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1 Department of Physiology and Biophysics, Rammelkamp Center for Education and Research, Case Western Reserve University, MetroHealth Campus, Cleveland 44109; and 2 Departments of Molecular Cardiology and of Cardiology, Center for Molecular Genetics, The Cleveland Clinic Foundation, Cleveland, Ohio 44195
Idiopathic
ventricular fibrillation (IVF) can cause sudden death in both adults
and children. One form of IVF (Brugada syndrome), characterized by S-T
segment elevation (STE) in the electrocardiogram, has been linked to
mutations of SCN5A, the gene encoding the voltage-gated cardiac Na+ channel. A missense mutation of
SCN5A that substitutes glutamine for leucine at codon 567 (L567Q, in the cytoplasmic linker between domains I and II) is
identified with sudden infant death and Brugada syndrome in one family.
However, neither the functional effect of the L567Q mutation nor the
molecular mechanism underlying the pathogenicity of the mutation is
known. Patch-clamp analysis of L567Q channels expressed in human
embryonic kidney cells revealed a marked acceleration and a negative
shift in the voltage dependence of inactivation. Unlike other Brugada
mutations, this phenotype was expressed independently of temperature or
auxiliary
1-subunits. These results support a proposed
linkage between Brugada syndrome and some instances of sudden infant
death and the hypothesis that reduced Na+ conductance is
the primary cause of IVF with STE.
SCN5A; Brugada syndrome; arrhythmia; sudden infant death syndrome
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