Peptides in coronary circulation: basis for therapeutic strategies

Promising approaches towards new therapeutic strategies in coronary heart disease might emerge from an improved pathophysiological understanding of the role of certain peptides, which require a localizing event for their accumulation or expression in the coronary vasculature. Temporal myocardial ischaemia or hypoperfusion with reperfusion are such localizing acute events, which induce endothelial dysfunction and subsequent tissue damage in the affected myocardium. Peptides involved in these pathological processes are elements of the complement system, cell adhesion molecules on endothelial cells and on leukocytes, endothelial proteins affecting the coagulation cascade, and enzymes contributing to endothelial production of cytokines or superoxide anion. Protection against postischaemic reperfusion damage of the endothelium by antagonists or antibodies can be shown in experiments, and this endothelial protection appears crucial for reducing myocardial cell damage.