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Biochemical and Biophysical Research Communications 364 (2007) 889895


www.elsevier.com/locate/ybbrc

Characterizations of a loss-of-function mutation in the Kir3.4


channel subunit q
Kirstine Calloe a,*, Lasse Steen Ravn c, Nicole Schmitt a, Jin Liang Sui b, Morten Duno e,
Stig Haunso c, Morten Grunnet d, Jesper Hastrup Svendsen c, Soren-Peter Olesen a
a
The Danish National Research Foundation Centre for Cardiac Arrhythmia, Department of Biomedical Sciences, 12.5.10,
University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen N, Denmark
b
CombinatoRx Inc., Cambridge, MA, USA
c
Department of Cardiology, The Heart Center, Copenhagen University Hospital, Denmark
d
NeuroSearch, Ballerup, Denmark
e
Department of Clinical Genetics, Copenhagen University Hospital, Denmark

Received 10 October 2007


Available online 29 October 2007

Abstract

Kir3.4 and Kir3.1 potassium channel subunits mediate the acetylcholine induced inwardly rectifying current IKACh in the heart. We
found a glycine to arginine substitution in codon 247 of Kir3.4 in a patient with a single episode of atrial brillation (AF). Expression in
Xenopus laevis oocytes and two-electrode voltage-clamp revealed that Kir3.4-G247R basal current was reduced compared to wild-type
Kir3.4 and co-expression with the muscarinic acetylcholine receptor type 2 showed that also the acetylcholine induced current was
severely reduced in Kir3.4-G247R, indicating that the mutation interfered with activation by the stimulatory Gbc-subunits. Co-expres-
sion of Kir3.4-G247R with wild-type Kir3.4 or Kir3.1 had a compensating eect on both basal current levels and the response to mus-
carinic stimulation suggesting the function of Kir3.4-G247R is compensated in vivo. This may explain the lack of clear clinical
manifestations and further studies are necessary to elucidate if mutations in Kir3.4 are predisposing AF.
2007 Elsevier Inc. All rights reserved.

Keywords: Kir3.4; GIRK; IKACh; Gbc; Atrial brillation; Arrhythmia

The Kir3.1 and Kir3.4 potassium channel subunits 2 (M2). Stimulation of the M2 receptor by ACh causes
form heterotetrameric channels that mediate the acetyl- dissociation of the coupled G-protein and the Gbc-sub-
choline (ACh) induced potassium current, IKACh [1]. units activate the Kir3.1/3.4 channel by direct binding
IKACh hyperpolarizes the cell membrane and is important [2]. Despite extensive eorts, the binding site for the
for the negative chronotropic eect of parasympathetic Gbc-subunit on the channel is still debated and intracel-
activity. ACh is released from the vagus nerve and stim- lular domains facing the cytoplasm in both the N- and
ulates a variety of cardiac receptors and channels, includ- C-termini have been suggested [38]. The mechanism
ing the muscarinic ACh G-protein coupled receptor type underlying Gbc activation of the channel is not well
understood but binding of Gbc to the channel complex
has been shown to stabilize the interaction between the
q
Funding: This work was supported by a grant from the Carlsberg Kir3 channel and phosphatidylinositol (4,5)-bisphosphate
Foundation (K.C.), the Danish National Research Foundation (N.S.), the (PIP2) [9]. This interaction with PIP2 is a requirement for
John and Birthe Meyer Foundation and the Danish Academy of
Cardiovascular Research (L.S.).
Kir channels activity and a decrease in bound PIP2
*
Corresponding author. Fax: +45 35327555. strongly decreases the open probability of the Kir3.1/
E-mail address: Kirstinec@m.ku.dk (K. Calloe). 3.4 channels [9,10].

