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Gable M, Ellis L, Fedorova OV, Bagrov AY, Askari A. Comparison of Digitalis Sensitivities of Na +/K +-ATPases from Human and Pig Kidneys. ACS OMEGA 2017; 2:3610-3615. [PMID: 28782051 PMCID: PMC5537699 DOI: 10.1021/acsomega.7b00591] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 07/06/2017] [Indexed: 05/16/2023]
Abstract
Digitalis drugs are selective inhibitors of the plasma membrane Na+/K+-ATPase. There are many studies on molecular mechanisms of digitalis interaction with purified pig kidney enzyme, with the tacit assumption that it is a good model of human kidney enzyme. However, previous studies on crude or recombinant human kidney enzymes are limited, and have not resulted in consistent findings on their digitalis sensitivities. Hence, we prepared comparably purified enzymes from human and pig kidneys and determined inhibitory constants of digoxin, ouabain, ouabagenin, bufalin, and marinobufagenin (MBG) on enzyme activity under optimal turnover conditions. We found that each compound had the same potency against the two enzymes, indicating that (i) the pig enzyme is an appropriate model of the human enzyme, and (ii) prior discrepant findings on human kidney enzymes were either due to structural differences between the natural and recombinant enzymes or because potencies were determined using binding constants of digitalis for enzymes under nonphysiological conditions. In conjunction with previous findings, our newly determined inhibitory constants of digitalis compounds for human kidney enzymes indicate that (i) of the compounds that have long been advocated to be endogenous hormones, only bufalin and MBG may act as such at kidney tubules, and (ii) beneficial effects of digoxin, the only digitalis with extensive clinical use, does not involve its inhibitory effect on renal tubular Na+/K+-ATPase.
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Affiliation(s)
- Marjorie
E. Gable
- Department
Biochemistry & Cancer Biology, College of Medicine & Life
Sciences, University of Toledo, 3000 Arlington Avenue, MS 1010, Toledo, Ohio 43614, United States
| | - Linda Ellis
- Department
Biochemistry & Cancer Biology, College of Medicine & Life
Sciences, University of Toledo, 3000 Arlington Avenue, MS 1010, Toledo, Ohio 43614, United States
| | - Olga V. Fedorova
- Laboratory
of Cardiovascular Science, National Institute of Aging, National Institutes of Health, Baltimore, Maryland 21224, United States
| | - Alexei Y. Bagrov
- Laboratory
of Cardiovascular Science, National Institute of Aging, National Institutes of Health, Baltimore, Maryland 21224, United States
- Sechenov
Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg 194223, Russia
| | - Amir Askari
- Department
Biochemistry & Cancer Biology, College of Medicine & Life
Sciences, University of Toledo, 3000 Arlington Avenue, MS 1010, Toledo, Ohio 43614, United States
- E-mail: . Phone: 419-383-3982
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Ochiai H, Takeda K, Soeda S, Tahara Y, Takenaka H, Abe K, Hayashi Y, Noguchi S, Inoue M, Schwarz S, Schwarz W, Kawamura M. Epigallocatechin-3-gallate is an inhibitor of Na+,K+-ATPase by favoring the E1 conformation. Biochem Pharmacol 2009; 78:1069-74. [DOI: 10.1016/j.bcp.2009.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Revised: 06/04/2009] [Accepted: 06/08/2009] [Indexed: 11/25/2022]
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Abstract
The Na-K-ATPase is an energy-transducing ion pump that converts the free energy of ATP into transmembrane ion gradients. It also serves as a functional receptor for cardiotonic steroids such as ouabain and digoxin. Binding of ouabain to the Na-K-ATPase can activate calcium signaling in a cell-specific manner. The exquisite calcium modulation via the Na-K-ATPase is achieved by the ability of the pump to integrate signals from numerous protein and non-protein molecules, including ion transporters, channels, protein kinases/phosphatases, as well as cellular Na+. This review focuses on the unique properties of the Na-K-ATPase and its role in the formation of different calcium-signaling microdomains.
