Key result
Lowering extracellular Ca2+ from 2.4 to 0.3 mM enhanced K+-induced loss of force and membrane excitability in HyperKPP mouse muscles even at normal K+ concentrations.
Why the study?
Ingestion of Ca2+ alleviates hyperkalemic periodic paralysis symptoms, but the underlying mechanism is unknown.
Lowering extracellular calcium exacerbates force depression and reduces salbutamol efficacy in HyperKPP mouse muscles, suggesting that the therapeutic benefit of calcium ingestion in HyperKPP relates to its effects on depolarized muscle fibers.
Supports calcium's protective role against depolarization in HyperKPP; leaves open translation to human therapy.
Hyperkalemic periodic paralysis (HyperKPP) manifests as stiffness or subclinical myotonic discharges before or during periods of episodic muscle weakness or paralysis. Ingestion of Ca2+ alleviates HyperKPP symptoms, but the mechanism is unknown because lowering extracellular [Ca2+] ([Ca2+]e) has no effect on force development in normal muscles under normal conditions. Lowering [Ca2+]e, however, is known to increase the inactivation of voltage-gated cation channels, especially when the membrane is depolarized. Two hypotheses were tested: (1) lowering [Ca2+]e depresses force in normal muscles under conditions that depolarize the cell membrane; and (2) HyperKPP muscles have a greater sensitivity to low Ca2+-induced force depression because many fibers are depolarized, even at a normal [K+]e. In wild type muscles, lowering [Ca2+]e from 2.4 to 0.3 mM had little effect on tetanic force and membrane excitability at a normal K+ concentration of 4.7 mM, whereas it significantly enhanced K+-induced depression of force and membrane excitability. In HyperKPP muscles, lowering [Ca2+]e enhanced the K+-induced loss of force and membrane excitability not only at elevated [K+]e but also at 4.7 mM K+. Lowering [Ca2+]e increased the incidence of generating fast and transient contractures and gave rise to a slower increase in unstimulated force, especially in HyperKPP muscles. Lowering [Ca2+]e reduced the efficacy of salbutamol, a β2 adrenergic receptor agonist and a treatment for HyperKPP, to increase force at elevated [K+]e. Replacing Ca2+ by an equivalent concentration of Mg2+ neither fully nor consistently reverses the effects of lowering [Ca2+]e. These results suggest that the greater Ca2+ sensitivity of HyperKPP muscles primarily relates to (1) a greater effect of Ca2+ in depolarized fibers and (2) an increased proportion of depolarized HyperKPP muscle fibers compared with control muscle fibers, even at normal [K+]e.
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Uwera et al. (2020) studied Hyperkalemic periodic paralysis (HyperKPP). Lowering extracellular [Ca2+] vs. Normal [Ca2+] (2.4 mM) was evaluated on Force and membrane excitability. Lowering extracellular Ca2+ from 2.4 to 0.3 mM enhanced K+-induced loss of force and membrane excitability in HyperKPP mouse muscles even at normal K+ concentrations.
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