title: Isoflurane-enhanced recovery of canine stunned myocardium: role for protein kinase C?
abstract: BACKGROUND
  Isoflurane enhances the functional recovery of postischemic, reperfused myocardium by activating adenosine A1 receptors and adenosine triphosphate-regulated potassium channels. Whether protein kinase C is involved in this process is unknown. The authors tested the hypothesis that inhibition of protein kinase C, using the selective antagonist bisindolylmaleimide, attenuates isoflurane-enhanced recovery of stunned myocardium in dogs.
  
  
  METHODS
  Fifty dogs were randomly assigned to receive intracoronary vehicle or bisindolylmaleimide (2 or 8 microg/min) in the presence or absence of isoflurane (1 minimum alveolar concentration). Five brief (5 min) coronary artery occlusions interspersed with 5-min reperfusion periods followed by 180 min of final reperfusion were used to produce myocardial stunning. Hemodynamics, regional segment shortening, and myocardial blood flow (radioactive microspheres) were measured at selected intervals.
  
  
  RESULTS
  There were no differences in baseline hemodynamics, segment shortening, or coronary collateral blood flow between groups. Isoflurane significantly (P<0.05) decreased heart rate, mean arterial pressure, rate pressure product, and the maximum rate of increase of left ventricular pressure (+dP/dt(max)) in the presence or absence of bisindolylmaleimide. Sustained contractile dysfunction was observed in dogs that received vehicle (recovery of segment shortening to 12+/-8% of baseline), in contrast to those that received isoflurane (75+/-7% recovery). Bisindolylmaleimide at a dose of 2 microg/min alone enhanced recovery of segment shortening (50+/-7% of baseline) compared with vehicle-pretreated dogs, and isoflurane in the presence of 2 microg/min bisindolylmaleimide further enhanced recovery of contractile function (79+/-8% of baseline). In contrast, 8 microg/min bisindolylmaleimide alone (32+/-12%) or combined with isoflurane (37+/-17%) did not enhance recovery of segment shortening compared with vehicle-pretreated dogs.
  
  
  CONCLUSIONS
  The results indicate that protein kinase C inhibition using low doses of bisindolylmaleimide alone produces cardioprotection, and isoflurane further enhances this protection. In contrast, high doses of bisindolylmaleimide are not cardioprotective in the presence or absence of isoflurane. A role for protein kinase C during isoflurane-induced recovery of the stunned myocardium cannot be excluded.
authors.affiliation: Department of Anesthesiology, Medical College of Wisconsin and the Zablocki VA Medical Center, Milwaukee 53226, USA.
authors.forename: W G
authors.initials: WG
authors.lastname: Toller
authors.forename: M W
authors.initials: MW
authors.lastname: Montgomery
authors.forename: P S
authors.initials: PS
authors.lastname: Pagel
authors.forename: D A
authors.initials: DA
authors.lastname: Hettrick
authors.forename: D C
authors.initials: DC
authors.lastname: Warltier
authors.forename: J R
authors.initials: JR
authors.lastname: Kersten
mesh_terms: D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D000818:Animals; D003326:Coronary Circulation / Q000187:drug effects; D004285:Dogs; D004305:Dose-Response Relationship, Drug; D005260:Female; D006321:Heart / Q000187:drug effects*; D006439:Hemodynamics / Q000187:drug effects; D007211:Indoles / Q000494:pharmacology; D019194:Ischemic Preconditioning; D007530:Isoflurane / Q000494:pharmacology*; D008297:Male; D008301:Maleimides / Q000494:pharmacology; D009200:Myocardial Contraction / Q000187:drug effects; D017682:Myocardial Stunning / Q000188:drug therapy* / Q000503:physiopathology; D011493:Protein Kinase C / Q000037:antagonists & inhibitors / Q000502:physiology*; D015398:Signal Transduction / Q000187:drug effects
chemical_list: D018685:Anesthetics, Inhalation; D007211:Indoles; D008301:Maleimides; D007530:Isoflurane; D011493:Protein Kinase C; C088060:bisindolylmaleimide