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Over the last decade, there has been a concerted clinical effort to deliver on the laboratory promise that a variety of maneuvers can profoundly increase cardiac tolerance to ischemia and/or reduce additional damage consequent upon reperfusion. Here we will review the proximity of the metabolic approach to clinical practice. Specifically, we will focus on how the citric acid cycle is involved in cardioprotection. Inspired by cross-fertilization between fundamental cancer biology and cardiovascular medicine, a set of metabolic observations have identified novel metabolic pathways, easily manipulable in man, which can harness metabolism to robustly combat ischemia-reperfusion injury.

Original publication




Journal article


Circ Cardiovasc Genet

Publication Date





711 - 719


cardioprotection, citric acid cycle, fumaric acid, nuclear factor (erythroid-derived 2)-like 2, oxidation-reduction, reperfusion injury, Animals, Citric Acid Cycle, Coronary Artery Disease, Heart, Humans, Myocardial Ischemia, Myocardium