Several lines of evidence indicate a role for elevated intracellular Ca 2+ in mechanisms of cell killing induced by a wide variety of agents. Cardiac myocytes are susceptible to killing under various conditions, including ischemia and exposure to monensin. In order to delineate the Ca 2+-dependent cell killing mechanism(s) to which cardiac myocytes are susceptible, we have investigated the mechanism by which they are killed by Ca 2+ plus the divalent cation ionophore A23187. Evidence has been obtained for two Ca 2+-mediated injury steps followed by a Na +-mediated step leading to cell death detected as membrane permeabilization to trypan blue dye. The first Ca 2+-mediated step requires the presence of A23187 and low extracellular Ca 2+ concentrations (1–100 μ m) and is inhibited by Mn 2+ and Ni 2+ ions. The second Ca 2+-dependent step requires extracellular Ca 2+ concentrations in approximately the physiological range (>1 m m), is not dependent on ionophore, and is not inhibited by Mn 2+. Arachidonic acid release occurs during both Ca 2+-mediated steps, but mostly during the second step. The second injury step is characterized by visible cell swelling and release of lactate dehydrogenase enzyme activity. The Na +-dependent step requires extracellular Na + equal to or greater than half the physiological concentration (i.e., ≥75 m m). Li +, which has a smaller ionic radius than Na +, can partially substitute for it in the Na +-dependent step, whereas K +, Cs +, Rb +, and NH 4 + (which have larger ionic radii) cannot.
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