Review Volume 10, Issue 8 pp 1825—1855

Remote ischemic conditioning: a promising therapeutic intervention for multi-organ protection

Da Zhou 1, 3, 4, 5, *, , Jiayue Ding 1, 3, 4, 5, *, , Jingyuan Ya 1, 3, 4, 5, , Liqun Pan 1, 3, 4, 5, , Yuan Wang 1, 3, 4, 5, , Xunming Ji 2, 3, 4, 5, , Ran Meng 1, 3, 4, 5, ,

  • 1 Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
  • 2 Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
  • 3 Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
  • 4 Department of China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
  • 5 National Clinical Research Center for Geriatric Disorders, Beijing, China
  • 6 Equal contribution
* Equal contribution

received: July 8, 2018 ; accepted: August 16, 2018 ; published: August 16, 2018 ;

https://doi.org/10.18632/aging.101527
How to Cite

Copyright: Zhou et al. This is an open‐access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Despite decades of formidable exploration, multi-organ ischemia-reperfusion injury (IRI) encountered, particularly amongst elderly patients with clinical scenarios, such as age-related arteriosclerotic vascular disease, heart surgery and organ transplantation, is still an unsettled conundrum that besets clinicians. Remote ischemic conditioning (RIC), delivered via transient, repetitive noninvasive IR interventions to distant organs or tissues, is regarded as an innovative approach against IRI. Based on the available evidence, RIC holds the potential of affording protection to multiple organs or tissues, which include not only the heart and brain, but also others that are likely susceptible to IRI, such as the kidney, lung, liver and skin. Neuronal and humoral signaling pathways appear to play requisite roles in the mechanisms of RIC-related beneficial effects, and these pathways also display inseparable interactions with each other. So far, several hurdles lying ahead of clinical translation that remain to be settled, such as establishment of biomarkers, modification of RIC regimen, and deep understanding of underlying minutiae through which RIC exerts its powerful function. As this approach has garnered an increasing interest, herein, we aim to encapsulate an overview of the basic concept and postulated protective mechanisms of RIC, highlight the main findings from proof-of-concept clinical studies in various clinical scenarios, and also to discuss potential obstacles that remain to be conquered. More well designed and comprehensive experimental work or clinical trials are warranted in future research to confirm whether RIC could be utilized as a non-invasive, inexpensive and efficient adjunct therapeutic intervention method for multi-organ protection.

Abbreviations

IRI: ischemia-reperfusion injury; IC: ischemic conditioning; RIC: remote ischemic conditioning; ICU: intensive care unit; RIPreC: remote ischemic preconditioning; RIPerC: remote ischemic perconditioning; RIPostC: remote ischemic postconditioning; LADCA: left anterior descending coronary artery; STEMI: ST segment elevated myocardial infarction; PCI: percutaneous coronary intervention; VEGF: vascular endothelial growth factor; MDA: malondialdehyde; CABG: coronary artery bypass surgery.