Remote Ischemic Conditioning (RIC) Decreases the Incidence and Severity of Necrotizing Enterocolitis (NEC) - Validation in a Large Animal Model
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Rahul Gadde, Jason Xia, Sophia Hameedi, Angela Saulsbery, Carly Schafer, Lourenço Sbragia, Oluyinka O Olutoye
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.
Transcript
Rick, or remote is chemic conditioning, has been shown to decrease rates of necrotizing intercalitis in a rat model. But can it also work in a large animal model? I'm Alex Halpern, a research fellow from Children's National. And this is an article that you should know. Gat at all using the established Pigglin neck model to try and answer this question. They randomly assign piglets that either receive Rick or service controls. Rick was initiated at 24 hours of life and consisted of four cycles of four minutes of arterial occlusion followed by reperfusion. These cycles were repeated every 24 hours in the low frequency group and every 12 hours in the high frequency group. 38 piglets were randomized into the control group, 26 into the low frequency group and 22 into the high frequency group. When compared to controls, high frequency Rick significantly reduced the incidence of nec. However, low frequency Rick did not. So it seems like high frequency Rick protects against neck and a pigler model. Let us know what you think in the comments below.