abstract: All organisms need to be able to sense and respond to their environment. Much of this process takes place via proteins embedded in the cell membrane, the border between a living thing and the external world. Transient receptor potential (TRP) ion channels are a superfamily of membrane proteins that play diverse roles in physiology. Among the 27 TRP channels found in humans and other animals, TRP melastatin 8 (TRPM8) and TRP vanilloid 1 (TRPV1) are the primary sensors of cold and hot temperatures, respectively. They underlie the molecular basis of somatic temperature sensation, but beyond this are also known to be involved in body temperature and weight regulation, inflammation, migraine, nociception, and some types of cancer. Because of their broad physiological roles, these channels are an attractive target for potential therapeutic interventions. This dissertation presents experimental studies to elucidate the mechanisms underlying TRPM8 and TRPV1 function and regulation. Electrophysiology experiments show that modulation of TRPM8 activity by phosphoinositide interacting regulator of TRP (PIRT), a small membrane protein, is species dependent; human PIRT attenuates TRPM8 activity, whereas mouse PIRT potentiates the channel. Direct binding experiments and chimeric mouse-human TRPM8 channels reveal that this regulation takes place via the transmembrane domain of the channel. Ligand activation of TRPM8 is also investigated. A mutation in the linker between the S4 and S5 helices is found to generally decrease TRPM8 currents, and to specifically abrogate functional response to the potent agonist icilin without affecting icilin binding. The heat activation thermodynamics of TRPV1 are also probed using temperature-controlled electrophysiology. The magnitude of the gating enthalpy of human TRPV1 is found to be similar to other species reported in the literature. Human TRPV1 also features an apparent heat inactivation process that results in reduced heat sensitivity after exposure to elevated temperatures. The work presented in this dissertation sheds light on the varied mechanisms of thermosensitive TRP channel function and regulation. / Dissertation/Thesis / Doctoral Dissertation Biochemistry 2019

Exercise has numerous health benefits. Yet, exercise can exacerbate pain for individuals with chronic musculoskeletal pain conditions such as myofascial pain syndrome (MPS) and fibromyalgia (FM). The exacerbation is out of proportion to the activity performed and lasts for long periods of time even after the cessation of activity. This pain acts as a barrier to healthy exercise and physical rehabilitation, which, when applied consistently, are effective treatments for MPS and FM--two diseases that produce substantial suffering and disability. The goal of the proposed studies is to determine the underlying peripheral mechanisms that contribute to enhanced pain following exercise. A better understanding of these mechanisms will lead to better pain management and prevention for these diseases. Previous data show that two hours of running wheel activity lowers the threshold necessary to induce muscle pain by acidic saline injection, producing robust pain behaviors to normally innocuous stimuli. Muscle activity that produces fatigue is associated with extracellular increases in protons, lactate, and ATP. These fatigue metabolites can directly activate muscle nociceptors and, when combined, produce a potentiated effect. Acid sensing ion channels (ASICs) are non-selective cation channels that open in response to increased proton concentrations, a response that is enhanced when lactate binds at a separate location. Ionotropic purinergic receptors (P2X) similarly produce an inward current in response to elevated ATP. Evidence suggests certain ASIC and P2X subtypes are capable of a physical interaction that allows ASIC activation at lower proton concentrations in the presence of ATP. This suggests that ATP, lactate, and protons released during exercise could activate ASIC and P2X receptors on muscle nociceptors, exciting the nociceptors and sensitizing them to subsequent muscle insult. However, the limitations of these experiments leave several gaps. First, the running wheel task fails to produce measurable increases in fatigue metabolites, possibly due to the fact that there was minimal fatigue (10%) or that their levels quickly return to baseline. Further, the running wheel task depends on central nervous system (CNS) activity and volitional running, which may introduce confounding factors upstream of muscle activation and result in large variation in the rate and duration of running. Second, it is unclear whether ASICs are necessary for the development of mechanical hyperalgesia induced by muscle activity, nor is it understood which ASIC subtypes might be required for such an effect. Finally, the molecules necessary for the induction of mechanical hyperalgesia after exercise are not known. Protons, lactate, and ATP have been suggested, but it is not known if these compounds are themselves sufficient or if they interact in an additive or synergistic manner. We address these concerns by developing an electrically-stimulated muscle fatigue paradigm that reliably fatigues a single muscle independent of the CNS, allowing for metabolite measurement during muscle activity and in vivo study of molecular mechanisms of muscle pain in the peripheral tissue. We then use genetic and pharmacologic approaches to test the role of ASIC subtypes in the development of mechanical hyperalgesia after exercise. Finally, we test the effectiveness of by-products of muscle activity in recapitulating the effects of the exercise-enhanced pain model.

