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Cardiovascular Research 2004 61(3):372-385; doi:10.1016/S0008-6363(03)00533-9
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Copyright © 2003, European Society of Cardiology

Mitochondrial permeability transition pore opening during myocardial reperfusion—a target for cardioprotection

Andrew P Halestrap*, Samantha J Clarke and Sabzali A Javadov1

Department of Biochemistry and The Bristol Heart Institute, University of Bristol, Bristol BS8 1TD, UK

* Corresponding author. Tel.: +44-117-928-8592; fax: +44-117-928-8274. a.halestrap{at}bristol.ac.uk

1 Current address: Department of Physiology and Pharmacology, University of Western Ontario, Medical Sciences Building, London, Ontario, Canada N6A 5C1.

Reperfusion of the heart after a period of ischaemia leads to the opening of a nonspecific pore in the inner mitochondrial membrane, known as the mitochondrial permeability transition pore (MPTP). This transition causes mitochondria to become uncoupled and capable of hydrolysing rather than synthesising ATP. Unrestrained, this will lead to the loss of ionic homeostasis and ultimately necrotic cell death. The functional recovery of the Langendorff-perfused heart from ischaemia inversely correlates with the extent of pore opening, and inhibition of the MPTP provides protection against reperfusion injury. This may be mediated either by a direct interaction with the MPTP [e.g., by Cyclosporin A (CsA) and Sanglifehrin A (SfA)], or indirectly by decreasing calcium loading and reactive oxygen species (ROS; key inducers of pore opening) or lowering intracellular pH. Agents working in this way may include pyruvate, propofol, Na+/H+ antiporter inhibitors, and ischaemic preconditioning (IPC). Mitochondrial KATP channels have been implicated in preconditioning, but our own data suggest that the channel openers and blockers used in these studies work through alternative mechanisms. In addition to its role in necrosis, transient opening of the MPTP may occur and lead to the release of cytochrome c and other proapoptotic molecules that initiate the apoptotic cascade. However, only if subsequent MPTP closure occurs will ATP levels be maintained, ensuring that cell death continues down an apoptotic, rather than a necrotic, pathway.

KEYWORDS Ischaemic preconditioning; Mitochondrial potassium channels; Calcium overload; Reactive oxygen species; Apoptosis

Abbreviations: ANT, adenine nucleotide translocase • BKA, bongkrekic acid • CAT, carboxyatractyloside • CsA, Cyclosporin A • CyP, cyclophilin • DOG, 2-deoxyglucose • EDP, end diastolic pressure • IPC, ischaemic preconditioning • LVDP, left ventricular developed pressure • MPT, mitochondrial permeability transition • MPTP, mitochondrial permeability transition pore • PPIase, peptidyl-prolyl cistrans isomerase • ROS, reactive oxygen species • SfA, Sanglifehrin A • VAAC, voltage-activated anion channel


Time for primary review 14 days


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Translocation of Connexin 43 to the Inner Mitochondrial Membrane of Cardiomyocytes Through the Heat Shock Protein 90-Dependent TOM Pathway and Its Importance for Cardioprotection
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[Abstract] [Full Text] [PDF]


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J. Pharmacol. Exp. Ther.Home page
S.-S. Park, H. Zhao, Y. Jang, R. A. Mueller, and Z. Xu
N6-(3-Iodobenzyl)-adenosine-5'-N-methylcarboxamide Confers Cardioprotection at Reperfusion by Inhibiting Mitochondrial Permeability Transition Pore Opening via Glycogen Synthase Kinase 3beta
J. Pharmacol. Exp. Ther., July 1, 2006; 318(1): 124 - 131.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
T. Takeda, M. Akao, M. Matsumoto-Ida, M. Kato, H. Takenaka, Y. Kihara, T. Kume, A. Akaike, and T. Kita
Serofendic Acid, a Novel Substance Extracted From Fetal Calf Serum, Protects Against Oxidative Stress in Neonatal Rat Cardiac Myocytes
J. Am. Coll. Cardiol., May 2, 2006; 47(9): 1882 - 1890.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
F. Di Lisa and P. Bernardi
Mitochondria and ischemia-reperfusion injury of the heart: Fixing a hole
Cardiovasc Res, May 1, 2006; 70(2): 191 - 199.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
Z.-Q. Zhao and J. Vinten-Johansen
Postconditioning: Reduction of reperfusion-induced injury
Cardiovasc Res, May 1, 2006; 70(2): 200 - 211.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
O. Gateau-Roesch, L. Argaud, and M. Ovize
Mitochondrial permeability transition pore and postconditioning
Cardiovasc Res, May 1, 2006; 70(2): 264 - 273.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
D. Garcia-Dorado, A. Rodriguez-Sinovas, M. Ruiz-Meana, J. Inserte, L. Agullo, and A. Cabestrero
The end-effectors of preconditioning protection against myocardial cell death secondary to ischemia-reperfusion
Cardiovasc Res, May 1, 2006; 70(2): 274 - 285.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
S. Kyoi, H. Otani, A. Hamano, S. Matsuhisa, Y. Akita, H. Fujiwara, R. Hattori, H. Imamura, H. Kamihata, and T. Iwasaka
Dystrophin is a possible end-target of ischemic preconditioning against cardiomyocyte oncosis during the early phase of reperfusion
Cardiovasc Res, May 1, 2006; 70(2): 354 - 363.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
J. Inserte, D. Garcia-Dorado, V. Hernando, I. Barba, and J. Soler-Soler
Ischemic preconditioning prevents calpain-mediated impairment of Na+/K+-ATPase activity during early reperfusion
Cardiovasc Res, May 1, 2006; 70(2): 364 - 373.
[Abstract] [Full Text] [PDF]


