The late phase of preconditioning

被引:613
作者
Bolli, R [1 ]
机构
[1] Univ Louisville, Div Cardiol, Louisville, KY 40292 USA
[2] Jewish Hosp, Heart & Lung Inst, Louisville, KY USA
关键词
myocardial ischemia; myocardial reperfusion; nitric oxide; cyclooxygenase; aldose reductase;
D O I
10.1161/01.RES.87.11.972
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Unlike the early phase of preconditioning (PC), which lasts 2 to 3 hours and protects against infarction but not against stunning, the late phase of PC lasts 3 to 4 days and protects against both infarction and stunning, suggesting that it may have greater clinical relevance. It is now clear that late PC is a polygenic phenomenon that requires the simultaneous activation of multiple stress-responsive genes. Chemical signals released by a sublethal ischemic stress (such as NO, reactive oxygen species, and adenosine) trigger a complex cascade of signaling events that includes the activation of protein kinase C, Src protein tyrosine kinases, and nuclear factor Kappa-B and culminates in increased synthesis of inducible NO synthase, cyclooxygenase-2, aldose reductase, Mn superoxide dismutase, and probably other cardioprotective proteins. An analogous sequence of events can be triggered by a variety of stimuli, such as heat stress, exercise, and cytokines. Thus, late PC appears to be a universal response of the heart to stress in general. Importantly, the cardioprotective effects of late PC can be reproduced pharmacologically with clinically relevant agents (eg, NO donors, adenosine receptor agonists, endotoxin derivatives, or opioid receptor agonists), suggesting that this phenomenon might be exploited for therapeutic purposes. The purpose of this review is to summarize current information regarding the pathophysiology and mechanism of late PC.
引用
收藏
页码:972 / 983
页数:12
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