Transient receptor potential (TRP) channels comprise a superfamily of cation-selective ion channels that are largely calcium (Ca2+) permeable and that play diverse physiological roles ranging from nociception in primary afferent neurons to the absorption of dietary Ca2+. The 28 mammalian TRP channels are categorized into 6 subfamilies. The vanilloid subfamily is named for its founding member, TRPV1, the capsaicin receptor, and has 6 members. TRPV1-4 are all heat sensitive ion channels whereas TRPV5 and TRPV6 are involved in renal Ca2+ reabsorption and Ca2+ absorption in the intestine, respectively. In our structural studies, we have focused on TRPV3 and TRPV6. TRPV6 is a highly Ca2+ selective TRP channel (PCa/PNa ~ 130) that functions in active Ca2+ absorption in the intestine. Its expression is upregulated by vitamin D and is, on the molecular level, regulated by PIP2 and calmodulin (CaM). Previously, the structure of TRPV6 was solved using X-ray crystallography. Using the crystal structure, a negatively charged extracellular vestibule was identified and anomalous diffraction was used to identify ion binding sites in the pore. Also, at the top of the selectivity filter, four aspartates were identified that coordinate Ca2+ entering the pore and confer to TRPV6 its selectivity for Ca2+. However, only the structure of the rat orthologue was solved and only in the closed, apo state. We used cryo-electron microscopy (cryo-EM) to solve structures of the human orthologue of TRPV6 in the open and closed (we used the mutation R470E to close the channel) states. The closed-to-open TRPV6 transition is accompanied by the formation of short π-helices in the middle of the pore-lining S6 helices, which in turn results in their turning and a different set of residues facing the pore. Additionally, the formation of the π-helices results in kinking of the S6 helices, which further widens the pore. TRPV6 is constitutively active when expressed heterologously. In other words, the addition of external stimuli is not necessary for the activation of the channel. Therefore, its activity needs to be regulated to prevent toxic Ca2+ overload. One mechanism by which this occurs is through its regulation by CaM. CaM has been shown to bind TRPV6 and regulate its function, however, the way it binds to and regulates TRPV6 remained unknown. To uncover this mechanism, we solved the structure of TRPV6 bound to CaM. We found that CaM binds TRPV6 in a 1:1 stoichiometric ratio and that CaM directly blocks the TRPV6 pore by inserting a positively charged lysine into a tera-tryptophan cage at the bottom of the pore. As a result, the channel adopts an inactivated conformation; although the pore-lining S6 helices still contain local π-helices, they are pulled closer together, narrowing the pore and further blocking it with hydrophobic side chains. We have also conducted studies of TRPV3. Unlike TRPV6, TRPV3 is a heat-activated vanilloid TRP channel. TRPV3 is expressed highly in keratinocytes where it has been implicated in wound healing and maintenance of the skin barrier, and in the regulation of hair growth. We solved the structure of apo TRPV3 in a closed state, and the structure of a TRPV3 mutant bound to 2-APB in an open state. Like TRPV6, the opening of TRPV3 is accompanied by the formation of local π-helices in the middle of the pore-lining S6 helices. The formation of the π-helices results in the lining of the ion permeation pathway with a different set of residues, resulting in a largely negatively charged pathway. Unlike TRPV6, TRPV3 is only slightly selective for Ca2+ and correspondingly, during gating state transitions, rearrangements were not only observed only in its pore-lining helices, but also in the cytosolic domain and the selectivity filter. Based on a comparison of our structures, we proposed a model of TRPV3 regulation by 2-APB. Together, our studies provide insight into the regulatory and gating mechanisms of the vanilloid subtype TRP channels and can provide the foundation for future studies.

