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(Circulation. 2009;120:S10-S15.)
© 2009 American Heart Association, Inc.

Myocardial Protection, Perioperative Management, and Vascular Biology

Reactive Oxygen Species–Induced Stimulation of 5'AMP-Activated Protein Kinase Mediates Sevoflurane-Induced Cardioprotection

Regis R. Lamberts, PhD; Geert Onderwater, MD; Nazha Hamdani; M. Jumoke A. Vreden; Jeroen Steenhuisen, MD; Etto C. Eringa, PhD; Stephan A. Loer, MD, PhD; Ger J.M. Stienen, PhD; R. Arthur Bouwman, MD, PhD

From the Department of Anesthesiology (R.R.L., G.O., M.J.A.V., J.S., S.A.L., R.A.B.) and the Laboratory for Physiology (N.H., E.C.E., G.J.M.S.), Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands.

Correspondence to Regis R. Lamberts, Department of Anesthesiology, VU University Medical Center (VUmc), De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. E-mail TTTr.lamberts{at}vumc.nl

Background— 5'AMP-activated protein kinase (AMPK), a well-known regulator of cellular energy status, is also implicated in ischemic preconditioning leading to cardioprotection. We hypothesized that AMPK is involved in anesthetic-induced cardioprotection and that this activation is mediated by reactive oxygen species (ROS).

Methods and Results— Isolated Langendorff-perfused rat hearts were subjected to 35 minutes of global ischemia (I) followed by 120 minutes of reperfusion (I/R). Hearts were assigned to a control group (Con) or a sevoflurane (Sevo) group receiving 3 times 5-minute episodes of sevoflurane (2.5vol%) before I/R. Phosphorylation of both AMPK and endothelial nitric oxide synthase (eNOS) were determined by Western blot analysis. Cardioprotection was assessed after I/R from recovery of left ventricular pressure and from infarct size (triphenyltetrazolium chloride staining). In the control group, ischemia resulted in a 2-fold increase in phosphorylation levels of AMPK (Con 0.13±0.01 versus Con-I 0.28±0.05, P<0.05), which was sustained after 120 minutes of reperfusion (Con-I/R 0.26±0.02, P<0.05). Sevoflurane preconditioning had no affect on AMPK phosphorylation before ischemia (Sevo 0.12±0.03, P>0.05), but almost doubled the increase in AMPK phosphorylation relative to control after ischemia (Sevo-I 0.48±0.09, P<0.05), an effect that was sustained after reperfusion (Sevo-I/R 0.49±0.12, P<0.05). The AMPK-inhibitor compound C (10 µmol/L) reduced the sevoflurane-mediated increase in phosphorylation of AMPK and its target eNOS and abolished cardioprotection. The ROS-scavenger n-(2-mercaptopropionyl)-glycine (1 mmol/L) blunted the sevoflurane-mediated increase in AMPK and eNOS phosphorylation and prevented cardioprotection.

Conclusions— Sevoflurane-induced AMPK activation protects the heart against ischemia and reperfusion injury and relies on upstream production of ROS.

Key Words: ischemia • signal transduction • free radicals • volatile anesthetics • protein kinase