In the heart, Na+ homeostasis is established by the Na+/K+-ATPase (NKA). Because NKA is functionally linked to the Na+/Ca2+ exchanger, changes in NKA activity influence Ca2+ levels and cardiac contractility. It is well known that NKA in the heart is inhibited by FXYD1, a member of the FXYD protein family. However, the cardiac expression of other FXYDs has not been determined. In this study, western blot analysis revealed that FXYDs 5, 6 and 7 are also expressed in the human myocardium. In patients with dilated cardiomyopathy (DCM), FXYD1 expression was decreased and FXYD6 expression was increased. Furthermore, immunofluorescence staining showed that upregulation of FXYD6 in DCM patients occurs in the cardiomyocytes, which are the cells primarily responsible for cardiac contraction. FXYD6, like FXYD1 inhibits NKA. Thus, FXYD6 upregulation may be compensating for FXYD1 downregulation in order to maintain cardiac contractility. However, we observed that FXYD6 is expressed as dimers in the heart, but binds to NKA as monomers. Using fluorescence resonance energy transfer (FRET) and western blotting, we found that FXYD6 dimerization occurs due to oxidative crosslinking of cysteine residues (C9, C60 and C62). Additionally, mutation of FXYD6 cysteine residues decreased FXYD6 dimerization and increased binding with NKA, as measured by FRET. Together, these results suggest that in DCM, NKA is dysregulated by a switch from FXYD1 to FXYD6, which can become oxidized to form dimers, sequestering monomeric FXYD6 away from NKA. Decreased inhibition of NKA would lead to decreased Ca2+ levels and cardiac contractility, both of which are features of DCM.
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