During each heartbeat, action potential (AP) propagation at intercalated discs (ID), specialized structures that electrically (gap junctions [GJ]) and mechanically (adherens junctions [AJ], desmosomes [Des]) couple cardiomyocytes, coordinates the contraction of billions of cardiomyocytes. Electrogenic proteins underlying excitability (cardiac sodium channels [NaV1.5], inward-rectifier potassium channels [Kir2.1] and sodium-potassium ATPase [NKA]) enriched within ID nanodomains are emerging as vital machinery for AP propagation. ID disruption is a hallmark of arrhythmic disease, yet, IDs are omitted from physiological models due to lack of structural data. We used indirect correlative light and electron microscopy [iCLEM] to quantify ID ultrastructure and molecular organization in health and disease and link them with functional properties (conduction velocity, arrhythmia vulnerability). Additional studies in hearts treated with adhesion inhibitor peptides targeting different ID nanodomains helped bridge health with complex disease. In healthy mouse hearts, transmission electron microscopy uncovered smaller, more frequent junctions and closer intermembrane distance at peri-junctional nanodomains in atria vs. ventricles. Confocal microscopy revealed greater NaV1.5, Kir2.1, NKA expression with more preferential ID enrichment in atrial myocytes than ventricular. STORM single molecule localization microscopy, a super-resolution technique, identified chamber-specific differences in NaV1.5, Kir2.1 and NKA clustering and distribution relative to AJ, Des, GJ as well as each other. Adhesion inhibitor peptides Nadp1 (target: AJ), dadp1 (target: Des) and βadp1 (target: GJ-adjacent perinexi), but not corresponding inactive control peptides, acutely (60 minutes) disrupted their respective target nanodomains and dispersed NaV1.5 clusters from those sites. These structural impacts led to conduction slowing and reentrant arrhythmias with severity proportional to the amount of NaV1.5 present at the target site. These data parallel our previous observations in atrial fibrillation (mouse models and human patients) and highlight NaV1.5-rich ID nanodomains as potential targets for antiarrhythmic therapy.
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