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Circulation Research. 1999;84:551-561

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(Circulation Research. 1999;84:551-561.)
© 1999 American Heart Association, Inc.


Original Contribution

Potential Molecular Basis of Different Physiological Properties of the Transient Outward K+ Current in Rabbit and Human Atrial Myocytes

Zhiguo Wang, Jianlin Feng, Hong Shi, Amber Pond, Jeanne M. Nerbonne, Stanley Nattel

From the Department of Medicine (Z.W., J.F., H.S., S.N.), Montreal Heart Institute, Department of Medicine, University of Montreal (Z.W., S.N.), and the Department of Pharmacology and Therapeutics (S.N.), McGill University, Montreal, Quebec, Canada, and the Department of Cell Biology (A.P., J.M.N.), Washington University, St. Louis, Mo.

Correspondence to Zhiguo Wang, PhD, Research Center, Montreal Heart Institute, 5000 Belanger East, Montreal, Quebec, Canada H1T 1C8.


*    Abstract
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*Abstract
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Abstract—The properties of the transient outward current (Ito) differ between rabbit and human atrial myocytes. In particular, rabbit Ito is known to recover more slowly than its human counterpart and to show much more frequency dependence. To assess the possibility that these physiological differences may reflect differing expression of K+ channel subunit gene products, we used a combination of whole-cell voltage-clamp, heterologous expression, pharmacological, antisense, and Western blot techniques. The inactivation of Ito in rabbit atrial myocytes was significantly slowed by hydrogen peroxide, with human Ito being unaffected. Use-dependent unblocking with 4-aminopyridine was not seen for rabbit Ito nor for Kv1.4 currents in Xenopusoocytes, whereas human Ito showed strong use-dependent unblock (as did Kv4 currents). Western blots indicated the presence of Kv4 proteins in both human and rabbit atrial membranes, but Kv1.4 was only detected in the rabbit. Antisense oligodeoxynucleotides directed against Kv4.3, Kv4.2, or Kv1.4 subunit sequences significantly inhibited Ito current density in cultured rabbit atrial myocytes, whereas only Kv4.3 antisense significantly inhibited Ito in human cells. Neither mismatch oligodeoxynucleotides nor vehicle altered currents in either species. We conclude that, unlike human atrial myocytes, rabbit atrial myocytes express Kv1.4 channel subunits, which likely contribute to a number of important physiological differences in Ito properties between the species. To our knowledge, these studies constitute the first demonstration of a functional role for Kv1.4 channels in cardiac membranes and provide insights into the molecular mechanisms of an important cardiac repolarizing current.


Key Words: electrophysiology • cardiac arrhythmia • action potential • antiarrhythmic drug


*    Introduction
up arrowTop
up arrowAbstract
*Introduction
down arrowMaterials and Methods
down arrowResults
down arrowDiscussion
down arrowReferences
 
Arapidly activating and inactivating K+ current, known in nerve as A-type current, is widely distributed in various tissues and organ systems of mammals. In cardiac cells, this current has been named the transient outward K+ current (Ito), and it is believed to play a major role in action potential repolarization.1 2 3 4 5 6 Ito is particularly important in early (phase 1) repolarization and influences the participation of other currents and membrane transport processes by influencing the voltage-time trajectory of the action potential. Changes in Ito contribute to action potential changes caused by heart disease,7 8 9 10 11 and Ito is a target for many antiarrhythmic drugs.12 13 14 15 16 Because of its important role in cardiac electrical activity, major efforts have been made to understand the biophysical properties and the molecular basis of Ito. Recent advances in molecular biology have resulted in the cloning of a large number of distinct cDNAs encoding K+ channel subunits. The heterologous expression of a variety of cloned K+ channel {alpha}-subunits, including Kv1.4,17 18 Kv3.3,19 Kv3.4,20 Kv4.1,21 Kv4.2,22 23 24 25 and Kv4.3,26 27 28 results in rapidly activating and inactivating K+ currents with characteristics similar to those of endogenous cardiac Ito.

The first cardiac clone found to encode an Ito-like current was Kv1.4.17 It was initially believed to be a strong candidate to underlie Ito in the heart; however, there are important discrepancies between the kinetics of Kv1.4 inactivation and those of native human Ito,17 and the distribution of Kv1.4 protein does not parallel that of Ito in the rat.29 30 Subsequent work has pointed to an important role of Shal-type genes, particularly Kv4.2 and Kv4.3, as a molecular basis for mammalian cardiac Ito.27 31 32 33 Thus, it is now widely accepted that Kv4 genes are important in encoding cardiac Ito and uncertain whether Kv1.4 participates at all in cardiac Ito.

The rabbit heart classically has a very important Ito1 and has served as a widely used model for the analysis of the role of Ito in cardiac repolarization. There are important differences between Ito in the rabbit and the corresponding current in humans,4 with human Ito strongly resembling that of other species, including rat,5 ferret,34 and dog.6 A striking difference is the slow reactivation rate of Ito in the rabbit1 4 compared with other species. The mechanisms underlying the unusual properties of rabbit Ito are unknown. Slow reactivation is typical of Kv1.4, apparently because of an essential role of C-type inactivation in determining the recovery rate.35 The physiological differences between human and rabbit Ito could be, at least in part, due to the unique participation of subunits encoded by Kv1.4 in the rabbit heart.

The purpose of the present study was to obtain further information about the potential basis for the differences between rabbit and human atrial Ito. A variety of techniques, including whole-cell patch clamp, pharmacological probes, antisense oligonucleotides, and detection of ion channel protein expression in cardiac cell membranes, were used to evaluate the hypothesis that differences in the molecular composition of rabbit and human Ito account for differences in physiological properties.


*    Materials and Methods
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*Materials and Methods
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Cell Isolation
Procedures for isolating cells from human tissues and from rabbit hearts were based on approaches described previously in detail.4 14 36 37 38 39 When cells were cultured, all procedures were conducted under strictly sterile conditions.

