Article

KATP channel Kir6.2 E23K variant overrepresented in human heart failure is associated with impaired exercise stress response

Marriott Heart Disease Research Program, Mayo Clinic, Rochester, MN 55905, USA.
Human Genetics (Impact Factor: 4.52). 09/2009; 126(6):779-89. DOI: 10.1007/s00439-009-0731-9
Source: PubMed

ABSTRACT ATP-sensitive K+ (K(ATP)) channels maintain cardiac homeostasis under stress, as revealed by murine gene knockout models of the KCNJ11-encoded Kir6.2 pore. However, the translational significance of K(ATP) channels in human cardiac physiology remains largely unknown. Here, the frequency of the minor K23 allele of the common functional Kir6.2 E23K polymorphism was found overrepresented in 115 subjects with congestive heart failure compared to 2,031 community-based controls (69 vs. 56%, P < 0.001). Moreover, the KK genotype, present in 18% of heart failure patients, was associated with abnormal cardiopulmonary exercise stress testing. In spite of similar baseline heart rates at rest among genotypic subgroups (EE: 72.2 ± 2.3, EK: 75.0 ± 1.8 and KK:77.1 ± 3.0 bpm), subjects with the KK genotype had a significantly reduced heart rate increase at matched workload (EE: 32.8 ± 2.7%, EK: 28.8 ± 2.1%, KK: 21.7 ± 2.6%, P < 0.05), at 75% of maximum oxygen consumption (EE: 53.9 ± 3.9%, EK: 49.9 ± 3.1%, KK: 36.8 ± 5.3%, P < 0.05), and at peak V(O2) (EE: 82.8 ± 6.0%, EK: 80.5 ± 4.7%, KK: 59.7 ± 8.1%, P < 0.05). Molecular modeling of the tetrameric Kir6.2 pore structure revealed the E23 residue within the functionally relevant intracellular slide helix region. Substitution of the wild-type E residue with an oppositely charged, bulkier K residue would potentially result in a significant structural rearrangement and disrupted interactions with neighboring Kir6.2 subunits, providing a basis for altered high-fidelity K(ATP) channel gating, particularly in the homozygous state. Blunted heart rate response during exercise is a risk factor for mortality in patients with heart failure, establishing the clinical relevance of Kir6.2 E23K as a biomarker for impaired stress performance and underscoring the essential role of K(ATP) channels in human cardiac physiology.

