Systemic response to local ischaemia: the evolving concept of remote ischaemic preconditioning

Pankaj Saxena

    Research output: ThesisDoctoral Thesis

    152 Downloads (Pure)

    Abstract

    [Truncated abstract] Life on our planet is possible because of oxygen. All mammals, including humans, evolved with an innate mechanism by which organs and cells may protect themselves against lack or excess of oxygen to some extent. This lack and excess of oxygen that occurs during interruption and restoration of blood supply to an organ is referred to as ischaemia-reperfusion (IR). IR is a ubiquitous phenomenon that accounts for a number of pathophysiological conditions. A prolonged period of ischaemia followed by reperfusion causes IR injury and leads to significant damage to the affected organ. The activation of a systemic inflammatory response is associated with the most detrimental effects of IR injury. It has been noticed that brief episodes of intermittent ischaemia applied locally render significant protection against subsequent prolonged lethal ischaemic insult. This was termed ischaemic pre-conditioning (IPC). Later, however, it was observed that similar protection occurs when brief intermittent episodes of ischemia and reperfusion were applied during or after prolonged ischaemia. These phenomena were termed per-conditioning and post-conditioning. Thus, protection against prolonged ischaemia by brief episodes of IR has recently evolved into the unified concept of ischemic conditioning (IC). It appears that brief intermittent episodes of ischaemia of the arm or leg can significantly decrease the systemic inflammatory response triggered by subsequent prolonged ischaemia of organs located remotely from the site of conditioning, for instance heart, lung, liver or kidney. Hence, remote ischaemic preconditioning (RIPC) is a global form of organ protection against ischaemia. The first clinical randomized controlled trial of RIPC application suggested that clinically relevant protection can be achieved by RIPC. Despite the proven benefits of the conditioning effects, the overall application of this organ protective strategy in clinical practice has been
    Original languageEnglish
    QualificationDoctor of Philosophy
    Publication statusUnpublished - 2009

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