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Physiol. Rev. 83: 1113-1151, 2003; doi:10.1152/physrev.00009.2003
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Preconditioning the Myocardium: From Cellular Physiology to Clinical Cardiology

DEREK M. YELLON and JAMES M. DOWNEY

The Hatter Institute for Cardiovascular Studies, University College London Hospital and Medical School, London, United Kingdom; and Department of Physiology, University of South Alabama College of Medicine, Mobile, Alabama

Yellon, Derek M., and James M. Downey. Preconditioning the Myocardium: From Cellular Physiology to Clinical Cardiology. Physiol Rev 83: 1113-1151, 2003; 10.1152/physrev.00009.2003.—The phenomenon of ischemic preconditioning, in which a period of sublethal ischemia can profoundly protect the cell from infarction during a subsequent ischemic insult, has been responsible for an enormous amount of research over the last 15 years. Ischemic preconditioning is associated with two forms of protection: a classical form lasting ~2 h after the preconditioning ischemia followed a day later by a second window of protection lasting ~3 days. Both types of preconditioning share similarities in that the preconditioning ischemia provokes the release of several autacoids that trigger protection by occupying cell surface receptors. Receptor occupancy activates complex signaling cascades which during the lethal ischemia converge on one or more end-effectors to mediate the protection. The end-effectors so far have eluded identification, although a number have been proposed. A range of different pharmacological agents that activate the signaling cascades at the various levels can mimic ischemic preconditioning leading to the hope that specific therapeutic agents can be designed to exploit the profound protection seen with ischemic preconditioning. This review examines, in detail, the complex mechanisms associated with both forms of preconditioning as well as discusses the possibility to exploit this phenomenon in the clinical setting. As our understanding of the mechanisms associated with preconditioning are unravelled, we believe we can look forward to the development of new therapeutic agents with novel mechanisms of action that can supplement current treatment options for patients threatened with acute myocardial infarction.


Address for reprint requests and other correspondence: D. M. Yellon, The Hatter Institute for Cardiovascular Studies, Centre for Cardiology, University College London Hospital and Medical School, Grafton Way, London WC1E 6DB, UK (E-mail: hatter-institute{at}ucl.ac.uk).




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