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2010, Number 4

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Rev Mex Anest 2010; 33 (4)

Postconditioning to protect the human heart

Luna-Ortiz P, Pastelin G, Torres JC, Martínez-Rosas M

Language: English
References: 100
Page: 187-199
PDF size: 676.11 Kb.


ABSTRACT

Recently, it has been shown that the heart can be protected against the ischemia reperfusion injury if brief coronary occlusions are performed just at the beginning of the reperfusion. This procedure has been called postconditioning (PostC). It can also be elicited by pharmacological interventions, which are named pharmacological PostC. In general, PostC reduces the reperfusion-induced injury, blunts oxidant-mediated damages and attenuates the local inflammatory response to reperfusion, decrease infarct size, diminishes apoptosis, neutrophil activation and endothelial dysfunction. The mechanisms that participate in PostC still are not completely understood. In this regard, adenosine, glycine, bradykinin, ciclosporin A, are involved in post C triggering. Similar to preconditioning, PostC triggers several signaling pathways and molecular components including nitric oxide (NO), Protein Kinase C (PKC), adenosine triphosphate-sensitive potassium channels (IKATP), the pathway: Reperfusion Injury Salvage Kinases (RISK) which compresses to: phosphatidylinositol-3-OH kinase (PI3K) and Extracellular signal-Regulated Kinase (ERK 1/2), and finally, the Survivor Activating Factor Enhancement (SAFE) pathway. In this review we describe the mechanisms of reperfusion-induced injury as well as the proposed protective pathways activated by PostC, which appear to converge in inhibition of mitochondrial permeability transition pores (mPTP) opening. On the other hand, experimental evidence indicated that volatile anesthetics and opioids are capable of exerting cardioprotective effects under certain conditions, constituting a very useful pharmacological Post C. In conclusion, the first minutes of reperfusion represent a window of opportunity for triggering the aforementioned mediators, which acting in concert lead to protection against reperfusion injury (PostC). Pharmacological, especially anesthetic, PostC may have a promising future in the clinical scenarios.


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