The Potential Effect of General Anesthetics in Cancer Surgery: Meta-Analysis of Postoperative Metastasis and Inflammatory Cytokines

Metastasis or recurrence following curative surgery is the main indicator of tumor progress and is the main cause of patient death. For more than three decades, the potential for general anesthesia to affect cancer outcomes has been a subject of concern with considerable research interest. Here, we conducted this systematic review and meta-analysis to summarize the effect of inhalational anesthesia (IHNA) vs. propofol-based total intravenous anesthesia (TIVA) on metastasis and recurrence after cancer surgery from clinical and pre-clinical studies. The relative risk for metastasis/recurrence in TIVA is 0.61 (95% confidence interval (95% CI) 0.46 to 0.82, p = 0.0009) compared to IHNA. Inflammatory cytokines have been implicated in cancer metastasis following cancer surgery, thus we analyzed inflammatory cytokines levels after surgery under IHNA or TIVA. Based on pooled analysis, a lower IL-6 level was noticed in TIVA in comparison to IHNA (standardized mean difference (SMD) = 0.77, 95% CI = 0.097 to 1.44, I² = 92%, p = 0.02) but not TNF-α or IL-10. Preclinical animal model studies show that inhalational anesthetics increase the risk of breast cancer metastasis compared to propofol. In conclusion, the current evidence suggests intravenous anesthetic propofol is associated with less metastasis/recurrence and lower postoperative IL-6 level over inhaled anesthetics in the oncological surgery. We urge more well-designed clinical and preclinical studies in this field.

A pan-cancer-bioinformatic-based literature review of TRPM7 in cancers

TRPM7, a divalent cation-selective channel with kinase domains, has been widely reported to potentially affect cancers. In this study, we conducted multiple bioinformatic analyses based on open databases and reviewed articles that provided evidence for the effects of TRPM7 on cancers. The purposes of this paper are 1) to provide a pan-cancer overview of TRPM7 in cancers; 2) to summarize evidence of TRPM7 effects on cancers; 3) to identify potential future studies of TRPM7 in cancer. Bioinformatics analysis revealed that no cancer-related TRPM7 mutation was found. TRPM7 is aberrantly expressed in most cancer types but the cancer-noncancer expression pattern varies across cancer types. TRPM7 was not associated with survival, TMB, or cancer stemness in most cancer types. TRPM7 affected drug sensitivity and tumor immunity in some cancer types. The in vitro evidence, preclinical in vivo evidence, and clinical evidence for TRPM7 effects on cancers as well as TRPM7 kinase substrate and TRPM7-targeting drugs associated with cancers were summarized to facilitate comparison. We matched the bioinformatics evidence to literature evidence, thereby unveiling potential avenues for future investigation of TRPM7 in cancers. We believe that this paper will help orient research toward important and relevant aspects of the role of TRPM7 in cancers.

Increased lung metastasis with sevoflurane in breast cancer surgery is associated with VEGF and elevated vascular permeability by VEGF in a mouse model of human breast cancer

e13060

Background: An on-going controversy is whether general anesthetics used in cancer surgery substantially influence the outcome of cancer patients. Thousands of cancer patients undergo surgery with hope of cure. However, postoperative metastasis remains a deadly disease that affects millions of lives, even with all the recent therapeutic advancements. Anesthesia is required for surgical resection of solid tumors and we have shown that general anesthetics substantially influences the process of breast cancer lung metastasis through increasing pulmonary permeability in animal models. Our previous study demonstrates that inhaled anesthetic sevoflurane used during resecting primary breast tumors promotes lung metastasis via IL6 pathway in syngeneic model of murine 4T1 breast cancer cells, compared with an intravenous anesthetic propofol. Methods: Xenograft model of human MDA-MB 231 breast cancer of spontaneous metastasis was utilized in this study to evaluate the effect of commonly used general anesthetics including sevoflurane and propofol on breast cancer lung metastasis and explore the potential mechanism. Results: In this study we show that the metastatic promoting effect of sevoflurane is associated with elevated secretion of VEGF and increased vascular permeability in xenograft model of human MDA-MB 231 breast cancer of spontaneous metastasis. Cytokine array profiling reveals that the mice receiving sevoflurane have increased levels of pro-angiogenic factor VEGF in serum and lung tissues. Sevoflurane enhances the expression level of VEGFR on HUVEC cells. Furthermore, sevoflurane disrupts endothelial monolayer in vitro and elevates pulmonary vascular permeability in vivo. The sevoflurane-promoted breast cancer lung metastasis is reversed by DC101, an antibody targeting mouse VEGFR-2. Conclusions: Our results show that the inhaled anesthetic sevoflurane during surgical removal of primary tumor alter the course of metastasis through regulating secretion of VEGF and associated vascular remodeling. The mechanistic study of general anesthetics on cancer cell metastasis establishes the causal link and could provide the potential therapeutic intervention and guide the clinical trials.

Lidocaine Suppresses Viability and Migration of Human Breast Cancer Cells: TRPM7 as a Target for Some Breast Cancer Cell Lines

Simple Summary

The local anesthetic lidocaine suppresses some cancer cell lines but the mechanism is unclear. Melastatin-like transient receptor potential 7 (TRPM7) ion channels play a role in cancer and may be a target for lidocaine. The aim of our study is to test the hypothesis that lidocaine affects the viability and migration of breast cancer cells by regulating TRPM7. We conducted several assays to measure viability, migration, and TRPM7 function in the presence of lidocaine. Our results showed that (a) lidocaine suppresses viability and migration of six types of breast cancer cells, but with different potency; (b) TRPM7 plays a role in mediating the effects of lidocaine on viability and migration of at least four of these breast cancer cell types. Our work contributes to the understanding of the effect of lidocaine on breast cancer cells and helps guide its potential clinical application in the surgical treatment of breast tumors.

Abstract

Background: The local anesthetic lidocaine suppresses some cancer cell lines but the mechanism is unclear. The melastatin-like transient receptor potential 7 (TRPM7) ion channel is aberrantly expressed in some cancers and may play a role in the disease. Hence, we suggested that lidocaine affects the viability and migration of breast cancer cells by regulating TRPM7. Methods: We measured the effects of lidocaine on TRPM7 function in HEK293 with exogenous TRPM7 expression (HEK-M7) using whole-cell patch-clamp and fura-2AM-based quench assay. We measured the effect of lidocaine on TRPM7 function, cell viability, and migration in TRPM7 expressing human breast cancer cell lines using fura-2AM-based quench, MTT, and wound-healing assays respectively. We compared cell viability and migration of wild type HEK293 cells (WT-HEK) with HEK-M7 and wild type MDA-MB-231 (WT-231) with TRPM7 knockout MDA-MB-231 (KO-231). Results: Lidocaine (1–3 mM) inhibited the viability and migration of all of these breast cancer cell lines. Functional evidence for TRPM7 was confirmed in the MDA-MB-231, AU565, T47D, and MDA-MB-468 cell lines where lidocaine at 0.3–3 mM suppressed the TRPM7 function. Lidocaine preferentially suppressed viability and migration of HEK-M7 over WT-HEK and WT-231 over KO-231. Conclusions: Lidocaine differentially reduced the viability and migration of human breast cancer cell lines tested. TRPM7 is one of the potential targets for the effects of lidocaine on viability and migration in MDA-MB-231, AU565, T47D, and MDA-MB-468.

