Teapot myositis

Barium chloride injures myofibers through calcium-induced proteolysis with fragmentation of motor nerves and microvessels

Background

Local injection of BaCl₂ is an established model of acute injury to study the regeneration of skeletal muscle. However, the mechanism by which BaCl₂ causes muscle injury is unresolved. Because Ba²⁺ inhibits K⁺ channels, we hypothesized that BaCl₂ induces myofiber depolarization leading to Ca²⁺ overload, proteolysis, and membrane disruption. While BaCl₂ spares resident satellite cells, its effect on other tissue components integral to contractile function has not been defined. We therefore asked whether motor nerves and microvessels, which control and supply myofibers, are injured by BaCl₂ treatment.

Methods

The intact extensor digitorum longus (EDL) muscle was isolated from male mice (aged 3–4 months) and irrigated with physiological salt solution (PSS) at 37 °C. Myofiber membrane potential (V_m) was recorded using sharp microelectrodes while intracellular calcium concentration ([Ca²⁺]_i) was evaluated with Fura 2 dye. Isometric force production of EDL was measured in situ, proteolytic activity was quantified by calpain degradation of αII-spectrin, and membrane disruption was marked by nuclear staining with propidium iodide (PI). To test for effects on motor nerves and microvessels, tibialis anterior or gluteus maximus muscles were injected with 1.2% BaCl₂ (50–75 μL) in vivo followed by immunostaining to evaluate the integrity of respective tissue elements post injury. Data were analyzed using Students t test and analysis of variance with P ≤ 0.05 considered statistically significant.

Results

Addition of 1.2% BaCl₂ to PSS depolarized myofibers from − 79 ± 3 mV to − 17 ± 7 mV with a corresponding rise in [Ca²⁺]_i; isometric force transiently increased from 7.4 ± 0.1 g to 11.1 ± 0.4 g. Following 1 h of BaCl₂ exposure, 92 ± 3% of myonuclei stained with PI (vs. 8 ± 3% in controls) with enhanced cleavage of αII-spectrin. Eliminating Ca²⁺ from PSS prevented the rise in [Ca²⁺]_i and ameliorated myonuclear staining with PI during BaCl₂ exposure. Motor axons and capillary networks appeared fragmented within 24 h following injection of 1.2% BaCl₂ and morphological integrity deteriorated through 72 h.

Conclusions

BaCl₂ injures myofibers through depolarization of the sarcolemma, causing Ca²⁺ overload with transient contraction, leading to proteolysis and membrane rupture. Motor innervation and capillarity appear disrupted concomitant with myofiber damage, further compromising muscle integrity.

[A case of hypokalemic myopathy induced by excessive drinking of a beverage containing green tea extract]

A 49-year-old man subacutely developed muscle weakness in four extremities over a few days. He had no past or family history of muscle weakness. His blood tests showed significant hypokalemia without endocrinological abnormalities. With the diagnosis of hypokalemic myopathy, potassium was administered orally, and his symptoms improved. The patient had been drinking a beverage containing green tea extract too much two weeks before the symptoms developed, in addition to taking a cold remedy for ten years. Thus, hypokalemia is considered to be induced by the excessive intake of caffeine that accompanies the excessive consumption of the beverage and cold remedy.

Coffee-induced Hypokalaemia

Taking an excess amount of caffeine (e.g. overdrinking caffeinated beverages) sometimes causes hypokalaemia. Although the detailed mechanism has not been clarified yet, an increased loss of potassium via the urine stream caused by the diuretic action of caffeine is proposed as one of the possibilities. We report the case of a 50-year-old female outpatient who rapidly developed severe generalized muscle weakness and fatigue. Her symptoms were considered to be principally due to hypokalaemia. Since her blood urea nitrogen concentration decreased greatly, it was suggested that she had massive polyuria due to overhydration (i.e. dilution of her body fluids). Initially, we considered that a urinary tract infection might have caused her illness. However, we found that she was a heavy coffee drinker and had constantly experienced massive diuresis. After a course of oral antibiotics, potassium replacement and stopping coffee (caffeine) ingestion, her symptoms resolved quickly. In conclusion, it was considered that overdrinking coffee (caffeine) induced her hypokalaemia. Probably, loss of potassium via the urine stream with secondary aldosteronism was the main cause of the hypokalaemia.

A thought on the biological activities of black tea

Tea is the most widely used ancient beverage in the world and black tea possesses many biological effects on the organisms. It acts as an effective antioxidant because of its free radical-scavenging and metal-chelating ability. Due to this, it is active against inflammation, clastogenesis, and several types of cancer. Tea reduces DNA damage and mutagenesis due to oxidative stress or the presence of pro-mutagens through antioxidant function, blocking activation pathways of mutagens, suppressing transcription of enzymes involved etc. Inhibition of low-density lipoprotein (LDL) peroxidation, suppression of fatty acid synthase etc., suggest that tea may have a role in preventing cardiovascular diseases. Some epidemiological studies support the protective role of black tea against cardiovascular diseases but some do not. Besides, black tea has beneficial effects on the gastrointestinal tract; it affects motility, absorption, microflora etc., by influencing the hormonal balance and antioxidant function black tea improves bone mineral density. It is also antiviral due to its enzyme-inhibiting and receptor-blocking properties. Although its role in cancers of the gastrointestinal tract, liver, and prostate is confirmed, its effect against urinary tract cancer is uncertain and further studies are required. Apart from these, excess consumption may lead to the formation of a stained pellicle layer on teeth, which is difficult to eliminate, inhibits trypsin, influences mineral absorption, causes convulsions etc. Excess caffeine intake may have adverse effects on selected organs as reported in studies on some organisms. These reports indicate that there is a wide scope of further research for the efficient use of black tea active conserves/isolates to reap health benefits.

Rhabdomyolysis: a review

Rhabdomyolysis, a syndrome of skeletal muscle breakdown with leakage of muscle contents, is frequently accompanied by myoglobinuria, and if sufficiently severe, acute renal failure with potentially life-threatening metabolic derangements may ensue. A diverse spectrum of inherited and acquired disorders affecting muscle membranes, membrane ion channels, and muscle energy supply causes rhabdomyolysis. Common final pathophysiological mechanisms among these causes of rhabdomyolysis include an uncontrolled rise in free intracellular calcium and activation of calcium-dependent proteases, which lead to destruction of myofibrils and lysosomal digestion of muscle fiber contents. Recent advances in molecular genetics and muscle enzyme histochemistry may enable a specific metabolic diagnosis in many patients with idiopathic recurrent rhabdomyolysis.