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Malignant hyperthermia (MH) is a pharmacogenetic myopathy that occurs in humans and several other mammalian species. There has been limited investigation of Ca2+ transport by human heavy sarcoplasmic reticulum (HSR) vesicles despite the fact that mutations of the ryanodine receptor Ca2+ release channel have been linked to inheritance of MH. In this study, the Ca2+ release and uptake mechanisms in human MH-susceptible HSR (MHS) vesicles were investigated and the kinetics and sensitivity compared to normal vesicles. Alterations in Ca2+ regulation were thereby elucidated. HSR vesicles from 6 normal (MHN) and 5 MHS patients were compared using a dual-wavelength continuous Ca2+ flux assay in the presence of pyrophosphate. The loading capacity and loading rate of Ca2+ in MHS vesicles were reduced by almost 50%. These parameters were restored to normal when the Ca2+ channel blocker ruthenium red was added. Calcium-induced calcium release, halothane-induced calcium release, and trifluoperazine-induced calcium release were clearly elevated in MHS HSR vesicles compared to MHN vesicles. The results suggest that MH ryanodine receptors exist in a more open resting state than those in normal muscle.

Determination of sensitivity and specificity of the in vitro contracture test (IVCT) for malignant hyperthermia (MH) susceptibility using the European MH Group (EMHG) protocol has been performed in some laboratories but only on a small sample from the combined EMHG. Thus, the purpose of the present study was to determine combined EMHG sensitivity and specificity of the test.Results of IVCT of patients with previous fulminant MH and normal, low-risk subjects (controls) were collected from 22 centres of the EMHG. IVCT was performed according to the EMHG protocol. Patients were included in the study if the clinical crisis had a score of at least 50 points with the Clinical Grading Scale. Low-risk subjects were included provided they did not belong to a family with known MH susceptibility, they had not developed any signs of MH at previous anaesthetics, and they did not suffer from any neuromuscular disease. For inclusion of both MH patients and low-risk subjects, at least 1 muscle bundle in the IVCT should have twitches of 10 mN (1 g) or more. For evaluation of individual tests, only muscle bundles with twitch heights of 10 mN (1 g) or more were used.A total of 1502 probands had undergone IVCT because of a previous anaesthesia with symptoms and signs suggestive of MH. Of these, 119 had clinical scores of 50 and above. From these 119 MH-suspected patients and from 202 low-risk subjects, IVCT data were collected. Subsequently, 14 MH-suspected patients were excluded from further analysis for the following reasons: In 3 patients, the suspected MH episode could be fully explained by diseases other than MH; in 11 MHS patients, IVCT was incomplete (n = 1), data were lost (n = 3), or none of the muscle bundles fulfilled twitch criteria (n = 7). Of the remaining 105 MH-suspected patients, 89 were MHS, 10 MHEh, 5 MHEc, and one MHN. Thus, we observed a diagnostic sensitivity of the IVCT of 99.0% if the MHE group is considered susceptible (95% confidence interval 94.8-100.0%). Of the 202 low-risk subjects, 3 were MHS, 5 MHEh, 5 MHEc, and 189 MHN. This gives a specificity of the IVCT of 93.6% (95% confidence interval 89.2-96.5%).The IVCT for diagnosis of MH susceptibility in Europe has a high sensitivity and a satisfactory specificity.

Malignant hyperthermia (MH) is an inherited human skeletal muscle disorder and is one of the main causes of death due to anaesthesia. The reported incidence of MH varies from 1 in 12,000 in children to 1 in 40,000 in adults. MH is triggered in susceptible people by all commonly used inhalational anaesthetics; it is characterized by a profoundly accelerated muscle metabolism, contractures, hyperthermia and tachycardia. Susceptibility to MH (MHS) is predicted by contracture tests on muscle tissue obtained by biopsy. An almost identical disorder known as porcine MH exists in pigs. The genetics of the porcine syndrome have been extensively studied; the locus controlling expression of porcine MH is genetically linked to the glucose phosphate isomerase locus (GPI). In man, GPI has been mapped to the q12-13.2 region of chromosome 19 (refs 10-12). We have now investigated genetic linkage in several extended Irish pedigrees in which MHS is segregating as an autosomal dominant trait. Here we show linkage between MHS and DNA markers from the GPI region of human chromosome 19 with a maximum log likelihood ratio (lod score) of 5.65 at the CYP2A locus. These results indicate that human and porcine MH are most probably due to mutations in homologous genes, and also provide a potentially accurate and noninvasive method of diagnosis for MHS.

