Chronology of critical events in neonatal rat ventricular myocytes occurring during reperfusion after simulated ischemia

While an ischemic insult poses a lethal danger to myocardial cells, a significant proportion of cardiac myocytes remain viable throughout the ischemic episode and die, paradoxically, only after the blood flow is reinstated. Despite decades of research, the actual chronology of critical events leading to cardiomyocyte death during the reperfusion phase remains poorly understood. Arguably, identification of the pivotal event in this setting is necessary to design effective strategies aimed at salvaging the myocardium after an ischemic attack. Here we used neonatal rat ventricular myocytes (NRVMs) subjected to 20–30 min of simulated ischemia followed by 1 hour of “reperfusion”. Using different combinations of spectrally-compatible fluorescent indicators, we analyzed the relative timing of the following events: (1) abnormal increase in cytoplasmic [Ca(2+)] (T(CaCy)); (2) abnormal increase in mitochondrial [Ca(2+)] (T(CaMi)); (3) loss of mitochondrial inner membrane potential (ΔΨ(m)) indicating mitochondrial permeability transitions (T(MPT)); (4) sacrolemmal permeabilization (SP) to the normally impermeable small fluorophore TO-PRO3 (T(SP)). In additional experiments we also analyzed the timing of abnormal uptake of Zn(2+) into the cytoplasm (T(ZnCy)) relative to T(CaCy) and T(SP). We focused on those NRVMs which survived anoxia, as evidenced by at least 50% recovery of ΔΨ(m) and the absence of detectable SP. In these cells, we found a consistent sequence of critical events in the order, from first to last, of T(CaCy), T(CaMi,) T(MPT), T(SP). After detecting T(CaCy) and T(CaMi), abrupt switches between 1.1 mM and nominally zero [Ca(2+)] in the perfusate quickly propagated to the cytoplasmic and mitochondrial [Ca(2+)]. Depletion of the sarcoplasmic reticulum with ryanodine (5 μM)/thapsigargin (1 μM) accelerated all events without changing their order. In the presence of ZnCl(2) (10–30 μM) in the perfusate we found a consistent timing sequence T(CaCy) < T(Zn) ≤ T(SP). In some cells ZnCl(2) interfered with Ca(2+) uptake, causing “steps” or “gaps” in the [Ca(2+)](Cy) curve, a phenomenon never observed in the absence of ZnCl(2). Together, these findings suggest an evolving permeabilization of NRVM’s sarcolemma during reoxygenation, in which the expansion of the pore size determines the timing of critical events, including T(MPT.)