We examined our hypothesis that (S)-1-(␣-naphthylmethyl)-6,7-dihydroxy-1,2,3,4-tetrahydroisoquinoline (CKD712) inhibits apoptosis in myocardial ischemia and reperfusion (I/R) injury in vivo via activation of the phosphatidylinositol 3-kinase (PI3K)/ Akt pathway and by reducing inflammation during I/R. To do this, we induced a 30-min period of ischemia by occlusion of the left anterior descending coronary artery of the rat followed by a 2-h (for phosphorylation of Akt), 6-h (for biochemical analysis), or 24-h (for functional analysis) period of reperfusion to determine the effect of CKD712 treatment. Pretreatment with CKD712 significantly improved myocardial function as evidenced by an increase in the ϮdP/dt and a decrease in the infarct size, which were antagonized by a PI3K inhibitor, wortmannin (WT). Interestingly, CKD712 increased the phosphorylation of Akt and cAMP-response element-binding protein and increased the expression of the Bcl-2 gene, but it reduced the expression of the Bax gene. CKD712 decreased not only the expression but also the activity of the caspase-3 protein in the myocardium after reperfusion. Thus, all of the antiapoptotic effects of CKD712 were significantly inhibited by WT. Furthermore, the antiapoptotic effects of CKD712 and its inhibition by WT in myocardium after reperfusion were confirmed by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling staining. Finally, CKD712 was found to reduce the serum levels of the high-mobility group box 1 protein, tumor necrosis factor-␣, and the cardiac troponin I protein in addition to tissue levels of malondialdehyde and myeloperoxidase activity in I/R hearts. Taken together, both the activation of PI3K/Akt and its anti-inflammatory action prevent apoptosis in myocardial I/R injury by CKD712.Early reperfusion during an episode of evolving myocardial infarction is essential for saving the myocardium and the patient's life. Nevertheless, sublethal reperfusion injury is unavoidable in angioplasty, coronary bypass surgery, transplantation, and thrombolysis, which are all commonly used to re-establish the blood flow to minimize damage to the heart because of severe myocardial ischemia, and as such, limits myocardial salvage. In fact, myocardial reperfusion causes deleterious effects to endothelial cells and cardiomyocytes, leading to myocardial apoptosis (Stephanou, 2004). Despite multiple significant therapeutic advances, ischemia and reperfusion (I/R)-induced myocardial injury is still a major unsolved health problem. Protection of cardiomyocytes from I/R-induced cell death would in principle increase the viable myocardium, thus providing acute and chronic bene-