Molecular genetic linkage studies on the inherited human disorder malignant hyperthermia have resulted in the mapping of the locus for malignant hyperthermia susceptibility (MHS) to the twenty centimorgan genetic interval in the q12-13.2 region of chromosome 19 defined by the anonymous polymorphic DNA markers D19S9 and BCL3. The mapping of the MHS locus to this interval now allows diagnosis of MHS in selected families with an accuracy of 97.5% using closely linked polymorphic DNA markers.

The muscle disease malignant hyperthermia is a disorder of intracellular free Ca2+ regulation in both humans and pigs. Current evidence indicates that the Ca2+ channel of the sarcoplasmic reticulum of MH muscle is abnormally sensitive to Ca2+ and to halothane. Mitochondria, the sarcolemma and the transverse tubule appear not to be involved in primary pathogenesis of MH. Molecular genetic studies indicate that the MH gene is on human chromosome 19 and that the likely candidate gene is that coding for the Ca2+ channel.

A suspected case of xanthine oxidase deficiency has been further investigated. The patient complained of arthralgia and myalgia. Further studies included histochemical and ultramicroscopic analysis of muscle sarcoplasmic reticulum, and biochemical studies. High levels of xanthine and hypoxanthine were found, while uric acid was absent in the muscle extracts.

Serum creatine phosphokinase activity was determined in German Landrace and Landrace x Large White pigs from 11 weeks to 28 weeks of age. A very pronounced age dependence of enzyme activity was observed in both groups, peak activities occurring at 19 weeks of age for the German Landrace and at 15 weeks for the crosses. The large increase in serum creatine phosphokinase activity observed occurred during the rapid phase of growth after which enzyme levels returned close to initial values. Sedatives and the stress of handling while obtaining blood can also cause raised serum creatine phosphokinase levels and complicate the interpretation of the data in regard to the detection of the stress syndrome. Enzyme activity also displayed a diurnal variation thus introducing a further parameter in the use of creatine phosphokinase activity for detection of the stress syndrome. Certain limitations in the method of measurement of creatine phosphokinase are discussed.

The widely-used food dye Erythrosin B inhibited ATP-dependent Ca2+ accumulation by rat brain microsomes, half-maximal inhibition requiring 1 microM dye. Addition of 0.5-20 microM dye to microsomes preloaded with Ca2+ did not cause any net Ca2+ release. 10 microM dye produced a constant inhibition of Ca2+ accumulation as the intravesicular free Ca2+ was lowered suggesting that, at low concentrations, it acts on the uptake system only. Ca2+ accumulation was ten-fold more sensitive to the dye than Erythrosin B-induced neurotransmitter release reported by others. Higher dye concentrations (100 microM) caused Ca2+ release.

A rapid and specific micromethod for semiquantitative determination of oxypurines in small specimens of skeletal muscle is described. Normal levels of xanthine plus hypoxanthine and uric acid in human skeletal muscle are in the ranges of 0,07-0,34 mg/100 g and 0,38-0,74 mg/100 g, respectively.

