Perspectives on mechanisms underlying remote ischemic conditioning against ischemic stroke

Abstract

Ischemic stroke is a major neurological disease with limited effective therapeutic options except for thrombolysis and thrombectomy. Remote ischemic conditioning (RIC) is an approach that promises an alternative to the current treatment portfolio. As an easy-handled, non-invasive regimen, it takes advantage of transient ischemia (currently often made through inflation and deflation of limb blood pressure cuff) to enhance the tolerance of vital organs to ischemia. RIC can be executed before, during and after the onset of stroke. The mechanisms of action of RIC employed at different stroke stages are similar and may involve humoral, neurological and inflammatory pathways. As new mechanisms underlying RIC-induced neuroprotection continue to be revealed, we review in this article some of the latest development in this field, including: ① RIC and RIC-induced fundamental change, hypoxia, as well as the role of hypoxia inducible factors against stroke; ② Potential role of RIC-induced extracellular vesicles in neuroprotection; ③ RIC-induced metabolic changes in tissue protection; ④ Potential effect of RIC on red blood cells (RBC) oxygen delivery; and ⑤ RIC and its anti-inflammatory potential.

Keywords

remote ischemic conditioning (RIC) / stroke / hypoxia inducible factors (HIF) / exosome / oxygen delivery / inflammation / metabolomics / microRNA