Comte, Blandine, Geneviè ve Vincent, Bertrand Bouchard, Mohamed Benderdour, and Christine Des Rosiers. Reverse flux through cardiac NADP ϩ -isocitrate dehydrogenase under normoxia and ischemia. Am J Physiol Heart Circ Physiol 283: H1505-H1514, 2002. First published June 6, 2002 10.1152/ajpheart.00287.2002Little is known about the role of mitochondrial NADP ϩ -isocitrate dehydrogenase (NADP ϩ -ICDH) in the heart, where this enzyme shows its highest expression and activity. We tested the hypothesis that in the heart, NADP ϩ -ICDH operates in the reverse direction of the citric acid cycle (CAC) and thereby may contribute to the fine regulation of CAC activity (Sazanov and Jackson, FEBS Lett 344: 109-116, 1994). We documented a reverse flux through this enzyme in rat hearts perfused with the medium-chain fatty acid octanoate using [U-13 C5]glutamate and mass isotopomer analysis of tissue citrate (Comte et al., J Biol Chem 272: 26117-26124, 1997). In this study, we assessed the significance of our previous finding by perfusing hearts with long-chain fatty acids and tested the effects of changes in O2 supply. We showed that under all of these conditions citrate was enriched in an isotopomer containing five 13 C atoms. This isotopomer can only be explained by substrate flux through reversal of the NADP ϩ -ICDH reaction, which is evaluated at 3-7% of flux through citrate synthase. Small variations in reversal fluxes induced by low-flow ischemia that mimicked hibernation occurred despite major changes in contractile function and O2 consumption of the heart as well as citrate and succinate release rates and tissue levels. Our data show a reverse flux through NADP ϩ -ICDH and support its hypothesized role in the fine regulation of CAC activity in the normoxic and O2-deprived heart. citric acid cycle; citrate release; isotopomer analysis; 13 C substrate; anaplerosis CARDIAC ISCHEMIC DISEASES have been associated with chronic alterations of energy metabolism such as increased myocardial citrate release (24, 42). The cause of this deregulated cardiac citrate metabolism is unclear. Myocardial citrate release reflects its efflux from mitochondria (43) where it is synthesized by citrate synthase during normal operation of the citric acid cycle (CAC; Fig. 1). Citrate release, which is modulated by substrates and/or O 2 supply (24, 28, 29, 43), represents at most 1% of CAC flux. Mitochondrial citrate efflux appears normally to be compensated largely by flux through anaplerotic reactions such as pyruvate carboxylation, which represents between 2 and 8% of CAC flux (5,28,29).Citrate synthesis could also occur through a reductive process, which involves the participation of the CAC enzymes aconitase and NADP ϩ -linked isocitrate dehydrogenase (NADP ϩ -ICDH). Aconitase catalyzes the reversible interconversion between citrate and isocitrate. Its activity is modulated by oxidative stress (3,25). NADP ϩ -ICDH catalyzes the reversible interconversion between isocitrate and ␣-ketoglutarate (␣-KG). It has no known allosteric effector. This...