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Proposed mechanisms of cardioprotection: Cholic acid and INT-777, acting as TGR5 agonists, activate Akt, ERK and PKA pathways which are cytoprotective and improve myocardial response to stress. Activation of Akt, may inhibit FOXO-1 and suppress PDK4, which improves the metabolic efficiency and adaptability of the heart to catecholamine, exercise, and pressure overload mediated stress
