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(Circulation. 2009;120:S1-S9.)
© 2009 American Heart Association, Inc.

Myocardial Protection, Perioperative Management, and Vascular Biology

Peripheral Nociception Associated With Surgical Incision Elicits Remote Nonischemic Cardioprotection Via Neurogenic Activation of Protein Kinase C Signaling

W. Keith Jones, PhD; Guo-Chang Fan, PhD; Siyun Liao, PhD; Jun-Ming Zhang, MD; Yang Wang, MD; Neal L. Weintraub, MD; Evangelia G. Kranias, PhD; Jo El Schultz, PhD; John Lorenz, PhD; Xiaoping Ren, MD

From Department of Pharmacology and Cell Biophysics (W.K.J., G.-C.F., S.L., Y.W., E.G.K., J.E.S., J.L., X.R.), Department of Anesthesiology (J.-M.Z.), Department of Internal Medicine (N.L.W.), Cardiovascular Division, and the Veteran’s Administration Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.

Correspondence to Xiaoping Ren, MD, Department of Pharmacology and Cell Biophysics, 231 Albert Sabin Way, University of Cincinnati, Cincinnati, OH 45267-0575. E-mail renxg{at}uc.edu

Background— Although remote ischemic stimuli have been shown to elicit cardioprotection against ischemia/reperfusion injury, there is little known about the effects of nonischemic stimuli. We previously described a remote cardioprotective effect of nonischemic surgical trauma (abdominal incision) called remote preconditioning of trauma (RPCT). In the present study, we elucidate mechanisms underlying this phenomenon.

Methods and Results— We used a murine model of myocardial infarction to evaluate ischemia/reperfusion injury, and either abdominal surgical incision, or application of topical capsaicin, to elicit cardioprotection. We show that the cardioprotective effect of RPCT is initiated by skin nociception, and requires neurogenic signaling involving spinal nerves and activation of cardiac sensory and sympathetic nerves. Our results demonstrate bradykinin-dependent activation and repression, respectively, of PKC and PKC in myocardium after RPCT, and we show involvement of the K^ATP channels in cardioprotection. Finally, we show that topical application of capsaicin, which selectively activates C sensory fibers in the skin, mimics the cardioprotective effect of RPCT against myocardial infarction.

Conclusions— Nontraumatic nociceptive preconditioning represents a novel therapeutic strategy for cardioprotection with great potential clinical utility.

Key Words: apoptosis • capsaicin • infarction • nervous system • remote preconditioning • signal transduction • sympathetic