Structural Basis of the Modulation of the Voltage-Gated Calcium Ion Channel Ca

1,4‐Dihydropyridines (DHP), the most commonly used antihypertensives, function by inhibiting the L‐type voltage‐gated Ca2+ (Cav) channels. DHP compounds exhibit chirality‐specific antagonistic or agonistic effects. The structure of rabbit Cav1.1 bound to an achiral drug nifedipine reveals the general binding mode for DHP drugs, but the molecular basis for chiral specificity remained elusive. Herein, we report five cryo‐EM structures of nanodisc‐embedded Cav1.1 in the presence of the bestselling drug amlodipine, a DHP antagonist (R)‐(+)‐Bay K8644, and a titration of its agonistic enantiomer (S)‐(−)‐Bay K8644 at resolutions of 2.9–3.4 Å. The amlodipine‐bound structure reveals the molecular basis for the high efficacy of the drug. All structures with the addition of the Bay K8644 enantiomers exhibit similar inactivated conformations, suggesting that (S)‐(−)‐Bay K8644, when acting as an agonist, is insufficient to lock the activated state of the channel for a prolonged duration.
High‐resolution cryo‐EM structures of nanodisc‐embedded Cav1.1 in complex with antagonists Levamlodipine, (R)‐(+)‐Bay K8644, and dual agonist/antagonist (S)‐(−)‐Bay K8644 reveal the molecular basis of the allosteric modulation of the voltage‐gated Ca2+ channel Cav1.1 by dihydropyridine (DHP) drugs. Advanced structural understanding of the stereo‐selective mode of action of DHP will facilitate drug discovery targeting Cav channels.