Abstract-The sarcolemmal Naϩ -Ca 2ϩ exchanger (NCX) is the main Ca 2ϩ extrusion mechanism in cardiac myocytes and is thus essential for the regulation of Ca 2ϩ homeostasis and contractile function. A cytosolic region (f-loop) of the protein mediates regulation of NCX function by intracellular factors including inhibition by exchanger inhibitory peptide (XIP), a 20 amino acid peptide matching the sequence of an autoinhibitory region involved in allosteric regulation of NCX by intracellular Na ϩ , Ca 2ϩ , and phosphatidylinositol-4,5-biphosphate (PIP 2 ). Previous evidence indicates that the XIP interaction domain can be eliminated by large deletions of the f-loop that also remove activation of NCX by intracellular Ca 2ϩ . By whole-cell voltage clamping experiments, we demonstrate that deletion of residues 562-679, but not 440 -456, 498 -510, or 680 -685 of the f-loop selectively eliminates XIP-mediated inhibition of NCX expressed either heterologously (HEK293 and A549 cells) or in guinea pig cardiac myocytes. In contrast, by plotting I NCX against reverse-mode NCX-mediated Ca 2ϩ transients in myocytes, we demonstrate that Ca 2ϩ -dependent regulation of NCX is preserved in ⌬562-679, but significantly reduced in the other three deletion mutants. The findings indicate that f-loop residues 562-679 may contain the regulatory site for endogenous XIP, but this site is distinct from the Ca 2ϩ -regulatory domains of the NCX. Because regulation of the NCX by Na ϩ and PIP 2 involves the endogenous XIP region, the ⌬562-679 mutant NCX may be a useful tool to investigate this regulation in the context of the whole cardiac myocyte. Key Words: cardiac myocytes Ⅲ adenovirus Ⅲ mutation T he sarcolemmal cardiac Na ϩ -Ca 2ϩ exchanger (NCX) catalyzes the exchange of three 1 or possibly four 2 Na ϩ ions for one Ca 2ϩ ion across the membrane. Depending on electrochemical gradients and membrane potential, the NCX functions in either the Ca 2ϩ -efflux (forward) or Ca 2ϩ -influx (reverse) mode. In larger animals and in man, the NCX removes Ϸ30% of the total systolic Ca 2ϩ during an intracellular Ca 2ϩ (Ca 2ϩ i ) transient to the extracellular space during diastole, matching the systolic influx via the L-type Ca 2ϩ channel at steady-state. 3 Under physiological conditions, reverse-mode NCX contributes only a small part to the Ca 2ϩ i transient during the early phase of the action potential (AP). In chronic heart failure, however, increased [Na ϩ ] i , decreased submembrane [Ca 2ϩ ] and prolonged AP duration may facilitate NCX-mediated Ca 2ϩ influx, which partially compensates for decreased sarcoplasmic reticulum (SR) Ca 2ϩ release. 4 -9 On the other hand, enhanced forward mode NCX activity in heart failure may contribute to SR Ca 2ϩ depletion. In this regard, inhibition of the NCX has recently been shown to increase Ca 2ϩ i transients in failing myocytes by improving SR Ca 2ϩ load. 10 Thus, it is critically important to understand the molecular basis underlying NCX regulation in the native myocyte. The NCX consists of nine transmembrane...