title: Intracellular ATP is required for mitochondrial apoptotic pathways in isolated hypoxic rat cardiac myocytes.
abstract: OBJECTIVE
  The present study examined the possibility that intracellular ATP levels dictate whether hypoxic cardiac myocytes die by apoptosis or necrosis.
  
  
  BACKGROUND
  Although apoptosis and necrosis may appear to be distinct forms of cell death, recent studies suggest that the two may represent different outcomes of a common pathway. In ischemic myocardium, apoptosis appears early, while energy stores are presumably still available, followed only later by necrosis.
  
  
  METHODS
  Neonatal rat cardiac myocytes were exposed to continuous hypoxia, during which the intracellular ATP concentration was modulated by varying the glucose content in the medium. The form of cell death was determined at the end of the hypoxic exposure.
  
  
  RESULTS
  Under total glucose deprivation, ATP dropped precipitously and cell death occurred exclusively by necrosis as determined by nuclear staining with ethidium homodimer-1 and smearing on DNA agarose gels. However, with increasing glucose concentrations (10, 20, 50, 100 mg/dl) cellular ATP increased correspondingly, and apoptosis progressively replaced necrosis until it became the sole form of cell death, as determined by nuclear morphology, DNA fragmentation on agarose gels, and caspase-3 activation. The data showed a significantly positive correlation between myocyte ATP content and the percentage of apoptotic cells. Hypoxia resulted in lactate production and cellular acidification which stimulates apoptosis. However, acidification-induced apoptosis was also increased in an ATP-dependent fashion. Loss of mitochondrial membrane potential and cytochrome c release from the mitochondria was observed in both the apoptotic and necrotic cells. Furthermore, translocation of Bax from cytosol into mitochondria preceded these events associated with mitochondrial permeability transition. Increased lactate production and a lack of effect by the mitochondrial inhibitor oligomycin indicated that ATP was generated exclusively through glycolysis.
  
  
  CONCLUSIONS
  We demonstrate that ATP, generated through glycolysis, is a critical determinant of the form of cell death in hypoxic myocytes, independently of cellular acidification. Our data suggest that necrosis and apoptosis represent different outcomes of the same pathway. In the absence of ATP, necrosis prevails. However, the presence of ATP favors and promotes apoptosis.
authors.affiliation: Second Department of Medicine, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan. tatsumi@koto.kpu-m.ac.jp
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Tatsumi
authors.forename: Jun
authors.initials: J
authors.lastname: Shiraishi
authors.forename: Natsuya
authors.initials: N
authors.lastname: Keira
authors.forename: Kazuko
authors.initials: K
authors.lastname: Akashi
authors.forename: Akiko
authors.initials: A
authors.lastname: Mano
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamanaka
authors.forename: Satoaki
authors.initials: S
authors.lastname: Matoba
authors.forename: Shinji
authors.initials: S
authors.lastname: Fushiki
authors.forename: Henry
authors.initials: H
authors.lastname: Fliss
authors.forename: Masao
authors.initials: M
authors.lastname: Nakagawa
mesh_terms: D000255:Adenosine Triphosphate / Q000032:analysis / Q000378:metabolism*; D000818:Animals; D000831:Animals, Newborn; D017209:Apoptosis; D001692:Biological Transport; D053148:Caspase 3; D020169:Caspases / Q000032:analysis / Q000378:metabolism; D002478:Cells, Cultured; D045304:Cytochromes c / Q000378:metabolism; D004734:Energy Metabolism; D000860:Hypoxia / Q000378:metabolism*; D007424:Intracellular Fluid / Q000201:enzymology*; D007773:Lactates / Q000032:analysis / Q000378:metabolism; D008564:Membrane Potentials; D008929:Mitochondria, Heart / Q000378:metabolism*; D032383:Myocytes, Cardiac / Q000737:chemistry / Q000378:metabolism*; D011518:Proto-Oncogene Proteins / Q000378:metabolism; D019253:Proto-Oncogene Proteins c-bcl-2; D051381:Rats; D013997:Time Factors; D051028:bcl-2-Associated X Protein
chemical_list: C494828:Bax protein, rat; D007773:Lactates; D011518:Proto-Oncogene Proteins; D019253:Proto-Oncogene Proteins c-bcl-2; D051028:bcl-2-Associated X Protein; D000255:Adenosine Triphosphate; D045304:Cytochromes c; C505410:Casp3 protein, rat; D053148:Caspase 3; D020169:Caspases