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Loss-of-function mutations in the cardiac Na +  channel α-subunit Na v 1.5, encoded by  SCN5A , cause Brugada syndrome (BrS), a hereditary disease characterized by sudden cardiac death due to ventricular fibrillation. We previously evidenced  in vitro  the dominant-negative effect of the BrS Na v 1.5-R104W variant, inducing retention of wild-type (WT) channels and leading to a drastic reduction of the resulting Na +  current ( I   Na  ). To explore this dominant-negative effect  in vivo , we created a murine model using adeno-associated viruses (AAVs).   Methods  Due to the large size of  SCN5A , a dual AAV vector strategy was used combining viral DNA recombination and  trans -splicing. Mice were injected with two AAV serotypes capsid 9: one packaging the cardiac specific troponin-T promoter, the 5′ half of  hSCN5A  cDNA, a splicing donor site and a recombinogenic sequence; and another packaging the complementary recombinogenic sequence, a splicing acceptor site, the 3′ half of  hSCN5A  cDNA fused to the  gfp  gene sequence, and the SV40 polyA signal. Eight weeks after AAV systemic injection in wild-type (WT) mice, echocardiography and ECG were recorded and mice were sacrificed. The full-length  hSCN5A-gfp  expression was assessed by western blot and immunohistochemistry in transduced heart tissues and the Na +  current was recorded by the patch-clamp technique in isolated adult GFP-expressing heart cells.    Results  Almost 75% of the cardiomyocytes were transduced in hearts of mice injected with hNa v 1.5 and ∼30% in hNa v 1.5-R104W overexpressing tissues. In ventricular mice cardiomyocytes expressing R104W mutant channels, the endogenous  I   Na   was significantly decreased. Moreover, overexpression of R104W channels in normal hearts led to a decrease of total Na v 1.5 expression. The R104W mutant also induced a slight dilatation of mice left ventricles and a prolongation of RR interval and P-wave duration in transduced mice. Altogether, our results demonstrated an  in vivo  dominant-negative effect of defective R104W channels on endogenous ones.    Conclusion  Using a  trans -splicing and viral DNA recombination strategy to overexpress the Na +  channel in mouse hearts allowed us to demonstrate  in vivo  the dominant-negative effect of a BrS variant identified in the N-terminus of Na v 1.5.

In vivo Dominant-Negative Effect of an SCN5A Brugada Syndrome Variant