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The role of the mitochondrial permeability transition pore in heart disease
Authors:Andrew P Halestrap  Philippe Pasdois
Institution:Department of Biochemistry and Bristol Heart Institute, University of Bristol, School of Medical Sciences, University Walk, Bristol BS8 1TD, UK
Abstract:Like Dr. Jeckyll and Mr. Hyde, mitochondria possess two distinct persona. Under normal physiological conditions they synthesise ATP to meet the energy needs of the beating heart. Here calcium acts as a signal to balance the rate of ATP production with ATP demand. However, when the heart is overloaded with calcium, especially when this is accompanied by oxidative stress, mitochondria embrace their darker side, and induce necrotic cell death of the myocytes. This happens acutely in reperfusion injury and chronically in congestive heart failure. Here calcium overload, adenine nucleotide depletion and oxidative stress combine forces to induce the opening of a non-specific pore in the mitochondrial membrane, known as the mitochondrial permeability transition pore (mPTP). The molecular nature of the mPTP remains controversial but current evidence implicates a matrix protein, cyclophilin-D (CyP-D) and two inner membrane proteins, the adenine nucleotide translocase (ANT) and the phosphate carrier (PiC). Inhibition of mPTP opening can be achieved with inhibitors of each component, but targeting CyP-D with cyclosporin A (CsA) and its non-immunosuppressive analogues is the best described. In animal models, inhibition of mPTP opening by either CsA or genetic ablation of CyP-D provides strong protection from both reperfusion injury and congestive heart failure. This confirms the mPTP as a promising drug target in human cardiovascular disease. Indeed, the first clinical trials have shown CsA treatment improves recovery after treatment of a coronary thrombosis with angioplasty.
Keywords:ANT  Adenine nucleotide translocase  BKA  bongkrekic acid  CAT  carboxyatractyloside  CsA  cyclosporin A  CyP  cyclophilin  GSK3  glycogen synthase kinase 3  IP  ischaemic pre-conditioning  mitoKATP  mitochondrial ATP-dependent potassium channels  mPTP  mitochondrial permeability transition pore  PAO  phenylarsine oxide  PiC  mitochondrial phosphate carrier  PKC  protein kinase C  PPIase  peptidyl-prolyl cis-trans isomerase  ROS  reactive oxygen species  SfA  sanglifehrin A  VDAC  voltage activated anion channel
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