Specimens of human right atrial appendage were obtained from the hearts of 26 patients (mean age, 62 years; range, 41 to 78 years) undergoing aortocoronary bypass surgery. The atria were all grossly normal and from patients without heart failure, atrial arrhythmias, or electrocardiographic P-wave abnormalities. The procedure for obtaining the tissue was approved by the Ethics Committee of the Montreal Heart Institute. Tissue chunks of {approx}1 mm3 were incubated in oxygenated (100% O2) nominally Ca2+-free Tyrode's solution containing (in mmol/L): NaCl 137, KH2PO4 5, MgSO4 8, dextrose 10, EGTA 0.1, HEPES 5, and taurine 10 (pH 7.4 with NaOH, 36°C), along with 140 U/mL collagenase (CLS II, Worthington Biochemical), 4 U/mL protease (type XXIV, Sigma), and 0.1%. BSA Dispersed cells were suspended in a storage solution containing (in mmol/L) KCl 20, KH2PO4 10, dextrose 10, glutamic acid 70, taurine 10, and EGTA 10 and 0.1% BSA (pH adjusted to 7.4 with KOH). Repeated exposures to fresh enzyme-containing solution were made until the yield was maximal. For cell culture, the cell suspension was centrifuged at 250 rpm for 5 minutes, and the pellet removed for culture.

Rabbits weighing 1.4 to 2.3 kg were euthanized by cervical dislocation, and their hearts were rapidly removed, mounted on a Langendorff apparatus, and perfused with nominally Ca2-free Tyrode's solution containing collagenase (CLS II, Worthington, 0.2%) and 1% BSA (Sigma) for 15 minutes. Atrial tissue was then removed and placed in the storage solution, and cells were dissociated by mechanical agitation with a Pasteur pipette. Cells were used freshly for biophysical and pharmacological studies or concentrated by centrifugation at 250 rpm for cell culture.

Cell Culture
Freshly isolated cells were plated at low density ({approx}104 cells/cm2) onto 2x2-mm square glass coverslips coated with laminin (20 µg/mL). Cells were maintained in Petri dishes (35 mm, Nunc) containing medium 199 with 10% FBS (GIBCO-BRL) supplemented with sodium penicillin G (1 U/mL) and streptomycin sulfate (1 µg/mL, GIBCO-BRL). Cultures were incubated at 37°C in a humidified, 5% CO2-enriched atmosphere.38 40

Cloning of cDNA Fragments From Rabbit Heart and Preparation of Antisense Constructs
Because the genes of Kv1.4, Kv4.2, and Kv4.3 had not been identified in rabbit hearts, cloning of cDNA sequences for these constructs was required to design appropriate antisense oligomers. Degenerate primer pairs for polymerase chain reaction (PCR) were designed (Table 1Down) on the basis of the published cDNA sequences of Kv1.4, Kv4.2, and Kv4.3, targeting regions with minimal homology to other channel sequences but with strong conservation across species. Reverse transcription was performed for first-strand cDNA synthesis from an RNA sample extracted from rabbit heart. PCR was then conducted to amplify the desired cDNA fragments. PCR products were subcloned into pGEM-T Easy vector (Promega) and subjected to sequencing analysis. Antisense oligomers (20 to 21 bp) were designed on the basis of the cloned cDNA sequences. Human constructs were based on previously published sequences, with regions of 100% identity between rabbit and human chosen. The specificity of antisense oligomers was confirmed by comparison with all other sequences in GenBank with the use of the Basic Local Alignment Search Tool (BLAST). As a control, mismatch oligomers were prepared that were identical to each gene-specific antisense sequence with the exception of 4 or 5 mismatch mutations. The oligodeoxynucleotide sequences used are shown in Table 2Down. Phosphorothioate oligodeoxynucleotides were synthesized commercially by Research Genetics Inc.


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Table 1. Primer Pairs for Cloning


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Table 2. Oligodeoxynucleotides Used in Antisense Study

Exposure to Oligodeoxynucleotides
Oligodeoxynucleotide treatment was started 24 hours after the onset of cell culture. Three groups of cultured cells were studied in all series of experiments. One group of cells (referred to as the control group) was exposed to the same volume of vehicle (sterile distilled water) used for oligodeoxynucleotide delivery, a second group was exposed to mismatch oligodeoxynucleotides, and a third group was exposed to antisense oligodeoxynucleotides. For each treatment, the growth medium was removed, and the cells were washed twice with serum-free medium and antibiotics. Medium 199 (1 mL) was mixed with lipofectin (4 µmol/L final concentration, GIBCO-BRL) and vehicle alone or vehicle containing antisense (0.5 µmol/L) or mismatch oligodeoxynucleotides (0.5 µmol/L) and then incubated at room temperature for 40 minutes before addition to the cells. After 6 hours of incubation at 37°C, the medium was removed and the cells were washed with fresh medium 199. The cells were then incubated in growth medium (including antibiotics and heat-inactivated serum) with vehicle, antisense, or mismatch oligomers (1 µmol/L) but without lipofectin for another 18 hours before patch-clamp experiments were performed.

Competitive Reverse Transcriptase (RT)–PCR
RNA Purification
Cultured cells were washed twice with PBS solution containing (in g/L) KCl 0.2, KH2PO4 0.2, NaCl 8, and Na2HPO4 · 7 H2O 2.16) and then incubated in Trizol reagent (GIBCO-BRL). Total RNA was extracted by the acidic guanidinium-isothiocyanate method using chloroform and precipitated with isopropanol. Isolated RNA was quantified from absorbance at 260 nm by spectrophotometry, and the purity was confirmed by the ratio of A260/A280. Integrity of the total RNA was evaluated by ethidium bromide staining of denaturing agarose gels. RNA samples were stored in DEPC-treated double-distilled H2O at –80°C.

Primers
Degenerate primers were designed on the basis of published cDNA sequences of Kv1.4, Kv4.2, and Kv4.3 with oligonucleotide sequences chosen from cDNA regions with minimal homology among clones. cDNA fragments were synthesized by RT-PCR of mRNA from rabbit hearts, and the PCR products were subcloned into pGEM-T easy vector (Promega) for sequencing. The gene-specific primer (GSP) pairs were then designed on the basis of cloned cDNA fragments for each channel. Specificity of the primer pairs was verified by comparison with the entire GenBank database using BLAST. Chimeric primer pairs were constructed with sequences homologous to human cardiac {alpha}-actin cDNA flanked at the 5' ends by GSPs, and an 8-nucleotide (GGCCGCGG) linker homologous to the 3' end sequence of T7 promoter was conjugated to the 5' end of each forward chimeric primer.

