Key result
The E1784K mutation in NaV1.5 shifts the conductance curve to more depolarized potentials due to altered fast inactivation, despite shifting the DIVS4 voltage-sensor movement to more hyperpolarized potentials.
The E1784K mutation in NaV1.5 causes a depolarizing shift in conductance due to altered fast inactivation rather than a direct effect on activation voltage-sensors, providing insight into the mechanisms of mixed LQT3/BrS1 syndrome.
May heighten arrhythmia risk during acidosis in E1784K carriers; leaves open clinical translation of pH-sensitive NaV1.5 modulation.
E1784K is the most common mixed long QT syndrome/Brugada syndrome mutant in the cardiac voltage-gated sodium channel NaV1.5. E1784K shifts the midpoint of the channel conductance-voltage relationship to more depolarized membrane potentials and accelerates the rate of channel fast inactivation. The depolarizing shift in the midpoint of the conductance curve in E1784K is exacerbated by low extracellular pH. We tested whether the E1784K mutant shifts the channel conductance curve to more depolarized membrane potentials by affecting the channel voltage-sensors. We measured ionic currents and gating currents at pH 7.4 and pH 6.0 in Xenopus laevis oocytes. Contrary to our expectation, the movement of gating charges is shifted to more hyperpolarized membrane potentials by E1784K. Voltage-clamp fluorimetry experiments show that this gating charge shift is due to the movement of the DIVS4 voltage-sensor being shifted to more hyperpolarized membrane potentials. Using a model and experiments on fast inactivation-deficient channels, we show that changes to the rate and voltage-dependence of fast inactivation are sufficient to shift the conductance curve in E1784K. Our results localize the effects of E1784K to DIVS4, and provide novel insight into the role of the DIV-VSD in regulating the voltage-dependencies of activation and fast inactivation.
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Peters et al. (2017) studied Long QT syndrome type 3 and Brugada syndrome type 1 (NaV1.5 E1784K mutation). E1784K mutation in NaV1.5 vs. Wild-type (C373F) NaV1.5 channels was evaluated on Voltage-dependence of conductance and fast inactivation. The E1784K mutation in NaV1.5 shifts the conductance curve to more depolarized potentials due to altered fast inactivation, despite shifting the DIVS4 voltage-sensor movement to more hyperpolarized potentials.
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