A new in vitro blood load test using a magnesium stable isotope for assessment of magnesium status

Prevention of hypomagnesemia in critically ill patients with acute kidney injury on continuous kidney replacement therapy: the role of early supplementation and close monitoring

Hypomagnesemia is a common electrolyte disorder in critically ill patients and is associated with increased morbidity and mortality risk. Many clinical conditions may contribute to hypomagnesemia through different pathogenetic mechanisms. In patients with acute kidney injury (AKI) the need for continuous or prolonged intermittent kidney replacement therapy (CKRT and PIKRT, respectively) may further add to other causes of hypomagnesemia, especially when regional citrate anticoagulation (RCA) is used. The basic principle of RCA is chelation of ionized calcium by citrate within the extracorporeal circuit, thus blocking the coagulation cascade. Magnesium, a divalent cation, follows the same fate as calcium; the amount lost in the effluent includes both magnesium-citrate complexes and the free fraction directly diffusing through the hemofilter. While increasing the magnesium content of dialysis/replacement solutions may decrease the risk of hypomagnesemia, the optimal concentration for the variable combination of solutions adopted in different KRT protocols has not yet been identified. An alternative and effective approach is based on including early intravenous magnesium supplementation in the KRT protocol, and close monitoring of serum magnesium levels, especially in the setting of RCA. Thus, strategies aimed at precisely tailoring both dialysis prescriptions and the composition of KRT fluids, as well as early magnesium supplementation and close monitoring, could represent a cornerstone in reducing KRT-related hypomagnesemia.

Using green emitting pH-responsive nanogels to report environmental changes within hydrogels: a nanoprobe for versatile sensing

Remotely reporting the local environment within hydrogels using inexpensive laboratory techniques has excellent potential to improve our understanding of the nanometer-scale changes that cause macroscopic swelling or deswelling. Whilst photoluminescence (PL) spectroscopy is a popular method for such studies this approach commonly requires bespoke and time-consuming synthesis to attach fluorophores which may leave toxic residues. A promising and more versatile alternative is to use a pre-formed nanogel probe that contains a donor/acceptor pair and then "dope" that into the gel during gel assembly. Here, we introduce green-emitting methacrylic acid-based nanogel probe particles and use them to report the local environment within four different gels as well as stem cells. As the swelling of the nanogel probe changes within the gels the non-radiative energy transfer efficiency is strongly altered. This efficiency change is sensitively reported using the PL ratiometric intensity from the donor and acceptor. We demonstrate that our new nanoprobes can reversibly report gel swelling changes due to five different environmental stimuli. The latter are divalent cations, gel degradation, pH changes, temperature changes and tensile strain. In the latter case, the nanoprobe rendered a nanocomposite gel mechanochromic. The results not only provide new structural insights for hierarchical natural and synthetic gels, but also demonstrate that our new green-fluorescing nanoprobes provide a viable alternative to custom fluorophore labelling for reporting the internal gel environment and its changes.

Erythrocyte intracellular Mg(2+) concentration as an index of recognition and memory

Magnesium (Mg(2+)) plays an important role in the neural system, and yet scarcely any research has quantitatively analyzed the link between endogenous Mg(2+) level and memory. Using our original technique, we measured erythrocyte intracellular ionized Mg(2+) concentration (RBC [Mg(2+)]i), which linearly correlated to recognition and spatial memory in normal aging rats. In the brain, RBC [Mg(2+)]i significantly correlated to hippocampus extracellular fluid Mg(2+) concentration, and further correlated to hippocampal synapse density. Elevation of Mg(2+) intake in aged rats demonstrated an association between RBC [Mg(2+)]i increase and memory recovery. The therapeutic effect of Mg(2+) administration was inversely correlated to individual basal RBC [Mg(2+)]i. In summary, we provide a method to measure RBC [Mg(2+)]i, an ideal indicator of body Mg(2+) level. RBC [Mg(2+)]i represents rodent memory performance in our study, and might further serve as a potential biomarker for clinical differential diagnosis and precise treatment of Mg(2+)-deficiency-associated memory decline during aging.

Magnesium basics

As a cofactor in numerous enzymatic reactions, magnesium fulfils various intracellular physiological functions. Thus, imbalance in magnesium status-primarily hypomagnesaemia as it is seen more often than hypermagnesaemia-might result in unwanted neuromuscular, cardiac or nervous disorders. Measuring total serum magnesium is a feasible and affordable way to monitor changes in magnesium status, although it does not necessarily reflect total body magnesium content. The following review focuses on the natural occurrence of magnesium and its physiological function. The absorption and excretion of magnesium as well as hypo- and hypermagnesaemia will be addressed.

