Objective-To investigate whether and how the endoplasmic reticulum (ER) stress-induced, CCAAT/enhancer-binding protein-homologous protein (CHOP)-mediated pathway regulates myocardial ischemia/reperfusion injury. Methods and Results-Wild-type and chop-deficient mice underwent 50 minutes of left coronary artery occlusion followed by reperfusion. Expression of chop and spliced x-box binding protein-1 (sxbp1) mRNA was rapidly and significantly increased in reperfused myocardium of wild-type mice. chop-deficient mice exhibited markedly reduced injury size after reperfusion compared with wild-type mice, accompanied by a decreasing number of terminal deoxynucleotidyl transferase dUTP nick-end labeling-positive cardiomyocytes. Interestingly, myocardial inflammation, as assessed by expression of inflammatory cytokines and chemokines and numbers of infiltrated inflammatory cells, was also attenuated in chop-deficient mice. Moreover, expression of interleukin-6 mRNA in response to lipopolysaccharide was enhanced by simultaneous stimulation with thapsigargin, a potent ER stressor, in wild-type cardiomyocytes but not in chop-deficient cardiomyocytes. Finally, we found that superoxide was produced in reperfused myocardium and that intravenous administration of edaravone, a free radical scavenger, immediately before reperfusion significantly suppressed the superoxide overproduction and subsequent expression of sxbp1 and chop mRNA, followed by reduced injury size in wild-type mice. Conclusion-The ER stress-induced, CHOP-mediated pathway, which is activated in part by superoxide overproduction after reperfusion, exacerbates myocardial ischemia/reperfusion injury by inducing cardiomyocyte apoptosis and myocardial inflammation. Key Words: ischemic heart disease Ⅲ reactive oxygen species Ⅲ reperfusion injury Ⅲ CHOP Ⅲ ER stress T he endoplasmic reticulum (ER), one of the largest cellular organelles, is recognized as the principal site of synthesis, folding, assembly, and modification of numerous proteins. Various pathophysiological stimuli, which increase the demand for protein folding or disrupt folding capacity, cause accumulation of unfolded or misfolded proteins within the ER, a condition collectively known as ER stress. To overcome ER stress, cells activate specific signaling pathways in what is termed the ER stress response, the initial intent of which is to restore ER homeostasis and promote cell survival through alteration of cellular transcriptional and translational programs. However, if restoration fails, ER stress triggers a final response, namely, apoptosis, to protect the organism by eliminating damaged cells. Induction of C/EBP-homologous protein (CHOP), a member of the C/EBP transcription factor family, is a signaling event underlying ER stress-induced apoptosis, 1-3 and the involvement of CHOPmediated apoptosis has been demonstrated in various diseases, including diabetes, neurodegenerative diseases, brain ischemia, and even some cardiovascular diseases. [3][4][5] In the setting of acute myocardial infarction, early...