“…This is in agreement with the idea that epinephrine may exacerbate CA/ CPR-induced heart dysfunction as a consequence of increased myocardial oxygen demand (Lin et al, 2014;Yu et al, 2013). Melanocortins have been shown to induce multi-organ protection in several experimental models of hypoxic conditions, including circulatory shock, respiratory arrest, brain ischemia, myocardial ischemia and more, and many investigations (both past and recent) suggest that these protective effects result from brain melanocortin MC 3 /MC 4 receptor-activated anti-inflammatory mechanisms, mediated by the vagus nerve (Bazzani et al, 2002;Bertolini et al, 1989;Getting et al, 2006;Giuliani et al, 2007aGiuliani et al, , 2007bGiuliani et al, , 2012Guarini et al, 1997a;Mioni et al, 2003Mioni et al, , 2005Ottani et al, 2010Ottani et al, , 2013. Indeed, melanocortins pass the blood-brain barrier in pharmacologically relevant concentration (Catania et al, 2004;Giuliani et al, 2012), and in previous studies with experimental models of short-term and prolonged myocardial ischemia/ reperfusion we demonstrated that melanocortins induce cardioprotection through a brain activation of an efferent vagal fibremediated cholinergic anti-inflammatory pathway (Mioni et al, 2005;Ottani et al, 2010).…”