The Cardioprotective Signaling Activity of Activated Protein C in Heart Failure and Ischemic Heart Diseases

Int J Mol Sci. 2019 Apr 10;20(7):1762. doi: 10.3390/ijms20071762.


Activated protein C (APC) is a vitamin-K dependent plasma serine protease, which functions as a natural anticoagulant to downregulate thrombin generation in the clotting cascade. APC also modulates cellular homeostasis by exhibiting potent cytoprotective and anti-inflammatory signaling activities. The beneficial cytoprotective effects of APC have been extensively studied and confirmed in a number of preclinical disease and injury models including sepsis, type-1 diabetes and various ischemia/reperfusion diseases. It is now well-known that APC modulates downstream cell signaling networks and transcriptome profiles when it binds to the endothelial protein C receptor (EPCR) to activate protease-activated receptor 1 (PAR1) on various cell types. However, despite much progress, details of the downstream signaling mechanism of APC and its crosstalk with other signaling networks are far from being fully understood. In this review, we focus on the cardioprotective properties of APC in ischemic heart disease and heart failure with a special emphasis on recent discoveries related to the modulatory effect of APC on AMP-activated protein kinase (AMPK), PI3K/AKT, and mTORC1 signaling pathways. The cytoprotective properties of APC might provide a novel strategy for future therapies in cardiac diseases.

Keywords: activated protein C; cardioprotection; endothelial protein C receptor; heart failure; ischemic heart disease.

Publication types

  • Review

MeSH terms

  • Animals
  • Anticoagulants / metabolism*
  • Blood Coagulation
  • Endothelial Protein C Receptor / metabolism
  • Heart Failure / metabolism*
  • Heart Failure / pathology
  • Humans
  • Mechanistic Target of Rapamycin Complex 1 / metabolism
  • Myocardial Ischemia / metabolism*
  • Myocardial Ischemia / pathology
  • Phosphatidylinositol 3-Kinases / metabolism
  • Protein C / metabolism*
  • Receptor, PAR-1 / metabolism
  • Signal Transduction*


  • Anticoagulants
  • Endothelial Protein C Receptor
  • PROCR protein, human
  • Protein C
  • Receptor, PAR-1
  • Phosphatidylinositol 3-Kinases
  • Mechanistic Target of Rapamycin Complex 1