Delayed adaptation of the heart to stress: Late preconditioning

Adam B. Stein, Xian Liang Tang, Yiru Guo, Yu Ting Xuan, Buddhadeb Dawn, Roberto Bolli

Research output: Contribution to journalArticlepeer-review

87 Scopus citations


The early phase of preconditioning (PC) lasts 2 to 3 hours and protects against myocardial infarction, but not against stunning. In contrast, the late phase of PC lasts for 3 to 4 days and protects against both myocardial stunning and infarction, making this phenomenon more clinically relevant. Late PC is a genetic reprogramming of the heart that involves the activation of several stress-responsive genes, which ultimately results in the development of a cardioprotective phenotype. Sublethal ischemic insults release chemical signals (nitric oxide [NO], adenosine, and reactive oxygen species) that trigger a series of signaling events (eg, activation of protein kinase C, Src protein tyrosine kinases, Janus kinases 1/2, and nuclear factor-κB) and culminates in increased synthesis of inducible NO synthase, cyclooxygenase-2, heme oxygenase-1, aldose reductase, Mn superoxide dismutase, and probably other cardioprotective proteins. In addition to ischemia, heat stress, exercise, and cytokines can also induce a similar series of events. Perhaps most importantly, many pharmacologic agents (eg, NO donors, adenosine receptor agonists, endotoxin derivatives, or opioid receptor agonists) can mimic the effects of ischemia in inducing the late phase of PC, suggesting that this phenomenon might be exploited therapeutically. The purpose of this review is to summarize the mechanisms that underlie the late phase of ischemic PC.

Original languageEnglish (US)
Pages (from-to)2676-2679
Number of pages4
Issue number11 SUPPL. 1
StatePublished - Nov 2004
Externally publishedYes


  • Ischemic preconditioning
  • Myocardial ischemia
  • Myocardial reperfusion
  • Nitric oxide

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing


Dive into the research topics of 'Delayed adaptation of the heart to stress: Late preconditioning'. Together they form a unique fingerprint.

Cite this