Isoflurane Postconditioning Prevents Opening of the Mitochondrial Permeability Transition Pore through Inhibition of Glycogen Synthase Kinase 3β

Background: Postischemic administration of volatile anesthetics activates reperfusion injury salvage kinases and decreases myocardial damage. However, the mechanisms underlying anesthetic postconditioning are unclear.

Methods: Isolated perfused rat hearts were exposed to 40 min of ischemia followed by 1 h of reperfusion. Anesthetic postconditioning was induced by 15 min of 2.1 vol% isoflurane (1.5 minimum alveolar concentration) administered at the onset of reperfusion. In some experiments, atractyloside (10 [mu]m), a mitochondrial permeability transition pore (mPTP) opener, and LY294002 (15 [mu]m), a phosphatidylinositol 3-kinase inhibitor, were coadministered with isoflurane. Western blot analysis was used to determine phosphorylation of protein kinase B/Akt and its downstream target glycogen synthase kinase 3[beta] after 15 min of reperfusion. Myocardial tissue content of nicotinamide adenine dinucleotide served as a marker for mPTP opening. Accumulation of MitoTracker Red 580 (Molecular Probes, Invitrogen, Basel, Switzerland) was used to visualize mitochondrial function.

Results: Anesthetic postconditioning significantly improved functional recovery and decreased infarct size (36 +/- 1% in unprotected hearts vs. 3 +/- 2% in anesthetic postconditioning; P < 0.05). Isoflurane-mediated protection was abolished by atractyloside and LY294002. LY294002 inhibited isoflurane-induced phosphorylation of protein kinase B/Akt and glycogen synthase kinase 3[beta] and opened mPTP as determined by nicotinamide adenine dinucleotide measurements. Atractyloside, a direct opener of the mPTP, did not inhibit phosphorylation of protein kinase B/Akt and glycogen synthase kinase 3[beta] by isoflurane but reversed isoflurane-mediated cytoprotection. Microscopy showed accumulation of the mitochondrial tracker in isoflurane-protected functional mitochondria but no staining in mitochondria of unprotected hearts.     

Isoflurane postconditioning prevents opening of the mitochondrial permeability transition pore through inhibition of glycogen synthase kinase 3beta

BACKGROUND: Postischemic administration of volatile anesthetics activates reperfusion injury salvage kinases and decreases myocardial damage. However, the mechanisms underlying anesthetic postconditioning are unclear. METHODS: Isolated perfused rat hearts were exposed to 40 min of ischemia followed by 1 h of reperfusion. Anesthetic postconditioning was induced by 15 min of 2.1 vol% isoflurane (1.5 minimum alveolar concentration) administered at the onset of reperfusion. In some experiments, atractyloside (10 microm), a mitochondrial permeability transition pore (mPTP) opener, and LY294002 (15 microm), a phosphatidylinositol 3-kinase inhibitor, were coadministered with isoflurane. Western blot analysis was used to determine phosphorylation of protein kinase B/Akt and its downstream target glycogen synthase kinase 3beta after 15 min of reperfusion. Myocardial tissue content of nicotinamide adenine dinucleotide served as a marker for mPTP opening. Accumulation of MitoTracker Red 580 (Molecular Probes, Invitrogen, Basel, Switzerland) was used to visualize mitochondrial function. RESULTS: Anesthetic postconditioning significantly improved functional recovery and decreased infarct size (36 +/- 1% in unprotected hearts vs. 3 +/- 2% in anesthetic postconditioning; P < 0.05). Isoflurane-mediated protection was abolished by atractyloside and LY294002. LY294002 inhibited isoflurane-induced phosphorylation of protein kinase B/Akt and glycogen synthase kinase 3beta and opened mPTP as determined by nicotinamide adenine dinucleotide measurements. Atractyloside, a direct opener of the mPTP, did not inhibit phosphorylation of protein kinase B/Akt and glycogen synthase kinase 3beta by isoflurane but reversed isoflurane-mediated cytoprotection. Microscopy showed accumulation of the mitochondrial tracker in isoflurane-protected functional mitochondria but no staining in mitochondria of unprotected hearts. CONCLUSIONS: Anesthetic postconditioning by isoflurane effectively protects against reperfusion damage by preventing opening of the mPTP through inhibition of glycogen synthase kinase 3beta.     

