Voltage-gated Na_v channel targeting in the heart requires an ankyrin-G-dependent cellular pathway

Voltage-gated Na_v channels are required for normal electrical activity in neurons, skeletal muscle, and cardiomyocytes. In the heart, Na _v1.5 is the predominant Na_v channel, and Na _v1.5-dependent activity regulates rapid upstroke of the cardiac action potential. Na_v1.5 activity requires precise localization at specialized cardiomyocyte membrane domains. However, the molecular mechanisms underlying Na_v channel trafficking in the heart are unknown. In this paper, we demonstrate that ankyrin-G is required for Na_v1.5 targeting in the heart. Cardiomyocytes with reduced ankyrin-G display reduced Na _v1.5 expression, abnormal Na v 1.5 membrane targeting, and reduced Na⁺ channel current density. We define the structural requirements on ankyrin-G for Na_v1.5 interactions and demonstrate that loss of Na_v1.5 targeting is caused by the loss of direct Na _v1.5-ankyrin-G interaction. These data are the first report of a cellular pathway required for Na_v channel trafficking in the heart and suggest that ankyrin-G is critical for cardiac depolarization and Na _v channel organization in multiple excitable tissues.