Nitric oxide (NO) inhibits myocardial glucose transport and metabolism, although the underlying mechanism(s) and functional consequences of this effect are not clearly understood. We tested the hypothesis that NO inhibits the activation of AMP-activated protein kinase (AMPK) and translocation of cardiac glucose transporters (GLUTs; GLUT-4) and reduces lactate production. Ischemia was induced in open-chest dogs by a 66% flow reduction in the left anterior descending coronary artery (LAD). During ischemia, dogs were untreated (control) or treated by direct LAD infusion of (i) nitroglycerin (NTG) (0.5 g⅐kg ؊1 ⅐min ؊1 ); (ii) 8-Br-cGMP (50 g⅐kg ؊1 ⅐min ؊1 ); or (iii) NO synthase inhibitor L-nitro-argininemethylester (40 g⅐kg ؊1 ⅐min ؊1 ; n ؍ 9 per group). Cardiac substrate oxidation was measured with isotopic tracers. There were no differences in myocardial blood flow or oxygen delivery among groups; however, at 45 min of ischemia, the activation of AMPK was significantly less in NTG (77 ؎ 12% vs. nonischemic myocardium) and 8-Br-cGMP (104 ؎ 13%), compared with control (167 ؎ 17%). Similarly, GLUT-4 translocation was significantly reduced in NTG (74 ؎ 7%) and 8-Br-cGMP (120 ؎ 11%), compared with control (165 ؎ 17%). Glucose uptake and lactate output were 30% and 60% lower in NTG compared with control. Inhibition of NO synthesis stimulated glucose oxidation (67% increase compared with control) but did not affect AMPK phosphorylation, GLUT-4 translocation and glucose uptake. Contractile function in the ischemic region was significantly improved by NTG and L-nitro-argininemethylester. In conclusion, in ischemic myocardium an NO donor inhibits glucose uptake and lactate production via a reduction in AMPK stimulation of GLUT-4 translocation, revealing a mechanism of metabolic modulation and myocardial protection activated by NO donors.heart ͉ ischemia ͉ metabolism N itric oxide (NO) affects myocardial substrate utilization, exerting an inhibitory action on myocardial glucose uptake and metabolism, although the underlying mechanisms and functional implications of this effect, in vivo, remain poorly understood. Exogenous NO, by means of its second messenger cGMP, inhibits glucose uptake and utilization in ischemic (1) as well as nonischemic isolated hearts (2) and in quiescent myocytes (3). Endogenous NO is likely to be responsible for a tonic inhibition of cardiac carbohydrate metabolism, as indicated by the marked elevation of glucose uptake, under basal conditions, in isolated hearts from endothelial NO synthase (NOS) knockout mice (4). This effect is not peculiar to in vitro preparations, because NOS blockade enhances cardiac glucose uptake and oxidation and reduces free fatty acid (FFA) utilization in conscious dogs (5, 6). Notably, NO synthesis increases in ischemic myocardium (7,8); however, the metabolic effects of endogenous NO under this pathological condition remain unclear.During ischemia, glucose uptake and glycolytic flux are markedly accelerated and assume a critical role in preserving myocyte function (9-...