Cell Cation Content Research Articles

Red Blood Cell Membrane Conductance in Hereditary Haemolytic Anaemias.

Congenital haemolytic anaemias are inherited disorders caused by red blood cell membrane and cytoskeletal protein defects, deviant hemoglobin synthesis and metabolic enzyme deficiencies. In many cases, although the causing mutation might be known, the pathophysiology and the connection between the particular mutation and the symptoms of the disease are not completely understood. Thus effective treatment is lagging behind. As in many cases abnormal red blood cell cation content and cation leaks go along with the disease, by direct electrophysiological measurements of the general conductance of red blood cells, we aimed to assess if changes in the membrane conductance could be a possible cause. We recorded whole-cell currents from 29 patients with different types of congenital haemolytic anaemias: 14 with hereditary spherocytosis due to mutations in α-spectrin, β-spectrin, ankyrin and band 3 protein; 6 patients with hereditary xerocytosis due to mutations in Piezo1; 6 patients with enzymatic disorders (3 patients with glucose-6-phosphate dehydrogenase deficiency, 1 patient with pyruvate kinase deficiency, 1 patient with glutamate-cysteine ligase deficiency and 1 patient with glutathione reductase deficiency), 1 patient with β-thalassemia and 2 patients, carriers of several mutations and a complex genotype. While the patients with β-thalassemia and metabolic enzyme deficiencies showed no changes in their membrane conductance, the patients with hereditary spherocytosis and hereditary xerocytosis showed largely variable results depending on the underlying mutation.

An Infant with Pseudohyperkalemia, Hemolysis, and Seizures: Cation-Leaky GLUT1-Deficiency Syndrome due to aSLC2A1Mutation

GLUT1 (glucose transporter 1) deficiency syndrome is a well-known presentation in pediatric practice. Very rare mutations not only disable carbohydrate transport but also cause the red cell membrane to be constitutively permeant to monovalent cations, namely sodium and potassium. The aim of this study was to describe the pediatric presentation of a patient with GLUT1 deficiency with such a cation-leaky state. The infant presented with erratic hyperkalemia, neonatal hyperbilirubinemia, anemia, hepatic dysfunction, and microcephaly. Later, seizures occurred and developmental milestones were delayed. Magnetic resonance imaging and computerized tomography scans of the brain showed multiple abnormalities including periventricular calcification. Visual impairment was present due to the presence of both cataracts and retinal dysfunction. Measurements of red cell cation content showed extremely leaky red cells (causing the hemolysis) and temperature-dependent loss of potassium from red cells (explaining the hyperkalemia as pseudohyperkalemia). A trinucleotide deletion in SLC2A1, coding for the deletion of isoleucine 435 or 436 in GLUT1, was identified in the proband. This is the fourth pedigree to be described with this most unusual syndrome. The multisystem pathology probably reflects a combination of glucose transport deficiency at the blood-brain barrier (as in typical GLUT1 deficiency) and the deleterious osmotic effects of a cation-leaky membrane protein in the cells where GLUT1 is expressed, notably the red cell. We hope that this detailed description will facilitate rapid diagnosis of this disease entity.

Effects of Hydroxyurea (HU) and Magnesium Pidolate (Mg) in Hemoglobin SC Disease (HbSC): the “CHAMPS” Trial.

