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Membrane-associated guanylate kinase (MAGUK) proteins function as adaptor proteins to mediate the recruitment and scaffolding of ion channels in the plasma membrane in various cell types. In the heart, the protein CASK (Calcium/CAlmodulin-dependent Serine protein Kinase) negatively regulates the main cardiac sodium channel, NaV1.5, which carries the sodium current (INa) by preventing its anterograde trafficking. CASK is also a new member of the dystrophin-glycoprotein complex, and like syntrophin, binds to the C-terminal domain of the channel. Here we show that both L27B and GUK domains are required for the negative regulatory effect of CASK on INa and NaV1.5 surface expression and that the HOOK domain is essential for interaction with the cell adhesion dystrophin-glycoprotein complex. Thus, the multi-modular structure of CASK potentially provides the ability to control channel delivery at adhesion points in cardiomyocyte.SUMMARYSequential functional domain deletion approach identifies three critical domains of CASK in cardiomyocytes. CASK binds the cell adhesion dystrophin-glycoprotein complex through HOOK domain and inhibits NaV1.5 channel membrane expression by impeding trafficking through L27B and GUK domains.

Catastrophic arrhythmias and sudden cardiac death can occur with even a small imbalance between inward sodium currents and outward potassium currents, but mechanisms establishing this critical balance are not understood. Here, we show that mRNA transcripts encoding INa and IKr channels (SCN5A and hERG, respectively) are associated in defined complexes during protein translation. Using biochemical, electrophysiological and single-molecule fluorescence localization approaches, we find that roughly half the hERG translational complexes contain SCN5A transcripts. Moreover, the transcripts are regulated in a way that alters functional expression of both channels at the membrane. Association and coordinate regulation of transcripts in discrete ‘microtranslatomes’ represents a new paradigm controlling electrical activity in heart and other excitable tissues.

Activation of the electrical signal and its transmission as a depolarizing wave in the whole heart requires highly organized myocyte architecture and cell-cell contacts. In addition, complex trafficking and anchoring intracellular machineries regulate the proper surface expression of channels and their targeting to distinct membrane domains. An increasing list of proteins, lipids, and second messengers can contribute to the normal targeting of ion channels in cardiac myocytes. However, their precise roles in the electrophysiology of the heart are far from been extensively understood. Nowadays, much effort in the field focuses on understanding the mechanisms that regulate ion channel targeting to sarcolemma microdomains and their organization into macromolecular complexes. The purpose of the present section is to provide an overview of the characterized partners of the main cardiac sodium channel, NaV1.5, involved in regulating the functional expression of this channel both in terms of trafficking and targeting into microdomains.

The density of functional Kv1.5 channels underlying IKur, the main repolarizing current in human atria, is a result of the equilibrium between exocytosis and endocytosis. We have shown that in addition to constitutive exocytosis, Kv1.5 channels can also undergo regulated exocytosis, for instance following changes in the mechanical environment or changes in the cholesterol content of the sarcolemma. Although constitutive and triggered endocytosis have been investigated for Kv1.5, its internalization pathway has not been described. Using high-resolution 3-D deconvolution microscopy, we showed that Kv1.5 channels are associated with clathrin vesicles (CVs) in atrial myocytes. Electron microscopy (EM) showed that CVs are found both at the intercalated disc and at the lateral sarcolemma, aligned along z-bands. Blockade of the clathrin pathway using hypertonic media or SiRNA increased IKur densityin atrial myocytes and led to Kv1.5 channels accumulating at the sarcolemma, as shown by biotinylation assays and fluorescence recovery after photobleaching (FRAP) experiments. These data support the hypothesis that Kv1.5 channels are internalized via the clathrin pathway.Next, we investigated Kv1.5 channel internalization in a rat model of atrial hemodynamic overload. Despite reduced Kv1.5 protein expression in dilated atria, IKur density was unchanged, suggesting increased functional Kv1.5 channels at the sarcolemma. Clathrin expression was reduced in dilated atria, and a decreased colocalization between Kv1.5 channels and CVs was observed. However, EM showed no significant difference in internalization activity between sham and dilated atria. Therefore, the reduced clathrin protein synthesis observed in dilated atria is not likely to be responsible for the accumulation of Kv1.5 channels at the sarcolemma. Other mechanisms such as increased recycling and/or membrane stabilization must be investigated to understand how IKur is maintained in dilated atria.

Atrial myocytes are continuously exposed to mechanical forces including shear stress. However, in atrial myocytes, the effects of shear stress are poorly understood, particularly with respect to its effect on ion channel function. Here, we report that shear stress activated a large outward current from rat atrial myocytes, with a parallel decrease in action potential duration. The main ion channel underlying the increase in current was found to be Kv1.5, the recruitment of which could be directly observed by total internal reflection fluorescence microscopy, in response to shear stress. The effect was primarily attributable to recruitment of intracellular pools of Kv1.5 to the sarcolemma, as the response was prevented by the SNARE protein inhibitor N-ethylmaleimide and the calcium chelator BAPTA. The process required integrin signaling through focal adhesion kinase and relied on an intact microtubule system. Furthermore, in a rat model of chronic hemodynamic overload, myocytes showed an increase in basal current despite a decrease in Kv1.5 protein expression, with a reduced response to shear stress. Additionally, integrin beta1d expression and focal adhesion kinase activation were increased in this model. This data suggests that, under conditions of chronically increased mechanical stress, the integrin signaling pathway is overactivated, leading to increased functional Kv1.5 at the membrane and reducing the capacity of cells to further respond to mechanical challenge. Thus, pools of Kv1.5 may comprise an inducible reservoir that can facilitate the repolarization of the atrium under conditions of excessive mechanical stress.

During the cardiac cycle atrial myocytes are continuously exposed to shear stress, which occurs when laminar sheets of cells move relative to each other. However, in atrial myocytes the effects of shear stress on ion channel regulation are poorly known. Here, we report that shear stress activates a large outward current, and corresponding decreased action potential duration in atrial myocytes, primarily attributable to an increase in the membrane density of the potassium channel Kv1.5. Total outward currents were reversibly increased upon shear stress from 3.8 ± 0.5 pA/pF to 43.2 ± 8.9 pA/pF, and could be blocked using 1mM 4-AP. The increase in current was due to recruitment of channels from submembranous pools to the plasma membrane, as it could be prevented by the SNARE protein inhibitor NEM, as well as with BAPTA to buffer intracellular calcium. Recruitment of EGFP-Kv1.5 could be directly observed using total internal reflection fluorescence microscopy. The mechanosensor was found to be the integrin system signalling through focal adhesion kinase, and an intact microtubule system was required. In a rat model of heart failure (HF), the integrin system was upregulated and myocytes showed an increase in basal current. Furthermore, HF myocytes had reduced Kv1.5 expression as well as a reduced response to shear stress. These data suggest that under conditions in which the integrin system is altered, the signalling pathway resulting in recruitment of Kv1.5 is overactivated leading to an increase in basal current and a reduced capacity to respond to further stimulation. We propose that pools of Kv1.5 comprise an inducible reserve which can mediate the repolarization of the atrium following mechanical stress, and that this system is disrupted when the mechanosensor is altered.