© 1998 by European Society of Cardiology
Copyright © 1998, European Society of Cardiology
Toward the heart of ischemic preconditioning
Department of Clinical and Experimental Cardiology, Academic Medical Center, M-0-54, P.O. Box 22700, 1100 DE Amsterdam, Netherlands
* Corresponding author.
Received 10 September 1997; accepted 11 September 1997
KEYWORDS Experimental; Heart; Pathophysiology; Preconditioning; Ischemia; Signal transduction
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1 Introduction |
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In 1986 Murry and co-workers introduced the term ‘Ischemic Preconditioning’ [1]. In this classical paper the authors referred to ischemic preconditioning as an adaptation to ischemic stress induced by repetitive short periods of ischemia and reperfusion. The protective effect comprised a reduction of energy consumption and a delay of the onset of lethal cell injury during ischemia resulting in a limitation of infarct size after 40 minutes, but not after three hours of sustained ischemia [1]. The fascination for this intrinsic protective property of the myocardium has led to a still expanding gamut of research, which was comprehensively reviewed by Yellon and co-workers in this issue of Cardiovascular Research [2].
Three aspects can be distinguished in the process of ischemic preconditioning. The initial trigger (1), that is included in the short periods of ischemia and reperfusion, activates signalling pathways (2), which in their turn act upon an
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2 The trigger of ischemic preconditioning |
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3 The endpoint of ischemic preconditioning |
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3.1 Infarct size reduction
3.2 Antiarrhythmic effects
3.3 Reduction of contractile dysfunction
3.4 Clinical applications
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4 Signalling pathways of ischemic preconditioning |
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4.1 A1 adenosine receptor
4.2 ATP-sensitive K+ channels
4.3 Protein kinase C
4.4 Other possible mechanisms
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5 The mechanism of the delay of ischemic damage |
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