Glycine-treated, hypoxic, proximal tubules developed a progressive ene
rgetic defect that resulted in failure to restore ATP levels to greate
r than 10 to 20% of control values during reoxygenation after 60 minut
es of hypoxia despite continued cytoprotection by glycine. The defect
was not corrected by supplementation with exogenous purines and was no
t modified by lowering the pH during hypoxia or reoxygenation. In the
continued presence of glycine, the failure to restore ATP was associat
ed with impaired recovery of structural changes that developed during
hypoxia and, if glycine was withdrawn, lethal membrane damage occurred
. The lesion was significantly ameliorated by the presence during hypo
xia of two agents known to suppress development of the mitochondrial p
ermeability transition, cyclosporine A and butacaine, which were most
effective when used in combination. The data suggest that development
of the mitochondrial permeability transition in glycine-protected tubu
les during hypoxia contributes to continued metabolic and structural i
mpairment and cell death that occur despite glycine replete conditions
such as exist frequently during in vivo insults and may be a target f
or therapeutic maneuvers.