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J Thorac Cardiovasc Surg 2001;122:986-992
© 2001 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology (CSP)

Myocardial protection by ischemic preconditioning and {delta}-opioid receptor activation in the isolated working rat heart

Matthias Karck, MDa, Satonori Tanaka, MDa, Steven F. Bolling, MDb, Andre Simon, MDa, Tsung-Ping Su, PhDc, Peter R. Oeltgen, PhDd, Axel Haverich, MDa

From the Department of Thoracic and Cardiovascular Surgery,a Hannover Medical School, Hannover, Germany; Section of Cardiac Surgery,b University of Michigan Hospitals, Ann Arbor, Mich; National Institute on Drug Abuse,c Addiction Research Center, Baltimore, Md; and the Department of Pathology,d University of Kentucky College of Medicine, Lexington, Ky.

This study was supported by a grant from the Deutsche Forschungsgemeinschaft (Ka 1169/1-2).

Received for publication Dec 21, 2000. Revisions requested Jan 25, 2001; revisions received April 19, 2001. Accepted for publication April 24, 2001. Address for reprints: Matthias Karck, MD, Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, 30623 Hannover, Germany.

Abstract

Objective: {delta}-Opioid receptors are involved in the cardioprotective effect of ischemic preconditioning. This study was designed (1) to assess the protective capacities of ischemic preconditioning and the synthetic {delta}-opioid receptor agonist D-Ala2-D-Leu5 enkephalin (DADLE) in a functionally oriented experimental model of ischemia and reperfusion and (2) to assess whether the effects of both protective measures are similarly blocked by naloxone, a nonspecific {delta}-opioid receptor antagonist.
Methods: Sixty-four isolated working rat hearts were subjected to 45 minutes of hypothermic ischemia at 30°C followed by 25 minutes of normothermic reperfusion. Rats were pretreated with DADLE (1 mg/kg body weight intravenously), naloxone (3 mg/kg body weight intravenously), or a combination thereof within 60 minutes before onset of isolated heart perfusion. During the preischemic perfusion period, 8 hearts per group were preconditioned by one cycle of 5 minutes of normothermic global ischemia and subsequent reperfusion whereas another 8 served as nonpreconditioned controls. The postischemic functional recovery of hearts and their creatine kinase leakage were determined.
Results: Pretreatment with DADLE and ischemic preconditioning improved the postischemic recovery of aortic flow when compared with nonpreconditioning (57.7% ± 4.0% and 60.8% ± 4.3% vs 40.0% ± 4.2% of preischemic baseline value, P < .001). Combined pretreatment with DADLE before ischemic preconditioning afforded additional aortic flow recovery compared with pretreatment with DADLE alone (68.6% ± 3.3% vs 57.7% ± 4.0% of preischemic baseline value; P = .038). With combined pretreatment, early postischemic creatine kinase release was lower than control in hearts without pretreatment (0.48 ± 0.11 vs 0.80 ± 0.12 IU/5 minutes per heart; P = .001). Naloxone abolished the beneficial functional effects of pretreatment with DADLE and ischemic preconditioning.
Conclusions: Pharmacologic activation of {delta}-opioid receptors affords improvement of functional protection in isolated working rat hearts similar to that conferred by classic ischemic preconditioning. The combination of both pretreatments reduces ischemic cellular damage and further adds to postischemic functional recovery. These changes are reversed by naloxone, an observation providing evidence that ischemic preconditioning involves signaling through opioid receptors.




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