Remote ischemic preconditioning for myocardial protection: update on mechanisms and clinical relevance
Remote ischemic preconditioning for myocardial protection: update on mechanisms and clinical relevance
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DOI：
10.1007/s11010-014-2312-z
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发表时间：
2015-04-01
影响因子：
4.3
通讯作者：
Kukreja, Rakesh C.
中科院分区：
文献类型：
--
作者：
Gill, Rabia;Kuriakose, Robin;Kukreja, Rakesh C.
缺血性心脏病是全世界男性和女性死亡的主要原因，2012年死亡人数达740万。人们一直在寻找更好的心脏保护方式，以减少心肌缺血-再灌注损伤。在这些尝试中，一种更方便的缺血预处理模型，称为远程缺血预处理（RIPC），于1993年由Przyklenk及其同事首次引入，他们报告了心脏一个血管床中的短暂区域闭塞-再灌注事件对远程心肌组织提供保护。随后，心肌RIPC的主要进展是使用骨骼肌作为缺血刺激。迄今为止，许多研究表明，RIPC应用于肾脏，肝脏，肠系膜和骨骼肌，都表现出心脏保护作用。本文就近5年来在辣椒素激活的C感觉纤维、缺氧诱导因子1 α、连接蛋白43、细胞外囊泡、microRNA-144、microRNA-1和亚硝酸盐等方面对RIPC分子机制的研究进展作一综述。此外，我们还讨论了最近几项RIPC人体临床试验的结果。总之，新出现的临床证据支持这样的概念，即RIPC的有效性与其低成本和非侵入性特征相结合，使其成为持续缺血后再灌注前的理想治疗方法。需要进行更精心设计的研究，以充分利用RIPC的临床益处及其对心血管疾病患者的潜在影响。
Ischemic heart disease is the leading cause of death for both men and women worldwide, accruing 7.4 million deaths in 2012. There has been a continued search for better cardioprotective modalities that would reduce myocardial ischemia-reperfusion injury. Among these attempts, a more convenient model of ischemic preconditioning, known as remote ischemic preconditioning (RIPC) was first introduced in 1993 by Przyklenk and colleagues who reported that brief regional occlusion-reperfusion episodes in one vascular bed of the heart render protection to remote myocardial tissue. Subsequently, major advances in myocardial RIPC came with the use of skeletal muscle as the ischemic stimulus. To date, numerous studies have revealed that RIPC applied to the kidney, liver, mesentery, and skeletal muscle, have all exhibited cardioprotective effects. The main purpose of this review article is to summarize the new advances in understanding the molecular mechanisms of RIPC during the past 5 years, including those related to capsaicin-activated C sensory fibers, hypoxia-inducible factor 1 alpha, connexin 43, extracellular vesicles, microRNA-144, microRNA-1, and nitrite. In addition, we have discussed results from several recent human clinical trials with RIPC. Taken together, the emerging clinical evidence supports the concept that the effectiveness of RIPC paired with its low-cost and non-invasive features makes it an ideal treatment before reperfusion after sustained ischemia. More carefully designed studies are warranted to fully exploit the clinical benefits of RIPC and its potential implications in patients with cardiovascular disease.