Synthesis of RNA Mimic
First-strand cDNA was synthesized by reverse transcription and was used as template for subsequent PCR amplification with chimeric primer pairs to obtain a cDNA mimic consisting of a 480-bp fragment of human cardiac {alpha}-actin flanked by a GSP sense sequence at the 5' and antisense sequence at the 3' end. A second run of PCR was performed with the T7 promoter sequence as a forward primer and a reverse GSP, and the resulting products were cDNA fragments carrying a T7 promoter followed by a forward GSP, an {alpha}-actin fragment, and then a reverse GSP. The products were then gel purified with the Glassmax (silica membrane for DNA binding) DNA Isolation Spin Cartridge System (GIBCO-BRL). RNA mimics were generated by in vitro transcription with purified cDNA mimics as templates using mMESSAGE mMACHINE (Ambion). To remove any remaining cDNA templates, the reaction products were incubated with RNase-free DNase 1 at 37°C for 20 minutes, followed by phenol/chloroform extraction and isopropanol precipitation.

Reverse Transcription
RNA mimic samples with serial 10-fold dilutions were prepared and added to a constant quantity of sample RNA (total RNA of 1 µg for each reaction). RNAs were denatured by incubating at 65°C for 15 minutes. Reverse transcription was carried out in a 20-µL reaction mixture containing reaction buffer (in mmol/L, Tris-HCl [pH 8.3] 10, KCl 50, and MgCl2 2.5), 1 mmol/L dNTPs (Boehringer Mannheim), 3.2 µg random primer p(dN)6 (Boehringer Mannheim), 5 mmol/L DTT, 50 units RNase inhibitor (GIBCO-BRL), and 200 units of Moloney murine leukemia virus RT (GIBCO-BRL). First-strand cDNAs were synthesized at 42°C for 60 minutes, and the remaining enzymes were inactivated by heating at 99°C for 5 minutes.

PCR Amplification
First-strand cDNA (10 µL) was used as a template for amplification in a total volume of 50 µL of reaction mixture. The reaction mixture contained (in mmol/L) Tris-HCl (pH 8.3) 10, KCl 50, MgCl2 1.5, and dNTPs 1; 0.5 µmol/L of each GSP pair; and 2.5 units of Taq polymerase (GIBCO-BRL). Reactions were hot-started at 94°C and continued for 3 minutes for initial melting. The cycling profiles were 30-second denaturing at 94°C, 30-second annealing at 54°C, and 40-second extension at 72°C, for 30 cycles, followed by a final 5-minute period at 72°C.

Quantification of PCR Products
Densitometry was used for quantification of PCR products.22 23 24 PCR products were visualized under UV light with the use of a PDI Image System and a Nighthawk camera after ethidium bromide staining of a 1.5% agarose gel. The density of each band was then determined by Quantity One software. A DNA mass marker (100 ng) was run in the gel to analyze the size and quantity of PCR products. The density of the DNA mass ladder was used to generate a standard curve by linear regression with extrapolation to 0 for each experiment. The density of each sample band was then converted to the absolute quantity by calibrating to the standard curve. Based on the principle of competitive PCR, when the target is coamplified with a known amount of the internal standard, the logarithmic ratio of target over standard product concentration will be linearly related to the initial amount of standard, intercepting the horizontal axis (target/standard ratio of 1) at an internal standard concentration equal to the concentration of the initial target. Accordingly, plots of log (mimic/target concentration) versus known log (mimic) concentration were constructed from the data and fit by linear regression to determine the abundance of target message present.

Whole-Cell Patch-Clamp Recording
Electrophysiological Recording From Native Myocytes
Borosilicate glass microelectrodes (1-mm outer diameter) were used, with tip resistances of 1 to 3 M{Omega} when filled with a pipette solution containing (in mmol/L) KCl 20, potassium aspartate 110, MgCl2 1, HEPES 5, EGTA 5, Mg-ATP 5, GTP 0.1, and Na2-phosphocreatine 5 (pH 7.3, adjusted with KOH). Cells were superfused with modified Tyrode's solution at 37°C containing (in mmol/L): NaCl 126, KCl 5.4, CaCl2 1, MgCl2 1, HEPES 5, and dextrose 10. Cd2+ (200 µmol/L) was added to the superfusate to block ICa. Any basal acetylcholine-activated current was inhibited by including atropine (1 µmol/L) in the superfusate. ATP-sensitive K+ current (IKATP) activation was prevented by including 5 mmol/L ATP in the pipette and 10 µmol/L glyburide in the external solution. INa was inactivated by using a holding potential of –50 mV, by replacing extracellular Na+ with choline, or both.

The electrodes were connected to a patch-clamp amplifier (Axopatch 1-D, Axon Instruments) that applied voltage command pulses with the use of pCLAMP6 software running on an IBM-compatible computer interfaced with a digital/analog converter. Recordings were low-pass filtered at 2 Hz. Junction potential offsets were compensated before formation of the membrane-pipette seal. After gigaseal formation (seal resistance>20 G{Omega}), gentle suction was applied to rupture the membrane for whole-cell recording. Cell capacitance averaged 29.6±1.8 and 26.5±1.8 pF before and after compensation, respectively, for human cells, and 49.6±3.2 and 43.5±2.4 pF for rabbit cells. Series resistance averaged 5.2±0.6 and 2.1±0.4 M{Omega} before and after compensation in human atrial cells and 5.0±0.4 and 1.9±0.6 M{Omega} in rabbit cells. Leak currents were minimal, and no leakage correction was applied.

The amplitude of Ito was measured as the difference between the peak of Ito and the current level at the end of the pulse. IKur was measured as the amplitude of the current at the end of the test pulse relative to the 0-current level. Individual currents were normalized to the membrane capacity to control for differences in cell size.

Expression and Recording of Currents Encoded by Kv1.4, Kv4.2, and Kv4.3
Kv1.4 was obtained as a kind gift from Dr Arthur Brown (Case Western University, Cleveland, Ohio). It was subcloned into a modified version of PCRII vector containing a small portion of the 3'-untranslated region of DRK1, including the poly A+ tail, to allow expression in Xenopus oocytes. Kv4.2 was subcloned into pRC-CMV vector. cRNAs were prepared with the mMESSAGE mMACHINE kit (Ambion) using T7 RNA polymerase after linearization of the plasmid, according to the manufacturer's protocols. cRNAs were dissolved in DEPC-treated sterile water, stored at –80°C, and diluted immediately before injection. Stage V through VI Xenopus oocytes were injected with 46 nL of cRNA.

