The antibiotic minocycline exerts cytoprotection in animal disease models. One proposed mechanism is modulation of the mitochondrial permeability transition (mPT), a Ca 2ϩ -dependent pathogenic event leading to necrotic and/or apoptotic cell death. [1][2][3][4][5] A recent study in HEPATOLOGY by Theruvath et al., 6 investigating storage/ reperfusion injury following rat liver transplantation, concluded that minocycline prevented mPT and mitigated liver injury by decreasing mitochondrial Ca 2ϩ uptake without affecting mitochondrial respiration. Further, the authors argue that it could be consistent with clinical practice to (pre)treat stored livers and graft recipients with minocycline. The driving force for mitochondrial Ca 2ϩ transport is the mitochondrial membrane potential and the amount of Ca 2ϩ retained is dependent on the proton gradient and the matrix pH. 7 Respiratory inhibition will decrease Ca 2ϩ retention capacity and sensitize mitochondria toward mPT. 5,7 Further, endogenous inhibitors of mPT such as adenine nucleotides and Mg 2ϩ will influence the amount of Ca 2ϩ sequestered prior to mPT. In Theruvath et al., the effect of minocyline on mPT was determined in two classical assays, both using bolus additions of calcium chloride: (1) the swelling assay and (2) the Ca 2ϩ retention capacity assay. In both assays, the endpoint is Ca 2ϩ overload and induction of mPT. The authors found that minocycline prevented Ca 2ϩ -induced swelling and decreased Ca 2ϩ retention and interpreted this as a specific inhibitory effect on Ca 2ϩ uptake. They excluded respiratory inhibition as the explanation to their findings by determining the respiration of mitochondria exposed to minocycline with and without Ca 2ϩ addition. However, the buffer used in the respiration assay was different from the one used in the Ca 2ϩ bolus assays, with high Mg 2ϩ concentration (Mg 2ϩ is a known endogenous inhibitor of mPT) and with the presence of the potent pharmacological mPT inhibitor cyclosporin A during Ca 2ϩ addition. We argue that minocycline at moderate to high dosing, similar to what we have shown in brain mitochondria, prevents Ca 2ϩ -uptake and mPT-induced swelling by respiratory inhibition. 1,5 Further, depending on the buffer system used, the decreased Ca 2ϩ retention can be explained by minocycline-induced increase of mPT sensitivity related to (1) inhibited respiration 1,5 and (2) chelating of Mg 2ϩ , 8 or (3) direct activation of mPT (even during concurrent cyclosporin A treatment) by adding Ca 2ϩ or in Ca 2ϩ loaded mitochondria, as recently shown by Kupsch et al. 8 To stringently evaluate effects of minocycline during the process of Ca 2ϩ uptake, retention, and mPT, mitochondrial oxygen consumption can be monitored during a continuous Ca 2ϩ infusion (Fig. 1A,B). This assay provides information of the bioenergetic demand on mitochondria caused by Ca 2ϩ uptake as well as the respiratory inhibition triggered by mitochondrial Ca 2ϩ overload and mPT. 5,7 Alternatively, the effect of minocycline on isolated mitochondria can be di...