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Thromb Haemost 2009; 101(04): 635-642
DOI: 10.1160/TH08-11-0764
Theme Issue Article
Schattauer GmbH

Myocardial protection against reperfusion injury: The cGMP pathway

David Garcia-Dorado
1   Laboratorio de Cardiología Experimental, Area del Cor, Hospital Universitari Vall d’Hebron, Barcelona, Spain
,
Luis Agulló
1   Laboratorio de Cardiología Experimental, Area del Cor, Hospital Universitari Vall d’Hebron, Barcelona, Spain
,
Carmem Lluisa Sartorio
1   Laboratorio de Cardiología Experimental, Area del Cor, Hospital Universitari Vall d’Hebron, Barcelona, Spain
,
Marisol Ruiz-Meana
1   Laboratorio de Cardiología Experimental, Area del Cor, Hospital Universitari Vall d’Hebron, Barcelona, Spain
› Author Affiliations Financial support:This study was supported by Fondo Investigación Sanitaria (FIS-RECAVA RD06/0014/0025); and Comisión Interministerial en Ciencia y Tecnología (CICYT SAF2005–1758).
Further Information

Publication History

Received: 24 November 2008

Accepted after minor revision: 08 February 2009

Publication Date:
23 November 2017 (online)

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Summary

Reperfusion injury may cause myocardial cell death and limit the benefit achieved by restoration of coronary artery patency in patients with acute myocardial infarction. The mechanism includes altered Ca2+ handling with cytosolic and mitochondrial Ca2+ overload, Ca2+- and ATP-dependent hypercontraction, cytoskeletal fragility, mitochondrial permeability transition and gap junction-mediated propagation of cell death, as well as alterations in non-cardiomyocyte cells, in particular platelets and endothelial cells. cGMP modulates favorably all these mechanism, mainly through PKG-mediated actions, but cGMP synthesis is altered in reperfused cardiomyocytes and endothelial cells by mechanisms that are only partially understood. Stimulation of cGMP synthesis during initial reperfusion by means of natriuretic peptides has been found protective in different animal models and in patients. Moreover, increasing evidence indicates that cGMP is an important step in signal transduction of endogenous cardioprotection. Thus, the cGMP pathway appears as a key element in the pathophysiology of myocardial ischaemiareperfusion and as a promising therapeutic target in patients with acute myocardial infarction.

Keywords

Ischaemic heart disease - platelet physiology - acute myocardial infarction
 

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