tetrodotoxin and Hyperkalemia

We previously demonstrated improved myocardial preservation with polarized (tetrodotoxin-induced), compared with depolarized (hyperkalemia-induced), arrest and hypothermic storage. This study was undertaken to determine whether polarized arrest reduced ionic imbalance during ischemic storage and whether this was influenced by Na+/K +/2Cl- cotransport inhibition.. We used the isolated crystalloid perfused working rat heart preparation (1) to measure extracellular K+ accumulation (using a K+-sensitive intramyocardial electrode) during ischemic (control), depolarized (K+ 16 mmol/L), and polarized (tetrodotoxin, 22 micromol/L) arrest and hypothermic (7.5 degrees C) storage (5 hours), (2) to determine dose-dependent (0.1, 1.0, 10 and 100 micromol/L) effects of the Na +/K+/2Cl- cotransport inhibitor, furosemide, on extracellular K+ accumulation during polarized arrest and 7.5 degrees C storage, and (3) to correlate extracellular K+ accumulation to postischemic recovery of cardiac function.. Characteristic triphasic profiles of extracellular K+ accumulation were observed in control and depolarized arrested hearts; a significantly attenuated profile with polarized arrested hearts demonstrated reduced extracellular K+ accumulation, correlating with higher postischemic function (recovery of aortic flow was 54% +/-4% [P =.01] compared with 39% +/-3% and 32% +/-3% in depolarized and control hearts, respectively). Furosemide (0.1, 1.0, 10, and 100 micromol/L) modified extracellular K+ accumulation by -18%, -38%, -0.2%, and +9%, respectively, after 30 minutes and by -4%, -27%, +31%, and +42%, respectively, after 5 hours of polarized storage. Recovery of aortic flow was 53% +/-4% (polarized arrest alone), 56% +/-8%, 70% +/-2% (P =.04 vs control), 69% +/-4% (P =.04 vs control), and 65% +/-3% ( P =. 04 vs control), respectively.. Polarized arrest was associated with a reduced ionic imbalance (demonstrated by reduced extracellular K+ accumulation) and improved recovery of cardiac function. Further attenuation of extracellular K + accumulation (by furosemide) resulted in additional recovery.

Topics: Animals; Chloride Channels; Disease Models, Animal; Diuretics; Dose-Response Relationship, Drug; Drug Evaluation, Preclinical; Extracellular Space; Furosemide; Glucose; Heart Arrest, Induced; Heart Transplantation; Hyperkalemia; Male; Myocardial Reperfusion Injury; Myocardium; Organ Preservation; Rats; Rats, Wistar; Sodium Channels; Sodium-Potassium-Exchanging ATPase; Tetrodotoxin; Time Factors; Tromethamine

Electrophysiological studies on muscle fibres from patients with hyperkalemic periodic paralysis with myotonia have shown that the episodes of weakness are caused by a sustained depolarization of the sarcolemma to potentials between -40 and -60 mV. In muscle fibre segments from three such patients this sustained depolarization was caused by noninactivating Na+ channels with reduced single-channel conductance blocked by TTX and procainamide. As the chloride conductance was normal, myotonia may be best explained with the abnormal reopenings of the Na+ channels. The recently described genetic linkage between hyperkalemic periodic paralysis with myotonia and the gene coding for the TTX-sensitive Na+ channel suggests an altered primary structure of this channel causing its abnormal function.

Topics: Electric Conductivity; Humans; Hyperkalemia; Ion Channel Gating; Membrane Potentials; Muscles; Paralyses, Familial Periodic; Procainamide; Sodium Channels; Tetrodotoxin

The hyperkalemic periodic paralyses are a clinically heterogeneous group of autosomal dominant syndromes characterized by episodic paralysis associated with an elevated serum potassium level. Affected individuals in the same family tend to have homogeneous symptom complexes, although phenotypic variation is present among different families. For example, myotonia is absent in some pedigrees, present in others, and, in a third variant, paramyotonia congenita, myotonia coexists with cold-induced paralysis. Electrophysiological studies have demonstrated variant-specific abnormalities in skeletal muscle membrane sodium conductance. We tested the hypothesis that hyperkalemic periodic paralysis (without myotonia) and paramyotonia congenita are tightly linked to the tetrodotoxin-sensitive adult skeletal muscle sodium channel gene on chromosome 17q23-25 in two large pedigrees. The DNA polymorphisms detected in the growth hormone skeletal muscle sodium channel complex (GH1-SCN4A) and by flanking polymorphic markers (D17S74 and D17S40) demonstrated no recombinants between the disease phenotypes and this complex. Phenotypic variation in the hereditary hyperkalemic periodic paralyses may result from allelic heterogeneity at the tetrodotoxin-sensitive adult skeletal muscle sodium channel locus.

Topics: Adult; Chromosomes, Human, Pair 17; Female; Genes; Humans; Hyperkalemia; Lod Score; Male; Muscle Proteins; Muscles; Myotonia Congenita; Paralyses, Familial Periodic; Pedigree; Phenotype; Polymorphism, Restriction Fragment Length; Sodium Channels; Tetrodotoxin

A recently described disorder in certain registered Quarter horses bears many clinical similarities to the muscle disease identified as hyperkalemic periodic paralysis (HPP) in humans. Pathological changes in membrane permeability or Na(+)-K+ pump activity have been proposed to produce the muscle depolarization and inexcitability that characterize the condition in humans. Biopsies of external intercostal muscle from normal and affected horses were used to determine whether alterations in either permeability and/or pump activity could be linked to the pathology in horses. Affected horse muscle is approximately 16 mV more depolarized than normal muscle at rest, and the muscle membrane potential of HPP horses is less responsive to changes in extracellular K+. Calculation of the relative membrane permeabilities of Na+ and K+ (PNa/PK) indicates that this ratio is significantly increased in HPP muscle. The increase is probably due to an increase in PNa rather than to a decrease in PK, since addition of 10(-6) M tetrodotoxin produces an approximately 14-mV membrane hyperpolarization in HPP fibers but is without effect in normal fibers. The clinical similarities between HPP in horses and humans suggest a common genetic defect in the two species.

Topics: Aging; Animals; Body Water; Epinephrine; Horse Diseases; Horses; Hyperkalemia; Membrane Potentials; Muscle Development; Muscles; Ouabain; Paralysis; Potassium; Reference Values; Temperature; Tetrodotoxin

Topics: Acidosis; Action Potentials; Animals; Dogs; Electrophysiology; Endocardium; Hyperkalemia; Hypoxia; Membrane Potentials; Papillary Muscles; Purkinje Fibers; Solutions; Tetrodotoxin; Verapamil