Inhibition of mitochondrial permeability transition enhances isoflurane-induced cardioprotection during early reperfusion: the role of mitochondrial KATP channels

Inhibition of the mitochondrial permeability transition pore (mPTP) mediates the protective effects of brief, repetitive ischemic episodes during early reperfusion after prolonged coronary artery occlusion. Brief exposure to isoflurane immediately before and during early reperfusion also produces cardioprotection, but whether mPTP is involved in this beneficial effect is unknown. We tested the hypothesis that mPTP mediates isoflurane-induced postconditioning and also examined the role of mitochondrial KATP (mKATP) channels in this process. Rabbits (n = 102) subjected to a 30-min coronary occlusion followed by 3 h reperfusion received 0.9% saline (control), isoflurane (0.5 or 1.0 MAC) administered for 3 min before and 2 min after reperfusion, or the mPTP inhibitor cyclosporin A (CsA, 5 or 10 mg/kg) in the presence or absence of the mPTP opener atractyloside (5 mg/kg) or the selective mK(ATP) channel antagonist 5-hydroxydecanoate (5-HD; 10 mg/kg). Other rabbits received 0.5 MAC isoflurane plus 5 mg/kg CsA in the presence and absence of atractyloside or 5-HD. Isoflurane (1.0 but not 0.5 MAC) and CsA (10 but not 5 mg/kg) reduced (P < 0.05) infarct size (21% +/- 4%, 44% +/- 6%, 24% +/- 3%, and 43% +/- 6%, respectively, mean +/- sd of left ventricular area at risk; triphenyltetrazolium staining) as compared with control (42% +/- 7%). Isoflurane (0.5 MAC) plus CsA (5 mg/kg) was also protective (27% +/- 4%). Neither atractyloside nor 5-HD alone affected infarct size, but these drugs abolished protection by 1.0 MAC isoflurane, 10 mg/kg CsA, and 0.5 MAC isoflurane plus 5 mg/kg CsA. The results indicate that mPTP inhibition enhances, whereas opening abolishes, isoflurane-induced postconditioning. This isoflurane-induced inhibition of mitochondrial permeability transition is dependent on activation of mitochondrial KATP channels in vivo.     

The influence of B-cell lymphoma 2 protein, an antiapoptotic regulator of mitochondrial permeability transition, on isoflurane-induced and ischemic postconditioning in rabbits

Brief exposure to isoflurane or repetitive, transient ischemia during early reperfusion after prolonged coronary artery occlusion protects against myocardial infarction by inhibiting the mitochondrial permeability transition pore (mPTP). Inhibition of mPTP during delayed ischemic preconditioning occurred concomitant with enhanced expression of the antiapoptotic protein B cell lymphoma-2 (Bcl-2). We tested the hypothesis that Bcl-2 mediates myocardial protection by isoflurane or brief ischemic episodes during reperfusion in rabbits (n = 91) subjected to a 30-min left anterior descending coronary artery occlusion followed by 3 h reperfusion. Rabbits received 0.9% saline, isoflurane (0.5 or 1.0 minimum alveolar concentration, MAC) administered for 3 min before and 2 min after reperfusion, 3 cycles of postconditioning ischemia (10 or 20 s each) during early reperfusion, 0.5 MAC isoflurane plus 3 cycles of postconditioning ischemia (10 s), or the direct mPTP inhibitor cyclosporin A (CsA, 10 mg/kg) in the presence or absence of the selective Bcl-2 inhibitor HA14-1 (2 mg/kg, i.p.). Isoflurane (1.0, but not 0.5, MAC) and postconditioning ischemia (20 s but not 10 s) significantly (P < 0.05) reduced infarct size (mean +/- sd, 21% +/- 4%, 43% +/- 7%, 19% +/- 7%, and 39% +/- 11%, respectively, of left ventricular area at risk) as compared with control (44% +/- 4%). Isoflurane (0.5 MAC) plus 10 s postconditioning ischemia and CsA alone also exerted protection. HA14-1 alone did not affect infarct size nor block protection produced by CsA but abolished reductions in infarct size caused by 1.0 MAC isoflurane, 20 s postconditioning ischemia, and 0.5 MAC isoflurane plus 10 s postconditioning ischemia. The results suggest that Bcl-2 mediates isoflurane-induced and ischemic postconditioning by indirectly modulating mPTP activity in vivo.     

环孢菌素A逆转利多卡因对七氟醚后处理心肌保护的作用

Objective To study the effects of lidocaine on sevoflurane postconditioning-induced cardioprotection.Methods Ischemic status was kept for 40 rain in isolated perfused rat hearts followed by 1 h of reperfusion.Sevoflurane(3%) was administered at the beginning of reperfusion for 15 rain with or without lidocaine (20 μg/ml) perfusion.The direct mitochondrial permeability transition pore (MPTP) inhibitor Cyclosporin A (CsA,0.2 μmol/L) was co-administered in the presence or absence of lidocaine.LVDP,LVEDP,+dp/dtmax were recorded and infarct size was measured with TTC staining.Results Sevoflurane postconditioning significantly improved the recovery of ischernic myocardial function and decreased the infarct size of rat hearts (P＜0.05),which was abolished by lidocaine perfusion.The inhibition of lidocaine on sevoflurane posteonditioning effect was reversed by CsA.Conclusion Sevoflurane postconditioning effectively protects myocardium against ischemia/reperfusion injury,and higher concentration of lidocaine inhibits this protective effect by opening MPTP.     