0006-291X/$ - see front matter 2007 Elsevier Inc. All rights reserved.
doi:10.1016/j.bbrc.2007.10.106
890 K. Calloe et al. / Biochemical and Biophysical Research Communications 364 (2007) 889895

Mice decient of Kir3.1 or 3.4 exhibit mild resting were kept in a low K solution (in mM; 90 NaCl, 4 KCl, 1 MgCl2, 1 CaCl2,
tachycardia [11] and impaired beat-to-beat control [12]. 5 Hepes, pH 7.4) at 19 C.
Electrophysiology. Whole-cell currents were measured 2472 h after
Remarkably, the Kir3.4 decient mice were resistant to Kir cRNA injection by two-electrode voltage-clamp (TEVC) amplier
atrial brillation (AF) caused by vagal stimulation [13]. (Clampator 1, Dagan, Chicago, IL). Pipettes were pulled from borosilicate
Increased activity of Kir3.4 has been linked to AF in sev- glass and had a nal tip resistance of 0.52.5 MX when lled with 2 M
eral animal models [1315] and constitutively active IKACh KCl and submerged in low K solution. Currents were measured in a high
has been demonstrated in patients with persistent AF K solution (in mM; 96 KCl, 10 Hepes, 1 MgCl2, 1.8 CaCl2, pH 7.4). In
some experiments 10 lM ACh (Sigma) was dissolved directly in the high K
where it may contribute to sustaining the arrhythmia [16]. solution. Data were sampled with Pulse (HEKA electronics, Germany)
This signies that a reduction of IKACh could be benecial and analyzed using the Igor software (WaveMetrics, Lake Oswego, OR)
in AF prevention and is concordant with the observation and GraphPad Prism (GraphPad Software, San Diego, CA). All data are
that AF can be induced by gain-of-function mutation in presented as mean standard error of the mean. For statistical analyses
cardiac potassium channels (http://www.fsm.it/cardmoc/). paired and unpaired T-tests as well as one way ANOVA combined with
Tukeys multiple comparison test were used. p < 0.05 was considered
Conversely, loss-of-function of atrial potassium channels signicant.
causing a diminished repolarization reserve and a concom-
itant prolongation of the atrial action potential duration
has also been suggested to promote atrial tachyarrhythmias Results and discussion
[17,18].
This prompted us to screen AF patients for mutations in The Caucasian female proband presented at age 69 years
the KCNJ5 gene that encodes the Kir3.4 potassium channel with a single episode of AF that spontaneously reverted
subunit. after 3 days. The clinical evaluation included examination,
12-lead ECG, exercise and ambulatory ECG monitoring.
The 12-lead ECG during sinus rhythm revealed normal
Methods PR intervals and neither signs of ventricular hypertrophy
nor bundle branch block. The patient had a normal echo-
Clinical analysis. The investigation conforms to the principles outlined
in the Declaration of Helsinki. Patients initially participated in the
cardiogram, the left atria had a diameter of 3.5 cm and
Copenhagen SAFIR investigation [19] and were included consecutively the ejection fraction was larger than 55 mL. The proband
from the Department of Cardiology, Copenhagen University Hospital showed no concomitant risk factors like diabetes, hyper-
Hvidovre, Denmark. The basic inclusion criterion was AF documented on tension or thromboembolic disease apart from age. Genetic
electrocardiogram (ECG) followed by restored sinus rhythm (SR). Three
screening revealed that the proband was heterozygote for a
years later 158 patients attended a follow-up visit with ECG and Holter
recording), echocardiogram, registration of disease history and blood novel variant in the KCNJ5 gene, in nucleotide 739, a G
samples. was replaced by A, resulting in a glycine to arginine substi-
DNA isolation and mutation analysis. Genomic DNA was isolated from tution in codon 247 of the Kir3.4 subunit. No aberrations
blood samples from the 158 AF patients and from 96 ethnically matched were found in other candidate genes associated with AF
controls using QIAamp DNA Blood Mini Kit (Qiagen, Germany). The (KCNQ1, KCNH2, KCNE1-5, and KCNJ2). The Kir3.4-
coding and exon anking regions of the KCNJ2 and KCNJ5 genes were
PCR amplied and directly sequenced. Other candidate genes associated G247R substitution was absent in 96 normal control sam-
with AF, KCNQ1, KCNH2, and KCNE1-5 were amplied by PCR and ples as well as in the remaining 157 AF patients investi-
single-strand conformation polymorphism of the fragments was investi- gated and it was not registered as a Caucasian variant in
gated using GeneGel Excel 12.5/24 kits (Amersham Biosciences AB, PharmGKB (www.pharmgkb.com) or in the single nucleo-
Sweden). Aberrant conformers were directly sequenced on a 3100-Avant
tide polymorphisms (SNP) database of National Center for
Genetic analyzer (Applied Biosystems, CA) using Big Dye chemistry.
Molecular biology. cDNAs encoding human Kir3.4 (Accession No.
Biotechnology Information (NCBI) (http://
NM_000890), Kir3.1 (NM_002239), Kir3.4-S143T (in the following www.ncbi.nlm.nih.gov). The 247G residue is conserved
referred to as Kir3.4*, based on Accession No. NM_000890), the musca- across species and between other members of the Kir fam-
rinic ACh receptor type 1 (M1, NM_000738) and the muscarinic ACh ily suggesting that G247R either represents a de novo muta-
receptor type 2 (M2, NM_001006630) were kind gifts from D.E. Logo- tion or a rare variation. Besides the G247R substitution,
thetis. The cDNAs were subcloned into the oocyte expression vector
pGEM and the mutation G247R was introduced into Kir3.4 and Kir3.4* three synonymous known SNPs were found in Kir3.4 from
by mutated oligonucleotide extension (Pfu Turbo Polymerase, Stratagene, the patient (rs6590357, rs7118824, and rs118833) and one
La Jolla, CA), digested with DpnI (Fermentas, Germany), and trans- known non-synonymous SNP (rs7102584), resulting in a
formed into Escherichia coli XL1 Blue cells. All constructs were veried by glutamine to glutamate substitution in codon 282,
DNA sequencing. cRNA was synthesized by standard in vitro run-o Q282E. According to the SNP database of NCBI, a Q at
transcription using the T7 mMessage Machine kit according to manu-
facturers instructions (Ambion, Austin, TX). position 282 is normal, but only 7 out of 158 patients were
Expression in Xenopus laevis oocytes. Oocytes were surgically removed heterozygote for 282Q and the remaining patients all were
from anaesthetized (2 g/L tricaine, Sigma) X. laevis frogs in accordance homozygote for 282E. Alignment of Kir3.4 shows that the
with the guidelines from the Danish National Committee for Animal residue E is conserved across species suggesting that 282Q
Studies and defolliculated enzymatically as described earlier [20] before
rather represents a common polymorphism. The proband
injection with 50 nL cRNA (0.52 ng/oocyte Kir cRNA and 0.5 ng/oocyte
M1/M2 cRNA). Kir3.1 and Kir3.4 cRNAs were mixed in equal molar was homozygote for Kir3.4-Q282E. As there is increasing
ratios. In some experiments M1 or M2 encoding cRNA were injected 48 h evidence that the presence of a polymorphism either on
prior to injection of Kir3 cRNA to allow sucient expression. Oocytes the same or a separate gene allel can aect the phenotype
K. Calloe et al. / Biochemical and Biophysical Research Communications 364 (2007) 889895 891

