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Recent developments in cardiac physiology have focused on the mechanisms underlying preconditioning against ischemia-reperfusion injury. Sensing, transduction and cardioadaptation to the initial stimulus suggests species-specific differences in strategy. We and others have found that ischemic stress can trigger catecholamine (alpha1-adrenoreceptor)-dependent mechanisms of preconditioning. However, in rabbits and dogs, adenosine receptor mechanisms appear to predominate. In contrast, the role of the adenosine receptors in rat remains controversial. Anticipating a minor role for this metabolite, we examined its ability to induce protection in rat heart against a modest ischemic injury and also its relationship to the noradrenergic alpha1 pathway. Although redundant pathways for inducing adaptation to stress are possible, single transient ischemic stress surprisingly utilizes both alpha1-adrenoreceptors and adenosine P1 receptors in obligate roles. Thus blockade of either purinergic P1 or alpha1-adrenergic receptors abolished functional protection induced by single transient ischemic stimulus. Selective noradrenergic alpha1-adrenoreceptor stimulation was sufficient to protect cardiac recovery after modest ischemic injury, and was unaffected by purinergic blockades, suggesting that this is the primary stress adaptation pathway for rat. However, exogenous purinergic P1 stimulated protection was abolished in either reserpine pretreated, or alpha1-adrenoreceptor blockaded hearts. Therefore the cardioadaptive ischemic preconditioning mechanisms in rat may involve facilitative modulation of a primary pathway rather than redundancy.

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The high incidence of coronary disease in the current population renders myocardial ischemia a leading cause of morbidity and death. Recent efforts have made rapid restoration of coronary flow a clinical reality. Despite progress in hypothermic arrest and cardioplegia, the widespread performance of open cardiac operation and increasing use of cardiac transplantation obligate myocardial I/R stress. Advances in understanding the pathophysiologic factors of reversible and irreversible I/R injury have been significant, but are incomplete. Myocardial infarction and myocardial "stunning" remain clinically important sequelae of coronary disease. In the long term, the solution to heart disease will likely come through preventative health measures. In the interim, however, measures to limit ischemic duration and prepare the heart for reperfusion are clinically desirable. The presence of intrinsic cellular protective mechanisms intimate the feasibility of the latter measure. Furthermore, recently delineated receptor-mediated mechanisms of ischemic preconditioning may render this phenomenon clinically exploitable. The multifactorial pathophysiologic nature of the I/R process suggests that optimal intervention will likely require a combination of pharmacologic adjuncts intended for the specific type and severity of I/R insult. Continued exploration of I/R pathophysiologic factors is needed to develop practical therapeutic interventions.

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Recent findings indicate that ischemia/reperfusion (IR) is associated with phospholipase C (PLC)-induced inositol 1,4,5-triphosphate production, as well as abnormal sarcoplasmic reticulum (SR) Ca2+ release. Therefore, we hypothesized that increased SR Ca2+ release may contribute to Ca2+ overload and myocardial stunning. Neomycin (NEO) was used to inhibit PLC, and sodium dantrolene (DAN) was used to inhibit myocardial SR Ca2+ release. The purposes of this study were (1) to determine if PLC inhibition would reduce IR-induced ventricular dysfunction, (2) to examine ventricular function during inhibition of SR Ca2+ release prior to ischemia, and (3) to examine the influence of SR Ca2+ release inhibition on post-IR ventricular function. Left ventricular developed pressure (DP) and +/- dP/dt of isolated crystalloid perfused rat heart (Langendorff apparatus) paced at 350 bpm were compared before and after global IR (38 degrees C, 20 min I, 40 min R) to assess functional recovery. PLC was inhibited with NEO (10 microM x 5 min prior to ischemia), and SR Ca2+ release was retarded with DAN (12.5 microM) in 0.05% DMSO (vehicle) infused for 3 min via the aortic cannula 13 min prior to ischemia. No effect on DP was observed during NEO or DAN infusion. NEO and DAN pretreatment each improved recovery of DP (% recovery +/- SEM) following IR: control, 46.5 +/- 5.1%; NEO + IR, 71.0 +/- 6.3%,* vehicle + IR, 44.4 +/- 2.9%; DAN + IR, 71.0 +/- 4.7%, *, # (*P < 0.05 vs control IR, #P < 0.05 vs vehicle + IR, ANOVA, Scheffe F test, n = 5 all groups). We conclude that SR Ca2+ release during IR contributes to myocardial stunning.

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Efforts to minimize the deleterious effects of intraoperative myocardial ischemia-reperfusion (I/R) injury have been primarily directed at optimizing cardioplegic solutions and altering reperfusion conditions. Classically, myocardial I/R has been associated with cardiac mechanical dysfunction ("stunning"). Recently, we reported an alpha 1-adrenergic receptor-mediated mechanism of paradoxical myocardial protection against I/R insult induced by a prior episode of transient ischemia, a phenomenon known as "ischemic preconditioning." Myocardial stunning resulting from transient ischemia has previously been associated with ischemic preconditioning, prompting intuitively negative bias against the clinical application of this phenomenon. The purpose of this study was to determine whether transient ischemia of insufficient duration to cause prolonged mechanical dysfunction (stunning) can induce favorable cardiac preconditioning. Isolated-perfused rat hearts were allowed to equilibrate for 8 minutes and were then subjected to either 2 minutes of global, normothermic transient ischemia or 2 minutes of 50 mumol/L phenylephrine infusion. A stabilization period of perfusion lasting 10 minutes after the termination of transient ischemia or phenylephrine infusion was followed by a standard I/R challenge (20 minutes of global, normothermic ischemia; 40 minutes of reperfusion). Ventricular function (measured as developed pressure in millimeters of mercury) recovered rapidly after transient ischemia such that no impairment was present before the subsequent standard I/R challenge. Phenylephrine treatment was associated with no residual inotropy before I/R challenge. Control hearts were subjected only to the standard I/R challenge after an initial 20-minute equilibration period. After reperfusion control hearts exhibited 54.4% recovery of initial left ventricular developed pressure. Transient ischemia- and phenylephrine-preconditioned hearts recovered 84.4% (p < 0.01) and 82.4% (p < 0.01), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

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