The calcium (Ca
2+)-paradox injury of the heart, induced by restoration of extracellular Ca
2+ after its short-term depletion, is known to provoke cardiomyocyte contracture. However, undetermined is how the Ca
2+-paradox provokes such a distinctive presentation of myocytes in the heart. To address this, we imaged sequential intracellular Ca
2+ dynamics and concomitant structures of the subepicardial ventricular myocytes in fluo3-loaded, Langendorff-perfused rat hearts produced by the Ca
2+ paradox. Under rapid-scanning confocal microscopy, repletion of Ca
2+ following its depletion produced high-frequency Ca
2+ waves in individual myocytes with asynchronous localized contractions, resulting in contracture within 10 min. Such alterations of myocytes were attenuated by 5-mM NiCl
2, but not by verapamil, SEA0400, or combination of ryanodine and thapsigargin, indicating a contribution of non-specific transmembrane Ca
2+ influx in the injury. However, saponin-induced membrane permeabilization of Ca
2+ showed no apparent contracture despite the emergence of high-frequency Ca
2+ waves, indicating an essential role of myocyte-myocyte and myocyte-extracellular matrix (ECM) mechanical connections in the Ca
2+ paradox. In immunohistochemistry Ca
2+ depletion produced separation of the intercalated disc that expresses cadherin and dissipation of
β-dystroglycan located along the sarcolemma. Taken together, along with the trans-sarcolemmal Ca
2+ influx, disruption of cell-cell and cell-ECM connections is essential for contracture in the Ca
2+-paradox injury.
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