Role of acadesine in clinical myocardial protection

摘要

Acadesine (AICA riboside, 5-amino-1-β-D-ribofura-nosyl-imidazole-4-carboxamide) is the prototype of a new class of compounds termed adenosine regulating agents. Acadesine is a purine nucleoside analogue that enters the myocyte and is immediately phosphorylated to ZMP (AICA ribotide)., which is further metabolised to inosine monophosphate (an intermediate in the synthesis of adenosine triphosphate (ATP) and guanosine triphos-phate). Claims that acadesine may serve as a substrate for ATP synthesis and result in repletion of myocardial ATP were supported by some studies and refuted by others. Because acadesine may be a precursor in the synthesis of myocardial ATP it was proposed as a possible agent of myocardial protection during ischaemia, particularly because myocardial ATP depletion has been linked to cell death. Initial studies suggested that acadesine can accelerate repletion of the adenine nucleotide pool during reperfusion but subsequent reports did not.