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© 2000 American Heart Association, Inc.
Review |
The Late Phase of Preconditioning
From the Division of Cardiology, University of Louisville and Jewish Hospital Heart and Lung Institute, Louisville, Ky.
Correspondence to Roberto Bolli, MD, Division of Cardiology, University of Louisville, Louisville, KY 40292. E-mail rbolli{at}louisville.edu
Abstract—Unlike
the early phase of preconditioning (PC), which lasts 2 to 3 hours and
protects against infarction but not against stunning, the late phase of
PC lasts 3 to 4 days and protects against both infarction and stunning,
suggesting that it may have greater clinical relevance. It is now clear
that late PC is a polygenic phenomenon that requires the simultaneous
activation of multiple stress-responsive genes. Chemical signals
released by a sublethal ischemic stress (such as NO, reactive oxygen
species, and adenosine) trigger a complex cascade of signaling events
that includes the activation of protein kinase C, Src protein tyrosine
kinases, and nuclear factor 
B and culminates in increased synthesis
of inducible NO synthase, cyclooxygenase-2, aldose reductase, Mn
superoxide dismutase, and probably other cardioprotective proteins. An
analogous sequence of events can be triggered by a variety of stimuli,
such as heat stress, exercise, and cytokines. Thus, late PC appears to
be a universal response of the heart to stress in general. Importantly,
the cardioprotective effects of late PC can be reproduced
pharmacologically with clinically relevant agents (eg, NO donors,
adenosine receptor agonists, endotoxin derivatives, or opioid receptor
agonists), suggesting that this phenomenon might be exploited for
therapeutic purposes. The purpose of this review is to summarize
current information regarding the pathophysiology and mechanism of late
PC.
Key Words: myocardial ischemia • myocardial reperfusion • nitric oxide • cyclooxygenase • aldose reductase
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