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2017 ; 114
(18
): 4811-4815
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Dantrolene requires Mg(2+) to arrest malignant hyperthermia
#MMPMID28373535
Choi RH
; Koenig X
; Launikonis BS
Proc Natl Acad Sci U S A
2017[May]; 114
(18
): 4811-4815
PMID28373535
show ga
Malignant hyperthermia (MH) is a clinical syndrome of skeletal muscle that
presents as a hypermetabolic response to volatile anesthetic gases, where
susceptible persons may develop lethally high body temperatures. Genetic
predisposition mainly arises from mutations on the skeletal muscle ryanodine
receptor (RyR). Dantrolene is administered to alleviate MH symptoms, but its
mechanism of action and its influence on the Ca(2+) transients elicited by MH
triggers are unknown. Here, we show that Ca(2+) release in the absence of Mg(2+)
is unaffected by the presence of dantrolene but that dantrolene becomes
increasingly effective as cytoplasmic-free [Mg(2+)] (free [Mg(2+)](cyto)) passes
mM levels. Furthermore, we found in human muscle susceptible to MH that
dantrolene was ineffective at reducing halothane-induced repetitive Ca(2+) waves
in the presence of resting levels of free [Mg(2+)](cyto) (1 mM). However, an
increase of free [Mg(2+)](cyto) to 1.5 mM could increase the period between
Ca(2+) waves. These results reconcile previous contradictory reports in muscle
fibers and isolated RyRs, where Mg(2+) is present or absent, respectively, and
define the mechanism of action of dantrolene is to increase the Mg(2+) affinity
of the RyR (or "stabilize" the resting state of the channel) and suggest that the
accumulation of the metabolite Mg(2+) from MgATP hydrolysis is required to make
dantrolene administration effective in arresting an MH episode.