title: Making the heart resistant to infarction: how can we further decrease infarct size?
abstract: Acute myocardial infarction (AMI) following coronary artery occlusion is a common cause of mortality and morbidity world-wide. Patients currently receive reperfusion therapy as the only anti-infarct intervention. A number of agents have been evaluated to further improve myocardial salvage, but until recently, none has demonstrated clear efficacy in clinical trials. A new target of cardioprotection, the Reperfusion Injury Salvage Kinase (RISK) pathway, has been proposed. These kinases are involved in mediating the cardioprotection of myocardial preconditioning and postconditioning induced by short non-lethal cycles of ischemia/reperfusion performed before (preconditioning) or just after (postconditioning) a lethal ischemic insult. Many pharmacological interventions are now available that protect the heart by activating the RISK pathway at the time of reperfusion. The present review will examine the efficacy of several strategies that have been proposed to protect the acutely ischemic myocardium including (1) those intended to directly alter adverse reperfusion events (e.g., calcium overload and free radical attack), (2) those based on activation of the RISK pathway including postconditioning, and (3) myocardial cooling.
authors.affiliation: INSERM, Unite 841, Creteil, F-94000 France.
authors.forename: Renaud
authors.initials: R
authors.lastname: Tissier
authors.forename: Alain
authors.initials: A
authors.lastname: Berdeaux
authors.forename: Bijan
authors.initials: B
authors.lastname: Ghaleh
authors.forename: Nicolas
authors.initials: N
authors.lastname: Couvreur
authors.forename: Thomas
authors.initials: T
authors.lastname: Krieg
authors.forename: Michael V
authors.initials: MV
authors.lastname: Cohen
authors.forename: James M
authors.initials: JM
authors.lastname: Downey
mesh_terms: D017209:Apoptosis; D002118:Calcium / Q000378:metabolism; D054059:Coronary Occlusion / Q000473:pathology; D005947:Glucose / Q000378:metabolism; D006801:Humans; D007249:Inflammation; D007328:Insulin / Q000378:metabolism; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods / Q000639:trends*; D008954:Models, Biological; D009203:Myocardial Infarction / Q000503:physiopathology* / Q000517:prevention & control*; D009206:Myocardium / Q000378:metabolism; D017382:Reactive Oxygen Species; D015424:Reperfusion; D013997:Time Factors
chemical_list: D007328:Insulin; D017382:Reactive Oxygen Species; D005947:Glucose; D002118:Calcium