Drug-induced long-QT syndrome associated with a subclinical SCN5A mutation

Naomasa Makita, Minoru Horie, Takeshi Nakamura, Tomohiko Ai, Koji Sasaki, Hisataka Yokoi, Masayuki Sakurai, Ichiro Sakuma, Hideo Otani, Hirofumi Sawa, Akira Kitabatake

Research output: Contribution to journalArticle

147 Citations (Scopus)

Abstract

Background - Subclinical mutations in genes associated with the congenital long-QT syndromes (LQTS) have been suggested as a risk factor for drug-induced LQTS and accompanying life-threatening arrhythmias. Recent studies have identified genetic variants of the cardiac K+ channel genes predisposing affected individuals to acquired LQTS. We have identified a novel Na+ channel mutation in an individual who exhibited drug-induced LQTS. Methods and Results - An elderly Japanese woman with documented QT prolongation and torsade de pointes during treatment with the prokinetic drug cisapride underwent mutational analysis of LQTS-related genes. A novel missense mutation (L1825P) was identified within the C-terminus region of the cardiac Na+ channel (SCN5A). The L1825P channel heterologously expressed in tsA-201 cells showed Na+ current with slow decay and a prominent tetrodotoxin-sensitive noninactivating component, similar to the gain-of-function phenotype most commonly observed for SCN5A-associated congenital LQTS (LQT3). In addition, L1825P exhibited loss of function Na+ channel features characteristic of Brugada syndrome. Peak Na+ current density observed in cells expressing L1825P was significantly diminished, and the voltage dependence of activation and inactivation was shifted toward more positive and negative potentials, respectively. Conclusions - This study demonstrates that subclinical mutations in the LQTS-related gene SCN5A may predispose certain individuals to drug-induced cardiac arrhythmias.

Original languageEnglish (US)
Pages (from-to)1269-1274
Number of pages6
JournalCirculation
Volume106
Issue number10
DOIs
StatePublished - Sep 3 2002
Externally publishedYes

Fingerprint

Long QT Syndrome
Mutation
Pharmaceutical Preparations
Genes
Cardiac Arrhythmias
Cisapride
Brugada Syndrome
Torsades de Pointes
Tetrodotoxin
Missense Mutation
Phenotype

Keywords

  • Drugs
  • Genetics
  • Ion channels
  • Long-QT syndrome
  • Torsade de pointes

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Makita, N., Horie, M., Nakamura, T., Ai, T., Sasaki, K., Yokoi, H., ... Kitabatake, A. (2002). Drug-induced long-QT syndrome associated with a subclinical SCN5A mutation. Circulation, 106(10), 1269-1274. https://doi.org/10.1161/01.CIR.0000027139.42087.B6

Drug-induced long-QT syndrome associated with a subclinical SCN5A mutation. / Makita, Naomasa; Horie, Minoru; Nakamura, Takeshi; Ai, Tomohiko; Sasaki, Koji; Yokoi, Hisataka; Sakurai, Masayuki; Sakuma, Ichiro; Otani, Hideo; Sawa, Hirofumi; Kitabatake, Akira.

In: Circulation, Vol. 106, No. 10, 03.09.2002, p. 1269-1274.

Research output: Contribution to journalArticle

Makita, N, Horie, M, Nakamura, T, Ai, T, Sasaki, K, Yokoi, H, Sakurai, M, Sakuma, I, Otani, H, Sawa, H & Kitabatake, A 2002, 'Drug-induced long-QT syndrome associated with a subclinical SCN5A mutation', Circulation, vol. 106, no. 10, pp. 1269-1274. https://doi.org/10.1161/01.CIR.0000027139.42087.B6
Makita, Naomasa ; Horie, Minoru ; Nakamura, Takeshi ; Ai, Tomohiko ; Sasaki, Koji ; Yokoi, Hisataka ; Sakurai, Masayuki ; Sakuma, Ichiro ; Otani, Hideo ; Sawa, Hirofumi ; Kitabatake, Akira. / Drug-induced long-QT syndrome associated with a subclinical SCN5A mutation. In: Circulation. 2002 ; Vol. 106, No. 10. pp. 1269-1274.
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AU - Makita, Naomasa

AU - Horie, Minoru

AU - Nakamura, Takeshi

AU - Ai, Tomohiko

AU - Sasaki, Koji

AU - Yokoi, Hisataka

AU - Sakurai, Masayuki

AU - Sakuma, Ichiro

AU - Otani, Hideo

AU - Sawa, Hirofumi

AU - Kitabatake, Akira

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N2 - Background - Subclinical mutations in genes associated with the congenital long-QT syndromes (LQTS) have been suggested as a risk factor for drug-induced LQTS and accompanying life-threatening arrhythmias. Recent studies have identified genetic variants of the cardiac K+ channel genes predisposing affected individuals to acquired LQTS. We have identified a novel Na+ channel mutation in an individual who exhibited drug-induced LQTS. Methods and Results - An elderly Japanese woman with documented QT prolongation and torsade de pointes during treatment with the prokinetic drug cisapride underwent mutational analysis of LQTS-related genes. A novel missense mutation (L1825P) was identified within the C-terminus region of the cardiac Na+ channel (SCN5A). The L1825P channel heterologously expressed in tsA-201 cells showed Na+ current with slow decay and a prominent tetrodotoxin-sensitive noninactivating component, similar to the gain-of-function phenotype most commonly observed for SCN5A-associated congenital LQTS (LQT3). In addition, L1825P exhibited loss of function Na+ channel features characteristic of Brugada syndrome. Peak Na+ current density observed in cells expressing L1825P was significantly diminished, and the voltage dependence of activation and inactivation was shifted toward more positive and negative potentials, respectively. Conclusions - This study demonstrates that subclinical mutations in the LQTS-related gene SCN5A may predispose certain individuals to drug-induced cardiac arrhythmias.

AB - Background - Subclinical mutations in genes associated with the congenital long-QT syndromes (LQTS) have been suggested as a risk factor for drug-induced LQTS and accompanying life-threatening arrhythmias. Recent studies have identified genetic variants of the cardiac K+ channel genes predisposing affected individuals to acquired LQTS. We have identified a novel Na+ channel mutation in an individual who exhibited drug-induced LQTS. Methods and Results - An elderly Japanese woman with documented QT prolongation and torsade de pointes during treatment with the prokinetic drug cisapride underwent mutational analysis of LQTS-related genes. A novel missense mutation (L1825P) was identified within the C-terminus region of the cardiac Na+ channel (SCN5A). The L1825P channel heterologously expressed in tsA-201 cells showed Na+ current with slow decay and a prominent tetrodotoxin-sensitive noninactivating component, similar to the gain-of-function phenotype most commonly observed for SCN5A-associated congenital LQTS (LQT3). In addition, L1825P exhibited loss of function Na+ channel features characteristic of Brugada syndrome. Peak Na+ current density observed in cells expressing L1825P was significantly diminished, and the voltage dependence of activation and inactivation was shifted toward more positive and negative potentials, respectively. Conclusions - This study demonstrates that subclinical mutations in the LQTS-related gene SCN5A may predispose certain individuals to drug-induced cardiac arrhythmias.

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