International Journal of Cardiology 187 (2015) 443–444
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Letter to the Editor
Morphine may enhance the cardioprotection induced by remote ischemic perconditioning Yao Lu a,b,⁎, Jun Hu c, Chunshan Dong b a b c
Department of Anesthesiology, Afﬁliated Province Hospital of Anhui Medical University, Hefei, Anhui Province, PR China Department of Anesthesiology, Third Afﬁliated Hospital of Anhui Medical University, Hefei, Anhui Province, PR China Department of Anesthesiology, Tongling People's Hospital, Tongling, Anhui Province, PR China
a r t i c l e
i n f o
Article history: Received 21 March 2015 Accepted 24 March 2015 Available online 26 March 2015 Keywords: Morphine Perconditioning Ischemia reperfusion injury
To the Editor We read with great interest the recent article by Andreadou et al.  Transient carotid ischemia as a remote conditioning stimulus for myocardial protection in anesthetized rabbits: Insights into intracellular signaling, the authors suggested that remote ischemic perconditioning reduces myocardial infarct size independently of RISK, SAFE, STAT5, Src kinase, angiotensin II or oxidative stress. Then, they ﬁrstly showed that eNOS along with apoptosis plays a predominant role in the cardioprotection of remote ischemic perconditioning. This is a very interest ﬁnding. Schmidt et al. ﬁrstly demonstrated that remote peripheral ischemia can induce cardioprotection in rats during coronary ischemia, then it is named as “remote ischemic perconditoning” . Morphine is widely used in patients with myocardial infarction, including those undergoing primary percutaneous coronary intervention. RISK pathway has been shown to play an essential role in morphine induced cardioprotection . A single-center, parallel-group, randomized study demonstrated that the addition of morphine infusion to remote ischemic postconditioning was associated with greater percentage of ST-segment resolution and lower peak Tn I levels in acute STsegment elevation myocardial infarction patients . It has been demonstrated that morphine reduces the threshold of remote ischemic
⁎ Corresponding author at: Department of Anesthesiology, Afﬁliated Province Hospital of Anhui Medical University, Hefei 230001, Anhui Province, PR China. E-mail address: [email protected]
http://dx.doi.org/10.1016/j.ijcard.2015.03.363 0167-5273/© 2015 Elsevier Ireland Ltd. All rights reserved.
preconditioning against myocardial ischemia and reperfusion injury in rats . Different activations of RISK pathway in the cardioprotection of opioids and remote ischemic perconditioning contribute to this stronger cardioprotection . Likewise, there still has been no study to indicate that the RISK pathway is mediated in remote ischemic perconditioning. Therefore, we populate that the role of the RISK pathway in the cardioprotection of opioids and remote ischemic perconditioning likely be different. The combined use of the protective strategies with different mechanisms might support each other, changing the activation of the RISK pathway. Then, the combination of opioids and remote ischemic preconditioning might obtain a better cardioprotection. It should be further pointed out that remote preconditioning with global cerebral ischemia preceding a coronary artery occlusion did not reduce myocardial infarct size, likely related to the modest increase in myocardial norepinephrine levels during cerebral ischemia . Information regarding which carotid artery selected to conduct remote ischemic perconditioning is not provided in the study of Andreadou et al. . Presumably, the carotid artery selected to induce perconditioning and cannulated for direct blood pressure monitoring in this study should be different. It would be also interesting if the authors could provide this speciﬁc information. Conﬂict of interest The authors have no conﬂict of interest to declare. Financial support National Natural Science Foundation of China (No. 81100105). References  I. Andreadou, S.I. Bibli, E. Mastromanolis, et al., Transient carotid ischemia as a remote conditioning stimulus for myocardial protection in anesthetized rabbits: insights into intracellular signaling, Int. J. Cardiol. 184C (2015) 140–151.  M.R. Schmidt, M. Smerup, I.E. Konstantinov, et al., Intermittent peripheral tissue ischemia during coronary ischemia reduces myocardial infarction through a KATPdependent mechanism: ﬁrst demonstration of remote ischemic perconditioning, Am. J. Physiol. Heart Circ. Physiol. 292 (2007) H1883–H1890.  E.R. Gross, A.K. Hsu, G.J. Gross, Opioid-induced cardioprotection occurs via glycogen synthase kinase beta inhibition during reperfusion in intact rat hearts, Circ. Res. 94 (2004) 960–966.
Y. Lu et al. / International Journal of Cardiology 187 (2015) 443–444
 I. Rentoukas, G. Giannopoulos, A. Kaoukis, et al., Cardioprotective role of remote ischemic periconditioning in primary percutaneous coronary intervention: enhancement by opioid action, JACC Cardiovasc. Interv. 3 (2010) 49–55.  Y. Lu, C.S. Dong, J.M. Yu, et al., Morphine reduces the threshold of remote ischemic preconditioning against myocardial ischemia and reperfusion injury in rats: the role of opioid receptors, J. Cardiothorac. Vasc. Anesth. 26 (2012) 403–406.
 Y.C. Xu, F.S. Xue, X. Liao, et al., Combined morphine and limb remote ischaemia postconditioning may produce an enhanced cardioprotection, Med. Hypotheses 73 (2009) 302–305.  S. de Zeeuw, T.W. Lameris, D.J. Duncker, et al., Cardioprotection in pigs by exogenous norepinephrine but not by cerebral ischemia-induced release of endogenous norepinephrine, Stroke 32 (2001) 767–774.