Inhibition of the sodium-proton exchanger (NHE) plays an important role in reducing tissue damage during ischemic reperfusion injury; however, pharmacological inhibitors of NHE have restricted access to acutely ischemic tissues because of severely compromised tissue perfusion. We describe the syntheses, characterization, and NHE inhibitory activities of a novel class of amiloride derivatives where peptides are conjugated to the amiloride C(5) amino group. These new peptide-C(5)-amiloride conjugates are inactive; however, peptide residues were chosen such that selective cleavage by neutral endopeptidase 24.11 (enkephalinase) liberates an amino acid-C(5)-amiloride conjugate that inhibits NHE in a glial cell line. These results confirm the feasibility of using peptide-amiloride conjugates as NHE inhibitor prodrugs. We envision the design of analogous peptide-amiloride prodrugs that can be administered prior to ischemic events and subsequently activated by endopeptidases selectively expressed by ischemic tissues.The sodium-proton exchanger (NHE) represents a family of sodium-dependent transport proteins that participate in various cellular functions (Orlowski and Grinstein, 1997). Seven isoforms (NHE1-7) have been identified (Numata and Orlowski, 2001;Brett et al., 2002;Slepkov and Fliegel, 2002). NHE1 and NHE5 to 7 are particularly important in maintaining the intracellular pH (pH i ) in human heart and brain. Additionally, increased NHE1 activity has been shown to maintain an alkalotic pH i in several human cancer cell types, including transformed astrocytes, i.e., malignant glioma cells (McLean et al., 2000;Hegde et al., 2004). Inhibition of NHE1 in glioma cells causes a reduction of intracellular sodium and associated cytotoxic edema (F. A. Gorin, R. Sriram, W. Harley, C. Floyd, A. Marshall, B. Lyeth, and T. Jue, unpublished data).There is a shift from oxidative to nonoxidative glycolysis during ischemia with increased intracellular acidosis. This reduction in pH i activates NHE, which increases intracellular Na ϩ ([Na ϩ ] i ) levels (step 2, Fig. 1) (Orlowski and Grinstein, 1997). The specifics of normalizing increased [Na ϩ ] i remain unclear but include regulation by Na ϩ /K ϩ ATPase and sodium-dependent calcium influx (reverse mode) by the sodium-calcium exchanger (NCX) (Satoh et al., 2003). Persistent activation of the reverse mode of NCX during vascular perfusion further increases intracellular Ca 2ϩ ([Ca 2ϩ ] i ) (step 4, Fig. 1), which is believed to initiate the irreversible cellular damage observed during ischemia-reperfusion (I/R) (Piper et al., 1996). This sequence of physiological events leading to I/R injury is initiated by NHE activation; consequently, the controlled inhibition of NHE is an area of intense research (Masereel et al., 2003) (Fig. 1).The significance of NHE participation in I/R injury in animals has been shown by demonstrating that NHE inhibitors, such as cariporide (Fig. 2), are effective in preventing cellular damage resulting from cerebral and myocardial ischemia when ad...