Glucose requirement for postischemic recovery of perfused working heart

The quantitative importance of glycolysis in cardiomyocyte reenergization and contractile recovery was examined in postischemic, preload‐controlled, isolated working guinea pig hearts. A 25‐min global but low‐flow ischemia with concurrent norepinephrine infusion to exhaust cellular glycogen stores was followed by a 15‐min reperfusion. With 5 mM pyruvate as sole reperfusion substrate, severe contractile failure developed despite normal sarcolemmal pyruvate transport rate and high intracellular pyruvate concentrations near 2 mM. Reperfusion dysfunction was characterized by a low cytosolic phosphorylation potential ([ATP]/([ADP][P_i]) due to accumulations of inorganic phosphate (P_i) and lactate. In contrast, with 5 mM glucose plus pyruvate as substrates, but not with glucose as sole substrate, reperfusion phosphorylation potential and function recovered to near normal. During the critical ischemia‐reperfusion transition at 30 s reperfusion the cytosolic creatine kinase appeared displaced from equilibrium, regardless of the substrate supply. When under these conditions glucose and pyruvate were coinfused, glycolytic flux was near maximum, the glyceraldehyde‐3‐phosphate dehydrogenase/3‐phosphoglycerate kinase reaction was enhanced, accumulation of P_i was attenuated, ATP content was slightly increased, and adenosine release was low. Thus, glucose prevented deterioration of the phosphorylation potential to levels incompatible with reperfusion recovery. Immediate energetic support due to maximum glycolytic ATP production and enhancement of the glyceraldehyde‐3‐phosphate dehydrogenase/3‐phosphoglycerate kinase reaction appeared to act in concert to prevent detrimental collapse of [ATP]/([ADP][P_i]) during creatine kinase dysfunction in the ischemia‐reperfusion transition. Dichloroacetate (2 mM) plus glucose stimulated glycolysis but failed fully to reenergize the reperfused heart; conversely, 10 mM 2‐deoxyglucose plus pyruvate inhibited glycolysis and produced virtually instantaneous de‐energization during reperfusion. The following conclusions were reached. (1) A functional glycolysis is required to prevent energetic and contractile collapse of the low‐flow ischemic or reperfused heart (2). Glucose stabilization of energetics in pyruvate‐perfused hearts is due in part to intensification of glyceraldehyde‐3‐phosphate dehydrogenase/3‐phosphoglycerate kinase activity. (3) 2‐Deoxyglucose depletes the glyceraldehyde‐3‐phosphate pool and effects intracellular phosphate fixation in the form of 2‐deoxyglucose 6‐phosphate, but the cytosolic phosphorylation potential is not increased and reperfusion failure occurs instantly. (4) Consistent correlations exist between cytosolic ATP phosphorylation potential and reperfusion contractile function. The findings depict glycolysis as a highly adaptive emergency mechanism which can prevent deleterious myocyte deenergization during forced ischemia‐reperfusion transitions in presence of excess oxidative substrate.