Simvastatin impairs ADP-stimulated respiration and increases mitochondrial oxidative stress in primary human skeletal myotubes

Free Radic Biol Med. 2012 Jan 1;52(1):198-207. doi: 10.1016/j.freeradbiomed.2011.10.449. Epub 2011 Oct 25.


Statins, the widely prescribed cholesterol-lowering drugs for the treatment of cardiovascular disease, cause adverse skeletal muscle side effects ranging from fatigue to fatal rhabdomyolysis. The purpose of this study was to determine the effects of simvastatin on mitochondrial respiration, oxidative stress, and cell death in differentiated primary human skeletal muscle cells (i.e., myotubes). Simvastatin induced a dose-dependent decrease in viability of proliferating and differentiating primary human muscle precursor cells, and a similar dose-dependent effect was noted in differentiated myoblasts and myotubes. Additionally, there were decreases in myotube number and size following 48 h of simvastatin treatment (5 μM). In permeabilized myotubes, maximal ADP-stimulated oxygen consumption, supported by palmitoylcarnitine+malate (PCM, complex I and II substrates) and glutamate+malate (GM, complex I substrates), was 32-37% lower (P<0.05) in simvastatin-treated (5 μM) vs control myotubes, providing evidence of impaired respiration at complex I. Mitochondrial superoxide and hydrogen peroxide generation were significantly greater in the simvastatin-treated human skeletal myotube cultures compared to control. In addition, simvastatin markedly increased protein levels of Bax (proapoptotic, +53%) and Bcl-2 (antiapoptotic, +100%, P<0.05), mitochondrial PTP opening (+44%, P<0.05), and TUNEL-positive nuclei in human skeletal myotubes, demonstrating up-regulation of mitochondrial-mediated myonuclear apoptotic mechanisms. These data demonstrate that simvastatin induces myotube atrophy and cell loss associated with impaired ADP-stimulated maximal mitochondrial respiratory capacity, mitochondrial oxidative stress, and apoptosis in primary human skeletal myotubes, suggesting that mitochondrial dysfunction may underlie human statin-induced myopathy.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adenosine Diphosphate / pharmacology
  • Anticholesteremic Agents / adverse effects
  • Apoptosis / drug effects
  • Cell Differentiation / drug effects
  • Cell Respiration / drug effects
  • Dose-Response Relationship, Drug
  • Electron Transport Complex I / genetics
  • Electron Transport Complex I / metabolism
  • Gene Expression / drug effects*
  • Humans
  • Hydrogen Peroxide / metabolism
  • Mitochondria / drug effects*
  • Mitochondria / metabolism
  • Muscle Fibers, Skeletal / cytology
  • Muscle Fibers, Skeletal / drug effects*
  • Muscle Fibers, Skeletal / metabolism
  • Muscular Diseases / chemically induced
  • Muscular Diseases / metabolism*
  • Muscular Diseases / pathology
  • Myoblasts / cytology
  • Myoblasts / drug effects
  • Myoblasts / metabolism
  • Oxidative Stress
  • Oxygen Consumption / drug effects
  • Oxygen Consumption / physiology
  • Primary Cell Culture
  • Proto-Oncogene Proteins c-bcl-2 / genetics
  • Proto-Oncogene Proteins c-bcl-2 / metabolism
  • Respiratory System Agents / pharmacology
  • Signal Transduction / drug effects*
  • Simvastatin / adverse effects*
  • Superoxides / metabolism


  • Anticholesteremic Agents
  • Proto-Oncogene Proteins c-bcl-2
  • Respiratory System Agents
  • Superoxides
  • Adenosine Diphosphate
  • Simvastatin
  • Hydrogen Peroxide
  • Electron Transport Complex I