title: K+-dependent paradoxical membrane depolarization and Na+ overload, major and reversible contributors to weakness by ion channel leaks.
abstract: Normal resting potential (P1) of myofibers follows the Nernst equation, exhibiting about -85 mV at a normal extracellular K(+) concentration ([K(+)](o)) of 4 mM. Hyperpolarization occurs with decreased [K(+)](o), although at [K(+)](o) < 1.0 mM, myofibers paradoxically depolarize to a second stable potential of -60 mV (P2). In rat myofiber bundles, P2 also was found at more physiological [K(+)](o) and was associated with inexcitability. To increase the relative frequency of P2 to 50%, [K(+)](o) needed to be lowered to 1.5 mM. In the presence of the ionophore gramicidin, [K(+)](o) reduction to only 2.5 mM yielded the same effect. Acetazolamide normalized this increased frequency of P2 fibers. The findings mimic hypokalemic periodic paralysis (HypoPP), a channelopathy characterized by hypokalemia-induced weakness. Of myofibers from 7 HypoPP patients, up to 25% were in P2 at a [K(+)](o) of 4 mM, in accordance with their permanent weakness, and up to 99% were in P2 at a [K(+)](o) of 1.5 mM, in accordance with their paralytic attacks. Of 36 HypoPP patients, 25 had permanent weakness and myoplasmic intracellular Na(+) ([Na(+)](i)) overload (up to 24 mM) as shown by in vivo (23)Na-MRI. Acetazolamide normalized [Na(+)](i) and increased muscle strength. HypoPP myofibers showed a nonselective cation leak of 12-19.5 microS/cm(2), which may explain the Na(+) overload. The leak sensitizes myofibers to reduced serum K(+), and the resulting membrane depolarization causes the weakness. We postulate that the principle of paradoxical depolarization and loss of function upon [K(+)](o) reduction may apply to other tissues, such as heart or brain, when they become leaky (e.g., because of ischemia).
authors.affiliation: Institute of Applied Physiology, Ulm University, Ulm, Germany. karin.jurkat-rott@uni-ulm.de
authors.forename: Karin
authors.initials: K
authors.lastname: Jurkat-Rott
authors.forename: Marc-André
authors.initials: MA
authors.lastname: Weber
authors.forename: Michael
authors.initials: M
authors.lastname: Fauler
authors.forename: Xiu-Hai
authors.initials: XH
authors.lastname: Guo
authors.forename: Boris D
authors.initials: BD
authors.lastname: Holzherr
authors.forename: Agathe
authors.initials: A
authors.lastname: Paczulla
authors.forename: Nikolai
authors.initials: N
authors.lastname: Nordsborg
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Joechle
authors.forename: Frank
authors.initials: F
authors.lastname: Lehmann-Horn
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D000818:Animals; D002412:Cations; D018076:DNA, Complementary / Q000235:genetics; D005260:Female; D006801:Humans; D020514:Hypokalemic Periodic Paralysis / Q000503:physiopathology; D066298:In Vitro Techniques; D042541:Intracellular Space / Q000187:drug effects / Q000378:metabolism; D015640:Ion Channel Gating / Q000187:drug effects; D007473:Ion Channels / Q000378:metabolism*; D008279:Magnetic Resonance Imaging; D008297:Male; D008564:Membrane Potentials / Q000187:drug effects*; D008875:Middle Aged; D018908:Muscle Weakness / Q000503:physiopathology*; D011188:Potassium / Q000494:pharmacology*; D024661:Potassium Channels, Inwardly Rectifying / Q000378:metabolism; D051381:Rats; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012964:Sodium / Q000378:metabolism*; D000254:Sodium-Potassium-Exchanging ATPase / Q000235:genetics / Q000378:metabolism
chemical_list: D002412:Cations; D018076:DNA, Complementary; D007473:Ion Channels; D024661:Potassium Channels, Inwardly Rectifying; D012964:Sodium; D000254:Sodium-Potassium-Exchanging ATPase; D011188:Potassium