Effects of local anesthetics on cancer cells

Local anesthetics are widely used during clinical cancer surgeries. Studies have suggested that the use and the type of anesthesia affect cancer outcomes. In vivo studies and clinical data show that the use of local anesthetics is potentially beneficial for cancer treatment. However, the effect of the use of local anesthetics on the survival rate of cancer patients following surgery is controversial and, so far, little is known about the direct effects of local anesthetics on cancer cells. This work reviews and summarizes the published literature regarding the preclinical research methods and findings on the influence of local anesthetics on cancer cells. We hope that a thorough understanding of this subject will help to define optimal anesthetic regimens that lead to better outcomes for clinical cancer patients.

The Role of Transient Receptor Potential Melastatin 7 (TRPM7) in Cell Viability: A Potential Target to Suppress Breast Cancer Cell Cycle

The divalent cation-selective channel transient receptor potential melastatin 7 (TRPM7) channel was shown to affect the proliferation of some types of cancer cell. However, the function of TRPM7 in the viability of breast cancer cells remains unclear. Here we show that TRPM inhibitors suppressed the viability of TRPM7-expressing breast cancer cells. We first demonstrated that the TRPM7 inhibitors 2-aminoethyl diphenylborinate (2-APB), ginsenoside Rd (Gin Rd), and waixenicin A preferentially suppressed the viability of human embryonic kidney HEK293 overexpressing TRPM7 (HEK-M7) cells over wildtype HEK293 (WT-HEK). Next, we confirmed the effects of 2-APB on the TRPM7 channel functions by whole-cell currents and divalent cation influx. The inhibition of the viability of HEK-M7 cells by 2-APB was not mediated by the increase in cell death but by the interruption of the cell cycle. Similar to HEK-M7 cells, the viability of TRPM7-expressing human breast cancer MDA-MB-231, AU565, and T47D cells were also suppressed by 2-APB by arresting the cell cycle in the S phase. Furthermore, in a novel TRPM7 knock-out MDA-MB-231 (KO-231) cell line, decreased divalent influx and reduced proliferation were observed compared to the wildtype MDA-MB-231 cells. 2-APB and Gin Rd preferentially suppressed the viability of wildtype MDA-MB-231 cells over KO-231 by affecting the cell cycle in wildtype but not KO-231 cells. Our results suggest that TRPM7 regulates the cell cycle of breast cancers and is a potential therapeutic target.

Effect of Propofol on breast Cancer cell, the immune system, and patient outcome

Breast cancer is the second leading cause of cancer death in women. Surgery is the first line of treatment for breast cancer. Retrospective clinical studies suggest that the type of anesthesia administered during oncological surgery may influence patient outcome. Propofol, the widely used intravenous anesthetic agent, may lead to better outcomes compared to volatile anesthetics. Here we review the literature on the effect of propofol in breast cancer cells, the immune system, pain management, and patient outcomes. Evidence from the study of breast cancer cell lines suggests that high concentrations of propofol have both anti-tumor and pro-tumor effects. Propofol and volatile anesthetics have different effects on the immune system. Propofol has also been shown to reduce the development and severity of acute and chronic pain following surgery. Although a retrospective study that included many types of cancer indicated that propofol increases the long-term survival of patients following surgery, the evidence for this in breast cancer is weak. It has been shown that Propofol combined with paravertebral block led to change of serum composition that affects the breast cancer cell behaviors and natural killer cell activity. Prospective studies are in progress and will be finished within 5 years. The existing evidence is not sufficient to warrant changes to current anesthetic management. Further research is needed to clarify the mechanisms by which propofol affects cancer cells and the immune system.

Effects of local anesthetics on breast cancer cell viability and migration

Background

Breast cancer accounts for nearly a quarter of all cancers in women worldwide, and more than 90% of women diagnosed with breast cancer undergo mastectomy or breast-conserving surgery. Retrospective clinical studies have suggested that use of regional anesthesia leads to improved patient outcomes. Laboratory studies have reported that breast cancer cells are inhibited by some local anesthetics at millimolar concentration. Here, we present a comprehensive analysis of the effects of six common local anesthetics on two human breast cancer cell lines. We used concentrations ranging from those corresponding to plasma levels during regional block by local anesthetic (plasma concentration) to those corresponding to direct infiltration of local anesthetic.

Methods

Human breast cancer cell lines, MDA-MB-231 and MCF7, were incubated with each of six local anesthetics (lidocaine, mepivacaine, ropivacaine, bupivacaine, levobupivacaine, and chloroprocaine) (10 μM ~ 10 mM) for 6 to 72 h. Assays for cell viability, cytotoxicity, migration, and cell cycle were performed.

Results

High concentrations (> 1 mM) of local anesthetics applied to either MDA-MB-231 or MCF7 cells for 48 h significantly inhibited cell viability and induced cytotoxicity. At plasma concentrations (~ 10 μM) for 72 h, none of the local anesthetics affected cell viability or migration in either cell line. However, at 10 × plasma concentrations, 72-h exposure to bupivacaine, levobupivacaine or chloroprocaine inhibited the viability of MDA-MB-231 cells by > 40% (p < 0.001). Levobupivacaine also inhibited the viability of MCF7 cells by 50% (p < 0.001). None of the local anesthetics affected the viability of a non-cancerous breast cell line, MCF10A. MDA-MB-231 cell migration was inhibited by 10 × plasma concentrations of levobupivacaine, ropivacaine or chloroprocaine and MCF7 cell migration was inhibited by mepivacaine and levobupivacaine (p < 0.05). Cell cycle analysis showed that the local anesthetics arrest MDA-MB-231 cells in the S phase at both 1 × and 10 × plasma concentrations.

Conclusions

Local anesthetics at high concentrations significantly inhibited breast cancer cell survival. At 10 × plasma concentrations, the effect of local anesthetics on cancer cell viability and migration depended on the exposure time, specific local anesthetic, specific measurement endpoint and specific cell line.

Neuroprotective effect of lidocaine: is there clinical potential?

Local anesthetic lidocaine has been shown to be protective in animal models of focal and global ischemia as well as in in vitro hypoxic models. Lidocaine has been tested in patients for its potential protective effect on postoperative cognitive dysfunction. This mini-review summarizes the laboratory and clinical evidences and discusses its clinical applications as neuroprotective agent.

Biophysical Properties of Kv3.1 Channels in SH-SY5Y Human Neuroblastoma Cells

Biophysical properties of delayed rectifier K channels in the human neuroblastoma SH-SY5Y were established using patch clamp recordings. The whole cell K+ conductance activated at membrane potentials positive to -20 mV. The midpoint of current activation was 9.6 +/- 5.1 mV, the equivalent charge was 3.7 +/-.6. Whole-cell currents inactivated slightly with time constants of 700 ms and 5 s. The K+ currents were sensitive to micromolar concentrations of TEA and 4-aminopyridine. RT-PCR experiments amplified a cDNA fragment specific for human Kv3.1 channels. Activation gating parameters in outside-out patches were shifted by approximately 14 mV in the hyperpolarizing direction.

