Potassium homeostasis - Physiology and pharmacology in a clinical context

K+-H+ coupling strategy for immune regulation and bone defect repair

Ion homeostasis is crucial for maintaining cell function. Potassium ion (K+) is one of the most important cations in the human body, and it plays key role in maintaining biological activities and cellular functions, including the intricate balance of ion homeostasis that underpins both physiological and pathological processes. This study explored a novel role of K+ ions in regulating immune cell function and promoting tissue repair, especially in macrophage-mediated environments after severe tissue injury. We designed and synthesized a platelet-liposome vesicles loaded KHCO3 (KHCO3@PLV) that precisely delivered potassium bicarbonate to the site of injury extracellular after intravenous injection; then, precise ultrasound-triggered K+ release regulated extracellular K+ concentrations in the local macrophage environment. These effects collectively validate the K+-H+ coupling strategy - a novel mechanism whereby extracellular K+ elevation induces intracellular pH modulation, subsequently activating the AMPK/Nrf2 axis to reprogram macrophage metabolism and facilitating tissue regeneration through resolution of chronic inflammation. The main conclusion of the study is that an elevated extracellular K+ environment, which is an innovative treatment, is a potentially effective strategy for regulating immune responses and promoting repair after severe tissue injury.

Downregulation of the HCN1 Channel Alleviates Anxiety- and Depression-Like Behaviors in Mice With Cerebral Ischemia-Reperfusion Injury by Suppressing the NLRP3 Inflammasome

BACKGROUND

Post-stroke depression (PSD) is a prevalent neuropsychiatric complication of stroke. However, the mechanisms underlying PSD are still unclear. Here, we aimed to investigate the role of HCN1 (hyperpolarization-activated cyclic nucleotide-gated cation channel 1) in the pathogenesis of PSD and its underlying mechanisms.

METHODS

The PSD mice model was established by middle cerebral artery occlusion in vivo. Four weeks after middle cerebral artery occlusion, anxiety- and depression-like behaviors of mice were evaluated by various behavioral tests. HCN channels were downregulated by pharmacological inhibitor or neuron-specific adeno-associated virus. The oxygen-glucose deprivation/reoxygenation model in SY5Y cells was used to study the pathogenesis of PSD in vitro.

RESULTS

Mice exhibited anxiety- and depression-like behavior 4 weeks after middle cerebral artery occlusion, along with a significant increase in HCN1 protein expression in the ischemic hippocampus. Furthermore, the Ih current on neurons in the hippocampus was notably enhanced, whereas neuronal excitability was decreased in PSD mice. Treatment with HCN channel selective inhibitor ZD7288 protected SY5Y cells against oxygen-glucose deprivation/reoxygenation injury by suppressing K+ efflux. Additionally, we observed a significant increase in protein expressions of NLRP3 (nucleotide-binding domain-like receptor protein 3) inflammasome pathway-related molecules in the ischemic hippocampus of PSD mice. Knockdown of HCN1 channels via virus injection into the hippocampus resulted in decreased protein expressions of NLRP3 inflammasome-related molecules and improvement in anxiety- and depression-like behaviors in PSD mice.

CONCLUSIONS

Downregulation of HCN1 channels has a beneficial effect on PSD by suppressing the NLRP3 inflammasome pathway, thus offering promise as a strategy for preventing and treating PSD.

Integration of Carbon Nanotubes into Manganese Dioxide Nanorods for Enhanced Enzymeless Electrochemical Glucose Sensing with High Sensitivity and Selectivity

Freestanding electrode designs, cost-effective catalysts, and enhanced electrical conductivity are crucial for improving the performance of fourth-generation non-enzymatic glucose electrochemical sensors. These factors enable more efficient, scalable, and durable sensors with better sensitivity, stability, and affordability for real-time glucose monitoring. In this study, we explore a freestanding electrode design combining carbon nanotubes (CNTs) with MnO2 nanorods to enhance charge transfer, increase surface area, and optimize catalytic activity. This CNTs/MnO2 electrode demonstrates exceptional catalytic activity for glucose oxidation, achieving a high sensitivity of 309.73 µA cm-2 mM-1 within a linear range of 0.5 to 10 mM-well above typical physiological glucose levels (3-8 mM), with a detection limit of 0.19 mM at a signal-to-noise ratio of 3. The electrode also shows excellent durability and remarkable selectivity for glucose over common interferents like ascorbic acid and uric acid, as well as antifouling properties in the presence of KCl. These attributes are essential for accurate glucose detection in complex biological samples. The integration of MnO2 nanorods with CNTs in freestanding nanostructures opens up exciting opportunities for developing high-performance, robust electrochemical sensors for diverse applications.

