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2015 ; 66
(5
): 846-56
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Remote ischemic preconditioning for kidney protection: GSK3?-centric insights
into the mechanism of action
#MMPMID26271146
Liu Z
; Gong R
Am J Kidney Dis
2015[Nov]; 66
(5
): 846-56
PMID26271146
show ga
Preventing acute kidney injury (AKI) in high-risk patients following medical
interventions is a paramount challenge for clinical practice. Recent data from
animal experiments and clinical trials indicate that remote ischemic
preconditioning, represented by limb ischemic preconditioning, confers a
protective action on the kidney. Ischemic preconditioning is effective in
reducing the risk for AKI following cardiovascular interventions and the use of
iodinated radiocontrast media. Nevertheless, the underlying mechanisms for this
protective effect are elusive. A protective signal is conveyed from the remote
site undergoing ischemic preconditioning, such as the limb, to target organs,
such as the kidney, by multiple potential communication pathways, which may
involve humoral, neuronal, and systemic mechanisms. Diverse transmitting pathways
trigger a variety of signaling cascades, including the reperfusion injury salvage
kinase and survivor activating factor enhancement pathways, all of which converge
on glycogen synthase kinase 3? (GSK3?). Inhibition of GSK3? subsequent to
ischemic preconditioning reinforces the Nrf2-mediated antioxidant defense,
diminishes the nuclear factor-?B-dependent proinflammatory response, and exerts
prosurvival effects ensuing from the desensitized mitochondria permeability
transition. Thus, therapeutic targeting of GSK3? by ischemic preconditioning or
by pharmacologic preconditioning with existing US Food and Drug
Administration-approved drugs having GSK3?-inhibitory activities might represent
a pragmatic and cost-effective adjuvant strategy for kidney protection and
prophylaxis against AKI.
|Acute Kidney Injury/metabolism/*prevention & control
[MESH]