Organ preconditioning

The initial discovery of cardiac preconditioning has evolved into an exciti ng series of practical surgical applications. An enormous amount of evidenc e demonstrating both the safety and efficacy of ischemic preconditioning is available from animal studies. The challenging premise of intentionally su bjecting patients and their organs to transient ischemia has acted as a for midable psychological and ethical impediment to the widespread clinical app lication of organ preconditioning. A more palatable alternative to ischemic preconditioning now involves approved medications designed to manipulate t he cellular machinery mediating ischemic preconditioning. Pharmacologically induced preconditioning seems to confer equal organ protection. The relati vely brief (but surgically relevant) window of protection provided by strat egies such as ischemic preconditioning or adenosine agonists and potassium- adenosine triphosphate channel openers may, in the future, be extended. We have developed and reported the feasibility of liposomal delivery of heat s hock protein to cardiac myocytes with subsequent protection against sepsis- induced dysfunction. Targeted strategies will ultimately broaden the therap eutic potential of organ preconditioning.