Perspectives on mechanisms underlying remote ischemic conditioning against ischemic stroke

摘要

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 alter-native to the current treatment portfolio. As an easy-han-dled, non-invasive regimen, it takes advantage of tran-sient 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 mecha-nisms 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 ⑤RIC and its anti-inflammatory potential.