Abstract 15316: Paradoxical Reduction in Myocardial Performance when Combining Two Independently Cardioprotective Agents: Mitochondrial-targeted Antioxidant MitoSNO and Adenosine Triphosphate-sensitive Potassium Channel Opener Diazoxide

Introduction: Adenosine triphosphate-sensitive potassium (K ATP ) channel opener diazoxide (DZX) and Antioxidant MitoSNO are both independently cardioprotective in animal models. The cardioprotective mechanism of diazoxide is unknown, and involves a non-sarcolemmal location, requires the inhibition of succinate dehydrogenase, and the K ATP channel subunit SUR1. Mitochondrial - targeted Antioxidant MitoSNO is a S-nitrosylating agent that stalls complex 1, reduces ROS production and succinate accumulation. In an isolated myocyte model of stress due to hyperkalemic cardioplegia (CPG), that the combination of DZX and MitoSNO negated the beneficial effects of each alone. Hypothesis: We hypothesized that the combination of DZX and MitoSNO would negate the beneficial effects of each alone in an isolated heart model of global ischemia. Methods: Isolated mouse hearts underwent assessment of end diastolic pressure (EDP) and left ventricular developed pressure (LVDP) utilizing an LV balloon in a Langendorff model before and after 90 min of global ischemia. Hearts received test solution (CPG (9°C) or CPG±DZX (100μM) at onset of ischemia +/- MitoSNO (1μM/L) at end of ischemia), followed by 30 min reperfusion. LVDP and EDP were compared between groups utilizing a linear mixed model to assess the impact of treatment on the outcome, adjusting for baseline and balloon volume. Results: Similar to previous results, DZX improved LVDP and reduced EDP after ischemia compared to CPG (Figure). Similarly, MitoSNO improved LVDP and reduced EDP compared to CPG (Figure). The addition of MitoSNO with DZX was associated with the loss of cardioprotection observed with MitoSNO or DZX alone. Conclusions: Similar to data in a myocyte model, both MitoSNO and DZX provide cardioprotection that is lost with the combination of both, suggesting mutually exclusive mechanisms of action and that DZX’s mechanism requires a functional complex 1, ROS production, or succinate accumulation.