Irx5 and transient outward K + currents contribute to transmural contractile heterogeneities in the mouse ventricle.

Previous studies have established that transmural gradients of the fast transient outward K ⁺ current ( I _to,f ) correlate with regional differences in action potential (AP) profile and excitation-contraction coupling (ECC) with high I _to,f expression in the epimyocardium (EPI) being associated with short APs and low contractility and vice versa. Herein, we investigated the effects of altering the I _to,f gradients on transmural contractile properties using mice lacking Irx5 (Irx5-KO) or lacking Kcnd2 (K _V 4.2-KO) or both. Irx5-KO mice exhibited decreased global LV contractility in association with elevated I _to,f , as well as reduced cell shortening and Ca ²⁺ transient amplitudes in cardiomyocytes isolated from the endomyocardium (ENDO) but not in cardiomyocytes from the EPI. Transcriptional profiling revealed that the primary effect of Irx5 ablation on ECC-related genes was to increase I _to,f gene expression (i.e., Kcnd2 and Kcnip2 ) in the ENDO, but not the EPI. By contrast, K _V 4.2-KO mice showed selective increases in cell shortening and Ca ²⁺ transients in isolated EPI cardiomyocytes, leading to enhanced ventricular contractility and mice lacking both Irx5 and Kcnd2 displayed elevated ventricular contractility, comparable to K _V 4.2-KO mice, demonstrating a dominant role of Irx5 -dependent modulation of I _to,f in the regulation of contractility. Our findings show that the transmural electromechanical heterogeneities in the healthy ventricles depend on the Irx5 -dependent I _to,f gradients. These observations provide a useful framework for assessing the molecular mechanisms underlying the alterations in contractile heterogeneity seen in the diseased heart. NEW & NOTEWORTHY Irx5 is a vital transcription factor that establishes the transmural heterogeneity of ventricular myocyte contractility, thereby ensuring proper contractile function in the healthy heart. Regional differences in excitation-contraction coupling in the ventricular myocardium are primarily mediated through the inverse relationship between Irx5 and the fast transient outward K ⁺ current ( I _to,f ) across the ventricular wall.