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Two internal pools of soluble polyphosphate in the cyanobacterium Synechocystis sp. strain PCC 6308: an in vivo 31P NMR spectroscopic study.

Two intracellular pools of soluble polyphosphate were identified by in vivo 31P NMR spectroscopy in the cyanobacterium Synechocystis sp. strain PCC 6308. Polyphosphate was present in the cells after growth in sulfur-limited media containing excess phosphate. The presence of polyphosphate was confirmed by transmission electron microscopy and chemical analysis. 31P NMR spectroscopy of whole cells treated with EDTA revealed two pools of mobile polyphosphate. A downfield shift and narrowing of part of the broad polyphosphate resonance was observed after EDTA treatment, suggesting that EDTA binds metal ions normally associated with some of the polyphosphate. Phosphate, but not polyphosphate, leaked out of the cells after this treatment. Addition of magnesium ions caused the downfield shift in the polyphosphate resonance to move back toward its original value. These data show that only part of the cation-complexed polyphosphate is accessible to the added EDTA and suggest that there are two internal fractions of NMR-visible polyphosphate in the cells, only one of which loses its associated cations to EDTA. Spheroplast formation showed that polyphosphate was not present in the periplasm of the cells.

Cyanobacteria↗

Manipulation of independent synthesis and degradation of polyphosphate in Escherichia coli for investigation of phosphate secretion from the cell.

The genes involved in polyphosphate metabolism in Escherichia coli were cloned behind different inducible promoters on separate plasmids. The gene coding for polyphosphate kinase (PPK), the enzyme responsible for polyphosphate synthesis, was placed behind the Ptac promoter. Polyphosphatase, a polyphosphate depolymerase, was similarly expressed by using the arabinose-inducible PBAD promoter. The ability of cells containing these constructs to produce active enzymes only when induced was confirmed by polyphosphate extraction, enzyme assays, and RNA analysis. The inducer concentrations giving optimal expression of each enzyme were determined. Experiments were performed in which ppk was induced early in growth, overproducing PPK and allowing large amounts of polyphosphate to accumulate (80 mumol in phosphate monomer units per g of dry cell weight). The ppx gene was subsequently induced, and polyphosphate was degraded to inorganic phosphate. Approximately half of this polyphosphate was depleted in 210 min. The phosphate released from polyphosphate allowed the growth of phosphate-starved cells and was secreted into the medium, leading to a down-regulation of the phosphate-starvation response. In addition, the steady-state polyphosphate level was precisely controlled by manipulating the degree of ppx induction. The polyphosphate content varied from 98 to 12 mumol in phosphate monomer units per g of dry cell weight as the arabinose concentration was increased from 0 to 0.02% by weight.

Acid Anhydride Hydrolases↗

Changes in metabolism of inorganic polyphosphate in rat tissues and human cells during development and apoptosis.

Age-dependent studies show that the amount of inorganic polyphosphate in rat brain strongly increases after birth. Maximal levels were found in 12-months old animals. Thereafter, the concentration of total polyphosphate decreases to about 50%. This decrease in the concentration of total polyphosphate is due to a decrease in the amount of insoluble, long-chain polyphosphates. The amount of soluble, long-chain polyphosphates does not change significantly in the course of ageing. In rat embryos and newborns, mainly soluble polyphosphates could be detected. In rat liver, the age-dependent changes are less pronounced. The changes in polyphosphate level are accompanied by changes in exopolyphosphatase activity, which degrades the polymers to orthophosphate; highest enzyme activities were found when the polyphosphate level was low. Induction of apoptosis in the human leukemic cell line HL-60 by actinomycin D results in degradation of long polyphosphate chains. The total polyphosphate content does not change significantly in apoptotic cells.

Aging↗

Polyphosphate-dependent enzymes in some coryneform bacteria isolated from sewage sludge.

