Objective-Relationships between intracellular Ca 2ϩ concentration ([Ca 2ϩ ] cyt ) and apoptotic events, such as mitochondrial depolarization (⌬⌿m loss) and Bcl-2 and Bad phosphorylation, were analyzed in platelets and Jurkat cells in relation to rapid procoagulant phosphatidylserine (PS) exposure. Methods and Results-Platelets were stimulated with A23187, thapsigargin (TG) and thrombin plus convulxin (Thr/Cvx), andJurkat cells with ionomycin, in the presence or absence of cyclosporin A (CsA), a mitochondrial permeability transition pore inhibitor. ⌬⌿m loss occurred when platelets were stimulated in Ca 2ϩ medium in conditions exposing PS, but also in EGTA medium. CsA inhibited PS exposure, [Ca 2ϩ ] cyt increase, and ⌬⌿m loss in platelets stimulated with TG and Thr/Cvx, but had no inhibitory effect on A23187 stimulation. CsA reduced TG-induced Ca 2ϩ release from the endoplasmic reticulum and, consequently, external Ca 2ϩ influx. In ionomycin-stimulated Jurkat cells, rapid PS exposure was evidenced but not ⌬⌿m loss, and CsA did not inhibit the process. The status of phosphorylated Bad and Bcl-2 in both cell types remained unchanged on stimulation. Conclusions-Whether ⌬⌿m loss occurs or not, PS exposure is triggered by a high [Ca 2ϩ ] cyt increase. Data further demonstrate that CsA prevents membrane scrambling by inhibiting the high [Ca 2ϩ ] cyt increase, independently of its effect on mitochondrial permeability transition pore. Key Words: platelets Ⅲ Jurkat Ⅲ apoptosis Ⅲ procoagulant phosphatidylserine Ⅲ thrombin plus convulxin P hospholipid scrambling, leading to phosphatidylserine (PS) exposure to the external leaflet of cell membranes, characterizes blood platelet procoagulant activation. The essential role of phospholipid reorganization on the surface of stimulated blood cells is illustrated by the existence of Scott syndrome, a rare bleeding disorder caused by defective membrane scrambling in platelets and hematopoietic cells such as lymphocytes (reviewed in 1 ).PS exposure also characterizes apoptosis and occurs during platelet storage with other typical morphological and biochemical features of apoptosis (reviewed in 2 ), including loss of the mitochondrial transmembrane potential (⌬⌿m). [3][4][5] ⌬⌿m loss is caused by opening of a channel, the mitochondrial permeability transition pore (mPTP), and requires an increase in mitochondrial Ca 2ϩ . 6 The mPTP is composed of several proteins, including the adenine nucleotide translocator (ANT), the voltage-dependent anion channel, and cyclophilin D (CypD). 7 mPTP opening is blocked by cyclosporin A (CsA), which binds to CypD and dissociates it from the translocator. 8 In platelets, the physiological procoagulant activity is triggered by dual agonist stimulation with thrombin (Thr) plus convulxin (Cvx), the latter stimulating GPVI, a platelet collagen receptor. 9 This leads a subpopulation of platelets, named coated-platelets, to express PS and high levels of several procoagulant proteins on their surface. 10 Studies have shown that both ⌬⌿m loss and ...