Unique cardiac Purkinje fiber transient outward current β-subunit composition: a potential molecular link to idiopathic ventricular fibrillation

Circ Res. 2013 May 10;112(10):1310-22. doi: 10.1161/CIRCRESAHA.112.300227. Epub 2013 Mar 26.


Rationale: A chromosomal haplotype producing cardiac overexpression of dipeptidyl peptidase-like protein-6 (DPP6) causes familial idiopathic ventricular fibrillation. The molecular basis of transient outward current (I(to)) in Purkinje fibers (PFs) is poorly understood. We hypothesized that DPP6 contributes to PF I(to) and that its overexpression might specifically alter PF I(to) properties and repolarization.

Objective: To assess the potential role of DPP6 in PF I(to).

Methods and results: Clinical data in 5 idiopathic ventricular fibrillation patients suggested arrhythmia origin in the PF-conducting system. PF and ventricular muscle I(to) had similar density, but PF I(to) differed from ventricular muscle in having tetraethylammonium sensitivity and slower recovery. DPP6 overexpression significantly increased, whereas DPP6 knockdown reduced, I(to) density and tetraethylammonium sensitivity in canine PF but not in ventricular muscle cells. The K(+)-channel interacting β-subunit K(+)-channel interacting protein type-2, essential for normal expression of I(to) in ventricular muscle, was weakly expressed in human PFs, whereas DPP6 and frequenin (neuronal calcium sensor-1) were enriched. Heterologous expression of Kv4.3 in Chinese hamster ovary cells produced small I(to); I(to) amplitude was greatly enhanced by coexpression with K(+)-channel interacting protein type-2 or DPP6. Coexpression of DPP6 with Kv4.3 and K(+)-channel interacting protein type-2 failed to alter I(to) compared with Kv4.3/K(+)-channel interacting protein type-2 alone, but DPP6 expression with Kv4.3 and neuronal calcium sensor-1 (to mimic PF I(to) composition) greatly enhanced I(to) compared with Kv4.3/neuronal calcium sensor-1 and recapitulated characteristic PF kinetic/pharmacological properties. A mathematical model of cardiac PF action potentials showed that I(to) enhancement can greatly accelerate PF repolarization.

Conclusions: These results point to a previously unknown central role of DPP6 in PF I(to), with DPP6 gain of function selectively enhancing PF current, and suggest that a DPP6-mediated PF early-repolarization syndrome might be a novel molecular paradigm for some forms of idiopathic ventricular fibrillation.

Keywords: ECG; cardiac arrhythmia mechanisms; genetic arrhythmia syndromes; molecular electrophysiology; potassium channels; sudden death; ventricular tachycardia arrhythmia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Animals
  • CHO Cells
  • Cells, Cultured
  • Cricetinae
  • Cricetulus
  • Dipeptidyl-Peptidases and Tripeptidyl-Peptidases / genetics
  • Dipeptidyl-Peptidases and Tripeptidyl-Peptidases / physiology*
  • Disease Models, Animal
  • Dogs
  • Female
  • Gene Knockdown Techniques
  • Heart Ventricles / pathology
  • Heart Ventricles / physiopathology
  • Humans
  • In Vitro Techniques
  • Kv Channel-Interacting Proteins / drug effects
  • Kv Channel-Interacting Proteins / genetics
  • Kv Channel-Interacting Proteins / physiology*
  • Male
  • Middle Aged
  • Models, Theoretical
  • Nerve Tissue Proteins / genetics
  • Nerve Tissue Proteins / physiology*
  • Patch-Clamp Techniques
  • Potassium Channel Blockers / pharmacology
  • Potassium Channels / drug effects
  • Potassium Channels / genetics
  • Potassium Channels / physiology*
  • Purkinje Fibers / pathology
  • Purkinje Fibers / physiology*
  • Shal Potassium Channels / drug effects
  • Shal Potassium Channels / genetics
  • Shal Potassium Channels / physiology*
  • Tetraethylammonium / pharmacology
  • Transfection
  • Ventricular Fibrillation / physiopathology*


  • Kv Channel-Interacting Proteins
  • Nerve Tissue Proteins
  • Potassium Channel Blockers
  • Potassium Channels
  • Shal Potassium Channels
  • Tetraethylammonium
  • DPP6 protein, human
  • Dipeptidyl-Peptidases and Tripeptidyl-Peptidases

Supplementary concepts

  • Paroxysmal ventricular fibrillation