Author response: Remote ischemic preconditioning effects on brain vasculature
PaulNyquist, Attending Physician, Professor of Medicins JOhns hopkins University
Submitted July 09, 2019
Prof. Sunil Munakomi makes some good points in his comment about our editorial.1 RIPC has been implicated in the activation of hypoxic inducible factor (HIF) and vascular endothelial growth factors (VEGF) via the adenosine receptors at the mitochondrial level. These are several biological system components activated in the setting of ongoing ischemia. The interesting achievement of this study was not the reductionist approach to identify pathways but the fact that the study identified the effects of a variety of biological pathways from several biological systems on the physiological parameter, the autoregulation of blood flow.2 As we enter a new age of systems biology, there will be greater import in the use of multiple biomarkers representing different biological systems and gaining insight on their effects together on complex biology. This is what Guo et al.2 did in this interesting study in a relevant human model when they identified diverse chemokine and cytokine associations with a change in biological function through the alteration of autoregulation. I strongly agree that, clinically, this is not ready for primetime and we are a long way away from the eloquent biological model required to make such a trial work.
Disclosure
The author reports no relevant disclosures. Contact journal@neurology.org for full disclosures.
Prof. Sunil Munakomi makes some good points in his comment about our editorial.1 RIPC has been implicated in the activation of hypoxic inducible factor (HIF) and vascular endothelial growth factors (VEGF) via the adenosine receptors at the mitochondrial level. These are several biological system components activated in the setting of ongoing ischemia. The interesting achievement of this study was not the reductionist approach to identify pathways but the fact that the study identified the effects of a variety of biological pathways from several biological systems on the physiological parameter, the autoregulation of blood flow.2 As we enter a new age of systems biology, there will be greater import in the use of multiple biomarkers representing different biological systems and gaining insight on their effects together on complex biology. This is what Guo et al.2 did in this interesting study in a relevant human model when they identified diverse chemokine and cytokine associations with a change in biological function through the alteration of autoregulation. I strongly agree that, clinically, this is not ready for primetime and we are a long way away from the eloquent biological model required to make such a trial work.
Disclosure
The author reports no relevant disclosures. Contact journal@neurology.org for full disclosures.
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