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Affiliation(s)
- Jiang Tian
- Department of Physiology and Pharmacology, University of Toledo Health Science Campus, Toledo, Ohio, USA
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Mimura K, Matsui H, Takagi T, Hayashi Y. Change in oligomeric structure of solubilized Na+/K(+)-ATPase induced by octaethylene glycol dodecyl ether, phosphatidylserine and ATP. BIOCHIMICA ET BIOPHYSICA ACTA 1993; 1145:63-74. [PMID: 8380718 DOI: 10.1016/0005-2736(93)90382-a] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Membrane-bound Na+/K(+)-ATPase purified from dog kidney was solubilized with octaethylene glycol dodecyl ether (C12E8), and the resultant solubilized enzyme was chromatographed on a TSKgel G4000SWXL or G3000SWXL column equilibrated with elution buffers containing various ligands affecting oligomerization of the enzyme. Weight-averaged molecular weight (Mw) values for the main protein components eluted were estimated by low-angle laser light-scattering photometry. With increasing concentration of C12E8 included in the elution buffer from 0.1 to 5 mg/ml, the Mw decreased from 230,000 to 153,000, indicating that C12E8 induced dissociation of the enzyme. In contrast, the Mw of the protein component increased up to 1.44.10(6) as the concentration of phosphatidylserine (PS) added to the elution buffer containing a fixed concentration of 0.3 mg/ml C12E8 was increased to 120 micrograms/ml. The association and/or aggregation were reversible by removal of the PS by rechromatography. Addition of PS to the elution buffer also allowed the solubilized enzyme to exhibit ATPase activity comparable to that of the membrane-bound enzyme during passage through the column. This was also the case with phosphatidylglycerol (PG) and phosphatidylinositol, but not with phosphatidylcholine or phosphatidylethanolamine. The specific refractive index increment (dn/dcp) of the solubilized enzyme was increased by addition of exogenous PG or PS, strongly suggesting that the phospholipid became bound to the enzyme, and that it induced association of the enzyme. The association induced by PS was inhibited by ATP and ADP, but not AMP. The concentrations for half-maximal inhibition were 0.44 mM for ATP and 0.88 mM for ADP. The PS-induced associated enzyme isolated by chromatography in the presence of 120 micrograms/ml PS was dissociated by ATP with K0.5 of 0.16 mM. The dissociating effect of C12E8, ATP and ADP and the associating effect of PS on the solubilized enzyme are consistent with the reports that C12E8 mimics the effect of regulatory ATP at the low-affinity site on the conformational transition from E2 to E1, and that phospholipids are essential for the reverse transition from E1 to E2. The results can be explained by assuming that the enzyme takes the form of a loosely associated diprotomer in the E1 state and a tightly associated one in the E2 state.
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Affiliation(s)
- K Mimura
- 1st Department of Biochemistry, Kyorin University School of Medicine, Tokyo, Japan
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Grimaldi S, Pascale E, Pozzi D, D'Onofrio M, Giganti MG, Verna R. Effect of ouabain binding on the fluorescent properties of the Na+/K+-ATPase. BIOCHIMICA ET BIOPHYSICA ACTA 1988; 944:13-8. [PMID: 2843233 DOI: 10.1016/0005-2736(88)90311-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The influence of occupancy by ouabain of its specific binding site on the stability and conformation of the Na+/K+-ATPase has been investigated. When native Na+/K+-ATPase is exposed to guanidinium chloride or diluted acid, tryptophanyl fluorescence falls to 50% of the initial value. If ouabain is bound, higher concentrations of GdmCl or acidity are needed to reach the same decrease in fluorescence. The rotational diffusion coefficient (relaxation time), shows higher values for the Na+/K+-ATPase (ouabain) complex compared to the enzyme alone, suggesting an increase in molecular asymmetry. This observation is confirmed by the Stern-Volmer analysis that shows an increase in the accessibility of the fluorophores in the Na+/K+-ATPase (ouabain) (KSV = 15.6 M-1) with respect to the native enzyme (KSV = 12.5 M-1). Iodine perturbation of the enzyme labelled with FITC, demonstrates a decrease in the accessibility of the fluorescein probe in the Na+/K+-ATPase(ouabain) (KSV = 4 M-1) compared to the Na+/K+-ATPase (KSV = 7 M-1) indicating that after ouabain binding this site of the enzyme is less exposed to the solvent. These data, in agreement with other reports, suggest an allosteric effect of ouabain binding on the Na+/K+-ATPase conformation.