Approximately 48 hours after cRNA injection, 2-electrode voltage clamp was performed on individual oocytes. Electrodes were filled with 3 mol/L KCl in agar and had resistances of {approx}0.5 to 1.0 M{Omega} when measured in the bath solution containing (in mmol/L) NaCl 100, KCl 5, CaCl2 0.3, MgCl2 2, and HEPES (pH 7.4) 10. The electrodes were connected to a GeneClamp-500 amplifier (Axon Instruments). The pClamp 6 suite of programs was used for data acquisition and analysis. Records were digitized at 5 kHz and filtered at 2 kHz. Experiments were conducted at room temperature (22°C to 23°C).

The entire coding region of Kv4.3 was subcloned into pBK-CMV vector (Stratagene). Kv4.3-pBK-CMV plasmid was linearized with MluI before transfection to facilitate recombination of the plasmid DNA with the HEK chromosomal DNA. HEK cells were incubated in DMEM at 37°C in a CO2 incubator until the cells were 70% to 80% confluent. For each transfection, the cells (1x106) were incubated with the linearized DNA (1 µg) mixed with 1 µg of CD8 antigen and 18 µg of the liposome preparation lipofectamine (GIBCO-BRL) for 5 hours at 37°C in serum-free DMEM. Fresh DMEM with 20% FBS was then added to the cells without removing the transfection mixture. Seventy-two hours after the start of transfection, Dynabeads M-450 CD8 (Dynal) were added to the medium at a final bead concentration of 1.4x105 beads/mL to permit recognition of the transfected cells. Whole-cell patch-clamp recording was performed on the cells with beads attached (indicating gene expression) 40 minutes after magnetic bead exposure.

Western Blots
Peptides corresponding to unique sequences in the N terminus of Kv1.4 (residues 13 to 37; CNSHMPYGYAAQARARERERLAHSR) and the C terminus of Kv4.3 (residues 484 to 502; CLEKTTNHEFVDEQVFEES) were generated by the Protein Chemistry Laboratory (Washington University Medical Center). The peptides were coupled to the keyhole limpet hemocyanin carrier protein and sent to Caltag (San Francisco, CA) for injection into rabbits. Sera were screened using ELISAs, and antibodies were subsequently affinity purified using the ImmunoPure Antigen/Antibody Immobilization Kit No. 2 (Pierce). ELISA assays on the affinity-purified antibodies revealed that each antibody detected only the peptide against which it was generated.

Rat brain membrane proteins were prepared essentially as previously described.30 All procedures were performed at 4°C, and all solutions contained a mixture of protease inhibitors (in mmol/L, iodoacetamide 1, 1,10-phenanthroline 1, and pefabloc 0.5 and 1.4 µmol/L pepstatin). Briefly, brains were homogenized in 10 mL of Tris-HCl buffer (5 mmol/L Tris; pH 7.4) with 0.32 mol/L sucrose. After nuclei and debris were pelleted by centrifugation (1000g, 10 minutes), the supernatant was centrifuged at 100 000g for 1 hour. The pellet was resuspended in 20 mmol/L Tris-HCl containing 1 mmol/L EDTA (pH 7.4), centrifuged again (40 000g, 20 minutes), and resuspended in solubilization buffer (20 mmol/L HEPES, 1 mmol/L EDTA, 10% glycerol, 120 mmol/L KCl, and 2% Triton X-100; pH 7.4). After incubation on ice for 1 hour, the final suspension was centrifuged at 78 000g for 2.5 hours to pellet insoluble material. Protein assays (Bio-Rad) were completed, and the samples were aliquoted and frozen at –20°C until used.

Human and rabbit heart membrane proteins were isolated using a protocol similar to that previously described.30 Rabbit atrial samples were harvested from anesthetized adult rabbits and placed on ice. Adult human atrial tissue samples from normal donor hearts not accepted for transplantation were procured from LifeBanc (Cleveland, OH) with consent for research use. Macroscopic and microscopic examination revealed no evidence of pathology or underlying cardiovascular disease. All procedures were performed at 4°C, and all solutions contained the mixture of protease inhibitors described, as well as 1 mmol/L benzamidine, 7.9 µmol/L aprotinin, and 0.15 µmol/L leupeptin. For the preparation of human membrane proteins, tissue samples (1 to 2 g) from individual donors were processed. Tissue samples were homogenized at 4°C in 10 mL TE buffer (containing 10 mmol/L Tris-HCl and 1 mmol/L EDTA; pH 7.4). After centrifugation (1000g, 10 minutes), the supernatants were retained and the pellets were resuspended to original volume in TE buffer, homogenized, and centrifuged. The supernatants were collected, pooled with the original supernatants, and centrifuged (40 000g, 10 minutes). The resulting pellets were resuspended in TE buffer containing 0.6 mol/L KI, incubated on ice (30 minutes), centrifuged (40 000g, 10 minutes), and then washed twice with TE buffer. The final pellets were resuspended in TE buffer containing 2% Triton X-100 and incubated on ice (1 hour) to solubilize membrane proteins. A final centrifugation (17 400g, 30 minutes) precipitated the insoluble material. After protein assays had been completed, samples were aliquoted and frozen at –20°C for subsequent analysis.

Rat brain membrane proteins and rabbit and human heart membrane proteins (15 to 30 µg) were fractionated by SDS-PAGE and then probed by Western blot analysis with the anti-Kv1.4 and anti-Kv4.3 antibodies.30 Membranes were fractionated on 10% polyacrylamide gels and transferred to Hybond polyvinylidene difluoride membrane (Amersham). The membranes were washed (3 minutes) in PBS and incubated (1 hour) in blocking buffer III (0.2% I-block blocking buffer [Tropix] in PBS with 0.1% Tween 20), followed by an overnight incubation at 4°C with either the anti-Kv1.4 or the anti-Kv4.3 antibody in blocking buffer. The next day, membranes were washed (10 minutes) and then incubated for 1 hour at room temperature with alkaline phosphatase-conjugated goat anti-rabbit IgG (Tropix) diluted 1:10,000 in blocking buffer III. After incubation, membranes were washed in blocking buffer III for 15 minutes and then for 2 minutes in assay buffer (0.1 mol/L diethanolamine with 1 mmol/L MgCl2, pH 9.8; Tropix). Bound antibodies were detected using Chemiluminescent Substrates for Alkaline Phosphatase Permit Light-Based Detection (CSPD; Tropix).

