(MPT). Kidney proximal tubule cells are especially prone to deleterious effects of mitochondrial damage because of their dependence on oxidative mitochondrial metabolism for ATP production. To clarify the role of CyPD and the MPT in proximal tubule injury during ischemia-reperfusion (I/R) and hypoxia-reoxygenation (H/R), we assessed freshly isolated tubules and in vivo injury in wild-type (WT) and Ppif Ϫ/Ϫ CyPD-null mice. Isolated mouse tubules developed a sustained, nonesterified fatty acid-mediated energetic deficit after H/R in vitro that could be substantially reversed by delipidated albumin and supplemental citric acid cycle substrates but was not modified by the absence of CyPD. Susceptibility of WT and Ppif Ϫ/Ϫ tubules to the MPT was increased by H/R but was less in normoxic and H/R Ppif Ϫ/Ϫ than WT tubules. Correction of the energetic deficit that developed during H/R strongly increased resistance to the MPT. Ppif Ϫ/Ϫ mice were resistant to I/R injury in vivo spanning a wide range of severity. The data clarify involvement of the MPT in oxygen deprivation-induced tubule cell injury by showing that the MPT does not contribute to the initial bioenergetic deficit produced by H/R but the deficit predisposes to subsequent development of the MPT, which contributes pathogenically to kidney I/R injury in vivo.acute kidney injury; membrane potential; mitochondria THE MITOCHONDRIAL PERMEABILITY transition (MPT) results from the regulated and reversible opening of an ϳ3-nm-diameter pore in the inner mitochondrial membrane with a size exclusion limit of ϳ1.5 kDa that is frequently termed the permeability transition pore (PTP) (33,35,42,56). Sustained opening of the PTP dissipates the transmembrane ion gradients necessary for energy conservation and leads to loss of inorganic and small organic matrix solutes and matrix swelling. Pore opening can be prevented and reversed by cyclosporin A (CsA) (7, 13) via binding by CsA of a mitochondrial matrix cyclophilin D (CyPD) (2,3,36,48,57,69). Although the specific proteins forming the PTP channel have not been conclusively identified (5,35,37), multiple inducers and antagonists are known (33,35,56,72). The endogenous metabolites ADP and Mg 2ϩ and matrix acidification potently antagonize pore opening. Inducers include multiple conditions commonly present during injury states, i.e., decrease of membrane potential (⌬⌿ m ) and increase of Ca 2ϩ , phosphate, reactive oxygen species (ROS), and a number of lipid metabolites, including nonesterified fatty acids (NEFA) and their CoA and carnitine esters and ceramides (33,56,72). Recent studies have shown that phosphate, in addition to promoting the effect of Ca 2ϩ to induce the MPT, is required for MPT inhibition by CyPD (4) and have implicated the phosphate carrier as a PTP component (43).Once the glycine-sensitive plasma membrane pores that mediate necrotic cell death (16, 50) form, the MPT is promoted by influx of extracellular Ca 2ϩ and loss of cytosolic metabolites such as ADP and Mg 2ϩ , so the process predictably occurs after ...