Identification of Susceptibility to Malignant Hyperpyrexia

While the serum level of creatine phosphokinase is useful as a screening test for malignant hyperpyrexia it does not provide certain identification of susceptible individuals. A much more accurate prediction may be made by pharmacological testing in vitro of muscle biopsy specimens. Individuals susceptible to malignant hyperpyrexia have muscle with heightened sensitivity to halothane, caffeine, succinylcholine, potassium chloride, and temperature change. Use of this test allows separation of susceptible individuals from those not at risk in families of patients who have experienced malignant hyperpyrexia.     

Screening for Malignant Hyperpyrexia

The methods used to screen patients for malignant hyperpyrexia at present are not sufficiently accurate. This paper reports more specific methods of detecting patients liable to develop malignant hyperpyrexia. A motor-point muscle biopsy is performed for histopathological examination and to detect muscle contracture in vitro after exposure to halothane and suxamethonium.     

Insulin Secretion in Malignant Hyperpyrexia

An increased glucose-induced insulin response has been observed in patients susceptible to malignant hyperpyrexia. This raises the possibility that the membrane abnormality present in the calcium-storing membranes in the muscle cell in malignant hyperpyrexia may be present also in the beta cell of the pancreas.     

Anaesthetic-induced Malignant Hyperpyrexia: A Suggested Method of Treatment

Experiments in susceptible Landrace pigs have shown that procaine blocks the initiation of anaesthetic-induced malignant hyperpyrexia by both halothane and succinylcholine. Pretreatment with curare prevents only the trigger action of succinylcholine. In a preliminary study procaine was used to treat the established syndrome in five pigs, two of which survived. On the basis of these findings a treatment regimen can be suggested for patients who develop malignant hyperpyrexia.     

Procaine in Malignant Hyperpyrexia

The caffeine contracture of normal human muscle, which has been used as a model for malignant hyperpyrexia, is greatly potentiated by halothane. Prior administration of procaine markedly reduces the halothane-potentiated caffeine contracture, and procaine given at the height of the contracture induces relaxation. Lignocaine, on the other hand, produces a variable response and sometimes increases the contracture.The muscle from a patient with an inherited susceptibility to malignant hyperpyrexia contracted spontaneously with halothane alone, and this contracture was reversed by procaine.These experiments support the therapeutic use of procaine in malignant hyperpyrexia.     

Sperm creatine phosphokinase activity as a measure of sperm quality in normospermic, variablespermic, and oligospermic men

We have found a significant inverse correlation between sperm concentrations and sperm creatine N-phosphotransferase (CPK) activities in oligospermic and normospermic human specimens. In the present work, we carried out serial CPK determinations to assess whether there is a relationship between fluctuating sperm concentrations and sperm quality in consistently oligospermic and variablespermic (sperm concentrations are occasionally in the greater than 20 million/ml range) husbands of 65 couples (23 normospermic men/51 samples, 25 consistently oligospermic men/80 samples, and 17 variablespermic men/68 samples). The sperm CPK activities were significantly lower in the normospermic vs. the oligospermic or variablespermic groups (p less than 0.001), but there were no differences between the latter two (p greater than 0.25). The mean CPK values of migrated sperm fractions in both the oligospermic and variablespermic populations were improved (at least 20% decline in CPK values) compared to those of the initial specimens (1.27 +/- 0.38 vs. 0.68 +/- 0.37 and 0.77 +/- 0.32 vs. 0.46 +/- 0.24 SEM U/100 million sperm, respectively, p less than 0.001 in both pairs) and the incidence of the "failed-to-improve" samples was also similar in the two groups (44/36 vs. 45/23, p greater than 0.2). The lack of differences in the mean CPK activities, in the distribution of CPK values under and over 0.250 U/100 million sperm level, and in the ratio of migrated samples with improved or with failed-to-improve CPK activities suggests that sperm quality is not different between men who are consistently oligospermic and those who occasionally produce normospermic specimens.(ABSTRACT TRUNCATED AT 250 WORDS)     

Hyperpyrexia During Anaesthesia

Work in pigs has shown that malignant hyperpyrexia during anaesthesia may occur without suxamethonium having been given. A virtually constant feature in reported cases and in our own observations is that all subjects developing hyperpyrexia had received nitrous oxide and halothane.     

Calmodulin and malignant hyperpyrexia

The function of calmodulin as a biological regulator is linked to the level of free Ca2+ in the cell, and there is evidence that calmodulin may itself be involved in the control of the movements of cellular Ca2+. Malignant hyperpyrexia, on the other hand, is caused by a disturbance in the level of myoplasmic Ca2+. We have investigated the possibility that calmodulin may be involved in malignant hyperpyrexia by studying the trifluoperazine-induced inhibition of calmodulin activation by phosphodiesterase, using crude and purified calmodulin preparations from control and MH-susceptible pigs. No abnormality was found in the pattern of either calmodulin activation or trifluoperazine-induced inhibition in MH muscle.     

