Voltage-gated calcium-channels are key molecular regulators of calcium-dependent signaling processes in electrically excitable cells. The family of L-type calcium-channels (LTCCs, Cav1.1-Cav1.4 pore-forming α1-subunits) are sensitive to organic calcium-channel blockers (e.g. dihydropyridines). The in vivo pharmacological effects of these widely used antihypertensives are limited to inhibition of Cav1.2 LTCCs in the cardiovascular system, despite the (often overlapping) expression of both Cav1.2 and Cav1.3 in most excitable tissues. Important insight into the physiological relevance of these channels therefore came from mutant mice and human disease pinpointing their distinct functions not only in the heart but also for hearing, brain and endocrine function. Cav1.2 and Cav1.3 α1 share high structural similarity and are frequently expressed in the same cell but exhibit important functional differences. Their activity is fine-tuned by auto-inhibitory domains within their long C-terminal tails but they use different mechanisms to adjust the extent of auto-inhibition. Moreover, Cav1.3 channels activate at more negative potentials allowing them to serve unique roles for sinoatrial node pacemaking and cochlear inner hair cell neurotransmitter release. Accordingly, a loss-of-function mutation in Cav1.3 α1 (CACNA1D) in humans causes sinoatrial node dysfunction and congenital deafness (SANDD). Human mutations also revealed a novel role for Cav1.3 in adrenal aldosterone-producing adenomas (APA). In APA somatic gain-of-function mutations can drive calcium-dependent aldosterone production causing secondary hypertension. SANDD and APA mutations also provided valuable insight into the structure-function relationship of Cav1.3 α1.Both channels have recently also been implicated as risk genes for psychiatric diseases, including autism spectrum disorders. It will therefore be important to understand how subtle changes in the function of these channels is associated with human disease and how calcium-channel blockers can be further optimized to specifically target them to LTCCs outside the cardiovascular system.(Support: Austrian Science Fund, F44020).
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