Acute pharmacologic preconditioning as a new concept and alternative approach for prevention of skeletal muscle ischemic necrosis.

The phenomenon of ischemic preconditioning for augmentation of ischemic tolerance has been well documented in the myocardium of common laboratory animals and human cardiomyocytes. The cellular mechanism of ischemic preconditioning is unclear, but adenosine is most likely the mediator in the rabbit, dog, pig and human. We have demonstrated recently that the protective effect of ischemic preconditioning and adenosine against ischemic injury can also be induced in pig skeletal muscles [116]. We speculate that adenosine is a potential treatment modality for prevention of skeletal muscle ischemic injury in vascular and musculoskeletal reconstructive surgery and in muscle and limb procurement for transplantation in the future. It is hoped that this review will stimulate workers at other laboratories to join the adventure in exploring the cellular mechanism and clinical application of adenosine for augmentation of skeletal muscle ischemic tolerance.