We have found a defect in the ouabain-sensitive Na+,K+-ATPase (Na+ pump, EC 3.6.1.37) oferythrocytes from streptozotocin diabetic rats. This defect was accompanied by an increase in cell volume and osmotic fragility and a decrease in the cytosolic K+/Na+ ratio. There was also a doubling in the time needed for diabetic erythrocytes to pass through 4.7-jim channels in a polycarbonate filter. Our data are consistent with a primary defect in the erythrocyte Na+ pump and secondary changes in cell volume, osmotic fragility, K+/Na+ ratio, and cell ifiterability. All were reversed or prevented in vivo by insulin or the aldose reductase inhibitor Sorbinil. Protein kinase C agonists (phorbol ester and diacylglycerol) and agonist precursor (myoinositol) reversed the Na+ pump lesion, suggesting that protein kinase C-dependent phosphorylation of the 100-kDa subunit regulates Na+ pump activity and that insulin can influence erythrocyte protein kinase C activity. Ouabain inhibition of the erythrocyte Na+ pump also produced increases in cell size and reductions in rates of ifitration. Theoretical treatment of the volume changes also predicts reduction in ifiterability as a consequence of cell swelling. We suggest that enlarged erythrocytes could play a role in the evolution of the microvascular changes of diabetes mellitus.A decrease in ouabain-sensitive Na',K+-ATPase (Na' pump, EC 3.6.1.37) activity has been found in diabetic lens, nerve, and glomerulus (1-3). This Na' pump impairment was corrected by aldose reductase inhibitors or by normalization of blood sugar with insulin. In contrast, Na' pump activity in diabetic erythrocytes (RBCs) is a subject of controversy, with reports of increases (4, 5) and decreases (6, 7). We therefore initiated a study of the Na' pump in erythrocytes of rats rendered diabetic with streptozotocin. The streptozotocin diabetic rat provided a reliable source ofRBCs whose time-integrated exposure to hyperglycemia was determined by measurement of glycated albumin. Since nondiabetic RBCs must deform considerably to pass through small capillaries, we were especially interested in learning whether such a putative Na' pump lesion would influence the volume and hence filterability of affected RBCs.
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