of a mutation constructs containing either an E or a Q at Fig. 1C. There was no apparent dierence in the reversal
position 282. No dierence in current levels, kinetics or rec- potential, rectication or the kinetic parameters of the
tication was found. Only data using 282E constructs are Kir3.1/3.4-G247R current compared to WT but a clear
presented in the following as the proband was homozygote eect on the current levels was observed. At 100 mV,
for 282E. the average current of Kir3.1/3.4-G247R was approxi-
Family history was obtained (Fig. 1A). One son was het- mately 40% less than that of Kir3.1/3.4 expressing oocytes.
erozygote for Kir3.4-G247R but was asymptomatic. The Oocytes co-expressing Kir3.1/3.4 with Kir3.1/3.4-G247R
four other sons did not carry the substitution, one of gave 10% less current than Kir3.1/3.4 WT expressing
which, however, had uncharacteristic chest complaint that oocytes. These experiments clearly demonstrated that
could be caused by arrhythmia. Despite thorough investi- G247R substitution resulted in a loss-of-function and there
gation no arrhythmia was documented or signs of struc- was no dominant negative eect of Kir3.4-G247R on co-
tural heart disease observed. expressed Kir3.1 or 3.4 subunits.
As co-expression with Kir3.1 could have a compensating
Electrophysiological characterization of Kir3.4-G247R eect on the phenotype of the Kir3.4-G247R mutant, we
attempted to measure currents from oocytes expressing
To investigate if the electrophysiological phenotype of homomeric Kir3.4 channels, but the currents were very
Kir3.4-G247R deviated from WT, both were co-expressed low as described earlier [21]. To circumvent this obstacle,
with the Kir3.1 subunit in oocytes. To mimic the heterozy- we used the Kir3.4-S143T construct, referred to as
gote state of the patient, Kir3.1/3.4 and Kir3.1/3.4-G247R Kir3.4*. Kir3.4* channels yield large currents in the absence
cRNAs were mixed in a 1:1 ratio. Whole-cell currents were of Kir3.1 due to a higher open probability [22] and have
measured by TEVC and large, inward rectifying currents been demonstrated to interact in a qualitative similar way
were observed in both WT and mutant expressing oocytes with Gbc as Kir3.1/3.4 WT channels [21]. Hence, we intro-
(Fig. 1B). The currentvoltage relationship is shown in duced the G247R substitution in Kir3.4*. Kir3.4* or