Eleven isolates obtained from a laboratory sewage treatment plant, most of them presumptively assigned to the coryneform genera Curtobacterium and Aureobacterium were studied for the presence of intracellular polyphosphates and polyphosphate dependent enzymes. All isolates stored polyphosphates and showed adenylate kinase activities ranging from 64 to 815 mU mg-1. Polyphosphate:AMP phosphotransferase could only be detected in one isolate. Three isolates showed a polyphosphate kinase activity also in minor amounts from 15 to 17 mU mg-1. A polyphosphate dependent NAD or 3-phosphoglycerate kinase could not be detected. Polyphosphate glucokinase activity was measured in cell-free extracts of nine isolates ranging from 2 to 376 mU mg-1. Three isolates showed in addition to the polyphosphate glucokinase, a glucose-6-phosphate-dependent NAD kinase. For the regeneration of NADP from NAD and polyphosphate, this enzyme system may give the isolates a distinct competitive advantage, especially for anabolic processes. The polyphosphate-dependent enzymes reported here may play an additional role in the complex process of 'biological' phosphate removal from wastewater.

Actinomycetales↗

[The possible role of high molecular weight polyphosphates in chlortetracycline biosynthesis by Streptomyces aureofaciens].

The content of condensed inorganic polyphosphates in high productive and low productive Streptomyces aureofaciens strains has been determined. At all the stages of growing the quantity of these compounds in low productive strain is 8-10-fold higher than in high productive strains. Maximum accumulation of condensed inorganic polyphosphates in both the strains Str. aureofaciens corresponds to the end of logarithmic phase of growth. In both strains the presence of two enzymes of polyphosphate biosynthesis -- ATP:polyphosphate-phosphotransferase and 1.3-diphosphoglycerate:polyphosphate-phosphotransferase has been revealed as well as the presence of the enzymes of their utilisation -- polyphosphate:D-glucose-6-phosphotransferase, polyphosphate-phosphohydrolase, tripolyphosphosphate-phosphohydrolase and pyrophosphate-phosphohydrolase. The difference in the activity of 1.3 diphosphoglycerate: polyphosphate-phosphotransferase and polyphosphate-phosphohydrolase has been revealed in both strains studied. On the basis of the data obtained it is supposed that there is a possibility of using phosphorus and energy of high molecular inorganic polyphosphate in the biosynthesis of so called products of "secondary metabolism".

Chlortetracycline↗

Immobilized polyphosphate kinase: preparation, properties, and potential for use in adenosine 5'-triphosphate regeneration.

Polyphosphate kinase (ATP:polyphosphate phosphotransferase; EC 2.7.4.1), partially purified from Escherichia coli, has been immobilized on glutaraldehyde-activated aminoethyl cellulose with a 10% retention of enzymatic activity. The immobilized enzyme can carry out the synthesis of ATP from ADP, using long-chain inorganic polyphosphate as a phosphoryl donor. Chromatographic analyses of the product mixture produced from ADP and [32P]polyphosphate demonstrated that 98% of the 32P was incorporated into ATP, indicating that the immobilized polyphosphate kinase is substantially free from contaminating polyphosphate phosphohydrolase (EC 3.6.1.11), adenosine triphosphatase (EC 3.6.1.4), and adenylate kinase (EC 2.7.4.3). Immobilized polyphosphate kinase loses no activity when stored in an aqueous suspension for 2 months at 5 degrees C or for 1-2 weeks at 25 degrees C. It may be stored indefinitely as a lyophilized powder at -10 degrees C. Michaelis constants for ADP and polyphosphate were determined to be 160 and 120 microM, respectively, for the immobilized enzyme. A small-batch reactor was found to produce ATP linearly with time up to 65% conversion of polyphosphate into ATP and to attain greater than 85% conversion to ATP at equilibrium. The ease of purification and immobilization of E. coli polyphosphate kinase, its storage stability, the purity and yield of its ATP product, and the low values of the Michaelis constants for its substrates make it a highly promising enzyme for ATP regeneration.

Adenosine Triphosphate↗

In situ 31P nuclear magnetic resonance for observation of polyphosphate and catabolite responses of chemostat-cultivated Saccharomyces cerevisiae after alkalinization.

