title: Remote ischaemic conditioning-a new paradigm of self-protection in the brain.
abstract: Remote ischaemic conditioning (RIC) triggers endogenous protective pathways in distant organs such as the kidney, heart and brain, and represents an exciting new paradigm in neuroprotection. RIC involves repetitive inflation and deflation of a blood pressure cuff on the limb, and is safe and feasible. The exact mechanism of signal transmission from the periphery to the brain is not known, but both humoral factors and an intact nervous system seem to have critical roles. Early-phase clinical trials have already been conducted to test RIC in the prehospital setting in acute ischaemic stroke, and in subarachnoid haemorrhage for the prevention of delayed cerebral ischaemia. Furthermore, two small randomized clinical trials in patients with symptomatic intracranial atherosclerosis have shown that RIC can reduce recurrence of stroke and have neuroprotective activity. RIC represents a highly practical and translatable therapy for acute, subacute, and chronic neurological diseases with an ischaemic or inflammatory basis. In this Review, we consider the principles and mechanisms of RIC, evidence from preclinical models and clinical trials that RIC is beneficial in neurological disease, and how the procedure might be used in the future in disorders such as vascular cognitive impairment and traumatic brain injury.
authors.affiliation: Department of Neurology, Medical College of Georgia, Georgia Regents University, 1120 15th Street Augusta, GA 30912, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Hess
authors.affiliation: Department of Neurology, Aarhus University Hospital, Norrebrogade 44, DK-8000, Aarhus C, Denmark.
authors.forename: Rolf A
authors.initials: RA
authors.lastname: Blauenfeldt
authors.affiliation: Department of Neurology, Aarhus University Hospital, Norrebrogade 44, DK-8000, Aarhus C, Denmark.
authors.forename: Grethe
authors.initials: G
authors.lastname: Andersen
authors.affiliation: Department of Neurology, Aarhus University Hospital, Norrebrogade 44, DK-8000, Aarhus C, Denmark.
authors.forename: Kristina D
authors.initials: KD
authors.lastname: Hougaard
authors.affiliation: Department of Medical Laboratory, Imaging, and Radiologic Sciences, College of Allied Health Sciences, Georgia Regents University, 1120 15th Street Augusta, GA 30912, USA.
authors.forename: Md Nasrul
authors.initials: MN
authors.lastname: Hoda
authors.affiliation: Department of Neurosurgery, Wayne State University, 4160 John R. Street, Suite 930, Detroit, MI 48201, USA.
authors.forename: Yuchuan
authors.initials: Y
authors.lastname: Ding
authors.affiliation: Xuanwu Hospital, Beijing Capital University, 45 Changchun Street, Xuanwu District, Beijing 100053, China.
authors.forename: Xunming
authors.initials: X
authors.lastname: Ji
mesh_terms: D001921:Brain / Q000098:blood supply* / Q000502:physiology*; D002545:Brain Ischemia / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D009422:Nervous System Diseases / Q000209:etiology / Q000517:prevention & control; D000066829:Neuroprotection / Q000502:physiology*; D015398:Signal Transduction / Q000502:physiology*