Electrocardiographic changes and arrhythmias in Brugada syndrome (BrS) remain controversial. Mutations in the Na channel gene SCN5A and its regulatory proteins have been linked to BrS. Aiba et al (Circ Cardiovasc Genet 2014;7:249, PMID 24795344) studied the properties of a BrS SCN5A mutation of a protein kinase A (PKA) consensus phosphorylation site, R526H. In vitro PKA phosphorylation was detected in the I-II linker of wild-type (WT) Na channels, but not in R526H or S528A mutants. Surface expression and peak Na current (INa) densities of R526H and S528A channels were reduced as compared with WT channels. Infection of rat cultures with WT and mutant channels increased conduction velocity compared with controls, but PKA stimulation significantly increased peak INa and conduction velocity only in WT cultures. With the intracellular application of NADH, both WT and mutant INa decrease, but this effect is reversed by PKA stimulation in WT channels but not in mutant channels. The authors conclude that the BrS mutation R526H is associated with a reduction in basal INa and a failure of PKA stimulation to augment the current, thus predisposing to arrhythmias in patients with BrS.
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