• Ikuomi Mikuni, Carlos G Torres, Tania Bakshi, Akihito Tampo, Brian E Carlson, Martin W Bienengraeber, and Wai-Meng Kwok.
• From the Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Japan (I.M.); Pediatric Residency Program, Massachusetts General Hospital for Children, Boston, Massachusetts (C.G.T.); Department of Biological Sciences, GlaxoSmithKline, Collegeville, Pennsylvania (T.B.); Department of Emergency Medicine, Asahikawa Medical University, Asahikawa, Japan (A.T.); Biotechnology and Bioengineering Center and Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin (B.E.C.); and Department of Anesthesiology and Department of Pharmacology and Toxicology, Medical College of Wisconsin, Milwaukee, Wisconsin (M.W.B., W.-M.K.). Current address: Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan (B.E.C.).
• Anesthesiology. 2015 Apr 1;122(4):806-20.

BackgroundThe impact of volatile anesthetics on patients with inherited long QT syndrome (LQTS) is not well understood. This is further complicated by the different genotypes underlying LQTS. No studies have reported on the direct effects of volatile anesthetics on specific LQTS-associated mutations. We investigated the effects of isoflurane on a common LQTS type 1 mutation, A341V, with an unusually severe phenotype.MethodsWhole cell potassium currents (IKs) were recorded from HEK293 and HL-1 cells transiently expressing/coexpressing wild-type KCNQ1 (α-subunit), mutant KCNQ1, wild-type KCNE1 (β-subunit), and fusion KCNQ1 + KCNE1. Current was monitored in the absence and presence of clinically relevant concentration of isoflurane (0.54 ± 0.05 mM, 1.14 vol %). Computer simulations determined the resulting impact on the cardiac action potential.ResultsIsoflurane had significantly greater inhibitory effect on A341V + KCNE1 (62.2 ± 3.4%, n = 8) than on wild-type KCNQ1 + KCNE1 (40.7 ± 4.5%; n = 9) in transfected HEK293 cells. Under heterozygous conditions, isoflurane inhibited A341V + KCNQ1 + KCNE1 by 65.2 ± 3.0% (n = 13) and wild-type KCNQ1 + KCNE1 (2:1 ratio) by 32.0 ± 4.5% (n = 11). A341V exerted a dominant negative effect on IKs. Similar differential effects of isoflurane were also observed in experiments using the cardiac HL-1 cells. Mutations of the neighboring F340 residue significantly attenuated the effects of isoflurane, and fusion proteins revealed the modulatory effect of KCNE1. Action potential simulations revealed a stimulation frequency-dependent effect of A341V.ConclusionsThe LQTS-associated A341V mutation rendered the IKs channel more sensitive to the inhibitory effects of isoflurane compared to wild-type IKs in transfected cell lines; F340 is a key residue for anesthetic action.

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