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2009, Number 3

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Bioquimia 2009; 34 (3)

Molecular mechanisms involve in mechanical maneuvers to prevent reperfusion injury in the ischemic myocardium

Correa-Segura F, Zazueta C

Language: Spanish
References: 53
Page: 137-149
PDF size: 146.45 Kb.


ABSTRACT

Infarct size is determined not only by the duration and severity of ischemia, but also by pathological processes initiated at reperfusion (reperfusion injury). Numerous pharmacological strategies have been reported which administer drugs at or just before the onset of reperfusion, with subsequent salubrious effects, notably a reduction in infarct size. However, two mechanical strategies alternatives show high efficiency to reduce the reperfusion injury. Pre-conditioning presented an experimental phenomenon that was the most markedly protective intervention able to limit infarct size in a consistent and reproducible manner. The wide reproducibility of this phenomenon using a variety of preconditioning protocols in a number of species and experimental preparations and with a number of endpoints of protection, rapidly led to ischemic preconditioning being established as a “gold standard” for cardioprotection. In other hand, post-conditioning, defined as repeated brief cycles of reperfusion interrupted by ischemia (or hypoxia) applied at the onset of reperfusion, was recently introduced as a mechanical strategy to attenuate reperfusion injury. Post-conditioning intervenes only during the first few minutes of reperfusion and reduces the infarct size significantly. Both maneuvers are efficient to reduce endothelial activation and dysfunction, the inflammatory response to reperfusion, necrosis, and apoptosis both acutely and long-term. In this revision we describe the molecular mechanism activated by pre and post-conditioning, that has been associated with cardioprotection. Knowledge of such mechanisms is now essential to maximize the likelihood of successful development of rational approaches to therapeutic protection for patients with ischemic heart disease.


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