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. Author manuscript; available in PMC: 2021 Apr 1.
Published in final edited form as: Anesthesiology. 2020 Apr;132(4):763–780. doi: 10.1097/ALN.0000000000003037

Figure 8. Suggested mechanism of ERBB1 and cardioprotection during myocardial ischemia and reperfusion injury.

Figure 8.

During myocardial ischemia and reperfusion injury, the heart experiences significant hypoxia. Hypoxia stabilizes transcription factor HIF2A, which is then recruited by RBM4 to the RNA hypoxia response element (rHRE). This complex initiates the translation of ErbB1 mRNA to produce ERBB1 protein. Also upregulated during myocardial injury is AREG. HIF2A binds to the AREG promotor and increases the transcription of AREG gene. Finally, increased AREG protein binds to the increased ERBB1 receptors and activate important ERBB1 downstream signaling cascades, such as Akt, to provide cardio-protection.