Faculty Bibliography

Cardiomyocytes are connected by mechanical and electrical junctions located at the intercalated discs (IDs). Although these structures have long been known, it is becoming increasingly clear that their components interact. This review describes the involvement of the ID in electrical disturbances of the heart and focuses on the role of the gap junctional protein connexin 43 (Cx43). Current evidence shows that Cx43 plays a crucial role in organizing microtubules at the intercalated disc and thereby regulating the trafficking of the cardiac sodium channel NaV1.5 to the membrane.

KEY POINTS: Na(+) current (INa ) results from the integrated function of a molecular aggregate (the voltage-gated Na(+) channel complex) that includes the beta subunit family. Mutations or rare variants in Scn1b (encoding the beta1 and beta1B subunits) have been associated with various inherited arrhythmogenic syndromes, including Brugada syndrome and sudden unexpected death in patients with epilepsy. We used Scn1b null mice to understand better the relation between Scn1b expression, and cardiac electrical function. Loss of Scn1b caused, among other effects, increased amplitude of tetrodotoxin-sensitive INa , delayed after-depolarizations, triggered beats, delayed Ca(2+) transients, frequent spontaneous calcium release events and increased susceptibility to polymorphic ventricular arrhythmias. Most alterations in Ca(2+) homeostasis were prevented by 100 nm tetrodotoxin. We propose that life-threatening arrhythmias in patients with mutations in Scn1b, a gene classically defined as ancillary to the Na(+) channel alpha subunit, can be partly consequent to disrupted intracellular Ca(2+) homeostasis. ABSTRACT: Na(+) current (INa ) is determined not only by the properties of the pore-forming voltage-gated Na(+) channel (VGSC) alpha subunit, but also by the integrated function of a molecular aggregate (the VGSC complex) that includes the VGSC beta subunit family. Mutations or rare variants in Scn1b (encoding the beta1 and beta1B subunits) have been associated with various inherited arrhythmogenic syndromes, including cases of Brugada syndrome and sudden unexpected death in patients with epilepsy. Here, we have used Scn1b null mouse models to understand better the relation between Scn1b expression, and cardiac electrical function. Using a combination of macropatch and scanning ion conductance microscopy we show that loss of Scn1b in juvenile null animals resulted in increased tetrodotoxin-sensitive INa but only in the cell midsection, even before full T-tubule formation; the latter occurred concurrent with increased message abundance for the neuronal Scn3a mRNA, suggesting increased abundance of tetrodotoxin-sensitive NaV 1.3 protein and yet its exclusion from the region of the intercalated disc. Ventricular myocytes from cardiac-specific adult Scn1b null animals showed increased Scn3a message, prolonged action potential repolarization, presence of delayed after-depolarizations and triggered beats, delayed Ca(2+) transients and frequent spontaneous Ca(2+) release events and at the whole heart level, increased susceptibility to polymorphic ventricular arrhythmias. Most alterations in Ca(2+) homeostasis were prevented by 100 nm tetrodotoxin. Our results suggest that life-threatening arrhythmias in patients with mutations in Scn1b, a gene classically defined as ancillary to the Na(+) channel alpha subunit, can be partly consequent to disrupted intracellular Ca(2+) homeostasis in ventricular myocytes.

AIMS: It is well-known that connexin43 (Cx43) forms gap junctions. We recently showed that Cx43 is also part of a protein interacting network that regulates excitability. Cardiac-specific truncation of Cx43 C-terminus (mutant "Cx43D378stop") led to lethal arrhythmias. Cx43D378stop localized to the intercalated disc (ID); cell-cell coupling was normal, but there was significant sodium current (INa) loss. We proposed that the microtubule plus-end is at the crux of the Cx43-INa relation. Yet, specific localization of relevant molecular players was prevented due to the resolution limit of fluorescence microscopy. Here, we use nanoscale imaging to establish: a) the morphology of clusters formed by the microtubule plus-end tracking protein "end binding 1" (EB1), b) their position, and that of sodium channel alpha-subunit NaV1.5, relative to N-cadherin rich sites, c) the role of Cx43 C-terminus on the above-mentioned parameters and on the location-specific function of INa. METHODS AND RESULTS: Super-resolution fluorescence localization microscopy in murine adult cardiomyocytes revealed EB1 and NaV1.5 as distinct clusters preferentially localized to N-cadherin-rich sites. Extent of co-localization decreased in Cx43D378stop cells. Macropatch and scanning patch clamp showed reduced INa exclusively at cell end, without changes in unitary conductance. Experiments in Cx43-modified HL1 cells confirmed the relation between Cx43, INa and microtubules. CONCLUSIONS: NaV1.5 and EB1 localization at cell end is Cx43-dependent. Cx43 is part of a molecular complex that determines capture of the microtubule plus-end at the ID, facilitating cargo delivery. These observations link excitability and electrical coupling through a common molecular mechanism.

