Human ether-a-go-go-related gene (HERG) potassium channels constitute a potential target involved in cardiotoxic side effects of amino-amide local anesthetics. The molecular interaction site of these low-affinity blockers with HERG channels is currently unknown. The aim of this study was to determine the effect of the mutations Y652A and F656A in the putative drug binding region of HERG on the inhibition by bupivacaine, ropivacaine, and mepivacaine.


The authors examined the inhibition of wild-type and mutant HERG channels, transiently expressed in Chinese hamster ovary cells by bupivacaine, ropivacaine, and mepivacaine. Whole cell patch clamp recordings were performed at room temperature.


Inhibition of HERG wild-type and mutant channels by the different local anesthetics was concentration dependent, stereoselective, and reversible. The sensitivity decreased in the order bupivacaine > ropivacaine > mepivacaine for wild-type and mutant channels. The mutant channels were approximately 4-30 times less sensitive to the inhibitory action of the different local anesthetics than the wild-type channel. The concentration-response data were described by Hill functions (bupivacaine: wild-type IC50 = 22 +/- 2 microm, n = 38; Y652A IC50 = 95 +/- 5 microm, n = 31). The mutations resulted in a change of the stereoselectivity of HERG channel block by ropivacaine. The potency of the local anesthetics to inhibit wild-type and mutant channels correlated with the lipophilicity of the drug (r > 0.9).


These results indicate that local anesthetics specifically but not exclusively interact with the aromatic residues Y652 and F656 in S6 of HERG channels.

HUMAN ether-a-go-go –related gene (HERG) codes for the pore-forming component of the rapid delayed rectifier channel (IKr) in the heart.1HERG channels constitute toxicologically relevant targets for many structurally and functionally unrelated substances, such as antiarrhythmic drugs,2,3antihistamines,4,5psychoactive drugs,6gastrointestinal prokinetic agents,7,8macrolide antibiotics,9and local anesthetics.10–12Pharmacologic inhibition of IKrmay cause drug-induced long QT syndrome, severe ventricular arrhythmia, and sudden cardiac death.

HERG channels lack the Pro-Val-Pro motif conserved in other Kv channels that is supposed to produce a kink in the S6 helix.13This results in a larger pore-forming cavity of HERG channels, allowing preferential trapping of many structurally unrelated drugs.14A scanning analysis of the S6 transmembrane domain of the channel identified two aromatic amino acids that are important for high-affinity drug binding to HERG: tyrosine 652 and phenylalanine 656.2Mutating these residues to alanine increases the IC50value of MK-499, terfenadine, and cisapride between 100- and 650-fold.2All high-affinity blockers (IC50values within the nanomolar range) tested are suggested to bind to this region of the channel2,15by hydrophobic interaction with Phe656 and π-cation interaction or π-stacking with Tyr652.16 

The situation is different for low-affinity blockers (IC50values within the micromolar range) of HERG channels. Mutating either of the aromatic amino acids to alanine has severe effects on the inhibition by some compounds, such as vesnarinone and quinidine,17–19but not by others, such as the selective serotonin reuptake inhibitor fluvoxamine20and the antiparkinsonian drug budipine.21Different structural requirements have therefore been suggested to mediate low-affinity block of HERG channels.22 

Based on their IC50values, amino-amide local anesthetics have to be regarded as low-affinity blockers of HERG channels10–12with a so far unknown molecular site of interaction. These local anesthetics differ by the length of their N-substituent, which is a butyl group (bupivacaine), a propyl group (ropivacaine), or a methyl group (mepivacaine). The length of the substituent determines the lipophilicity and may thus be a structural requirement for hydrophobic interactions between the drug and the channel protein. It was shown before that the length of the N-substituent influences the potency of local anesthetics to block Kv1.5 channels23and HERG channels.11If amino-amide local anesthetics were to interact with the aromatic amino acids in the S6 region, the potency to inhibit HERG channels would be expected to correlate with the lipophilic properties of the drugs. Point mutations of these aromatic amino acids may furthermore be expected to alter the relation between inhibitory potency and lipophilic drug properties. Inhibition of HERG channels by amino-amide local anesthetics is also stereoselective.11,12If local anesthetics were to interact with the aromatic amino acids Y652 and F656, mutating these amino acids might also alter stereoselectivity of local anesthetic inhibition.

Therefore, the aim of this study was to clarify whether inhibition of HERG wild-type (wt) and mutant channels is related to the lipophilic properties of bupivacaine, ropivacaine, and mepivacaine. It was furthermore intended to establish whether and to what extent the aromatic amino acids Y652 and F656 in the S6 region influence drug affinity and stereoselective local anesthetic inhibition. As a prerequisite to these experiments, the gating changes induced by mutating these residues2needed to be characterized first. The results of this study may help to identify structural requirements for low-affinity block of HERG channels by amino-amide local anesthetics.

