Protection of the myocardium by ischaemic preconditioning: mechanisms and therapeutic implications

Preconditioning of the heart with brief periods of ischaemia protects the myocardium for up to 90 min against a more sustained ischaemic injury. A "second window of protection" occurs 24 hr after preconditioning with ischaemia. The cardioprotective effects of ischaemic preconditioning involve the release of mediators (adenosine, bradykinin, catecholamines, prostaglandins, endothelin-1), which either alone or in concert activate protein kinase C, which translocates to the cell membrane. This manuscript reviews (i) the cardioprotective effects of ischaemic preconditioning, (ii) the underlying mechanisms, (iii) the effects of ischaemic preconditioning of other tissues (skeletal muscle, brain and kidney), and (iv) the clinical implications.