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远程但不遥远:远程缺血预处理作为缺血性中风潜在治疗的实验模型和临床试验综述。

Remote but not Distant: a Review on Experimental Models and Clinical Trials in Remote Ischemic Conditioning as Potential Therapy in Ischemic Stroke.

机构信息

UCIBIO, Applied Molecular Biosciences Unit, Department of Chemistry, NOVA School of Science and Technology, Universidade NOVA de Lisboa, Campus de Caparica, 2829-526, Caparica, Portugal.

CEDOC, Faculdade de Ciências Médicas/NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.

出版信息

Mol Neurobiol. 2022 Jan;59(1):294-325. doi: 10.1007/s12035-021-02585-6. Epub 2021 Oct 22.

Abstract

Stroke is one of the main causes of neurological disability worldwide and the second cause of death in people over 65 years old, resulting in great economic and social burden. Ischemic stroke accounts for 85% of total cases, and the approved therapies are based on re-establishment of blood flow, and do not directly target brain parenchyma. Thus, novel therapies are urgently needed. In this review, limb remote ischemic conditioning (RIC) is revised and discussed as a potential therapy against ischemic stroke. The review targets both (i) fundamental research based on experimental models and (ii) clinical research based on clinical trials and human interventional studies with healthy volunteers. Moreover, it also presents two approaches concerning RIC mechanisms in stroke: (i) description of the underlying cerebral cellular and molecular mechanisms triggered by limb RIC that promote neuroprotection against stroke induced damage and (ii) the identification of signaling factors involved in inter-organ communication following RIC procedure. Limb to brain remote signaling can occur via circulating biochemical factors, immune cells, and/or stimulation of autonomic nervous system. In this review, these three hypotheses are explored in both humans and experimental models. Finally, the challenges involved in translating experimentally generated scientific knowledge to a clinical setting are also discussed.

摘要

中风是全球范围内导致神经功能障碍的主要原因之一,也是 65 岁以上人群的第二大致死原因,给经济和社会带来了巨大的负担。缺血性中风占总病例的 85%,已批准的治疗方法基于恢复血流,而不是直接针对脑实质。因此,迫切需要新的治疗方法。在这篇综述中,肢体远程缺血预处理(RIC)被重新评估,并被讨论为一种针对缺血性中风的潜在治疗方法。这篇综述的目标是(i)基于实验模型的基础研究和(ii)基于临床试验和健康志愿者的人体介入研究的临床研究。此外,它还介绍了两种与中风中 RIC 机制相关的方法:(i)描述肢体 RIC 引发的潜在脑细胞和分子机制,这些机制促进了对中风诱导损伤的神经保护作用,(ii)鉴定 RIC 过程后涉及器官间通讯的信号因子。肢体到大脑的远程信号可以通过循环生化因子、免疫细胞和/或自主神经系统的刺激来发生。在这篇综述中,这三种假说在人类和实验模型中都进行了探讨。最后,还讨论了将实验产生的科学知识转化为临床应用所涉及的挑战。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8684/8533672/2735a597158c/12035_2021_2585_Fig1_HTML.jpg

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