The proposed pH buffering and phosphagenic functions of polyphosphate were investigated by subjecting chemostat-cultivated Saccharomyces cerevisiae to alkalinization (NaOH addition) and anaerobiosis. The subsequent changes in intracellular phosphate-containing species were observed in situ by nuclear magnetic resonance (NMR) spectroscopy by using the NMR cultivator we developed. For the alkalinization experiments, changes in catabolite secretion were also measured in parallel experiments. Additionally, a range of potential neutralization capacity was investigated: a dilute culture and concentrated cultures with low or high polyphosphate content. The concentrated cultures displayed increased cytosolic pH and rapid polyphosphate degradation to small chains. The pH changes and extent of polyphosphate degradation depended inversely on initial polyphosphate content. The dilute culture restored extracellular pH rapidly and secreted acetate. The concentrated culture with low polyphosphate reserves also secreted acetate. In contrast to the alkalinization-induced polyphosphate dynamics, anaerobiosis resulted in the complete hydrolysis of polyphosphate to P(i), as opposed to small chains, and reduced cytosolic pH. The results and calculations suggest that the bulk of NMR-observable polyphosphate (vacuolar) degradation to short polymers conceivably contributes to neutralizing added alkalinity. In other circumstances, such as anaerobiosis, degradation serves other functions, such as phosphorylation potential regulation.

Anaerobiosis↗

Changes in polyphosphate composition and localization in Propionibacterium acnes after near-ultraviolet irradiation.

Electron microscopy showed that electron-dense granules accumulated in Propionibacterium acnes in larger amounts when the bacteria were grown on a phosphate-rich medium. X-ray microanalysis demonstrated that the granules contained mostly phosphorus and potassium, indicating that the cells contained polyphosphate granules. When cells were grown on a complex Bacto-agar medium, the amount and the size of the polyphosphate granules were reduced. Polyphosphate was also detected with 31P nuclear magnetic resonance (31P-NMR). Of the polyphosphates observed with 31P-NMR, 20% seemed to be located outside the cell membrane. Broad-band near-ultraviolet irradiation (emission maximum 366 nm) corresponding to doses that killed 37% of the cells increased the amount of polyphosphate in cells grown on the phosphate-rich medium. The fluorescent chromophore 4',6-diamidino-2-phenylindole (DAPI) shifted the fluorescence emission from 478 to 538 nm when bound to polyphosphate and excited at 340 nm. DAPI was used to detect polyphosphates generated after near-ultraviolet irradiation of the cells. Nonirradiated cells showed no increased fluorescence at 538 nm, indicating no polyphosphate is presented in the cells. We conclude that DAPI did not have "access" to the intracellular polyphosphate as long as the cells were not light damaged. This observation is important for the interpretation of near-UV damage to cells.

Centrifugation, Density Gradient↗

Polyphosphate-cation interaction in the amino acid-containing vacuole of Neurospora crassa.

The vacuoles of Neurospora crassa, grown in minimal medium, contain a 1:1 ratio of basic amino acids and phosphate, the latter in the form of long-chain, inorganic polyphosphate-P. Vacuoles isolated from cells depleted of polyphosphate retain basic amino acids despite the absence of over 90% of their polyphosphate. Thus, vacuolar retention of basic amino acids is not dependent upon binding to or charge neutralization by polyphosphate. Polyphosphate was found to be the only macromolecular polyanion in vacuoles of normal or phosphate-depleted cells. Gel filtration experiments revealed that about half the polyphosphate of normal vacuoles is bound strongly by vacuolar spermidine, Mg2+, and Ca2+. The polyphosphate thus occupied was not available for basic amino acid binding. We have identified about 90% of the cations of isolated vacuoles; in addition to spermidine, Mg2+, and Ca2+, the cation pool consists mainly of arginine, ornithine, histidine, lysine, and Na+, with a small amount of K+. Isolated vacuoles appear to be almost wholly impermeable to all these ions, and in vivo, vacuoles appear to be highly selective in ion uptake by an active process. The interaction of basic amino acid with the available polyphosphate was found to reduce the chemical activity of the former. In keeping with this effect, cells with abnormally high basic amino acid-polyphosphate ratios displayed greatly swollen vacuoles, indicating considerable osmotic activity of the basic amino acids and their counterions under these conditions.

Amino Acids↗

Diadenosine polyphosphates in insulin-secreting cells: interaction with specific receptors and degradation.