Update on the assessment of magnesium status

Magnesium (Mg) is the fourth most abundant mineral in the body and the most abundant intracellular divalent cation, with essential roles in many physiological functions. Consequently, the assessment of Mg status is important for the study of diseases associated with chronic deficiency. In spite of intense research activities there is still no simple, rapid, and accurate laboratory test to determine total body Mg status in humans. However, serum Mg < 0.75 mmol/l is a useful measurement for severe deficiency, and for values between 0.75 and 0.85 mmol/l a loading test can identify deficient subjects. The loading test seems to be the gold standard for Mg status, but is unsuitable in patients with disturbed kidney and intestinal functions when administered orally. There is also a need to reach a consensus on a standardized protocol in order to compare results obtained in different clinical units. Other cellular Mg measurements, such as total or ionized Mg, frequently disagree and more research and systematic evaluations are needed. Muscle Mg appears to be a good marker, but biopsies limit its usefulness, as is the case with bone Mg, the most important but heterogeneous Mg compartment. The development of new and non invasive techniques such as nuclear magnetic resonance (NMR) may provide valuable tools for routinely analysing ionized Mg in tissues. With the development of molecular genetics techniques, the recent discovery of Transient Receptor Potential Melastatin channels offers new possibilities for the sensitive and rapid evaluation of Mg status in humans.

Erythrocyte magnesium fluxes in mice with nutritionally and genetically low magnesium status

Low intracellular magnesium (Mg) contents may be observed in case of severe Mg insufficient intake or because of genetic regulation. This work was conducted to investigate the influence of intracellular Mg content on erythrocyte Mg(2+) influx and efflux in mice with low nutritionally and genetically (MGL and MGH mice) Mg status. C57BL6 mice were fed for 2 wks a diet containing 1000 mg Mg/kg diet Mg (control group), 100 mg Mg/kg diet (Mg-marginal group) or 30 mg Mg/kg diet (Mg deficient group), while mice with low (MGL) and high (MGH) Mg levels were fed a control diet for 2 wks. The quantification of erythrocyte Mg(2+) influx and efflux was performed using a stable isotope of Mg. Our results showed that erythrocyte Mg(2+) influx and efflux were respectively increased and decreased in nutritional Mg deficiency; while in genetically determined Mg status Mg(2+) fluxes were lower in MGL mice compared to MGH mice. Moreover Mg(2+) efflux was significantly correlated to Mg level in erythrocytes in all the mice studied (p < 0.001). In conclusion, erythrocyte Mg(2+) influx and efflux are modulated by low Mg status, namely decreased Mg(2+) efflux compensate for nutritional Mg deficiency, while the genetic regulation of erythrocyte Mg(2+) content depends on modification of Mg(2+) influx.

Stable isotopes in studies of intestinal absorption, exchangeable pools and mineral status: the example of magnesium

Magnesium (Mg) is a biologically essential mineral and Mg deficiency is known to lead to severe biochemical and symptomatic disorders. Radioactive isotopes and, more recently, stable isotopes have been used as research tools to determine intestinal Mg absorption in humans and animals under different nutritional and physiological conditions. Mg isotopes are given orally or orally plus intravenously and analysed in faeces and/or in plasma and urine in order to calculate intestinal Mg absorption and possibly endogenous Mg excretion. Mg isotopes have been used to assess exchangeable pools of Mg under nutritional and physiopathological conditions. Mg isotopes are given intravenously and are analysed in plasma and urine to calculate the size and half-life of the various Mg exchangeable pools. More recently, in vitro isotopic tests have been developed to study the need of cells for Mg in different nutritional and genetic conditions. Whole blood is incubated with Mg isotopes and isotopic blood cell enrichment is measured, which reflects the avidity of cells for Mg and thus its initial status. This paper is a report on the use of stable Mg isotopes and their advantages in these different fields of Mg absorption and metabolism. The studies available have clearly demonstrated that stable isotopes provide a useful research tool for determining intestinal Mg absorption, and represent a precious research tool for the study of Mg metabolism and the assessment of Mg status.

Magnesium metabolism in mice selected for high and low erythrocyte magnesium levels

A genetic control of blood magnesium (Mg) levels has been suggested. To investigate the mechanisms and the biologic significance of this genetic regulation, a mouse model, ie, mice selected for low magnesium level (MGL) and high magnesium level (MGH), was developed. The purpose of this study was to explore the Mg status and Mg metabolism in female MGL and MGH mice. We observed that MGL mice had reduced total and ionized plasma Mg, lower erythrocyte Mg, lower tibia, and kidney Mg levels. In contrast, total urinary Mg and (25)Mg levels were significantly higher in MGL mice. MGL mice had smaller total Mg exchangeable pool masses compared with MGH, and fractional transport rates of Mg (exchange constant) were different. In vitro (25)Mg enrichments in erythrocytes from MGL mice were significantly lower. Moreover, Mg efflux from erythrocytes was significantly higher in MGL. In conclusion, this work demonstrates that MGL mice present lower body stores of Mg than MGH mice and lower body Mg retention. This is confirmed at a cellular level by a lower enrichment of (25)Mg in erythrocytes. The lower retention of Mg by MGL erythrocyte in comparison to MGH appears to be partly due to a higher Mg efflux in MGL erythrocyte. It can be hypothesized that a genetic factor that modulates Na(+)/Mg(2+) exchanger activity may be important in the regulation of Mg metabolism. Further investigations on the mechanisms responsible for differences in Mg retention between MGL and MGH mice could contribute to a better understanding of the genetic regulation of cellular Mg.