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Acute myocardial infarction (MI) is a major cause of death and disability worldwide. In patients with MI, the treatment of choice for reducing acute myocardial ischemic injury and limiting MI size is timely and effective myocardial reperfusion using either thombolytic therapy or primary percutaneous coronary intervention (PPCI). However, the process of reperfusion can itself induce cardiomyocyte death, known as myocardial reperfusion injury, for which there is still no effective therapy. A number of new therapeutic strategies currently under investigation for preventing myocardial reperfusion injury have the potential to improve clinical outcomes in patients with acute MI treated with PPCI.

Background-Whether alterations in mitochondrial morphology affect the susceptibility of the heart to ischemia/ reperfusion injury is unknown. We hypothesized that modulating mitochondrial morphology protects the heart against ischemia/reperfusion injury. Methods and Results-In response to ischemia, mitochondria in HL-1 cells (a cardiac-derived cell line) undergo fragmentation, a process that is dependent on the mitochondrial fission protein dynamin-related protein 1 (Drp1). Transfection of HL-1 cells with the mitochondrial fusion proteins mitofusin 1 or 2 or with Drp1 K38A , a dominantnegative mutant form of Drp1, increased the percentage of cells containing elongated mitochondria (65Ϯ4%, 69Ϯ5%, and 63Ϯ6%, respectively, versus 46Ϯ6% in control: nϭ80 cells per group; PϽ0.05), decreased mitochondrial permeability transition pore sensitivity (by 2.4Ϯ0.5-, 2.3Ϯ0.7-, and 2.4Ϯ0.3-fold, respectively; nϭ80 cells per group; PϽ0.05), and reduced cell death after simulated ischemia/reperfusion injury (11.6Ϯ3.9%, 16.2Ϯ3.9%, and 12.1Ϯ2.9%, respectively, versus 41.8Ϯ4.1% in control: nϭ320 cells per group; PϽ0.05). Treatment of HL-1 cells with mitochondrial division inhibitor-1, a pharmacological inhibitor of Drp1, replicated these beneficial effects. Interestingly, elongated interfibrillar mitochondria were identified in the adult rodent heart with confocal and electron microscopy, and in vivo treatment with mitochondrial division inhibitor-1 increased the percentage of elongated mitochondria from 3.6Ϯ0.5% to 14.5Ϯ2.8% (Pϭ0.023). Finally, treatment of adult murine cardiomyocytes with mitochondrial division inhibitor-1 reduced cell death and inhibited mitochondrial permeability transition pore opening after simulated ischemia/reperfusion injury, and in vivo treatment with mitochondrial division inhibitor-1 reduced myocardial infarct size in mice subject to coronary artery occlusion and reperfusion (21.0Ϯ2.2% with mitochondrial division inhibitor-1 versus 48.0Ϯ4.5% in control; nϭ6 animals per group; PϽ0.05). Conclusion-Inhibiting mitochondrial fission protects the heart against ischemia/reperfusion injury, suggesting a novel pharmacological strategy for cardioprotection. Key Words: cardiomyocytes Ⅲ hypoxia Ⅲ ischemia Ⅲ myocardial infarction Ⅲ reperfusion I nnovative treatment strategies for protecting the heart from ischemia/reperfusion injury (IRI) are needed to improve clinical outcomes in patients with coronary heart disease. Previous studies suggest that mitochondria are highly dynamic and that changes in mitochondrial shape can affect a variety of biological processes such as apoptosis, respiration, mitosis, and development. 1,2 Mitochondria change their morphology by undergoing either fusion or fission, resulting in either elongated, tubular, interconnected mitochondrial networks or fragmented, discontinuous mitochondria, respectively. 1,2 These 2 opposing processes are regulated by the mitochondrial fusion proteins mitofusin (Mfn) 1, Mfn2, and optic atrophy protein 1 and the mitochondrial fission proteins dynamin-related...

Remote ischemic preconditioning did not improve clinical outcomes in patients undergoing elective on-pump CABG with or without valve surgery. (Funded by the Efficacy and Mechanism Evaluation Program [a Medical Research Council and National Institute of Health Research partnership] and the British Heart Foundation; ERICCA ClinicalTrials.gov number, NCT01247545.).

Brief intermittent episodes of ischemia and reperfusion, at the onset of reperfusion after a prolonged period of ischemia, confer cardioprotection, a phenomenon termed "ischemic postconditioning" (Postcond). We hypothesized that this phenomenon may just represent a modified form of reperfusion that activates the reperfusion injury salvage kinase (RISK) pathway. Isolated perfused rat hearts were subjected to: (a) 35 minutes of ischemia and 120 minutes of reperfusion, and infarct size was determined by tetrazolium staining; or (b) 35 minutes of ischemia and 7 minutes of reperfusion, and the phosphorylation states of Akt, endothelial NO synthase (eNOS), and p70S6K were determined. Postcond reduced infarct size from 51.2؎3.4% to 31.5؎4.1% (P<0.01), an effect comparable with ischemic preconditioning (IPC; 27.5؎2.3%; P<0.01). Of interest, the combined protective effects of IPC and Postcond were not additive (30.1؎4.8% with IPC؉Postcond; P‫؍‬NS). Inhibiting phosphatidylinositol 3-kinase (PI3K) at reperfusion using LY or Wortmannin (Wort) during the first 15 minutes of reperfusion completely abolished Postcond-induced protection (31.5؎4.1% with Postcond versus 51.7؎4.5% with Postcond؉LY, P<0.01; 56.2؎10.1% with Postcond؉ Wort; P<0.01), suggesting that Postcond protects the heart by activating PI3K-Akt. Western blot analysis demonstrated that Postcond induced a significant increase in phosphorylation of Akt, eNOS, and p70S6K in an LY-and Wort-sensitive manner. In conclusion, we show for the first time that ischemic Postcond protects the myocardium by activating the prosurvival kinases PI3K-Akt, eNOS, and p70S6K in accordance with the RISK pathway.

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Acute myocardial infarction (AMI) and the heart failure that often follows, are major causes of death and disability worldwide. As such, new therapies are required to limit myocardial infarct (MI) size, prevent adverse left ventricular (LV) remodeling, and reduce the onset of heart failure following AMI. The inflammatory response to AMI, plays a critical role in determining MI size, and a persistent pro-inflammatory reaction can contribute to adverse post-MI LV remodeling, making inflammation an important therapeutic target for improving outcomes following AMI. In this article, we provide an overview of the multiple players (and their dynamic roles) involved in the complex inflammatory response to AMI and subsequent LV remodeling, and highlight future opportunities for targeting inflammation as a therapeutic strategy for limiting MI size, preventing adverse LV remodeling, and reducing heart failure in AMI patients.