Cell Culture

Chinese hamster ovary cells were cultured in 50 ml-flasks (NUNC, Roskilde, Denmark) at 37°C in MEM Alpha medium (GIBCO; Invitrogen, Carlsbad, CA) with 10% fetal calf serum, 100 U/ml penicillin, and 100 mg/ml streptomycin in a humidified atmosphere (5% CO2). Cells were subcultured in 35-mm diameter monodishes (NUNC) at least 1 day before transfection.

Molecular Biology and Transfection of Cells

The mutants HERG Y652A and F656A were created by site-directed mutagenesis. All channels were cloned in the pcDNA3 expression vector. Chinese hamster ovary cells were transiently transfected with 1 μg HERG wt or mutant cDNA, 0.5 μg EFGP cDNA, and 3 μl lipofectamine reagent (Invitrogen) per dish according to the manufacturer’s protocol after 1 day. Cells were cotransfected with an EGFP pcDNA3 construct to verify successful transfection. Only green fluorescing cells were used for patch clamp experiments. Patch clamp experiments were performed 1 or 2 days after transfection.


Whole cell currents were recorded using the patch clamp technique24with an EPC-9 amplifier and Pulse software version 8.50 (HEKA Electronik, Lambrecht, Germany). Patch electrodes were pulled from borosilicate glass capillary tube (World Precision Instruments, Saratoga, FL) on a horizontal puller (P-97; Sutter Instrument Co., Novato, CA) and had a pipette resistance of 1.5–3.5 MΩ. The internal solution contained 160 mm KCl, 0.5 mm MgCl2, 10 mm HEPES, and 2 mm Na-ATP (all from Sigma, Deissenhofen, Germany), adjusted to a pH of 7.2 with KOH. The external solution contained 135 mm NaCl, 5 mm KCl, 2 mm CaCl2, 2 mm MgCl2, 5 mm HEPES, 10 mm sucrose, and 0.1 mg/ml phenol red (all from Sigma), adjusted to a pH of 7.4 with NaOH. To record inward tail currents of HERG channels, an extracellular solution with high [K+] was used, containing 40 mm NaCl, 100 mm KCl, 2 mm CaCl2, 2 mm MgCl2, 5 mm HEPES, 10 mm sucrose, and 0.1 mg/ml phenol red, adjusted to a pH of 7.4 with NaOH.

Series resistance was 2.5–6.0 MΩ and was actively compensated for by 85%. A leak subtraction protocol was used except for recordings with high extracellular [K+] ([K+]o). The recorded signal was filtered at 2 kHz and stored with a sampling rate of 5 kHz for analysis. Bupivacaine (Sigma), levobupivacaine, S  (−)-ropivacaine, R  (+)-ropivacaine, and mepivacaine (all from AstraZeneca, Södertalje, Sweden) were dissolved in the extracellular solution. A hydrostatically driven perfusion system was used to apply the drugs onto the cells and to exchange the extracellular solutions. All experiments were performed at room temperature.

Different pulse protocols were used for characterization of the channels and to establish their pharmacologic sensitivities. The holding potential was −80 mV for all experiments. For the activation protocol, cells were depolarized from −80 to +60 mV in 10-mV steps for 1 s, and tail currents were recorded at −40 mV. In high [K+]o, the tail potential was changed to −120 mV. To analyze the deactivation, channels were activated by a 2-s pulse to +60 mV, and deactivating tail currents were recorded at potentials from −120 to +40 mV in 10-mV steps. The same protocol was used in high [K+]o. To compare the three channels, currents were normalized to the minimum. The deactivation was fitted with an exponential function that yielded two time constants. For the steady state inactivation, a three-step protocol was used: First, the cells were depolarized for 2 s from −80 to +40 mV; then, a pulse from −100 to +60 mV in 10-mV steps was applied for 30 ms; and finally, the membrane potential was held at +40 mV for 0.5 s. The inactivation was corrected for the closing during the hyperpolarizing step at very negative potentials as described previously.25The corrected curves were fitted by a Boltzmann function. During the instantaneous activation protocol channels were activated and inactivated by depolarization from a holding potential of −80 to +20 mV for 2 s. After recovery from inactivation by repolarization to −80 mV for 30 ms, the instantaneous current was recorded at potentials from +40 mV to −120 mV in 10-mV steps. The time constants of inactivation were derived from a monoexponential fit of the decay. This protocol was also used for pharmacologic experiments. For this purpose, the total length of the protocol was reduced, and the potential was increased in 30-mV steps from −120 to +60 mV.