Monte Carlo simulation of buffered diffusion into and out of a model synapse

Buffered diffusion occurs when ligands enter or leave a restricted space, such as a chemical synapse, containing a high density of binding sites. This study used Monte Carlo simulations to determine the time and spatial dependences of buffered diffusion without a priori assumptions about kinetics. The synapse was modeled as a box with receptors on one inner face. The exterior was clamped to some ligand concentration and ligands diffused through two sides. Onset and recovery simulations were carried out and the effects of receptor density, ligand properties and synapse geometry were investigated. This study determined equilibration times for binding and the spatial gradient of unliganded receptors. Onset was characterized by a high spatial gradient; equilibration was limited by the time needed for sufficient ligands to enter the synapse. Recovery showed a low spatial gradient with receptor equilibration limited by ligand rebinding. Decreasing ligand association rate or increasing ligand diffusion coefficient reduced the role of buffered diffusion and decreased the spatial gradient. Simulations with irreversible ligands showed larger, persistent spatial gradients. These simulations identify characteristics that can be used to test whether a synaptic process is governed by buffered diffusion. They also indicate that fundamental differences in synapse function may occur with irreversible ligands.

The local anaesthetics proadifen and adiphenine inhibit nicotinic receptors by different molecular mechanisms

BACKGROUND AND PURPOSE

Many local anaesthetics are non-competitive inhibitors of nicotinic receptors (acetylcholine receptor, AChR). Proadifen induces a high-affinity state of the receptor, but its mechanism of action and that of an analogue, adiphenine, is unknown.

EXPERIMENTAL APPROACH

We measured the effects of proadifen and adiphenine on single-channel and macroscopic currents of adult mouse muscle AChR (wild-type and mutant). We assessed the results in terms of mechanisms and sites of action.

KEY RESULTS

Both proadifen and adiphenine decreased the frequency of ACh-induced single-channel currents. Proadifen did not change cluster properties, but adiphenine decreased cluster duration (36-fold at 100 micromolxL(-1)). Preincubation with proadifen decreased the amplitude (IC(50)= 19 micromolxL(-1)) without changing the decay rate of macroscopic currents. In contrast, adiphenine did not change amplitude but increased the decay rate (IC(50)= 15 micromolxL(-1)). Kinetic measurements demonstrate that proadifen acts on the resting state to induce a desensitized state whose kinetics of recovery resemble those of ACh-induced desensitization. Adiphenine accelerates desensitization from the open state, but previous application of the drug to resting receptors is required. Both drugs stabilize desensitized states, as evidenced by the decrease in the number of clusters elicited by high ACh concentrations. The inhibition by adiphenine is not affected by proadifen, and the mutation alphaE262K decreases the sensitivity of the AChR only for adiphenine, indicating that these drugs act at different sites.

CONCLUSIONS AND IMPLICATIONS

Two analogous local anaesthetics bind to different sites and inhibit AChR activity via different mechanisms and conformational states. These results provide new information on drug modulation of AChR.

Site selectivity of competitive antagonists for the mouse adult muscle nicotinic acetylcholine receptor

The muscle-type nicotinic acetylcholine receptor has two nonidentical binding sites for ligands. The selectivity of acetylcholine and the competitive antagonists (+)-tubocurarine and metocurine for adult mouse receptors is known. Here, we examine the site selectivity for four other competitive antagonists: cisatracurium, pancuronium, vecuronium, and rocuronium. We rapidly applied acetylcholine to outside-out patches from transfected BOSC23 cells and measured macroscopic currents. We have reported the IC(50) of the antagonists individually in prior publications. Here, we determined inhibition by pairs of competitive antagonists. At least one antagonist was present at a concentration producing > or =67% receptor inhibition. Metocurine shifted the apparent IC(50) of (+)-tubocurarine in quantitative agreement with complete competitive antagonism. The same was observed for pancuronium competing with vecuronium. However, pancuronium and vecuronium each shifted the apparent IC(50) of (+)-tubocurarine less than expected for complete competition but more than expected for independent binding. The situation was similar for cisatracurium and (+)-tubocurarine or metocurine. Cisatracurium did not shift the apparent IC(50) of pancuronium or vecuronium, indicating independent binding of these two pairs. The data were fit to a two-site, two-antagonist model to determine the antagonist binding constants for each site, L(alphaepsilon) and L(alphadelta). We found L(alphaepsilon)/L(alphadelta) = 0.22 (range, 0.14-0.34), 20 (9-29), 21 (4-36), and 1.5 (0.3-2.9) for cisatracurium, pancuronium, vecuronium, and rocuronium, respectively. The wide range of L(alphaepsilon)/L(alphadelta) for some antagonists may reflect experimental uncertainties in the low affinity site, relatively poor selectivity (rocuronium), or possibly that the binding of an antagonist at one site affects the affinity of the second site.

Synergy between pairs of competitive antagonists at adult human muscle acetylcholine receptors

BACKGROUND

Synergistic neuromuscular blocking effects have been observed clinically with certain pairs of nicotinic acetylcholine receptor (nAChR) competitive antagonists. The mechanism for synergy has not been elucidated. We tested the hypothesis that synergy arises from a differential selectivity of antagonists for the two ligand binding sites on adult human nAChR.

METHODS

We expressed nAChR in BOSC23 cells. We applied ACh with or without antagonists to outside-out patches and measured macroscopic currents at room temperature. We determined the IC(90) for (+)-tubocurarine, metocurine, pancuronium, vecuronium, cisatracurium, rocuronium, and atracurium. For 15 combinations of two antagonists, we determined the IC(90) for one antagonist in the presence of the IC(70) of a second antagonist. We constructed isobolograms for 90% inhibition. For single antagonists, we measured inhibition of receptors containing mutations in the epsilon- and delta-subunits to determine site selectivity.

RESULTS

Two pairs of antagonists, metocurine+cisatracurium and cisatracurium+ atracurium exhibited additive inhibition. Ten combinations, including (+)-tubocurarine+ pancuronium and pancuronium+vecuronium, were highly synergistic such that the combination was two to three times more effective than expected for additivity. Three combinations were 1.5-1.6 times more effective than expected for additivity. Inhibition by (+)-tubocurarine and metocurine was sensitive to mutations in the epsilon-subunit only. Vecuronium was affected by the delta-subunit mutation only. Inhibition by other antagonists was decreased by mutations in either subunit.

CONCLUSIONS

Many combinations of antagonists exhibited synergistic effects on adult human nAChR. Synergy was observed with structurally similar and dissimilar antagonists. The degree of synergy did not always correlate well with site specificity assayed with mutants. In some, but not all cases, the synergy at the receptor level correlated with clinical determinations of synergy. We conclude that the synergistic actions of muscle relaxants can be partially explained by direct interactions with adult human nAChR.