吗啡后处理对大鼠离体心脏缺血再灌注损伤的影响

目的 评价吗啡后处理对大鼠离体心脏缺血再灌注损伤的影响.方法 雄性SD大鼠,体重180～200 g,应用Langendorff灌流装置,采用全心停灌45 min、再灌注60 min的方法制备大鼠离体心脏缺血再灌注模型.实验一:取模型制备成功的心脏32个,随机分为4组(n=8):Ⅰ组～Ⅳ组,Ⅰ组不予处理,Ⅱ组～Ⅳ组于再灌注即刻分别灌注含0.3、3.0和30 μmol/L吗啡的K-H液10 min,随后灌注正常K-H液50 min;实验二:根据实验一的结果,选择对离体心脏缺血再灌注损伤影响最强的吗啡浓度,另取模型制备成功的心脏32个,随机分为4组(n=8):Ⅰ组～Ⅳ组,Ⅰ组不予处理,Ⅱ组～Ⅳ组于再灌注即刻分别灌注含吗啡的K-H液5、10和20 min,随后灌注正常K-H液50 min;实验三:根据实验二的结果,选取对离体心脏缺血再灌注损伤影响最强的吗啡后处理方法.另取模型制备成功的心脏37个,随机分为5组:Ⅰ组(n=8)不予处理;Ⅱ组(n=8)、Ⅲ组～Ⅴ组(n=7)于再灌注即刻分别灌注含吗啡、10 μmol/L非选择性阿片受体阻断剂纳洛酮和吗啡、5 μmol/L选择性κ受体阻断剂nor-binahorphimine和吗啡、5 μmol/L选择性δ受体阻断剂naltrindole和吗啡的K-H液,各组均再灌注正常K-H液50 min.于再灌注60 min时测定心肌肌酸激酶同工酶(CK-MB)活性,计算心肌缺血危险区/梗塞区(IS/AAR).结果 根据实验一、二的结果于再灌注即刻灌注含3.0 μmol/L吗啡的K-H液10 min行后处理.实验三的结果:与Ⅰ组比较,Ⅱ组和Ⅴ组心肌IS/AAR和CK-MB活性降低,Ⅳ组心肌CK-MB活性降低(P<0.05或0.01),Ⅲ组以上指标差异无统计学意义(P>0.05);与Ⅱ组比较,Ⅲ组和Ⅳ组心肌IS/AAR和CK-MB活性升高(P<0.01),Ⅴ组上述指标差异无统计学意义(P>0.05).结论 吗啡后处理可减轻大鼠离体心脏缺血再灌注损伤,此作用可能与激活心肌κ受体有关.     

右美托咪啶后处理对大鼠离体心脏缺血再灌注时线粒体损伤的影响

目的 探讨右美托咪啶后处理对大鼠离体心脏缺血再灌注时线粒体损伤的影响.方法 健康雌性Wistar大鼠,体重220～250 g,成功制备Langendorff离体灌注模型的40个心脏随机分为5组(n=8):缺血再灌注组(A组)、右美托咪啶10 nmol/L组(B组)、右美托咪啶100 nmol/L组(C组)、线粒体通透性转换孔开放剂苍术苷组(D组)及右美托咪啶联合苍术苷组(E组).离体心脏经K-H液平衡灌注20 min后,采用全心停灌40 min再灌注60 min的方法制备离体心脏缺血再灌注模型.于再灌注即刻B组、C组、D组和E组分别灌注含10 nmol/L右美托咪啶、100 nmol/L右美托咪啶、20μmol/L苍术苷、100 nmol/L右美托咪啶和20 μmol/L苍术苷的K-H液10 min.再灌注结束即刻取心尖组织,分离线粒体,测定SOD、Na+ -K+ -ATP酶、Ca2+-ATP酶活性和MDA和Ca2+含量.结果 与A组比较,B组和C组线粒体SOD、Na+ -K+ -ATP酶和Ca2+ -ATP酶活性升高,MDA和Ca2+含量降低(P＜0.05),D组和E组上述指标比较差异无统计学意义(P＞0.05);与C组比较,D组和E组线粒体SOD、Na+-K+-ATP酶和Ca2+ -ATP酶活性降低,MDA和Ca2+含量升高(P＜0.05),B组上述指标比较差异无统计学意义(P＞0.05).结论 右美托咪啶后处理可减轻大鼠离体心脏缺血再灌注时的线粒体损伤,其机制可能与抑制线粒体通透性转换孔开放有关.     

