Clinical Pharmacology of Preconditioning and Adenosinergic Drugs

  • Herman Van Belle
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 194)


On an array of cells and organs adenosine may exert a multitude of effects, all apparently serving one purpose: restore and maintain the balance between energy supply and demand (for recent reviews, Refs. 1,2). Its rapid formation in response to ischemia constitutes a natural defense system which appears to be extremely efficient, hence very attractive, for three reasons:
  1. 1.

    Adenosine’s formation is the simple consequence of a disequilibrium between dephosphorylation of ATP (’energy demand) and rephosphorylation (mitochondrial oxidative metabolism > energy supply). AMP, adenosine’s immediate precursor, is a most sensitive sensor of energy shortage.

  2. 2.

    Adenosine’s formation is small and temporarily. It is limited to the ischemic area within most vital organs and only when oxygen supply is insufficient to cope with the demand. Nature has even taken precautions to prevent spreading of this potent messenger to normoxic regions or organs by providing rapid catabolism in the endothelial cells lining the microvessels, and in erythrocytes.

  3. 3.

    Adenosine’s production initiates a cascade of effects. Its most prominent activity, microvascular vasodilatation, will be a first-aid measure to restore the balance. If not sufficient, more adenosine will accumulate and more receptors within reach may be triggered: demand will be moderated and there will be a delay in the start of a vicious circle of events leading to major organ damage.



Adenosine Deaminase Nucleoside Transport Left Ventricular Ejection Time Mitochondrial Oxidative Metabolism European Stroke Prevention Study 
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© Springer Science+Business Media New York 1997

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  • Herman Van Belle

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