Data Analysis
Comparisons among groups were performed by ANOVA with Scheffé's contrasts. A 2-tailed probability of 5% was taken to indicate statistical significance. Group data are presented as mean±SEM. Nonlinear curve fitting (the Marquardt procedure) was performed using software for patch-clamp data acquisition and analysis (Clampfit in pClamp6).


*    Results
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Comparison of Biophysical and Pharmacological Properties of Rabbit and Human Ito
Reactivation Kinetics
Figures 1ADown and 1BDown illustrate the recovery kinetics of Ito in rabbit and human atrial cells, respectively. A double-pulse protocol was used to assess Ito recovery, with 200-ms test pulses after an identical conditioning pulse at a variable interval. The results shown are mean±SEM for 12 rabbit and 14 human cells. Recovery was biexponential in the rabbit, with mean recovery time constants averaging 21.8±1.3 ms (16±2% of current) and 2780±57 ms (83±6% of current) at –80 mV. In human cells, recovery was monoexponential with a mean time constant at –80 mV of 15.4±0.7 ms. As illustrated in Figure 1ADown and 1BDown, Ito recovery slowed at less negative holding potentials. The kinetic differences between Ito in the 2 species are not due to differences in voltage dependence of inactivation, as shown by the results in Figure 1CDown. A 1000-ms prepulse from a holding potential of –80 mV was followed by a 200-ms test pulse to +50 mV. In 7 rabbit and 6 human cells, the half-activation potential averaged –33.3±2.1 mV in rabbit and –32.7±2.4 mV in human cells (P=NS), indicating no difference in the voltage dependence of Ito inactivation.



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Figure 1. Recovery kinetics and voltage dependence of inactivation of Ito in rabbit and human atrial myocytes. A and B, Reactivation kinetics. Time-dependent reactivation was evaluated with the use of a paired-pulse protocol, in which 2 identical 200-ms pulses (P1 and P2) from a holding potential (HP) of –80 or –50 mV to +50 mV were delivered with increasing P1-P2 coupling intervals to rabbit (A, n=12) or human (B, n=14) myocytes. Lines are double-exponential fits to experimental data (mean±SEM). C, Voltage-dependent steady-state inactivation of Ito. A 2-pulse protocol was used, with a 1-second prepulse to various conditioning potentials followed by a 200-ms test pulse to +50 mV. Currents recorded with prepulses at each conditioning potential were normalized to values obtained with a prepulse to –90 mV. Data are mean±SEM for 7 rabbit and 6 human myocytes, and lines are best-fit curves with the Boltzmann equation.

Effects of 4-Aminopyridine (4AP) on Ito
4AP is a classical Ito blocker.1 2 3 15 As illustrated by the data in Figure 2Down, the responses of human and rabbit Ito to 4AP are quite different. Figure 2ADown shows Ito elicited in a rabbit cell in the presence of 2 mmol/L 4AP on depolarization for 100 ms from –60 to +40 mV. Results are shown during 2 consecutive pulses (P1 and P2) at 1 Hz after a long quiescent period (>1 minute). Virtually no time-dependent current is elicited by either the first or second pulse. Figure 2BDown shows data obtained in a human cell with an identical protocol. During the first pulse, there is a small but measurable Ito, and the second pulse elicits a relatively large Ito. Figure 2CDown shows mean data for current in the presence of 4AP relative to control current (4AP/Control) as a function of pulse number during pulsing at 1 Hz after a >1-minute quiescent period in 6 human and 5 rabbit cells. In rabbit cells, strong inhibition is present during all pulses, whereas in human cells there is prominent use-dependent unblocking. Figure 2DDown shows results obtained with the same protocol applied to Kv1.4 channels expressed in Xenopus oocytes. As was the case for rabbit Ito, little 4AP unblocking is observed. In contrast, when Kv4.3 is expressed in HEK cells and the same protocol applied, clear Ito unblocking is seen (Figure 2EDown). Figure 2FDown shows mean data for 4AP block obtained in 15 oocytes for Kv1.4, 4 cells for Kv4.3, and 8 oocytes for Kv4.2 and indicates that the absence of use-dependent unblocking of 4AP is typical of Kv1.4 channels.



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Figure 2. Use-dependent 4AP block of Ito. A and B, Original recordings of Ito in the presence of 4AP (2 mmol/L) during a first (P1) and second (P2) pulse 100 ms from the holding potential (–50 mV) to +50 mV at 1 Hz in a rabbit (A) and a human (B) atrial myocyte. C, Mean (±SEM) current in the presence of 4AP during each 100-ms pulse to +50 mV during a 10-pulse train at 1 Hz, after a prolonged quiescent period. Data are expressed as current in the presence of 4AP divided by current under control conditions from the same cell during a corresponding pulse applied with the identical protocol. D and E, Recordings obtained from a Xenopus oocyte injected with cRNA encoding Kv1.4 (D) and from a HEK cell transfected with cRNA for Kv4.3, studied with the same protocol as the rabbit and human cells illustrated in panels A and B. F, Current (mean±SEM) in the presence of 4AP normalized to current obtained under control conditions in the same cell, as a function of pulse number for a pulse train protocol identical to that in panel C.

Effects of H2O2
The inactivation of Kv1.4, but not Kv4.2 or Kv4.3, has been shown to be substantially slowed in response to oxidative stress.27 41 42 We therefore compared the response of rabbit and human Ito to the addition of H2O2 in the superfusate. Typical results are displayed in Figure 3ADown. Oxidative stress resulting from 0.01% H2O2 dramatically slowed the inactivation of Ito in rabbit myocytes (Figure 3ADown, left). In contrast, human Ito was not significantly affected by exposure to H2O2 (Figure 3ADown, right) under the same conditions. Average kinetics before and after H2O2 in 10 rabbit cells and 8 human cells are shown in Figure 3BDown. Overall, the rapid and slow inactivation time constants of rabbit Ito increased from 21.1±3.0 and 249.2±30.3 ms under control conditions to 34.7±5.1 and 364.8±45.3 ms (P<0.001 for each) after exposure to 0.01% H2O2 in 10 cells. In addition, the proportion of slowly inactivating Ito in rabbit cells was increased by H2O2 from 24±6% to 63±6% of total current (P<0.01). For human Ito, the rapid and slow phases of Ito inactivation had time constants of 7.1±1.0 and 22.2±2.3 ms before and 5.1±1.2 and 19.0±2.5 ms (n=6 cells, P=NS) after exposure to H2O2, respectively. The proportion of slowly inactivating current in human cells averaged 44±16% before and 41±8% after (P=NS) exposure to H2O2.



