. Acute toxicity of doxorubicin on isolated perfused heart: response of kinases regulating energy supply. Am J Physiol Heart Circ Physiol 289: H37-H47, 2005. First published March 11, 2005; doi:10.1152/ajpheart.01057.2004 is a widely used and efficient anticancer drug. However, its application is limited by the risk of severe cardiotoxicity. Impairment of cardiac high-energy phosphate homeostasis is an important manifestation of both acute and chronic DXR cardiotoxic action. Using the Langendorff model of the perfused rat heart, we characterized the acute effects of 1-h perfusion with 2 or 20 M DXR on two key kinases in cardiac energy metabolism, creatine kinase (CK) and AMP-activated protein kinase (AMPK), and related them to functional responses of the perfused heart and structural integrity of the contractile apparatus as well as drug accumulation in cardiomyocytes. DXR-induced changes in CK were dependent on the isoenzyme, with a shift in protein levels of cytosolic isoenzymes from muscle-type CK to brain-type CK, and a destabilization of octamers of the mitochondrial isoenzyme (sarcometric mitochondiral CK) accompanied by drug accumulation in mitochondria. Interestingly, DXR rapidly reduced the protein level and phosphorylation of AMPK as well as phosphorylation of its target, acetyl-CoA-carboxylase. AMPK was strongly affected already at 2 M DXR, even before substantial cardiac dysfunction occurred. Impairment of CK isoenzymes was mostly moderate but became significant at 20 M DXR. Only at 2 M DXR did upregulation of brain-type CK compensate for inactivation of other isoenzymes. These results suggest that an impairment of kinase systems regulating cellular energy homeostasis is involved in the development of DXR cardiotoxicity. creatine kinase; adenosine 5Ј-monophosphate-activated protein kinase; anthracyclines; cardiac energetics; cardiotoxicity DOXORUBICIN (DXR) is a widely used and very efficient anticancer drug. However, its administration is limited by the risk of severe cardiotoxicity (31, 41). An important manifestation of DXR cardiotoxicity is an impaired cardiac high-energy phosphate metabolism. Acute and chronic consequences of DXR administration include compromised mitochondrial functions, such as respiration and generation of high-energy phosphates (30) and lowered phosphocreatine-to-creatine (PCr/Cr), PCr-to-ATP (PCr/ATP), and ATP-to-ADP (ATP/ADP) ratios as well as compromised calcium homeostasis (8,29,31). However, the involved molecular mechanisms are not yet entirely understood.The maintenance of stable concentrations of myocardial high-energy phosphates, ATP, and PCr is a fundamental principle in the vertebrate heart. The PCr/ATP ratio is constant across species, as well as within a species, over a wide range of physiological cardiac workloads (12). Different regulatory systems have evolved to control cellular energy production and utilization. A key player of this regulatory network is the concerted action of several kinase systems, in particular, the energy transfer and buffer system of c...