Decoding Voltage-Gated Sodium Channels Structure: Molecular Mechanisms Linking Architecture, Function, and Disease.

Authors

João Pedro Boazinha, João Carneiro, Nuno M F S A Cerqueira, Sérgio F Sousa

Published in

Pharmacological research. Pages 109648. Sep 28, 2026. Epub Sep 28, 2026.

Abstract

Voltage-gated sodium (NaV) channels are critical transmembrane proteins responsible for the initiation and propagation of electrical signals in excitable tissues. They consist of a large α subunit and auxiliary β subunits. Together, the voltage sensing, ion selectivity, and rapid gating transitions regulate neuronal, muscular, and cardiac excitability. Recent cryo-electron microscopy breakthroughs have transformed the understanding of NaV structure-function relationships, revealing the asymmetric organization of voltage-sensing domains (VSD), the architecture of the DEKA selectivity filter, the mechanical coupling between S4-S5 linkers and S6 gating helices, and the allosteric mechanism by which the IFMT motif mediates fast inactivation. Across the nine human NaV isoforms, subtle structural divergences underlie distinct tissue distributions, biophysical properties, and disease susceptibilities, explaining the diverse channelopathies that range from epilepsy and cardiac arrhythmias to skeletal muscle disorders and painful neuropathies. These high-resolution structures also illuminate isoform-specific pharmacological pockets, including membrane-dependent cavities in VSD4 and dynamic fenestrations that govern state-dependent drug access, enabling the rational design of small molecules, peptide toxins, and hybrid therapeutics with improved selectivity. Advances in structural biology, biochemistry, and computation have established an integrated mechanistic model that connects NaV channels architecture to gating, inactivation, isoform-specific function, and human disease. This growing molecular atlas now supports next-generation precision therapies aimed at selectively modulating NaV channels activity in neurological, muscular, cardiac, and pain disorders.

PMID:
42805517
Bibliographic data and abstract were imported from PubMed on 29 Sep 2026.

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