hen ischemic heart muscle is reperfused before irreversible injury occurs, contractile function remains impaired for a long period, a phenomenon known as myocardial stunning. 1 There are several hypotheses for the mechanisms of myocardial stunning: Ca 2+ overload 2,3 and ATP depletion in the myocardium, oxygen-derived free radical generation, 4 decreased sensitivity to Ca 2+ by the myofilaments 2 and coronary microcirculatory disturbances, 5 any or all of which may occur during ischemia and reperfusion, cause myocardial stunning. On the other hand, endogenous adenosine, mainly produced via myocardial ecto-5'-nucleotidase during ischemia and reperfusion, has many biological effects, 6 and attenuates myocardial stunning and reperfusion injury. [7][8][9][10] Adenosine is reported to exert (1) preservation of ATP, (2) coronary vasodilation, 11 (3) inhibition of platelet aggregation, 12 (4) attenuation of catecholamine-induced increases in myocardial contractility, 13 (5) inhibition of catecholamine release, 14 (6) attenuation of Ca 2+ overload in ischemic and reperfused myocardium, 15,16 and (7) inhibition of neutrophil activation. 17 These lines of evidence hint that if adenosine production during ischemia and reperfusion is enhanced by pharmacological intervention, the extent of myocardial stunning may be reduced through the beneficial cardiovascular effects of adenosine. 8 A possible strategy to enhance adenosine production is to administer 5-amino-4-imidazole carboxamide (AICA) riboside, 8,18,19 which increases the venous adenosine levels in ischemic myocardium without changing the adenosine metabolism in non-ischemic myocardium.In the present study, we examined whether AICA riboside improves myocardial contractile dysfunction during reperfusion by augmenting adenosine release. Furthermore, to investigate the cellular mechanisms of increased adenosine release, we measured the 5'-nucleotidase activity of reperfused myocardium with or without AICA riboside. Finally, we tested whether the effects of AICA riboside are blunted by either an antagonist of adenosine receptors or an inhibitor of ecto-5'-nucleotidase.
Methods
InstrumentationMongrel dogs weighing 15-24 kg were anesthetized with pentobarbital sodium (30 mg/kg, intravenous), intubated and artificially ventilated with room air mixed with oxygen (100% O2, 1-2 L/min). The chest was opened through the left fifth intercostal space, and the heart was suspended in a pericardial cradle. The left anterior descending coronary artery (LAD) was cannulated and perfused with blood via the left carotid artery through an extracorporeal bypass tube. Coronary blood flow (CBF) of the Jpn Circ J 1999; 63: 542 -553 (Received January 26, 1999; revised manuscript received March 23, 1999; accepted April 6, 1999 In 49 open-chest dogs, contractile function assessed by fractional shortening (FS) was observed 3 h after the onset of reperfusion following 15 min of occlusion of the left anterior descending coronary artery. During reperfusion, the treatment with AICA riboside increased ...