Modulation of Ca2+-dependent K+ transport by modifications of the NAD+/NADH ratio in intact human red cells

Cardiac Na+ current regulation by pyridine nucleotides

RATIONALE

Mutations in glycerol-3-phosphate dehydrogenase 1-like (GPD1-L) protein reduce cardiac Na+ current (I(Na)) and cause Brugada Syndrome (BrS). GPD1-L has >80% amino acid homology with glycerol-3-phosphate dehydrogenase, which is involved in NAD-dependent energy metabolism.

OBJECTIVE

Therefore, we tested whether NAD(H) could regulate human cardiac sodium channels (Na(v)1.5).

METHODS AND RESULTS

HEK293 cells stably expressing Na(v)1.5 and rat neonatal cardiomyocytes were used. The influence of NADH/NAD+ on arrhythmic risk was evaluated in wild-type or SCN5A(+/-) mouse heart. A280V GPD1-L caused a 2.48+/-0.17-fold increase in intracellular NADH level (P<0.001). NADH application or cotransfection with A280V GPD1-L resulted in decreased I(Na) (0.48+/-0.09 or 0.19+/-0.04 of control group, respectively; P<0.01), which was reversed by NAD+, chelerythrine, or superoxide dismutase. NAD+ antagonism of the Na+ channel downregulation by A280V GPD1-L or NADH was prevented by a protein kinase (PK)A inhibitor, PKAI(6-22). The effects of NADH and NAD+ were mimicked by a phorbol ester and forskolin, respectively. Increasing intracellular NADH was associated with an increased risk of ventricular tachycardia in wild-type mouse hearts. Extracellular application of NAD+ to SCN5A(+/-) mouse hearts ameliorated the risk of ventricular tachycardia.

CONCLUSIONS

Our results show that Na(v)1.5 is regulated by pyridine nucleotides, suggesting a link between metabolism and I(Na). This effect required protein kinase C activation and was mediated by oxidative stress. NAD+ could prevent this effect by activating PKA. Mutations of GPD1-L may downregulate Na(v)1.5 by altering the oxidized to reduced NAD(H) balance.

The hSK4 (KCNN4) isoform is the Ca2+-activated K+ channel (Gardos channel) in human red blood cells

The question is, does the isoform hSK4, also designated KCNN4, represent the small conductance, Ca2+-activated K+ channel (Gardos channel) in human red blood cells? We have analyzed human reticulocyte RNA by RT-PCR, and, of the four isoforms of SK channels known, only SK4 was found. Northern blot analysis of purified and synchronously growing human erythroid progenitor cells, differentiating from erythroblasts to reticulocytes, again showed only the presence of SK4. Western blot analysis, with an anti-SK4 antibody, showed that human erythroid progenitor cells and, importantly, mature human red blood cell ghost membranes, both expressed the SK4 protein. The Gardos channel is known to turn on, given inside Ca2+, in the presence but not the absence of external Ko+ and remains refractory to Ko+ added after exposure to inside Ca2+. Heterologously expressed SK4, but not SK3, also shows this behavior. In inside-out patches of red cell membranes, the open probability (Po) of the Gardos channel is markedly reduced when the temperature is raised from 27 to 37 degrees C. Net K+ efflux of intact red cells is also reduced by increasing temperature, as are the Po values of inside-out patches of Chinese hamster ovary cells expressing SK4 (but not SK3). Thus the envelope of evidence indicates that SK4 is the gene that codes for the Gardos channel in human red blood cells. This channel is important pathophysiologically, because it represents the major pathway for cell shrinkage via KCl and water loss that occurs in sickle cell disease.

Erythrocytes reduce extracellular ascorbate free radicals using intracellular ascorbate as an electron donor

Ascorbate is readily oxidized in aqueous solution by ascorbate oxidase. Ascorbate radicals are formed, which disproportionate to ascorbate and dehydroascorbic acid. Addition of erythrocytes with increasing intracellular ascorbate concentrations decreased the oxidation of ascorbate in a concentration-dependent manner. Concurrently, it was found, utilizing electron spin resonance spectroscopy, that extracellular ascorbate radical levels were decreased. Control experiments showed that these results could not be explained by leakage of ascorbate from the cells, inactivation of ascorbate oxidase, or oxygen depletion. Thus, this means that intracellular ascorbate is directly responsible for the decreased oxidation of extracellular ascorbate. Exposure of ascorbate-loaded erythrocytes to higher levels of extracellular ascorbate radicals resulted in the detection of intracellular ascorbate radicals. Moreover, efflux of dehydroascorbic acid was observed under these conditions. These data confirm the view that intracellular ascorbate donates electrons to extracellular ascorbate free radical via a plasma membrane redox system. Such a redox system enables the cells to effectively counteract oxidative processes and thereby prevent depletion of extracellular ascorbate.

Activation of red cell Ca2(+)-activated K+ channel by Ca2+ involves a temperature-dependent step

We found that vanadate-induced 45Ca2+ uptake by red cells is maximal at 25 degrees C. At this temperature, the Cai-induced increase of the K+ permeability (the Gárdos effect) shows a lag (up to 8 min) which is not observed at 37 degrees C. This cannot be explained by the lack of availability of Ca2+ for the Ca2(+)-activated K+ channel, and suggests that its activation by Ca2+ is mediated by a temperature-dependent mechanism which remains unknown so far. The lag is not observed when the Gárdos effect was initiated by propranolol. This shows that the putative temperature-dependent step is different from chloride transport.