Cardiac Purkinje cells are important triggers of ventricular arrhythmias associated with heritable and acquired syndromes; however, the mechanisms responsible for this proarrhythmic behavior are incompletely understood. Here, through transcriptional profiling of genetically labeled cardiomyocytes, we identified expression of Purkinje cell protein-4 (Pcp4), a putative regulator of calmodulin and Ca2+/calmodulin-dependent kinase II (CaMKII) signaling, exclusively within the His-Purkinje network. Using Pcp4-null mice and acquired cardiomyopathy models, we determined that reduced expression of PCP4 is associated with CaMKII activation, abnormal electrophysiology, dysregulated intracellular calcium handling, and proarrhythmic behavior in isolated Purkinje cells. Pcp4-null mice also displayed profound autonomic dysregulation and arrhythmic behavior in vivo. Together, these results demonstrate that PCP4 regulates cardiac excitability through both Purkinje cell-autonomous and central mechanisms and identify this modulator of CaMKII signaling as a potential arrhythmia-susceptibility candidate.

Mutations in proteins of the desmosome are associated with arrhythmogenic cardiomyopathy (AC; also referred to as "ARVC" or "ARVD"). Life-threatening ventricular arrhythmias often occur in the concealed phase of the disease before the onset of structural changes. Among the various potential mechanisms for arrhythmogenesis in AC, in this article, we concentrate on the relation between desmosomes and sodium channel function. We review evidence indicating that (1) loss of desmosomal integrity (including mutations or loss of expression of plakophilin-2; PKP2) leads to reduced sodium current (INa), (2) the PKP2-INa relation could be partly consequent to the fact that PKP2 facilitates proper trafficking of proteins to the intercalated disc, and (3) PKP2 mutations can be present in patients diagnosed with Brugada syndrome (BrS), thus supporting the previously proposed notion that AC and BrS are not two completely separate entities, but "bookends" in a continuum of variable sodium current deficiency and structural disease.

Introduction: The main function of connexins is to form gap junctions; yet, recent studies show that Cx43 is not only a gap junction protein. In fact, Cx43 is a part of a protein interacting network (the connexome), likely to regulate other functions in a gap junction-independent manner. Recently, it was reported that loss of the last five amino acids of Cx43 (Cx43D378stop) leads to lethal ventricular arrhythmias in mice. Localization of Cx43 at the membrane and electrical coupling between cells was normal. Interestingly, there was a significant loss of sodium current amplitude. These observations linked two fundamental steps in action potential propagation, excitability and electrical coupling, through a common molecular mechanism. Here, we explore the hypothesis that the microtubular network at the cell end is part of the common link. Methods: N/A Results: Functional assays: Macropatch, and super-resolution scanning patch clamp in ventricular myocytes isolated from Cx43D378stop and Cre-negative (control) mice revealed a reduction in the amplitude of sodium current exclusively at the intercalated disc (ID), without a change in channel unitary conductance. Super-resolution fluorescence microscopy: direct stochastic optical reconstruction microscopy (20 nm resolution) showed Nav1.5 clusters in close proximity (or overlapping) with N-cadherin plaques. The distance between NaV1.5 clusters and the cell end increased from 57.2+12nm, n=365 in control to 111.7+11nm, n=446 in Cx43D378stop myocytes (p<0.001), indicating that mutation Cx43D378stop reduced NaV1.5 surface expression. This coincided with separation of the microtubule plus-end protein EB1 from N-cadherin-rich cell ends, from 23.7+31.9nm, n=665 in control, to 123.5+13.5nm, n=502 in Cx43D378stop cells (p<0.05). Conclusions: Functional surface expression of NaV1.5 at the ID depends on preservation of the Cx43 C-end. Cx43 is part of a molecular complex that anchors the microtubule plus-end to the cell end, thus allowing proper delivery of its ca!

This review summarizes data in support of the notion that the cardiac intercalated disc is the host of a protein interacting network, called "the connexome", where molecules classically defined as belonging to one particular structure (e.g., desmosomes, gap junctions, sodium channel complex) actually interact with others, and together, control excitability, electrical coupling and intercellular adhesion in the heart. The concept of the connexome is then translated into the understanding of the mechanisms leading to two inherited arrhythmia diseases: arrhythmogenic cardiomyopathy, and Brugada syndrome. The cross-over points in these two diseases are addressed to then suggest that, though separate identifiable clinical entities, they represent "bookends" of a spectrum of manifestations that vary depending on the effect that a particular mutation has on the connexome as a whole.