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      Magnesium basics

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          Abstract

          As a cofactor in numerous enzymatic reactions, magnesium fulfils various intracellular physiological functions. Thus, imbalance in magnesium status—primarily hypomagnesaemia as it is seen more often than hypermagnesaemia—might result in unwanted neuromuscular, cardiac or nervous disorders. Measuring total serum magnesium is a feasible and affordable way to monitor changes in magnesium status, although it does not necessarily reflect total body magnesium content. The following review focuses on the natural occurrence of magnesium and its physiological function. The absorption and excretion of magnesium as well as hypo- and hypermagnesaemia will be addressed.

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          Human vascular smooth muscle cells undergo vesicle-mediated calcification in response to changes in extracellular calcium and phosphate concentrations: a potential mechanism for accelerated vascular calcification in ESRD.

          Patients with ESRD have a high circulating calcium (Ca) x phosphate (P) product and develop extensive vascular calcification that may contribute to their high cardiovascular morbidity. However, the cellular mechanisms underlying vascular calcification in this context are poorly understood. In an in vitro model, elevated Ca or P induced human vascular smooth muscle cell (VSMC) calcification independently and synergistically, a process that was potently inhibited by serum. Calcification was initiated by release from living VSMC of membrane-bound matrix vesicles (MV) and also by apoptotic bodies from dying cells. Vesicles released by VSMC after prolonged exposure to Ca and P contained preformed basic calcium phosphate and calcified extensively. However, vesicles released in the presence of serum did not contain basic calcium phosphate, co-purified with the mineralization inhibitor fetuin-A and calcified minimally. Importantly, MV released under normal physiologic conditions did not calcify, and VSMC were also able to inhibit the spontaneous precipitation of Ca and P in solution. The potent mineralization inhibitor matrix Gla protein was found to be present in MV, and pretreatment of VSMC with warfarin markedly enhanced vesicle calcification. These data suggest that in the context of raised Ca and P, vascular calcification is a modifiable, cell-mediated process regulated by vesicle release. These vesicles contain mineralization inhibitors derived from VSMC and serum, and perturbation of the production or function of these inhibitors would lead to accelerated vascular calcification.
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            Magnesium metabolism and its disorders.

            Magnesium is the fourth most abundant cation in the body and plays an important physiological role in many of its functions. Magnesium balance is maintained by renal regulation of magnesium reabsorption. The exact mechanism of the renal regulation is not fully understood. Magnesium deficiency is a common problem in hospital patients, with a prevalence of about 10%. There are no readily available and easy methods to assess magnesium status. Serum magnesium and the magnesium tolerance test are the most widely used. Measurement of ionised magnesium may become more widely available with the availability of ion selective electrodes. Magnesium deficiency and hypomagnesaemia can result from a variety of causes including gastrointestinal and renal losses. Magnesium deficiency can cause a wide variety of features including hypocalcaemia, hypokalaemia and cardiac and neurological manifestations. Chronic low magnesium state has been associated with a number of chronic diseases including diabetes, hypertension, coronary heart disease, and osteoporosis. The use of magnesium as a therapeutic agent in asthma, myocardial infarction, and pre-eclampsia is also discussed. Hypermagnesaemia is less frequent than hypomagnesaemia and results from failure of excretion or increased intake. Hypermagnesaemia can lead to hypotension and other cardiovascular effects as well as neuromuscular manifestations. Causes and management of hypermagnesaemia are discussed.
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              Relationship between configuration, function, and permeability in calcium-treated mitochondria.

              Low levels of calcium (100 nmol/mg) added to beef heart mitochondria induced a configurational transition from the aggregated to the orthodox state and a simultaneous uncoupling of oxidative phosphorylation. The primary effect of calcium was to cause a nonspecific increase in the permeability of the inner membrane, resulting in entry of sucrose into the matrix space and the observed configurational transition. The uncoupling and permeability change induced by calcium could readily be reversed by lowering the calcium:magnesium ratio in the presence of either substrate or ATP. The configurational state, however, remained orthodox. This, along with studies of hypotonically induced orthodox mitochondria in which the membrane remained coupled and impermeable until after the addition of calcium, led to the conclusion that coupling was related to the permeability state of the inner membrane rather than the configurational state. Phosphate, arsenate, or oleic acid was found to cause a transition similar to that induced by calcium. Studies with the specific calcium transport inhibitors, EGTA, ruthenium red, and lanthanum revealed that endogenous calcium is required for the anion-induced transitions. A single mechanism was further indicated by a common sensitivity to N-ethylmaleimide. Strontium was ineffective as an inducer of the transition, even though it is transported by the same mechanism as calcium. This indicates that there are additional calcium-binding sites responsible for triggering the transition. Magnesium and calcium appeared to compete for these additional sites, since magnesium competitively inhibited the calcium-induced transition, but had no effect on calcium uptake. Calcium was found to potently inhibit the respiration of all NAD+-requiring substrates prior to the transition. Strontium also produced this inhibition without a subsequent transition. ATPase activity was induced at the exact time of transition with calcium and was not induced by strontium. This suggests that calcium-induced ATPase uniquely required the transition for activity, in contrast to the ATPase induced by uncoupler or valinomycin. The results of this work indicate that mitochondria have a built-in mechanism which responds to low levels of calcium, phosphate, and fatty acids, resulting in simultaneous changes, including increased permeability, inducation of ATPase, uncoupling of oxidative phosphorylation, and loss of respiratory control.
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                Author and article information

                Journal
                Clin Kidney J
                Clin Kidney J
                ndtplus
                ckj
                Clinical Kidney Journal
                Oxford University Press
                2048-8505
                2048-8513
                February 2012
                February 2012
                : 5
                : Suppl 1 , Magnesium - a versatile and often overlooked element: New perspectives with a focus on chronic kidney disease
                : i3-i14
                Affiliations
                [1 ]RWTH Aachen University, Helmholtz Institute for Biomedical Engineering, Biointerface Laboratory, Aachen, Germany
                [2 ]Klinikum Coburg, III. Medizinische Klinik, Coburg, Germany
                Author notes
                Correspondence and offprint requests to: Wilhelm Jahnen-Dechent; E-mail: willi.jahnen@ 123456rwth-aachen.de
                Article
                10.1093/ndtplus/sfr163
                4455825
                26069819
                eb6bca8b-17b2-41cb-b8d4-44b5b4020f19
                © The Author 2012. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

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                Page count
                Pages: 12
                Categories
                Articles

                Nephrology
                magnesium,physicochemical properties,physiological function,regulation,hypomagnesaemia,hypermagnesaemia

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