Autophagy is simultaneously a mode of programmed cell death and an important physiological process for cell survival, but its pathophysiological significance in cardiac myocytes remains largely unknown. We induced autophagy in isolated adult rat ventricular cardiomyocytes (ARVCs) by incubating them in
glucose-free,
mannitol-supplemented medium for up to 4 days. Ultrastructurally, intracellular vacuoles containing degenerated subcellular organelles (e.g., mitochondria) were markedly apparent in the
glucose-starved cells. Microtubule-associated protein-1 light chain 3 was significantly upregulated among the
glucose-starved ARVCs than among the controls. After 4 days,
glucose-starved ARVCs showed a significantly worse survival rate (19+/-5.2%) than the controls (55+/-8.3%, P<0.005). Most dead ARVCs in both groups showed features of
necrosis, and the rate of apoptosis did not differ between the groups. Two inhibitors of autophagy,
3-methyladenine (3-MA) and
leupeptin, significantly and dose-dependently reduced the viability of both control and
glucose-starved ARVCs and caused specific morphological alterations; 3-MA reduced autophagic findings, whereas
leupeptin greatly increased the numbers and the sizes of vacuoles that contained incompletely digested organelles. The knockdown of the autophagy-related genes with
small interfering RNA also reduced the
glucose-starved ARVCs viability, but
rapamycin, an autophagy enhancer, improved it. Reductions in the
ATP content of ARVCs caused by
glucose depletion were exacerbated by the inhibitors while attenuated by
rapamycin, suggesting that autophagy inhibition might accelerate energy depletion, leading to
necrosis. Taken together, our findings suggest that autophagy in cardiomyocytes reflects a prosurvival, compensatory response to stress and that autophagic cardiomyocyte death represents an unsuccessful outcome due to
necrosis.