Acid-sensing ion channel 1A (ASIC1A) is abundant in the nucleus accumbens (NAc), a region known for its role in addiction. Because ASIC1A has been previously suggested to promote associative learning, we hypothesized that disrupting ASIC1A in the NAc would reduce drug-associated learning and memory. However, contrary to this hypothesis, we found that disrupting ASIC1A in the NAc increased cocaine-conditioned place preference, suggesting an unexpected role for ASIC1A in addiction-related behavior. Investigating the underlying mechanisms, we identified a novel postsynaptic current during neurotransmission mediated by ASIC1A and ASIC2 and thus well-positioned to regulate synapse structure and function. Consistent with this possibility, disrupting ASIC1A altered dendritic spine density and glutamate receptor function, and increased cocaine-evoked plasticity in AMPA-to-NMDA ratio, all resembling changes previously associated with cocaine-induced behavior. Together, these data suggest ASIC1A inhibits plasticity underlying addiction-related behavior, and raise the possibility of therapies for drug addiction by targeting ASIC-dependent neurotransmission. The amygdala plays critical roles in the learning and expression of fear-related behavior. Previous studies have implicated the amygdala in CO2-evoked fear-like behavior in mice; however, a more recent study demonstrated that humans lacking the amygdala bilaterally experience fear and panic with CO2-inhalation. Because all subjects lacking the amygdala had panic attacks after inhaling CO2 compared to only 25% of controls, this data suggests the amygdala may play an inhibitory role in CO2-evoked panic. To assess the role of the amygdala in CO2-evoked behaviors in mice, we lesioned the amygdala and optogenetically stimulated different amygdalar nuclei. We found that large unilateral and bilateral amygdala lesions caused the emergence of escape-like jumping behavior in mice exposed to CO2 and a relative deficit in CO2-evoked freezing. This jumping behavior depended on the dorsal periaqueductal gray, a brain area previously associated with panic attacks. Additionally, the putative CO2 chemosensor ASIC1A and ASIC2 are not necessary for CO2-evoked jumping, and may even play an inhibitory role in this behavior. Optogenetic manipulation of the amygdala revealed that stimulation of the basolateral amygdala enhanced jumping behavior and inhibited freezing behavior. This may be due to the basolateral amygdala's ability to inhibit the main output center of the amygdala, the central nucleus. Together, these results suggest that different amygdalar nuclei differentially modulate CO2-evoked behavior by regulating the switch between mobile and immobile defense responses. Additionally, they provide additional evidence that amygdalar dysfunction may contribute to panic disorder.

Voltage-gated sodium channels auxiliary subunits evolutionary emerged nearly 500 million years ago during the Cambrian explosion. These subunits alter one the most important ion channels to electrical signaling, the voltage-gated sodium channels support the propagation of electric impulses in animals. The mechanism for the auxiliary subunits effects on the channels is poorly understand, as is the stoichiometry between the auxiliary subunit and the channel. The focus of my thesis is to generate assays and to use these approaches to understand the interactions different types of voltage-gated channels and their auxiliary subunits. A biochemical approach was taken to identify novel interactions between the eukaryotic sodium channel auxiliary subunits and a prokaryotic voltage-gated sodium channel, a protein that diverged from the eukaryotic voltage-gated sodium channels billions of years ago. These interactions between the auxiliary subunits and channels were probed with chemical and photochemical crosslinkers in search of interaction surfaces and similarity to explain the mechanisms of interaction. The work in this thesis identified novel interactions between the voltage-gated sodium channel auxiliary subunits and voltage-gated channels that are distantly related to the voltage-gated sodium channels principally thought to be modulated by the auxiliary subunits. From this work a rudimentary concept can be theorized that the voltage-gated sodium channel β-subunits and not only β1 have a more primary role in electrophysiology by associating with multiple different types of ion channels.

