␣-Scorpion toxins and sea anemone toxins bind to a common extracellular site on the Na ؉ channel and inhibit fast inactivation. Basic amino acids of the toxins and domains I and IV of the Na ؉ channel ␣ subunit have been previously implicated in toxin binding. To identify acidic residues required for toxin binding, extracellular acidic amino acids in domains I and IV of the type IIa Na ؉ channel ␣ subunit were converted to neutral or basic amino acids using site-directed mutagenesis, and altered channels were transiently expressed in tsA-201 cells and tested for 125 I-␣-scorpion toxin binding. Conversion of Glu 1613 at the extracellular end of transmembrane segment IVS3 to Arg or His blocked measurable ␣-scorpion toxin binding, but did not affect the level of expression or saxitoxin binding affinity. Conversion of individual residues in the IVS3-S4 extracellular loop to differently charged residues or to Ala identified seven additional residues whose mutation caused significant effects on binding of ␣-scorpion toxin or sea anemone toxin. Moreover, chimeric Na ؉ channels in which amino acid residues at the extracellular end of segment IVS3 of the ␣ subunit of cardiac Na ؉ channels were substituted into the type IIa channel sequence had reduced affinity for ␣-scorpion toxin characteristic of cardiac Na ؉ channels. Electrophysiological analysis showed that E1613R has 62-and 82-fold lower affinities for ␣-scorpion and sea anemone toxins, respectively. Dissociation of ␣-scorpion toxin is substantially accelerated at all potentials compared to wild-type channels. ␣-Scorpion toxin binding to wild type and E1613R had similar voltage dependence, which was slightly more positive and steeper than the voltage dependence of steady-state inactivation. These results indicate that nonidentical amino acids of the IVS3-S4 loop participate in ␣-scorpion toxin and sea anemone toxin binding to overlapping sites and that neighboring amino acid residues in the IVS3 segment contribute to the difference in ␣-scorpion toxin binding affinity between cardiac and neuronal Na ؉ channels. The results also support the hypothesis that this region of the Na ؉ channel is important for coupling channel activation to fast inactivation.Voltage-gated Na ϩ channels are responsible for the conduction of electrical impulses in most excitable tissues (1). The importance of their function is demonstrated by the effects of Na ϩ channel-specific neurotoxins that bind to at least six different receptor sites on the Na ϩ channel molecule and disrupt its normal behavior (reviewed in Refs. 2 and 3). These natural toxins are powerful tools for understanding and correlating ion channel structure and function, as exemplified by identification of molecular determinants for binding of the pore blocker tetrodotoxin, which has provided important information about the structure of the ion selectivity filter and pore (3, 4). Similarly, the identification of molecular determinants for binding of toxins that modify activation or inactivation will likely provide important ...