TISSUE DISTRIBUTION OF ELECTROLYTES, CA47, AND MG28 IN ACUTE HYPERCALCEMIA

Regulation of brain and cerebrospinal fluid calcium by brain barrier membranes following vitamin D-related chronic hypo- and hypercalcemia in rats

Male Fischer-344 rats, 21 days old, were fed diets containing 0 (LOD), 2,200 (CONT), or 440,000 (HID) international units of vitamin D3 per kilogram for 12 weeks. [Ca] was measured in plasma, CSF, brain, and choroid plexus. In addition, 45Ca and 36Cl transfer coefficients (KCa and KCl) for uptake from blood into CSF and brain were determined. Although plasma ionized [Ca]s in LOD and HID rats were 50% and 136%, respectively, of values in CONT animals, CSF and brain [Ca]s ranged from only 85% to 110% of respective CONT values. Choroid plexus [Ca] was increased by 37% after HID diet, but was decreased only 10% after LOD. KCa values at CSF, parietal cortex, and pons-medulla were negatively correlated with plasma ionized [Ca], whereas KCl values at CSF and brain were not different between the diet groups. The findings demonstrate that central nervous system [Ca] is maintained during chronic hypo- or hypercalcemia by saturable transport of Ca at brain barrier membranes. This transport does not seem to involve modulation by 1,25-dihydroxyvitamin D3.

Increased transfer of 45Ca into brain and cerebrospinal fluid from plasma during chronic hypocalcemia in rats

Recent studies have shown regulation of central nervous system [Ca] after chronic hypo- and hypercalcemia. To investigate the mechanism of this regulation, 3-week-old rats were fed diets for 8 weeks that contained low or normal levels of Ca. Plasma [Ca] was 40% less in rats fed the low Ca diet than in animals fed normal diet. Unidirectional transfer coefficients for Ca (KCa) and Cl (KCl) into cerebrospinal fluid (CSF) and brain were determined from the 10 min uptake of intravenously injected 45Ca and 36Cl in awake animals. KCa for CSF was 68% greater in low-Ca rats than in normal rats. Likewise, the values of KCa for brain regions with areas adjacent to the ventricles like the hippocampus and pons-medulla were 50% higher than in normal animals. On the other hand, KCas for parietal cortex, a brain region distant from the choroid plexus and not expected to be influenced by Ca entry into CSF, were similar between the groups. Comparison of the regional ratios of KCa/KCl revealed that a selective increase of Ca transport occurred into CSF and all brain regions except the parietal cortex in Ca-deficient rats. The results suggest that Ca homeostasis of CSF and brain [Ca] during chronic hypocalcemia is due to increased transfer of Ca from blood to brain, and that the regulation occurs via the CSF, possibly at the choroid plexus, but not via the cerebral capillaries.

Calcium in rat peripheral nerve during chronic alterations in plasma calcium

The calcium content in desheathed tibial nerve was compared to that in cerebellum in rats fed diets containing either 0.01% (low), 0.67% (control) or 3.0% (high) Ca, for 8 weeks. For changes in concentration of plasma ionized Ca, 48% below and 35% above the control mean, percent change in endoneurial Ca content is linearly related, with a slope of 0.80, to percent change in plasma ionized Ca. A line with a slope of 0.21 describes the relation between percent change in cerebellum Ca and percent change in plasma ionized Ca. Plasma, cerebellum and nerve concentrations of Na, K and Cl were similar in the control compared with the two experimental groups of animals. The concentration of plasma Mg varied 20% below and 17% above the control mean, inversely with plasma Ca, but nerve and cerebellum Mg did not change from control values. The results of this study fail to demonstrate Ca homeostasis in rat peripheral nerve endoneurium during chronic hypo- and hypercalcemia. Endoneurial Mg, however, appears to be regulated.