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HypertensionHome page
M. S. Mozaffari, C. Patel, and S. W. Schaffer
Mechanisms Underlying Afterload-Induced Exacerbation of Myocardial Infarct Size: Role of T-Type Ca2+ Channel
Hypertension, May 1, 2006; 47(5): 912 - 919.
[Abstract] [Full Text] [PDF]


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SEMIN CARDIOTHORAC VASC ANESTHHome page
J. G. Bovill
Intravenous Anesthesia for the Patient with Left Ventricular Dysfunction
Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2006; 10(1): 43 - 48.
[Abstract] [PDF]


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Am. J. Physiol. Heart Circ. Physiol.Home page
L. M. Schwartz and C. J. Lagranha
Ischemic postconditioning during reperfusion activates Akt and ERK without protecting against lethal myocardial ischemia-reperfusion injury in pigs
Am J Physiol Heart Circ Physiol, March 1, 2006; 290(3): H1011 - H1018.
[Abstract] [Full Text] [PDF]


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FASEB J.Home page
G. Petrosillo, N. Di Venosa, M. Pistolese, G. Casanova, E. Tiravanti, G. Colantuono, A. Federici, G. Paradies, and F. M. Ruggiero
Protective effect of melatonin against mitochondrial dysfunction associated with cardiac ischemia- reperfusion: role of cardiolipin
FASEB J, February 1, 2006; 20(2): 269 - 276.
[Abstract] [Full Text] [PDF]


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CirculationHome page
J. Vinten-Johansen, D. M. Yellon, and L. H. Opie
Postconditioning: A Simple, Clinically Applicable Procedure to Improve Revascularization in Acute Myocardial Infarction
Circulation, October 4, 2005; 112(14): 2085 - 2088.
[Full Text] [PDF]


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Circ. Res.Home page
J. Inserte, D. Garcia-Dorado, V. Hernando, and J. Soler-Soler
Calpain-Mediated Impairment of Na+/K+-ATPase Activity During Early Reperfusion Contributes to Cell Death After Myocardial Ischemia
Circ. Res., September 2, 2005; 97(5): 465 - 473.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
K. Boengler, G. Dodoni, A. Rodriguez-Sinovas, A. Cabestrero, M. Ruiz-Meana, P. Gres, I. Konietzka, C. Lopez-Iglesias, D. Garcia-Dorado, F. Di Lisa, et al.
Connexin 43 in cardiomyocyte mitochondria and its increase by ischemic preconditioning
Cardiovasc Res, August 1, 2005; 67(2): 234 - 244.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
G. C. Rodrigo and N. B. Standen
Role of mitochondrial re-energization and Ca2+ influx in reperfusion injury of metabolically inhibited cardiac myocytes
Cardiovasc Res, August 1, 2005; 67(2): 291 - 300.
[Abstract] [Full Text] [PDF]


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J. Histochem. Cytochem.Home page
B. J. van Beek-Harmsen and W. J. van der Laarse
Immunohistochemical Determination of Cytosolic Cytochrome c Concentration in Cardiomyocytes
J. Histochem. Cytochem., July 1, 2005; 53(7): 803 - 807.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Regul. Integr. Comp. Physiol.Home page
M. A. Menze, K. Hutchinson, S. M. Laborde, and S. C. Hand
Mitochondrial permeability transition in the crustacean Artemia franciscana: absence of a calcium-regulated pore in the face of profound calcium storage
Am J Physiol Regulatory Integrative Comp Physiol, July 1, 2005; 289(1): R68 - R76.
[Abstract] [Full Text] [PDF]


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CirculationHome page
H. T.F. Facundo, A. J. Kowaltowski, L. Argaud, O. Gateau-Roesch, O. Raisky, J. Loufouat, M. Ovize, and D. Robert
Letter Regarding Article by Argaud et al, "Postconditioning Inhibits Mitochondrial Permeability Transition"
Circulation, June 21, 2005; 111(24): e442 - e442.
[Full Text] [PDF]


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Exp. Biol. Med.Home page
K. H. H. Lim, A. P. Halestrap, G. D. Angelini, and M.-S. Suleiman
Propofol Is Cardioprotective in a Clinically Relevant Model of Normothermic Blood Cardioplegic Arrest and Cardiopulmonary Bypass
Experimental Biology and Medicine, June 1, 2005; 230(6): 413 - 420.
[Abstract] [Full Text] [PDF]



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