For the pharmacologic experiments with HERG wt and Y652A, a ramp protocol was used.12,26Cells were depolarized from a holding potential of −80 mV to +60 mV and repolarized to −80 mV within 1 s. In high [K+]o, a single pulse to +20 mV for 2 s and a tail potential of −120 mV was used for the pharmacologic tests. Repetitive pulses were applied to determine that steady state inhibition was reached.

Data Analysis

Data were analyzed with Pulse Fit software (HEKA Electronik) and with Kaleidagraph software (Synergy Software, Reading, PA). The normalized tail currents during the activation protocol were fitted by a modified Boltzmann equation: I = Imax/[1 + exp((V0.5− Vm)/k)], where V0.5is the voltage of half-maximal activation, Vmis the membrane potential, and k  is the slope factor. The exponential decay of deactivation or inactivation was fitted with one or two time constants according to the following equation: y = C + Afastexp(−t/τfast) + Aslowexp(t/τslow), with the time constants τfastand τslowand the amplitudes Afastand Aslow. The inhibition of currents was quantified by the reduction of the maximal current during the ramp protocol or during a single pulse in case of the high-[K+]oexperiments. Also, the charge crossing the membrane during the ramp protocol (Qramp) and the reduction of Qrampwere analyzed. The charge crossing the membrane is equivalent to the time integrals of current traces and was determined using Pulse Fit software. The fractional block f was calculated by the following formula: f = 1 −[2 × Imax, drug/(Imax, control+ Imax, washout)]. Concentration–response curves were fitted by a Hill function: f = 1/[1 + (IC50/c)h], where IC50is the concentration of half-maximal inhibition, c is the concentration of the local anesthetic, and h is the Hill coefficient. Statistical significance was tested using a two-sided Student t  test or analysis of variance (Excel; Microsoft, Redmond, WA). Data are presented as mean ± SD unless stated otherwise; n values indicate the number of experiments.

Properties of HERG wt, HERG Y652A, and HERG F656A

Representative current traces of HERG wt and HERG Y652A elicited by the activation protocol are shown in figure 1A. The voltage dependence of activation of HERG Y652A channels was not significantly different from wt channels (fig. 1B; wt: voltage of half-maximal activation V0.5= 4.85 ± 4.23 mV, slope = 8.51 ± 0.83 mV, n = 6; Y652A: V0.5= 5.35 ± 4.31 mV, slope = 8.79 ± 1.27 mV, n = 12). Also, the time constants of activation did not differ between wt and mutant channels. However, the decay of HERG Y652A currents was faster than that of HERG wt currents (exponential fit of the decay after activation to 50 mV, wt: τ= 1.42 ± 0.5 s; Y652A: τ= 0.86 ± 0.3 s; P < 0.01). Figure 1Cshows exemplary current traces obtained by the deactivation protocol. Both HERG wt and HERG Y652A currents exhibited inward rectification with no difference in the voltage dependence of deactivation (fig. 1D). The steady state inactivation was analyzed next (fig. 2A). The voltage dependence of HERG Y652A current inactivation was shifted to more positive potentials compared with HERG wt (fig. 2B; V0.5=−36.2 ± 10.6 mV, n = 6 for Y652A versus  V0.5=−69.6 ± 7.8 mV, n = 7 for wt; P < 0.05). Instantaneous currents inactivated in a voltage-dependent manner (fig. 2C) with time constants that were smaller for HERG Y652A than for wt channels (fig. 2D; n = 4 each, P < 0.05).

HERG F656A channels only conducted very small currents under low extracellular [K+].2Inward currents of this mutation were therefore recorded using high extracellular [K+].20To compare all three channels, HERG wt and HERG Y652A currents were recorded under these conditions as well (fig. 3). Tail current densities at −120 mV under high extracellular [K+] were 968 ± 475 pA/pF for HERG wt, 571 ± 272 pA/pF for HERG Y652A, and 129 ± 49 pA/pF for HERG F656A channels, respectively (n = 5 for each). Only the difference between HERG F656A and HERG wt was significant. Exemplary current traces evoked by the activation protocol in high [K+]oare shown in figure 3A. Voltage dependence of activation did not differ between HERG wt and HERG Y652A currents, whereas HERG F656A channels activated with a V0.5shifted by 10 mV to more negative potentials (fig. 3B). Figure 3Cshows deactivating currents of all three channels. HERG F656A hyperpolarized the voltage dependence of deactivation (fig. 3D) and slowed the deactivation kinetics, whereas deactivation kinetics were accelerated by HERG Y652A (fig. 3D, inset). The differences between HERG wt and the mutant channels were significantly different (confirmed by analysis of variance).

