Myocardial ischemia is associated with increased production of cyclic
adenosine monophosphate (cAMP), with potentially deleterious effects. We hypothesized that the
ischemia-induced activation of
cAMP-dependent protein kinase A (PKA), could beneficially be inhibited by a
PKA-inhibitor N-(2-[p-bromocinnamylamino]ethyl)-5-
isoquinoline-
sulfonamide (H-89).
H-89 when given to isolated perfused rat hearts before 30 minutes of global
ischemia-reperfusion improved postischemic function and decreased
infarct size. In another series,
H-89 administered prior to preconditioning by 10 minutes of transient global
ischemia decreased PKA activity (measured at the end of the preconditioning protocol) and augmented postischemic mechanical recovery.
H-89 given for 5 minutes before the 10 minutes of transient
ischemia further decreased
infarct size from 13.4 +/- 1.0% (preconditioning alone) to 7.0 +/- 0.93 (P < 0.01). In a third series,
forskolin (0.3 muM, 5 minutes, 10 minutes washout prior to
ischemia) increased PKA activity and reduced
infarct size. Prior
H-89 decreased PKA activity after 5 minutes of
forskolin and further reduced
infarct size versus
forskolin alone. In conclusion, three procedures increased postischemic recovery and reduced
infarct size:
H-89; preconditioning by transient
ischemia; or
forskolin as a preconditioning-mimetic. PKA-inhibition by
H-89 further decreased
infarct size beyond preconditioning or
forskolin. Despite the reservation that
H-89 could be non-selective in its actions, we propose
H-89 as a candidate
cardioprotective agent.