Gada, K. D. | bioRxiv Science

bioRxiv2026

PIP2 stabilizes Nav1.5 gating and links receptor signaling to cardiac late sodium current

The cardiac sodium channel NaV1.5 initiates each heartbeat by generating the rapid depolarizing upstroke of the action potential. Dysregulation of NaV1.5 gating can produce cardiac arrhythmias by slowing inactivation, increasing late sodium current (INa,L), and impairing electrical stability. Here, we show that phosphatidylinositol-4,5-bisphosphate (PIP2) is a critical membrane cofactor that stabilizes NaV1.5 gating. Acute PIP2 depletion in human iPSC-derived cardiomyocytes, produced by activation of endogenous AT1 receptors, activation of an engineered M3q-DREADD, or optogenetic recruitment of CRY2-pseudojanin, shifted voltage dependence, slowed fast inactivation, and increased INa,L. These effects were prevented by augmenting intracellular PIP2, required PLC activity when driven by Gq-coupled receptors, and were independent of downstream Ca{superscript 2} or PKC signaling. Unlike the skeletal-muscle isoform NaV1.4, NaV1.5 displayed PIP2-dependent shifts in both activation and steady-state inactivation, indicating isoform-specific lipid coupling. Induced-fit docking and molecular dynamics simulations identified a PIP2-interaction interface between the domain IV voltage sensor and pore that contains disease-linked residues. The disease-reported variant R1644C weakened and redistributed the predicted PIP2-contact network, produced elevated basal INa,L, showed enhanced sensitivity to PIP2 depletion, and caused an approximately 30-fold reduction in apparent functional PIP2 sensitivity in excised patches. These findings define a lipid-dependent mechanism that stabilizes NaV1.5 gating and reveal how physiological Gq signaling and inherited channel variants can converge on the channel-PIP2 axis to promote proarrhythmic late sodium current.

physiology↗

bioRxiv2025

Hypoxia Exacerbates Kir2.1 Channel Dysfunction in an Andersen-Tawil Syndrome Variant Through a SUMO-Dependent Mechanism

BackgroundAndersen-Tawil Syndrome type 1 (ATS1) is a multisystem channelopathy that predisposes patients to ventricular dysrhythmias and increases the risk of sudden cardiac death. ATS1 arises from loss-of-function mutations in Kir2.1, the inward rectifying potassium channel responsible for most of IK1 in ventricular cardiomyocytes. IK1 is suppressed by SUMOylation, a post- translational modification upregulated in hypoxia, a known proarrhythmic stimulus. We investigated whether current from the ATS1-linked variant Kir2.1-R67Q is inhibited by hypoxia and whether this suppression can be reversed by pharmacological inhibition of the SUMO pathway. MethodsWe used patch-clamp recording to measure IK1 and Kir2.1 currents under acute hypoxia, with and without the SUMO pathway inhibitor TAK-981. To quantify SUMOylation stoichiometry, we applied single molecule photobleaching. A multidisciplinary approach combining electrophysiology, molecular modeling, and optogenetic phosphoinositide was used to measure the impact of Kir2.1- R67Q and SUMOylation on channel interactions with phosphatidylinositol 4,5-bisphosphate (PIP2), a required gating cofactor. ResultsKir2.1 can be modified by up to two SUMO proteins attached to diagonally opposite subunits, with each SUMOylation event reducing current by [~]20%. Heterozygouse channels containing two R67Q subunits were more susceptible to hypoxic suppression than wild type. TAK-981 blocked hypoxic inhibition of IK1 in ventricular cardiomyocytes and abolished Kir2.1 SUMOylation. In cells expressing Kir2.1-R67Q, TAK-981 significantly increased currents and mitigated hypoxic suppression. Computational modeling and optogenetic dephosphorylation revealed that both the R67Q mutation and converge to disrupt Kir2.1- PIP2 interactions, producing synergistic inhibition of channel function. ConclusionsHypoxia-induced SUMOylation and the R67Q mutation synergistically suppress Kir2.1 activity by impairing channel-PIP2 interactions. TAK-981 restores IK1 by preventing SUMOylation under hypoxic conditions and enhancing current through Kir2.1-R67Q channels. These findings support a two-hit model of arrhythmogenesis in ATS1 and identify SUMO pathway inhibition as a potential therapeutic strategy to reduce arrhythmic risk in affected patients.

physiology↗