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Myocardial Protection From Reperfusion Injury With Adenosine

  • Jakob Vinten-Johansen
  • Zhi-Qing Zhao
Chapter
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 194)

Abstract

Adenosine has recently been moved into the limelight for its clinically applicable physiological effects. Certainly, its cardiovascular effects have long been recognized,1 and its vasodilator effects have been proposed as a central mechanism of autoregulation of coronary blood flow.2 In addition, its negative inotropic and chronotropic effects have been understood for many years.3,4 However, it has not been until the last decade that adenosine has been appreciated for its cardioprotective potential against ischemic-reperfusion injury. Since the observations of Olafsson et al,5 there has been a virtual explosion of research focused on unraveling the mechanisms by which this endogenous autacoid protects the heart from non-lethal as well as lethal injury after ischemia and reperfusion. As investigative efforts have progressed, the temporal dynamics and mechanisms by which adenosine exerts cardioprotection have become more intriguing, and more complex. Adenosine has potential to exert cardioprotection during all three windows of cardioprotection (pretreatment or preconditioning, ischemia and reperfusion). Therefore, adenosine has emerged as a broad-spectrum cardioprotective agent that exerts protection endogenously as well as by pharmacological application (exogenously). However, the observation of adenosine as protagonist of injury by its stimulation of neutrophil-mediated events, a provider of substrate for enhanced generation of superoxide anions via xanthine oxidase of its metabolites xanthine and hypoxanthine, and antagonist to injury via numerous mechanisms offers an intriguing challenge to investigators to elucidate its entire spectrum of physiological and molecular effects. During which of these windows adenosine exerts its effects on the participants in the injury processes will determine its optimal therapeutic use.6 This chapter will focus on the mechanisms of myocardial protection by endogenous and exogenous adenosine, and receptor-specific analogs with specific reference to mechanisms involved in reperfusion injury; a full discussion of adenosine regulating agents is beyond its scope.

Keywords

Infarct Size Reperfusion Injury Myocardial Protection Myocardial Stunning Blood Cardioplegia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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© Springer Science+Business Media New York 1997

Authors and Affiliations

  • Jakob Vinten-Johansen
  • Zhi-Qing Zhao

There are no affiliations available

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