Muscle adenosine triphosphate (ATP), glucose-6-phosphate, phosphocreatine, and pH were measured in nine malignant hyperthermia (MH)-susceptible and 14 MH-resistant Landrace pigs. Muscle biopsies were taken before (under barbiturate anesthesia) and after exposure to halothane. When compared to levels during barbiturate anesthesia, exposure to halothane had no immediate effect on muscle ATP levels in either MH-susceptible or -resistant pigs. However, once malignant hyperthermia developed in susceptibe pigs ATP levels decreased significantly. In both susceptible and resistant pigs halothane increased muscle glucose-6-phosphate and decreased muscle phosphocreatine and pH significantly below control levels observed during barbiturate anesthesia. In susceptible pigs these changes were significantly more marked than were the changes produced in resistant pigs. These data indicate that the effect of halothane on muscle metabolism is similar in both MH-resistant and -susceptible pigs. The results suggest that the effect of halothane is to inhibit aerobic metabolism by preventing mitochondrial dehydrogenation of pyruvate. Inhibition is complete in susceptible pigs but only retarded in resistant pigs. In susceptible pigs the consequent lactacidosis, hyperthermia, and reduction in ATP synthesis contribute to the development and maintenance of rigidity.

A member of a family which was known to be susceptible to malignant hyperpyrexia, who was identified as a carrier by the presence of an elevated serum creatine-phosphokinase, has been investigated further. Muscle was examined biochemically, and the study included the sarcoplasmic ATPase-activity, actinomycin, Mg2+ ATPase activity, ATP, phosphocreatine and glucose-6-phosphate. In addition, the calcium uptake by the sarcoplasmic reticulum was studied. The histochemical analysis of the muscle revealed the presence of a new fibre type characterised by a dense rim of ATPase activity, which gives the impression of a 'picture-frame'. Ultramicroscopic study revealed changes in the mitochondria and areas of myofibrillar disruption with swelling of the sarcoplasmic reticulum.

The flight-related tergo-coxal muscles of flying and flightless beetles are compared. In the flying beetle, Pachynoda sinuata, the myofibrils and cylindrical and the myofilaments packed in double hexagonal arrays. The sarcomeres are short (2.8 micrometer) and wide with many large, closely packed adjacent mitochondria but the sarcoplasmic reticulum is poorly developed in this fibrillar (asynchronous) muscle. Sarcoplasmic glycogen in rosette form is abundant. In the flightless beetle, Anthia thoracica, the myofibrils are lamellar-like with sarcomeres of 5.3 micrometer. The myosin filaments form a single hexagonal array each thick filament having an orbital of 11 to 12 thin filaments. The width of the Z-line (120 nm) of A. thoracia muscle was twice that of the Z-line of P. sinuata muscle. The sarcoplasmic reticulum and T-system are well-developed in this afibrillar (synchronous) muscle. Few glycogen granules are present. Triangular projections of the sarcolemma occur regularly opposite the Z-lines in A. thoracica and they appear to extend into the Z-lines. Membranous connections joint adjacent Z-lines in A. thoracica and occasionally in P. sinuata.

Procaine caused respiratory arrest in halothane-anaesthetized normal Landrace pigs at a dose of 4,2 - 8,2 mg/kg. In some cases death due to respiratory failure occurred after giving 10 - 13 mg/kg. Because of its toxicity in pigs procaine is unsuitable for treating the porcine malignant hyperthermia syndrome.

Plasma cortisol levels were measured in Landrace pigs susceptible to malignant hyperthermia (MH), Landrace pigs resistant to MH and in Largewhite pigs, during growth halothane anaesthesia and after injections of Synachten. From 3 to 6 months of age mean cortisol levels in susceptible Landrace were 193,2 +/- 49,7 nmol/l, in resistant Landrace 220,8 +/- 24,8 nmol/l and in Largewhite 278,8 +/- 13,8 nmol/l. These values were not significantly different. After injection of 1 mg Synachten intravenously, plasma cortisol levels did not increase significantly in susceptible pigs. In resistant landrace pigs and Largewhite pigs the plasma levels after injection were significantly greater than pre-injection levels (P less than 0,05) and significantly different from susceptible Landrace levels. During halothane anaesthesia, cortisol levels rose more in resistant pigs than in susceptible pigs, but differences were no significant. These results suggest that susceptible pigs have a decreased ability to secrete cortisol during stress.