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Cerebral Ischemic Preconditioning: the Road So Far…

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Abstract

Cerebral preconditioning constitutes the brain’s adaptation to lethal ischemia when first exposed to mild doses of a subtoxic stressor. The phenomenon of preconditioning has been largely studied in the heart, and data from in vivo and in vitro models from past 2–3 decades have provided sufficient evidence that similar machinery exists in the brain as well. Since preconditioning results in a transient protective phenotype labeled as ischemic tolerance, it can open many doors in the medical warfare against stroke, a debilitating cerebrovascular disorder that kills or cripples thousands of people worldwide every year. Preconditioning can be induced by a variety of stimuli from hypoxia to pharmacological anesthetics, and each, in turn, induces tolerance by activating a multitude of proteins, enzymes, receptors, transcription factors, and other biomolecules eventually leading to genomic reprogramming. The intracellular signaling pathways and molecular cascades behind preconditioning are extensively being investigated, and several first-rate papers have come out in the last few years centered on the topic of cerebral ischemic tolerance. However, translating the experimental knowledge into the clinical scaffold still evades practicality and faces several challenges. Of the various preconditioning strategies, remote ischemic preconditioning and pharmacological preconditioning appears to be more clinically relevant for the management of ischemic stroke. In this review, we discuss current developments in the field of cerebral preconditioning and then examine the potential of various preconditioning agents to confer neuroprotection in the brain.

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Abbreviations

IT:

Ischemic tolerance

IPC:

Ischemic preconditioning

CPC:

Cerebral preconditioning

HPC:

Hypoxic preconditioning

RIPC:

Remote ischemic preconditioning

PPC:

Pharmacological preconditioning

ADK:

Adenosine kinase

NCX:

Na+/Ca2+ exchanger

TACE:

Tumor necrosis factor-α converting enzyme

HRE:

Hypoxia-responsive elements

EPO:

Erythropoietin

VEGF:

Vascular endothelial growth factor

SIP:

Sphingosine-1-phosphate

εPKC:

Epsilon protein kinase C

CCL:

Chemokine (C–C motif) ligand

SPK:

Sphingosine kinase

COX:

Cyclooxygenase

TLR:

Toll-like receptor

CNS:

Central nervous system

LPS:

Lipopolysaccharide

TNF-α:

Tumor necrosis factor-α

IL:

Interleukin

ROS:

Reactive oxygen species

SAH:

Subarachnoid haemorrhage

iNOS:

Inducible nitric oxide synthase

nNOS:

Neuronal nitric oxide synthase

eNOS:

Endothelial nitric oxide synthase

NOS:

Nitric oxide synthase

NO:

Nitric oxide

cAMP:

Cyclic adenosine monophosphate

AMP:

Adenosine monophosphate

AMPA:

α-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid

AMPK:

Adenosine 5′-monophosphate-activated protein kinase

JNK:

c-Jun N-terminal kinase

ERK:

Extracellular signal-regulated kinase

NF-κB:

Nuclear factor-κB

NMDA:

N-methyl-D-aspartate

EA:

Electroacupuncture

3-NPA:

3-Nitropropionic acid

CREB:

cAMP responsive element binding

HIF:

Hypoxia inducible factor

HBO:

Hyperbaric oxygenation

ATP:

Adenosine triphosphate

MCAO:

Middle cerebral artery occlusion

OGD:

Oxygen–glucose deprivation

tPA:

Tissue plasminogen activator

IPost:

Ischemic post-conditioning

TGF:

Transforming growth factor

TGF-α:

Transforming growth factor alpha

HSP:

Heat shock protein

MeCP2:

Methyl-CpG-binding protein 2

IGF:

Insulin-like growth factor

PcG:

Polycomb group

TrxG:

Trithorax group

TIA:

Transient ischemic attack

IRI:

Ischemia-reperfusion injury

IR:

Ionizing radiation

HCA:

Hypothermic circulatory arrest

BAIPC:

Bilateral arm ischemic preconditioning

IAS:

Intracranial arterial stenosis

AKT:

Protein kinase B

RHP:

Repetitive hypoxic preconditioning

p53:

Tumor protein p53

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  1. School of Biotechnology, DBT—Centre for Bioinformatics, National Institute of Technology Calicut, Calicut, 673601, India

    Thushara Vijayakumar N, Amit Sangwan, Bhargy Sharma & Rajanikant GK

  2. Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK

    Arshad Majid

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N, T., Sangwan, A., Sharma, B. et al. Cerebral Ischemic Preconditioning: the Road So Far…. Mol Neurobiol 53, 2579–2593 (2016). https://doi.org/10.1007/s12035-015-9278-z

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