Hallmarks of apoptosis include cell shrinkage, which is at least partially due to cellular K(+) loss. The decline of cellular K(+) concentration has been suggested to participate in the triggering of apoptosis. Suicidal erythrocyte death or eryptosis is triggered by increased cytosolic Ca(2+) activity leading to activation of Ca(2+)-sensitive K(+) channels with subsequent cellular K(+) loss and cell shrinkage, and to Ca(2+)-sensitive scambling of the cell membrane with subsequent phosphatidylserine (PS) exposure at the cell surface. Phosphatidylserine exposing erythrocytes are recognized by macrophages, engulfed, degraded and thus cleared from circulating blood. The present study explored whether cellular loss of K(+) and/or cell shrinkage actively participate in the triggering of cell membrane phospholipid scrambling. Cellular K(+) loss was achieved by treatment of human erythrocytes with the K(+) ionophore valinomycin (1 nM) at different extracellular K(+) concentrations (5-125 mM) and osmolarities (300-550 m Osm). Cell volume was estimated from forward scatter and PS exposure from annexin V binding in FACS analysis. Treatment with 1 nM valinomycin indeed decreased forward scatter and increased annexin V binding. The effect was significantly blunted in the presence of staurosporine (1 microM). Increase of extracellular K(+) concentration gradually blunted the decrease of forward scatter but inhibited annexin V binding only at extracellular K(+) concentrations >or=75 mM. An increase of extracellular osmolarity (+150 mM or 250 mM sucrose) reversed the protective effect of 75 mM KCl during valinomycin treatment. A correlation between forward scatter and annexin binding at different osmolarities and K(+) concentrations suggests that the cellular K(+) content determines the rate of suicidal erythrocyte death primarily through its influence on cell volume.