NaV1.6 specifically sensitizes Slack to quinidine blockade.

(A) The voltage protocol and current traces from control (non-transfected) HEK293 cells. The arrows on the voltage protocol indicate the onset of inward sodium currents through NaV channels and delayed outward potassium currents through Slack channels. The currents were evoked by applying 600-ms step pulses to voltages varying from -120 mV to +100 mV in 10 mV increments, with a holding potential of -90 mV and a stimulus frequency of 0.20 Hz. (B) Example current traces from HEK293 cells expressing Slack alone. The left traces show the family of control currents; the right traces show Slack currents remaining after application of 30 μΜ quinidine in the bath solution. (C-E) Example current traces from HEK293 cells co-expressing Slack with NaV1.2 (C), NaV1.6 (D), or NaV1.5 (E) channels before and after application of 30 μΜ quinidine. (F) The concentration-response curves for blocking of Slack by quinidine at +100 mV upon expression of Slack alone (n = 6) and co-expression of Slack with NaV1.1 (n = 7), NaV1.2 (n = 10), NaV1.3 (n = 13), NaV1.5 (n = 9), or NaV1.6 (n = 19). Please refer to Supplementary Table 1 for IC50 values. (G-H) Delayed outward currents in primary cortical neurons from homozygous NaV1.6 knockout C3HeB/FeJ mice (NaV1.6-KO) (H) and the wild-type littermate controls (WT) (G). Current traces were elicited by 600-ms step pulses to voltages varying from -120 mV to +100 mV in 20 mV increments, with a holding potential of -70 mV, and recorded with different bath solutions in the following order: Na+-based bath solution (IControl), replacement of external Na+ with Li+ in equivalent concentration (ILi), washout of quinidine by Na+-based bath solution (IWash), Na+-based bath solution with 3 μM quinidine (IQuid), Li+-based bath solution with 3 μM quinidine (ILi+Quid). The removal and subsequent replacement of extracellular Na+ revealed the IKNa in neurons. (I-J), The sensitivity of native sodium-activated potassium currents (IKNa) to 3 μM quinidine blockade in WT (I) and NaV1.6-KO (J) neurons. IKNa before application of quinidine was obtained from the subtraction of IControl and ILi. Maintained IKNa after application of 3 μM quinidine was obtained from the subtraction of IQuid and ILi+Quid. (K) Summarized amplitudes of IKNa before and after application of 3 μM quinidine in the bath solution in WT (black, n = 12) and NaV1.6-KO (red, n = 10) primary cortical neurons. ****p < 0.0001, Two-way repeated measures ANOVA followed by Bonferroni’s post hoc test.

Blocking transient sodium influx through NaV1.6 reduces NaV1.6-mediated sensitization of Slack to quinidine blockade.

(A) Example current traces from HEK293 cells expressing Slack alone (top) and co-expressing Slack with NaV1.6 (bottom), with 100nM TTX in the bath solution. The left traces show the family of control currents; the right traces show Slack currents remaining after application of quinidine. (B) The concentration-response curves for blocking of Slack by quinidine at +100 mV upon expression of Slack alone (n = 3) and co-expression of Slack with NaV1.6 (n = 7), with 100 nM TTX in the bath solution. (C) Top, example current traces recorded from a HEK293 cell co-expressing Slack with NaV1.6 and evoked from a 100-ms prepulse (pre) of -90 mV. Bottom, example current traces recorded from the same cell but evoked from a 100-ms prepulse of -40 mV, before and after application of quinidine. (D) I-V curves of Slack upon co-expression with NaV1.6. The currents were evoked from a prepulse of -90 mV (black) or -40 mV (blue). (E) The concentration-response curves for blocking of Slack by quinidine at +100 mV with a prepulse of -90 mV (black, n = 19) or -40 mV (blue, n = 5). (F) Top, example current traces recorded from a HEK293 cell co-expressing Slack and NaV1.6 without riluzole in the bath solution. Bottom, example current traces recorded from the same cell with 20 µM riluzole in the bath solution, before and after application of quinidine. (G) I-V curves of Slack upon co-expression with NaV1.6 before (black) and after (red) application of 20 µM riluzole into bath solution.The concentration-response curves for blocking of Slack by quinidine upon co-expression of Slack with NaV1.6, without (n = 19) or with (n = 6) 20 µM riluzole in the bath solution. (I-J) The sensitivity of NaV channel subtypes to quinidine blockade upon expression of NaV alone in HEK293 cells. Example current traces (I) were evoked by a 50-ms step depolarization to 0 mV from a holding potential of -90 mV. The Concentration-response curves for blocking of NaV channel subtypes by quinidine (J) were shown on the right panel (n = 5 for NaV1.1, n = 3 for NaV1.2, n = 6 for NaV1.3, n = 6 for NaV1.5, and n = 4 for NaV1.6).

