Division of Cardiovascular Health and Disease, Department of Medicine, University of Cincinnati , Cincinnati, Ohio.
Department of Biomedical Engineering, University of Cincinnati , Cincinnati, Ohio.
Am J Physiol Heart Circ Physiol. 2018 Dec 1;315(6):H1748-H1758. doi: 10.1152/ajpheart.00347.2018. Epub 2018 Sep 14.
The present study assessed whether tefillin use (tight, nonocclusive, wrapping of the arm) elicits a remote ischemic preconditioning (RIPC)-like effect in subjects with both acute and chronic use. RIPC, created by short bursts of ischemia-reperfusion, has not been successfully taken to the bedside. Several large population studies have found that Orthodox Jewish men (who wear tefillin almost daily) have decreased cardiovascular mortality compared with non-Orthodox counterparts. We hypothesized that tefillin use is a relevant component in triggering a preconditioning effect. Jewish men ( n = 20) were enrolled; 9 men were daily tefillin users (conditioned) and 11 men were nonusers of tefillin as controls (naïve). Subjects were evaluated for adherence to traditional Jewish practice, had vital signs measured, blood drawn for analysis of circulating cytokines and monocyte function, and underwent brachial flow-mediated dilation to evaluate vascular reactivity at baseline (basal) and after 30 min of using tefillin (acute treatment). Under basal conditions, both groups had similar peak systolic velocity (SV), diameter, and flow volume, although the conditioned group had higher SV at 120 s postdeflation ( P = 0.05). Acute tefillin use augmented artery diameter and flow volume in both groups, with conditioned subjects experiencing higher SV than control subjects at 90 and 120 s postdeflation ( P = 0.03 and P = 0.02, respectively). Conditioned subjects had decreased inflammation, monocyte migration and adhesion, and endothelial activation compared with control subjects at baseline. Acute use of tefillin did not significantly alter monocyte function in either group. In this pilot study, acute tefillin use improves vascular function, whereas chronic tefillin use is associated with an anti-inflammatory RIPC-like phenotype. NEW & NOTEWORTHY We hypothesized that tefillin use among Orthodox Jewish men (who practice a nonocclusive leather banding of their nondominant arm) will induce a remote ischemic preconditioning phenotype. Chronic use of tefillin in Orthodox Jewish men was associated with increased systolic velocity and attenuated inflammation and monocyte chemotaxis and adhesion versus Jewish men who do not wear tefillin. Acute use of tefillin in both populations augmented brachial artery diameter and blood flow but not inflammatory profiles compared with baseline.
本研究评估了在急性和慢性使用情况下，tefillin（一种紧密的、非闭塞性的手臂包裹物）的使用是否会产生类似于远程缺血预处理（RIPC）的效果。RIPC 是通过短暂的缺血再灌注产生的，但尚未成功应用于临床。几项大型人群研究发现，正统犹太男性（几乎每天都佩戴 tefillin）的心血管死亡率低于非正统犹太男性。我们假设，tefillin 的使用是触发预处理效应的一个相关因素。我们招募了 20 名犹太男性；其中 9 名男性是每天佩戴 tefillin 的使用者（有条件组），11 名男性是非使用者（对照组）。评估受试者对传统犹太教习俗的遵守情况，测量生命体征，抽取血液分析循环细胞因子和单核细胞功能，并进行肱动脉血流介导的扩张，以评估基线（基础）和佩戴 tefillin 30 分钟后的血管反应（急性治疗）。在基础状态下，两组的收缩期峰值速度（SV）、直径和流量均相似，尽管有条件组在充气后 120 秒时 SV 更高（P=0.05）。急性佩戴 tefillin 增加了两组的动脉直径和流量，充气后 90 秒和 120 秒时，有条件组的 SV 高于对照组（P=0.03 和 P=0.02）。与对照组相比，有条件组在基础状态下的炎症、单核细胞迁移和黏附以及内皮激活程度较低。急性佩戴 tefillin 并未显著改变两组的单核细胞功能。在这项初步研究中，急性佩戴 tefillin 可改善血管功能，而慢性佩戴 tefillin 与抗炎的类似 RIPC 表型相关。新的和值得注意的是，我们假设在正统犹太男性（他们将非优势手臂的皮革带绑在非优势手臂上）中使用 tefillin 将诱导远程缺血预处理表型。与不佩戴 tefillin 的犹太男性相比，正统犹太男性的慢性使用 tefillin 与更高的收缩速度以及炎症和单核细胞趋化性和黏附的减弱有关。与基线相比，两种人群的急性使用 tefillin 均增加了肱动脉直径和血流量，但未改变炎症谱。
