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CPR: cardiac phosphatase in resuscitation
Arjun Deb
Arjun Deb
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Commentary

CPR: cardiac phosphatase in resuscitation

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Abstract

Out-of-hospital cardiac arrest is associated with a dismal mortality rate and low long-term survival. A large pharmacological knowledge gap exists in identifying drugs that preserve neurological function and increase long-term survival after cardiac arrest. In this issue of the JCI, Li, Zhu, and colleagues report on their engineering of a 20–amino acid cell-permeable peptide (TAT-PHLPP9c) that antagonized the phosphatase PHLPP1 and prevented PHLPP1-mediated dephosphorylation and AKT inactivation. TAT-PHLPP9c administration maintained activated AKT after arrest and led to AKT-mediated beneficial effects on the heart, brain, and metabolism, resulting in increased cardiac output and cerebral blood flow and rescue of ATP levels in affected tissues. TAT-PHLPP9c improved neurological outcomes and increased survival after cardiac arrest in murine and porcine models of cardiac arrest. These findings provide proof of concept that pharmacological targeting of PHLPP1 may be a promising approach to augmenting long-term survival after cardiac arrest.

Authors

Arjun Deb

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Figure 1

Inhibition of PHLPP1 using the 20–amino acid peptide TAT-PHLPP9c augments brain, heart, and metabolic function after cardiac arrest in preclinical models.

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Inhibition of PHLPP1 using the 20–amino acid peptide TAT-PHLPP9c augment...
Following cardiac arrest, PHLPP1 dephosphorylates and inactivates AKT at Ser473. TAT-PHLPP9c peptide inhibits PHLPP1-mediated dephosphorylation of AKT, which leads to maintenance of Ser473 phosphorylation and activation of AKT. Activated AKT mediates beneficial effects on the heart, brain, metabolism, and damaged tissues. Secondary beneficial effects (dashed arrows) are mediated by increased cardiac output, increased blood flow in organs, and attenuation of tissue hypoxia. Collectively, these effects of maintaining activated AKT lead to increased survival after cardiac arrest. EF, ejection fraction.

Copyright © 2026 American Society for Clinical Investigation
ISSN: 0021-9738 (print), 1558-8238 (online)

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