Pretreatment with D-myo-inositol-1,4,5-trisphosphate hexasodium (D-myo-IP 3 ), the sodium salt of the second messenger inositol 1,4,5-trisphosphate (IP 3 ), is cardioprotective and triggers a reduction of infarct size comparable in magnitude to that obtained with ischemic preconditioning. However, this observation is enigmatic; whereas IP 3 signaling is conventionally initiated by receptor binding, IP 3 receptors are typically considered to be intracellular, and D-myo-IP 3 is membrane-impermeable. We propose that this paradox is explained by the presence of poorly characterized external IP 3 receptors and hypothesize that: 1) infarct size reduction with D-myo-IP 3 is receptor-mediated; and 2) communication via gap junctions and/or hemichannels is required to initiate this protection. To investigate the role of receptor binding, isolated buffer-perfused rabbit hearts underwent 30 min of coronary occlusion (CO) and 2 h of reflow. Prior to CO, hearts received no treatment (controls), D-myo-IP 3 , L-myo-IP 3 (enantiomer not recognized by the IP 3 receptor), D-myo-IP 3 ϩ the IP 3 receptor inhibitor xestospongin C (XeC), or XeC alone. Infarct size, assessed by tetrazolium staining, was reduced with D-myo-IP 3 treatment, whereas hearts that received L-myo-IP 3 or D-myo-IP 3 ϩ XeC showed no protection. To evaluate the contribution of gap junctions/hemichannels, additional control and D-myo-IP 3 -treated cohorts received a 5-min infusion of heptanol or Gap 27, two structurally distinct gap junction inhibitors, administered at doses confirmed to attenuate intercellular transmission of a gap junction-permeable fluorescent dye. There was no infarct-sparing effect of D-myo-IP 3 in inhibitor-treated hearts. These data support the concepts that infarct size reduction with D-myo-IP 3 is triggered by receptor binding and that communication via gap junctions/hemichannels is involved in initiating this protection.Inositol 1,4,5-trisphosphate (IP 3 ) is a ubiquitous second messenger generated in parallel with diacylglycerol in response to activation of G-protein-coupled receptors. Previous studies from our group have shown that prophylactic administration of D-myo-IP 3 hexasodium, the sodium salt of IP 3 , renders the heart resistant to a subsequent sustained ischemic insult and triggers a reduction of infarct size that is comparable in magnitude to the cardioprotection achieved with ischemic preconditioning (Gysembergh et al., 1999). However, this observation is enigmatic; i.e., whereas IP 3 (and presumably D-myo-IP 3 ) signaling is conventionally initiated by receptor binding, IP 3 receptors have historically been considered to be intracellular (specifically located on the endoplasmic reticulum or in the perinuclear region), and D-myo-IP 3 is well known to be membrane-impermeable (Berridge, 1993(Berridge, , 2002Taylor and Broad, 1998;Wilcox et al., 1998;Gysembergh et al., 1999;Ibarra et al., 2004;Vermassen et al., 2004).One potential explanation for this apparent paradox is that reduction of infarct size triggered by exog...