Key result
The Nav1.7 p.I848T mutation caused a hyperpolarized shift in the voltage dependence of activation by -9.73 mV compared to wildtype, which was shown to be mediated by protein kinase C phosphorylation.
Why the study?
The mutation Nav1.7 p.I848T causes inherited erythromelalgia and induces a hyperpolarized shift in voltage dependence of activation, but the mechanism explaining this increased voltage sensitivity was unknown.
Mean Difference: -9.73 (95% CI -12.67–-6.86)
Absolute Event Rate: -28.06% vs -18.3%
p-value: p=<0.0001
Phosphorylation of the Nav1.7 p.I848T mutation by protein kinase C causes a hyperpolarized shift in voltage sensitivity, providing a mechanistic explanation for the chronic pain syndrome inherited erythromelalgia.
May enable mutation-specific erythromelalgia therapies; extends Nav1.7 channelopathy mechanisms but leaves clinical translation open.
Mutations in voltage-gated sodium channels (Navs) can cause alterations in pain sensation, such as chronic pain diseases like inherited erythromelalgia. The mutation causing inherited erythromelalgia, Nav1.7 p.I848T, is known to induce a hyperpolarized shift in the voltage dependence of activation in Nav1.7. So far, however, the mechanism to explain this increase in voltage sensitivity remains unknown. In the present study, we show that phosphorylation of the newly introduced Thr residue explains the functional change. We expressed wildtype human Nav1.7, the I848T mutant, or other mutations in HEK293T cells and performed whole-cell patch-clamp electrophysiology. As the insertion of a Thr residue potentially creates a novel phosphorylation site for Ser/Thr kinases and because Nav1.7 had been shown in Xenopus oocytes to be affected by protein kinases C and A, we used different nonselective and selective kinase inhibitors and activators to test the effect of phosphorylation on Nav1.7 in a human system. We identify protein kinase C, but not protein kinase A, to be responsible for the phosphorylation of T848 and thereby for the shift in voltage sensitivity. Introducing a negatively charged amino acid instead of the putative phosphorylation site mimics the effect on voltage gating to a lesser extent. 3D modeling using the published cryo-EM structure of human Nav1.7 showed that introduction of this negatively charged site seems to alter the interaction of this residue with the surrounding amino acids and thus to influence channel function. These results could provide new opportunities for the development of novel treatment options for patients with chronic pain.
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Kerth et al. (2020) studied Inherited erythromelalgia. Nav1.7 p.I848T mutation vs. Wildtype Nav1.7 was evaluated on Half-maximal voltage dependence of activation (V1/2) (MD -9.73 mV, 95% CI -12.67 to -6.86, p=<0.0001). The Nav1.7 p.I848T mutation caused a hyperpolarized shift in the voltage dependence of activation by -9.73 mV compared to wildtype, which was shown to be mediated by protein kinase C phosphorylation.
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