Abstract 819 Background.HbSC is characterized by increased red cell density and clinical complications but has rarely been the target of therapeutic trials. The CHAMPS Trial was a prospective, randomized, double-blinded, multi-center Phase II study of HU and Mg in children and adults with HbSC conducted by the Comprehensive Sickle Cell Centers Clinical Trials Consortium. HU is clinically efficacious in HbSS, but its value has not been demonstrated for HbSC; Mg reduces cation transport activity and improves hydration of HbSS erythrocytes. The primary objective of the trial was to measure the ability of HU and Mg individually and in combination to reduce the density of HbSC erythrocytes. Secondary objectives were to determine the effects of the 2 agents on hematologic parameters and red cell pathobiology, to identify toxicities of HU and Mg, and to record adverse events. Methods.Eligible subjects had HbSC and at least 1 vaso-occlusive event in the previous 12 months (but none in the 4 weeks before study entry) and were ≥ age 5 years. After providing informed consent and baseline evaluations, subjects were randomized to 1 of 4 arms: (A) HU (20 mg/kg/d PO) and Mg (0.6 mEq/kg/d PO in 2 doses), (B) HU and placebo for Mg, (C) HU placebo and Mg, or (D) placebos for both. Subjects were evaluated at 2 or 4 week intervals for 11 months (15 visits). In addition to physical exams, blood counts and chemistry profiles, subjects had central lab evaluations [including measurements of red cell density (by Advia instrument), HbF, red cell cation content, KCl co-transport and Gardos channel activity, cell adhesion to endothelial cells and laminin, and erythrocyte membrane phosphatidyl serine (PS exposure)] at baseline (twice) and weeks 8, 16, 24, and 44. The primary endpoint was red cell density measured at week 8. Results.Forty-four subjects (median age 13.6 years, range 5-53, 73% < age 16) had baseline evaluations and were randomized, 36 reached the primary endpoint and 22 completed 11 months on study drugs. The trial was halted prematurely because of slow enrollment. Subjects in the HU groups (A and B) had increased red cell MCV, cell Hb and HbF compared to baseline and to groups C and D at week 8 (p<0.001); these differences were further increased at week 24 (Table). Mg did not have measurable effects. No differences were seen among the groups in Hb level, hyperdense red cells, erythrocyte Na, K, and Mg, KCl co-transport and Gardos channel activity, plasma magnesium, serum LDH, red cell PS exposure and adhesion to endothelium. Adults did not differ significantly from children. Ten acute events required ER visits/hospitalizations in group A, 15 in group B, 15 in group C, and 19 in group D (differences not significant). Average compliance with HU/HU placebo was approximately 83% and Mg/Mg placebo 77%. No significant toxicity was associated with HU or Mg alone or in combination.Table:Effects of HU on HbSC ErythrocytesMean valuesBaselineWeek 8Week 24HU*No HU*HU*No HU*HU*No HU*n232114-1718-1912-1313-14MCV (fl)79.379.188.880.094.380.1Cell Hb (pg)27.928.631.628.633.628.6Dense cells (%)‡9.611.211.711.89.010.1HbF (g/dL)1.32.02.31.95.22.2*“HU” includes groups A+B; “No HU” includes Groups C+D‡Red cell hemoglobin concentration mean (CHCM) >41 g/dL (Advia) Conclusions.HU had significant effects on HbSC erythrocytes, including increased HbF and MCV, with increasing response over 6 months. Mg at a dose of 0.6 mEq/kg/d had no measurable effect on red cell properties or endothelial interactions, either alone or in combination with HU. This may have been related to suboptimal dosing, since the maximum tolerated dose was recently found to be 0.9 mEq/kg/d. Differences in acute events, although not significant, suggest a need for studies with larger enrollment. These data provide a basis for performing clinical efficacy trials using HU, perhaps at higher doses, in subjects with HbSC disease. Disclosures:Off Label Use: Hydroxyurea is being tested for its effects on red blood cells in persons with HbSC disease. Magnesium pidolate is being tested for its effects on red blood cells in persons with HbSC disease.

Red Blood Cell Indices, Cation Content, and Membrane Cation Transports

In sickle cell disease, in the homozygous state, the increased heterogeneity of erythrocytes results mainly from membrane defects secondary to Hb S polymerization and the increased survival of F cells. The density distribution curve, using phthalate esters or the red blood cell indices measured with the H*3 system, are useful methods for the hematological follow-up of patients under specific therapies. The methods evaluating the red blood cell cation contents and the abnormal membrane potassium transport pathways are also described, in order to evaluate agents which can restore normal hemoglobin concentration and water content in dehydrated sickle cells.

