Inter-regulation of kv 4.3 and voltage-gated sodium channels underlies predisposition to cardiac and neuronal channelopathies

Abstract

Background: Genetic variants in voltage-gated sodium channels (Nav) encoded by SCNXA genes, responsible for INa, and Kv 4.3 channels encoded by KCND3, responsible for the transient outward current (Ito), contribute to the manifestation of both Brugada syndrome (BrS) and spinocerebellar ataxia (SCA19/22). We examined the hypothesis that Kv 4.3 and Nav variants regulate each other’s function, thus modulating INa /Ito balance in cardiomyocytes and INa /I(A) balance in neurons. Methods: Bicistronic and other constructs were used to express WT or variant Nav 1.5 and Kv 4.3 channels in HEK293 cells. INa and Ito were recorded. Results: SCN5A variants associated with BrS reduced INa, but increased Ito. Moreover, BrS and SCA19/22 KCND3 variants associated with a gain of function of Ito, significantly reduced INa, whereas the SCA19/22 KCND3 variants associated with a loss of function (LOF) of Ito significantly increased INa. Auxiliary subunits Nav β1, MiRP3 and KChIP2 also modulated INa /Ito balance. Co-immunoprecipitation and Duolink studies suggested that the two channels interact within the intracellular compartments and biotinylation showed that LOF SCN5A variants can increase Kv 4.3 cell-surface expression. Conclusion: Nav and Kv 4.3 channels modulate each other’s function via trafficking and gating mechanisms, which have important implications for improved understanding of these allelic cardiac and neuronal syndromes.