Abstract-The critical time for opening mitochondrial (mito) K ATP channels, putative end effectors of ischemic preconditioning (PC), was examined. In isolated rabbit hearts 29Ϯ3% of risk zone infarcted after 30 minutes of regional ischemia. Ischemic PC or 5-minute exposure to 10 mol/L diazoxide, a mito K ATP channel opener, reduced infarction to 3Ϯ1% and 8Ϯ1%, respectively. The mito K ATP channel closer 5-hydroxydecanoate (200 mol/L), bracketing either 5-minute PC ischemia or diazoxide infusion, blocked protection (24Ϯ3 and 28Ϯ6% infarction, respectively). However, 5-hydroxydecanoate starting 5 minutes before long ischemia did not affect protection. Glibenclamide (5 mol/L), another K ATP channel closer, blocked the protection by PC only when administered early. These data suggest that K ATP channel opening triggers protection but is not the final step. Five minutes of diazoxide followed by a 30-minute washout still reduced infarct size (8Ϯ3%), implying memory as seen with other PC triggers. The protection by diazoxide was not blocked by 5 mol/L chelerythrine, a protein kinase C antagonist, given either to bracket diazoxide infusion or just before the index ischemia. Bracketing preischemic exposure to diazoxide with 50 mol/L genistein, a tyrosine kinase antagonist, did not affect infarction, but genistein blocked the protection by diazoxide when administered shortly before the index ischemia. Thus, although it is not protein kinase C-dependent, the protection by diazoxide involves tyrosine kinase. Bracketing diazoxide perfusion with N-(2-mercaptopropionyl) glycine (300 mol/L) or Mn(III)tetrakis(4-benzoic acid) porphyrin chloride (7 mol/L), each of which is a free radical scavenger, blocked protection, indicating that diazoxide triggers protection through free radicals. Therefore, mito K ATP channels are not the end effectors of protection, but rather their opening before ischemia generates free radicals that trigger entrance into a preconditioned state and activation of kinases. (Circ Res. 2000;87:460-466.)

Abstract-Ischemic and pharmacological preconditioning can be triggered by an intracellular signaling pathway in which G i -coupled surface receptors activate a cascade including phosphatidylinositol 3-kinase, endothelial nitric oxide synthase, guanylyl cyclase, and protein kinase G (PKG). Activated PKG opens mitochondrial K ATP channels (mitoK ATP ) which increase production of reactive oxygen species. Steps between PKG and mitoK ATP opening are unknown. We describe effects of adding purified PKG and cGMP on K ϩ transport in isolated mitochondria. Light scattering and respiration measurements indicate PKG induces opening of mitoK ATP similar to K ATP channel openers like diazoxide and cromakalim in heart, liver, and brain mitochondria. This effect was blocked by mitoK ATP inhibitors 5-hydroxydecanoate, tetraphenylphosphonium, and glibenclamide, PKG-selective inhibitor KT5823, and protein kinase C (PKC) inhibitors chelerythrine, Ro318220, and PKC-⑀ peptide antagonist ⑀V 1-2 . MitoK ATP are opened by the PKC activator 12-phorbol 13-myristate acetate. We conclude PKG is the terminal cytosolic component of the trigger pathway; it transmits the cardioprotective signal from cytosol to inner mitochondrial membrane by a pathway that includes PKC-⑀. (Circ Res. 2005;97:329-336.)Key Words: ATP-sensitive K ϩ channel Ⅲ cGMP Ⅲ preconditioning Ⅲ protein kinase C Ⅲ protein kinase G I schemic (IPC) and pharmacological preconditioning by ligands such as acetylcholine and bradykinin initiates a signaling cascade that opens mitochondrial ATP-sensitive K ϩ channels (mitoK ATP ). Many components of this signaling pathway have been identified. 1 Surface receptors activate phosphatidylinositol 3-(PI3-) kinase by transactivation of epidermal growth factor receptors (EGFRs). A signaling complex composed of transactivated EGFR, Src kinase, and PI3-kinase causes phosphorylation of phosphatidylinositol bisphosphate, which in turn activates the phosphatidylinositol-dependent kinases (PDKs). 2 The PDKs then phosphorylate Akt 3 which activates the remainder of the cytosolic signaling pathway (Figure 1) including phosphorylation of endothelial nitric oxide synthase (eNOS), production of NO, stimulation of guanylyl cyclase, generation of cGMP, and activation of protein kinase G (PKG).cGMP and presumably PKG activation are important during preconditioning. Delayed preconditioning by diazoxide involves NO, 4 and cGMP accumulation after inhibition of cGMP-specific phosphodiesterase by sildenafil induces acute and delayed preconditioning. 5 Direct activation of PKG increases generation of reactive oxygen species (ROS) in cardiomyocytes, and this effect depends on mitoK ATP opening. 3 Whereas PKG antagonists abort ROS generation by PKG activators, they have no effect on ROS triggered by diazoxide, a direct opener of mitoK ATP , indicating PKG is upstream of mitoK ATP . A direct activator of PKG mimics IPC in intact hearts. 6 We hypothesized that PKG opens mitoK ATP by causing its phosphorylation, 7 and that the open channel increases generation of mi...

