Abstract-The cardiac sodium channel Na v 1.5 plays a key role in cardiac excitability and conduction. The purpose of this study was to elucidate the role of the PDZ domain-binding motif formed by the last three residues (Ser-Ile-Val) of the Na v 1.5 C-terminus. Pull-down experiments were performed using Na v 1.5 C-terminus fusion proteins and human or mouse heart protein extracts, combined with mass spectrometry analysis. These experiments revealed that the C-terminus associates with dystrophin, and that this interaction was mediated by alpha-and beta-syntrophin proteins.Truncation of the PDZ domain-binding motif abolished the interaction. We used dystrophin-deficient mdx 5cv mice to study the role of this protein complex in Na v 1.5 function. Western blot experiments revealed a 50% decrease in the Na v 1.5 protein levels in mdx 5cv hearts, whereas Na v 1.5 mRNA levels were unchanged. Patch-clamp experiments showed a 29% decrease of sodium current in isolated mdx 5cv cardiomyocytes. Finally, ECG measurements of the mdx 5cv mice exhibited a 19% reduction in the P wave amplitude, and an 18% increase of the QRS complex duration, compared with controls. These results indicate that the dystrophin protein complex is required for the proper expression and function of Na v 1.5. In the absence of dystrophin, decreased sodium current may explain the alterations in cardiac conduction observed in patients with dystrophinopathies. Key Words: Duchenne dystrophy Ⅲ dystrophin Ⅲ ECG Ⅲ mouse Ⅲ sodium channels Ⅲ syntrophin T he main cardiac voltage-gated sodium channel, Na v 1.5, generates the fast depolarization of the cardiac action potential, and plays a key role in cardiac conduction. Its importance for normal cardiac function has been exemplified by the description of numerous naturally occurring genetic variants of the gene SCN5A, which encodes Na v 1.5, that are linked to various cardiac diseases. 1 Among them, the congenital long QT syndrome type-3 and the Brugada syndrome are caused by gain or loss-of-function of Na v 1.5, respectively. 1 Na v 1.5 is the pore-forming ␣-subunit protein of the cardiac sodium channel. It has a molecular weight of Ϸ220 kDa, and may be associated with at least 4 types of auxiliary small (30 to 35 kDa) -subunits. Recently, several proteins that bind directly to Na v 1.5 have been described. 2 However, in most cases the physiological relevance of these interactions remains poorly understood, mainly because of a lack of appropriate animal models. With the exception of ankyrin-G, 3 all these partner proteins interact with the 243-residues-long intracellular C-terminal domain of the channel which contains several protein-protein interaction motifs. 2 Among them, the last three residues of Na v 1.5 (2014-Ser-Ile-Val-2016) constitute a PDZ domain-binding motif to which syntrophins and dystrophin have been shown to interact directly or indirectly, respectively. 4 -6 However, thus far, the role of these interacting proteins in the heart has never been investigated.In this study, by performing mass spe...