Ro-54864对缺血/再灌注心肌功能和线粒体的保护作用

目的 利用Langendorff离体灌注模型探讨Ro-54864对缺血/再灌注心肌功能和线粒体的保护作用.方法 大鼠心脏上架平衡20min后,随机分为5组.假手术组:持续灌注115min;对照组:续灌10min,缺血25min,复灌60min;Ro(Ro-54864)组:缺血前灌注含0.1μmol/L Ro-54864的K-H液10 min;苍术苷(atractyloside,ATR)组:缺血前灌注含20 μmol/L苍术苷的K-H液10 min;ATR+Ro组:缺血前灌注含20 μmol/L苍术苷和0.1 μmol/L Ro-54864的K-H液10 min.分别在平衡20min、缺血前、复灌15 min、60 min记录左室力学指标.在复灌注末,用氯化三苯基四氮唑染色法(TTC)测定心肌梗死面积百分比;分离浆膜下线粒体,电镜下观察线粒体的形态和结构,并进行评分.结果 再灌注15 min后,Ro组的冠脉流量(CF)和血流动力学指标(LVDP,dp/dtmax,dp/dtmin)明显高于对照组和其它处理组,而ATR组的各指标低于对照组(P＜0.05).与对照组(41%±3%)比较,再灌注末期Ro组(28%±3%)心肌梗死面积明显减少(P＜0.05),而ATR组(51%±2%)的梗死面积明显增大(P＜0.05).Ro组(1.51±0.24)心肌线粒体损伤比对照组(2.21±0.27)明显减轻(P＜0.05),而ATR组(3.23±0.36)线粒体损伤较对照组严重(P＜0.05).ATR+Ro组的各项指标与对照组比较无统计学差异.结论 外周苯二氯(卓)受体(peripheral benzodi azepine receptor,PBR)激动剂Ro-54864能够明显减少缺血心肌的梗死面积,保护线粒体,增加冠脉流量,促进缺血心肌功能恢复.线粒体通透性转换孔开放剂苍术苷减弱Ro-54864的心肌保护作用.     

Age-associated differences in the inhibition of mitochondrial permeability transition pore opening by cyclosporine A

Background: Inhibiting mitochondrial permeability transition pore (mPTP) opening is a key protection of the myocardium from ischemia/reperfusion (I/R) injury. Here, we investigated age‐associated differences in the ability of cyclosporine A (CsA) to protect the heart and to modulate mPTP opening during I/R injury in vivo and its opening induced by reactive oxygen species (ROS) in vitro. Methods: Fischer 344 male rats were assigned from their respective age groups, young or old groups, to (1) I/R or (2) I/R+CsA. All animals were subjected to 30 min of ischemia following 120 min of reperfusion to determine myocardial infarct size in vivo. To measure mPTP opening in vivo, left ventricular tissues were collected 10 min after reperfusion and nicotinamide adenine dinucleotide (NAD⁺) levels were measured. In parallel experiments, rat ventricular myocytes were prepared from young and old hearts, loaded with tetramethylrhodamine ethylester and then subjected to oxidative stress in the presence or absence of CsA, and the mPTP opening time was measured using laser scanning confocal microscopy. Results: CsA reduced myocardial infarct size in young I/R rats. Whereas CsA failed to significantly affect myocardial infarct size in old I/R rats, NAD⁺ levels were better preserved in young CsA‐treated rats, but this relative improvement was not observed in old rats. CsA also significantly prolonged the time necessary to induce mPTP opening in young cardiomyocytes, but not in cardiomyocytes isolated from the old rats. Conclusions: mPTP regulation is dysfunctional in the aged myocardium and this could account for loss of cardioprotection with aging.     

κ-Opioid Receptors Mediate Cardioprotection by Remote Preconditioning

Background: Remote preconditioning is known to be cardioprotective, but the exact mechanism has not been fully elucidated. The objective of the current study was to investigate the role of [kappa]-opioid receptors in cardioprotection by remote preconditioning and reveal possible underlying mechanisms.

Methods: Remote preconditioning was induced in anesthetized male Sprague-Dawley rats by three cycles of 5 min of right femoral artery occlusion followed by 5 min of reperfusion. Myocardial ischemia-reperfusion was achieved by ligation of the left anterior descending coronary artery for 30 min and then reperfusion for 120 min. Infarct size was determined by 2,3,5-triphenyltetrazolium chloride staining. Levels of lactate dehydrogenase, dynorphin, and met-enkephalin in plasma were measured. The opening of the mitochondrial permeability transition pore was monitored with fluorescent calcein in isolated ventricular myocytes.