Local Anesthetic Sensitivity of HERG wt and HERG Y652A

The inhibitory effects of the local anesthetics bupivacaine, levobupivacaine, ropivacaine, and mepivacaine on HERG wt and HERG Y652A currents were investigated using the ramp protocol. This protocol evoked bell-shaped currents (fig. 4A). The mean time to peak current was 723 ± 10 ms for HERG wt (n = 116) and 615 ± 12 ms for HERG Y652A (n = 91). These values correspond to voltages of −40 ± 1 mV (HERG wt) and −26 ± 2 mV (HERG Y652A), respectively. All local anesthetics reduced HERG wt and HERG Y652A currents in a concentration-dependent and reversible manner (figs. 4B–F). The inhibition was quantified as the decrease of the maximum current as well as the reduction of the charge. The concentration–response data were mathematically described by Hill functions (figs. 5A and Band table 1). The concentration of half-maximal inhibition (IC50) by the local anesthetics was between 4 and 10 times higher for HERG Y652A compared with the wt channel. The Hill coefficients were close to unity for inhibition of both channels by all local anesthetics. Application of local anesthetics furthermore caused a concentration-dependent and reversible rightward shift of the peak HERG wt current and therefore increased the time to peak current response (figs. 4B–F). In contrast, the application of the local anesthetics caused a concentration-dependent and reversible leftward shift of the peak HERG Y652A current and therefore decreased the time to peak current response. Because of the reduced sensitivity of HERG Y652A, the shift is also more pronounced at higher concentrations of local anesthetics. For example, 30 μm bupivacaine caused a shift of the time to peak HERG wt current response of +62 ± 10 ms (n = 9), and 100 μm bupivacaine caused a shift of +90 ± 27 ms (n = 5), corresponding to shifts in voltage of +9 ± 1 and +13 ± 4 mV, respectively. For HERG Y652A, 100 μm bupivacaine caused a shift of the time to peak current of −37 ± 17 ms (n = 9), and 300 μm bupivacaine caused a shift of −71 ± 18 ms (n = 9). These values correspond to shifts in voltage of −5 ± 2 and −10 ± 2 mV, respectively. For both HERG wt and HERG Y652A, the IC50values of the local anesthetics increased in the order levobupivacaine < bupivacaine < ropivacaine < mepivacaine.

The influence of the mutation Y652A on stereoselective inhibition of HERG currents was further analyzed. The wt channel was twice as sensitive to levobupivacaine than to bupivacaine (IC5012.7 ± 1.4 vs.  21.9 ± 1.6 μm; table 1), whereas the ratio of IC50values of both drugs approximated unity for the mutant channel HERG Y652A (IC5082.9 ± 3.2 vs.  95.2 ± 5.0 μm; table 1). For ropivacaine, the influence of HERG Y652A on stereoselective inhibition was even more pronounced (compare figs. 4D and E). S  (−)-ropivacaine was a more potent inhibitor of HERG wt currents than R  (+)-ropivacaine (25 μm: 53 ± 5%, n = 8 vs.  28 ± 2%, n = 5; P < 0.05; 83 μm: 79 ± 4%, n = 8 vs.  60 ± 4%, n = 5; P < 0.05), whereas R  (+)-ropivacaine was a more potent inhibitor of HERG Y652A currents than S  (−)-ropivacaine (83 μm: 41 ± 3%, n = 7 vs.  27 ± 2%, n = 7; P < 0.05; 250 μm: 63 ± 3%, n = 7 vs.  49 ± 3%, n = 7; P < 0.05).

The inhibition of HERG wt and HERG Y652A channels by bupivacaine was further analyzed by applying an instantaneous current protocol (fig. 6; see Materials and Methods section). Bupivacaine inhibited Imaxof both channels (fig. 7) in a voltage-independent manner (fig. 7A). The local anesthetic significantly altered the voltage dependence and the size of the inactivation time constants of HERG wt but not of HERG Y652A channels (fig. 7B; tested by analysis of variance). The time courses of deactivating currents (−120 mV) of both HERG wt and HERG Y652A were slowed by bupivacaine (HERG wt: τdeact, fast= 18.98 ± 4.31 ms, τdeact, slow= 179.3 ± 44.9 ms under control and washout conditions; τdeact, fast= 27.14 ± 5.89 ms, τdeact, slow= 259.6 ± 63.3 ms under 20 mm bupivacaine; n = 5, paired experiments, P < 0.05; HERG Y652A: τdeact, fast= 12.13 ± 2.50 ms, τdeact, slow= 59.57 ± 21.37 ms under control and washout conditions; τdeact, fast= 13.28 ± 2.12 ms, τdeact, slow= 90.71 ± 27.66 ms under 90 μm bupivacaine; n = 5, paired experiments, P < 0.01).

