Visualization of mitochondrial respiratory function using cytochrome c oxidase/succinate dehydrogenase (COX/SDH) double-labeling histochemistry

Mitochondrial DNA (mtDNA) defects are an important cause of disease and may underlie aging and aging-related alterations (1,2). The mitochondrial theory of aging suggests a role for mtDNA mutations, which can alter bioenergetics homeostasis and cellular function, in the aging process (3). A wealth of evidence has been compiled in support of this theory (1,4), an example being the mtDNA mutator mouse (5); however, the precise role of mtDNA damage in aging is not entirely understood (6,7). Observing the activity of respiratory enzymes is a straightforward approach for investigating mitochondrial dysfunction. Complex IV, or cytochrome c oxidase (COX), is essential for mitochondrial function. The catalytic subunits of COX are encoded by mtDNA and are essential for assembly of the complex (Figure 1). Thus, proper synthesis and function are largely based on mtDNA integrity (2). Although other respiratory complexes could be investigated, Complexes IV and II are the most amenable to histochemical examination (8,9). Complex II, or succinate dehydrogenase (SDH), is entirely encoded by nuclear DNA (Figure 1), and its activity is typically not affected by impaired mtDNA, although an increase might indicate mitochondrial biogenesis (10-12). The impaired mtDNA observed in mitochondrial diseases, aging, and age-related diseases often leads to the presence of cells with low or absent COX activity (2,12-14). Although COX and SDH activities can be investigated individually, the sequential double-labeling method (15,16) has proved to be advantageous in locating cells with mitochondrial dysfunction (12,17-21). Many of the optimal constitutions of the assay have been determined, such as substrate concentration, electron acceptors/donors, intermediate electron carriers, influence of pH, and reaction time (9,22,23). 3,3'-diaminobenzidine (DAB) is an effective and reliable electron donor (22). In cells with functioning COX, the brown indamine polymer product will localize in mitochondrial cristae and saturate cells (22). Those cells with dysfunctional COX will therefore not be saturated by the DAB product, allowing for the visualization of SDH activity by reduction of nitroblue tetrazolium (NBT), an electron acceptor, to a blue formazan end product (9,24). Cytochrome c and sodium succinate substrates are added to normalize endogenous levels between control and diseased/mutant tissues (9). Catalase is added as a precaution to avoid possible contaminating reactions from peroxidase activity (9,22). Phenazine methosulfate (PMS), an intermediate electron carrier, is used in conjunction with sodium azide, a respiratory chain inhibitor, to increase the formation of the final reaction products (9,25). Despite this information, some critical details affecting the result of this seemly straightforward assay, in addition to specificity controls and advances in the technique, have not yet been presented.