SUMMARYLysophosphatidylcholine (LPC) is an amphiphilic metabolite that can be produced from membrane-phospholipids by activation of phospholipase A2 (PLA2), and it accumulates in the heart during ischemia and reperfusion. It is known that LPC is an arrhythmogenic substance. Recent studies have revealed that LPC produces mechanical and metabolic derangements in perfused working rat hearts, and Ca2+-overload in isolated cardiac myocytes. Thus, LPC possesses an ischemia-like effect on the heart. LPC accumulated in the myocardium activates phospholipase A2, establishing a vicious circle; i.e. LPC itself has an ability to produce another LPC. Therefore, a drug that has an anti-LPC effect would protect or improve ischemia/reperfusion damage. This article will review the effect of LPC in relation to ischemia, and consider a possibility of developing new anti-ischemic drugs on the basis of the anti-LPC action. (Jpn Heart J 1997; 38: 11-25) Key words: Lysophosphatidylcholine, Free fatty acid, Ischemia reperfusion, anti-ischemic drugs SCHEMIA and reperfusion of the heart produce myocardial damage.Although the mechanism of ischemia/reperfusion damage of the heart is not well known, there is a common understanding that Ca2+-overload is the final step in the events induced by ischemia/reperfusion, and that the Ca2+-overload is probably responsible for the ischemia-reperfusion damage. By what mechanism does ischemia/reperfusion induce Ca2+-overload? There are some candidates for the etiology of ischemia/reperfusion-induced Ca2+-overload; one is reduction of the tissue levels of high-energy phosphates including adenosine triphosphateFrom the Department of Pharmacology, Asahikawa Medical College, Asahikawa, Japan, and 1Department of Pharmacology and Toxicology, University of Western Ontario, London , Ontario, Canada.Address for correspondence: Hiroko Hashizume, MD, Department of Pharmacology , Asahikawa Medical College, Nishikagura 4-5, Asahikawa 078, Japan.Received for publication January 12, 1996. Accepted January 19, 1996.11 12 HASHIZUME ET AL Jpn Heart J January 1997(ATP) and the other is production of free radicals. In this mini review we propose that lysophosphatidylcholine (LPC) is also one of the candidates responsible for Ca2+-overload during ischemia and reperfusion, and that substances that counteract the effect of LPC can be new anti-ischemic drugs.