Attenuation of apoptosis and the eye of the beholder.
OBJECTIVE
We consider the conundrum suggested by myocardial hibernation and late restoration of function despite the absence of a substantial lateral peri-infarction border zone with respect to oxygenation, and suggest a pivotal role for apoptosis and its attenuation in salvaging jeopardized myocardium.


METHODS
Selective pertinent literature is reviewed, and some recent observations indicating difficulties in identifying and quantifying apoptosis microscopically are summarized.


RESULTS
Apoptosis seems to occur primarily after reperfusion following ischemia rather than persistent ischemia leading to necrosis. Refinements of markers of its presence are needed in vitro for use ultimately in vivo and should be pivotal in defining the extent to which tissue-protective interventions can salvage myocardium in the context of a fixed magnitude and duration of ischemia.


CONCLUSIONS
Apoptosis is strongly implicated in the overall demise of jeopardized myocardium. Its attenuation seems likely to be potentially beneficial. Validation of this hypothesis will require progress in identification, delineation, and assessment of the extent of apoptosis in the threatened heart.
Sobel
Burton E
BE
Cardiovascular Research Institute, University of Vermont College of Medicine, Burlington, Vermont, USA. Burton.Sobel@uvm.edu
Zaman
Tarikuz
T
Budd
Ralph C
RC
Schneider
David J
DJ
Taatjes
Douglas J
DJ
D000818:Animals; D017209:Apoptosis / Q000502:physiology*; D006801:Humans; D017202:Myocardial Ischemia / Q000503:physiopathology*; D015428:Myocardial Reperfusion Injury / Q000503:physiopathology*; D017682:Myocardial Stunning / Q000503:physiopathology*