The endogenous neuropeptide pituitary adenylate cyclase-activating polypeptide (PACAP) exerts various neuromodulatory functions in mammalian brain. Enhancement of synaptic activity, mediation of chronic inflammatory and neuropathic pain, and neuroprotection in cerebral ischemia reperfusion injury constitute some of the exemplary functions of PACAP. However, it remains unclear whether PACAP signaling can directly influence the function of critical voltage-gated ion channels, which could profoundly alter the excitability of neurons. Voltage-gated K+ (Kv) channels are critical regulators of neuronal excitability. The major Kv channel in the dendrites of mammalian neurons, Kv4.2, contributes most of the fast-activating and rapidly-inactivating K+ currents (IA), and is a key regulator of dendritic excitability, as well as modulation of synaptic inputs. In addition, the major somatic Kv channel Kv2.1 that contributes the bulk of slow-activating and non-inactivating K+ currents (IK), acts as an integrator of neuronal inputs and limits high frequency firing in neurons. As such, it provides homeostatic control of excitability under hyperexcitable and ischemic conditions. Both these Kv channels are known to undergo extensive post-translational modifications mainly by phosphorylation that alters their localization and biophysical properties. PACAP can activate its specific receptor PAC1 that could result in downstream activation of various kinases including protein kinase A (PKA), protein kinase C (PKC), extracellular signal-regulated kinase (ERK1/2). Therefore, I hypothesize that PACAP activation of PAC1 receptor can cause phosphorylation-dependent modulation of somatodendritic Kv4.2 and Kv2.1 channels, resulting in altered neuronal excitability. First, I identified the various PAC1 receptor isoforms expressed in rat and mouse brain and elucidated that their activation by PACAP caused downstream PKA- and PKC-dependent signaling pathways, ultimately converging on ERK1/2 activation. Further, PACAP caused reduction in IA that was mediated by phosphorylation-dependent internalization of the channel protein from the plasma membrane. These effects were mediated by direct phosphorylation of the channel by ERK1/2 at the cytoplasmic C-terminus of the channel. Although PACAP did not significantly alter the voltage-dependence of Kv4.2 channel activation/inactivation, I observed distinct ERK1/2- and PKA-dependent changes in the extent and kinetics of channel inactivation. Next, I observed that PACAP induced dephosphorylation of the Kv2.1 channel in CHN that was mediated by protein phosphatase 2A (PP2A), and was dependent on PKC activation but was independent of the effects of PACAP on Kv4.2 currents. Rapid but reversible dephosphorylation of Kv2.1 was also observed following induction of ischemia in neurons by oxygen-glucose deprivation (OGD). PACAP prolonged the dephosphorylation of Kv2.1 following in vitro ischemia-reperfusion and also reduced neuronal death. My results therefore suggest a novel PACAP/PAC1-PKC-PP2A-Kv2.1 signaling axis that provides neuroprotection during ischemia reperfusion injury. In summary, my results suggest that PACAP can induce direct phosphorylation-dependent modulation of the Kv4.2 and Kv2.1 channel localization and function in mammalian brain neurons. The effect of PACAP on these two critical somatodendritic ion channels occurs via distinct signaling - convergent PKA-PKC-ERK-mediated phosphorylation of Kv4.2 channel, and PKC-PP2A-mediated dephosphorylation of the Kv2.1 channel. Such distinct modulations of these ion channels are presumably responsible for the multifarious roles of PACAP in the central nervous system.

The proper orchestration of voltage-gated ion channel gating is vital to maintaining normal heart rhythms throughout an animal's lifespan. Voltage-gated sodium channels, Nav, are responsible for the initiation of the cardiac action potential, which leads to cardiac systole. Comparison of neonatal ventricular and atrial myocyte Nav gating with adult indicated that the neonatal ventricular Nav gated following a ~10 mV greater depolarization than did atrial or adult ventricular Nav. In this study I questioned whether development- and/or chamber-dependent changes in Nav-associated functional sialic acids could account for these differences. When desialylated with neuraminidase, all gating characteristics for the lower voltage activated atrial and adult ventricular Nav shifted significantly to more depolarized potentials. However, desialylation of the higher voltage activated neonatal ventricular Nav had no effect on channel gating. Furthermore, channels were stripped of their N-glycosylation via PNGase-F in an attempt to separate the potential effects of the remaining glycosylation structure on Nav gating. Following treatment, neonatal ventricular Nav gating remained unchanged while atrial and adult ventricular Nav gating again shifted to depolarized potentials nearly identical to those of the neonatal ventricular channel. Immunoblot analyses indicated that atrial and adult ventricular Nav α subunits are more heavily sialylated than the neonatal ventricular a subunit, with approximately 15 more sialic acid residues. The data indicate that differential sialylation of myocyte Nav α subunits is responsible for much of the developmental and chamber-specific remodeling of Nav gating observed here. In addition, the Nav1.5 α subunit can associate with β subunits, also believed to be sialylated. The potential for functional β1 trans sialic acids to further modulate Nav1.5 gating was tested via co-transfection of β1 with the Nav1.5 α subunit into the Pro5/Lec2 mammalian expression system. Co-transfection revealed that the additional b1 trans sialic acids caused a hyperpolarizing shift in all tested gating parameters. When transfected into neonatal ventricular myocytes, β1 expression revealed no effect, implying that β1 expression alone is not responsible. Together, the myocyte and expression system studies describe a novel mechanism by which Nav gating, and subsequently cardiac excitability, are modulated by the regulated change in channel-associated functional sialic acids.

