Cardioprotective and nonprotective regimens of chronic hypoxia diversely affect the myocardial antioxidant systems. Physiol Genomics 47: 612-620, 2015. First published October 13, 2015; doi:10.1152/physiolgenomics.00058.2015.-It has been documented that adaptation to hypoxia increases myocardial tolerance to ischemia-reperfusion (I/R) injury depending on the regimen of adaptation. Reactive oxygen species (ROS) formed during hypoxia play an important role in the induction of protective cardiac phenotype. On the other hand, the excess of ROS can contribute to tissue damage caused by I/R. Here we investigated the relationship between myocardial tolerance to I/R injury and transcription activity of major antioxidant genes, transcription factors, and oxidative stress in three different regimens of chronic hypoxia. Adult male Wistar rats were exposed to continuous normobaric hypoxia (FIO 2 0.1) either continuously (CNH) or intermittently for 8 h/day (INH8) or 23 h/day (INH23) for 3 wk period. A control group was kept in room air. Myocardial infarct size was assessed in anesthetized open-chest animals subjected to 20 min coronary artery occlusion and 3 h reperfusion. Levels of mRNA transcripts and the ratio of reduced and oxidized glutathione (GSH/GSSG) were analyzed by real-time RT-PCR and by liquid chromatography, respectively. Whereas CNH as well as INH8 decreased infarct size, 1 h daily reoxygenation (INH23) abolished the cardioprotective effect and decreased GSH/GSSG ratio. The majority of mRNAs of antioxidant genes related to mitochondrial antioxidant defense (manganese superoxide dismutase, glutathione reductase, thioredoxin/thioredoxin reductase, and peroxiredoxin 2) were upregulated in both cardioprotective regimens (CNH, INH8). In contrast, INH23 increased only PRX5, which was not sufficient to induce the cardioprotective phenotype. Our results suggest that the increased mitochondrial antioxidant defense plays an important role in cardioprotection afforded by chronic hypoxia. adaptation to hypoxia; cardioprotection; ischemia-reperfusion injury; oxidative stress; antioxidant defense ADAPTATION TO CHRONIC HYPOXIA may improve cardiac tolerance to acute ischemia-reperfusion (I/R) injury under certain conditions. Whereas chronic continuous hypoxia induces a protective cardiac phenotype, a brief daily interruption of hypoxic adaptation for 1 h eliminates the protective effect (31). Tissue damage caused by I/R insult is tightly related to the excess of reactive oxygen species (ROS), but the exact molecular mechanism underlying these adverse effects is still not fully elucidated. Intracellular ROS initiate a sequence of oxidation reactions that can seriously damage cell structures. ROS differ in their reactivity, as well as in mechanisms and sites of their production. These harmful species can be eliminated by specific scavengers. If production of ROS exceeds the capacity limit of antioxidant systems or if the systemic capacity is insufficient, the level of ROS in individual cell compartments increases and generates ...