Homeostasis of brain and cerebrospinal fluid calcium concentrations during chronic hypo- and hypercalcemia

Three-week-old rats were made hypocalcemic or hypercalcemic by being fed diets low or high in Ca. Both total and ionized [Ca]s in the plasma decreased about 40% and remained depressed for 4 weeks in rats fed a low-Ca diet. Plasma [Ca]s in rats fed a high-Ca diet increased by 30% and remained elevated for 7 weeks. After 8 weeks on the diets, cerebrospinal fluid (CSF) [Ca] changed by less than 30% whereas brain [Ca] changed by less than 20% of the chronic changes in plasma ionized [Ca]. Assuming a brain extracellular volume of 20% and noting that brain extracellular volume equilibrates freely with CSF, the findings demonstrate only small perturbations in the Ca content of the brain cellular compartment during sustained hypo or hypercalcemia. Partial regulation of CSF and brain extracellular Ca suggests a role for the blood-brain barrier in regulating CNS [Ca] during chronic changes in plasma [Ca].

Calcium influxes into brain and cerebrospinal fluid are linearly related to plasma ionized calcium concentration

Unidirectional Ca influxes into brain and cerebrospinal fluid (CSF) were measured at different plasma concentrations of ionized Ca ([Ca]i) in pentobarbital-anesthetized rats. Plasma [Ca]i was varied acutely from 0.6 to 3.0 mumol/ml by intravenous infusion of EGTA, NaCl or CaCl2 or by thyroparathyroidectomy. Ca influx was determined from the 15-min uptake of 45Ca after intravenous injection. There were significant regional differences in 45Ca uptake into the CNS, with a approximately 20-fold greater rate into ventricular CSF than into frontal cortex. Autoradiographs of 45Ca uptake demonstrated that uptake into frontal cortex reflects primarily transport across the cerebral capillaries, whereas uptake into ventricular CSF reflects transport across the choroid plexuses. At both sites, Ca influx was a linear function of plasma [Ca]i and extrapolated to zero at [Ca]i = 0. Infusion of EGTA or CaCl2 did not alter the integrity of the blood-brain barrier, as determined by the permeability to [14C]sucrose. These results indicate that Ca influx into the CNS is not regulated by a saturable mechanism that is sensitive to acute changes in plasma [Ca]i. The proportionality between influx and concentration is suggestive of passive diffusional transport. The brain is protected from acute changes in plasma [Ca]i by the low cerebrovascular permeability to Ca, approximately 5 X 10(-8) cm/s.

Effect of chronic uremia in the rat on cerebral mitochondrial calcium concentrations

Whole cerebral and isolated mitochondrial calcium levels were determined in normal and chronically uremic Sprague-Dawley rats. Uremia was induced by a two-stage 5/6 nephrectomy 4 weeks prior to study. Serum was obtained for urea, calcium, magnesium, phosphate, and i-PTH. Mitochondria were isolated by gradient centrifugation and calcium was determined by flameless atomic absorption spectrophotometry. The results demonstrate that mitochondrial calcium levels in uremic rats are not different from normal (8.0 +/- 2.8 vs. 7.8 +/- 1.8 nmoles/mg protein) despite an 11% increase in whole cerebral calcium concentration (17.3 +/- 2.0 vs. 15.5 +/- 2.8 nmoles/mg protein; P less than 0.005) in 24 severely uremic rats (BUN greater than 18.0 mmoles/liter). Multiple regression analysis demonstrates a significant positive correlation between cerebral calcium concentrations and both serum calcium (P less than 0.005) and serum magnesium levels (P less than 0.005). No relationship was found for urea, serum phosphate, or i-PTH. Similar analysis of mitochondrial calcium concentration demonstrated a significant positive correlation with serum calcium (P less than 0.005) and i-PTH (P less than 0.05) suggesting that increased PTH may be necessary for maintaining normal intracellular calcium levels in uremia. We conclude that uremia in the rat is associated with a small rise in whole cerebral calcium but that intracellular calcium as reflected by mitochondrial levels is not elevated.

