title: The evolving concept of physiological ischemia training vs. ischemia preconditioning.
abstract: Ischemic heart diseases are the leading cause of death with increasing numbers of patients worldwide. Despite advances in revascularization techniques, angiogenic therapies remain highly attractive. Physiological ischemia training, which is first proposed in our laboratory, refers to reversible ischemia training of normal skeletal muscles by using a tourniquet or isometric contraction to cause physiologic ischemia for about 4 weeks for the sake of triggering molecular and cellular mechanisms to promote angiogenesis and formation of collateral vessels and protect remote ischemia areas. Physiological ischemia training therapy augments angiogenesis in the ischemic myocardium by inducing differential expression of proteins involved in energy metabolism, cell migration, protein folding, and generation. It upregulates the expressions of vascular endothelial growth factor, and induces angiogenesis, protects the myocardium when infarction occurs by increasing circulating endothelial progenitor cells and enhancing their migration, which is in accordance with physical training in heart disease rehabilitation. These findings may lead to a new approach of therapeutic angiogenesis for patients with ischemic heart diseases. On the basis of the promising results in animal studies, studies were also conducted in patients with coronary artery disease without any adverse effect in vivo, indicating that physiological ischemia training therapy is a safe, effective and non-invasive angiogenic approach for cardiovascular rehabilitation. Preconditioning is considered to be the most protective intervention against myocardial ischemia-reperfusion injury to date. Physiological ischemia training is different from preconditioning. This review summarizes the preclinical and clinical data of physiological ischemia training and its difference from preconditioning.
authors.affiliation: Department of Rehabilitation Medicine, the Affiliated Hospital of Nantong University , Nantong, Jiangsu 226000 , China .
authors.forename: Jun
authors.initials: J
authors.lastname: Ni
authors.affiliation: The Second People's Hospital , Nantong, Jiangsu 226002 , China .
authors.forename: Hongjian
authors.initials: H
authors.lastname: Lu
authors.affiliation: Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China .
authors.forename: Xiao
authors.initials: X
authors.lastname: Lu
authors.affiliation: Department of Cardiology, the Affiliated Hospital of Nantong University , Nantong, Jiangsu 226000 , China .
authors.forename: Minghui
authors.initials: M
authors.lastname: Jiang
authors.affiliation: Department of Cardiology, the Affiliated Hospital of Nantong University , Nantong, Jiangsu 226000 , China .
authors.forename: Qingyun
authors.initials: Q
authors.lastname: Peng
authors.affiliation: Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China .
authors.forename: Caili
authors.initials: C
authors.lastname: Ren
authors.affiliation: Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China .
authors.forename: Jie
authors.initials: J
authors.lastname: Xiang
authors.affiliation: Department of Rehabilitation Medicine, the Affiliated Hospital of Nantong University , Nantong, Jiangsu 226000 , China .
authors.forename: Chengyao
authors.initials: C
authors.lastname: Mei
authors.affiliation: Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University , Nanjing, Jiangsu 210029 , China .
authors.forename: Jianan
authors.initials: J
authors.lastname: Li
keywords: angiogenesis; ischemia preconditioning; physiological ischemia training; vascular endothelial growth factor