Objective: To investigate the protective effect of dexmedetomidine (DEX) on myocardial ischemia-reperfusion injury in diabetic mice and its possible molecular mechanism. Methods: Sixty 8-week-old SPF C57BL mice were fed with high fat for 6 weeks. At the 7th week, the type 2 diabetes model was established by intraperitoneal injection of streptozotocin (STZ) 45 mg/kg/d once a day for5 days. After modeling, the mice were randomly divided into sham operation group (sham group), ischemia-reperfusion group (I/R group), hypoxia-inducible factor-1α (HIF-1α) inhibitor 2ME2 group (2ME2 group), DEX group and DEX+2ME2 group (DM group), with 12mice in each group. In sham group, the skin was only cut and sutured. In the other four groups, the left anterior descending coronary artery was ligated through thoracotomy, and the ligating wire was released after 60 minutes of ischemia, followed by 120 minutes of reperfusion to establish the ischemia-reperfusion injury model. Blood samples were collected from the abdominal aorta at 120 min of reperfusion for determination of serum concentrations of troponin I (cTnI), interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α)by ELISA. Then the mice were sacrificed and left ventricles were isolated for observation of morphology and structure of myocardium by HE staining. The expression of HIF-1α and NOD-like receptor protein 3 (NLRP3) was detected by Western blot. Cardiac function was assessed by echocardiography at 24 h of reperfusion. Results: Compared with sham group, the concentrations of cTnI, IL-1β and TNF-α were significantly increased, myocardial tissue structure disorder, myocardial fiber rupture, myocardial cell swelling, inflammatory cell infiltration were significantly increased, the expression of NLRP3 in myocardial tissue was significantly increased, and stroke volume (SV), ejection fraction (EF) % and fractional shortening (FS) % were significantly decreased in I/R, 2ME2, DEX and DM groups (P<0.05).Compared with I/R group, the expression of HIF-1α was significantly increased, the expression of NLRP3 was significantly decreased, the concentrations of cTnI, IL-1β and TNF-α were significantly decreased, myocardial tissue structure was significantly improved, inflammatory cell infiltration was significantly decreased, SV, EF and FS were significantly increased in DEX and DM groups (P<0.05). Compared with the DEX group, the expression of HIF-1α was significantly decreased, the expression of NLRP3 was significantly increased, the concentrations of cTnI, IL-1β and TNF-α were significantly increased, myocardial tissue structure disorder, myocardial fiber rupture, myocardial cell swelling, inflammatory cell infiltration were significantly increased, SV, EF and FS were significantly decreased in the DM group (P<0.05). Conclusions: DEX can alleviate myocardial I/R injury in diabetic mice by up-regulating HIF-1α, inhibiting the activation of NLRP3 inflammasome and reducing inflammatory response. [ABSTRACT FROM AUTHOR]