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Affiliation(s)
- S Grimaldi
- Istituto di Medicina Sperimentale C.N.R., Roma, Italy
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6
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Kutryk MJ, Pierce GN. Stimulation of sodium-calcium exchange by cholesterol incorporation into isolated cardiac sarcolemmal vesicles. J Biol Chem 1988. [DOI: 10.1016/s0021-9258(18)37686-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Matsuda T, Iwata H. Difference between neuronal and nonneuronal (Na+ + K+)-ATPases in their conformational equilibrium. Arch Biochem Biophys 1988; 263:323-33. [PMID: 2837150 DOI: 10.1016/0003-9861(88)90643-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Several experiments were carried out to study the difference between two isozymes (alpha(+) and alpha) of (Na+ + K+)-ATPase in the conformational equilibrium. Rat brain (Na+ + K+)-ATPase was much more thermolabile than the kidney enzyme. Both enzymes were protected from heat inactivation not only by Na+ and K+, but also by choline in varying degrees, though there was a difference between the two enzymes in the protection by the ligands. The brain enzyme was partially protected from N-ethylmaleimide (NEM) inactivation by both Na+ and K+, but the effects of the ligands on NEM inactivation of the kidney enzyme were more complex. Though ligands differentially affected the thermostability and NEM sensitivity of the two enzymes, the effects were not simply related to the conformational states. The sensitivity of phosphoenzyme (EP) formed in the presence of ATP, Na+, and Mg2+ to ADP or K+ and K+-p-nitrophenyl phosphatase (pNPPase) was then studied as a probe of the differences in the conformational equilibrium between the two isozymes. The EP of the brain enzyme was partially sensitive to ADP, while those of the heart and kidney enzymes were not. At physiological Na+ concentrations the percentages of E1P formed by the brain and kidney enzymes were determined to be about 40-50 and 10-20% of the total EP, respectively. The hydrolytic activity of pNPP in the presence of Li+, a selective activator at catalytic sites of the reaction, was much higher in the kidney enzyme than in the brain enzyme. The inhibition of K+-stimulated pNPPase by ATP and Na+ was greater in the latter enzyme than in the former. These results suggest that neuronal and nonneuronal (Na+ + K+)-ATPases differ in their conformational equilibrium: the E1 or E1P may be more stable in the alpha(+) than in the alpha during the turnover, and conversely the E2 or E2P may be more stable in the latter than in the former.
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Affiliation(s)
- T Matsuda
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, Osaka University, Japan
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8
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Matsuda T, Iwata H. Difference in phospholipid dependence between two isozymes of brain (Na+ + K+)-ATPase. BIOCHIMICA ET BIOPHYSICA ACTA 1986; 860:620-5. [PMID: 3017425 DOI: 10.1016/0005-2736(86)90561-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The effect of phospholipase C on two isozymes (alpha (+) and alpha forms) of rat brain (Na+ + K+)-ATPase and the temperature-dependence of their activities were investigated. Phospholipase C from Clostridium welchii inhibited the activities of the enzymes treated with and without pyrithiamin or N-ethylmaleimide, a preferential inhibitor of the alpha (+) form, but the extent of the inhibition was higher in the control enzyme than in the treated enzymes. The treatment of the (Na+ + K+)-ATPase with phospholipase C altered a ratio between high- and low-affinity components for ouabain inhibition. It also caused the similar change in a ratio between the alpha (+) and alpha forms of Na+-stimulated phosphorylation from [gamma-32P]ATP. These findings indicate that the alpha (+) form of rat brain (Na+ + K+)-ATPase is more sensitive to phospholipase C than the alpha form. Analysis of Arrhenius plots of the activities of the control and pyrithiamin-treated enzymes showed that there was a difference between the two enzymes in a break point. We suggest that two isozymes of rat brain (Na+ + K+)-ATPase differ in the interaction with phospholipids or in the lipid-environment.
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Anner BM. Interaction of (Na+ + K+)-ATPase with artificial membranes. I. Formation and structure of (Na+ + K+)-ATPase-liposomes. BIOCHIMICA ET BIOPHYSICA ACTA 1985; 822:319-34. [PMID: 2998473 DOI: 10.1016/0304-4157(85)90013-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Chatelain P, Laruel R, Gillard M. Effect of amiodarone on membrane fluidity and Na+/K+ ATPase activity in rat-brain synaptic membranes. Biochem Biophys Res Commun 1985; 129:148-54. [PMID: 2988546 DOI: 10.1016/0006-291x(85)91415-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In rat-brain synaptic membranes at a fixed temperature (37 degrees C), amiodarone dose-dependently inhibits the Na+/K+ ATPase activity (IC50 approximately equal to 2.10(-5)M) and produces a linear increase in the degree of fluorescence depolarization (P) of 1,6-diphenylhexatriene embedded in the lipid matrix. Amiodarone has no effect on Mg++ ATPase and K+PNPase activity up to 3.10(-4)M. Studies carried out at different temperatures indicate that 10(-5)M amiodarone inhibits the Na+/K+ ATPase and decreases the lipid fluidity at all the temperatures studied (9 - 40 degrees C). The compound significantly displaces the temperature of transition observed around 20 degrees C in both Na+/K+ ATPase activity and lipid fluidity to 24 degrees C with no changes in slopes. The results suggest that part of the selective inhibition of Na+/K+ ATPase activity by amiodarone could be due to the effects of the drug on lipid dynamics.