A C Vm (mV)
AF, 69
-100 -50 50
-10
I (A)
*** -20

48 50 52 53 56 ** -30

-40

B Kir3.1/3.4 D

3.4*-G247R
I (A)

-10 0mV 50mV


Kir3.1/3.4-G247R
20 A

-100mV
3.4*
-20
500 ms 0.0 0.2 0.4 0.6 0.8
Time (s)

Fig. 1. Pedigree and electrophysiological characterization of Kir3.4-G247. (A) Pedigree for the family (circle = female; squares = males). The age is
indicated. The proband and one son, age 48, were heterozygote for Kir3.4-G247R as indicated by half-lled circle/square. (B) Kir3.1/3.4 and Kir3.1/3.4-
G247R currents elicited by a step protocol, from 100 mV to 60 mV in 20 mV increments. (C) Currentvoltage relationship Kir3.1/3.4 (squares), Kir3.1/
3.4-G247R (triangles) and Kir3.1/3.4+Kir3.1/3.4-G247R (open triangles). At 100 mV, the average current for Kir3.1/3.4 was 37.80 2.5 lA (n = 7),
for Kir3.1/3.4+Kir3.1/3.4-G247R it was 33.7 1.7 lA (n = 7) and for Kir3.1/3.4-G247R, 22.70 1.522 lA (n = 7). The Kir3.1/3.4 was signicantly
dierent from Kir3.1/3.4-G247. Kir3.1/3.4+Kir3.1/3.4-G247R was signicantly dierent from Kir3.1/3.4-G247R but not signicantly dierent from
Kir3.1/3.4. (D) Kir3.4* or Kir3.4*-G247R or Kir3.4* and Kir3.4*-G247R currents elicited by the depicted ramp protocol. At 100 mV the average current
was 20.5 2.5 lA (n = 5) for Kir3.4*, 8.83 1.2 lA (n = 6) for Kir3.4*/Kir3.4*-G247R and for Kir3.4*-G247R it was 4.32 0.97 lA (n = 5). The
Kir3.4* current was signicantly dierent than Kir3.4*/Kir3.4*-G247 (p < 0.001) and from Kir3.4*-G247R (p < 0.001). The dierence between Kir3.4*/
Kir3.4*-G247R and Kir3.4*-G247R was not signicantly dierent.
892 K. Calloe et al. / Biochemical and Biophysical Research Communications 364 (2007) 889895

