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In recent years there has been considerable interest concerning the role of oxygen radicals in myocardial ischemia and reperfusion injury. The sequential univalent reduction of oxygen gives rise to very reactive intermediate products. Normally, the tissue concentration of these intermediate products of oxygen is limited and the aerobic myocardium survives because of the existence of a delicate balance between the generation of the various oxidants and the maintenance of the antioxidant defense mechanism. Several possible sources have been identified for the production of active oxygen species after ischemia and reperfusion and these sources may be mutually interactive. The ability of scavengers of oxygen free radicals, including vitamin E, to improve mechanical, mitochondrial, and sarcoplasmic reticulum function in animal models of ischemic-reperfusion injury also suggests that oxygen free radicals are partly responsible for myocardial damage in these models, although caution in the interpretation of these data is necessary.

There is evidence that oxygen free radicals play a role in myocardial ischemic and reperfusion injury. We investigated the effect of ischemia and reperfusion on glutathione status. Reperfusion after prolonged ischemia (60 min) induced an important release of reduced (GSH) and oxidized (GSSG) glutathione, concomitant with an increase of tissue GSSG and no recovery of mechanical function, indicating that reperfusion results in oxidative stress. These alterations are associated with tissue and mitochondrial calcium accumulation, loss of mitochondrial function, and membrane damage. We also determined the arteriocoronary sinus difference for GSH and GSSG of 16 CAD patients undergoing coronary artery bypass. Patients were divided in two groups according to the length of clamping period: 25 +/- 2 min (group 1), and 55 +/- 6 min (group 2). In group 1, reperfusion resulted in a transient release of GSH, GSSG, CPK, and lactate, with return to preclamping values in 10 minutes. In group 2, reperfusion determined a sustained and pronounced release of GSH, GSSG, CPK, and lactate during declamping, suggesting the occurrence of an oxidative stress. Using an in vitro model, administration of alpha-tocopherol bound with albumin showed protection of mitochondrial function, improved recovery of contraction, and reduced oxidative stress during reperfusion.

To establish if the administration of gallopamil, a derivative of verapamil, protects heart muscle against the deleterious effect of ischemia and subsequent reperfusion, rabbits were injected subcutaneously twice daily with 2 mg/kg of Gallopamil for 5-6 days. The hearts were isolated and perfused with aerobic Krebs-Henseleit buffer solution by the Langendorff method. The hearts were paced (180 b/min) and wall temperature was controlled. Ischemia was induced by reducing coronary flow from 25 ml/min to 1 ml/min for 90 min and then the hearts were reperfused for 30 min. At the end of either the ischemic period or reperfusion, the hearts were assayed for ATP, CP, and calcium. Others were homogenized, their mitochondria harvested and monitored for oxidative phosphorylating and ATP generating activity as well as calcium content and uptake. The mechanical function of the hearts and noradrenaline release was also measured. Hearts that were made ischemic gained calcium, their endogenous stores of ATP and CP were depleted, their mitochondria had reduced RCI and state 3 respiration and increased calcium concentrations. During reperfusion tissue and mitochondrial calcium was significantly increased, the capacity of mitochondria to use oxygen for state 3 respiration was further impaired and their ATP generating capacity reduced. Diastolic pressure increased and there was no recovery of developed pressure and important noradrenaline release. Pretreatment with gallopamil protected the mitochondria against the ischemically induced changes in RCI, state 3 respiration. There was also a less marked rise in tissue and mitochondrial calcium and a reduced increase of diastolic pressure. Gallopamil also diminished the effect of reperfusion on the calcium accumulating activity of mitochondria and on the decline in the ATP generating and oxygen utilizing capacity of the mitochondria. The tissue levels of ATP and CP were better maintained, and noradrenaline release was reduced, the systolic pressure generating capacity was enhanced by the treatment with gallopamil. These results are discussed in accordance with the hypothesis that this drug protects heart muscle against the deleterious effects of ischemia and reperfusion by ensuring that sufficient ATP remains available to maintain homeostasis with respect to calcium.

Reperfusion of isolated rabbit heart after 60 min of ischaemia resulted in poor recovery of mechanical function, release of reduced (GSH) and oxidized glutathione (GSSG), reduction of tissue GSH/GSSG ratio and shift of cellular thiol redox state toward oxidation, suggesting the occurrence of oxidative stress. Pretreatment of the isolated heart with propionyl-L-carnitine (10(-7) M) improved the functional recovery of the myocardium, reduced GSH and GSSG release and attenuated the accumulation of tissue GSSG. This effect was specific for propionyl-L-carnitine as L-carnitine and propionic acid did not modify myocardial damage.