Naltrindole Exhibits Robust Cardioprotection in Myocardial Ischemia Reperfusion Injury

Abstract

The predominant opioid receptor subtypes in heart tissue are delta and kappa opioid receptors. Activation of delta and kappa opioid receptors during preconditioning have been shown to reduce infarct size in myocardial ischemia reperfusion (I/R) injury. This cardioprotective effect has been abolished with naloxone (NX), a broad-spectrum opioid receptor antagonist (e.g., delta, kappa, and mu). Previously, we demonstrated that a novel tripeptide, structurally similar to other delta or kappa opioid peptide receptor agonists, when given prior to global ischemia, significantly reduced infarct size and improved post-reperfused cardiac function using a Langendorf rat I/R heart ex vivo model. To identify the opioid receptor subtype responsible for tripeptide's cardioprotective effects, we used naltrindole (NTI), a selective delta opioid receptor antagonist. The cardioprotective effects of tripeptide were blocked by NX, but not NTI. To determine whether the cardioprotective effects of the combination was due to tripeptide or NTI, the effects of NTI and NX were evaluated individually in the same model. Male Sprague-Dawley rats (~300g) were subjected to global I(30min)/R(50min). NX (10 μM, n=6) or NTI (5 μM, n=8) or H2O vehicle (control n= 10) were given to hearts 5 min prior to ischemia and during the first 5 min of reperfusion in a Langendorf perfused model. Left ventricular (LV) cardiac function indices were measured using a pressure transducer. At the end of reperfusion (50min), hearts were frozen, sectioned (2 mm), and stained with 1% triphenyltetrazolium chloride (TTC). Infarcted heart tissue was compared to total tissue weight. Data were evaluated using ANOVA Student-Newman-Keuls post-hoc analysis. Control hearts (n=10) exhibited increased final LV end diastolic pressure (LVEDP) of 60±5 mmHg from baseline values (~8mmHg for all groups) and a mean infarct size of 36 ± 3% at 50 min post-reperfusion. NX showed no significant cardioprotective effect, since final LVEDP (64 ± 5%) and infarct size (35 ± 5%) was similar to control hearts. Surprisingly, the selective delta opioid antagonist, NTI, remarkably improved final LVEDP to 17 ± 3mmHg to near baseline values and reduced infarct size to 7 ± 2% compared to control and NX hearts (both p<0.01). The results indicate that NTI can prevent ischemic injury and restore post-reperfused heart function to pre-ischemic levels. In future studies, we will examine the intracellular mechanisms of NTI responsible for preventing myocardial ischemic injury.