The kinetics of competitive antagonism of nicotinic acetylcholine receptors at physiological temperature

Detailed information about the ligand-binding site of nicotinic acetylcholine receptors has emerged from structural and mutagenesis experiments. However, these approaches provide only static images of ligand-receptor interactions. Kinetic measurements of changes in protein function are needed to develop a more dynamic picture. Previously, we measured association and dissociation rate constants for competitive inhibition of current through embryonic muscle acetylcholine receptor channels at 25 degrees C. Little is known about competitive antagonism at physiological temperatures. Here, we performed measurements at 37 degrees C and used thermodynamics to estimate the energetics of antagonism. We used rapid solution exchange protocols to determine equilibrium and kinetics of inhibition of acetylcholine-activated currents in outside-out patches by (+)-tubocurarine, pancuronium and cisatracurium. Kinetic rates as high as 600 s(-1) were resolved by this technique. Binding was primarily enthalpy driven. The 12 degrees C increase in temperature decreased equilibrium antagonist binding by 1.7- to 1.9-fold. In contrast, association and dissociation rate constants increased 1.9- to 6.0-fold. Activation energies for dissociation were 90 +/- 6, 106 +/- 8 and 116 +/- 10 kJ mol(-1) for cisatracurium, (+)-tubocurarine and pancuronium, respectively. The corresponding apparent activation energies for association were 38 +/- 6, 85 +/- 6 and 107 +/- 13 kJ mol(-1). The higher activation energy for association of (+)-tubocurarine and pancuronium compared with cisatracurium is notable. This may arise from either a more superficial binding site for the large antagonist cisatracurium compared to the other ligands, or from a change in receptor conformation upon binding of (+)-tubocurarine and pancuronium but not cisatracurium. Differences in ligand desolvation and ligand conformation are not likely to be important.

Roles of amino acids and subunits in determining the inhibition of nicotinic acetylcholine receptors by competitive antagonists

BACKGROUND

Binding sites for agonists and competitive antagonists (nondepolarizing neuromuscular blocking agents) are located at the alpha-delta and alpha-epsilon subunit interfaces of adult nicotinic acetylcholine receptors. Most information about the amino acids that participate in antagonist binding comes from binding studies with (+)-tubocurarine and metocurine. These bind selectively to the alpha-epsilon interface but are differentially sensitive to mutations. To test the generality of this observation, the authors measured current inhibition by five competitive antagonists on wild-type and mutant acetylcholine receptors.

METHODS

HEK293 cells were transfected with wild-type or mutant (alphaY198F, epsilonD59A, epsilonD59N, epsilonD173A, epsilonD173N, deltaD180K) mouse muscle acetylcholine receptor complementary DNA. Outside-out patches were excised and perfused with acetylcholine in the absence and presence of antagonist. Concentration-response curves were constructed to determine antagonist IC50. An antagonist-removal protocol was used to determine dissociation and association rates.

RESULTS

Effects of mutations were antagonist specific. alphaY198F decreased the IC50 of (+)-tubocurarine 10-fold, increased the IC50 of vecuronium 5-fold, and had smaller effects on other antagonists. (+)-Tubocurarine was the most sensitive antagonist to epsilonD173 mutations. epsilonD59 mutations had large effects on metocurine and cisatracurium. deltaD180K decreased inhibition by pancuronium, vecuronium, and cisatracurium. Inhibition by these antagonists was increased for receptors containing two delta subunits but no epsilon subunit. Differences in IC50 arose from differences in both dissociation and association rates.

CONCLUSION

Competitive antagonists exhibited different patterns of sensitivity to mutations. Except for pancuronium, the antagonists were sensitive to mutations at the alpha-epsilon interface. Pancuronium, vecuronium, and cisatracurium were selective for the alpha-delta interface. This suggests the possibility of synergistic inhibition by pairs of antagonists.

From individual to population: the minimum alveolar concentration curve

PURPOSE OF REVIEW

The concept of minimum alveolar concentration is central to the study of inhalational anesthetics. The minimum alveolar concentration curve is a population concentration-response curve that describes the relationship between anesthetic concentration and oblation of the movement response to painful stimuli. Two features of the minimum alveolar concentration curve, the anesthetic concentration that immobilizes 50% of patients and the steep slope of the curve, may contain useful mechanistic information. There is some dispute, however, about the interpretation of this information. This review examines hypotheses about the shape of the minimum alveolar concentration curve, and recent theoretical and experimental approaches to the question.

RECENT FINDINGS

The major determining factor for the slope of a quantal, population concentration-response curve is individual variability. The slope of the underlying in-vitro concentration-response curves contributes as well. At the molecular level, in-vitro curves are not steep. The integration of molecular signals that occurs in cells and neuronal circuits can result in steep in-vitro curves, due to multiple molecular targets, amplification and co-operativity.

SUMMARY

The shape of the minimum alveolar concentration curve has not provided any unambiguous clues about the sites or mechanisms of general anesthesia; however, the universality of anesthetic-induced immobility suggests some future research directions.

Informed consent for labor epidurals: a survey of Society for Obstetric Anesthesia and Perinatology anesthesiologists from the United States

BACKGROUND

Ethicists agree that informed consent is a process rather than just simply the signing of a form. It should provide the patient with needed information and understanding to authorize a procedure. Essential elements of informed consent for women requesting labor epidurals include a description of the procedure, the risks and benefits, and alternative treatments for analgesia including the associated risks and benefits. The purpose of this pilot study was to determine practices and opinions of obstetric anesthesiologists regarding informed consent for parturients.

METHODS

Questionnaires were sent to 885 anesthesiologists who were members of the Society of Obstetric Anesthesia and Perinatology based in United States institutions in 2002.

RESULTS

Of the 885 questionnaires sent, 448 (51%) were returned with 47% from academic and 47% from private practice institutions. Forty-six percent worked as part of an obstetric anesthesia team; 51% worked in centers where there were >3000 deliveries/year. Sixty-eight percent suggested that "parturients in active labor are able to give informed consent for labor epidural analgesia." Thirteen percent recommend antenatal anesthesia consults for parturients inquiring about labor epidurals and 41% participated in childbirth classes. Responses did not differ significantly between physicians in academic vs. private practice. More obstetric team practices than non-team practices participated in childbirth education (54% vs. 30%, P < 0.0001).

CONCLUSION

Despite the painful, stressful circumstances confronted by parturients, many respondents (76% in academic, 64% in private practice) thought that women in active labor are able to give informed consent.

The effects of general anaesthetics on ligand-gated ion channels

The experimental effort that has been expended in investigating the effects of general anaesthetics on LGICs has been enormous over the past decade. Members of all three LGIC superfamilies have been examined using electrophysiological techniques. Anaesthetics that have been examined include volatile anaesthetics, gaseous anaesthetics, alcohols, i.v. anaesthetics and non-immobilizers. Obsolete anaesthetics (ether, cyclopropane, butane) have been used in order to increase the variability of the structure and polarity of experimental compounds. The tools of molecular biology have been used to make chimeric receptors and to make single-site mutations. Interestingly, this work has been taking place in parallel with efforts to understand the structure of these proteins. Anaesthetic research often stimulates structural research as well as vice versa. There are some common themes in the interactions between anaesthetics and the three superfamilies of LGICs. In many cases, anaesthetics have both inhibitory and potentiating effects on the channels. It is likely that the number of examples of this will increase when experiments are designed to look specifically for one or the other type of effect. So we must conclude that there are multiple binding sites for anaesthetics on LGICs. The degree of inhibition or potentiation is not easily predictable. In retrospect, this is not surprising when we consider that the sensitivity of a channel to anaesthetics can be altered by a single amino-acid mutation. The large structural differences between the cys-loop, glutamate-activated and P2X superfamilies do not lead to large differences in anaesthetic sensitivity. It is the smaller, almost insignificant, changes that do this. This observation that small changes may lead to large effects reinforces the idea that at least some of the interactions between anaesthetics and LGICs are direct drug-protein interactions that are not mediated by the lipids. This review has not addressed the question of whether the effects of anaesthetics seen on LGICs are relevant to anaesthesia. This question cannot really be answered at present. Although potent effects can be observed on the channels themselves, we have only begun to try to understand whether these effects are important for a synapse, a neuronal circuit or the function of an animal's nervous system. We have studied the trees; now we must go on to study the forest and the ecosystem.

