Insulin acts in hypokalemic periodic paralysis by reducing inward rectifier K current

Ruff, Robert L.

doi:10.1212/wnl.53.7.1556

Cited by 112Ion channel regulation and functionCardiac electrophysiology and arrhythmiasPotassium and Related Disorders

Insulin acts in hypokalemic periodic paralysis by reducing inward rectifier K current

Ruff, Robert L.·1999·Neurology

DOI 10.1212/wnl.53.7.1556

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Abstract

OBJECTIVE: To define how insulin acts in hypokalemic periodic paralysis (HypoPP). BACKGROUND: HypoPP results from point mutations of the skeletal muscle L-type Ca2+ channel. Attacks of flaccid paralysis are associated with hypokalemia and triggered by insulin. A persistent inward current causes depolarization-induced paralysis. The relationships of the Ca2+ channel mutations to the persistent inward current and how insulin triggers paralytic attacks are not yet known. METHODS: Intercostal muscle fibers from HypoPP and normal subjects were studied in vitro at 37 degrees C using two electrodes to determine action potential thresholds and a three-electrode voltage clamp to study membrane currents. RESULTS: HypoPP fibers were depolarized in bathing solution with 4 mM K+. Reducing K+ from 4.0 mM to 2.5 or 1.0 mM depolarized HypoPP fibers but hyperpolarized normal fibers. Adding 12 mU/mL of insulin to bathing fluids increased the depolarization of HypoPP fibers and increased the hyperpolarization of normal fibers. Depolarized HypoPP had increased action potential thresholds. The fraction of excitable muscle fibers decreased with increasing fiber depolarization. Blocking Na+ channels or L-type Ca2+ channels did not prevent depolarization induced by hypokalemia or by insulin. Insulin reduced the conductance of the inward rectifier K+ channel for outward-flowing currents. CONCLUSIONS: Insulin potentiates depolarization of hypokalemic periodic paralysis (HypoPP) fibers by reducing inward rectifier K+ conductance. The Ca2+ mutations in HypoPP indirectly derange membrane excitability by altering the function of other membrane channels.

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Insulin and catecholamines not only activate Na+, K+-ATPase but may also inhibit inward rectifying K+ (Kir) channels.
“In fact, insulin and catecholamines not only activate Na+, K+-ATPase but may also inhibit inward rectifying K+ (Kir) channels (39).”
From A 10-year analysis of thyrotoxic periodic paralysis in 135 patients: focus on symptomatology and precipitants (2013) · cites this paper as [39]
Insulin and catecholamine not only activate Na+/K+ ATPase but also inhibit Kir channels.
“Moreover, insulin and catecholamine not only activate Na+/K+ ATPase but also inhibit Kir channels [17].”
From Thyrotoxic Periodic Paralysis: Clinical Challenges (2014) · cites this paper as [17]

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Authors: Ruff, R. L.
Affiliations: University Hospitals of Cleveland (US)
Corresponding author: Ruff, Robert L.
ORCID: Ruff, Robert L.
Venue: Neurology
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 1999-10-22
Volume: 53
Issue: 7
Pages: 1556-1556
ISSN: 0028-3878 (ISSN-L)
1526-632X
DOI: 10.1212/wnl.53.7.1556
OpenAlex: W1967798714
Cited by: 112
References: 39
Citations by year: 2026: 1 · 2025: 3 · 2024: 2 · 2023: 4 · 2022: 1 · 2021: 4 · 2020: 4 · 2019: 1 · 2018: 4 · 2017: 6 · 2015: 3 · 2014: 7 · 2013: 6 · 2012: 6
FWCI: 2.05
Type: journal article
Language: en
Open access: closed
Locations: Neurology (publishedVersion)
PubMed (publishedVersion)
Topics: Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Ion channel regulation and function
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Potassium and Related Disorders
Keywords: hypokalemic periodic paralysis, insulin, inwardly rectifying potassium channels, hypokalemia, action potential threshold, muscle excitability
MeSH terms: Adult, Electric Conductivity, Electrophysiology, Extracellular Space, Humans, Insulin, Male, Membrane Potentials, Potassium, Potassium Channels, Muscle Fibers, Skeletal, Hypokalemic Periodic Paralysis, Potassium Channel Blockers

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Insulin acts in hypokalemic periodic paralysis by reducing inward rectifier K current

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