Kir3.4*-G247R constructs were expressed in oocytes. Rep- take place within a part of the intracellular region but the
resentative currents for both WT and mutant Kir3.4* are exact domain(s) of the interaction is a matter of debate.
shown in Fig. 1D. At 100 mV, Kir3.4*-G247R expressing The region just upstream the G247R mutation has been
oocytes had approximately 80% less current than Kir3.4* suggested as a putative Gbc-subunit binding site in
expressing oocytes. In experiments where Kir3.4* was co- Kir3.4 [6]. Replacing a small glycin with a bulky arginine
expressed with Kir3.4*-G247R in a 1:1 ratio, the current residue may disturb the secondary protein structure adja-
was reduced by 57% compared to Kir3.4* current. This cent to the mutation and this could aect the Gbc mediated
could suggest that if homomeric Kir3.4 channels were pres- activation. Interestingly, the same sequence stretch has also
ent in the patient, the current through these channels would been demonstrated to aect the PIP2 anity of the channel
be severely reduced. However, the absence of attributable [24] and we therefore addressed the eect of muscarinic
cardiac or non-cardiac phenotype in the heterozygote car- stimulation on mutant and WT channels.
riers suggest reduced current through Kir3.4 homomeric To test if the interaction between the Gbc-subunits and
channels is either well compensated in vivo or alternatively the Kir3.1/3.4 channel was aected by the G247R substitu-
that homomeric Kir3.4 channels only play a small role tion, Kir3.1/3.4 and Kir3.1/3.4-G247R were co-expressed
physiologically, in agreement with the ndings in Kir3.4 with the M2 receptor and currents measured before and
decient mice [11]. during exposure to 10 lM ACh (Fig. 2A). For both WT
and mutant, the current was signicantly increased during
Kir3.4-G247 and muscarinic stimulation ACh stimulation. On average, WT current was increased
by almost 90% during ACh exposure and the Kir3.1/3.4-
The G247R substitution is located in the cytoplasmic G247R/M2 current was increased by 80% (Fig. 2B and
region of the Kir3.4 C-terminus and alignment with the C) during ACh exposure.
published structure of the cytoplasmic region of mouse The experiments were repeated with Kir3.4*. As Kir3.4*
Kir3.1 proteins (PDB: 1U4F [23] and 1N9P [8]) it suggests -G247R had very low currents, the amount of injected
that the G247R residue is facing the cytoplasm proximal to Kir3.4*-G247R cRNA was increased fourfold to yield
the interaction site between two Kir subunits and near a basal current comparable to that of Kir3.4*. Representative
turn in the secondary structure. The interaction between currents recordings for Kir3.4*/M2 and Kir3.4*-G247R/
the Kir3.1/3.4 protein and Gbc-subunits is presumed to M2 are shown in Fig. 3A. The Kir3.4*/M2 current was

