Persistent Inward Currents Play a Role in Muscle Dysfunction Seen in Myotonia Congenita

Myotonia congenita is a rare skeletal muscle channelopathy caused by a reduced chloride channel (ClC-1) current, which results in debilitating muscle hyperexcitability, prolonged contractions, and transient episodes of weakness. The excitatory events that trigger myotonic action potentials in the absence of stabilizing ClC-1 current are not fully understood. My in vitro intracellular recordings from a mouse homozygous knockout of ClC-1 revealed a slow after-depolarization (AfD) that triggers myotonic action potentials. The AfD is well-explained by a tetrododoxin-sensitive and voltage-dependent Na+ persistent inward current (NaPIC). Notably, this NaPIC undergoes slow inactivation over seconds, thus providing the first mechanistic explanation for the end of myotonic runs. Highlighting the significance of this mechanism, we show that ranolazine and elevated serum divalent cations eliminate myotonia by inhibiting AfD and NaPIC. The electrophysiological events responsible for the transient weakness are not well understood either. My in vitro intracellular recordings revealed a novel behavior, in which the muscle is functionally inexcitable for seconds to minutes. This hanging behavior, as I refer to it, is likely to be responsible for periods of weakness described by patients and is explained by another persistent inward current. Partial pharmacological block of this other PIC decreases the hanging behavior in myotonic muscle. This work significantly changes our understanding of the mechanisms underlying myotonia and transient weakness seen in myotonia congenita and reveals a novel and highly effective therapeutic target

Persistent Inward Currents Play a Role in Muscle Dysfunction Seen inMyotonia Congenita

Myotonia congenita is a rare skeletal muscle channelopathy caused by a reduced chloride channel (ClC-1) current, which results in debilitating muscle hyperexcitability, prolonged contractions, and transient episodes of weakness. The excitatory events that trigger myotonic action potentials in the absence of stabilizing ClC-1 current are not fully understood. My in vitro intracellular recordings from a mouse homozygous knockout of ClC-1 revealed a slow after-depolarization (AfD) that triggers myotonic action potentials. The AfD is well-explained by a tetrododoxin-sensitive and voltage-dependent Na+ persistent inward current (NaPIC). Notably, this NaPIC undergoes slow inactivation over seconds, thus providing the first mechanistic explanation for the end of myotonic runs. Highlighting the significance of this mechanism, we show that ranolazine and elevated serum divalent cations eliminate myotonia by inhibiting AfD and NaPIC. The electrophysiological events responsible for the transient weakness are not well understood either. My in vitro intracellular recordings revealed a novel behavior, in which the muscle is functionally inexcitable for seconds to minutes. This hanging behavior, as I refer to it, is likely to be responsible for periods of weakness described by patients and is explained by another persistent inward current. Partial pharmacological block of this other PIC decreases the hanging behavior in myotonic muscle. This work significantly changes our understanding of the mechanisms underlying myotonia and transient weakness seen in myotonia congenita and reveals a novel and highly effective therapeutic target

Treatment of Myotonia Congenita With Retigabine in Mice

Patients with myotonia congenita suffer from muscle stiffness caused by muscle hyperexcitability. Although loss-of-function mutations in the ClC-1 muscle chloride channel have been known for 25 years to cause myotonia congenita, this discovery has led to little progress on development of therapy. Currently, treatment is primarily focused on reducing hyperexcitability by blocking Na+ current. However, other approaches such as increasing K+ currents might also be effective. For example, the K+ channel activator retigabine, which opens KCNQ channels, is effective in treating epilepsy because it causes hyperpolarization of the resting membrane potential in neurons. In this study, we found that retigabine greatly reduced the duration of myotonia in vitro. Detailed study of its mechanism of action revealed that retigabine had no effect on any of the traditional measures of muscle excitability such as resting potential, input resistance or the properties of single action potentials. Instead it appears to shorten myotonia by activating K+ current during trains of action potentials. Retigabine also greatly reduced the severity of myotonia in vivo, which was measured using a muscle force transducer. Despite its efficacy in vivo, retigabine did not improve motor performance of mice with myotonia congenita. There are a number of potential explanations for the lack of motor improvement in vivo including central nervous system side effects. Nonetheless, the striking effectiveness of retigabine on muscle itself suggests that activating potassium currents is an effective method to treat disorders of muscle hyperexcitability

Treatment of Myotonia Congenita With Retigabine in Mice

Patients with myotonia congenita suffer from muscle stiffness caused by muscle hyperexcitability. Although loss-of-function mutations in the ClC-1 muscle chloride channel have been known for 25 years to cause myotonia congenita, this discovery has led to little progress on development of therapy. Currently, treatment is primarily focused on reducing hyperexcitability by blocking Na+ current. However, other approaches such as increasing K+ currents might also be effective. For example, the K+ channel activator retigabine, which opens KCNQ channels, is effective in treating epilepsy because it causes hyperpolarization of the resting membrane potential in neurons. In this study, we found that retigabine greatly reduced the duration of myotonia in vitro. Detailed study of its mechanism of action revealed that retigabine had no effect on any of the traditional measures of muscle excitability such as resting potential, input resistance or the properties of single action potentials. Instead it appears to shorten myotonia by activating K+ current during trains of action potentials. Retigabine also greatly reduced the severity of myotonia in vivo, which was measured using a muscle force transducer. Despite its efficacy in vivo, retigabine did not improve motor performance of mice with myotonia congenita. There are a number of potential explanations for the lack of motor improvement in vivo including central nervous system side effects. Nonetheless, the striking effectiveness of retigabine on muscle itself suggests that activating potassium currents is an effective method to treat disorders of muscle hyperexcitability