Introdução: O hiperaldosteronismo primário (HP) é a causa mais comum de hipertensão arterial sistêmica (HAS) secundária, com prevalência de até 21% em pacientes com HAS resistente. Na última década, foram feitos consideráveis avanços na compreensão da patogênese do HP. Variantes patogênicas somáticas nos genes de canais iônicos KCNJ5, CACNA1D, ATP1A1 e ATP2B3, envolvidos na manutenção da homeostase iônica intracelular, foram descritas em 38%, 9,3%, 5,3% e 1,7% dos tumores, respectivamente. Variantes patogênicas somáticas no gene CTNNB1, fundamental para o desenvolvimento do córtex da suprarrenal, foram também identificadas em aproximadamente 5% dos aldosteronomas. Mais recentemente, uma variante germinativa no gene CACNA1H, que codifica a subunidade Alfa1H do canal de cálcio Cav 3.2, foi identificada em um paciente com aldosteronoma. Objetivos: O objetivo geral desse projeto foi investigar as bases genéticas do HP causado por aldosteronoma. Os objetivos específicos foram: 1) Investigar variantes patogênicas somáticas nos genes KCNJ5, ATP1A1, ATP2B3 e CTNNB1 em aldosteronomas de indivíduos com HP; 2) Sequenciar o exoma (pareado sangue e tumor) dos casos de HP causados por aldosteronoma, negativos para variantes nos genes citados acima; 3) Correlacionar o genótipo com os parâmetros clínicos e hormonais dos pacientes com aldosteronomas. Métodos: As regiões hot-spot dos genes KCNJ5, ATP1A1, ATP2B3 e CTNNB1 foram sequenciadas por Sanger em 62 tumores [56% mulheres; mediana de idade ao diagnóstico 50 anos (variação, 20 a 68)]. Pacientes sem variantes patogênicas somáticas nos genes descritos acima foram submetidos a genotipagem do exoma (pareado sangue e tecido) por sequenciamento paralelo em larga escala (HiSeq 2500, Illumina). Variantes germinativas raras (MAF < 0,01% no 1000 genomes, ExAC, gnomAD e AbraOM) em genes codificadores de canais iônicos ou associados a hiperplasia adrenal foram selecionadas para segregação familial. Resultados: Variantes patogênicas somáticas em heterozigose foram encontradas em 34 de 62 (54,8%) aldosteronomas. As variantes identificadas nos genes KCNJ5, ATP1A1, ATP2B3 e CTNNB1 eram previamente conhecidas. Variantes patogênicas no KCNJ5 foram detectadas em 28 de 62 (45,2%) aldosteronomas. Duas variantes recorrentes foram encontradas: p.Gly151Arg em 13 de 28 (46%) e p.Leu168Arg em 14 de 28 (50%) tumores. A variante patogênica p.Glu145Gln do KCNJ5 foi identificada em um (4%) aldosteronoma. Adicionalmente, a variante patogênica p.Leu104Arg do ATP1A1 foi detectada em 2 (3,2%) aldosteronomas; a variante patogênica p.Leu425_Val426del do ATP2B3 em um (1,6%) caso e a variante patogênica p.Ser45Pro do CTNNB1 em 2 (3,2%) aldosteronomas. Uma nova variante p.Leu276Pro somática em heterozigose no CACNA1D foi identificada em um aldosteronoma no exoma e classificada como provavelmente patogênica. Aldosteronomas com variantes patogênicas no KCNJ5 foram diagnosticados mais frequentemente em mulheres (p= 0,047) e em idades mais jovens (p= 0,002) quando comparado com tumores sem variantes no KCNJ5. O tamanho do nódulo foi maior em aldosteronomas com variantes patogênicas no KCNJ5 (p= 0,0001). O percentual de pacientes com tempo de HAS < 5 anos foi similar nos dois grupos. A remissão pós-operatória da HAS foi observada em 50% dos pacientes com tumor contendo variante patogênica no KCNJ5, enquanto apenas 15% dos pacientes com tumor sem variante no KCNJ5 tiveram remissão da HAS (p= 0,003). Na análise multivariada, somente a presença de variante patogênica somática no KCNJ5 foi um preditor independente de remissão da HAS (p= 0,03). Após filtragem das variantes encontradas no sequenciamento exômico, quatro variantes germinativas missense em heterozigose foram consideradas deletérias em mais de 3 algoritmos de predição in silico: 1) uma nova variante (p.Pro559Thr) no gene CACNA1H, já associado ao fenótipo de HP; 2) a variante p.Arg178Cys no gene CACNA1I, que codifica a subunidade Alfa 1I do canal Cav 3.3; 3) a variante p.Glu52Ala no gene ATP13A3, que codifica uma proteína transmembrana da família de proteínas ATPase