A role of diadenosine polyphosphates as second messengers was suggested for insulin-secreting cells. It has not yet been investigated whether specific receptors for these compounds exist and how these extracellular compounds and their degradation products may contribute to insulin release. Specific saturable binding sites for diadenosine polyphosphates exist in INS-1 cells and rat pancreatic islets. In INS-1 cells, the rank order of diadenosine polyphosphates displacing [3H]Ap4A from binding sites was Ap4A = Ap5A >Ap3A = Ap6A. Binding was specific, since suramin was not able to displace the binding; adenosine, ATP, UTP, alpha,beta-methylene ATP, beta,gamma-methylene ATP, ADP-betaS, 2-methylthio ATP, and pyridoxalphosphate-6-azophenyl-2',4'-disulfonic acid (PPADS) were able to displace [3H]Ap4A from its binding sites. Insulin release was investigated in INS-1 cells. Perifusion experiments showed an increase in insulin release stimulated by the diadenosine polyphosphates in the presence of 8.3 mmol/l glucose; in static incubations (90 min), however, insulin release was inhibited dose dependently by the four diadenosine polyphosphates. This discrepancy might be due to the instability of the compounds. [3H]Ap4A was degraded in the extracellular medium to mainly adenosine and low concentrations of ATP, ADP, AMP, and inosine (half-maximal degradation after 25 min). The insulin stimulatory effect is due to the original compounds (acute perifusion experiments), and the insulin inhibitory effect (static incubation experiments) is due to the production of inhibitory compounds, such as adenosine, in the medium. Small amounts of intact [3H]Ap4A, but mainly [3H]ATP, accumulated in the cells within 20 min. The uptake of labeled compounds is dependent on an intact metabolism and intact receptor internalization. This data indicates that 1) specific bindings sites for diadenosine polyphosphates exist in INS-1 cells and rat pancreatic islets mediating insulin release; 2) the receptors involved in INS-1 cells may be diadenosine polyphosphate receptors, albeit others, such as P2X-receptors, cannot be ruled out; and 3) diadenosine polyphosphates, and mainly their degradation products in the extracellular space, are to a high degree accumulated within cells with unknown function. Thus, diadenosine polyphosphates are worth being investigated more closely in physiological and pathophysiological terms.

Adenine Nucleotides↗

Isolation and characterization of polyphosphates from the yeast cell surface.

When cells of Saccharomyces fragilis are subjected to osmotic shock, they release a limited amount of inorganic polyphosphate into the medium, which represents about 10% of the total cellular content. The osmotic shock procedure causes no substantial membrane damage, as judged from the unimpaired cell viability, limited K+ leakage and low percentage of stained cells. It is therefore suggested that this polyphosphate fraction is localized outside the plasma membrane. The released polyphosphate fraction differs from the remaining cellular polyphosphates in two respects: the mean chain length of the shock-sensitive fraction is significantly higher than that of the total cellular polyphosphates and its metabolic turnover rate, subsequent to pulsing with [32P]orthophosphate is much lower compared to the rest of the cellular polyphosphate. Incubation of intact cells with the anion exchange resin Dowex AG 1-X4 results in the release of high molecular weight polyphosphates. These results suggest that the osmotic shock-sensitive polyphosphate fraction has specific characteristics in both its cellular localization and metabolism.

Aerobiosis↗

Introduction of polyphosphate as a novel phosphate pool in the chloroplast of transgenic potato plants modifies carbohydrate partitioning.

Potato plants (Solanum tuberosum L., cv. Désirée) were transformed with the polyphosphate kinase gene from Escherichia coli fused to the leader sequence of the ferredoxin oxidoreductase gene (FNR) from Spinacea oleracea under the control of the leaf specific St-LS1 promoter to introduce a novel phosphate pool in the chloroplasts of green tissues. Transgenic plants (cpPPK) in tissue culture developed necrotic lesions in older leaves and showed earlier leaf senescence while greenhouse plants showed no noticeable phenotype. Leaves of cpPPK plants contained less starch but higher concentrations of soluble sugars. The presence of polyphosphate in cpPPK leaves was demonstrated by toluidine blue staining and unambiguously verified and quantified by in vitro 31P-NMR of extracts. Polyphosphate accumulated during leaf development from 0.06 in juvenile leaves to 0.83 mg P g-1 DW in old leaves and had an average chain length of 18 residues in mature leaves. In situ 31P-NMR on small leaf pieces perfused with well-oxygenated medium showed only 0.036 mg P g-1 DW polyphosphate that was, however, greatly increased upon treatment with 50 mM ammonium sulfate at pH 7.3. This phenomenon along with a yield of 0.47 mg P g-1 DW polyphosphate from an extract of the same leaf material suggests that 93% of the polyphosphate pool is immobile. This conclusion is substantiated by the observation that no differences in polyphosphate pool sizes could be discerned between darkened and illuminated leaves, leaves treated with methylviologen or anaerobis and control leaves, treatments causing a change in the pool of ATP available for polyPi synthesis. Results are discussed in the context of the chelating properties of polyphosphates for cations and its consequences for the partitioning of photoassimilate between starch and soluble sugars.

