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Biochemical evidence indicates that veratridine (VTD) and batrachotoxin (BTX) share a common binding site in Na+ channels. Under whole-cell voltage-clamp conditions, we examined this single receptor hypothesis by studying the VTD phenotype in BTX-resistant muscle Na+ channels, microl-I433K, N434K, L437K, F1579K, and N1584K. Derived from point mutations at segments D1-S6 and D4-S6, these mutant Na+ channels are resistant to 5 microM BTX when expressed in human embryonic kidney cells. In contrast to the wild-type phenotype, VTD at 200 microM elicits little or no maintained current during a test pulse at +50 mV, and little or no "tail" current after the test pulse in all BTX-resistant mutant channels. Paradoxically, VTD retains its ability to inhibit the peak Na+ current in BTX-resistant mutant Na+ channels. To explain these mutant phenotypes, we propose a two-step binding reaction scheme. An initial VTD-binding interaction with the Na+ channel results in the inhibition of peak current amplitude, and a second binding reaction results in the trapping of VTD within the D1-S6 and D4-S6 domain interface. The failure of BTX-resistant mutant Na+ channels to trap VTD suggests that segments of D1-S6 and D4-S6 form a common receptor for VTD and BTX.

Outpatient Palliative Care: Why It Is Important, How to Build It at Your Institution, and How to Deliver the Care (P9) (Advanced) Vicki Jackson, MD MPH, Massachusetts General Hospital, Boston, MA. Juliet Jacobsen, MD, Massachusetts General Hospital, Boston, MA. Connie Dahlin, ACHPN ANP, Massachusetts General Hospital Palliative Care Service, Boston, MA. Margaret Seaver, MD MPH, Lahey Clinic Medical Center, Burlington, MA. Sponsored by AAHPM (All speakers for this session have disclosed no relevant financial relationships.)