Local Anesthetic Sensitivity of HERG F656A

To meaningfully compare the pharmacologic sensitivities between all three channels, bupivacaine effects on HERG wt and HERG Y652A channels were in addition established under high extracellular [K+]. Bupivacaine (100 μm) inhibited wt currents by 66 ± 5% (n = 5). Both mutants reduced the sensitivity (figs. 8A and B), with HERG F656A currents being less sensitive than HERG Y652A (32 ± 4% for Y652A, n = 5; 17 ± 6% for F656A, n = 5; P < 0.01). Because of the low sensitivity of HERG F656A channels, it was not possible to determine whole concentration–response curves for the different local anesthetics. Instead, local anesthetic sensitivity was compared at a concentration of 1 mm. HERG F656A channels exhibited the same order of decreasing pharmacologic sensitivity as HERG wt (fig. 8C). However, HERG wt currents were inhibited more potently by S  (−)-ropivacaine than by R  (+)-ropivacaine, whereas HERG F656A currents were inhibited more potently by R  (+)-ropivacaine than by S  (−)-ropivacaine (R-ropivacaine vs.  S-ropivacaine: 74 ± 2% vs.  84 ± 1%, n = 5, paired experiments, P < 0.01 for wt; 43 ± 5% vs.  31 ± 5%, n = 4, paired experiments, P < 0.05 for F656A). The time constants of deactivation in high extracellular [K+] and the effect of bupivacaine on deactivation (figs. 8D and E) revealed that high extracellular [K+] slows the deactivation kinetics of both HERG wt and HERG Y652A. However, deactivation of HERG channels is slowed by bupivacaine (100 μm) under normal as well as high extracellular [K+], whereas deactivation of HERG Y652A and HERG F656A follows a faster time course under the influence of bupivacaine (100 μm for HERG Y652A, 1 mm for HERG F656A) compared with drug-free conditions under high extracellular [K+].

In the current work, the effects of the mutations Y652A and F656A in the S6 region of HERG potassium channels2on the inhibition by amino-amide local anesthetics have been established. Mutating either of the aromatic residues diminished the block by these local anesthetics 4- to 10-fold (Y652A) and 20- to 30-fold (F656A), respectively. In accord with previous studies,2,16the voltage dependence of activation and deactivation remained unchanged by the mutation Y652A. However, the voltage dependence of steady state inactivation was shifted to more positive potentials, and the inactivation and deactivation time constants were significantly faster. This may explain the observation that the time to peak current was shorter for HERG Y652A than for HERG wt during the ramp protocol. The mutation F656A reduced the current density by approximately 90% compared with the wt channel. Furthermore, the voltage dependence of activation and deactivation were shifted to more negative potentials, and the deactivation kinetics were slowed.

The effects of bupivacaine, levobupivacaine, and ropivacaine but not of mepivacaine on HERG wt channels have been analyzed before.11However, instead of conventional stimulation protocols, we used a ramp protocol26to establish drug sensitivity of wt and mutant channels. Such a protocol has repeatedly been used to measure drug sensitivity of HERG channels.12,27,28This protocol yielded IC50values and Hill coefficients of bupivacaine, levobupivacaine, and ropivacaine that are nearly identical to those obtained with conventional pulse protocols.11Furthermore, the different current responses of HERG wt and HERG Y652A to the ramp protocol suggest that differences in channel gating between wt and mutant channels are elicited by the ramp protocol. The ramp protocol therefore allows comparing local anesthetic sensitivity of wt and mutated HERG channels. The effect of bupivacaine on these channels was in addition assessed with an instantaneous current protocol.25By this protocol, the effect of bupivacaine on channels in the open state, on channel deactivation, and on channel inactivation was studied. Bupivacaine increased the fast and slow time constants of deactivation in both HERG wt and HERG Y652A channels compatible with open channel block. Bupivacaine accelerated macroscopic current decline of wt but not of HERG Y652A channels. Because inactivation of HERG Y652A under drug-free conditions is already faster than macroscopic current decline of HERG wt channels under drug conditions, the time constants of current decline of HERG Y652A under drug conditions likely reflect channel inactivation rather than drug–channel interaction. The already accelerated inactivation time constant of HERG Y652A channels under control conditions may therefore have precluded resolving the time course of the bupivacaine effect. The extent of inhibition of the instantaneous peak current response of HERG wt and HERG Y652A was identical to the extent of inhibition predicted from the respective concentration–response curves obtained with the ramp protocol. Taken together, these results may suggest that ramp current inhibition mainly reflects open channel inhibition. This idea is supported by the experiments with high extracellular [K+]. Inhibition of HERG wt as well as HERG Y652 is reduced by the presence of high extracellular [K+]. This has previously been described for the open channel blocker E-4031.29It may therefore be hypothesized that interaction with the open channel pore constitutes an important mechanism contributing to local anesthetic inhibition of wt11as well as mutated HERG channels.

