Rationale The early description of the intercalated disc defined three structures, all of them involved in cell-cell communication: desmosomes, gap junctions and adherens junctions. Current evidence demonstrates that molecules not involved in providing a physical continuum between cells, also populate the intercalated disc. Key among them is the voltage-gated sodium channel (VGSC) complex. An important component of this complex is the cytoskeletal adaptor protein ankyrin-G (AnkG). Objective To test the hypothesis that AnkG partners with desmosome and gap junction molecules, and exerts a functional effect on intercellular communication in the heart. Methods and Results We utilized a combination of microscopy, immunochemistry, patch clamp and optical mapping to assess the interactions between AnkG, plakophilin-2 (PKP2) and Connexin43 (Cx43). Co-immunoprecipitation studies from rat heart lysate demonstrated associations between the three molecules. Using siRNA technology we demonstrated that loss of AnkG expression caused significant changes in subcellular distribution and/or abundance of PKP2 and Cx43, as well as a decrease in intercellular adhesion strength and electrical coupling. Regulation of AnkG and of Nav1.5 by PKP2 was also demonstrated. Finally, optical mapping experiments in AnkG-silenced cells demonstrated a shift in the minimal frequency at which rate-dependence activation block was observed. Conclusions These experiments support the hypothesis that AnkG is a key functional component of the intercalated disc, at the intersection of three complexes often considered independent: the VGSC, gap junctions and the cardiac desmosome. Possible implications to the pathophysiology of inherited arrhythmias (such as arrhythmogenic right ventricular cardiomyopathy; ARVC) are discussed.

Desmosomes are intercellular junctions that anchor intermediate filaments to the plasma membrane, forming a supracellular scaffold that provides mechanical resilience to tissues. This anchoring function is accomplished by specialized members of the cadherin family and associated cytoskeletal linking proteins, which together form a highly organized membrane core flanked by mirror image cytoplasmic plaques. Due to the biochemical insolubility of desmosomes, the mechanisms that govern assembly of these components into a functional organelle remained elusive. Recently developed molecular reporters and live cell imaging approaches have provided powerful new tools to monitor this finely-tuned process in real time. Here we discuss studies that are beginning to decipher the machinery and regulation governing desmosome assembly and homeostasis in situ, and how these mechanisms are affected during disease pathogenesis.