The role of cell swelling in the stimulation of glycogen synthesis by insulin

In hepatocyte cultures, insulin stimulates cellular accumulation of K+, partly (approximately 20%) by net replacement of cell Na+, but largely (approximately 80%) by increasing the cell K++Na+ content, with a consequent increase in cell volume. An increase in cation content occurred within 5 min of exposure to insulin and was not secondary to metabolic changes. Insulin also increased the cation content, by increasing the Na+ content, in a K(+)-free medium or when K+ uptake was inhibited with 1 mM-ouabain. However, insulin did not increase the cation content in a Na(+)-free medium. The stimulation of glycogen synthesis by insulin, like the increase in cation content, was blocked in a Na(+)-free medium, but not when K+ uptake was inhibited. Hypo-osmotic swelling restored the stimulation of glycogen synthesis in a Na(+)-free medium, indicating that the lack of effect of insulin in the iso-osmotic Na(+)-free medium was not due to a direct requirement for Na+ for glycogen synthesis, but to a secondary mechanism, dependent on Na+ entry, that can be mimicked by hypo-osmotic swelling. Quinine increased cell volume further and caused a further increase in glycogen synthesis. The hypothesis that cellular uptake of K+ may be part of the mechanism by which insulin controls metabolism was discounted, because inhibition of K+ uptake does not block the metabolic effects of insulin [Czech (1977) Annu. Rev. Biochem. 46, 359-384]. The present results support the hypothesis that an increase in cell cation content, and thereby cell volume, rather than K+ uptake, is part of the mechanism by which insulin stimulates glycogen synthesis in hepatocytes.

Effect of irradiation on red cell cation content and transport.

The effect of irradiation on red cell (RBC) cation content and membrane transport was studied. When units of RBCs collected in AS-1 (n = 8) were exposed to radiation (2000 cGy) and then stored at 4 degrees C, there was a significant increase in external K and internal Na and a decrease in internal K relative to control units (n = 3). Similar changes in internal cation contents were noted for RBCs collected in CPD; because of the higher hematocrit, the external K concentration was higher than that in AS-1-collected RBCs. Cellular K loss and Na gain were balanced, and the total cation content remained constant; however, both control and irradiated cells swelled over time as a consequence of the decreased pH and 2.3 DPG content. These changes in volume and cation content were reversed when the cells were incubated at 37 degrees C. A specific effect of radiation on the Na-K pump and Na-K-Cl and K-Cl cotransport systems was ruled out, because no significant differences between irradiated cells and controls were found. These data indicate that radiation induces an increased permeability to Na and K on the part of the RBC membrane lipid bilayer and that this increase is balanced and reversible.

Insulin resistance as cause of increased blood pressure in the elderly: effects on intracellular ion contents

Previous reports have evidenced a strong relationship between high plasma insulin levels and blood pressure in diabetic and obese subjects but not in the elderly. During aging many patho-physiological changes in cardiovascular functions and autonomic nervous system occur, so that aging per se might be a cause of a “physiological’ increase in blood pressure. Nevertheless, an insulin resistance also develops during aging. The present study investigates the possible role of age-dependent insulin resistance in the genesis of increased blood pressure. Our data show that insulin resistance calculated by the glucose infusion rate during a euglycemic hyperinsulinemic glucose clamp procedure is significantly correlated with the insulin-mediated net decrease in erythrocyte Na + content ( r = 0.58, P < 0.05), as well as with net increase in erythrocyte K + ( r = 0.64, P < 0.05) and Mg 2+ ( r = 0.67, P < 0.01) content and to basal diastolic blood pressure ( r = −0.63, P < 0.05). We conclude that in elderly subjects the age-related and normally occurring insulin resistance might contribute to the increase of arterial blood pressure through its effect on cell cation content.

Monensin-induced cation movements in bovine erythrocytes

Monensin is a carboxylic ionophore that has been observed to increase cation permeability across the membrane of several cell types. Additionally, it is used commercially as an anticoccidial agent and has been found to increase feed efficiency in cattle. The objectives of these experiments were to determine the ability of monensin to stimulate cation (Na and K) transport across the bovine erythrocyte membrane and determine the effects of anion substitution on the action of the compound. Erythrocyte cation analyses revealed that all of the animals used in this study were low potassium (LK). Red cells were incubated in an artificial medium in the presence or absence of monensin, and cell sodium, potassium and water were determined at several time periods. It was observed that monensin stimulated the movement of sodium and potassium down their respective concentration gradients. Cell water content (“D”) was observed to increase in response to an elevation in cell cation content. In synthetic media containing acetate, sulfate, citrate, thiocynate and gluconate substituted for chloride as the anion specie in the presence of monensin, there were measurable differences in intracellular sodium and water during the incubation period. The addition of DIDS to the control media containing chloride was observed to inhibit from 60 to 80 percent of the monensin-stimulated sodium movements. The results of this study show that monensin stimulates cation movements in bovine erythrocytes and anion substitutes may alter the action of this ionophore. Additionally, it was demonstrated that the action of monensin can be modified by inhibition of Band 3.