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Jedlicki A, Zambrano F. Role of sulfatide on phosphoenzyme formation and ouabain binding of the (Na+ + K+)ATPase. Arch Biochem Biophys 1985; 238:558-64. [PMID: 2986554 DOI: 10.1016/0003-9861(85)90200-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A microsomal fraction rich in (Na+ + K+)ATPase activity has been isolated from the outer medulla of pig kidney. The ability of this preparation to form phosphoenzyme on incubation with [gamma-32P]ATP and to bind [3H]ouabain was studied when its sulfatide was hydrolyzed by arylsulfatase treatment. The K+-dependent hydrolysis of the Na+-dependent phosphorylated intermediate as well as the ouabain binding were inactivated in direct relation to the breakdown of sulfatide. Both characteristics of the (Na+ + K+)ATPase preparation, lost by arylsulfatase treatment, were partially restored by the sole addition of sulfatide. These experiments indicate that sulfatide may play a role in sodium ion transport either in the conformational transition of the K+-insensitive phosphointermediate, E1P, to the K+-sensitive intermediate, E2P, or in the configuration of the high-affinity binding site for K+ of the E2P form. In addition, this glycolipid may have a specific role in the proteolipidic subunit that binds ouabain.
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Schuurmans Stekhoven FM, Swarts HG, Fu YF, Kuijpers GA, De Pont JJ, Bonting SL. Thiophosphorylation of (Na + K+)-ATPase yields an ADP-sensitive phosphointermediate. BIOCHIMICA ET BIOPHYSICA ACTA 1984; 774:277-87. [PMID: 6331507 DOI: 10.1016/0005-2736(84)90302-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
1) Treatment of (Na+ + K+)-ATPase from rabbit kidney outer medulla with the gamma-35S labeled thio-analogue of ATP in the presence of Na+ + Mg2+ and the absence of K+ leads to thiophosphorylation of the enzyme. The Km value for [gamma-S]ATP is 2.2 microM and for Na+ 4.2 mM at 22 degrees C. Thiophosphorylation is a sigmoidal function of the Na+ concentration, yielding a Hill coefficient nH = 2.6. (2) The thio-analogue (Km = 35 microM) can also support overall (Na+ + K+)-ATPase activity, but Vmax at 37 degrees C is only 1.13 mumol X (mg protein)-1 X h-1 or 0.09% of the specific activity for ATP (Km = 0.43 mM). (3) The thiophosphoenzyme intermediate, like the natural phosphoenzyme, is sensitive to hydroxylamine, indicating that it also is an acylphosphate. However, the thiophosphoenzyme, unlike the phosphoenzyme, is acid labile at temperatures as low as 0 degree C. The acid-denatured thiophosphoenzyme has optimal stability at pH 5-6. (4) The thiophosphorylation capacity of the enzyme is equal to its phosphorylation capacity, indicating the same number of sites. Phosphorylation by ATP excludes thiophosphorylation, suggesting that the two substrates compete for the same phosphorylation site. (5) The (apparent) rate constants of thiophosphorylation (0.4 s-1 vs. 180 s-1), spontaneous dethiophosphorylation (0.04 s-1 vs. 0.5 s-1) and K+-stimulated dethiophosphorylation (0.54 s-1 vs. 230 s-1) are much lower than those for the corresponding reactions based on ATP. (6) In contrast to the phosphoenzyme, the thiophosphoenzyme is ADP-sensitive (with an apparent rate constant in ADP-induced dethiophosphorylation of 0.35 s-1, Km ADP = 48 microM at 0.1 mM ATP) and is relatively K+-insensitive. The Km for K+ in dethiophosphorylation is 0.9 mM and in dephosphorylation 0.09 mM. The thiophosphoenzyme appears to be for 75-90% in the ADP-sensitive E1-conformation.