Slack physically interacts with NaV1.6 in vitro and in vivo.

(A) Immunofluorescence of Slack, NaV1.2, NaV1.6 (green), and AnkG (red) in hippocampus CA1 (left) and neocortex (right). Confocal microscopy images were obtained from Coronal brain slices of C57BL/6 mice. The panels from top to bottom show the double staining of Slack with AnkG, NaV1.2 with AnkG, and NaV1.6 with AnkG, respectively. (B) Coimmunoprecipitation (Co-IP) of Slack and NaV1.6 in cell lysates from HEK293T cells co-transfected with Slack and NaV1.6. (C) Co-IP of Slack and NaV1.6 in mouse brain tissue lysates. Input volume corresponds to 10% of the total lysates for Co-IP. (D) A schematic diagram showing the fluorescence-labeled Slack and NaV1.6. mTFP1 and mVenus were fused to the C-terminal region of Slack (Slack-mTFP1) and NaV1.6 (NaV1.6-mVenus), respectively. (E) FRET imaging of Slack-mTFP1 and NaV1.6-mVenus co-expressed in HEK293 cells. The emission spectra measured from the edge of cell (dotted arrows in red) are used for FRET efficiency calculation. (F) The apparent FRET efficiency measured from cells co-expressing the fluorophore-tagged ion channels or co-expressing the fluorophores. **** p < 0.0001, Mann-Whitney test. (G-H) The FRET efficiency measured from cells co-expressing the fluorophore-tagged ion channels (G), or from cells co-expressing fluorophores (H). The efficiency value was plotted as a function of the fluorescence intensity ratio between mTFP1 and mVenus (Fc/Fy). Each symbol represents a single cell. The solid curve represents the FRET model that yields the best fit; dotted curves represent models with 5% higher or lower FRET efficiencies.

NaV1.6’s N- and C-termini interacting with Slack is a prerequisite for NaV1.6-mediated sensitization of Slack to quinidine blockade.

(A) The sensitivity of Slack to quinidine blockade upon expression of Slack alone (n = 3) and co-expression of Slack with NaV1.6 (n = 3) from excised inside-out patches. The pipette solution contained (in mM) 130 KCl, 1 EDTA, 10 HEPES and 2 MgCl2 (pH 7.3); the bath solution contained (in mM) 140 NaCl, 1 EDTA, 10 HEPES and 2 MgCl2 (pH 7.4). The membrane voltage was held at 0 mV and stepped to voltages varying from −100 mV to 0 mV in 10 mV increments. Example current traces were shown on the left panel. The concentration-response curves for blocking of Slack by quinidine were shown on the right panel. (B) Domain architecture of the human NaV channel pore-forming α subunit. Calculated IC50 values at +100 mV of quinidine on Slack upon co-expression with indicated cytoplasmic fragments from NaV channels. For NaV1.6, cytoplasmic fragments used include N-terminus (NaV1.6-N, residues 1-132), inter domain linkers (Domain I-II linker, residues 409-753; Domain II-III linker, residues 977-1199; Domain III-IV linker, residues 1461-1523), and C-terminus (NaV1.6-C, residues 1766-1980). For NaV1.5, cytoplasmic fragments used include N-terminus (NaV1.5-N, residues 1-131) and C-terminus (NaV1.5-C, residues 1772-2016). (D) Co-IP of Slack and terminal domains of NaV1.6 in cell lysates from HEK293T cells co-expressing 3×Flag-tagged Slack (Slack-3×Flag) and 3×HA-tagged termini of NaV1.6 (3×HA-NaV1.6-N or 3×HA-NaV1.6-C). The 3×Flag tag was fused to the C-terminal region of Slack and the 3×HA tag was fused to the N-terminal region of NaV1.6’s fragments. (E) The sensitivity of Slack to quinidine blockade upon co-expression of Slack with GFP (n = 12) or N- and C-termini of NaV1.6 (n = 11), from whole-cell recordings. (F) The sensitivity of Slack to quinidine blockade upon co-expression of Slack with N- and C-termini of NaV1.6, from excised inside-out recordings (n = 10, using the same protocols as in Fig. 4A). Example current traces before and after application of quinidine were shown on the left panel. The concentration-response curves were shown on the right panel. (G) A schematic diagram of the NaV1.5-1.6 chimeric channels (NaV1.5/6NC and NaV1.5/6N) used in this study. (H) Example current traces recorded from HEK293 cells co-expressing Slack and NaV1.5-1.6 chimeras before and after application of the indicated concentration of quinidine. (I) The concentration-response curves for blocking of Slack by quinidine upon co-expression of Slack with NaV1.5 (n = 9), NaV1.6 (n = 19), NaV1.5/6NC (n = 9), or NaV1.5/6N (n = 9).

