Effect of extracellular potassium on the loss of potassium from human red blood cells treated with propranolol

Lack of influence of short-term treatment with propranolol and terbutaline on metabolism and energy expenditure of the Na-K pump in human erythrocytes evaluated by microcalorimetry

A double blind placebo-controlled study was conducted of the effects of oral propranolol (beta 1 beta 2-adrenoceptor antagonist) and terbutaline (beta 2-adrenoceptor agonist) on erythrocyte heat production, measured by direct microcalorimetry under static conditions at 37 degrees C and pH 7.4. Propranolol 80 mg and terbutaline slow-release 7.5 mg were randomly administered twice daily for one week to 15 healthy males, using a cross-over design. No thermogenic difference was detected. Serum potassium was significantly decreased by terbutaline but was only slightly increased by propranolol, but no relationship was found between changes in the extra- and intracellular levels. In the placebo group, 10% of total cell energy was consumed by the Na-K pump, as assessed by ouabain inhibition, and this value was not significantly affected by the treatments. Thus, it seems unlikely that there is a clinically relevant influence on the Na-K pump in erythrocytes during continuous terbutaline or propranolol medication. It is concluded that short term medication with propranolol and terbutaline in therapeutic doses has almost no thermal or metabolic effect on human erythrocytes. The results indirectly imply that no clinically relevant beta-adrenoceptor effects are mediated in erythrocytes and this may also be true with regard to the 'membrane effect' of propranolol.

Interaction between propranolol and electron donors in altering the calcium ion-dependent potassium ion-permeability of the human red blood cell membrane

Both propranolol and the electron donors ascorbate plus phenazine methosulfate increase the K+-permeability of the red blood cell membrane. The present investigation examined whether these effects were additive. Contrary to expectations, propranolol added after electron donors sharply inhibited the K+ (86Rb) efflux induced by such donors, without forming new K4 channels analogous to those induced by propranolol in intact red blood cells. The inhibitory effect of propranolol may be due to generalized disturbances of membrane structures necessary for the functioning of the K+ channels organized in the presence of reducing agents. In contrast, the electron donors added after propranolol caused a further stimulation of the 86Rb loss from the propranolol-treated red cells. The combined effect of these drugs therefore depends on the order of their addition. The possible mechanism of their interaction is briefly discussed.

Calcium ions, drug action and the red cell membrane

Intracellular calcium regulates a number of membrane functions in the erythrocyte, including control of shape, membrane lipid composition and cation permeability. Measurement of total red cell calcium has yielded values between 5 and 15 nmol/ml cells, and these low values in part reflect the absence of Ca2+ -containing organelles. Most intracellular Ca2+ is bound and the low cell ionized Ca2+ concentration (approximately 0.2 microM) is maintained by a combination of low membrane permeability and a powerful Ca2+ -pump. This pump has been identified with a (Ca2+ + Mg2+)-stimulated ATPase, and both Ca2+ transport and ATP splitting are stimulated by calmodulin, a low molecular weight protein which binds Ca2+ avidly and activates many Ca2+ -dependent enzymes. Both high and low affinity kinetics for Ca2+ pumping have been demonstrated, depending on the extent of binding of calmodulin to the pump. A stoichiometry of either 1 or 2 Ca2+ ions pumped per ATP molecule split has been shown, and the value may vary with the level of intracellular Ca2+. Phenothiazines, such as chlorpromazine inhibit the Ca2+ -pump by antagonizing the increment in activity produced by calmodulin. The passive inward leak of Ca2+ into erythrocytes can be quantitated by 45Ca2+ uptake into red cells whose Ca2+ -pump has been inhibited. Estimates of the Ca2+ permeability, based on unidirectional influx, yield values many orders of magnitude lower than for nucleated cells. Influx of Ca2+ into human erythrocytes occurs by a facilitated diffusion process, which can be inhibited by phenothiazines and the cinchona alkaloids. Calcium affects many membrane functions including cation permeability, lipid composition and some cytoskeletal interactions which may determine cell shape. Any rise in intracellular Ca2+ activates a specific K+ channel which normally makes little contribution to K+ fluxes. Kinetic studies of this process demonstrate either high or low affinity Ca2+ -activation of K+ efflux, with low affinity of the channel to Ca2+ being the probable state in vivo. Propranolol is the best known activator of Ca2+ -stimulated K+ efflux, although the mechanism of stimulation is unclear. Like other tissues, red cells possess a Ca2+ -activated phosphoinositol phosphodiesterase. Although it has been suggested that the echinocytic shape change induced by Ca2+ is due to the hydrolysis of polyphosphoinositides, it seems more likely that this shape change results from an effect of Ca2+ on the macromolecular interactions of the cytoskeleton. Abnormal Ca2+ permeability may contribute to red cell destruction in a variety of diseases. For example, in sickle cell anemia a large Ca2+ influx occurs when cells are sickled under deoxy conditions, and moreover, the ability of the Ca2+ -pump to extrude the increment of cell Ca2+ is impaired. Thus, red cell Ca2+ is increased 3-7-fold above normal and this may contribute to the short survival of sickle red cells...