Consumption of lettuce with seaweed extract biostimulant application improved iron homeostasis in a randomized interventional trial of healthy individuals

Minerals have key roles in the body's metabolism and homeostasis. Biostimulants application to vegetables, such as seaweed extracts derived from Ecklonia maxima (SwE), is a useful agronomic approach to improve crop yield and quality by a naturally functionalizing process. We hypothesized that SwE biostimulants would impact the minerals profile of the lettuce and the consumption of lettuce with SwE application would affect blood minerals concentration in the health population. This in turn would impact metabolic pathways essential for human homeostasis. A group 48 healthy adults, of both sexes, was allocated in a double-blinded manner into groups that consumed 100 g a day of control lettuce, lettuce with SwE application or an iron tablet (30 mg) for four weeks. Blood samples were collected at baseline (T0) and at the end of the trial (T2) and compared for differences in serum mineral concentrations, iron, lipid and glucose homeostasis. In lettuce, SwE biostimulant enhanced iron concentration by about 63%. The consumption of lettuce with SwE application increased serum iron by about 38%, transferrin saturation by about 47%, and reduced total cholesterol by about 19% and Low-density lipoprotein by about 22%. Supplementation of iron in tablets has similar effects to lettuce with SwE application but with side effects (diarrhea or constipation). The study offers an innovative perspective by assessing lettuce with SwE application as a natural alternative to iron supplements that are commonly associated with gastrointestinal side effects. The results are of interest in the context of dietary iron deficiency especially among populations that avoid meat-based diets. This research could have broad implications for enhancing the nutritional value of plant-based foods to support dietary health by promoting intersection of sustainable agriculture and human nutrition.Clinical trial registration number: NCT06656871.

Nutrients and Nutraceuticals from Vitis vinifera L. Pomace: Biological Activities, Valorization, and Potential Applications

Grape pomace, also known as wine pomace, is a by-product of winemaking that has traditionally been discarded. However, recent studies have highlighted its rich nutritional and bioactive potential, positioning it as a promising resource for various applications in the functional food, pharmaceutical, and cosmetic sectors. This review explores the nutrient and nutraceutical contents of grape pomace, including its high levels of polyphenols, dietary fiber, vitamins, minerals, and melatonin. The biological activities of grape pomace, such as antioxidant, anti-inflammatory, antimicrobial, and anticancer effects, are also discussed, emphasizing its potential as raw material endowed with multifunctional properties. Additionally, the valorization of grape pomace as a food supplement and for the development of cosmetics is examined, focusing on its incorporation into dietary products and skincare formulations. The growing interest in the sustainable utilization of grape pomace is underscored, highlighting its significant role in promoting human health and contributing to a circular economy.

Association between admission baseline blood potassium levels and all-cause mortality in patients with acute kidney injury combined with sepsis: A retrospective cohort study

INTRODUCTION

Imbalances in blood potassium (K) homeostasis is a significant contributor to the emergence of severe complications, especially among critically ill patients. Hypokalemia and hyperkalemia are both associated with an increased risk of adverse events. However, it is not known about the impact of blood K levels on risk of intensive care units (ICU) mortality for Acute kidney injury (AKI) combined with sepsis patients. This study aimed to explore the relationship between admission blood K levels and ICU 30-day mortality in patients with AKI combined with sepsis.

METHODS

We selected patients diagnosed with AKI and sepsis on their first ICU admission from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The first blood K levels within 24 hours of admission were categorized into three groups according to tertiles (T1 < 3.9 mmol/L, 3.9 ≤ T2 < 4.5 mmol/L, and T3 ≥ 4.5 mmol/L), with T2 serving as the reference. We examined the association between blood K levels and ICU 30-day mortality using accelerated failure time (AFT) models and survival analysis.

