Mitochondrial calcium (Ca 2ϩ ) dyshomeostasis constitutes a critical step in the metabolic crossroads leading to cell death. Therefore, we have studied here whether 7-chloro-5-(2-chlorophenyl)-1,5-dihydro-4,1-benzothiazepin-2(3H)-one (CGP37157; CGP), a blocker of the mitochondrial Na . This drastic cytoprotective effect of CGP could be explained in part through its regulatory actions on the mNCX.In general, it is accepted that a dysregulation of the mechanism that fine tunes the transient or more sustained levels of the cytosolic Ca 2ϩ concentrations ([Ca 2ϩ ] c ), leads to excitotoxic neuronal death (Schanne et al., 1979) and to neurodegeneration (Mattson, 2007). However, Ca 2ϩ may behave as both a cell survival supporter and a cell death inducer. For instance, cell depolarization and subsequent Ca 2ϩ entry into the cytosol helps to sustain the survival of cerebellar granule cells (Gallo et al., 1987) and bovine chromaffin cells (Orozco et al., 2006). However, chronic elevation of [Ca 2ϩ ] c by ionophores induces apoptosis (Martikainen et al., 1991). The opposite is also true, i.e., Ca 2ϩ antagonists that reduce [Ca 2ϩ ] c also cause neuronal death (Koh and Cotman, 1992) and chromaffin cell death (Novalbos et al., 1999). These apparent contradictory findings may be explained in the frame of the hypothesis suggesting that the [Ca 2ϩ ] c changes occurring during cell activation must move within a critical set point; beyond this point a cytoprotective signal might turn into a cytotoxic one (Koike et al., 1989). In this context, the suggestion of Nicholls (1985) and White and Reynolds (1995) that Ca 2ϩ accumulation into mitochondria could play a neuropro- Article, publication date, and citation information can be found at http://jpet.aspetjournals.org. doi:10.1124/jpet.109.154765.ABBREVIATIONS: mNCX, mitochondrial Na ϩ /Ca 2ϩ -exchanger; DMSO, dimethyl sulfoxide; FPL64176, FPL, 2,5-dimethyl-4-[2-(phenylmethyl)benzoyl]-1H-pyrrole-3-carboxylic acid methyl ester; 30 K ϩ /FPL, 30 mM K ϩ /0.3 M FPL; MTT formazan, 1-(4,5-dimethylthiazol-2-yl)-3,5-diphenylformazan, thiazolyl blue formazan; CGP37157, 7-chloro-5-(2-chlorophenyl)-1,5-dihydro-4,1-benzothiazepin-2(3H)-one; TTX, tetrodotoxin citrate, octahydro-12-(hydroxymethyl)-2-imino-5,9:7,10a-dimethan o-10aH- [1,3] dioxocino [6,5-d]pyrimidine