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Figure 3. Effects of H2O2 on Ito inactivation time course in rabbit (left) and human (right) myocytes. A, Original recordings of Ito during 100-ms (human) or 500-ms (rabbit) depolarizations from –50 mV to voltages between –40 and +50 mV (with 10-mV increments) before and after 0.01% H2O2. Note difference in time scale for rabbit vs human cells. Current scales in bottom panels of A apply to both control and H2O2 for rabbit and human, respectively. B, Inactivation time constants before and after exposure to H2O2 in rabbit (left) and human (right) atrial myocytes. ***P<0.001 vs control.

Detection of Kv1.4 and Kv4.3 Proteins in Rabbit and Human Myocardial Membranes
Western blots of fractionated rat brain membrane proteins with the anti-Kv4.3 antibody revealed a prominent protein band at {approx}75 kDa (Figure 4ADown, lane B). The band was eliminated when the antibody was preincubated with the peptide against which it was generated. In Western blots of fractionated rabbit and human heart membrane proteins, prominent bands at {approx}75 kDa were also detected with this antibody (Figure 4ADown, lanes RA and HA). There is also a broad, intense band at {approx}55 to 60 kDa in the blot of the rabbit atrial membrane proteins; this corresponds to rabbit IgG, also detected by the goat anti-rabbit (IgG) secondary antibody. Although no attempt was made to quantify these blots, it is of interest to note that the expression levels of the Kv4.3 protein in rabbit and human heart are similar.



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Figure 4. Rat brain and human atrial membrane proteins were fractionated by SDS-PAGE and transfected to polyvinylidene difluoride membranes, which were then immunoblotted with subunit-specific antibodies and subsequently developed by chemiluminescence. A, Rabbit and human atrial (RA and HA lanes, respectively) and rat brain (B lanes) membrane proteins (30 µg) were immunoblotted with specific anti-Kv4.3 antibodies and reveal a band at {approx}74 kDa in all samples blotted with antibody not incubated with antigenic peptide (–). These bands are not seen in the samples blotted with antibody blocked by preincubation with antigenic peptide (+), indicating specificity. Similar results were obtained in experiments with 4 rabbit and 3 human hearts. B, Rabbit and human atrial (RA and HA lanes, respectively) and rat brain (B lanes) membrane proteins (30, 30, and 15 µg of protein, respectively) were immunoblotted with specific anti-Kv1.4 antibodies. A highly dense band at {approx}97 kDa was revealed in brain, and a less intense band of similar molecular mass was detected in rabbit atrium when all samples were immunoblotted with antibody not exposed to antigenic peptide (–). These bands were absent from immunoblots blocked by preincubation of antibody with antigenic peptide (+). No band(s) appeared in the lane loaded with human atrial protein when developed under the same conditions (10-minute exposure). However, when the film was exposed to the chemiluminescing membranes for a longer period (20 minutes; HA'), a faint band appeared in nonblocked immunoblots at a much lower molecular mass ({approx}65 kDa) than expected for intact Kv1.4. This band is absent from blocked immunoblots. The brain and rabbit atrial bands were saturated at 20 minutes. Similar results were obtained from 3 rabbit and 3 human hearts.

Western blots of fractionated rat brain membrane proteins with the anti-Kv1.4 antibody revealed a prominent protein band at 95 kDa (Figure 4BUp, lane B), and this band was eliminated when the antibody was preincubated with the peptide against which it was generated. In Western blots of fractionated rabbit heart membrane proteins, a prominent band at {approx}95 kDa was detected with this antibody (Figure 4BUp, lane RA). As in the blots with the anti-Kv4.3 antibody, rabbit IgG was also detected in this blot. In contrast to these results, however, no bands were detected with the anti-Kv1.4 antibody in immunoblots of fractionated human heart membrane proteins probed with the same antibody under identical experimental conditions (Figure 4BUp, lane HA). When the film was exposed for a considerably longer time (30 minutes), a faint band at {approx}65 kDa was detected with the anti-Kv1.4 antibody (Figure 4BUp, lane HA'). Although this band was eliminated when the antibody was preincubated with the peptide against which it was generated, the low molecular mass (65 kDa) suggests that this is not Kv1.4, which has a predicted molecular mass of 85 kDa. Similar results were obtained with all 3 preparations of each tissue type (each from a different subject) studied.

Effects of Antisense Oligodeoxynucleotides on Rabbit and Human Ito
The above results point to a potentially important role for Kv1.4 in rabbit but not human heart, and the potential participation of Kv4 proteins in both species. This possibility was further assessed by the antisense experiments illustrated in Figures 5Down (for rabbit) and 6 (for human cardiomyocytes). Results in rabbit cells exposed to mismatch oligodeoxynucleotides differed from those of rabbit cells exposed to antisense oligodeoxynucleotides directed against Kv1.4, Kv4.2 and Kv4.3 sequences, all of which reduced Ito amplitude (Figure 5Down). Human cells, unlike those of rabbits, did not appear to be appreciably affected by Kv1.4 and Kv4.2 antisense oligodeoxynucleotides; however, exposure to Kv4.3 antisense produced significant reductions in Ito (Figure 6Down).



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Figure 5. Representative experiments showing effects of antisense and mismatch oligodeoxynucleotides on rabbit Ito. Ito was elicited by 700-ms pulses from a holding potential of –50 mV to voltages between –40 and +50 mV with 10-mV increments at 0.1 Hz.



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Figure 6. Representative experiments showing effects of antisense and mismatch oligodeoxynucleotides on human Ito. Ito was elicited with 100-ms pulses from a holding potential of –50 mV to voltages between –40 and +50 mV at 10-mV increments and a frequency of 0.1 Hz.

Mean data for all cells studied (rabbit, 57, 45, and 59 control cells for Kv1.4, Kv4.2, and Kv4.3, respectively; 34, 29, and 37 cells for Kv1.4, Kv4.2, and Kv4.3 mismatch; and 54, 49, and 57 cells for Kv1.4, Kv4.2, and Kv4.3 antisense; human, 48, 42, and 55 control cells for Kv1.4, Kv4.2, and Kv3.4, respectively; 32, 34, and 41 cells for Kv1.4, Kv4.2, and Kv4.3 mismatch; and 52, 48, and 51 cells for Kv1.4, Kv4.2, and Kv4.3 antisense) are shown in Figure 7Down. In rabbit myocytes, there was a 45±2% decrease (P<0.01, compared with vehicle control) produced by Kv1.4 antisense at +60 mV, 40±2% by Kv4.2 antisense (P<0.01), and 68±3% by Kv4.3 antisense (P<0.01). In human cells, however, only Kv4.3 antisense produced a significant reduction in Ito expression.