The kinetics of inhibition of nicotinic acetylcholine receptors by (+)-tubocurarine and pancuronium

Equilibrium conditions of neurotransmitter concentration and receptor binding are never achieved during synaptic transmission at the neuromuscular junction. Thus, it is important to determine the binding kinetics of drugs that act this synapse. Previous determinations of the dissociation rate of (+)-tubocurarine have produced inconsistent results ranging from 0.1 to 4000/s. Here, we used a direct approach to measure association (l(on)) and dissociation (l(on)) rates for two competitive antagonists (clinically used as nondepolarizing muscle relaxants), pancuronium and (+)-tubocurarine, at nicotinic acetylcholine receptors (nAChR). We made macroscopic current recordings from outside-out patches of BC3H-1 cells expressing embryonic mouse muscle nAChR. We used a three-tube rapid perfusion system to make timed applications of antagonists and acetylcholine to the patch. We made independent measurements of the equilibrium inhibition (IC(50)) and the kinetics of onset and recovery of antagonist inhibition at 20 to 23 degrees C. Rate constants were calculated from the predictions of a single (high-affinity) site model of competitive inhibition. For pancuronium: IC(50) = 5.5 +/- 0.5 nM (mean +/- S.D.), l(on) = 2.7 +/- 0.9 x 10(8) M(-1) s(-1), l(off) = 2.1 +/- 0.7/s [corrected] x 10(8)/s. For (+)-tubocurarine: IC(50) = 41 +/- 2 nM, l(on) = 1.2 +/- 0.2 x 10(8) M(-1) s(-1), l(off) = 5.9 +/- 1.3/s. The kinetic results are consistent with the equilibrium results in that l(off)/l(on) is in good agreement with the IC(50) values. All differences between the antagonists are significant at the p < 0.001 level. The higher affinity of pancuronium is caused by a faster association rate (2.2-fold) coupled with a slower dissociation rate (2.8-fold). The association rates of both antagonists are comparable with or greater than the association rate for acetylcholine binding to nAChR.

The kinetics of competitive antagonism by cisatracurium of embryonic and adult nicotinic acetylcholine receptors

Competitive antagonists to nicotinic acetylcholine receptors are clinically used as muscle relaxants. Previously, we reported the kinetics of inhibition (in the absence of acetylcholine) by (+)-tubocurarine and pancuronium on embryonic receptors. Here, we examine cisatracurium, a commonly used muscle relaxant. Outside-out patches were equilibrated with cisatracurium before application of 300 microM acetylcholine. cisatracurium inhibited the initial peak current, but the decay of these currents displayed a pronounced biphasic behavior. The IC(50) value was 54 +/- 2 nM and 115 +/- 4 nM for adult and embryonic receptors, respectively. We designed a rapid perfusion system to apply or remove cisatracurium for various times before application of acetylcholine. We determined the association (embryonic, 3.4 +/- 0.4 x 10(8) M(-1) s(-1); adult, 1.8 +/- 0.3 x 10(8) M(-1) s(-1)) and dissociation (embryonic, 34 +/- 6/s; adult: 13 +/- 5/s) rates for cisatracurium. Association was 2.9- and 1.3-fold greater than that of (+)-tubocurarine and pancuronium, respectively. Dissociation was 6- and 16-fold higher than (+)-tubocurarine and pancuronium, respectively. These measurements correspond to dissociation of cisatracurium from receptors in the absence of acetylcholine. Physiologically, acetylcholine interacts with receptors equilibrated with antagonist. We developed a mathematical technique that removes the effect of desensitization and determined dissociation (embryonic, 52 +/- 9/s; adult, 33 +/- 5/s) in the presence of acetylcholine. These data suggest that presence of acetylcholine on one binding site of the receptor increases the dissociation rate of antagonist from the other binding site. We incorporated all of these rates into a computer simulation of a comprehensive 11-state Markov model. There was excellent agreement (without curve fitting) between simulated and experimental currents.

The Effects of isoflurane on acetylcholine receptor channels: 3. Effects of conservative polar-to-nonpolar mutations within the channel pore

We performed macroscopic and single-channel current measurements on wild-type (WT) and two mutant muscle-type nicotinic acetylcholine (ACh) receptor channels transiently expressed in HEK-293 cells. The mutants contained polar-to-nonpolar substitutions at the 10' (alpha(2)S10'A beta T10'A gamma delta) and 6' positions (alpha(2)S6'A beta gamma delta S6'A) in the M2 pore region of the channel. We studied the behavior of these channels in the absence and presence of the volatile general anesthetic isoflurane. Both mutations changed the gating behavior of the channel. A comparison of the alpha(2)S10'A beta T10'A gamma delta mutant to WT receptors revealed faster desensitization kinetics, increased sensitivity to ACh, a higher efficacy for activation by the partial nicotinic agonist decamethonium, and a greater number of openings per burst. A comparison of the alpha(2)S6'A beta gamma delta S6'A mutant to WT receptors also revealed increased sensitivity to ACh and an increased burst duration at the single-channel level with ACh as agonist. The alpha(2)S10'A beta T10'A gamma delta mutation increased the sensitivity of the ACh receptor to isoflurane, whereas the alpha(2)S6'A beta gamma delta S6'A mutation did not. These changes were probably not caused by the differential effects of the mutation on channel gating and desensitization. The increased sensitivity of the alpha(2)S10'A beta T10'A gamma delta receptor to isoflurane is state-dependent; the mutation changes the affinity of the closed state but not that of the open state of the channel.

The noncompetitive inhibitor quinacrine modifies the desensitization kinetics of muscle acetylcholine receptors

Quinacrine has been shown to act as a noncompetitive inhibitor of the nicotinic acetylcholine receptor (nAChR). However, its mechanism of action is still a matter of controversy. We analyzed in detail the action of quinacrine at both the single-channel and macroscopic current levels. The main effect of quinacrine is a profound concentration-dependent decrease in both the frequency of opening events and the duration of clusters elicited by high acetylcholine concentrations. Quinacrine also significantly increases (40-fold at 30 microM) the decay rate of macroscopic currents elicited by rapid perfusion of acetylcholine to outside-out patches. This decay is still well-described by a single exponential. Quinacrine has very little effect on the peak amplitude of the response, suggesting that it acts mainly on open channels. The recovery from desensitization after removal of acetylcholine is delayed in the presence of quinacrine. Results from both single-channel and macroscopic current recordings indicate that quinacrine increases the rate of nAChR desensitization and stabilizes the desensitized state. Interestingly, in equilibrium agonist-binding assays, quinacrine does not promote the typical high-affinity desensitized state. Thus, quinacrine seems to induce an intermediate state exhibiting the permeability but not the agonist binding properties of desensitization.