The results of our study demonstrate that the mutations in the S6 segment are not conservative with regard to ion channel gating. Therefore, it cannot entirely be ruled out that differences in channel gating induced by the mutations Y652A and F656A may have influenced local anesthetic affinity. Mutations that disable inactivation (G628C-S631C) or selective inhibition of HERG channel inactivation by addition of Cd2+ions or removal of Na+ions reduce block by D-sotalol.30Removal of C-type inactivation reduces bupivacaine sensitivity and confers voltage dependence to the inhibition of HERG channels.10However, as judged from the results obtained with the instantaneous current protocol, voltage dependence of inhibition does not differ between HERG wt and HERG Y652A. Also, inhibition of both channels HERG wt and HERG Y652A was reduced by increasing the concentration of extracellular [K+]. Both results point to a common inhibitory mechanism. In addition, the inhibitory potency of the local anesthetics significantly correlated with the number of the CH2groups of the local anesthetics for HERG wt (figs. 9A and B), HERG Y652A (fig. 9A), and HERG F656A (fig. 9B). The correlations had similar slope factors. If the quantitatively and qualitatively different changes in channel gating were to play a fundamental role in reducing local anesthetic affinity, a conserved response to extracellular [K+] as well as a conserved relation between physicochemical properties of the drugs and blocking affinity would be unlikely. The conserved relation between physicochemical properties of the drugs and blocking affinity would furthermore point to a nonspecific membrane-mediated effect underlying inhibition by the local anesthetics.31,32As an alternative, it may be hypothesized that hydrophobic interactions occurring at a site different from the inner S6 cavity22are crucial for local anesthetic interaction. Both alternatives seem less likely.

HERG wt channels were inhibited more potently by the S  (−)-enantiomer than by the R  (+)-enantiomer of ropivacaine. Mutating the aromatic amino acids Tyr652 or Phe656 to alanine reversed the stereoselectivity of ropivacaine block. This change in the stereoselectivity of block suggests a direct interaction of the drug molecules with the residues Tyr652 and Phe656 rather than a membrane-mediated effect. The aromatic residues in the S6 region of HERG channels are therefore likely to be involved in the interaction with the local anesthetics investigated. Kv channels exhibit a reversed local anesthetic stereoselectivity23,33compared with HERG channels, with the R  (+)-enantiomer being more potent than the S  (−)-enantiomer. Exchanging either of the aromatic residues in the S6 of HERG for alanine results in a pattern of stereoselective inhibition resembling that of Kv channels. These results indicate that both aromatic amino acids are necessary for the pattern of stereoselective inhibition by local anesthetics specific for HERG channels. The conserved correlation of inhibitory potency and lipophilic properties of the drugs, however, suggests that additional hydrophobic amino acids residing in the inner cavity of HERG channels16may be involved in local anesthetic action.

Our results demonstrate that local anesthetic affinity of HERG channels is determined by the lipophilic properties of the drugs. The longer the alkyl side chain is, the more potent the drug is. Also, the orientation of the local anesthetic molecule influences drug affinity of HERG channels, with the S  (−)-isomer being more potent than the R  (+)-isomer. HERG channels constitute well-established, toxicologically relevant targets for many structurally and functionally unrelated substances, including local anesthetics.2,10–12Inadvertent intravascular injection of amino-amide local anesthetics, such as those investigated in this study, are capable of inducing severe ventricular arrhythmia and sudden death.34,35On the other hand, modest inhibition of HERG channels may result in class III antiarrhythmic action.3Like the class III antiarrhythmic agent sotalol30and other proarrhythmic drugs,36local anesthetics may therefore exhibit antiarrhythmic action at lower concentrations and cardiotoxic side effects at higher concentrations. It may be worth considering that because of the specific structure of HERG channels, both antiarrhythmic as well as proarrhythmic action may increase with the lipophilicity of amino-amide local anesthetics and may be more pronounced for the S  (−)-enantiomers.