Primary hyperparathyroidism is associated with decreased insulin receptor binding and glucose intolerance

We studied insulin receptor-binding and carbohydrate and metabolism in 15 patients with symptomatic primary hyperparathyroidism in comparison with 20 healthy controls. Insulin binding to monocytes and erythrocytes was measured by radioreceptor-ligand-assay. Furthermore, patients and controls were characterized by testing oral (100 g glucose load) glucose tolerance as well as insulin tolerance (0.1U insulin/kg body weight). Compared with controls, patients with primary hyperparathyroidism exhibited marked hyperinsulinemia (P less than 0.01) and significantly higher glucose levels (P less than 0.01) after an oral glucose load. The glucose lowering effect of intravenous insulin was significantly diminished in primary hyperparathyroidism compared with controls (P less than 0.01). Receptor studies revealed a significantly lower (P less than 0.01) insulin binding to monocytes and to erythrocytes in patients with primary hyperparathyroidism compared with controls. The present data indicate an insulin-resistant state in primary hyperparathyroidism, which is caused at least in part, by a downregulation of insulin receptors.

Peripheral insulin resistance in primary hyperparathyroidism

Carbohydrate metabolism was investigated in 9 patients with symptomatic primary hyperparathyroidism. Before and after parathyroidectomy intravenous and oral glucose tolerance test, tolbutamide test, arginine infusion test and insulin tolerance test were performed. During intravenous and oral glucose tolerance tests, patients with primary hyperparathyroidism exhibited hyperinsulinemia and impaired glucose tolerance without normalization after surgery. Tolbutamide-induced induced insulin release did not differ pre- or postoperatively. After restoration of normocalcemia and normocalcemia and normophosphatemia we found significantly lower glucose and insulin levels following arginine infusion and a significantly increased hypoglycemic response to parenterally administered insulin, probably indicating partial improvement of glucose tolerance after surgery. Our findings suggest that biochemical abnormalities associated with primary hyperparathyroidism, like hypercalcemia, hypophosphatemia, and elevated parathyroid hormone levels may cause and sustain a form of endogenous insulin resistance, which consequently leads to hyperinsulinemia and to impaired glucose tolerance. Since hyperinsulinemia as well as impaired glucose tolerance seem to be only slowly and partially reversible in symptomatic primary hyperparathyroidism, these data could be considered as an additional argument for early surgical intervention in this disorder.

Reduction of brain calcium after consumption of diets deficient in calcium or vitamin D

Rats fed diets deficient in calcium or vitamin D for 4 weeks displayed hypocalcemia, as indicated by a 50% reduction in serum calcium and a sevenfold elevation of serum parathyroid hormone. These treatments also decreased the calcium content of brain tissue. On a regional basis, this effect was greatest in the brain stem (24% decrease) and least in striatum (10% decrease). Subcellular analysis indicated that the depletion of brain calcium was greatest in the soluble and the microsomal fractions. Infusion of calcium solutions reversed the depletion of brain calcium produced by dietary deficiencies. In control rats, parathyroidectomy or infusion of parathyroid hormone did not alter the calcium content of brain tissue, although these treatments affected the levels of calcium in the serum. In general, these treatments had no effect on the magnesium content of serum or brain tissue. However, vitamin D deficiency did increase the magnesium content of the myelin and synaptosomal fractions. This increase was reversed by parathyroidectomy. These observations demonstrate that long-term hypocalcemia produces distinct changes in the localization of calcium and magnesium in brain tissue. Furthermore, these studies suggest that though brain calcium levels are influenced by serum concentrations, serum changes must be of large magnitude and long duration for brain calcium levels to be affected.

Calcium metabolism and mental disorder

This is an uncertain, neglected and misunderstood corner of organic psychiatry. Calcium disturbances are clinically the concern of physicians interested in bone diseases, in malabsorption or nutritional deficiencies, and opinions vary on whether such illnesses are accompanied by emotional and behavioural disorder: at least psychiatrists are not usually called in. Parathyroid disease is generally granted to have frequent psychiatric accompaniments (e.g. see Granville-Grossman, 1971) but is very rare in the psychiatric clinic, and possibly under-diagnosed there. Laboratory aids tend to be underused or inadequately applied. Total plasma calcium as a screening test cannot be understood without at least a plasma protein measurement as well; but serum phosphate, parathormone and plasma 1, 25-dihydroxycholecalciferol levels, urinary calcium and magnesium, and Ca45, may all have roles in fuller investigation (Nordin, 1976).