Results: Both remote preconditioning and U-50,488H (10 mg/kg intravenous), a [kappa]-opioid receptor agonist, significantly decreased the infarct size and plasma lactate dehydrogenase level induced by ischemia-reperfusion, and these effects were attenuated by nor-binaltorphimine (10 mg/kg intravenous), a [kappa]-opioid receptor antagonist, and atractyloside (5 mg/kg intravenous), a mitochondrial permeability transition pore activator. However, administration of naltrindole (5 mg/kg), a [delta]-opioid receptor antagonist, had no effect on the cardioprotection by remote preconditioning. The dynorphin plasma level was increased after remote preconditioning treatment, but the met-enkephalin level did not change. In isolated ventricular myocytes loaded with calcein, U-50,488H (300 [mu]m) decreased the mitochondrial permeability transition pore opening induced by calcium (200 [mu]m), and this effect was attenuated by cotreatment with nor-binaltorphimine (5 [mu]m) or atractyloside (20 [mu]m).     

Opening of mitochondrial ATP-sensitive potassium channels enhances cardioplegic protection

BACKGROUND: Mitochondrial and sarcolemmal ATP-sensitive potassium channels have been implicated in cardioprotection; however, the role of these channels in magnesium-supplemented potassium (K/Mg) cardioplegia during ischemia or reperfusion is unknown. METHODS: Rabbit hearts (n = 76) were used for Langendorff perfusion. Sham hearts were perfused for 180 minutes. Global ischemia hearts received 30 minutes of global ischemia and 120 minutes of reperfusion. K/Mg hearts received cardioplegia before ischemia. The role of ATP-sensitive potassium channels in K/Mg cardioprotection during ischemia and reperfusion was investigated, separately using the selective mitochondrial ATP sensitive potassium and channel blocker, 5-hydroxydecanoate, and the selective sarcolemmal ATP-sensitive potassium channel blocker HMR1883. Separate studies were performed using the selective mitochondrial ATP-sensitive potassium channel opener, diazoxide, and the nonselective ATP-sensitive potassium channel opener pinacidil. RESULTS: Infarct size was 1.9%+/-0.4% in sham, 3.7%+/-0.5% in K/Mg, and 27.8%+/-2.4% in global ischemia hearts (p < 0.05 versus K/Mg). Left ventricular peak-developed pressure (percent of equilibrium) at the end of 120 minutes of reperfusion was 91%+/-6% in sham, 92% +/-2% in K/Mg, and 47%+/-6% in global ischemia (p < 0.05 versus K/Mg). Blockade of sarcolemmal ATP-sensitive potassium channels in K/Mg hearts had no effect on infarct size or left ventricular peak-developed pressure. However, blockade of mitochondrial ATP-sensitive potassium channels before ischemia significantly increased infarct size to 23%+/-2% in K/Mg hearts (p < 0.05 versus K/Mg; no statistical significance [NS] as compared to global ischemia) and significantly decreased left ventricular peak-developed pressure to 69%+/-4% (p < 0.05 versus K/Mg). Diazoxide when added to K/Mg cardioplegia significantly decreased infarct size to 1.5%+/-0.4% (p < 0.05 versus K/Mg). CONCLUSIONS: The cardioprotection afforded by K/Mg cardioplegia is modulated by mitochondrial ATP-sensitive potassium channels. Diazoxide when added to K/Mg cardioplegia significantly reduces infarct size, suggesting that the opening of mitochondrial ATP-sensitive potassium channels with K/Mg cardioplegic protection would allow for enhanced myocardial protection in cardiac operations.     

七氟醚后处理对大鼠离体心脏缺血再灌注时心肌细胞凋亡的影响

目的 探讨七氟醚后处理对大鼠离体心脏缺血再灌注(IR)时心肌细胞凋亡的影响.方法 雄性SD大鼠48只,随机分4组(n=12),制备离体心脏灌注模型,K-H液平衡灌注30 min后,C组灌注K-H液120 min;IR组缺血30 min,K-H液再灌注90 min;缺血后处理组(IP组)缺血30 min后行4个循环复灌20 s/缺血20 s,再灌注K-H液;七氟醚后处理组(SP组)缺血30 min后灌注含七氟醚的K-H液5 min,K-H液冲洗10 min,再灌注K-H液.IP组和SP组再灌注总时间90 min.灌注期间测定心功能,灌注结束时取心脏测定心梗面积、Bcl-2、细胞色素C和Caspase-3蛋白表达水平,计算心肌细胞凋亡指数(AI).结果 与C组比较,其余各组左心室最大上升或下降速率(±dp/dt)、左心室发展压(LVDP)、HR降低,左心室舒张末压(LVEDP)和AI升高,Bel-2、细胞色素C和Caspase-3蛋白表达上调(P<0.05);与IR组比较,IP组和SP组±dp/dt、LVDP升高,LVEDP和AI降低,心梗面积减小,Bcl-2表达上调,细胞色素C和Caspase-3蛋白表达下调(P<0.05).结论 七氟醚后处理可减少大鼠离体心脏IR时心肌细胞凋亡,其机制与其下调细胞色素C和Caspase-3蛋白表达,上调Bcl-2表达有关.     

