Current Modalities and Mechanisms Underlying Cardioprotection by Ischemic Conditioning

John H. Rosenberg, John H. Werner, Michael J. Moulton, Devendra K. Agrawal

Research output: Contribution to journalReview articlepeer-review

25 Scopus citations


Ischemic preconditioning is a process which serves to mitigate reperfusion injury. Preconditioning of the heart can be achieved through natural, pharmacological, and mechanical means. Mechanical preconditioning appears to have the greatest chance of good outcomes while methods employing pharmacologic preconditioning have been largely unsuccessful. Remote ischemic preconditioning achieves a cardioprotective effect by applying cycles of ischemia and reperfusion in a distal limb, stimulating the release of a neurohumoral cardioprotective factor incited by stimulation of afferent neurons. The cardioprotective factor stimulates the reperfusion injury salvage kinase (RISK) and survivor activator factor enhancement (SAFE) signaling cascades in cardiomyocytes which promote cell survival by the expression of anti-apoptotic genes and inhibition of the opening of mitochondrial permeability transition pores. Clinical application of ischemic preconditioning involving targets in the RISK and SAFE signaling appears promising in the treatment of acute myocardial infarction; however, clinical trials have yet to demonstrate additional benefit to current therapy.

Original languageEnglish (US)
Pages (from-to)292-307
Number of pages16
JournalJournal of Cardiovascular Translational Research
Issue number4
StatePublished - Aug 1 2018


  • Cardiomyocytes
  • Cardioprotection
  • Ischemia
  • Ischemic conditioning
  • Reperfusion injury
  • Reperfusion injury salvage kinase
  • Survival activator factor enhancement

ASJC Scopus subject areas

  • Molecular Medicine
  • Genetics
  • Pharmaceutical Science
  • Cardiology and Cardiovascular Medicine
  • Genetics(clinical)


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