Comparison of adenylate kinase from normal and malignant hyperpyrexic porcine muscle

Adenylate kinase has been implicated as a key factor in malignant hyperpyrexia, a complication of general anaesthesia which is usually triggered by the anaesthetic drug, halothane. Because of this, the enzyme was purified from both malignant hyperpyrexia susceptible and control porcine muscle. Electrophoretic studies, amino acid analysis, and peptide mapping of the purified enzymes revealed no significant differences between the two preparations. Both enzymes responded similarly to halothane and to the three sulfhydryl reacting reagents which were tested and they also showed an identical affinity for the substrate AMP. It is concluded that porcine MH is not due to an abnormality in the enzyme AK.     

Increased release of beta thromboglobulin during acute myocardial infarction

Beta thromboglobulin (betaTG) is a platelet-specific protein released during platelet aggregation. To classify the role of platelet aggregation in acute myocardial infarction (AMI), betaTG levels were measured by means of a specific and highly sensitive radioimmunoassay in patients admitted to the Coronary Care Unit for the evaluation of acute chest pain. These levels were compared to creatine phosphokinase (CPK) values and the percentage of myocardial fraction (MB), as well as electrocardiographic criteria for AMI. Beta thromboglobulin was considered elevated when it was greater than 132 micro/1. The CPK and MB fraction were considered to indicate AMI if there was an increase of MB fraction greater than 5% of the total CPK and a progressive increase of the total CPK and MB fraction during the course of the disease. Ten patients were compared to 28 control subjects. Seven patients had electrocardiographic evidence of AMI in addition to CPK and MB criteria. Six of these patients also had elevated betaTG values, whereas one did not. This patient was admitted late during his clinical course, as evidenced by the CPK-MB curve. Of the three patients without clinical evidence of AMI, two had normal betaTG levels, whereas the third patient had one normal betaTG level and one mildly elevated level. This study implicates the role of platelet aggregation in AMI and suggests its potential usefulness as a diagnostic aid in evaluating acute chest pain.     

Hereditary malignant hyperpyrexia associated with muscle adenylate kinase deficiency

Summary Muscle adenylate kinase deficiency was recognized in a family, in which two children died due to malignant hyperpyrexia following halothane anesthesia.Supported by the Deutsche Forschungsgemeinschaft.     

Biochemical Basis of Malignant Hyperpyrexia

Pharmacologically-induced muscle contracture in vitro has been used as a model to study the biochemical basis of malignant hyperpyrexia. In 15 susceptible subjects halothane, succinylcholine, and potassium chloride all produced an abnormal muscle contracture, and the caffeine-induced contracture was greater than normal. The contractures were reproducible only in the presence of extracellular calcium ions. The fact that such dissimilar pharmacological stimuli all induced contracture in the affected muscle suggests that the essential abnormality in the muscle cell in malignant hyperpyrexia is an impaired binding of calcium ions to the membranes of the sarcoplasmic reticulum and the sarcolemma. Exposure of these membranes to halothane, succinylcholine, and other anaesthetic agents then leads to a rapid and abnormally large release of calcium into the myoplasm, which in turn gives rise to all the clinical features of the syndrome.     

Calmodulin in porcine malignant hyperpyrexia

The anaesthetic complication malignant hyperpyrexia (MH) is due to an elevation of the myoplasmic Ca2+ concentration. Examination of calmodulin isolated from MH susceptible swine suggests that the disorder in calcium regulation in MH is not due to an abnormality in calmodulin.     

Freeman-Sheldon (whistling face) syndrome with hyperpyrexia in the newborn: case report

Freeman Sheldon syndrome (FSS) is a rare, multiple congenital contracture syndrome that is relatively well-known, since affected children have a striking appearance. This entity was historically referred to as the "whistling-face syndrome". Malignant hyperthermia and hyperpyrexia have been documented in FSS after general anesthesia related to the neuropathy. We report a male neonate with FSS and hyperpyrexia without anesthesia. To our knowledge, our patient is the first in the literature with hyperpyrexia in the newborn period without anesthesia.     

Circadian variations of the serum creatine kinase level--a masking effect?

