Korge, Paavo, and Glenn A. Langer. Mitochondrial Ca 2ϩ uptake, efflux, and sarcolemmal damage in Ca 2ϩ -overloaded cultured rat cardiomyocytes. Am. J. Physiol. 274 (Heart Circ. Physiol. 43): H2085-H2093, 1998.-The purpose of this study was to determine mitochondrial Ca 2ϩ accumulation and its possible role in initiation of mitochondrial permeability transition (MPT) and sarcolemmal damage in Ca 2ϩ -overloaded cardiomyocytes. Cellular Ca 2ϩ overload, generated secondary to ouabain or p-chloromercuribenzoatestimulated cell Na ϩ concentration increase, induced Ca 2ϩ accumulation in mitochondria (ϳ 3 ⁄4 of total net uptake) as identified by kinetic analysis and verified by use of mitochondrial inhibition. Mitochondrial Ca 2ϩ uptake was followed by a rapid Ca 2ϩ efflux (ϳ1 mmol · kg dry wt Ϫ1 · min Ϫ1 ) that can be best explained by efflux via Ca 2ϩ -dependent nonspecific pores. Cell ATP concentration was stable during mitochondrial Ca 2ϩ uptake and decreased in parallel with Ca 2ϩ efflux. In addition, sarcolemmal damage was not related to the increase in mitochondrial Ca 2ϩ concentration per se, but rather connected with the extent of Ca 2ϩ efflux from the mitochondria. A decrease in the rate of this Ca 2ϩ efflux, indicating also a decrease in a subpopulation of mitochondria with open pores, was followed by decreased sarcolemmal damage. Both dithiothreitol and cyclosporin A decreased rapid Ca 2ϩ efflux and inhibited sarcolemmal damage, implicating MPT as an important component in the mechanism of sarcolemmal damage. mitochondrial permeability transition; cyclosporin A; sulfhydryl groups ALTHOUGH NUMEROUS STUDIES suggest that cellular Ca 2ϩ overload is responsible for irreversible myocardial injury in ischemia/reperfusion or hypoxia/reoxygenation, it remains unclear how Ca 2ϩ mediates cell injury (34). One frequently proposed mechanism for transition from reversible to irreversible injury implicates mitochondrial Ca 2ϩ overload with a subsequent Ca 2ϩ -dependent increase in mitochondrial inner membrane permeability. This is characterized by loss of mitochondrial membrane potential and equilibration of all solutes under 1,500 Da across the inner membrane (for reviews see Refs. 9 and 16). Mitochondrial matrix Ca 2ϩ concentration ([Ca 2ϩ ]) increase and interaction with poorly defined binding sites on the matrix side of the inner membrane is a specific and almost absolute requirement (one known exception is the phenylarsine oxide effect) for this megachannel opening, also termed mitochondrial permeability transition (MPT; see Ref. 16). It seems likely that, in cardiac cells during reperfusion/reoxygenation, MPT is initiated by Ca 2ϩ in conjunction with another agent(s) called Ca 2ϩ -releasing or -inducing agent(s). In vitro experiments have generated a long list of transition-inducing agents, including various oxidizing and sulfhydril reagents (16). An increasing number of publications suggest that MPT is strongly regulated by oxidation/reduction of mitochondrial thiols (5,19,37). This type of regulation could be oper...