic preconditioning and postconditioning protect the heart from reperfusion injury. These strategies, involving limb ischemia, show promise for clinical application in reducing heart damage.
Area of Science:
- Cardiovascular Science
- Physiology
- Regenerative Medicine
Background:
- Acute myocardial ischemic injury necessitates timely reperfusion.
- Myocardial reperfusion can paradoxically cause further cardiomyocyte death (reperfusion injury).
- Remote ischemic preconditioning and postconditioning are emerging cardioprotective strategies.
Purpose of the Study:
- To review the mechanisms of remote ischemic preconditioning and postconditioning.
- To update on the latest research regarding these cardioprotective interventions.
- To discuss the clinical potential of remote ischemic preconditioning and postconditioning.
Main Methods:
- Review of current scientific literature on remote ischemic preconditioning and postconditioning.
- Analysis of proposed humoral and neural pathways involved in cardioprotection.
- Examination of clinical trial data and ongoing research.
Main Results:
- Remote ischemic preconditioning involves both humoral and neural pathways, potentially interdependent.
- Remote ischemic postconditioning primarily utilizes the humoral pathway.
- Intermittent limb ischemia is a feasible method for clinical application.
Conclusions:
- Remote ischemic preconditioning and postconditioning offer promising cardioprotection against ischemia/reperfusion injury.
- These techniques can be clinically implemented using limb ischemia.
- Further research is ongoing to define their full clinical utility in reducing infarct size.
Purpose Of Review:
The most effective strategy for reducing acute myocardial ischemic injury is timely and effective reperfusion. However, myocardial reperfusion can induce further cardiomyocyte death (reperfusion injury). Interventions that protect the heart from ischemia/reperfusion injury, reducing infarct size, can involve remote ischemic preconditioning and postconditioning. These interventions have a promising potential clinical application, and have been the focus of recent research. In this review, we provide an update of remote ischemic preconditioning and postconditioning mechanisms.
Recent Findings:
Remote ischemic preconditioning cardioprotection can occur via a humoral pathway and/or a neural pathway. These two pathways have been described as mechanistically different, but it has been suggested that they could be interdependent. However, remote ischemic postconditioning mainly involves the humoral pathway. In this review, we will discuss the different pathways and mechanisms involved in remote ischemic preconditioning and postconditioning.
Summary:
Remote ischemic preconditioning and postconditioning is possible to perform in a clinical setting by intermittent ischemia of an upper or lower limb. Furthermore, clinical trials using this procedure in the context of predictable ischemia-reperfusion have produced promising results, and other studies to define the potential clinical use of these strategies are ongoing.