Since the serum level of the enzyme creatine (phospho)kinase (CPK) is frequently used for diagnostic purposes and since circadian variations of this parameter have been observed under different stress conditions, it had to be determined whether they are induced by an endogenous circadian rhythm or whether they are activity-related masking effects. For this purpose, 15 untrained male test persons were examined for a period of 25h each under different conditions: lying constantly in a climatic chamber, everyday activity conditions, resting conditions with intermittent bicycle ergometer tests (1.4 W/kg body weight) between 09:00 and 11:30 or between 15:00 and 17:30. In addition, 5 sportsmen were included in the study under resting conditions and the bicycle ergometer tests in the forenoon. The serum CPK was determined at intervals of 2h or 4h, respectively. Under constant resting conditions, the mean serum CPK level decreased continuously (p < .001, repeated measures analysis of variance [Rep. Mes. ANOVA]), and the final values amounted to approximately 80% of the initial values. In contrast, under everyday conditions, the mean CPK level rose during the activity phase and decreased again to below the initial values during subsequent rest (p < .001, Rep. Mes. ANOVA). In the ergometer tests, the CPK blood level rose in each case after the activity phase and fell again continuously in the following resting period. However, in the calculation of the deviations from the linear trend, it was shown that certain daily variations in the CPK values can be detected under constant resting conditions; however, the amplitude was much smaller than the amplitude under everyday activity conditions. All in all, it can be stated that serum CPK levels are mainly dependent on the physical load conditions, and that the daily changes observed under everyday conditions disappear almost entirely under resting conditions. The daily variation of the serum creatine kinase level under everyday conditions can thus be regarded as a masking effect. These results are of practical significance for diagnosis to the extent that the physical activity that has taken place before the determination of the CPK level must be taken into account in the interpretation of the values. According to the results obtained so far, the CPK serum level may be used in chronobiology as an indicator of masking by physical activity.     

The effects of chlorbutol on skeletal muscle sarcoplasmic reticulum function in porcine malignant hyperpyrexia

1. Chlorbutol, a muscle relaxant, inhibits the in vitro muscle hypercontractility which is characteristic of the anaesthetic complication, malignant hyperpyrexia (MH). 2. Studies on isolated sarcoplasmic reticulum vesicles have shown that this effect of chlorbutol in MH is not due to a modification of Ca2+-transport mechanisms.     

Correlation between sperm creatine phosphokinase activity and sperm concentrations in normospermic and oligospermic men

Toward the development of biochemical probes for the assessment of sperm function we have measured the activities of sperm creatine-N-phosphotransferase (CPK). There was a highly significant inverse correlation (P < 0.001 in all comparisons) between sperm CPK activities and sperm concentrations in specimens of normospermic and oligospermic men with > 30 million sperm/ml (0.106 ± 0.01 SEM, Nequals;90, expressed as CPK U/100 million sperm), 20–30 million sperm/ml (0.333 ± 0.07 SEM, Nequals;30) and 10–20 million sperm/ml (0.583 ± 0.12 SEM, Nequals;30) when compared with the CPK values of the < 10 million/ml specimens (2.242 ± 0.46 SEM, Nequals;30). Furthermore, the distribution of CPK activities within these four groups showed that 96%, 67%, 43%, and 4% of the samples, respectively, were in the < 0.250 CPK U/100 million sperm normal range (mean + 2 SD of the > 30 million sperm/ml group). However, there was no relationship between sperm CPK activities and the values of sperm motility (P > 0.15) or morphology (Pequals;0.38) in the samples. The migrated sperm fractions (significantly improved in motility and velocity parameters) showed CPK activities lower than the initial semen specimens (P < 0.01, Nequals;150). In fact, in some oligospermic men the CPK activities of the migrated sperm fractions were within the range of normospermic samples. The data suggest that sperm CPK values in the initial specimens and the degree of improvement in the migrated sperm fractions reflect the relative concentrations of a “normal” sperm subpopulation. We propose that CPK activities and similar objective biochemical parameters may be important in predicting sperm quality and the fertilizing potential of oligospermic men.     

Molecular evolution of two duplicated CDPK genes CPK7 and CPK12 in grass species: a case study in wheat (Triticum aestivum L.)

