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Ischemic preconditioning in humans: models, mediators, and clinical relevance
F Tomai1, F Crea, L Chiariello
1Divisione di Cardiochirurgia, Università di Roma Tor Vergata, European Hospital and Istituto di Cardiologia (F.C.), Università Cattolica del Sacro Cuore, Rome, Italy.
Circulation
|August 3, 1999
Summary
Ischemic preconditioning offers endogenous protection against myocardial infarction in humans, evidenced by studies on heart tissue and patients. Its mechanisms involve specific drug targets, suggesting therapeutic potential.
Area of Science:
- Cardiology
- Physiology
- Pharmacology
Background:
- Ischemic preconditioning is a natural defense against myocardial infarction observed in animals.
- Demonstrating this in humans is challenging due to ethical and logistical constraints.
- Previous studies suggest its occurrence in human heart tissue and clinical settings.
Purpose of the Study:
- To investigate the evidence for ischemic preconditioning in humans.
- To identify the molecular mediators involved in human ischemic preconditioning.
- To explore the therapeutic implications of ischemic preconditioning in myocardial infarction.
Main Methods:
- In vitro studies on human atrial trabeculae.
- Analysis of patient data from coronary bypass surgery and angioplasty.
- Observation of drug effects on ischemia adaptation in human models.
Main Results:
- Human studies suggest adaptation to ischemia, indicating preconditioning.
- Drug interactions with K(ATP) channels, purinergic, and alpha-adrenergic receptors support preconditioning mechanisms.
- Preconditioning may influence the warm-up phenomenon and preinfarction angina.
Conclusions:
- Ischemic preconditioning occurs in humans and is influenced by specific drug targets.
- Understanding these mediators can inform therapeutic strategies for myocardial infarction.
- Caution is advised with drugs blocking preconditioning; those eliciting it may be beneficial.
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