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1 Department of Surgery, University of Kentucky College of Medicine, Lexington, KY, USA
2 Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
* To whom correspondence should be addressed. E-mail: rlasley{at}uky.edu.
The intermediary metabolite pyruvate has been shown to exert significant beneficial effects in in vitro models of myocardial oxidative stress and ischemia-reperfusion injury. However, there have been few reports of pyruvate's ability to attenuate myocardial stunning or reduce infarct size in vivo. This study tested whether supraphysiological levels of pyruvate protect against reversible and irreversible in vivo myocardial ischemia-reperfusion injury. Anesthetized, open chest pigs (n = 7/group) underwent 15 min left anterior descending coronary artery (LAD)occlusion and 3 hours reperfusion to induce stunning. Load insensitive contractility measurements of regional preload recruitable stroke work (PRSW) and PRSW area (PRSWA) were generated. Vehicle or pyruvate (100 mg/kg iv bolus + 10 mg/kg/min intra-atrial infusion) was administered during ischemia and for the first hour of reperfusion. In infarct studies pigs (n= 6/group) underwent 1 hour LAD ischemia and 3 hours reperfusion. Group I pigs received vehicle or pyruvate for 30 min prior to and throughout ischemia. In Group II the infusion was extended through 1 hr reperfusion. In the stunning protocol pyruvate significantly improved the recovery of PRSWA at 1 hour (50 ± 4% vs 23 ± 3% in controls) and 3 hours (69 ± 5% vs 39 ± 3% in controls) reperfusion. Control pigs exhibited infarct sizes of 66 ± 1% of the area at risk. The pyruvate I protocol was associated with an infarct size of 49 ± 3% (p < 0.05), whereas the pyruvate II protocol was associated with an infarct size of 30 ± 2% (p < 0.05 vs control and pyruvate I). These findings suggest that pyruvate attenuates stunning and decreases myocardial infarction in vivo in part by reduction of reperfusion injury. Metabolic interventions, such as pyruvate, should be considered when designing the optimal therapeutic strategies for limiting myocardial ischemia-reperfusion injury.
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