RESULTS

A total of 8,242 ICU patients with AKI combined with sepsis were included. In multivariate AFT models, each 1 mmol/L increase in blood K levels was associated with a 13% increase in the risk of ICU 30-day mortality (p < 0.001, 95% confidence interval (CI): 1.06-1.20). Extended multivariable AFT models showed that, compared to the middle category, patients with high blood K levels (≥ 4.5 mmol/L) were associated with all-cause mortality (p = 0.002, adjusted hazard ratio (HR) = 1.22, 95% CI: 1.08-1.38), whereas those with low blood K levels (< 3.9 mmol/L) showed no significant difference (p = 0.385, adjusted HR = 1.06, 95% CI: 0.93-1.21). Kaplan-Meier curves indicated that patients with high blood K levels had higher mortality, and those with middle blood potassium levels (3.9 ≤ K < 4.5 mmol/L) had the lowest mortality.

CONCLUSION

The admission baseline blood K levels were significantly associated with ICU 30-day mortality in intensive care patients suffering from AKI in conjunction with sepsis. Therefore, immediate and careful correction of blood potassium imbalances may prove to be a crucial approach in improving outcomes for these patients.

Drug-Related Pyroglutamic Acidosis: Systematic Literature Review

Background: Inborn errors of glutathione metabolism may cause high anion gap metabolic acidosis due to pyroglutamic acid accumulation. Since 1988, cases of this acidosis have been reported in individuals without these defects. Methods: Given the poorly characterized predisposing factors, presentation, management, and prognosis of acquired pyroglutamic acidosis, we conducted a systematic review using the National Library of Medicine, Excerpta Medica, Web of Science, and Google Scholar databases. Results: A total of 131 cases were found. Most patients were females (79%), adults (92%) aged 51 years or older (66%) with pre-existing conditions (74%) such as undernutrition, alcohol-use disorder, or kidney disease, and had an ongoing infection (69%). The clinical features included diminished consciousness (60%), Kussmaul breathing (56%), and nausea or vomiting (27%). At least 92% of patients were on paracetamol therapy for >10 days at an appropriate dose, 32% on a β-lactamase-resistant penicillin, and 2.3% on vigabatrin. Besides severe anion gap acidosis, patients also presented with hypokalemia (24%) and kidney function deterioration (41%). Management involved discontinuing the offending drug (100%), bicarbonate (63%), acetylcysteine (42%), and acute kidney replacement therapy (18%). The fatality rate was 18%, which was higher without acetylcysteine (24%) compared to with it (11%). Conclusions: Acquired pyroglutamic acidosis is a rare, potentially fatal metabolic derangement, which usually occurs after paracetamol use, frequently combined with a β-lactamase-resistant penicillin or vigabatrin. This condition predominantly affects adults, especially women with factors like undernutrition, alcohol-use disorder, or kidney disease, often during infection. Increased awareness of this rare condition is necessary.

Evaluation of potential human health risks associated with Li and their relationship with Na, K, Mg, and Ca in Romania's nationwide drinking water

Background

Increasing lithium (Li) demand worldwide due to its properties and role in renewable energy will raise water reservoir pollution and side effects on human health. Divergent results regarding Li concentration in water and affective disorders are found in the literature, which is why regional reports are expected.

Objective

The present study evaluated the occurrence and human health risks resulting from oral exposure, respectively, and the relationship between alkali metals (Li, Na, and K) and minerals (Mg, Ca) in balanced purified water (bottled) and spring water.

Methods

The ICP-MS technique was used to measure a national database with 53 bottled and 42 spring water samples randomly selected. One-way ANOVA, Pearson correlation, and HCA analysis were applied to assess the possible relationship between metals in water. The possible side effects of Li poisoning of water resources on human health have been evaluated using the Estimated Daily Intake Index (EDI) and Total Hazard Quotient (THQ).

Results

The toxic metals (As, Hg, and Pb) were measured, and the results indicate values above the detection limit of 22.3% of samples in the case of lead but not exceeding the safety limits. Depending on the water sources, such as bottled and spring water, the Li concentration varied between 0.06-1,557 and 0.09-984% μg/L. We found a strong positive correlation between Li and Na and Mg, varying between bottled and spring waters (p% <%0.001). Li exceeded the limit set by the Health-Based Screening Level (HBSL) in 41.37 and 19% of bottled and spring water samples. The oral reference doses (p-RfDs) for the noncancer assessment of daily oral exposure effects for a human lifetime exceeded threshold values. The THQ index shows potential adverse health effects, requiring further investigations and remedial actions in 27.58% of approved bottled waters and 2.38% of spring waters.

