Mitochondrial Cx43 hemichannels contribute to mitochondrial calcium entry and cell death in the heart

Mitochondrial connexin 43 (Cx43) plays a key role in cardiac cytoprotection caused by repeated exposure to short periods of non-lethal ischemia/reperfusion, a condition known as ischemic preconditioning. Cx43 also forms calcium (Ca²⁺)-permeable hemichannels that may potentially lead to mitochondrial Ca²⁺ overload and cell death. Here, we studied the role of Cx43 in facilitating mitochondrial Ca²⁺ entry and investigated its downstream consequences. To that purpose, we used various connexin-targeting peptides interacting with extracellular (Gap26) and intracellular (Gap19, RRNYRRNY) Cx43 domains, and tested their effect on mitochondrial dye- and Ca²⁺-uptake, electrophysiological properties of plasmalemmal and mitochondrial Cx43 channels, and cell injury/cell death. Our results in isolated mice cardiac subsarcolemmal mitochondria indicate that Cx43 forms hemichannels that contribute to Ca²⁺ entry and may trigger permeability transition and cell injury/death. RRNYRRNY displayed the strongest effects in all assays and inhibited plasma membrane as well as mitochondrial Cx43 hemichannels. RRNYRRNY also strongly reduced the infarct size in ex vivo cardiac ischemia–reperfusion studies. These results indicate that Cx43 contributes to mitochondrial Ca²⁺ homeostasis and is involved in triggering cell injury/death pathways that can be inhibited by RRNYRRNY peptide.