Morphine postconditioning protects against reperfusion injury in the isolated rat hearts

BACKGROUND: Postconditioning is a novel strategy of attaining cardioprotection. Previous studies have suggested morphine mimics the effects of ischemic preconditioning. Whether it is also capable of producing postconditioning or not is still unclear. The purpose of this study was to determine (1) whether morphine postconditioning (MPostcond) would protect the heart against reperfusion injury and the subtype(s) of opioid receptors (OR) involved, (2) whether combining MPostcond with morphine preconditioning (MPC) would afford additive cardioprotection, and (3) to evaluate the role mitochondrial adenosine triphosphate-sensitive potassium (mito-K atp) channel played in MPostcond. MATERIALS AND METHODS: Isolated perfused rat hearts were subjected to 45 min of ischemia followed by 1 h of reperfusion. First, three morphine concentrations (0.3, 3.0 and 30 microM) were used to study the protective effect of MPostcond. Second, the effect of blockade of OR subtypes by three antagonists (nonselective OR antagonist naloxone, kappa-OR antagonist nor-binaltorphimine, and delta-OR antagonist naltrindole) on MPostcond was investigated. Third, the protective effects of MPC, MPostcond and the combining MPC with MPostcond on reperfusion injury were compared. Last, the effect of blockade of mito-K atp by 5-hydroxydecanoate on MPostcond was studied. MPostcond was induced by a 10-min perfusion of morphine in Krebs-Ringer's solution performed at the onset of reperfusion, and MPC was produced by a 20-min perfusion of morphine 10 min before ischemia. Infarct size (IS/AAR, as a percentage of the area at risk) was determined by 2,3,5-triphenyltetrazolium staining. RESULTS: IS/AAR was significantly reduced after MPostcond from 58% +/- 8% (control) to 37% +/- 6% (morphine 3.0 microM, P < 0.01). This effect was abolished by coadministering naloxone (58% +/- 7%), nor-binaltorphimine (52% +/- 5%), but not naltrindole (34% +/- 5%). MPC and MPostcond had similar extent of protective effect on IS/AAR, and combining MPC with MPostcond did not afford further cardiprotection. 5-Hydroxydecanoate also abolished the cardioprotection of MPostcond. Unexpectedly, all three OR antagonists and 5-hydroxydecanoate themselves also afforded some extent of cardioprotection. CONCLUSIONS: MPost confers cardioprotection via activating kappa-OR but not delta-OR and opening mito-K atp channels. MPost and MPC have no additive protection. kappa-OR and mito-K atp channel may play a dual role in protecting ischemia-reperfusion injury.     

Cardioprotection induced by olprinone,a phosphodiesterase III inhibitor,involves phosphatidylinositol-3-OH kinase-Akt and a mitochondrial permeability transition pore during early reperfusion

Purpose Ischemic preconditioning is mediated by the activation of phosphatidylinositol-3-OH kinase-Akt (PI3K-Akt) and by the inhibition of the opening of a mitochondrial permeability transition pore (mPTP) during early reperfusion. Preischemic administration of the phosphodiesterase type III inhibitor olprinone protects the myocardium against infarction, but its mechanism has not been fully clarified. We hypothesized that this olprinone-induced cardioprotective effect was mediated by the activation of PI3K-Akt and by the inhibition of mPTP during early reperfusion. Methods Pentobarbital-anesthetized rats (n = 42) subjected to 30-min coronary occlusion followed by 2-h reperfusion, received olprinone (20 μg·kg⁻¹) or saline (control) in the preischemic phase in the presence or absence of the PI3K-Akt inhibitor wortmannin (0.6 mg·kg⁻¹) or the mPTP opener atractyloside (5 mg·kg⁻¹) before 5 min of reperfusion. The myocardial infarct size was expressed as a percentage of the area at risk. All values were expressed as means ± SD. Statistical comparisons within groups were made using repeated-measures analysis of variance (ANOVA), followed by a paired t-test, and comparisons among groups were analyzed using a two-way ANOVA, followed by the Tukey-Kramer test. Results Mean arterial pressure and heart rate showed no significant differences within or among groups. The preischemic administration of olprinone significantly reduced the infarct size (12 ± 4%) as compared with that in the control group (43 ± 4%). Wortmannin or atractyloside abolished the protective effect of olprinone (42 ± 11% or 41 ± 10%). Conclusion The olprinone-induced cardioprotective effect could be exerted via the activation of PI3K-Akt and the inhibition of mPTP during early reperfusion.     