Conclusion

We can conclude that water is safe based on the Li concentration found in drinking water and supported by a gap in strict regulations regarding human Li ingestion. The present study can serve decision-makers and represent a starting database with metals of interest for further clinical studies. Decision-makers can also use it to find solutions for sustainable management of clean and safe drinking water.

Kinetic Modeling of In Vivo K+ Distribution and Fluxes with Stable K+ Isotopes: Effects of Dietary K+ Restriction

Maintaining extracellular potassium (K+) within narrow limits, critical for membrane potential and excitability, is accomplished through the internal redistribution of K+ between extracellular fluid (ECF) and intracellular fluid (ICF) in concert with the regulation of renal K+ output to balance K+ intake. Here we present evidence from high-precision analyses of stable K+ isotopes in rats maintained on a control diet that the tissues and organs involved in the internal redistribution of K+ differ in their speed of K+ exchange with ECF and can be grouped into those that exchange K+ with ECF either rapidly or more slowly ("fast" and "slow" pools). After 10 days of K+ restriction, a compartmental analysis indicates that the sizes of the ICF K+ pools decreased but that this decrease in ICF K+ pools was not homogeneous, rather occurring only in the slow pool (15% decrease, p < 0.01), representing skeletal muscles, not in the fast pool. Furthermore, we find that the dietary K+ restriction is associated with a decline in the rate constants for K+ effluxes from both the "fast" and "slow" ICF pools (p < 0.05 for both). These results suggest that changes in unidentified transport pathways responsible for K+ efflux from ICF to ECF play an important role in buffering the internal redistribution of K+ between ICF and ECF during K+ restriction. Thus, the present study introduces novel stable isotope approaches to separately characterize heterogenous ICF K+ pools in vivo and assess K+ uptake by individual tissues, methods that provide key new tools to elucidate K+ homeostatic mechanisms in vivo.

Far from Their Origins: A Transcriptomic Investigation on How 2,4-Di-tert-butyl-6-(5-chloro-2H-benzotriazol-2-yl) Phenol Affects Rainbow Trout Alevins

Benzotriazole ultraviolet stabilizers (BUVSs) are a group of widely used chemicals added to a variety of consumer (e.g., plastics) and industrial (e.g., metal coating) goods. Although detected globally as an environmentally persistent pollutant, BUVSs have received relatively little toxicological attention and only recently have been acknowledged to affect development and the endocrine system in vivo. In our previous study, altered behavior, indicative of potential neurotoxicity, was observed among rainbow trout alevins (day 14 posthatching) that were microinjected as embryos with a single environmentally relevant dose of 2,4-di-tert-butyl-6-(5-chloro-2H-benzotriazol-2-yl) phenol (UV-327). In the present follow-up study, we performed whole-transcriptome profiling (RNA sequencing) of newly hatched alevins from the same batch. The primary aim was to identify biomarkers related to behavior and neurology. Dose-specifically, 1 to 176 differentially expressed genes (DEGs) were identified. In the group presenting altered behavior (273.4 ng g-1), 176 DEGs were identified, yet only a fraction was related to neurological functions, including water, calcium, and potassium homeostasis; acetylcholine transmission and signaling; as well insulin and energy metabolism. The second objective was to estimate the transcriptomic point of departure (tPOD) and assess if point estimate(s) are protective of altered behavior. A tPOD was established at 35 to 94 ng UV-327 g-1 egg, making this tPOD protective of behavioral alterations. Holistically, these transcriptomic alterations provide a foundation for future research on how BUVSs can influence rainbow trout alevin development, while providing support to the hypothesis that UV-327 can influence neurogenesis and subsequent behavioral endpoints. The exact structural and functional changes caused by embryonic exposure to UV-327 remain enigmatic and will require extensive investigation before being deciphered and understood toxicologically. Environ Toxicol Chem 2024;43:2026-2038. © 2024 The Author(s). Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

Electrolyte disorders related emergencies in children

This article provides a comprehensive overview of electrolyte and water homeostasis in pediatric patients, focusing on some of the common serum electrolyte abnormalities encountered in clinical practice. Understanding pathophysiology, taking a detailed history, performing comprehensive physical examinations, and ordering basic laboratory investigations are essential for the timely proper management of these conditions. We will discuss the pathophysiology, clinical manifestations, diagnostic approaches, and treatment strategies for each electrolyte disorder. This article aims to enhance the clinical approach to pediatric patients with electrolyte imbalance-related emergencies, ultimately improving patient outcomes.Trial registration This manuscript does not include a clinical trial; instead, it provides an updated review of literature.