Metabolic control of the K+ channel of human red cells

The effects of cAMP, ATP and GTP on the Ca2(+)-dependent K+ channel of fresh (1-2 days) or cold-stored (28-36 days) human red cells were studied using atomic absorption flame photometry of Ca2(+)-EGTA loaded ghosts which had been resealed to monovalent cations in dextran solution. When high-K+ ghosts were incubated in an isotonic Na+ medium, the rate constant of Ca2(+)-dependent K+ efflux was reduced by a half on increasing the theophylline concentration to 40 mM. This effect was observed in ghosts from both fresh and stored cells, but only if they were previously loaded with ATP. The inhibition was more marked when Mg2+ was added together with ATP, and it was abolished by raising free Ca2+ to the micromolar level. Like theophylline, isobutyl methylxanthine (10 mM) also affected K+ efflux. cAMP (0.2-0.5 mM), added both internally and externally (as free salt, dibutyryl or bromide derivatives), had no significant effect on K+ loss when the ghost free-Ca2+ level was below 1 microM, but it was slightly inhibitory at higher concentrations. The combined presence of cAMP (0.2 mM) plus either theophylline (10 mM), or isobutyl methylxanthine (0.5 mM), was more effective than cAMP alone. This inhibition showed a strict requirement for ATP plus Mg2+ and it was not overcome by raising internal Ca2+. Ghosts from stored cells seemed more sensitive than those from fresh cells, to the combined action of cAMP and methylxanthines. Loading ATP into ghosts from fresh or stored cells markedly decreased K+ loss. Although this effect was observed in the absence of added Mg2+ (0.5 mM EDTA present), it was potentiated upon adding 2 mM Mg2+. The K+ efflux from ATP-loaded ghosts was not altered by dithio-bis-nitrobenzoic acid (10 mM) or acridine orange (100 microM), while it was increased two- to fourfold by incubating with MgF2 (10 mM), or MgF2 (10 mM) + theophylline (40 mM), respectively. By contrast, a marked efflux reduction was obtained by incorporating 0.5 mM GTP into ATP-containing ghosts. The degree of phosphorylation obtained by incubating membranes with (gamma-32P)ATP under various conditions affecting K+ channel activity, was in direct correspondence to their effect on K+ efflux. The results suggest that the K+ channel of red cells is under complex metabolic control, via cAMP-mediated and nonmediated mechanisms, some which require ATP and presumably, involve phosphorylation of the channel proteins.

An estimate of the number of Ca2+-dependent K+ channels in the human red cell

An original approach has been designed to count Ca2+-dependent K+ channels in the human red cell using a preparation of inside-out vesicles. The relative frequency of vesicles having no K+ channels is estimated from the fraction of 42K+ (or 86Rb+) which is not released from loaded vesicles on maximal stimulation with Ca2+. The mean number of channels per vesicle is then calculated from this figure assuming a Poisson distribution for the K+ channels. From this value and the mean vesicular radius, computed from the volume/surface ratio, the mean number of channels per cell can be estimated. A value of 142 +/- 27 (mean +/- S.E.) was obtained, which is well above that estimated by comparison of unitary conductance and tracer equilibration rate measurements (about 10 channels/cell, Grygorczyk, R. Schwarz, W. and Passow, H. (1984) Biophys. J. 45, 693-698), but compares favourably with the channel density inferred from comparison with the number of Na+ pumps in a similar preparation of inside-out vesicles (100-200/cell, Lew, V.L., Muallem, S. and Seymour, C.A. (1982) Nature 296, 742-744). The procedure described here can be considered for general application as an alternative to other known procedures.

Delayed activation of calcium pump during transient increases in cellular Ca2+ concentration and K+ conductance in hyperpolarizing human red cells

The net Ca2+ influx was increased in human red cells in suspension by adding moderate concentrations of the Ca2+ ionophore A23187, and due to the increased cellular Ca2+ concentration [( Ca]i) the K+ channels opened (the 'Gardos effect'). At low K+ concentration and with the protonophore CCCP in the buffer-free medium the cells hyperpolarized and the extracellular pH (pH0) increased, enhancing the A23187-mediated net Ca2+ influx. This elicited a prolonged response, viz. a primary transient increase of pH0 and [Ca]i followed by one or more spontaneous pH0 and [Ca]i transients. We explored the pump-mediated Ca2+ efflux by blocking the A23187-mediated Ca2+ flux with CoCl2 at appropriate times during the prolonged response. The Ca2+ pumping was higher during the descendent than during the ascendent phase of the primary transient at equal values of [Ca]i. The data were analyzed using a mathematical model that accounts for the prolonged oscillatory response, including pH0 and [Ca]i. In conclusion, the activation of the Ca2+ pump is delayed due to slow binding of cellular calmodulin, which is a hysteretic response to a rapid increase of the cellular Ca2+ concentration. This mechanism may be important for generation and execution of transient signals in other types of cell.