Remote Ischemic Conditioning (RIC) Decreases the Incidence and Severity of Necrotizing Enterocolitis (NEC) | Animal study Single Center | 86 preterm piglets | randomized into 3 groups: | Low Frequency (LF)-RIC (every 24 hr) | High Frequency (HF)-RIC (every 12 hr) | Control (No RIC) | RIC initiated at 24 hr of life | 4 x 4-min occlusion followed by reperfusion | Results vs controls | LF-RIC did not decrease the incidence of NEC (p = 0.02) | (in contrast to the rodent models) | HF-RIC significantly reduced the incidence of NEC and resulted in a lower severity of NEC (p < 0.0001) | Conclusion: RIC protects against NEC in piglets only with more frequent dosing than in rodents. Further research is needed to determine optimal frequency for clinical use. | @EmGooteeМD | @globalcastmd | @EmGooteeМD | @StayCurrentMD | Cincinnati Children's | https://pubmed.ncbi.nlm.nih.gov/39368858/ | Gadde R et al. | Center for Regenerative Medicine - Abigail Wexner Research Institute and Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA | Journal of Pediatric Surgery
Remote Ischemic Conditioning (RIC) Decreases the Incidence and Severity of Necrotizing Enterocolitis (NEC)
Infographic · May 2025 · 1 min read
In brief
In brief
This piglet study demonstrates that high-frequency remote ischemic conditioning (every 12 hours) significantly reduces NEC incidence by 87% and disease severity in preterm models, while low-frequency protocols showed no benefit. Findings suggest RIC frequency requirements differ between species and warrant optimization studies before clinical translation.
- High-frequency RIC (every 12h) reduced NEC incidence by 87% (OR=0.13) in preterm piglets compared to controls.
- Low-frequency RIC (every 24h) showed no protective effect, indicating dosing frequency is critical for efficacy.
- RIC significantly decreased NEC severity scores in the high-frequency group versus controls (p<0.0001).
- Translation from rodent models required protocol adjustment—piglets need more frequent RIC cycles than smaller animals.
- Non-invasive limb occlusion cycles may offer a preventive strategy for NEC in high-risk preterm neonates.
Written by the GCMD Library team from the infographic.
The infographic uses a light blue header with white text, followed by sections in white and cream backgrounds. It features illustrations of a researcher with a microscope on the left and a pink piglet on the right. A small rodent illustration appears at the bottom left. The layout flows from study design at top, through methodology in the middle, to results and conclusion at bottom. Color coding distinguishes three experimental groups (burgundy, green, and blue text). A yellow banner highlights the conclusion.
Rahul Gaddea, Jason Xiaa, Sophia Hameedia,Angela Saulsberya, Carly Schafera, Lourenço Sbragiaa, Oluyinka O. Olutoyea
Background
Necrotizing enterocolitis (NEC) remains a devastating intestinal disease that affects 5–7% of preterm neonates. Remote ischemic conditioning (RIC) has been shown to protect against intestinal ischemia in rodents. We aimed to determine the efficacy of RIC in a large animal model of NEC.
Methods
Using an established piglet model of NEC, preterm piglets of 103–107 days gestation (term = 115 days) were randomly assigned to receive RIC or serve as untreated controls. RIC was initiated at 24 h of life and consisted of 4 cycles of 4-min occlusion followed by reperfusion; cycles were repeated every 24 or 12 h for low frequency (LF) and high frequency (HF) groups, respectively. Piglets were monitored clinically for NEC which was confirmed postmortem using established anatomic and histologic scoring.
Results
Eighty-six piglets were randomized into controls (N = 38), LF-RIC (n = 26) and HF-RIC (n = 22) groups. In contrast to the rodent models, in piglets LF-RIC (every 24 h) did not decrease the incidence of NEC compared to controls. However, HF-RIC (every 12 h) significantly reduced the incidence of NEC (OR = 0.13; 95% CI: 0.03, 0.55; p = 0.02) and resulted in a lower severity of NEC (p < 0.0001) compared to controls.
Conclusions
RIC offers protection against NEC in the piglet model only when administered more frequently than in rodents. Further studies are needed to define the optimum frequency of RIC for piglets that may translate to clinical use.