Animals↗

NMR-Observed phosphate trafficking and polyphosphate dynamics in wild-type and vph1-1 mutant Saccharomyces cerevisae in response to stresses.

The phosphagenic, osmotic, and metabolic roles of polyphosphate in chemostat-cultivated yeast were investigated with a new NMR cultivator. Wild-type yeast and a vacuolar vph1-1 mutant, which lacks polyphosphate, were subjected to different stimuli. Starved wild-type yeast exclusively directed phosphate to vacuoles despite other competing sinks. After DNP or iodoacetate exposure, which significantly affected cytosolic pH or ATP metabolism, polyphosphate hydrolysis did not occur, which casts doubt on the phosphagen function of vacuolar polyphosphate. It took about 1 h for Mn2+ to traffic to vacuoles, and some evidence was obtained for polyphosphate responding to osmotic challenges. Fast NMR scans show that rapid polyphosphate hydrolysis to small polymers follows alkalinization. The small polymers then degrade to orthophosphate, which coincides with sugar phosphates increasing and subsequent reacidification. In contrast, when vph1-1 mutants were subjected to alkalinization, the absence of a vacuolar source of phosphate slowed reacidification. Based on known yeast physiology and observed sugar phosphate dynamics, polyphosphate degradation may enable rapid glycogen mobilization to glycolysis for considerable acid and ATP production. Overall, maintaining both polyphosphate and carbohydrate reserves may endow yeast with the ability to rapidly manage the extracellular environment.

Biological Transport↗

Polyphosphate metabolism in Escherichia coli.

Polyphosphate metabolism in Escherichia coli was studied in order to determine the role of polyphosphates in energy and phosphate metabolism. Phosphate-shift experiments were performed on wild-type E. coli W3110 and on an E. coli strain mutant in the genes encoding the polyphosphate-metabolizing enzymes polyphosphate kinase (PPK) and polyphosphatase (PPX). The levels of polyphosphates were measured by [31P]NMR, and the activities of PPK and PPX were measured using enzymatic assays. During phosphate starvation, the intracellular level of polyphosphate was not detectable in E. coli W3110; the activities of PPX and alkaline phosphatase were high relative to those during exponential growth. During the shift from phosphate starvation to phosphate surplus conditions, PPX activity decreased and PPK activity and intracellular polyphosphate stores increased dramatically. These results imply an important role for polyphosphates in cellular energy and phosphate storage and in adaptation to adverse growth conditions.

Acid Anhydride Hydrolases↗

Basic amino acids and inorganic polyphosphates in Neurospora crassa: independent regulation of vacuolar pools.

At least 78%, and perhaps all, of inorganic polyphosphate is shown to be contained within the vesicles (vacuoles) of Neurospora crassa, where over 97% of the soluble arginine, lysine, and ornithine pools are known to accumulate. Furthermore, synthetic polyphosphate can concentrate arginine up to 400-fold from dilute (0.01 mM) solutions in equilibrium dialysis. For these reasons and because the molar ratio of basic amino acids and polyphosphate phosphorus is approximately 1, we tested the hypothesis that there was an obligate physiological relationship between them. Experiments in which nitrogen starvation and arginine excess were imposed upon cells showed that polyphosphate content was insensitive to changes in the basic amino acid content. Experiments involving phosphate starvation and restoration showed that basic amino acid content was almost wholly independent of polyphosphate pools. Moreover, the normal high degree of compartmentation of arginine in vesicles was maintained despite polyphosphate depletion, and arginine was still exchanged across the vesicular membrane. We conclude that N. crassa, like yeasts, can regulate polyphosphates and basic amino acids independently, and that the accumulation of basic amino acids in vesicles may depend upon an energy-requiring mechanism in addition to the demonstrated charge interaction with polyphosphate.

Arginine↗

Inorganic polyphosphate in human osteoblast-like cells.

