Abstract:The Na + /Ca 2+ exchanger (NCX) is the major Ca 2+ efflux system in cardiac myocytes, and thereby its global knockout is embryonically lethal. However, Henderson et al. (2004) found that mice with the cardiospecific knockout of NCX1 lived to adulthood. No adaptation was detected in expression levels of other proteins except for a 50% reduction in the L-type Ca 2+ current (I CaL ) as revealed in electrophysiological studies. To predict mechanisms of survival, we simulated cardiac myocyte activity in the absence of NCX using a mathematical model of guinea pig ventricular myocytes. The NCX knockout resulted in contracture of the model cell because of a rise in the cytoplasmic Ca 2+ ([Ca 2+ ] i ). However, up-regulation of the sarcolemmal Ca 2+ pump (PMCA) and/or down-regulation of I CaL enables steady rhythmic contractions even if NCX is totally excluded. The simulation predicted that the steady activities are maintained by a functional up-regulation of PMCA by about 2.3 times in addition to the down-regulation of I CaL to a half, as observed in the experiment. However, the model analysis predicted that the myocyte depending on PMCA for Ca 2+ extrusion is unstable against any changes in ionic fluxes and energetically unfavorable in comparison with the control. The reason for the instability is that the activity of PMCA driven by the ATP hydrolysis is hardly affected by changes in [Ca 2+ ] i , but NCX has a reversal potential in the middle level of the action potential and is immediately affected by the Ca 2+ flux via NCX itself. The source code of the model is available at http://www.sim-bio.org/.Key words: Na + /Ca 2+ exchanger, NCX1, sarcolemmal Ca 2+ pump.Cardiac excitation-contraction coupling is initiated by the influx of Ca 2+ through voltage-dependent Ca 2+ channels; it subsequently triggers Ca 2+ release from the sarcoplasmic reticulum (SR). To maintain stable excitationcontraction coupling, this Ca 2+ influx must be balanced by Ca 2+ efflux. The Na + /Ca 2+ exchanger (NCX) and ATP-dependent Ca 2+ pump (PMCA) are the two mechanisms that mediate Ca 2+ efflux via the plasma membrane, and the dominant role in cardiac myocytes of NCX1, an isoform of NCX, has been well documented [1,2]. Thus if NCX1 is removed, cardiac myocytes should become nonfunctional because of Ca 2+ overload. Therefore in our current understanding, it is almost inconceivable that myocardium could survive in the absence of NCX1. In fact, four laboratories have reported that a global knockout of the NCX1 is embryonically lethal [3][4][5][6]. However, surprisingly, Henderson et al. [7] reported that mice with a cardiospecific knockout of NCX1 lived to adulthood with only modestly reduced cardiac function. They could detect no adaptation in the expression levels of PMCA, the dihydropyridine receptor, ATP-dependent Ca 2+ pump on SR (SERCA), or calsequestrin as measured by both immunoblots and microarray analyses, but demonstrated that L-type Ca 2+ currents (I CaL ) were reduced by ~50% in the knockout mice.These findings raise severa...