Inhibition of 5-HT3 receptors by propofol: equilibrium and kinetic measurements

Patch-clamp/rapid solution exchange experiments as well as tracer ([14C]-guanidinium) influx measurements were applied to investigate effects of propofol on 5-HT3 receptor channels and compare the results with those obtained with pentobarbital. Currents induced by 30 microM 5-HT were recorded in outside-out patches from N1E-115 cells. Application of propofol 45 s before and during 5-HT application inhibited peak-currents and integrated current responses in a concentration-dependent manner (IC50 values=14.5 and 10.5 microM; Hill coefficients -1.5 and -1.3, respectively). The inhibitory effect of propofol in the current measurements was similar to the propofol-induced inhibition in tracer influx experiments in whole N1E-115 cells (Barann et al., 1993. Naunyn-Schmiedeberg's Archives of Pharmacology 347, 125-132). Pentobarbital-induced inhibition of 5-HT3 receptors in both patch-clamp (Barann et al., 1997. Neuropharmacology 36, 655-664) and tracer influx measurements indicated a lower potency and lower slope (IC50 values=130 and 55 microM; Hill coefficients -0.8 and -0.7, respectively) compared to propofol. Propofol, in contrast to pentobarbital, showed nearly the full potency when applied to the patches exclusively 45 s before 5-HT. Propofol was least effective when administered exclusively during 5-HT. The onset of inhibition of 5-HT-induced peak currents by propofol had a time constant of 220 ms, similar to the kinetics of 5-HT-induced desensitization.

Interactions of general anesthetics within the pore of an ion channel

(1) We review the electrophysiological evidence that the ion channel pore is the site at which general anesthetics bind to inhibit muscle-type acetylcholine receptor channels. (2) The amphipathic character of a pore certainly offers a suitable environment for the binding of amphipathic anesthetics. (3) The absence of direct information about the binding sites of these rather non-specific drugs, forces us to rely on indirect information provided by kinetic experiments. (4) We also discuss the implications of these findings for the interaction of general anesthetics with other ion channels.

Auscultation revisited: the waveform and spectral characteristics of breath sounds during general anesthesia

Although auscultation is commonly used as a continuous monitoring tool during anesthesia, the breath sounds of anesthetized patients have never been systematically studied. In this investigation we used digital audio technology to record and analyze the breath sounds of 14 healthy adult patients receiving general anesthesia with positive pressure ventilation. Sounds recorded from inside the esophagus were compared to those recorded from the surface of the chest, and corresponding airflow was measured with a pneumotachograph. The sound samples associated with inspiratory and expiratory phases were analyzed in the time domain (RMS amplitude) and frequency domain (peak frequency, spectral edge, and power ratios). There was a positive linear correlation (R2 > 0.9) between inspiratory flow and sound amplitude in the precordial and esophageal samples of all patients. The RMS amplitude of the inspiratory and expiratory sounds was approximately 13 times greater when recorded from inside the esophagus than from the surface of the chest in all patients at all flows (p < 0.001). The peak frequency (Hz) was significantly higher in the esophageal recordings than the precordial samples (298 +/- 9 vs 181 +/- 10, P < 0.0001), as was the 97% spectral edge (Hz) (740 +/- 7 vs 348 +/- 16, P < 0.0001). In the adult population esophageal stethoscopes yield higher frequencies and greater amplitude than precordial stethoscopes. Quantification of lung sounds may provide for improved monitoring and diagnostic capability during anesthesia and surgery.

Mechanisms of barbiturate inhibition of acetylcholine receptor channels

We used patch clamp techniques to study the inhibitory effects of pentobarbital and barbital on nicotinic acetylcholine receptor channels from BC3H-1 cells. Single channel recording from outside-out patches reveals that both drugs cause acetylcholine-activated channel events to occur in bursts. The mean duration of gaps within bursts in 2 ms for 0.1 mM pentobarbital and 0.05 ms for 1 mM barbital. In addition, 1 mM barbital reduces the apparent single channel current by 15%. Both barbiturates decrease the duration of openings within a burst but have only a small effect on the burst duration. Macroscopic currents were activated by rapid perfusion of 300 microM acetylcholine to outside-out patches. The concentration dependence of peak current inhibition was fit with a Hill function; for pentobarbital, Ki = 32 microM, n = 1.09; for barbital, Ki = 1900 microM, n = 1.24. Inhibition is voltage independent. The kinetics of inhibition by pentobarbital are at least 30 times faster than inhibition by barbital (3 ms vs. < 0.1 ms at the Ki). Pentobarbital binds > or = 10-fold more tightly to open channels than to closed channels; we could not determine whether the binding of barbital is state dependent. Experiments performed with both barbiturates reveal that they do not compete for a single binding site on the acetylcholine receptor channel protein, but the binding of one barbiturate destabilizes the binding of the other. These results support a kinetic model in which barbiturates bind to both open and closed states of the AChR and block the flow of ions through the channel. An additional, lower-affinity binding site for pentobarbital may explain the effects seen at > 100 microM pentobarbital.

Interactions of general anaesthetics with single acetylcholine receptor channels

We used single-channel recording techniques to study the effects of general anaesthetics on nicotinic acetylcholine receptor channels. Normally, these channels remain open for a few milliseconds. Anaesthetics induce three different patterns of channel activity. Ether causes the channel amplitude to be smaller and noisier than normal; isoflurane induces a flickery pattern in which openings occur in bursts of brief openings; propofol causes the channels to appear as isolated brief openings. These patterns can all be understood in terms of a model in which the anaesthetics bind directly to the channel protein and interrupt the flow of ions through the channel. The difference in pattern is determined by the duration of anaesthetic binding. Ether remains bound for the shortest period (< or = 0.01 ms), followed by isoflurane (0.5 ms) and propofol (> or = 2 ms). The anaesthetics may either be physically obstructing the pore of the channel or acting allosterically by inducing a new, non-conducting conformation of the channel.

Evidence for direct actions of general anesthetics on an ion channel protein. A new look at a unified mechanism of action

BACKGROUND

Ion permeation through the nicotinic acetylcholine receptor channel is inhibited by general anesthetics. This inhibition could be mediated either by binding of anesthetic molecules to the channel protein itself or by the effects of anesthetics on the lipid environment of the protein.

METHODS

Patch clamp recording techniques were used to investigate the effects of ether and propofol on acetylcholine receptor channels in outside-out patches from BC3H-1 cells. The kinetic and conductance properties of single channels were measured. A rapid perfusion system was used to make rapid changes in anesthetic concentration during patch clamp recording to determine the kinetics of inhibition by anesthetics.

RESULTS

Ether, isoflurane (results from previous studies), and propofol produce distinct kinetic patterns of single acetylcholine receptor channel activity. Ether reduces the apparent current amplitude of channels, isoflurane induces flickering channel activity and propofol merely decreases the open time of the channel. The kinetics of inhibition are also different for these anesthetics. Ether (< 40 microseconds) is faster than isoflurane (300-600 microseconds) which is faster than propofol (> or = 2 ms).

CONCLUSIONS

These diverse patterns can be interpreted in terms of a unitary mechanism in which the anesthetics interact directly with the channel protein. Each anesthetic is considered to bind to a site on the protein (perhaps, but not necessarily within the pore of the channel) and interrupt the flow of ions through the pore. Anesthetics have access to this inhibitory binding site even when the gate of the channel is closed. The pattern of channel activity induced by an anesthetic is determined by the frequency and duration of binding events.

