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ATP Metabolism and Ischemic Preconditioning

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Book cover Purines and Myocardial Protection

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 181))

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Abstract

Two general facets of myocardial ischemia are the progressive loss of high energy phosphates and adenine nucleotides and the progressive accumulation of a variety of catabolites. The relative importance of ATP depletion vs. accumulation of potentially deleterious catabolites in the transition from reversible to irreversible (lethal) ischemic cell injury is uncertain. Interventions which delay the onset of lethal injury delay both facets of ischemic metabolism. Ischemic preconditioning (IP) induces tolerance to a subsequent lethal episode of myocardial ischemia which is manifest by a substantial limitation of myocardial infarct size. A key feature and the likely final pathway of ischemic preconditioning is a reduction in ischemic myocardial energy demand. This reduction in energy demand is manifest by a reduced rate of high energy phosphate utilization and reduced accumulation of products of anaerobic glycolysis. Studies to date have shown that the slower ischemic energy utilization of preconditioned myocardium is not due to earlier inhibition of the mitochondrial ATPase, nor is it a feature of post-ischemic contractile dysfunction (stunning) that normally accompanies IP. Other proposed mechanisms include catecholamine-mediated effects, activation of adenosine A1 receptors, and earlier or more complete opening of ATP-sensitive potassium (K +ATP ) channels. Which of these (or other) pathways mediate the energy sparing effects of ischemic preconditioning remains unknown.

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Author information

Authors and Affiliations

  1. Department of Pathology, Duke University Medical Center, Box 3712, Durham, North Carolina, USA

    Keith A. Reimer, Richard S. Vander Heide & Robert B. Jennings

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  1. Keith A. Reimer
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  2. Richard S. Vander Heide
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  3. Robert B. Jennings
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Editor information

Editors and Affiliations

  1. Cardiothoracic Division, Department of Surgery, Box 890532, MCV Station, Richmond, VA, 23298-0532, USA

    Anwar-Saad A. Abd-Elfattah MS, Ph.D.

  2. Department of Surgery, Medical College of Virginia, Richmond, Virginia, 23298-0532, USA

    Andrew S. Wechsler M.D.

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© 1996 Kluwer Academic Publishers

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Reimer, K.A., Vander Heide, R.S., Jennings, R.B. (1996). ATP Metabolism and Ischemic Preconditioning. In: Abd-Elfattah, AS.A., Wechsler, A.S. (eds) Purines and Myocardial Protection. Developments in Cardiovascular Medicine, vol 181. Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-0455-5_27

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  • DOI: https://doi.org/10.1007/978-1-4613-0455-5_27

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4613-8056-6

  • Online ISBN: 978-1-4613-0455-5

  • eBook Packages: Springer Book Archive

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