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Hayashi Y, Takagi T, Maezawa S, Matsui H. Molecular weights of alpha beta-protomeric and oligomeric units of soluble (Na+, K+)-ATPase determined by low-angle laser light scattering after high-performance gel chromatography. BIOCHIMICA ET BIOPHYSICA ACTA 1983; 748:153-67. [PMID: 6313058 DOI: 10.1016/0167-4838(83)90291-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The (Na+, K+)-ATPase of canine renal outer medulla was solubilized with a nonionic surfactant, octaethylene glycol n-dodecyl ether (C12E8), in the presence of 0.2 M sodium ion. The solubilized ATPase retained 74% of the enzymatic activity expressed before solubilization. Molecular species of the solubilized ATPase were analyzed by high-performance chromatography through a TSK-GEL G3000SW column in the presence of 1 mg/ml C12E8 at 23 degrees C. The eluate was monitored by one or two monitors chosen from the following: an ultraviolet absorption monitor, a precision differential refractometer and a low-angle laser light scattering photometer. The three kinds of elution pattern thus obtained can best be interpreted by assuming the presence of at least four kinds of protein component with molecular weights 1 740 000 +/- 230 000, 836 000 +/- 82 000, 286 000 +/- 30 000 and 123 000 +/- 8 000, respectively. Among them, those with the last two molecular weight were the major components. The amounts of the first three components were found to increase with time during the incubation before application to the column at the expense of that of the last one. The amounts of the last two were 18 and 73%, respectively, when measured immediately after the solubilization. A stoichiometric composition of 1:1 molar ratio for the alpha and beta polypeptide chains was obtained for the two major components as well as for the intact ATPase by high-performance gel chromatography in the presence of sodium dodecyl sulfate using the same column as above. The (Na+, K+)-ATPase was, thus, indicated to be solubilized with C12E8 to give the alpha beta-protomer and its dimer as the main components.
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14
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White B, Blostein R. Comparison of red cell and kidney (Na+ +K+)-ATPase at 0 degrees C. BIOCHIMICA ET BIOPHYSICA ACTA 1982; 688:685-90. [PMID: 6288089 DOI: 10.1016/0005-2736(82)90280-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Human red cell and guinea pig kidney (Na+ +K+)-ATPase were phosphorylated at 0 degrees C. Using concentrations of ATP ranging from 10(-6) to 10(-8) M, ATP-dependent regulation of reactivity is observed with red cell but not kidney (Na+ +K+)-ATPase at 0 degrees C. In particular, with the red cell enzyme only, the following are observed: (i) the ratio of enzyme-bound ATP (E.ATP, measured by the pulse-chase method of Post, R.L., Kume, S., Tobin, T., Orcutt, B. and Sen, A.K. (1969) J. Gen. Physiol. 54, 306s-326s) to steady-state level of total phosphoenzyme (EP) decreases with decrease in ATP concentration and (ii) the apparent turnover of phosphoenzyme (ratio of Na+-stimulated ATP hydrolysis to level of total EP at steady state) also varies as a function of ATP concentration. In addition, when EP is formed at very low ATP (0.02 microM), and then EDTA is added, rapid disappearance of a fraction of EP occurs, presumably due to ATP resynthesis, only with the red cell enzyme. These differences in behaviour of the red cell and kidney enzymes are explained on the basis of the observed predominance of K+-insensitive EP in red cell, but K+-sensitive EP in kidney (Na+ +K+)-ATPase at 0 degrees C.
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Roelofsen B. The (non)specificity in the lipid-requirement of calcium- and (sodium plus potassium)-transporting adenosine triphosphatases. Life Sci 1981; 29:2235-47. [PMID: 6275223 DOI: 10.1016/0024-3205(81)90556-7] [Citation(s) in RCA: 74] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Hegyvary C, Jorgensen P. Conformational changes of renal sodium plus potassium ion-transport adenosine triphosphatase labeled with fluorescein. J Biol Chem 1981. [DOI: 10.1016/s0021-9258(19)69162-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Trachtenberg MC, Packey DJ, Sweeney T. In vivo functioning of the Na+, K+-activated ATPase. CURRENT TOPICS IN CELLULAR REGULATION 1981; 19:159-217. [PMID: 6277572 DOI: 10.1016/b978-0-12-152819-5.50022-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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