Cooperative interactions between general anesthetics and QX-222 within the pore of the acetylcholine receptor ion channel

To test the hypothesis that general anesthetics block nicotinic acetylcholine receptor channels by binding within the pore of the channel, we looked for competitive interactions between ether and QX-222 at the single channel current level. Experiments were performed on outside-out patches excised from BC3H-1 cells. QX-222 causes channels to flicker as it repeatedly binds within the pore of the channel and blocks the flow of current through the channel. Ether reduces the apparent unitary conductance of the channel. This effect of ether may be due to frequent, short-lived, unresolved, blockages of the channel. When both ether and QX-222 are applied, the effects of both drugs are seen on single channels. However, the duration of QX-222 blocking events are longer when ether is present; the duration of block is 0.89 +/- 0.06 ms with 30 microM QX-222 alone and 2.23 +/- 0.37 ms with 30 microM QX-222 + 20 mM ether (n = 5 +/- S.D.; -100 mV). Similar results are obtained when butanol is used in place of ether. We conclude that ether and QX-222 do not compete for a common binding site. Conversely, ether decreases the dissociation rate of QX-222. The simplest interpretation of these data is that the binding sites for ether and the aromatic moiety of QX-222 are distinct but close to each other; when ether is bound to its site, the binding of QX-222 is stabilized. We cannot, however, discount the possibility that ether stabilizes QX-222 by binding to a remote site and allosterically modifying the pore of the channel.

Effects of alcohols and volatile anesthetics on the activation of nicotinic acetylcholine receptor channels

The n-alcohols butanol through nonanol and the volatile anesthetic ether increase the frequency of bursts of nicotinic acetylcholine (ACh) receptor channels induced by low concentrations of agonists. For example, 10 mM butanol increases the burst frequency induced by 0.2 microM ACh (a full agonist) and 1 microM decamethonium (a partial agonist) by 1.6-fold and 2.7-fold, respectively. An increase in burst frequency could arise from effects of the drug on agonist binding, channel gating, or desensitization. To distinguish among these alternatives, we measured the current response to rapid application of saturating concentrations of agonists. We found that 10 mM butanol increases the peak current induced by 100 microM decamethonium by 2-fold. In addition, 20 mM butanol and 3 mM pentanol both decrease the onset time of the current response to 10 mM ACh by about 40%. In contrast, ether does not increase the current response to 100 microM decamethonium and does not significantly change the onset time for 10 mM ACh. Neither ether nor butanol changes the degree of steady state desensitization induced by 0.2 microM ACh. We conclude that butanol and pentanol increase burst frequency by increasing the channel opening rate, whereas ether does so by increasing the agonist binding affinity of the ACh receptor.

The effects of isoflurane on acetylcholine receptor channels.: 2. Currents elicited by rapid perfusion of acetylcholine

We studied the effects of the volatile anesthetic isoflurane on nicotinic acetylcholine (ACh) receptor channels using a technique for rapid perfusion of ACh to outside-out patches. Channels were activated by ACh, at concentrations ranging from 1 microM to 10 mM, and the macroscopic current flowing through tens or hundreds of channels was measured. Isoflurane reduced the peak current response to saturating concentrations of ACh, increased the current decay rate due to desensitization, and decreased the rate of recovery from desensitization. The effect of isoflurane on peak currents was concentration dependent; at 2% isoflurane, the peak current was reduced by half. The effect of isoflurane on the peak current induced by nonsaturating concentrations of ACh was smaller. We measured the onset and recovery of current inhibition by isoflurane, by rapidly applying and removing isoflurane to the patch within 100 microseconds. 2% isoflurane, currents were inhibited with a time constant of 200-300 microseconds and recovered with a time constant of 500-700 microseconds. We interpreted our results in terms of a kinetic model in which isoflurane binds directly to both open and closed channels (not necessarily within the pore of the channel) and stops the flow of ions through open channels. This model provides a quantitative explanation for the kinetic and equilibrium effects of isoflurane on peak currents activated by saturating concentrations of ACh. Our data support the idea that the flickering effect of isoflurane on single ACh receptor channels is caused by rapid binding and dissociation of isoflurane to an inhibitory binding site on the protein. The effects of isoflurane on the apparent affinity of ACh and on desensitization are not predicted by the model. These effects may arise from the binding of isoflurane to other sites, not necessarily on the protein itself.

Application of the one- and two-dimensional Ising models to studies of cooperativity between ion channels

The Ising model of statistical physics provides a framework for studying systems of protomers in which nearest neighbors interact with each other. In this article, the Ising model is applied to the study of cooperative phenomena between ligand-gated ion channels. Expressions for the mean open channel probability, rho o, and the variance, sigma 2, are derived from the grand partition function. In the one-dimensional Ising model, interactions between neighboring open channels give rise to a sigmoidal rho o versus concentration curve and a nonquadratic relationship between sigma 2 and rho o. Positive cooperativity increases the slope at the midpoint of the rho o versus concentration curve, shifts the apparent binding affinity to lower concentrations, and increases the variance for a given rho o. Negative cooperativity has the opposite effects. Strong negative cooperativity results in a bimodal sigma 2 versus rho o curve. The slope of the rho o versus concentration curve increases linearly with the number of binding sites on a protomer, but the sigma 2 versus rho o relationship is independent of the number of ligand binding sites. Thus, the sigma 2 versus rho o curve provides unambiguous information about channel interactions. In the two-dimensional Ising model, rho o and sigma 2 are calculated numerically from a series expansion of the grand partition function appropriate for weak interactions. Virtually all of the features exhibited by the one-dimensional model are qualitatively present in the two-dimensional model. These models are also applicable to voltage-gated ion channels.

Decamethonium is a partial agonist at the nicotinic acetylcholine receptor

The efficacy of decamethonium as an agonist at the nicotinic acetylcholine receptor has never been determined. Here, we demonstrate how patch clamp recording during rapid perfusion of agonists to outside-out patches from BC3H-1 cells can be used to provide an unambiguous estimate of the efficacy of decamethonium. First, we obtain the decamethonium concentration-response relationship between 10 and 1,000 microM decamethonium. The maximum channel open probability is small (< 0.02) and occurs at about 100 microM. This suggests two alternative explanations: decamethonium is a poor agonist or decamethonium is an efficacious agonist but a potent channel blocker. To distinguish between these alternatives, we perfuse mixtures of decamethonium and acetylcholine to generate acetylcholine concentration-response curves in the presence of 30, 100, and 1,000 microM decamethonium. We use a model for activation and block of the acetylcholine receptor by both agonists to fit these data and determine the binding affinity, efficacy, and blocking affinity of decamethonium. We conclude that the efficacy of decamethonium is low, 0.016. Decamethonium is a true partial agonist.

Desensitization of acetylcholine receptors in BC3H-1 cells

We studied desensitization of nicotinic acetylcholine (ACh) receptor channels in the clonal BC3H-1 cell line. We measured the current response to rapid perfusion of outside-out patches with 1 microM to 5 mM ACh, carbamylcholine and suberyldicholine. After binding to the receptors and opening the ion channels, all agonists induce a rapid, concentration-dependent decay of channel activity. The time constant of the current decay ranged from several seconds at low agonist concentrations to about 50 ms at saturating concentrations. The decay rate at saturating concentrations was independent of voltage. The ratio of steady-state to peak current ranged from 0.5 at low agonist concentrations to 0.02 or less at high concentrations. The rate of recovery from desensitization after removal of agonist was also measured. For ACh, the recovery time constant was 320 ms; recovery from desensitization by carbamylcholine was twice as fast. A linear kinetic results. The data are consistent with a cyclic model, although, it is not possible to uniquely determine all of the rate constants in this scheme. The results are compared with competitive binding and single channel studies of desensitization in BC3H-1 cells.

