The sequelae of mercury intoxication include induction of apoptosis. In nucleated cells, Hg2+-induced apoptosis involves mitochondrial damage. The present study has been performed to elucidate effects of Hg2+ in erythrocytes which lack mitochondria but are able to undergo apoptosis-like alterations of the cell membrane. Previous studies have documented that activation of a Ca2+-sensitive erythrocyte scramblase leads to exposure of phosphatidylserine at the erythrocyte surface, a typical feature of apoptotic cells. The erythrocyte scramblase is activated by osmotic shock, oxidative stress and/or energy depletion which increase cytosolic Ca2+ activity and/or activate a sphingomyelinase leading to formation of ceramide. Ceramide sensitizes the scramblase to Ca2+. The present experiments explored the effect of Hg2+ ions on erythrocytes. Phosphatidylserine exposure after mercury treatment was estimated from annexin binding as determined in FACS analysis. Exposure to Hg2+ (1 microM) indeed significantly increased annexin binding from 2.3+/-0.5% (control condition) to 23+/-6% (n=6). This effect was paralleled by activation of a clotrimazole-sensitive K+-selective conductance as measured by patch-clamp recordings and by transient cell shrinkage. Further experiments revealed also an increase of ceramide formation by approximately 66% (n=7) after challenge with mercury (1 microM). In conclusion, mercury ions activate a clotrimazole-sensitive K+-selective conductance leading to transient cell shrinkage. Moreover, Hg2+ increases ceramide formation. The observed mechanisms could similarly participate in the triggering of apoptosis in nucleated cells by Hg2+.