In summary, our results suggest that local anesthetics interact with the inner cavity of the HERG channel pore. Interaction may involve the aromatic residues Tyr652 and Phe656. However, the correlation between the lipophilic properties of the drugs and inhibitory potency remains unaltered by the mutations Y652A and F656A. Additional hydrophobic domains of the channel contributing to local anesthetic interaction with HERG channels thus remain to be identified.

The authors thank Olaf Pongs, Ph.D. (Director of the Institute of Neural Signal Transduction, University Medical Center Hamburg-Eppendorf, Germany), for his generous support; Andrea Zaisser (Medicinal Technical Assistant, Institute for Neural Signal Transduction, University Medical Center Hamburg-Eppendorf, Germany) for technical assistance; and Anna Solth, M.Sc., and Axel Neu, M.D. (Research Fellows, Institute for Neural Signal Transduction, University Medical Center Hamburg-Eppendorf, Germany), for critically reading the manuscript.

Sanguinetti MC, Jiang C, Curran ME, Keating MT: A mechanistic link between an inherited and an acquired cardiac arrhythmia:HERG encodes the IKr potassium channel. Cell 1995; 81:299–307
Mitcheson JS, Chen J, Lin M, Culberson C, Sanguinetti MC: A structural basis for drug-induced long QT syndrome. Proc Natl Acad Sci U S A 2000; 97:12329–33
Spector PS, Curran ME, Keating MT, Sanguinetti MC: Class III antiarrhythmic drugs block HERG, a human cardiac delayed rectifier K+ channel: Open-channel block by methanesulfonanilides. Circ Res 1996; 78:499–503
Suessbrich H, Waldegger S, Lang F, Busch AE: Blockade of HERG channels expressed in Xenopus oocytes by the histamine receptor antagonists terfenadine and astemizole. FEBS Lett 1996; 385:77–80
Roy M, Dumaine R, Brown AM: HERG, a primary human ventricular target of the nonsedating antihistamine terfenadine. Circulation 1996; 94:817–23
Rampe D, Murawsky MK, Grau J, Lewis EW: The antipsychotic agent sertindole is a high affinity antagonist of the human cardiac potassium channel HERG. J Pharmacol Exp Ther 1998; 286:788–93
Rampe D, Roy ML, Dennis A, Brown AM: A mechanism for the proarrhythmic effects of cisapride (Propulsid): High affinity blockade of the human cardiac potassium channel HERG. FEBS Lett 1997; 417:28–32
Walker BD, Singleton CB, Bursill JA, Wyse KR, Valenzuela SM, Qiu MR, Breit SN, Campbell TJ: Inhibition of the human ether-a-go-go-related gene (HERG) potassium channel by cisapride: Affinity for open and inactivated states. Br J Pharmacol 1999; 128:444–50
Stanat SJ, Carlton CG, Crumb Jr, WJ Agrawal, KC, Clarkson CW: Characterization of the inhibitory effects of erythromycin and clarithromycin on the HERG potassium channel. Mol Cell Biochem 2003; 254:1–7
Lipka LJ, Jiang M, Tseng GN: Differential effects of bupivacaine on cardiac K channels: Role of channel inactivation and subunit composition in drug-channel interaction. J Cardiovasc Electrophysiol 1998; 9:727–42
Gonzalez T, Arias C, Caballero R, Moreno I, Delpon E, Tamargo J, Valenzuela C: Effects of levobupivacaine, ropivacaine and bupivacaine on HERG channels: Stereoselective bupivacaine block. Br J Pharmacol 2002; 137:1269–79
Friederich P, Solth A, Schillemeit S, Isbrandt D: Local anaesthetic sensitivities of cloned HERG channels from human heart: comparison with HERG/MiRP1 and HERG/MiRP1 T8A. Br J Anaesth 2004; 92:93–101
del Camino D, Holmgren M, Liu Y, Yellen G: Blocker protection in the pore of a voltage-gated K+ channel and its structural implications. Nature 2000; 403:321–5
Mitcheson JS, Chen J, Sanguinetti MC: Trapping of a methanesulfonanilide by closure of the HERG potassium channel activation gate. J Gen Physiol 2000; 115:229–40
Lees-Miller JP, Duan Y, Teng GQ, Duff HJ: Molecular determinant of high-affinity dofetilide binding to HERG1 expressed in Xenopus oocytes: Involvement of S6 sites. Mol Pharmacol 2000; 57:367–74
