Merrill, Gary F. Acetaminophen and low-flow myocardial ischemia: efficacy and antioxidant mechanisms. Am J Physiol Heart Circ Physiol 282: H1341-H1349, 2002; 10.1152/ajpheart.00716.2001.-In the current study, the cardioprotective efficacy of 0.35 mmol/l acetaminophen administered 10 min after the onset of a 20-min period of global, low-flow myocardial ischemia was investigated. Matched control hearts were administered an equal volume of KrebsHenseleit physiological buffer solution (vehicle). In separate groups of hearts, the concentration-dependent, negative inotropic properties of hydrogen peroxide and the ability of acetaminophen to attenuate these actions, as well as the effects of acetaminophen on ischemia-reperfusion-mediated protein oxidation, were studied. Acetaminophen-treated hearts regained a significantly greater fraction of baseline, preischemia control function during reperfusion than vehicle-treated hearts. For example, contractility [rate of maximal developed pressure in the left ventricle (ϮdP/dtmax)] after 10 min of reperfusion was 109 Ϯ 24 and 42 Ϯ 9 mmHg/s (P Ͻ 0.05), respectively, in the two groups. The corresponding pressure-rate products were 1,840 Ϯ 434 vs. 588 Ϯ 169 mmHg ⅐ beats ⅐ min Ϫ1 (P Ͻ 0.05). Acetaminophen attenuated peroxynitrite-mediated chemiluminescence in the early minutes of reperfusion (e.g., at 6 min, corresponding values for peak light production were ϳ8 ϫ 10 6 counts/min for vehicle vs. Ͻ4 ϫ 10 6 counts/min for acetaminophen, P Ͻ 0.05) and the negative inotropic effects of exogenously administered hydrogen peroxide (e.g., at 0.4 mmol/l hydrogen peroxide, pressure-rate products were ϳ1.0 ϫ 10 4 and 3.8 ϫ 10 3 mmHg ⅐ beats ⅐ min Ϫ1 in acetaminophen-and vehicle-treated hearts, respectively, P Ͻ 0.05). Ischemia-mediated protein oxidation was reduced by acetaminophen. The ability of acetaminophen to attenuate the damaging effects of peroxynitrite and hydrogen peroxide and to limit protein oxidation suggest antioxidant mechanisms are responsible for its cardioprotective properties during postischemia-reperfusion. coronary circulation; ventricular function; peroxynitrite; hydrogen peroxide ACETAMINOPHEN WAS INTRODUCED into Western medicine more than 100 years ago, and its pain-relieving and temperature-lowering actions have been under investigation for several decades (1, 9, 26). Potential cardiovascular properties of acetaminophen have gone undiscovered, in part, because no one has made an effort to do the experiments. This might have been influenced by standard textbooks of pharmacology that report that acetaminophen lacks efficacy in the cardiovascular system of mammals (12). The recent literature, however, suggests that investigators are beginning to fill this void. For example, Nakamoto et al. (22) reported beneficial effects of acetaminophen against gastric mucosal injury caused by ischemia-reperfusion in the rat. Farquhar et al. (10) reported reduced renal dysfunction in the stressed human kidney in the presence of acetaminophen vs. ibuprofen, and Colletti et al. (7) fou...