A Ach Kir3.4/3.1
B 0

PIP2
M2
-10
I (uA)

i/o
K+
***
-20
3.1/3.4/M2

-30 ***
3.1/3.4/ 3.1/3.4-G247R/
M2 M2

ACh C
100 NS
3.1/3.4-G247R/M2
% increase

50

ACh
10 A

0
3.1/3.4/ 3.1/3.4-G247R/
200 ms M2 M2

Fig. 2. Kir3.4-G247 and Gbc-stimulation. Kir3.1/3.4/M2 and Kir3.1/3.4-G247R/M2 currents before and during stimulation with 10 lM ACh. (A) The
activated pathway is shown and representative Kir3.1/3.4/M2 and Kir3.1/3.4-G247R/M2 currents. (B) Average current at 100 mV before and during
ACh stimulation (grey bar). The Kir3.1/3.4/M2 current was increased from 13.4 1.3 lA (n = 13) to 25.2 1.7 lA (n = 13) during ACh stimulation.
For Kir3.1/3.4-G247R/M2, the current increased from 6.66 0.66 lA (n = 13) to 11.8 1.35 lA (n = 13). (C) Percentage increase in current during
ACh stimulation. For Kir3.1/3.4/M2 ACh stimulation increased currents at 100 mV by 96.7 10% (n = 13) and for Kir3.1/3.4-G247R/M2, the currents
were increased by 78.4 11% (n = 13).
K. Calloe et al. / Biochemical and Biophysical Research Communications 364 (2007) 889895 893

A B 0

3.4*/M2 -10

I (A)
-20
NS
-30 **
ACh
3.4*/ 3.4*-G247R/
M2 M2

C
3.4*-G247R/M2 40

30

% increase
20
10 A

10
***
0
200 ms 3.4* 3.4*-G247R

Fig. 3. Kir3.4*-G247 and Gbc-stimulation. Kir3.4*/M2 and Kir3.4*_G247R/M2 currents before and during stimulation with 10 lM ACh. (A)
Representative Kir3.4*/M2 and Kir3.4*-G247R/M2 currents. (B) Average currents at 100 mV before and during ACh stimulation (grey bar). Kir3.4*/
M2 had an average current of 19.5 3.0 lA (n = 9) before ACh stimulation and 25.5 4.0 lA (n = 9) during ACh stimulation. For Kir3.4*-G247R/
M2, currents were 19.7 5.2 lA (n = 7) before stimulation and 19.8 5.2 lA (n = 7) during stimulation. (C) Percentage increase in current during
ACh stimulation. For Kir3.4*/M2 ACh stimulation increased to currents at 100 mV by 30.7 4.7% (n = 9), whereas Kir3.4*-G247R/M2 currents were
increased by 1.5 0.56% (n = 7).

Ach
Kir3.4/3.1
A B
PIP2
M1

PLC NS
IP3 + DAG 11/q
30
% Decrease

3.1/3.4/M1 20

10
ACh
0
3.1/3.4/ 3.1/3.4-G247R/
M1 M1

C
30 NS
3.1/3.4-G247R/M1
% Decrease

20

ACh
10
5 A

0
3.4*/M1 3.4*-G247R/
200 ms
M1

Fig. 4. Kir3.4-G247 and PIP2 interaction. Kir3.1/3.4/M1 and Kir3.1/3.4-G247R/M1 currents before and during stimulation with 10 lM ACh. (A) The
activated pathway and representative Kir3.1/3.4/M1 and Kir3.1/3.4-G247R/M1 currents. (B) The percentage decrease in current during ACh stimulation.
For Kir3.1/3.4/M1 ACh stimulation decreased currents at 100 mV by 32.7 1.9% (n = 11). Kir3.1/3.4-G247R/M1 currents were decreased by
29.8 1.6% (n = 8). The decrease in Kir3.1/3.4/M1 and Kir3.1/3.4-G247R/M1 current were not signicantly dierent. (C) The percentage decrease in
current during ACh stimulation for Kir3.4*/M1 and Kir3.4*-G247R/M1. For Kir3.4*/M1 ACh stimulation signicantly decreased currents at 100 mV by
24.6 5.3% (n = 7) and for Kir3.4*-G247R/M1, the current was reduced by 24.0 3.19% (n = 7).
894 K. Calloe et al. / Biochemical and Biophysical Research Communications 364 (2007) 889895

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