Abstract: The Ca 2+ -activated SK4 K + channel is gated by Ca 2+ -calmodulin (CaM) and is expressed in immune cells, brain and heart. A cryo-EM structure of the human SK4 K + channel recently revealed four CaM molecules per channel tetramer, where the apo CaM C-lobe and the holo CaM N-lobe interact with the proximal C-terminus and the linker S4-S5, respectively, to gate the channel. Here, we show that phosphatidylinositol 4-5 bisphosphate (PIP2) potently activates SK4 channels by docking to the boundary of the CaM binding domain. A novel allosteric blocker, BA6b9, was designed to act to the calmodulin-PIP2 binding domain, a previously untargeted region of SK4 channels, at the interface of the proximal C-terminus and the linker S4-S5. Molecular docking and patch-clamp electrophysiology indicate that BA6b9 inhibits SK4 channels by interacting with two specific residues, Arg191 and His192 in the linker S4-S5, not conserved in SK1-SK3 subunits, thereby conferring selectivity and preventing the Ca 2+ -CaM N-lobe to properly interact with the channel linker region. Immunohistochemistry of the SK4 channel protein in rat hearts showed a widespread expression in the sarcolemma of atrial myocytes, with a sarcomeric striated Z-band pattern, and a weaker occurrence in the ventricle but a marked incidence at the intercalated discs. BA6b9 significantly prolonged atrial and atrioventricular effective refractory periods in rat isolated hearts and reduced atrial fibrillation induction ex vivo. Our work suggests that inhibition of SK4 K + channels by targeting drugs to the calmodulin-PIP2 binding domain provides a promising anti-arrhythmic therapy.