The role of different nutrients in the prevention and treatment of cardiovascular diseases

Cardiovascular health is a hot topic around the world, and as the incidence of cardiovascular disease increases each year, people are increasingly focusing on the management of their heart health. Dietary and lifestyle changes as non-pharmacological treatments have been increasingly recognized as important in the prevention of cardiovascular disease and in reducing the risk of cardiovascular accidents. Awareness of different nutrients and their effects on cardiovascular health is important for establishing a good dietary pattern. This review summarizes the effects of the five major nutrients in the daily diet, namely carbohydrates, proteins, dietary fats, vitamins, and minerals, on cardiovascular health, and aims to provide a more comprehensive understanding of the effects of a healthy dietary pattern on cardiovascular health.

A modeling analysis of whole body potassium regulation on a high-potassium diet: proximal tubule and tubuloglomerular feedback effects

Potassium (K+) is an essential electrolyte that plays a key role in many physiological processes, including mineralcorticoid action, systemic blood-pressure regulation, and hormone secretion and action. Indeed, maintaining K+ balance is critical for normal cell function, as too high or too low K+ levels can have serious and potentially deadly health consequences. K+ homeostasis is achieved by an intricate balance between the intracellular and extracellular fluid as well as balance between K+ intake and excretion. This is achieved via the coordinated actions of regulatory mechanisms such as the gastrointestinal feedforward effect, insulin and aldosterone upregulation of Na+-K+-ATPase uptake, and hormone and electrolyte impacts on renal K+ handling. We recently developed a mathematical model of whole body K+ regulation to unravel the individual impacts of these regulatory mechanisms. In this study, we extend our mathematical model to incorporate recent experimental findings that showed decreased fractional proximal tubule reabsorption under a high-K+ diet. We conducted model simulations and sensitivity analyses to investigate how these renal alterations impact whole body K+ regulation. Model predictions quantify the sensitivity of K+ regulation to various levels of proximal tubule K+ reabsorption adaptation and tubuloglomerular feedback. Our results suggest that the reduced proximal tubule K+ reabsorption under a high-K+ diet could achieve K+ balance in isolation, but the resulting tubuloglomerular feedback reduces filtration rate and thus K+ excretion.NEW & NOTEWORTHY Potassium homeostasis is maintained in the body by a complex system of regulatory mechanisms. This system, when healthy, maintains a small extracellular potassium concentration, despite large fluctuations of dietary potassium. The complexities of the system make this problem well suited for investigation with mathematical modeling. In this study, we extend our mathematical model to consider recent experimental results on renal potassium handling on a high potassium diet and investigate the impacts from a whole body perspective.

Ripening stage impacts nutritional components, antiglycemic potential, digestibility and antioxidant properties of grumixama (Eugenia brasiliensis Lam.) fruit

This study aimed to determine the nutritional components (macronutrients ans minerals) and α-amylase inhibition capacity of freeze-dried grumixama (Eugenia brasiliensis Lam) seeds (S) and pulp/peel (P) portions, at ripe and mid-ripe stages. In vitro digestion was also performed on S and P from grumixama to assess the bioaccessibility of total phenolic compound (TPC), flavonoids (TFC), and anthocyanins (TAC), as well as to examine their impact on antioxidant activity (DPPH, ABTS, FRAP). The ripening process impacts the bioactive compounds and individual phenolics of S and P portions. The ripe S was source of myricetin and exhibited higher antioxidant activity, while mid-ripe S was high in flavonoids and cinnamic acid with higher antiglycemic potential. Ripe P showed higher soluble fiber, carbohydrate, TAC, and caffeic acid content, whereas mid-ripe P had increased mineral content (calcium, potassium, manganese), catechin, and TPC. After in vitro digestion, the P portion showed a bioaccessibility of total phenolic content (TPC) and total flavonoid content (TFC) exceeding 40% at intestinal phase. In contrast, the S portions had better release of TPC and TFC and antioxidant activity at gastric phase. Considering the outstanding nutritional and biological properties of grumixama fruit, freeze-dried S and P portions from both ripening stages possess could be explored as valuable sources of nutrients and antioxidant compounds.