Significant amounts of inorganic polyphosphates and of polyphosphate-degrading exopolyphosphatase activity were detected in human mandibular-derived osteoblast-like cells. The amount of both soluble and insoluble long-chain polyphosphate in unstimulated osteoblast-like cells was higher than in human gingival cells, erythrocytes, peripheral blood mononuclear cells, and human blood plasma. The cellular content of polyphosphate in osteoblast-like cells strongly decreased after a combined treatment of the cells with the stimulators of osteoblast proliferation and differentiation, dexamethasone, beta-glycerophosphate, epidermal growth factor, and ascorbic acid. The amount of soluble long-chain polyphosphate, but not the amount of insoluble long-chain polyphosphate, further decreased after an additional treatment with 1alpha,25-dihydroxyvitamin D3 (1,25(OH)2D3). The decrease in polyphosphate content during treatment with dexamethasone, beta-glycerophosphate, epidermal growth factor, and ascorbic acid was accompanied by a decrease in exopolyphosphatase, pyrophosphatase, and alkaline phosphatase activity. However, additional treatment with 1,25(OH)2D3 resulted in an increase in these enzyme activities. Osteoblast-like cell exopolyphosphatase activity and exopolyphosphatase activity in yeast, rat tissues, and human leukemia cell line HL60 were inhibited by the bisphosphonates etidronate and, to a lesser extent, clodronate and pamidronate. From our results, we assume that inorganic polyphosphate may be involved in modulation of the mineralization process in bone tissue.

Acid Anhydride Hydrolases↗

Optimization of polyphosphate degradation and phosphate secretion using hybrid metabolic pathways and engineered host strains

Polyphosphate degradation and phosphate secretion were optimized in Escherichia coli strains overexpressing the E. coli polyphosphate kinase gene (ppk) and either the E. coli polyphosphatase gene (ppx) or the Saccharomyces cerevisiae polyphosphatase gene (scPPX1) from different inducible promoters on medium- and high-copy plasmids. The use of a host strain without functional ppk or ppx genes on the chromosome yielded the highest levels of polyphosphate, as well as the fastest degradation of polyphosphate when the gene for polyphosphatase was induced. The introduction of a hybrid metabolic pathway consisting of the E. coli ppk gene and the S. cerevisiae polyphosphatase gene resulted in lower polyphosphate concentrations than when using both the ppk and ppx genes from E. coli, and did not significantly improve the degradation rate. It was also found that the rate of polyphosphate degradation was highest when ppx was induced late in growth, most likely due to the high intracellular polyphosphate concentration. The phosphate released from polyphosphate allowed the growth of phosphate-starved cells; excess phosphate was secreted into the medium, leading to a down-regulation of the phosphate-starvation (Pho) response. The production of alkaline phosphatase, an indicator of the Pho response, can be precisely controlled by manipulating the degree of ppx induction. Copyright 1998 John Wiley & Sons, Inc.

Journal Article↗

Alterations of inositol polyphosphates in skeletal muscle during porcine malignant hyperthermia.

Malignant hyperthermia (MH) may result from increased intracellular calcium concentrations. Increased 1,4,5-IP3 concentrations could mediate this increase in Ca2+. In this study we measured inositol polyphosphates in selectively bred MH susceptible (MHS) and MH non-susceptible (MHN) swine. MH crisis was induced by halothane challenge, and dantrolene was administered in order to measure inositol polyphosphates after MH reversal. Muscle biopsies of skeletal muscles of the hind limbs were obtained in random order and inositol polyphosphates determined by high pressure liquid chromatography using a metal dye detection method. Inositol polyphosphates were determined in three groups: (1) MHS vs MHN basal, (2) during MH crisis induced by halothane and (3) following treatment with dantrolene after halothane challenge. Clinical variables (P(_)VO2, P(-)VCO2, PE'CO2 and pH) indicated that MH was readily induced in MHS swine. Basal concentrations of all inositol polyphosphates were higher in MHS swine compared with MHN swine. After halothane challenge, 1,3,4-IP3, 1,3,4,6-IP4 and 1,3,4,5-IP4 concentrations increased in MHS animals compared with the respective baseline values, whereas no changes in MHN animals could be detected. Dantrolene administration decreased inositol polyphosphate concentrations in MHS swine. MHN swine showed no changes in inositol polyphosphates after dantrolene. These findings indicate that inositol polyphosphates may be involved in metabolic changes after triggering and treatment of MH.

Anesthetics, Inhalation↗