T he potential of intermedin (IMD) as a regulator of cardiovascular activity is well established. For example, studies have shown that IMD exhibits vasodilatory activity 1 and decreases blood pressure. 2,3 In pathophysiological states, it has been reported that the expression of IMD is enhanced during heart failure. 4 In addition, higher IMD expression in hypertrophied left ventricular cardiomyocytes suggests an important role for the peptide in the response to chronic hypertension. 5 In an investigation published in this issue, Zhang et al. 6 use a mouse model to study the effects of IMD in relation to the important clinical problem of myocardial ischemiareperfusion injury. The role of IMD in this pathological condition remains poorly understood, and little is known with regard to changes in the expression of IMD and the receptor components. In the current investigation, the authors use a mouse model involving ligation of the left descending artery. They report that there are changes induced in pulse pressure and heart rate following induction of infarction and reperfusion. With respect to furthering our understanding of ischemia-reperfusion, it is important to note that there were also changes in factors associated with IMD. Observations included raised levels of IMD in plasma and of expression in the infarcted area. In addition, there was modulation of receptor activity-modifying protein (RAMP)2 and RAMP3 expression. The peptide was administered to consider the effects of IMD, and these included reduction in the size of the necrotic area. Furthermore, levels of IMD in blood were positively associated with diastolic blood pressure and negatively associated with pulse pressure. These results are consistent with a cardioprotective function.The authors have supplied new information on the response and potential role of IMD in myocardial ischemia-reperfusion injury. This is important in light of the knowledge that there are a number of endogenous bioactive factors involved in cardiovascular control. These include the peptides endothelin-1, CNP, angiotensin-II, urocortin and adrenomedullin (ADM), among others. To understand (and therefore control) the system, it is necessary to delineate the distinct effects of the different peptides. The activities and responses of the peptides will potentially complement each other in physiological functioning by being activated in different circumstances.The relationship between IMD and ADM is of particular interest because of their structural similarity and the possibility that they comprise a distinct family within the calcitonin gene-related peptide superfamily. 3 It has been observed that the effects of IMD on the cardiovascular system can indeed sometimes be similar to those of ADM, so perhaps in some circumstances we could expect the effects to be additive in vivo. Even with regard to ischemia-reperfusion injuries, cardio-protective activity has been reported for both ADM and IMD. 7 The current study has observed that IMD reduces neutrophil infiltration and has an increase...