Sevoflurane Preconditioning before Moderate Hypothermic Ischemia Protects against Cytosolic [Ca2+] Loading and Myocardial Damage in Part via Mitochondrial KATP Channels

Background: Brief sevoflurane exposure and washout (sevoflurane preconditioning [SPC]) before 30-min global ischemia at 37[degrees]C is known to improve cardiac function, decrease cytosolic [Ca2+] loading, and reduce infarct size on reperfusion. It is not known if anesthetic preconditioning (APC) applies as well to hypothermic ischemia and reperfusion and if KATP channels are involved. The authors examined in guinea pig isolated hearts the effect of sevoflurane exposure before 4-h global ischemia at 17[degrees]C on cardiac function, cytosolic [Ca2+] loading, and infarct size. In addition they tested the potential role of the mitochondrial KATP channel in eliciting the cardioprotection by SPC.

Methods: Hearts were randomly assigned to (1) a nontreated hypothermic ischemia group (CON), (2) a group given 3.5 vol% sevoflurane for 15 min with a 15-min washout before hypothermic ischemia (SPC), and (3) an SPC group in which anesthetic exposure was bracketed with 200 [mu]m 5-hydroxydecanoate (5-HD) from 5 min before until 5 min after sevoflurane (SPC + 5-HD). Cytosolic [Ca2+] was measured in the left ventricular (LV) free wall with the intracellularly loaded fluorescence probe indo-1.

Results: Initial reperfusion in CON hearts markedly increased systolic and diastolic [Ca2+] and reduced contractility (dLVP/dtmax), relaxation (diastolic LVP, dLVP/dtmin), myocardial oxygen consumption (Mvo2), and cardiac efficiency. In SPC hearts, cytosolic [Ca2+] overloading (especially diastolic [Ca2+]) was decreased with increased myocardial [Ca2+] influx (d[Ca2+]/dtmax) and efflux (d[Ca2+]/dtmin), improved contractility, relaxation, coronary flow, Mvo2, cardiac efficiency, and decreased infarct size. In SPC + 5HD hearts, the reduction in infarct size was antagonized by 5-HD, but functional return was less affected by 5-HD.     

吗啡预处理-后处理对大鼠离体心脏缺血再灌注损伤的影响

目的 探讨吗啡预处理-后处理对大鼠离体心脏缺血再灌注损伤的影响.方法 雄性SD大鼠,体重180～200 g,应用Langendorff体外灌流装置,采用全心停灌45 min、再灌注60 min的方法制备大鼠离体心脏缺血再灌注模型.取模型制备成功的心脏40个,随机分为5组(n=8):缺血再灌注组(IR组)、吗啡预处理组(M1组)、吗啡后处理组(M2组)、吗啡预处理-后处理组(M1+M2组)、5-羟葵酸(5-HD)混合吗啡后处理组(5-HD+M2组).M1组全心停灌前30 min灌注含3.0 μmol/L吗啡的K-H液20 min,随后灌注K-H液10 min.M2组再灌注即刻灌注含3.0 μmol/L吗啡的K-H液10 min,随后灌注正常K-H液50 min.5-HD+M1组再灌注即刻灌注含3.0 μmol/L吗啡+10-4nunol/L 5-HD的K-H液10 min,随后灌注正常K-H液50 min.于再灌注60 min时,测定心肌肌酸激酶(CK-MB)活性,计算心肌梗死区与缺血危险区的比值(IS/AAR).结果 与IR组相比,其余各组IS/AAR减少,CK-MB活性降低(P<0.05);与M2组比较,5-HD+M2组CK-MB活性及IS/AAR升高(P<0.05);M1组、M2组和M1+M2组上述指标比较差异无统计学意义(P>0.05).结论 吗啡预处理.后处理虽然可减轻大鼠离体心脏缺血冉灌注损伤,但是与单独应用时效果相似,其原因可能是两者单独应用减轻心脏缺血再灌注损伤的机制均与开放线粒体ATP敏感性钾通道有关.     

Nitric oxide-generating beta-adrenergic blocker nipradilol preserves postischemic cardiac function.

