Repeated ischaemic preconditioning: A novel therapeutic intervention and potential underlying mechanisms.

Abstract

Ischaemic preconditioning (IPC) refers to the phenomenon that short periods of cyclical tissue ischaemia confer subsequent protection against ischaemia-induced injury. As a consequence, IPC can ameliorate the myocardial damage following infarction and reduce infarct size. The ability of IPC to confer remote protection makes IPC a potentially feasible cardioprotective strategy. In this review, we discuss the concept that repeatedly exposing tissue to IPC may increase the "dose" of protection, and subsequently lead to enhanced protection against ischaemia-induced myocardial injury. This may be relevant for clinical populations, who demonstrate attenuated efficacy of IPC to prevent or attenuate ischaemic injury (and therefore myocardial infarct size). Furthermore, episodic IPC facilitates repeated exposure to local (e.g. shear stress) and systemic (e.g. hormones, cytokines, blood-borne substances) stimuli, which may induce improvement in vascular function and health. Such adaptation may contribute to prevention of cardio- and cerebro-vascular events. The clinical benefits of repeated IPC may, therefore, result from both the prevention of ischaemic events and attenuation of their consequences. We provide an overview of the literature pertaining to the impact of repeated IPC on cardiovascular function, related to both local and or remote adaptation, as well as potential clinical implications. This article is protected by copyright. All rights reserved.