do tipo P; 4) a variante p.Tyr507Ser no gene KCNC4, que codifica o canal de potássio Kv 3.4. Conclusão: Foi caracterizado o espectro de variantes patogênicas somáticas em uma coorte brasileira de tumores corticais adrenais produtores de aldosterona, bem como o impacto das variantes no KCNJ5 na predição de remissão da HAS após adrenalectomia. Além disso, foram identificados novos genes candidatos provavelmente relacionados a patogênese do HP causado por aldosteronomas / Introduction: Primary aldosteronism (PA) is the most common form of secondary hypertension (HT), with a prevalence of approximately 20% in patients with resistant hypertension. In the last decade, somatic mutations in KCNJ5, CACNA1D, ATP1A1 and ATP2B3 genes, which are involved in maintaining intracellular ionic homeostasis and cell membrane potential, were described in 38%, 9.3%, 5.3% and 1.7% of aldosterone-producing adenomas (APAs), respectively. All these mutations lead to the activation of calcium signaling, the major trigger for aldosterone production. Additionally, somatic activating mutations in exon 3 of CTNNB1 gene, which is involved in the adrenocortical development, were identified in approximately 5% of APAs. More recently, the germline p.V1951G CACNA1H variant was described in a PA patient with an APA. Aims: To investigate the genetics of APAs. The specific aims of this study were: 1) To investigate somatic variants in KCNJ5, ATP1A1, ATP2B3 and CTNNB1 genes in APAs from PA patients; 2) To perform exome sequencing of PA patients caused by APAs without mutations in those genes already associated with PA; 3) To correlate genetic findings and clinical parameters. Methods: Hot-spot regions of KCNJ5, ATP1A1, ATP2B3 e CTNNB1 genes were sequenced by Sanger in 62 APAs [56% women; median of age at diagnosis 50 yrs (range, 20 to 68)]. We performed whole exome sequencing (HiSeq 2500, Illumina) in paired blood and tumor DNA samples from 10 unrelated subjects with PA caused by APAs without somatic mutations in hot-spot regions of KCNJ5, ATP1A1, ATP2B3 and CTNNB1.We searched for rare germline coding variants (MAF < 0.01% in 1000 genomes, ExAC, gnomAD and AbraOM) in ionchannel genes, which are expressed in normal adrenal tissue, or in genes previously related to adrenal hyperplasia. Results: Pathogenic somatic heterozygous variants were identified in 34 out of 62 (54.8%) APAs. KCNJ5 pathogenic variants were detected in 28 out of 62 (45.2%) APAs. Two recurrent variants were found in KCNJ5: the p.Gly151Arg in 13 out of 28 (46%) and the p.Leu168Arg in 14 out of 28 (50%) APAs. KCNJ5 pathogenic variant p.Glu145Gln was identified in one (4%) APA. In addition, the p.Leu104Arg ATP1A1 mutation was detected in two APAs (3.2%); the p.Leu425_Val426del ATP2B3 mutation in one APA (1.6%); and the p.Ser45Pro CTNNB1 mutation in two APAs (3.2%). The novel CACNA1D somatic heterozygous variant p.Leu276Pro (likely pathogenic) was identified by exome sequencing in one APA. APAs with KCNJ5 pathogenic variants were diagnosed more often in women (p= 0.047) and at younger ages (p= 0.002) when compared to APAs without KCNJ5 variants. Nodule size was larger in APAs with KCNJ5 pathogenic variants (p= 0.0001). The frequency of PA patients com HT duration < 5 yrs was similar in both groups. HT remission was observed in 50% of patients with APAs harboring KCNJ5 pathogenic variants, whereas only 15% of patients with APAs without KCNJ5 pathogenic variants had HT remission (p= 0.003). In multivariate analysis, only the presence of a KCNJ5 pathogenic variant was an independent predictor of HT remission (p= 0.03). After exome sequencing analysis, four germline missense heterozygous variants predicted to be pathogenic in >=3 in silico tools were selected: 1) the novel p.Pro559Thr variant in CACNA1H gene, previously associated with PA phenotype; 2) the p.Arg178Cys variant in CACNA1I gene, which encodes the Alpha 1I subunit of Cav 3.3 channel; 3) the p.Glu52Ala variant in ATP13A3 gene, which is a member of the P-type ATPase family of membrane transport proteins; and 4) the p.Tyr507Ser variant in KCNC4 gene, which encodes the voltage-gated potassium channel Kv 3.4. Conclusion: We have characterized the spectrum of somatic pathogenic variants in a Brazilian cohort of APAs, and evaluated the impact of KCNJ5 somatic pathogenic variants in predicting HT remission after adrenalectomy. In addition, we identified potential novel gene candidates in the pathogenesis of PA caused by APAs

