Type II diabetes increases mitochondrial DNA mutations in the left ventricle of the Goto-Kakizaki diabetic rat. Am J Physiol Heart Circ Physiol 304: H903-H915, 2013. First published February 1, 2013 doi:10.1152/ajpheart.00567.2012.-Mitochondrial dysfunction has a significant role in the development of diabetic cardiomyopathy. Mitochondrial oxidant stress has been accepted as the singular cause of mitochondrial DNA (mtDNA) damage as an underlying cause of mitochondrial dysfunction. However, separate from a direct effect on mtDNA integrity, diabetic-induced increases in oxidant stress alter mitochondrial topoisomerase function to propagate mtDNA mutations as a contributor to mitochondrial dysfunction. Both glucose-challenged neonatal cardiomyocytes and the diabetic GotoKakizaki (GK) rat were studied. In both the GK left ventricle (LV) and in cardiomyocytes, chronically elevated glucose presentation induced a significant increase in mtDNA damage that was accompanied by decreased mitochondrial function. TTGE analysis revealed a number of base pair substitutions in the 3' end of COX3 from GK LV mtDNA that significantly altered the protein sequence. Mitochondrial topoisomerase DNA cleavage activity in isolated mitochondria was significantly increased in the GK LV compared with Wistar controls. Both hydroxycamptothecin, a topoisomerase type 1 inhibitor, and doxorubicin, a topoisomerase type 2 inhibitor, significantly exacerbated the DNA cleavage activity of isolated mitochondrial extracts indicating the presence of multiple functional topoisomerases in the mitochondria. Mitochondrial topoisomerase function was significantly altered in the presence of H 2O2 suggesting that separate from a direct effect on mtDNA, oxidant stress mediated type II diabetesinduced alterations of mitochondrial topoisomerase function. These findings are significant in that the activation/inhibition state of the mitochondrial topoisomerases will have important consequences for mtDNA integrity and the well being of the diabetic myocardium. diabetic cardiomyopathy; type 2 diabetes; mitochondrial DNA damage; mitochondrial dysfunction CARDIOVASCULAR DISEASE is responsible for a higher incidence of mortality in diabetics than the general population. Diabetic cardiomyopathy (DCM) is characterized by the development of a myopathy that manifests initially as diastolic dysfunction, but evolves into increased cavitary dilation and mural thinning, which is reflective of decompensated eccentric hypertrophy. DCM is considered to be independent of atherosclerosis or hypertension but is exacerbated by either (94). Mitochondrial dysfunction has long been known to have a significant role in the development and complications of DCM (32,46,66,82,92). Mitochondrial dysfunction is also associated with other pathologies including cancer, skeletal muscle disorders, and neurodegenerative diseases such as Wolfram syndrome or Leber's hereditary optic neuropathy (LHON) (18,36,54,104).Separate from inborn errors, mitochondrial DNA (mtDNA) mutations are thought to accumul...