BACKGROUND: Preconditioning protects the heart from ischemic injury, but some of its effects are reversed by beta-adrenergic blockade. We hypothesize that because nitric oxide is known to precondition the heart, the nitric oxide-generating beta-blocker nipradilol may simultaneously precondition and provide clinically relevant beta-blockade. METHODS: Isolated, crystalloid-perfused rabbit hearts underwent 1 hour of left anterior descending coronary artery ischemia followed by 1 hour of reperfusion. Before ischemia, six hearts received nipradilol, six received the nitric oxide donor L-arginine, four hearts received the nitric oxide synthase inhibitor N(G)-nitro-L-arginine methyl ester before L-arginine, nine underwent ischemic preconditioning, and six received beta-blockade by esmolol before ischemic preconditioning. Seven hearts received no pretreatment (control). Action potential duration and ventricular pressure were measured. Infarct size was determined at the end of reperfusion. RESULTS: Both L-arginine and ischemic preconditioning prolonged action potential duration significantly at 60 minutes of reperfusion. Compared with control, infarct size was reduced by ischemic preconditioning (26%+/-4% versus 49%+/-3%, IPC versus control; p<0.01), L-arginine (24%+/-2%; p<0.01 versus control), and nipradilol (24%+/-2%; p<0.01 versus control). Only nipradilol preserved peak developed pressure during reperfusion. CONCLUSIONS: Despite its properties as a beta-adrenergic blocking agent, nipradilol was able to precondition the heart, probably as a result of its ability to produce nitric oxide.     

Mitochondrial ATP-sensitive potassium channel plays a dominant role in ischemic preconditioning of rabbit heart

BACKGROUND: The ATP-sensitive potassium (K(ATP)) channel has been shown to be important in the ischemic preconditioning (IPC) response. Recently, the mitochondrial rather than the sarcolemmal K(ATP) channel has been focused on due to its energy-modulating property. Hence, this study was undertaken to elucidate the role of the mitochondrial K(ATP) channel in IPC by modulating the mitochondrial K(ATP) channel in isolated perfused rabbit hearts. METHODS: Seven hearts served as a control with no interventions. Seven hearts underwent IPC consisting of two 5-min cycles of global ischemia followed by 5 min of reperfusion. Seven hearts received the selective mitochondrial K(ATP) channel blocker 5-dehydroxydecanoate (5-HD, 100 microM) for 5 min before IPC, and 7 hearts received the selective mitochondrial K(ATP) channel opener diazoxide (50 microM) for 5 min. Then, all hearts were subjected to 1 h of left anterior descending coronary artery ischemia and 1 h of reperfusion. Left ventricular pressures, monophasic action potentials and coronary flow were measured throughout the experiment and infarct size was detected at the end of experiment. RESULTS: (1) The mitochondria-selective K(ATP) channel opener diazoxide reduced infarct size as compared to control (p < 0.05); (2) IPC reduced infarct size and preserved postischemic diastolic function as compared to control (p < 0.05), and (3) the mitochondria-selective K(ATP) channel blocker 5-HD reversed these effects. CONCLUSION: The mitochondrial ATP-sensitive potassium channel may be a potential site of cardioprotection.     

Anesthetic preconditioning attenuates mitochondrial Ca2+ overload during ischemia in Guinea pig intact hearts: reversal by 5-hydroxydecanoic acid

Cardiac ischemia/reperfusion (IR) injury is associated with mitochondrial (m)Ca(2+) overload. Anesthetic preconditioning (APC) attenuates IR injury. We hypothesized that mCa(2+) overload is decreased by APC in association with mitochondrial adenosine triphosphate-sensitive K(+) (mK(ATP)) channel opening. By use of indo-1 fluorescence, m[Ca(2+)] was measured in 40 guinea pig Langendorff-prepared hearts. Control (CON) hearts received no treatment for 50 min before IR; APC hearts were exposed to 1.2 mM (8.8 vol%) sevoflurane for 15 min; APC + 5-hydroxydecanoate (5-HD) hearts received 200 micro M 5-HD from 5 min before to 15 min after sevoflurane exposure; and 5-HD hearts received 5-HD for 35 min. Sevoflurane was washed out for 30 min and 5-HD for 15 min before 30 min of global ischemia and 120 min of reperfusion. During ischemia, the peak m[Ca(2+)] accumulation was decreased by APC from 489 +/- 37 nM (CON) to 355 +/- 28 nM (P < 0.05); this was abolished by 5-HD (475 +/- 38 nM m[Ca(2+)]). APC resulted in improved function and reduced infarct size on reperfusion, which also was blocked by 5-HD. 5-HD pretreatment alone did not affect m[Ca(2+)] (470 +/- 34 nM) or IR injury. Thus, preservation of function and morphology on reperfusion is associated with attenuated mCa(2+) accumulation during ischemia. Reversal by 5-HD suggests that APC may be triggered by opening mK(ATP) channels. IMPLICATIONS: Myocardial ischemia/reperfusion injury is associated with mitochondrial Ca(2+) overload. Mitochondrial [Ca(2+)] and function were measured in guinea pig isolated hearts. Anesthetic preconditioning attenuated mitochondrial Ca(2+) overload during ischemia, improved function, and reduced infarct size. Reversal by 5-hydroxydecanoate suggests that anesthetic preconditioning may be triggered by mitochondrial adenosine triphosphate-sensitive K channel opening.