Remote ischemic preconditioning as treatment for non-ischemic gastrointestinal disorders: beyond ischemia-reperfusion injury.
Common gastrointestinal diseases such as radiation enteritis (RE), acute pancreatitis, inflammatory bowel diseases (IBD) and drug-induced hepatotoxicity share pathophysiological mechanisms at the molecular level, mostly involving the activation of many pathways of the immune response, ultimately leading to tissue injury. Increased oxidative stress, inflammatory cytokine release, inflammatory cell infiltration and activation and the up-regulation of inflammatory transcription factors participate in the pathophysiology of these complex entities. Treatment varies in each specific disease, but at least in the cases of RE and IBD immunosuppressors are effective. However, full therapeutic responses are not always achieved. The pathophysiology of ischemia-reperfusion (IR) injury shares many of these mechanisms. Brief and repetitive periods of ischemia in an organ or limb have been shown to protect against subsequent major IR injury in distant organs, a phenomenon called remote ischemic preconditioning (RIP). This procedure has been shown to protect the gut, pancreas and liver by modulating many of the same inflammatory mechanisms. Since RIP is safe and tolerable, and has shown to be effective in some recent clinical trials, I suggest that RIP could be used as a physiologically relevant adjunct treatment for non-ischemic gastrointestinal inflammatory conditions.
Carlos Rodrigo Camara-Lemarroy, Departamento de Medicina Interna, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, NL 64460, México.
Carlos Rodrigo
CR
Camara-Lemarroy
D000818:Animals; D016207:Cytokines / Q000378:metabolism; D004751:Enteritis / Q000473:pathology; D005767:Gastrointestinal Diseases / Q000473:pathology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007249:Inflammation; D015212:Inflammatory Bowel Diseases / Q000473:pathology / Q000628:therapy; D007422:Intestines / Q000473:pathology; D019194:Ischemic Preconditioning / Q000379:methods*; D008099:Liver / Q000187:drug effects / Q000473:pathology; D018384:Oxidative Stress; D010179:Pancreas / Q000473:pathology; D010195:Pancreatitis / Q000628:therapy; D015427:Reperfusion Injury / Q000378:metabolism / Q000473:pathology*
D016207:Cytokines; D007166:Immunosuppressive Agents
Acute pancreatitis; Hepatotoxicity; Inflammation; Inflammatory bowel diseases; Ischemia reperfusion; Ischemic preconditioning; Radiation enteritis; Remote ischemic preconditioning