Furosemide-sensitive Na and K fluxes in human red cells. Net uphill Na extrusion and equilibrium properties.

This paper reports experiments designed to find the concentrations of internal and external Na and K at which inward and outward furosemide-sensitive (FS) Na and K fluxes are equal, so that there is no net FS movement of Na and K. The red cell cation content was modified by using the ionophore nystatin, varying cell Na (Nai) from 0 to 34 mM (K substitution, high-K cells) and cell K (Ki) from 0 to 30 mM (Na substitution, high-Na cells). All incubation media contained NaCl (Nao = 130 or 120 nM), and KCl (Ko = 0-30 mM). In high-K cells, incubated in the absence of Ko, there was net extrusion of Na through the FS pathway. The net FS Na extrusion increased when Nai was increased. Low concentrations of Ko (0-6 mM) slightly stimulated, whereas higher concentrations of Ko inhibited, FS Na efflux. Increasing Ko stimulated the FS Na influx (K0.5 = 4 mM). Under conditions similar to those that occur in vivo (Nai = 10, Ki = 130, Nao = 130, Ko = 4 mM, Cli/Clo = 0.7), net extrusion of Na occurs through the FS pathway (180-250 mumol/liter cell X h). The concentration of Ko at which the FS Na influx and efflux and the FS K influx and efflux become equal increased when Nai increased in high-K cells and when Ki was increased in high-Na cells. The net FS Na and K fluxes both approached zero at similar internal and external Na and K concentrations. In high-K cells, under conditions when net Na and K fluxes were near zero, the ratio of FS Na to FS K unidirectional flux was found to be 2:3. In high-K cells, the empirical expression (Nai/Nao)2(Ki/Ko)3 remained at constant value (apparent equilibrium constant, Kappeq +/- SEM = 22 +/- 2) for each set of internal and external cation concentrations at which there was no net Na flux. These results indicate that in the physiological region of concentrations of internal and external Na, K, and Cl, the stoichiometry of the FS Na and K fluxes is 2 Na:3 K. In high-Na cells under conditions when net FS Na and K fluxes were near zero, the ratio of FS Na to FS K unidirectional fluxes was 3:2 (1).(ABSTRACT TRUNCATED AT 400 WORDS)

Cellular K+ permeation across the cortical collecting tubule: effects of Na+-K+ pump inhibition and membrane depolarization

These experiments examined the possibility that alterations in cell cation content and/or membrane voltage could influence cell K+ permeability of the cortical collecting tubule. Using the amiloride-treated isolated perfused rabbit cortical collecting tubule, ouabain or a K+-free bath reduced the magnitude of the K+ diffusion voltage. In addition, both methods of Na+-K+-ATPase inhibition reduced the K+ efflux (lumen-to-bath) rate coefficient (KK) without affecting the Na+ efflux rate coefficient. The magnitude of the reduction of KK could not be explained by a model of simple diffusion across two membranes in series even if the intracellular voltage were abolished. Thus, pump inhibition reduced cell K+ permeability. To determine whether membrane depolarization could induce a change in membrane permeability, [K+] was increased to 20 mM in both perfusate and bath. The reduction in KK was within the range predicted by the three-compartment model (36%). Differential membrane depolarization by raising lumen [K+] or bath [K+] produced disparate results. Apical depolarization reduced KK but basolateral depolarization did not. Taken together these results indicate that intracellular ion content may play a major role in regulating cell K+ permeability independent of voltage-dependent effects. In addition, under these experimental conditions, the apical membrane may be the rate-limiting barrier to cellular transfer.

Effects of depletion of K+, Na+, or Ca2+ on DNA synthesis and cell cation content in chick embryo fibroblasts.