Fernandez D, Ghanta A, Kauffman GW, Sanguinetti MC: Physicochemical features of the HERG channel drug binding site. J Biol Chem 2004; 279:10120–7
Kamiya K, Mitcheson JS, Yasui K, Kodama I, Sanguinetti MC: Open channel block of HERG K(+) channels by vesnarinone. Mol Pharmacol 2001; 60:244–53
Sanchez-Chapula JA, Navarro-Polanco RA, Culberson C, Chen J, Sanguinetti MC: Molecular determinants of voltage-dependent human ether-a-go-go related gene (HERG) K+ channel block. J Biol Chem 2002; 277:23587–95
Sanchez-Chapula JA, Ferrer T, Navarro-Polanco RA, Sanguinetti MC: Voltage-dependent profile of human ether-a-go-go-related gene channel block is influenced by a single residue in the S6 transmembrane domain. Mol Pharmacol 2003; 63:1051–8
Milnes JT, Crociani O, Arcangeli A, Hancox JC, Witchel HJ: Blockade of HERG potassium currents by fluvoxamine: Incomplete attenuation by S6 mutations at F656 or Y652. Br J Pharmacol 2003; 139:887–98
Scholz EP, Zitron E, Kiesecker C, Lueck S, Kathofer S, Thomas D, Weretka S, Peth S, Kreye VA, Schoels W, Katus HA, Kiehn J, Karle CA: Drug binding to aromatic residues in the HERG channel pore cavity as possible explanation for acquired Long QT syndrome by antiparkinsonian drug budipine. Naunyn Schmiedebergs Arch Pharmacol 2003; 368:404–14
Mitcheson JS. Drug binding to HERG channels: Evidence for a “non-aromatic” binding site for fluvoxamine. Br J Pharmacol 2003; 139:883–4
Valenzuela C, Delpon E, Tamkun MM, Tamargo J, Snyders DJ: Stereoselective block of a human cardiac potassium channel (Kv1.5) by bupivacaine enantiomers. Biophys J 1995; 69:418–27
Hamill OP, Marty A, Neher E, Sakmann B, Sigworth FJ: Improved patch-clamp techniques for high-resolution current recording from cells and cell-free membrane patches. Pflugers Arch 1981; 391:85–100
Smith PL, Baukrowitz T, Yellen G: The inward rectification mechanism of the HERG cardiac potassium channel. Nature 1996; 379:833–6
Hancox JC, Levi AJ, Witchel HJ: Time course and voltage dependence of expressed HERG current compared with native “rapid” delayed rectifier K current during the cardiac ventricular action potential. Pflugers Arch 1998; 436:843–53
Zhou Z, Gong Q, Ye B, Fan Z, Makielski JC, Robertson GA, January CT: Properties of HERG channels stably expressed in HEK 293 cells studied at physiological temperature. Biophys J 1998; 74:230–41
Sesti F, Abbott GW, Wei J, Murray KT, Saksena S, Schwartz PJ, Priori SG, Roden DM, George Jr, AL Goldstein SA: A common polymorphism associated with antibiotic-induced cardiac arrhythmia. Proc Natl Acad Sci U S A 2000; 97:10613–8
Wang S, Morales MJ, Liu S, Strauss HC, Rasmusson RL: Modulation of HERG affinity for E-4031 by [K+]o and C-type inactivation. FEBS Lett 1997; 417:43–7
Numaguchi H, Mullins FM, Johnson Jr JP Johns, DC, Po SS, Yang IC, Tomaselli GF, Balser JR: Probing the interaction between inactivation gating and Dd-sotalol block of HERG. Circ Res 2000; 87:1012–8
Friederich P, Urban BW: Interaction of intravenous anesthetics with human neuronal potassium currents in relation to clinical concentrations. Anesthesiology 1999; 91:1853–60
Friederich P, Benzenberg D, Trellakis S, Urban BW: Interaction of volatile anesthetics with human Kv channels in relation to clinical concentrations. Anesthesiology 2001; 95:954–8
Franqueza L, Longobardo M, Vicente J, Delpon E, Tamkun MM, Tamargo J, Snyders DJ, Valenzuela C: Molecular determinants of stereoselective bupivacaine block of hKv1.5 channels. Circ Res 1997; 81:1053–64
Albright GA: Cardiac arrest following regional anesthesia with etidocaine or bupivacaine. Anesthesiology 1979; 51:285–7
Polley LS, Santos AC: Cardiac arrest following regional anesthesia with ropivacaine: Here we go again! Anesthesiology 2003; 99:1253–4
Webster R, Leishman D, Walker D: Towards a drug concentration effect relationship for QT prolongation and torsades de pointes. Curr Opin Drug Discov Dev 2002; 5:116–26