Advances in intervention methods and brain protection mechanisms of in situ and remote ischemic postconditioning
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REVIEW ARTICLE
Advances in intervention methods and brain protection mechanisms of in situ and remote ischemic postconditioning Chun-Yan Li 1 & Wei Ma 1 & Kuang-Pin Liu 1 & Jin-Wei Yang 2 & Xian-Bin Wang 1 & Zhen Wu 2 & Tong Zhang 2 & Jia-Wei Wang 2 & Wei Liu 1 & Jie Liu 1 & Yu Liang 1 & Xing-Kui Zhang 1 & Jun-Jun Li 1 & Jian-Hui Guo 2 & Li-Yan Li 1 Received: 3 December 2019 / Accepted: 5 March 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Ischemic postconditioning (PostC) conventionally refers to a series of brief blood vessel occlusions and reperfusions, which can induce an endogenous neuroprotective effect and reduce cerebral ischemia/reperfusion (I/R) injury. Depending on the site of adaptive ischemic intervention, PostC can be classified as in situ ischemic postconditioning (ISPostC) and remote ischemic postconditioning (RIPostC). Many studies have shown that ISPostC and RIPostC can reduce cerebral IS injury through protective mechanisms that increase cerebral blood flow after reperfusion, decrease antioxidant stress and anti-neuronal apoptosis, reduce brain edema, and regulate autophagy as well as Akt, MAPK, PKC, and KATP channel cell signaling pathways. However, few studies have compared the intervention methods, protective mechanisms, and cell signaling pathways of ISPostC and RIPostC interventions. Thus, in this article, we compare the history, common intervention methods, neuroprotective mechanisms, and cell signaling pathways of ISPostC and RIPostC. Keywords Ischemic stroke . Ischemic postconditioning . In situ ischemic postconditioning . Remote ischemic postconditioning . Neuroprotection
Background Ischemic stroke (IS) is a cerebrovascular event, with high morbidity, disability, and mortality rates. IS comprises the majority of the global stroke burden (Katan and Luft 2018). IS is caused by various regional blood supply disorders within the brain that lead to ischemic hypoxic necrosis of brain tissue, which, in turn, produces clinical manifestations of neurofunctional deficits. Vascular recanalization is the primary treatment for IS; however, this treatment is time dependent, with a thrombolytic treatment time window of 4.5 h (Powers et al. 2015). Delayed blood vessel recirculation can lead to an
increase in harmful substances, such as free radicals and excitatory amino acids, the accumulation of these substances leads to cerebral edema and intracerebral hemorrhage, which threatens the patient’s life and leads to Ischemia / reperfusion (I/R) injury (Powers et al. 2015). Therefore, neuroprotective treatments that can reduce reperfusion injury are very important in patients with IS. Some studies have found that PostC has a protective effect against I/R injury, which has led to new ideas concerning IS prevention and treatment (Xie et al. 2018). Depending on the site of adaptive ischemic intervention, PostC can be classified as ISPostC and RIPostC (Ebner et al. 2015; Chen et al. 2018b).
Jian-Hui Guo and Li-Yan Li contributed equally to this work. * Jian-Hui Guo guoj
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