Gene duplication contributes to the expansion of gene families and subsequent functional diversification. Calcium-dependent protein kinases (CDPKs) are members of an important calcium sensor family involved in abiotic and biotic stress signaling in plants. We report here the molecular evolution and expression analysis of a pair of duplicated CDPK genes CPK7 and CPK12 that arose in the common ancestor of grass species. With higher nonsynonymous/synonymous ratios (dN/dS, or ω), CPK12 genes appear to diverge more rapidly than CPK7s, suggesting relaxed selection constraints on CPK12s. Sliding window analysis revealed increased dN and ω values at N-terminal regions and the calcium-binding EF hand loops. Likelihood analyses using various models in PAML 4.0 showed purifying selection on both CPK7 and CPK12 lineages. In addition to the divergence in cis-element combinations on their promoters, functional divergence of CPK7 and CPK12 genes was also observed in wheat where TaCPK7 was found to respond to drought (PEG), salt (NaCl), cold, and hydrogen peroxide (H(2)O(2)) while TaCPK12 responded only to the treatment of ABA, a feature that may complement or expand TaCPK7-mediated stress signaling networks of wheat. The contrasting expression patterns of CPK7 and CPK12 genes under stress conditions were also observed in rice, suggesting conservative functional evolution of these genes. Since no positive selection was detected between the two lineages, the divergence of CPK7 and CPK12 genes should be ascribed to subfunctionalization, rather than neofunctionalization. Thus, our work demonstrates another case of evolutionary employment of duplicated genes via subfunctionalization for better adaptation.     

Effect of Experimental Diabetic Retinopathy on the Non-Image-Forming Visual System

Since the serum level of the enzyme creatine (phospho)kinase (CPK) is frequently used for diagnostic purposes and since circadian variations of this parameter have been observed under different stress conditions, it had to be determined whether they are induced by an endogenous circadian rhythm or whether they are activity-related masking effects. For this purpose, 15 untrained male test persons were examined for a period of 25h each under different conditions: lying constantly in a climatic chamber, everyday activity conditions, resting conditions with intermittent bicycle ergometer tests (1.4 W/kg body weight) between 09:00 and 11:30 or between 15:00 and 17:30. In addition, 5 sportsmen were included in the study under resting conditions and the bicycle ergometer tests in the forenoon. The serum CPK was determined at intervals of 2h or 4h, respectively. Under constant resting conditions, the mean serum CPK level decreased continuously (p <. 001, repeated measures analysis of variance [Rep. Mes. ANOVA]), and the final values amounted to approximately 80% of the initial values. In contrast, under everyday conditions, the mean CPK level rose during the activity phase and decreased again to below the initial values during subsequent rest (p <. 001, Rep. Mes. ANOVA). In the ergometer tests, the CPK blood level rose in each case after the activity phase and fell again continuously in the following resting period. However, in the calculation of the deviations from the linear trend, it was shown that certain daily variations in the CPK values can be detected under constant resting conditions; however, the amplitude was much smaller than the amplitude under everyday activity conditions. All in all, it can be stated that serum CPK levels are mainly dependent on the physical load conditions, and that the daily changes observed under everyday conditions disappear almost entirely under resting conditions. The daily variation of the serum creatine kinase level under everyday conditions can thus be regarded as a masking effect. These results are of practical significance for diagnosis to the extent that the physical activity that has taken place before the determination of the CPK level must be taken into account in the interpretation of the values. According to the results obtained so far, the CPK serum level may be used in chronobiology as an indicator of masking by physical activity. (Chronobiology International, 17(4), 583–590, 2000)     

Ca2+-Dependent Protein Kinase11 and 24 Modulate the Activity of the Inward Rectifying K+ Channels in Arabidopsis Pollen Tubes

Potassium (K⁺) influx into pollen tubes via K⁺ transporters is essential for pollen tube growth; however, the mechanism by which K⁺ transporters are regulated in pollen tubes remains unknown. Here, we report that Arabidopsis thaliana Ca²⁺-dependent protein kinase11 (CPK11) and CPK24 are involved in Ca²⁺-dependent regulation of the inward K⁺ (K+_in) channels in pollen tubes. Using patch-clamp analysis, we demonstrated that K+_in currents of pollen tube protoplasts were inhibited by elevated [Ca²⁺]_cyt. However, disruption of CPK11 or CPK24 completely impaired the Ca²⁺-dependent inhibition of K+_in currents and enhanced pollen tube growth. Moreover, the cpk11 cpk24 double mutant exhibited similar phenotypes as the corresponding single mutants, suggesting that these two CDPKs function in the same signaling pathway. Bimolecular fluorescence complementation and coimmunoprecipitation experiments showed that CPK11 could interact with CPK24 in vivo. Furthermore, CPK11 phosphorylated the N terminus of CPK24 in vitro, suggesting that these two CDPKs work together as part of a kinase cascade. Electrophysiological assays demonstrated that the Shaker pollen K+_in channel is the main contributor to pollen tube K+_in currents and acts as the downstream target of the CPK11-CPK24 pathway. We conclude that CPK11 and CPK24 together mediate the Ca²⁺-dependent inhibition of K+_in channels and participate in the regulation of pollen tube growth in Arabidopsis.