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Pre- Peri- Post-Conditioning the Ischemic Myocardium: Challenges, Confounders and Expectations

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Introduction to Translational Cardiovascular Research

Abstract

The heart is afforded with endogenous mechanisms of protection against ischemic-reperfusion injury. Both preconditioning with short-lived periods of ischemia-reperfusion prior to a prolonged ischemia and postconditioning with very brief episodes of ischemia-reperfusion immediately after an index ischemia confer effective protection. Initial experimental studies investigated the natural history, the signal transduction pathways and the pharmaceutical agents that are involved in myocardial protection. Clinical studies that followed verified the laboratory findings transferring the acquired knowledge into clinical practice. Autacoids like adenosine, bradykinin and opioids are some of the experimentally and clinically most used agents that trigger the mechanism of protection by up-regulation of several kinases and of mediators, which prevent the opening of mitochondrial permeability pores. Clinical studies may be categorized as observational, reproducible and pharmacological. The remote form of myocardial conditioning by application of ischemia in a distal vascular territory, e.g. by blood pressure cuff inflation at the time of an evolving myocardial infarction, has shown promising results and may be used as an adjunctive to clinical methods of flow restoration and in parallel to the other treatment modalities. Although there are chances, there are also some confounders, which render the reproducibility of conditioning more difficult in clinical reality.

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Abbreviations

AR:

Adenosine receptors

IPC:

Ischemic preconditioning

mPTP:

Mitochondrial permeability transition pores

PKC:

Protein kinase C

PostC:

Postconditioning

ROS:

Reactive oxygen species

SAFE:

Survival activating factor Enhancement

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Authors and Affiliations

  1. Second Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Athens, Greece

    Efstathios K. Iliodromitis, Nikolaos Dagres & Dimitrios T. Kremastinos

  2. Department of Pharmaceutical Chemistry, University of Athens School of Pharmacy, Athens, Greece

    Ioanna Andreadou

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  1. Efstathios K. Iliodromitis
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  2. Ioanna Andreadou
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  3. Nikolaos Dagres
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  4. Dimitrios T. Kremastinos
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Correspondence to Efstathios K. Iliodromitis .

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  1. Academy of Athens, Biomedical Research Foundation, Athens, Greece

    Dennis V. Cokkinos

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Iliodromitis, E.K., Andreadou, I., Dagres, N., Kremastinos, D.T. (2015). Pre- Peri- Post-Conditioning the Ischemic Myocardium: Challenges, Confounders and Expectations. In: Cokkinos, D. (eds) Introduction to Translational Cardiovascular Research. Springer, Cham. https://doi.org/10.1007/978-3-319-08798-6_28

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