Acadesine: a unique cardioprotective agent for myocardial ischemia.

Acadesine is the prototype of a new class of drugs referred to as adenosine-regulating agents. These drugs act by increasing adenosine generation from adenosine monophosphate during conditions of myocardial ischemia. Adenosine itself has many beneficial cardioprotective properties that may therefore be harnessed by this new class of drugs. Unlike adenosine, acadesine acts specifically at sites of ischemia and is therefore void of the systemic hemodynamic effects that may complicate adenosine therapy. Animal and in vitro studies have established acadesine as a promising new agent for attenuating ischemic and reperfusion damage to the myocardium. Most published research involving the use of acadesine in humans has revolved around reducing ischemic complications of coronary artery bypass graft (CABG) surgery. These studies have produced promising yet inconclusive results as to the therapeutic role of acadesine in this setting. Acadesine also possesses the theoretical (but unproven) benefit of attenuating reperfusion injury after acute myocardial infarction (MI). Further research is needed to define the full potential of this unique agent in various clinical situations involving myocardial ischemia.