Purpose: To evaluate the ameliorative effect of Angelica sinensis polysaccharide (ASP) in myocardial ischemia-reperfusion injury (MIRI) rats through Toll-like receptor 4 (TLR4)/Nuclear factor κB (NF-κB) pathway. 
 Methods: The MIRI rat model was established. Sprague-Dawley rats were randomized to sham, MIRI, and ASP low-dose (50 mg/kg) and high-dose (100 mg/kg) groups, and a model of hypoxia-reoxygenation (H/R) injury was established. In in vitro studies, H/R cardiomycetes (derived from neonatal cell culture) were randomized to control, H/R, H/R + ASP low dose (5 μg/mL), H/R + ASP high dose (10 μg/mL), and ASP high dose + TLR4 activator groups. 
 Results: After intragastric administration of ASP for 4 consecutive weeks, creatine kinase isoenzyme (CK-MB) and lactate dehydrogenase (LDH) were reduced after ASP treatment in MIRI rats (p < 0.05). Both in vivo and in vitro, ASP reduced TNF-α, IL-6, and IL-1β expressions (p < 0.05), and alleviated inflammatory response. Apoptosis was inhibited by ASP, which also increased Bcl2, reduced Bax and cleaved caspase-3 expressions, while TLR-4, p-IκBα, and p-p65 were decreased. 
 Conclusion: The cardioprotective effect of ASP on MIRI results in the inhibition of TLR4/NF-κB pathway. Thus, this study broadens the current body of knowledge on the pharmacological prevention of MIRI and the therapeutic potential of ASP.
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