Kir6.1- and SUR2-dependent K(ATP) overactivity disrupts intestinal motility in murine models of Cantú syndrome

Cantú syndrome (CS), caused by gain-of-function (GOF) mutations in pore-forming (Kir6.1, KCNJ8) and accessory (SUR2, ABCC9) ATP-sensitive potassium (K(ATP)) channel subunit genes, is frequently accompanied by gastrointestinal (GI) dysmotility, and we describe 1 CS patient who required an implanted intestinal irrigation system for successful stooling. We used gene-modified mice to assess the underlying K(ATP) channel subunits in gut smooth muscle and to model the consequences of altered K(ATP) channels in CS gut. We show that Kir6.1/SUR2 subunits underlie smooth muscle K(ATP) channels throughout the small intestine and colon. Knockin mice, carrying human KCNJ8 and ABCC9 CS mutations in the endogenous loci, exhibited reduced intrinsic contractility throughout the intestine, resulting in death when weaned onto solid food in the most severely affected animals. Death was avoided by weaning onto a liquid gel diet, implicating intestinal insufficiency and bowel impaction as the underlying cause, and GI transit was normalized by treatment with the K(ATP) inhibitor glibenclamide. We thus define the molecular basis of intestinal K(ATP) channel activity, the mechanism by which overactivity results in GI insufficiency, and a viable approach to therapy.