Slack’s C-terminus is required for NaV1.6-mediated sensitization of Slack to quinidine blockade.

(A) Domain architecture of the human Slack channel subunit. Slack’s N-terminus (Slack-N, residues 1-116) and C-terminus (Slack-C, residues 345-1235) were shown in the blue boxes. (B) The concentration-response curves for blocking of Slack by quinidine upon additional expression of Slack’s N- or C-terminus in HEK293T cells co-expressing Slack and NaV1.5/6NC. (C) The concentration-response curves for blocking Slack by quinidine upon additional expression of Slack’s C-terminus in HEK293 cells co-expressing Slack and NaV1.6. (C) Co-IP of Myc-tagged Slack’s C-terminus (Slack-C-Myc) with 3×HA-tagged NaV1.6’s termini (3×HA-NaV1.6-N or 3×HA-NaV1.6-C) in HEK293T cell lysates. The 3×HA tag was fused to the N-terminal region of NaV1.6’s fragments, and the Myc tag was fused to the C-terminal region of Slack’s fragment.

NaV1.6 sensitizes epilepsy-related Slack mutant variants to quinidine blockade.

(A) Co-IP of 3×Flag-tagged Slack or its mutations (Slack-3×Flag) with 3×HA-tagged NaV1.6 (NaV1.6-3×HA) in HEK293T cell lysates. The tags were all fused to the C-terminal region of wild-type or mutant ion channels. (B-D) The sensitivity of Slack mutant variants (SlackK629N [B], SlackR950Q [C], and SlackK985N [D]) to quinidine blockade upon expression of Slack mutant variants alone and co-expression of Slack mutant variants with NaV1.6. Left, example current traces recorded from HEK293 cells expressing Slack mutant variants alone and co-expressing Slack mutant variants with NaV1.6, before and after application of the indicated concentrations of quinidine. Right, the concentration-response curves for blocking of Slack mutant variants by quinidine upon expression of Slack mutant variants alone (n = 8 for SlackK629N, n = 7 for SlackR950Q, and n = 5 for SlackK985N) and co-expression of Slack mutant variants with NaV1.6 (n = 8 for SlackK629N upon co-expression with NaV1.6, n = 5 for SlackR950Q upon co-expression with NaV1.6, and n = 7 for SlackK985N upon co-expression with NaV1.6). Please refer to Supplementary Table 4 for IC50 values.

Viral expression of Slack’s C-terminus prevents SlackG269S-induced seizures.

(A-B) The current densities of Slack mutant variants (SlackG288S [A] and SlackR398Q [B]) upon co-expression with NaV1.5/6NC in HEK293T cells were reduced by additional expression of Slack’s C-terminus. Left, example current traces from HEK293T cells co-expressing Slack mutant variants and NaV1.5/6NC or co-expressing Slack mutant variants, NaV1.5/6NC, and Slack’s C-terminus. Right, summarized current densities at +100 mV. * p < 0.05, ** p < 0.01, *** p < 0.001; one-way ANOVA followed by Bonferroni’s post hoc test. (C) Architecture for expression cassettes of AAVs. (D) Top, Immunofluorescence of HA-tagged SlackG269S (green), 3×Flag-tagged Slack’s C-terminus (red), and DAPI (blue) at 5 weeks after viral injection of SlackG269S with Slack’s C-terminus into CA1 of mice. Bottom, study design and timeline for the stereotactic injection model. (E) Time-course of KA-induced seizure stage changes at 10-min intervals based on a modified Racine, Pinal, and Rovner scale (please refer to Methods for further details). The number of mice used: “GFP” control group (n = 11), “SlackG269S+GFP” group (n = 12), “SlackG269S+Slack-C” group (n = 12). “GFP” vs. “SlackG269S+GFP”: F(1,21) = 10.48, p = 0.0040, * p < 0.05, ** p < 0.01; “SlackG269S+GFP” vs. “SlackG269S+Slack-C”: F(1,22) = 10.30, p = 0.0040, # p < 0.05, ## p < 0.01. “GFP” vs. “SlackG269S+Slack-C”: F(1,21) = 0.09574, p = 0.7600. Repeated two-way ANOVA followed by Bonferroni’s post hoc test. (F) Total seizure score per mouse over the 2 h after KA injection of these three groups. * p < 0.05, ** p < 0.01; one-way ANOVA followed by Bonferroni’s post hoc test. (G) The percentage of mice with stage VI∼IX seizures over the 2 h after KA injection in each group. * p < 0.05; Fisher’s exact test.