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Preconditioning and postconditioning: new strategies for cardioprotection

Hausenloy, DJ; Yellon, DM; (2008) Preconditioning and postconditioning: new strategies for cardioprotection. DIABETES OBES METAB , 10 (6) 451 - 459. 10.1111/j.1463-1326.2007.00762.x.

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Abstract

Despite optimal therapy, the morbidity and mortality of coronary heart disease (CHD) remains significant, particularly in patients with diabetes or the metabolic syndrome. New strategies for cardioprotection are therefore required to improve the clinical outcomes in patients with CHD. Ischaemic preconditioning (IPC) as a cardioprotective strategy has not fulfilled it clinical potential, primarily because of the need to intervene before the index ischaemic event, which is impossible to predict in patients presenting with an acute myocardial infarction (AMI). However, emerging studies suggest that IPC-induced protection is mediated in part by signalling transduction pathways recruited at time of myocardial reperfusion, creating the possibility of harnessing its cardioprotective potential by intervening at time of reperfusion. In this regard, the recently described phenomenon of ischaemic postconditioning (IPost) has attracted great interest, particularly as it represents an intervention, which can be applied at time of myocardial reperfusion for patients presenting with an AMI. Interestingly, the signal transduction pathways, which underlie its protection, are similar to those recruited by IPC, creating a potential common cardioprotective pathway, which can be recruited at time of myocardial reperfusion, through the use of appropriate pharmacological agents given as adjuvant therapy to current myocardial reperfusion strategies such as thrombolysis and primary percutaneous coronary intervention for patients presenting with an AMI. This article provides a brief overview of IPC and IPost and describes the common signal transduction pathway they both appear to recruit at time of myocardial reperfusion, the pharmacological manipulation of which has the potential to generate new strategies for cardioprotection.

Type: Article
Title: Preconditioning and postconditioning: new strategies for cardioprotection
DOI: 10.1111/j.1463-1326.2007.00762.x
Keywords: diabetes, metabolic syndrome, postconditioning, preconditioning, reperfusion, ACUTE MYOCARDIAL-INFARCTION, MITOCHONDRIAL PERMEABILITY TRANSITION, PERCUTANEOUS CORONARY INTERVENTION, GLUCAGON-LIKE PEPTIDE-1, ST-SEGMENT ELEVATION, ISOLATED RAT-HEART, METABOLIC SYNDROME, REPERFUSION INJURY, DIABETIC HEART, RABBIT HEARTS
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Cardiovascular Science > Pre-clinical and Fundamental Science
URI: http://discovery.ucl.ac.uk/id/eprint/90590
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