Abstract-Apoptosis has been causally linked to the pathogenesis of myocardial infarction and heart failure in rodent models. This death process is mediated by two central pathways, an extrinsic pathway involving cell surface receptors and an intrinsic pathway using mitochondria and the endoplasmic reticulum. Each of these pathways has been implicated in myocardial pathology. In this review, we summarize recent advances in the understanding of the intrinsic pathway and how it relates to cardiac myocyte death and heart disease. Key Words: apoptosis Ⅲ necrosis Ⅲ cell death Ⅲ mitochondria Ⅲ Bcl-2 Ⅲ caspase Ⅲ death-inducing signaling complex Ⅲ apoptosome Ⅲ ischemia Ⅲ heart failure O ver the past decade, interest in cell death has intensified among scientists in multiple areas of biology and medicine. This fascination has been driven by the discovery that apoptosis is mediated by an ancient program that is hard-wired into all metazoan cells. Renewed attention in the cardiovascular field has been fueled by the notion that cell death is often an active process that, in principle, can be inhibited in various disease states.

The energy utilization associated with contraction was measured in isolated slow-and fast-twitch muscles of the mouse at 20~ The extent of this utilization was estimated from either the extent of high-energy phosphate splitting occurring during contraction (the initial chemical change, A "-, Pinit) or from the extent of recovery resynthesis calculated from the observed oxygen consumption and lactate production occurring during the recovery period (recovery chemical resynthesis, A ~ P,~). For short tetani, the cost to maintain isometric tension in the fast-twitch extensor digitorum longus (EDL) was approximately threefold greater than that in the slow-twitch soleus. With prolonged stimulation, however, the energy cost in the EDL diminished so that after 12 s of stimulation, the energy cost in the EDL was only 50% greater than that of the soleus. For both the slow-twitch soleus and the fast-twitch EDL and for all tetanus durations (up to 15 s), the extent of the initial chemical change was identical with the amount of recovery chemical resynthesis, showing that a biochemical energy balance existed in these muscles.

Recent studies have shown that chronic beta-adrenergic receptor (beta-AR) stimulation alters cardiac myocyte survival in a receptor subtype-specific manner. We examined the effect of selective beta(1)- and beta(2)-AR subtype stimulation on apoptosis induced by hypoxia or H(2)O(2) in rat neonatal cardiac myocytes. Although neither beta(1)- nor beta(2)-AR stimulation had any significant effect on the basal level of apoptosis, selective beta(2)-AR stimulation protected myocytes from apoptosis. beta(2)-AR stimulation markedly increased mitogen-activated protein kinase/extracellular signal-regulated protein kinase (MAPK/ERK) activation as well as phosphatidylinositol-3'-kinase (PI-3K) activity and Akt/protein kinase B phosphorylation. beta(1)-AR stimulation also markedly increased MAPK/ERK activation but only minimally activated PI-3K and Akt. Pretreatment with pertussis toxin blocked beta(2)-AR-mediated protection from apoptosis as well as the beta(2)-AR-stimulated changes in MAPK/ERK, PI-3K, and Akt/protein kinase B. The selective PI-3K inhibitor, LY 294002, also blocked beta(2)-AR-mediated protection, whereas inhibition of MAPK/ERK activation at an inhibitor concentration that blocked agonist-induced activation but not the basal level of activation had no effect on beta(2)-AR-mediated protection. These findings demonstrate that beta(2)-ARs activate a PI-3K-dependent, pertussis toxin-sensitive signaling pathway in cardiac myocytes that is required for protection from apoptosis-inducing stimuli often associated with ischemic stress.