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    • "Both mutations are located in the NBD2 and compromise the ability of ATP to be hydrolysed (Bienengraeber et al., 2004). In KIR6.2, a non-synonymous polymorphism leading to the coding change, E23K, was identified in 18% of heart failure patients (Reyes et al., 2009) and is also known to lead to an increased risk of type 2 diabetes (Gloyn et al., 2003). Both heterozygous and homozygous patients have the same resting heart rates and show similar degrees of left ventricular dysfunction and remodelling. "
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    ABSTRACT: ATP-sensitive K(+) channels (KATP ) are widely distributed and present in a number of tissues including muscle, pancreatic β cells and the brain. Their activity is regulated by adenine nucleotides characteristically being activated by falling ATP and rising ADP levels. Thus they link cellular metabolism with membrane excitability. Recent studies using genetically modified mice and genomic studies in patients have implicated KATP channels in a number of physiological and pathological processes. In this review, we focus on their role in cellular function and protection particularly in the cardiovascular system.
    British Journal of Pharmacology 09/2013; 171(1). DOI:10.1111/bph.12407 · 4.99 Impact Factor
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    • "In spite of similar baseline heart rates at rest among genotypic subgroups, subjects with the KK genotype had a significantly reduced heart rate increase at matched workloads. Molecular modeling of the tetrameric Kir6.2 pore structure revealed the E23 residue within the functionally relevant intracellular slide helix region [101]. Substitution of the wild-type E residue with an oppositely charged, bulkier K residue would potentially result in a significant structural rearrangement and disrupted interactions with neighboring Kir6.2 subunits, providing a basis for altered high-fidelity KATP channel gating, particularly in the homozygous state. "
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    ABSTRACT: Assembly of an inward rectifier K+ channel pore (Kir6.1/Kir6.2) and an adenosine triphosphate (ATP)-binding regulatory subunit (SUR1/SUR2A/SUR2B) forms ATP-sensitive K+ (KATP) channel heteromultimers, widely distributed in metabolically active tissues throughout the body. KATP channels are metabolism-gated biosensors functioning as molecular rheostats that adjust membrane potential-dependent functions to match cellular energetic demands. Vital in the adaptive response to (patho)physiological stress, KATP channels serve a homeostatic role ranging from glucose regulation to cardioprotection. Accordingly, genetic variation in KATP channel subunits has been linked to the etiology of life-threatening human diseases. In particular, pathogenic mutations in KATP channels have been identified in insulin secretion disorders, namely, congenital hyperinsulinism and neonatal diabetes. Moreover, KATP channel defects underlie the triad of developmental delay, epilepsy, and neonatal diabetes (DEND syndrome). KATP channelopathies implicated in patients with mechanical and/or electrical heart disease include dilated cardiomyopathy (with ventricular arrhythmia; CMD1O) and adrenergic atrial fibrillation. A common Kir6.2 E23K polymorphism has been associated with late-onset diabetes and as a risk factor for maladaptive cardiac remodeling in the community-at-large and abnormal cardiopulmonary exercise stress performance in patients with heart failure. The overall mutation frequency within KATP channel genes and the spectrum of genotype-phenotype relationships remain to be established, while predicting consequences of a deficit in channel function is becoming increasingly feasible through systems biology approaches. Thus, advances in molecular medicine in the emerging field of human KATP channelopathies offer new opportunities for targeted individualized screening, early diagnosis, and tailored therapy.
    Pflügers Archiv - European Journal of Physiology 07/2010; 460(2):295-306. DOI:10.1007/s00424-009-0771-y · 4.10 Impact Factor
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    • "Responsible for adenine nucleotide recognition and processing, the SUR2A NBD1/2 tandem is integral in transduction of metabolic signals to the K ATP channel pore (Bienengraeber et al., 2000; Karger et al., 2008; Zingman et al., 2001; Zingman et al., 2002). Genetic mutations in SUR2A NBDs alter channel function, and human K ATP channelopathies have been implicated in cardiac disease susceptibility underscoring the structural integrity of regulatory domains in optimal channel performance (Bienengraeber et al., 2004; Kane et al., 2005; Olson et al., 2007; Reyes et al., 2009; Sattiraju et al., 2008). "
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    ABSTRACT: Heterodimeric nucleotide binding domains NBD1/NBD2 distinguish the ATP-binding cassette protein SUR2A, a recognized regulatory subunit of cardiac ATP-sensitive K(+) (K(ATP)) channels. The tandem function of these core domains ensures metabolism-dependent gating of the Kir6.2 channel pore, yet their structural arrangement has not been resolved. Here, purified monodisperse and interference-free recombinant particles were subjected to synchrotron radiation small-angle X-ray scattering (SAXS) in solution. Intensity function analysis of SAXS profiles resolved NBD1 and NBD2 as octamers. Implemented by ab initio simulated annealing, shape determination prioritized an oblong envelope wrapping NBD1 and NBD2 with respective dimensions of 168x80x37A(3) and 175x81x37A(3) based on symmetry constraints, validated by atomic force microscopy. Docking crystal structure homology models against SAXS data reconstructed the NBD ensemble surrounding an inner cleft suitable for Kir6.2 insertion. Human heart disease-associated mutations introduced in silico verified the criticality of the mapped protein-protein interface. The resolved quaternary structure delineates thereby a macromolecular arrangement of K(ATP) channel SUR2A regulatory domains.
    Journal of Structural Biology 11/2009; 169(2):243-51. DOI:10.1016/j.jsb.2009.11.005 · 3.23 Impact Factor
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