Ren J. Heavy metal scavenger metallothionein mitigates deep hypothermia-induced myocardial contractile anomalies: role of autophagy. Am J Physiol Endocrinol Metab 304: E74 -E86, 2013. First published November 6, 2012; doi:10.1152/ajpendo.00176.2012.-Low-ambient temperature environment exposure increased the risk of cardiovascular morbidity and mortality, although the underlying mechanism remains unclear. This study was designed to examine the impact of cardiac overexpression of metallothionein, a cysteine-rich heavy metal scavenger, on low temperature (4°C)-induced changes in myocardial function and the underlying mechanism involved, with a focus on autophagy. Cold exposure (4°C for 3 wk) promoted oxidative stress and protein damage, increased left ventricular end-systolic and -diastolic diameter, and suppressed fractional shortening and whole heart contractility, the effects of which were significantly attenuated or ablated by metallothionein. Levels of the autophagy markers LC3B-II, beclin-1, and Atg7 were significantly upregulated with unchanged autophagy adaptor protein p62. Fluorescent immunohistochemistry revealed abundant LC3B puncta in cold temperature-exposed mouse hearts. Coimmunoprecipitation revealed increased dissociation between Bcl2 and Beclin-1. Cold exposure reduced phosphorylation of the autophagy inhibitory signaling molecules Akt and mTOR, increased ULK1 phosphorylation, and dampened eNOS phosphorylation (without changes in their total protein expression). These cold exposureinduced changes in myocardial function, autophagy, and autophagy signaling cascades were significantly alleviated or mitigated by metallothionein. Inhibition of autophagy using 3-methyladenine in vivo reversed cold exposure-induced cardiomyocyte contractile defects. Cold exposure-induced cardiomyocyte dysfunction was attenuated by the antioxidant N-acetylcysteine and the lysosomal inhibitor bafilomycin A1. Collectively, these findings suggest that metallothionein protects against cold exposure-induced cardiac anomalies possibly through attenuation of cardiac autophagy. cold exposure; metallothionein; cardiac function; autophagy; autophagy flux LOW-AMBIENT TEMPERATURE ENVIRONMENT is known to increase the risk of cardiovascular morbidity and mortality through hypertension, stroke, and myocardial infarction (1-4). A 10°C drop in ambient air temperature is expected to trigger an approximate 15-20% rise in coronary events (7). Moreover, cold exposure seems to prompt much more pronounced cardiovascular sequelae in individuals with preexisting cardiovascular and respiratory illnesses (4,17). Although a number of theories have been postulated for cold exposure-induced cardiovascular anomalies, including overactivation of endothelin-1 cascade, oxidative stress, and compromised antioxidant defense following cold stress (15,26,35), the ultimate culprit factor and effective therapeutic remedy against cold exposureinduced cardiovascular comorbidities remain elusive. Recent evidence from our laboratory revealed that cold exposure elici...