Plasma insulin disturbances in primary hyperparathyroidism

Plasma insulin dynamics were evaluated in 10 patients with primary hyperparathyroidism before and after parathyroidectomy and correction of hypercalcemia. Before surgery fasting plasma insulin concentrations and insulin responses to administered glucose, tolbutamide, and glucagon were significantly greater than postoperative values. Hyperinsulinemia was not associated with altered glucose curves during glucose or glucagon tolerance tests, but a relatively greater insulin response to tolbutamide resulted in an increased hypoglycemic effect following its administration. The glucose-lowering action of intravenous insulin was slightly impaired before treatment. Intramuscular injections of parathormone to six normal men for 8 days induced mild hypercalcemia and hypophosphatemia and reproduced augmented plasma insulin responses to oral glucose and intravenous tolbutamide. 4-hr intravenous infusions of calcium to another group of six normal men raised serum calcium concentrations above 11 mg/100 ml. This did not alter glucose or insulin curves during oral glucose tolerance but markedly accentuated insulin responses to tolbutamide and potentiated its hypoglycemic effect. When highly purified parathormone was incubated with isolated pancreatic islets of male rats, glucose-stimulated insulin secretion was unaffected. These findings suggest that chronic hypercalcemia of hyperparathyroidism sustains a form of endogenous insulin resistance that necessitates augmented insulin secretion to maintain plasma glucose homeostasis. This state is insufficient to oppose tolbutamide-induced hypoglycemia because of an additional direct, selective enhancement of hypercalcemia on pancreatic beta cell responsiveness to the sulfonylurea. The possible direct role of parathormone in these events has not been established.

Calcium metabolism in HeLa cells and the effects of parathyroid hormone

Calcium metabolism was investigated in HeLa cells. 90% of the calcium of the cell monolayer is bound to an extracellular cell coat and can be removed by trypsin-EDTA. The calcium concentration of the naked cell, freed from its coat, is 0.47 mM. The calcium concentration of the medium does not affect the concentration of the naked cell calcium. However, the calcium of the cell coat is proportional to the calcium concentration in the medium. Calcium uptake into the cell coat increases with increasing calcium concentration of the medium, whereas uptake by the naked cell is independent of the calcium of the medium. Anaerobic conditions and metabolic inhibitors do not inhibit calcium uptake by the cell, a fact suggesting that this transfer is a passive phenomenon. The calcium in the extracellular cell coat, was not affected by parathyroid hormone. In contrast, the hormone increased the cellular calcium concentration by stimulating calcium uptake or by enhancing calcium binding to some cell components. These results suggest that, contrary to current thinking, parathyroid hormone influences the cellular calcium balance by mobilizing calcium from the extracellular fluids in order to increase its concentration in some cellular compartment. It is proposed that these effects can enhance calcium transport.

The cellular transport of calcium in rat liver

The bidirectional transport of calcium in rat liver was studied using slices labeled with Ca(47) in a closed two compartment system. Steady-state conditions were observed with influx and efflux transfer coefficients of 0.070 and 0.018 per minute, respectively. The rapidly exchanging cell fraction of calcium existed at a concentration three times higher than the average cell concentration of calcium and occupied cell loci comprising less than 25% of the cell mass, suggesting that calcium associated with the cell membranes, nuclei, and mitochondria participated in the rapidly exchanging fraction. At pH 7.4 and 377deg;C, the influx transfer coefficient was 25% above the steady-state condition and accumulation of calcium by the slices occurred. Studies of the effects of varied physical and chemical conditions revealed that the influx transfer coefficient was increased by elevated pH, strontium, certain metabolic inhibitors, and 2 mM concentrations of cyclic adenosinemonophosphate and adenosinetriphosphate. The influx transfer coefficient was decreased by reduced temperature, decreased pH, magnesium, and 10 mM adenosinetriphosphate. The efflux transfer coefficient was increased by elevated pH, strontium, iodoacetate, and adenosinetriphosphate, and was decreased by reduced temperature and by N-ethylmaleimide. These data support the thesis that cell transport of calcium is accomplished by the attachment of calcium atoms to the cell surface and transport through the plasma membrane bound to either specific carriers or to membrane constituents. Conditions which change the affinities, capacities, and mobilities of plasma membrane ligands that bind calcium or cause extracellular chelation of calcium are capable of altering the rate of calcium transport.