Review of remote ischemic preconditioning: from laboratory studies to clinical trials.
In remote ischemic preconditioning (RIPC) short periods of non-lethal ischemia followed by reperfusion of tissue or organ prepare remote tissue or organ to resist a subsequent more severe ischemia-reperfusion injury. The signaling mechanism of RIPC can be humoral communication, neuronal stimulation, systemic modification of circulating immune cells, and activation of hypoxia inducible genes. Despite promising evidence from experimental studies, the clinical effects of RIPC have been controversial. Heterogeneity of inclusion and exclusion criteria and confounding factors such as comedication, anesthesia, comorbidities, and other risk factors may have influenced the efficacy of RIPC. Although the cardioprotective pathways of RIPC are more widely studied, there is also evidence of benefits in CNS, kidney and liver protection. Future research should explore the potential of RIPC, not only in cardiac protection, but also in patients with threatening ischemia of the brain, organ transplantation of the heart, liver and kidney and extensive cardiovascular surgery. RIPC is generally well-tolerated, safe, effective, and easily feasible. It has a great prospect for ischemic protection of the heart and other organs.
a Heart Center, Turku University Hospital , Turku , Finland.
Vesa
V
Anttila
b Research Unit of Surgery, Anesthesia and Intensive Care , University of Oulu and MRC Oulu , Oulu , Finland.
Henri
H
Haapanen
b Research Unit of Surgery, Anesthesia and Intensive Care , University of Oulu and MRC Oulu , Oulu , Finland.
Fredrik
F
Yannopoulos
b Research Unit of Surgery, Anesthesia and Intensive Care , University of Oulu and MRC Oulu , Oulu , Finland.
Johanna
J
Herajärvi
b Research Unit of Surgery, Anesthesia and Intensive Care , University of Oulu and MRC Oulu , Oulu , Finland.
Tuomas
T
Anttila
c Department of Cardiac Surgery , Heart and Lung Center HUCH , Helsinki , Finland.
Tatu
T
Juvonen
D000818:Animals; D001341:Autonomic Nervous System / Q000503:physiopathology; D006801:Humans; D056724:Immunity, Humoral; D019194:Ischemic Preconditioning / Q000009:adverse effects / Q000379:methods*; D019157:Ischemic Preconditioning, Myocardial; D015428:Myocardial Reperfusion Injury / Q000276:immunology / Q000503:physiopathology / Q000517:prevention & control; D012039:Regional Blood Flow; D015427:Reperfusion Injury / Q000276:immunology / Q000503:physiopathology / Q000517:prevention & control*; D012307:Risk Factors; D015398:Signal Transduction
Remote ischemic preconditioning; cerebral protection; myocardial protection; spinal cord protection