Biological ion channels are responsible for, and regulate the communication system in the body. In this thesis I develop, test and apply theoretical models of ion channels, that can relate their structure to their functional properties. Brownian dynamics simulations are introduced, in which the motions of individual ions are simulated as they move through the channel and in baths attached to each end. The techniques for setting boundary conditions which maintain ion concentrations in the baths and provide a driving potential are tested. Provided the bath size is large enough, all boundary conditions studied yield the same results. ¶ Continuum theories of electrolytes have previously been used to study ion permeation. However, I show that these continuum models do not accurately reproduce the physics taking place inside ion channels by directly comparing the results of both equilibrium Poisson-Boltzmann theory, and non-equilibrium Poisson-Nernst-Planck theory to simulations. In both cases spurious shielding effects are found to cancel out forces that play an important role in ion permeation. In particular, the `reaction field' created by the ion entering the narrow channel is underestimated. Attempts to correct these problems by adding extra force terms to account for this reaction field also fail. ¶ A model of the L-type calcium channel is presented and studied using Brownian dynamics simulations and electrostatic calculations. The mechanisms of permeation and selectivity are explained as the result of simple electrostatic interactions between ions and the fixed charges in the protein. The complex conductance properties of the channel, including the current-voltage and current-concentration relationships, the anomalous mole fraction behaviour between sodium and calcium ions, the attenuation of calcium currents by monovalent ions and the effects of mutating glutamate residues, are all reproduced. ¶ Finally, the simulation and electrostatic calculation methods are used to study the gramicidin A channel. It is found that the continuum electrostatic calculations break down in this narrow channel, as the concept of applying a uniform dielectric constant is not accurate in this situation. Thus, the permeation properties of the channel are examined using Brownian dynamics simulations without electrostatic calculations. Future applications and improvements of the Brownian dynamics simulation technique are also described.

Hyperkalemic periodic paralysis is characterized by myotonic discharges followed by paralysis. Caused by a mutation in the gene encoding for NaV1.4 channel, patients do not experience symptoms during infancy, but the onset starts between 1-10 years of age. The symptoms severity then increases with age until adolescence. A large increase in gene expression marked by an increase in oxidative capacity of muscles has also been reported in HyperKPP. It is possible that the onset of symptoms is related solely to NaV1.4 channel content/activity reaching a critical level. It is also possible that the onset of some symptoms are due to defective NaV1.4, while other symptoms and the increase in severity with age are related to changes in membrane components as a result of changes in gene expression. To test these possibilities, the progression of paralysis and changes in fiber types were followed with age in HyperKPP mice in relation to changes in NaV1.4 content and activity. Changes in fiber types (index of changes in gene expression), started after the onset of paralysis was observed, which coincided with NaV1.4 channels reaching maximum expression. Therefore, the onset of symptoms was related to defective NaV1.4 channels.