Effects of isoflurane on acetylcholine receptor channels. 1. Single-channel currents

We studied the effects of the volatile general anesthetic isoflurane on single acetylcholine (ACh) receptor channels from clonal BC3H-1 cells. Excised patches were exposed to concentrations of isoflurane ranging from 0.18% to 4.0%, in the presence of 200 nM ACh. Isoflurane transformed channel behavior from isolated openings into bursts of brief openings. The channel open time decreased monotonically with the concentration of isoflurane; the mean open time was half of control at 0.4% isoflurane. The duration of bursts also decreased in the presence of isoflurane. The duration of brief closures within bursts was 300-400 musec at concentrations above 0.3% isoflurane. The number of openings per burst increased moderately with isoflurane but did not exceed 3. The frequency of bursts increased with the concentration of isoflurane. The apparent single-channel conductance decreased to 75% of control at 4% isoflurane. These results are discussed in terms of models of channel block. The concentration dependence of the open time, the gap duration, and the conductance are consistent with a sequential open-channel blocking mechanism in which most but not all blocking events were resolved. A model that assumes that isoflurane "blocks" both open and closed channels was then considered. This model is consistent not only with the open time data but also with the burst duration and number of openings per burst. These results indicate that isoflurane has effects on closed as well as open ACh receptor channels.

Opening rate of acetylcholine receptor channels

The nicotinic acetylcholine (ACh) receptor is responsible for rapid conversion of chemical signals to electrical signals at the neuromuscular junction. Because the receptor and its ion channel are components of a single transmembrane protein, the time between ACh binding and channel opening can be minimized. To determine just how quickly the channel opens, we made rapid (100-400 microseconds) applications of 0.1-10 mM ACh to outside-out, multichannel membrane patches from BC3H-1 cells, while measuring the onset of current flow through the channels at 11 degrees C. Onset time is steeply dependent upon ACh concentration when channel activation is limited by binding of ACh (0.1-1 mM). At +50 mV, the 20-80% onset time reaches a plateau near 110 microseconds above 5 mM ACh as channel opening becomes rate limiting. Thus, we calculate the opening rate, beta = 12/ms, without reference to specific channel activation schemes. At -50 mV, the combination of a rapid, voltage-dependent block of channels by ACh with a finite solution exchange time distorts onset. To determine opening rate at -50 mV, we determine the kinetic parameters of block from "steady-state" current and noise analyses, assume a sequential model of channel activation/block, and numerically simulate current responses to rapid perfusion of ACh. Using this approach, we find beta = 15/ms. In contrast to the channel closing rate, the opening rate is relatively insensitive to voltage.

The temperature dependence of some kinetic and conductance properties of acetylcholine receptor channels

We examined the temperature dependence of single-channel properties of the nicotinic acetylcholine receptor channel from clonal BC3H-1 cells over a range of 10-40 degrees C. We found temperature sensitivities (Q10 values) of 2-4 for the mean channel open time. The Q10 did not depend strongly on voltage and the voltage dependence of the mean open time was temperature-independent. The Q10 of closing rate of the long-lived open state was 3-4 but the Q10 of closing rate of the brief open state was independent of temperature. The duration of brief closures could be measured only between 10 and 25 degrees C. Since this approached the limit of the experimental time resolution, an accurate determination of the Q10 could not be made. The current decay due to desensitization after rapid application of high concentrations of agonist varied with a Q10 of about 2. The conductance of single channels (the inverse of the ion translocation rate) had a Q10 of 1.3-1.5. We found no obvious nonlinearities in the Arrhenius curves for any of the measured properties.

Direct measurement of the concentration- and time-dependent open probability of the nicotinic acetylcholine receptor channel

Using the outside-out patch clamp recording technique together with a rapid solution exchange system, we measured ionic currents through nicotinic acetylcholine (ACh) receptor channels from BC3H-1 cells in response to rapid applications of 0.3-1,000 microM ACh. We used nonstationary fluctuation analysis of ensembles of responses to deduce the number of channels in the patch, the maximum open channel probability as a function of ACh concentration and the time course of a fast desensitization process. We found that: (a) Excised patches from BC3H-1 cells typically contain between 50 and 150 functional ACh receptor ion channels. (b) The open channel probability is proportional to [ACh]1.95 at low concentrations of ACh, is half-maximal at 20 microM ACh and saturates above 100 microM ACh. (c) ACh is a very efficacious agonist; 100 microM ACh opens at least 90% of the available channels. This estimate of efficacy is model-independent. (d) The rate of decay of the agonist-induced current is concentration-dependent. In the presence of 100 microM ACh the current decays with a time constant of 50-100 ms. It decays more slowly in the presence of lower concentrations of agonist but is relatively insensitive to voltage.

Whole cell currents and mechanical responses of isolated outer hair cells

Outer hair cells (OHCs) exhibit electrically induced cell movements which are considered to enhance the frequency selectivity and sensitivity of basilar membrane vibration. Using simultaneous whole cell voltage clamp and video analysis, we demonstrate that the mechanical response of OHCs is not altered by agents which alter membrane currents under voltage clamp. Thus the underlying mechanism of OHC movements appears to be dependent upon membrane potential, rather than transmembrane currents.

Isoflurane causes "flickering" of the acetylcholine receptor channel: observations using the patch clamp

The authors investigated the effects of a volatile anesthetic (isoflurane) on the functional properties of a well characterized membrane ion channel (the acetylcholine receptor channel), using the patch clamp electrophysiological method together with local microperfusion of isoflurane. They found that isoflurane causes single acetylcholine receptor channels to "flicker" rapidly between open and closed states, reminiscent of the kinetic pattern induced by local anesthetics. The mean amplitude of currents flowing through open channels was unchanged. Although these observations initially suggested that isoflurane blocks open ion channels, closer analysis of the "isoflurane pattern" revealed features inconsistent with classical open channel block: the duration of bursts of channel openings is shortened, and that of the brief closures within bursts lengthens as the concentration of isoflurane is increased. The authors suggest that isoflurane exerts its characteristic effects on the kinetic properties of acetylcholine receptor channel by an allosteric mechanism. In addition, and apart from their mechanistic significance, these effects may underlie the known potentiation by isoflurane of curariform neuromuscular blockade.

A method for the rapid exchange of solutions bathing excised membrane patches

In this communication we describe a technique for rapidly exchanging solutions bathing excised membrane patches, and present examples of its implementation using both outside-out and inside-out patches. The ability to make step changes in the concentration of channel-activating ligands (e.g., acetylcholine, calcium) offers a novel and direct means of measuring kinetic processes in the 10-100-ms range. The responses to step ligand concentration changes are well suited to ensemble variance analysis, yielding estimates of the number of channels in a patch, and testing assumptions of channel independence and homogeneity. Kinetic analysis of the pseudomacroscopic currents obtained by averaging large numbers of responses can be compared and correlated with analysis of the microscopic behavior of single channels, using the same membrane patch for both approaches. Practical and theoretical limitations associated with the method are briefly discussed.