Human K(ATP) channelopathies: diseases of metabolic homeostasis

Assembly of an inward rectifier K(+) channel pore (Kir6.1/Kir6.2) and an adenosine triphosphate (ATP)-binding regulatory subunit (SUR1/SUR2A/SUR2B) forms ATP-sensitive K(+) (K(ATP)) channel heteromultimers, widely distributed in metabolically active tissues throughout the body. K(ATP) channels are metabolism-gated biosensors functioning as molecular rheostats that adjust membrane potential-dependent functions to match cellular energetic demands. Vital in the adaptive response to (patho)physiological stress, K(ATP) channels serve a homeostatic role ranging from glucose regulation to cardioprotection. Accordingly, genetic variation in K(ATP) channel subunits has been linked to the etiology of life-threatening human diseases. In particular, pathogenic mutations in K(ATP) channels have been identified in insulin secretion disorders, namely, congenital hyperinsulinism and neonatal diabetes. Moreover, K(ATP) channel defects underlie the triad of developmental delay, epilepsy, and neonatal diabetes (DEND syndrome). K(ATP) channelopathies implicated in patients with mechanical and/or electrical heart disease include dilated cardiomyopathy (with ventricular arrhythmia; CMD1O) and adrenergic atrial fibrillation. A common Kir6.2 E23K polymorphism has been associated with late-onset diabetes and as a risk factor for maladaptive cardiac remodeling in the community-at-large and abnormal cardiopulmonary exercise stress performance in patients with heart failure. The overall mutation frequency within K(ATP) channel genes and the spectrum of genotype–phenotype relationships remain to be established, while predicting consequences of a deficit in channel function is becoming increasingly feasible through systems biology approaches. Thus, advances in molecular medicine in the emerging field of human K(ATP) channelopathies offer new opportunities for targeted individualized screening, early diagnosis, and tailored therapy.