Decreasing the K+ concentration of the medium from 5 mM to 0.59 mM decreased the K+ content of chick embryo fibroblasts to 22% of control values and increased the Na+ content to 820% of control values. The alteration of monovalent cation content occurred within two hours but had no effect on the rate of DNA synthesis, as measured by 3H-thymidine incorporation, for at least 16 hours. By decreasing the Na+ concentration in the medium, a 50% reduction in cellular Na+ could be obtained with no effect on thymidine incorporation. Since these changes in cellular Na+ or K+ are much larger than any known to occur under physiological conditions but have no effect on thymidine incorporation, we conclude that Na+ and K+ do not play a critical role in determining multiplication rate. Addition of 1.8 mEGTA to cells in media containing 1.7 mM Ca2+ and 0.8 mM Mg2+ inhibited thymidine incorporation and sharply decreased cellular K+ and increased cellular Na+ content. However, there was no reduction in total cellular Ca2+ levels. Likewise, decreasing the Ca2+ concentration of the medium below 0.01 mM inhibited thymidine incorporation, decreased cellular K+ and Mg2+, and increased cellular Na+ but did not affect total cellular Ca2+ levels. Inhibition of DNA synthesis, therefore, could not be correlated with changes in cellular Ca2+ levels.

Correlated effects of external magnesium on cation content and DNA synthesis in cultured chicken embryo fibroblasts

AbstractDepletion of Mg2+ in the growth medium for chicken embryo fibroblasts produces a large decrease in DNA synthesis as measured by 3H‐thymidine incorporation, and concomitant decreases in cellular K+ and Mg2+ and increases in Na+ and Ca2+. In cells grown in media containing 0.2 mM Ca2+, graded reduction of Mg2+ from 0.8 mM (control) to 0.016 mM produced graded decreases in DNA synthesis to 10% of control at 0.016 mM Mg2+. Concomitantly, cell cations showed graded changes, Na+ increasing to 227%, K+ decreasing to 52.5%, Mg2+ decreasing to 57.5% and Ca2+ increasing to 153.5% of control. The effects of Mg2+ depletion on DNA synthesis and cell cation content exhibited a dependence on Ca2+ concentration, the effects being larger at low Ca2+ concentration. Use of inorganic pyrophosphate in the growth medium as a selective complexor of Mg2+ caused a marked decrease in DNA synthesis which was accompanied by changes in cellular cation content similar to those produced by direct Mg2+ depletion.The effects of Mg2+ depletion on cell cation content are explainable in terms of changes in membrane permeability caused by rapid external surface exchange of bound divalent cations. Among the several interpretations of the data in terms of possible mechanisms by which changes in external Mg2+ concentration may affect cell metabolism, the most consistent with known properties of the system is the concept of a central role for intracellular free Mg2+ in the coordinate control of growth and metabolism in animal cells.

Congenital hemolytic anemia associated with dehydrated erythrocytes and increased potassium loss.

A 21-year-old woman was found to have congenital hemolytic anemia characterized by dehydrated-appearing erythrocytes in the peripheral blood. The red-cell sodium was increased, potassium was decreased, and the cell water content was reduced. No metabolic or hemoglobin abnormalities were detected to account for this cation distribution. The basic defect appeared to be increased membrane permeability to cations that was greater for potassium than for sodium. Consequently, these cells lost potassium in excess of sodium gained, the total cell cation content decreased, and rigid, osmotically resistant desiccytes (dehydrated erythrocytes) were formed as water left the cells in response to the decreased solute concentration. Clinically, this patient has done well in spite of persistent hemolysis. Her three-year-old son also has congenital hemolytic anemia with the same clinical abnormalities, including a marked decrease in red-cell potassium. Whereas previous studies have demonstrated that permeability abnormalities can lead to water-loaded cells and hemolysis, our findings indicate that cellular dehydration may also produce hemolytic anemia. (N Engl J Med 291:491–496, 1974)

Incubation of HK and LK sheep red cells in vitro for long periods

HK and LK sheep red cells have been maintained in vitro at 37°C for periods of up to 3 weeks. During the incubation, periodic measurements of cell Na +, K +, ouabain-sensitive and ouabain-insensitive K + influxes were made. The effects of lowering the in vitro incubation temperature and of reducing the K + concentration in the medium on cell cation content and volume were also investigated. The results of these experiments were, in general, consistent with previous measurements of the effects of these parameters on K + and Na + fluxes in short term experiments. In vitro incubation for several days was also used to show that exposure to anti-L serum produces a net uptake of K + and extrusion of Na + in LK sheep red cells. A new procedure for measuring the active and passive influxes of K + was developed. The early time course of K + influx inhibition by ouabain was also studied by this procedure.