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(Circulation. 2000;101:54.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Cardiac Na⁺ Channel Dysfunction in Brugada Syndrome Is Aggravated by ß₁-Subunit

Naomasa Makita, MD, PhD; Nobumasa Shirai, MD; Dao W. Wang, MD; Koji Sasaki, MD; Alfred L. George, Jr, MD; Morio Kanno, MD, PhD; Akira Kitabatake, MD, PhD

From the Department of Cardiovascular Medicine (N.M., N.S., K.S., A.K.) and Department of Pharmacology (M.K.), Hokkaido University School of Medicine, Sapporo, Japan, and the Departments of Medicine and Pharmacology, Vanderbilt University School of Medicine (D.W.W., A.L.G.), Nashville, Tenn.

Correspondence to Naomasa Makita, MD, PhD, Department of Cardiovascular Medicine, Hokkaido University School of Medicine, Kita-15, Nishi-7, Kita-Ku, Sapporo 060-8638, Japan. E-mail makitan{at}med.hokudai.ac.jp

Background—Mutations in the gene encoding the human cardiac Na⁺ channel -subunit (hH1) are responsible for chromosome 3–linked congenital long-QT syndrome (LQT3) and idiopathic ventricular fibrillation (IVF). An auxiliary ß₁-subunit, widely expressed in excitable tissues, shifts the voltage dependence of steady-state inactivation toward more negative potentials and restores normal gating kinetics of brain and skeletal muscle Na⁺ channels expressed in Xenopus oocytes but has little if any functional effect on the cardiac isoform. Here, we characterize the altered effects of a human ß₁-subunit (hß₁) on the heterologously expressed hH1 mutation (T1620M) previously associated with IVF.

Methods and Results—When expressed alone in Xenopus oocytes, T1620M exhibited no persistent currents, in contrast to the LQT3 mutant channels, but the midpoint of steady-state inactivation (V_1/2) was significantly shifted toward more positive potentials than for wild-type hH1. Coexpression of hß₁ did not significantly alter current decay or recovery from inactivation of wild-type hH1; however, it further shifted the V_1/2 and accelerated the recovery from inactivation of T1620M. Oocyte macropatch analysis revealed that the activation kinetics of T1620M were normal.

Conclusions—It is suggested that coexpression of hß₁ exposes a more severe functional defect that results in a greater overlap in the relationship between channel inactivation and activation (window current) in T1620M, which is proposed to be a potential pathophysiological mechanism of IVF in vivo. One possible explanation for our finding is an altered -/ß₁-subunit association in the mutant.

Key Words: action potentials • arrhythmia • death, sudden • electrophysiology • fibrillation

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