Lower Ca(2+) enhances the K(+)-induced force depression in normal and HyperKPP mouse muscles

Hyperkalemic periodic paralysis (HyperKPP) manifests as stiffness or subclinical myotonic discharges before or during periods of episodic muscle weakness or paralysis. Ingestion of Ca(2+) alleviates HyperKPP symptoms, but the mechanism is unknown because lowering extracellular [Ca(2+)] ([Ca(2+)](e)) has no effect on force development in normal muscles under normal conditions. Lowering [Ca(2+)](e), however, is known to increase the inactivation of voltage-gated cation channels, especially when the membrane is depolarized. Two hypotheses were tested: (1) lowering [Ca(2+)](e) depresses force in normal muscles under conditions that depolarize the cell membrane; and (2) HyperKPP muscles have a greater sensitivity to low Ca(2+)-induced force depression because many fibers are depolarized, even at a normal [K(+)](e). In wild type muscles, lowering [Ca(2+)](e) from 2.4 to 0.3 mM had little effect on tetanic force and membrane excitability at a normal K(+) concentration of 4.7 mM, whereas it significantly enhanced K(+)-induced depression of force and membrane excitability. In HyperKPP muscles, lowering [Ca(2+)](e) enhanced the K(+)-induced loss of force and membrane excitability not only at elevated [K(+)](e) but also at 4.7 mM K(+). Lowering [Ca(2+)](e) increased the incidence of generating fast and transient contractures and gave rise to a slower increase in unstimulated force, especially in HyperKPP muscles. Lowering [Ca(2+)](e) reduced the efficacy of salbutamol, a β2 adrenergic receptor agonist and a treatment for HyperKPP, to increase force at elevated [K(+)](e). Replacing Ca(2+) by an equivalent concentration of Mg(2+) neither fully nor consistently reverses the effects of lowering [Ca(2+)](e). These results suggest that the greater Ca(2+) sensitivity of HyperKPP muscles primarily relates to (1) a greater effect of Ca(2+) in depolarized fibers and (2) an increased proportion of depolarized HyperKPP muscle fibers compared with control muscle fibers, even at normal [K(+)](e).