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High-throughput screens identify genotype-specific therapeutics for channelopathies
Christian L. Egly, … , Brett M. Kroncke, Björn C. Knollmann
Christian L. Egly, … , Brett M. Kroncke, Björn C. Knollmann
Published September 30, 2025
Citation Information: JCI Insight. 2025;10(22):e191697. https://doi.org/10.1172/jci.insight.191697.
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Research Article Cardiology Genetics

High-throughput screens identify genotype-specific therapeutics for channelopathies

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Abstract

Genetic diseases such as ion channelopathies substantially burden human health. Existing treatments are limited and not genotype specific. Here, we report a 2-step high-throughput approach to rapidly identify drug candidates for repurposing as genotype-specific therapy. We first screened 1,680 medicines using a thallium-flux trafficking assay against Kv11.1 gene variants causing long QT syndrome (LQTS), an ion channelopathy associated with fatal cardiac arrhythmia. We identified evacetrapib as a suitable drug candidate that improves membrane trafficking and activates channels. We then used deep mutational scanning to prospectively identify all Kv11.1 missense variants in an LQTS hotspot region responsive to treatment with evacetrapib. Combining high-throughput drug screens with deep mutational scanning establishes a paradigm for mutation-specific drug discovery translatable to personalized treatment of carriers with rare genetic disorders.

Authors

Christian L. Egly, Alex Shen, Tri Q. Do, Carlos Tellet Cabiya, Paxton A. Ritschel, Suah Woo, Matthew Ku, Brian P. Delisle, Brett M. Kroncke, Björn C. Knollmann

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Figure 5

Evacetrapib slows activation and deactivation kinetics of WT.

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Evacetrapib slows activation and deactivation kinetics of WT.
(A–C) Kv11...
(A–C) Kv11.1 channel activation kinetics. (A) Typical current traces in Kv11.1 with holding potentials to assess time constant of activation. Tail currents were normalized to the max current at –100 mV step. (B) Current-time plot showing normalized current (I/Imax) from peak tail currents at –100 mV step after increasing durations of depolarizing step potentials. Solid lines represent single-phase exponential decay function fit to data. (C) Time constants of activation (τ) measured from individual cells in the presence of vehicle (n = 4) or evacetrapib (n = 6). **P < 0.01 by 2-tailed Student’s t test. (D–F) Kv11.1 channel deactivation kinetics. (D) Typical current traces in Kv11.1 measured at step potential to 120 mV. Gray boxed inset shows enlarged tail currents. Black arrows show the area of double exponential decay fit to measure deactivation rates of the fast (τf) and slow (τs) time components. (E and F) Rate constant measurements for the (E) fast and (F) slow component of deactivation in Kv11.1 cells held at different voltages in the presence of vehicle (n = 7) or evacetrapib (n = 8). *P < 0.05 by multiple t tests with 2-stage step up with Benjamini, Krieger, and Yekutieli. All current traces and analyses in the presence of vehicle (0.1% DMSO, black) or evacetrapib (15 μmol/L, blue) in bath solution. All data are reported as mean ± SD.

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