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Figure 7. Ito density (mean±SEM) in rabbit (top) or human (bottom) cells exposed to vehicle (control), antisense, or mismatch oligodeoxynucleotides. Currents were recorded with 100-ms pulses from a holding potential of –50 mV to voltages between –40 and +50 mV (10-mV increments) at 0.1 Hz. *P<0.05 and **P<0.01 vs control and mismatch groups.

None of the antisenses significantly altered the kinetics of Ito. For example, on depolarization to +40 mV, the fast and slow inactivation time constants in rabbit cells averaged 26.4±2.3 and 261.2±40.8 ms, respectively, under control conditions (n=31), and 24.3±3.9 and 246.7±38.4 ms in the presence of Kv1.4 antisense (n=29), 26.3±4.7 and 281.5±41.1 ms in the presence of Kv4.2 antisense (n=25), and 27.2±3.4 and 282.3±42.1 ms in the presence of Kv4.3 antisense (n=23). In human cells, the inactivation time constants averaged 7.4±1.7 and 29.4±3.2 ms under control conditions (n=20) and 7.3±2.0 and 27.2±3.1 ms after Kv4.3 antisense (n=22).

The lack of effect of mismatch oligodeoxynucleotides on Ito in rabbit and human cells argues against nonspecific effects of oligodeoxynucleotides. To verify further the specificity of antisense effects, we evaluated possible effects on IKur in human atrium and ICa in rabbit atrium. The results (Figure 8Down) show that ICa was not altered by any of the antisense molecules in the rabbit, nor was IKur in human cells affected by Kv4.3 antisense.



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Figure 8. Current density-voltage relations for Ito (A) and ICa (B) in rabbit atrial myocytes, and for Ito (C) and IKur (D) in human atrial myocytes, cultured in the presence of vehicle (control) or antisense to each clone indicated. Ito and IKur were elicited in human cells with 100-ms pulses from –50 mV to voltages ranging from –40 to +50 mV, with a 1000-ms prepulse 10 ms before the test pulse used to isolate IKur in human cells. In rabbit cells, Ito was elicited with 700-ms pulses from –50 mV, and ICa was elicited with 100-ms pulses from –60 mV. Data are mean±SEM.

Finally, we performed additional experiments to determine the effects of antisense on the concentration of various mRNA species in rabbit atrial myocytes. In each experiment, separate groups of cells from 1 heart were exposed to vehicle, antisense oligodeoxynucleotides against 1 ion channel mRNA species, or mismatch oligodeoxynucleotides. At least 3 experiments were done with each construct. Figure 9ADown shows typical gels for competitive RT-PCR of Kv4.3 mRNA in cells exposed to vehicle (left), Kv4.3 antisense (middle), and mismatch (right) sequences. The point of identity shifted to the right in the antisense-treated group, indicating a decline in Kv4.3 mRNA expression. Figure 9BDown illustrates the graphical solution of mRNA concentration with the use of data for Kv4.3. Figures 9CDown through 9E show that antisense reduced the mRNA concentration of the corresponding species significantly compared with vehicle or mismatch oligodeoxynucleotide–treated cells. To exclude antisense effects on other molecular species, we measured mRNA concentrations of the nontargeted molecular species in response to antisense. No nonspecific effects were seen: with Kv1.4 antisense, Kv4.2 mRNA concentrations were 6.3±1.1 (control) versus 6.4±1.5 amol/µg RNA (antisense-treated cells) and Kv4.3 mRNA concentrations were 12.5±2.2 (control) versus 12.6±2.7 (antisense) amol/µg RNA; with Kv4.2 antisense, concentrations of Kv1.4 mRNA were 8.4±2.0 (control) and 8.2±2.6 (antisense) amol/µg and of Kv4.3 mRNA were 12.5±2.2 (control) and 12.1±2.4 (antisense) amol/µg; and with Kv4.3 antisense, mRNA concentrations for Kv1.4 mRNA were 8.4±2.0 (control) and 8.2±1.2 (antisense) amol/µg and for Kv4.2 mRNA were 6.3±1.1 (control) and 5.5±1.8 (antisense) amol/µg. We were unable to study the effects of antisense on mRNA concentrations in human atrial cells because of the very small number of cells available in the small specimens obtained.



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Figure 9. Downregulation of mRNAs coding for Kv1.4, Kv4.2, and Kv4.3 by the corresponding antisense deoxynucleotides in RNA samples extracted from rabbit atrial myocytes. A, Representative agarose gels for competitive RT-PCR of Kv4.3 K+ channel subunits in samples from control cells, antisense-treated cells, and mismatch oligodeoxynucleotide–treated cells. Lane 0, DNA mass ladder. Lanes 1 through 4, Results obtained with serial dilutions of RNA internal standard (lane 1, 20 pg; lane 2, 2 p; lane 3, 0.2 pg; and lane 4, 0.02 pg). The lower bands correspond to channel mRNA; upper bands are internal standards. B, Graph of the logarithmic ratio of optical intensity of amplified target DNA/mimic DNA vs logarithm of mimic RNA intensity. The leftward shift of the intersection of the regression line with the horizontal axis in antisense-treated cells indicates a decrease in Kv4.3 mRNA concentration. C, Abundance of Kv4.3 mRNA from groups of myocytes exposed to vehicle (Cont), Kv4.3 antisense (AS), or mismatch (MAS) (n=3 analyses per group, with each analysis performed with atrial cells from 1 individual heart; **P<0.01 vs control). D, Abundance of Kv1.4 mRNA from groups of myocytes exposed to vehicle, Kv1.4 antisense, or mismatch (n=4 analyses for each group; *P<0.05 vs control). E, Abundance of Kv4.2 mRNA from myocytes exposed to vehicle, Kv4.2 antisense, or mismatch (n=3 analyses for each group; *P<0.05 vs control). C through E, Cont indicates control; AS, antisense; and MAS, mismatch oligonucleotides.