Bradykinin (BK) mimics ischemic preconditioning by generating reactive oxygen species (ROS). To identify intermediate steps that lead to ROS generation, rabbit cardiomyocytes were incubated in reduced MitoTracker Red stain, which becomes fluorescent after exposure to ROS. Fluorescence intensity in treated cells was expressed as a percentage of that in paired, untreated cells. BK (500 nM) caused a 51 +/- 16% increase in ROS generation (P < 0.001). Coincubation with either the BK B2-receptor blocker HOE-140 (5 microM) or the free radical scavenger N-(2-mercaptopropionyl)glycine (1 mM) prevented this increase, which confirms that the response was receptor mediated and ROS were actually being measured. Closing mitochondrial ATP-sensitive K+ (mitoKATP) channels with 5-hydroxydecanoate (5-HD, 1 mM) prevented increased ROS generation. BK-induced ROS generation was blocked by Nomega-nitro-m-arginine methyl ester (m-NAME, 200 microM), which implicates nitric oxide as an intermediate. Blockade of guanylyl cyclase with 1-H-[1,2,4]oxadiazole[4,3-a]quinoxalin-1-one (ODQ, 10 microM) aborted BK-induced ROS generation but not that from diazoxide, a direct opener of mitoKATP channels. The protein kinase G (PKG) blocker 8-bromoguanosine-3',5'-cyclic monophosphorothioate (25 microM) eliminated the effects of BK. Conversely, direct activation of PKG with 8-(4-chlorophenylthio)-guanosine-3',5'-cyclic monophosphate (100 microM) increased ROS generation (39 +/- 15%; P < 0.004) similar to BK. This increase was blocked by 5-HD. Finally, the nitric oxide donor S-nitroso-N-acetylpenicillamine (1 microM) increased ROS by 34 +/- 6%. This increase was also blocked by 5-HD. In intact rabbit hearts, BK (400 nM) decreased infarction from 30.5 +/- 3.0 of the risk zone in control hearts to 11.9 +/- 1.4% (P < 0.01). This protection was aborted by either 200 microM m-NAME or 2 microM ODQ (35.4 +/- 5.7 and 30.4 +/- 3.0% infarction, respectively; P = not significant vs. control). Hence, BK preconditions through receptor-mediated production of nitric oxide, which activates guanylyl cyclase. The resulting cGMP activates PKG, which opens mitoKATP. Subsequent release of ROS triggers cardioprotection.

Although protein kinase C (PKC) plays a key role in ischemic preconditioning (IPC), the actual mechanism of that protection is unknown. We recently found that protection from IPC requires activation of adenosine receptors during early reperfusion. We, therefore, hypothesized PKC might act to increase the heart's sensitivity to adenosine. IPC limited infarct size in isolated rabbit hearts subjected to 30-min regional ischemia/2-h reperfusion and IPC's protection was blocked by the PKC inhibitor chelerythrine given during early reperfusion revealing involvement of PKC at reperfusion. Similarly chelerythrine infused in the early reperfusion period blocked the increased phosphorylation of the protective kinases Akt and ERK1/2 observed after IPC. Infusing phorbol 12-myristate 13-acetate (PMA), a PKC activator, during early reperfusion mimicked IPC's protection. As expected, the protection triggered by PMA at reperfusion was blocked by chelerythrine, but surprisingly it was also blocked by MRS1754, an adenosine A 2b receptor-selective antagonist, suggesting that PKC was somehow facilitating signaling from the A 2b receptors. NECA [5′-(N-ethylcarboxamido) adenosine], a potent but not selective A 2b receptor agonist, increased phosphorylation of Akt and ERK1/2 in a dose-dependent manner. Pretreating hearts with PMA or brief preconditioning ischemia had no effect on phosphorylation of Akt or ERK1/2 per se, but markedly lowered the threshold for NECA to induce their phosphorylation. BAY 60-6583, a highly selective A 2b agonist, also caused phosphorylation of ERK 1/2 and Akt. MRS1754 prevented phosphorylation induced by BAY 60-6583. BAY 60-6583 limited infarct size when given to ischemic hearts at reperfusion. These results suggest that activation of cardiac A 2b receptors at reperfusion is protective, but because of the very low affinity of the receptors endogenous cardiac adenosine is unable to trigger their signaling. We propose that the key protective event in IPC occurs when PKC increases the heart's sensitivity to adenosine so that endogenous adenosine can activate A 2b -dependent signaling.Correspondence: James M. Downey, Ph.D., Department of Physiology, MSB 3074, University of South Alabama, College of Medicine, Mobile, AL 36688, jdowney@usouthal.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Hausenloy et al. NIH Public Access[1] noted protection from IPC is exerted early in reperfusion following the lethal ischemic insult and requires activation of phosphatidylinositol 3-OH kinase (PI3-K) and extracellular signal-regulated protein kinase (ERK) at that time. ...