*    Discussion
up arrowTop
up arrowAbstract
up arrowIntroduction
up arrowMaterials and Methods
up arrowResults
*Discussion
down arrowReferences
 
In the present study, we obtained several lines of evidence suggesting that, whereas Kv1.4 subunits do not appear to play a role in human atrial Ito, they are importantly involved in rabbit cardiac Ito. This conclusion is suggested by the effect of oxidative stress, the lack of use-dependent unblocking of 4AP, and the effect of Kv1.4 antisense on rabbit Ito, with human Ito failing to respond to oxidative stress or Kv1.4 antisense and showing prominent 4AP unblocking. Furthermore, Kv1.4 protein was demonstrated in rabbit heart membranes and was clearly absent from the human heart.

Previous Studies on the Molecular Mechanisms of Ito
A variety of cDNA clones encoding K+ channel subunits, including Kv1.4,17 18 Kv3.3,19 Kv3.4,20 Kv4.1,21 Kv4.2,22 23 24 25 and Kv4.3,26 27 28 carry currents resembling Ito on heterologous expression. Transcripts for many of these clones are detectable in mammalian hearts,43 but protein expression for Ito subunits may not match that of mRNA.30 44 Direct evidence for the subunit composition of native Ito is limited. Studies of protein expression suggest that members of the Shal (Kv4) subfamily of K+ channel subunits are likely involved in forming rat,30 dog,27 and human27 Ito. Recent studies using antisense techniques showed that Ito in the rat is reduced by exposure to Kv4.2 or Kv4.3 antisense.31 The expression of dominant negative Kv4.2 constructs strongly reduces Ito expression in rats32 and mice.33

In the present studies, we found a variety of types of evidence for differences in the molecular composition between rabbit and human Ito. Rabbit Ito showed little use-dependent unblocking of 4AP, whereas human Ito showed prominent unblocking with repeated depolarizing pulses. A lack of 4AP unblocking was also found to typify currents carried by Kv1.4, whereas currents carried by Kv4.2 and 4.3 showed prominent unblocking. Exposure to H2O2 clearly slowed inactivation of rabbit Ito but had no appreciable effect on human Ito. Kv1.4 currents are known to be highly sensitive to changes in redox potential, whereas those carried by Kv4.2 and Kv4.3 are not.27 41 42 45 Western blots demonstrated the presence of Kv1.4 and Kv4.3 protein in rabbit atrial and ventricular membranes, but only Kv4.3 was found in human atrium and ventricle. Finally, antisense oligodeoxynucleotides directed against Kv1.4, Kv4.2, and Kv4.3 all reduced Ito currents in cultured rabbit myocytes, but only Kv4.3 antisense significantly altered human Ito.

Potential Significance
Ito is an important repolarizing current in the heart. Abnormalities in Ito have been detected in a variety of cardiac pathologies, including ventricular failure,46 47 myocardial infarction,48 impaired metabolic function,49 and atrial fibrillation.50 51 Furthermore, differences in regional expression of Ito appear to be important in the generation of the T wave,52 in explaining the electrophysiological response to myocardial ischemia,53 in proarrhythmic reactions to antiarrhythmic drugs,54 and in the electrocardiographic response to physiological perturbations such as hypothermia.55 It is therefore important to understand the molecular basis of the Ito channel. The present studies are the first of which we are aware to provide direct evidence for a role of Kv1.4 in forming native Ito channels, in terms of data obtained with Western blot, pharmacological, and antisense approaches. Preliminary results have been published that indicate, on the basis of immunohistochemical and biophysical evidence, that Kv1.4 may encode a portion of Ito in ferret left ventricular endocardium.56 The involvement of Kv1.4 subunits in forming rabbit Ito channels may account for their typically very slow reactivation kinetics.4

Significant differences have been observed in the reactivation kinetics of Ito among various ventricular regions of the human heart.57 58 Whereas subepicardial cells recover rapidly from inactivation and show little frequency dependence, much like human atrial cells, subendocardial cells show an important slow phase of recovery and strong frequency dependence, much like rabbit atrial myocytes. It is thus quite conceivable that Kv1.4 channel subunits play a significant role in contributing to transmural repolarization gradients in the human ventricle. As mentioned above, preliminary data suggest this to be the case in ferret ventricle. Differences in the pharmacological and physiological properties of Kv1.4 and Kv4.3 subunits may have important potential implications for understanding interspecies and intertissue differences in Ito regulation.

Potential Limitations
None of the antisense molecules studied produced complete inhibition of Ito in either rabbit or human atrium. This observation is compatible with findings in previous studies of antisense oligodeoxynucleotide effect on K+ channel function.34 38 Possible explanations include incomplete inhibition of target subunit protein production by antisense and the existence of as-yet-unidentified subunits contributing to macroscopic currents.

A second issue relates to the nature of the contribution of Kv1.4 subunits to overall current in the rabbit. If Kv1.4 subunits existed in separate, homotetrameric channels from those involving Kv4 subunits, one might have expected to see a change in channel kinetics with antisense exposure and to see use-dependent unblocking of a portion of current (that portion carried by Kv4 channels) in the presence of 4AP. Neither of these phenomena was seen: antisense did not alter kinetics of Ito in the rabbit, nor was a component of 4AP unblocking seen. One possible explanation of this observation would be the coassembly of Kv1.4 and Kv4 subunits as heterotetramers. The experiments necessary to determine whether Kv1.4 and Kv4 subunits can coassemble have not, to our knowledge, been performed; however, the observation that a Kv4 dominant negative construct did not inhibit coexpressed Kv1.4 channels32 makes coassembly unlikely. The final limitation is that our study is limited to {alpha}-subunits that encode 4AP-sensitive transient outward channel subunits. The potential role of other subunits, including ß peptides, cannot be assessed from the present experiments.


*    Acknowledgments
 
This work was supported by the Medical Research Council of Canada, the Heart and Stroke Foundation of Quebec, the Fonds de la Recherche en Santé du Québec, NIH (grant NHLBI RO1-HL 34161), and the Fonds de la Recherche de l'Institut de Cardiologie de Montréal. Dr Wang is a research scholar of the Heart and Stroke Foundation of Canada. Dr Pond was supported by a postdoctoral fellowship from NIH. The authors thank Nathalie Talbot and XiaoFan Yang for their excellent technical assistance, Diane Campeau for secretarial help with the manuscript, and Dr David Van Wagoner for providing the human heart samples.

Received September 8, 1998; accepted January 3, 1999.


*    References
up arrowTop
up arrowAbstract
up arrowIntroduction
up arrowMaterials and Methods
up arrowResults
up arrowDiscussion
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