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<meta name="description" content="Our results demonstrate a normalizing effect of CBZ on mutant Na(v)1.7 channels in this kindred with CBZ-responsive inherited erythromelalgia. The selective effect of CBZ on the mutant Na(v)1.7 channel appears to explain the ameliorative response to treatment in this kindred. Our results suggest tha …"><meta name="keywords" content="pmid:19557861, PMC4103031, doi:10.1002/ana.21678, Case Reports, Comparative Study, Research Support, Non-U.S. Gov&#x27;t, Research Support, U.S. Gov&#x27;t, Non-P.H.S., Tanya Z Fischer, Elaine S Gilmore, Stephen G Waxman, Adult, Anticonvulsants / therapeutic use*, Carbamazepine / therapeutic use*, Cell Line, Erythromelalgia / diagnosis, Erythromelalgia / drug therapy*, Erythromelalgia / genetics*, Female, Humans, Male, Mutation* / drug effects, NAV1.7 Voltage-Gated Sodium Channel, Pedigree, Sodium Channels / genetics*, PubMed Abstract, NIH, NLM, NCBI, National Institutes of Health, National Center for Biotechnology Information, National Library of Medicine, MEDLINE"><meta name="robots" content="index,nofollow,noarchive"><meta property="og:title" content="A novel Nav1.7 mutation producing carbamazepine-responsive erythromelalgia - PubMed"><meta property="og:url" content="https://pubmed.ncbi.nlm.nih.gov/19557861/"><meta property="og:description" content="Our results demonstrate a normalizing effect of CBZ on mutant Na(v)1.7 channels in this kindred with CBZ-responsive inherited erythromelalgia. The selective effect of CBZ on the mutant Na(v)1.7 channel appears to explain the ameliorative response to treatment in this kindred. Our results suggest tha …"><meta property="og:image" content="https://cdn.ncbi.nlm.nih.gov/pubmed/persistent/pubmed-meta-image-v2.jpg"><meta property="og:image:secure_url" content="https://cdn.ncbi.nlm.nih.gov/pubmed/persistent/pubmed-meta-image-v2.jpg"><meta property="og:type" content="website"><meta property="og:site_name" content="PubMed"><meta name="twitter:domain" content="pubmed.ncbi.nlm.nih.gov"><meta name="twitter:card" content="summary_large_image"><meta name="twitter:title" content="A novel Nav1.7 mutation producing carbamazepine-responsive erythromelalgia - PubMed"><meta name="twitter:url" content="https://pubmed.ncbi.nlm.nih.gov/19557861/"><meta name="twitter:description" content="Our results demonstrate a normalizing effect of CBZ on mutant Na(v)1.7 channels in this kindred with CBZ-responsive inherited erythromelalgia. The selective effect of CBZ on the mutant Na(v)1.7 channel appears to explain the ameliorative response to treatment in this kindred. Our results suggest tha …"><meta name="twitter:image" content="https://cdn.ncbi.nlm.nih.gov/pubmed/persistent/pubmed-meta-image-v2.jpg">
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<input type="email" aria-label="Sender Email Address" placeholder="email@example.com" id="email-from" class="email-from" pattern="^[a-zA-Z0-9_.+-]+@[a-zA-Z0-9-]+\.[a-zA-Z0-9-.]+$" maxlength="256">
</div>
<div class="action-panel-control-wrap">
<label for="email-citation-format" class="action-panel-label">
Format:
</label>
<select id="email-citation-format" name="citation-format" class="action-panel-selector email-citation-format">
<option selected="selected" value="summary">Summary</option>
<option value="summary-text">Summary (text)</option>
<option value="abstract">Abstract</option>
<option value="abstract-text">Abstract (text)</option>
</select>
</div>
<div class="include-supplemental-container">
<input type="checkbox" aria-label="Include MeSH and other data" name="include-supplemental" id="email-include-supplemental" class="email-include-supplemental">
<label for="email-include-supplemental" class="email-include-supplemental-label">MeSH and other data</label>
</div>
<div class="form-field recaptcha ">
<div class="g-recaptcha" id="id-recaptcha" data-sitekey="6LfsWHMdAAAAAClKbtOpjQ2pMjgsGxvv7NdZW9uI"></div>
</div>
<div id="captcha-error-message" class="usa-input-error-message captcha-validation-message" role="alert"></div>
<div class="action-panel-actions">
<button class="action-panel-submit"
type="submit"
data-loading-label="Sending..."
data-ga-category="save_share"
data-ga-action="email"
data-ga-label="send">
Send email
</button>
<button class="action-panel-cancel"
aria-label="Close 'Email citations' panel"
ref="linksrc=close_email_panel"
aria-controls="email-action-panel"
aria-expanded="false"
data-ga-category="save_share"
data-ga-action="email"
data-ga-label="cancel">
Cancel
</button>
</div>
<input type="hidden" name="email-search-details" value="" />
<input type="hidden" name="email-search-details-hash" value="0e42663a6c3bd85498fcb88798998fed7bfdc45d457db35281e41afe13cc0524" />
</form>
</div>
</div>
<div id="collections-action-panel"
class="collections-action-panel action-panel in-progress-dots-panel"
aria-hidden="true"
data-collections-open-panel-enabled="false"
data-collections-open-panel-url-hash="#open-collections-panel">
<div class="inner-wrap">
<h3 class="action-panel-heading">
Add to Collections
</h3>
<form id="collections-action-panel-form"
class="collections-action-panel-form action-panel-content action-form action-panel-smaller-selectors"
data-existing-collections-url="/list-existing-collections/"
data-add-to-existing-collection-url="/add-to-existing-collection/"
data-create-and-add-to-new-collection-url="/create-and-add-to-new-collection/"
data-get-article-ids-by-search-url="/get-article-ids-by-search/"
data-myncbi-max-collection-name-length="100"
data-add-to-collection-max-amount="1000"
data-collections-root-url="https://www.ncbi.nlm.nih.gov/myncbi/collections/">
<input type="hidden" name="csrfmiddlewaretoken" value="aK3t3syfxNe1zLV4YrlTai3O5eD6hBcirxNyGi1B7o1vtc1UBKYVEqzsDiliacKC">
<div class="choice-group" role="radiogroup">
<ul class="radio-group-items">
<li>
<input type="radio"
id="collections-action-panel-new"
class="collections-new"
name="collections"
value="new"
data-ga-category="save_share"
data-ga-action="collections"
data-ga-label="collections_radio_new">
<label for="collections-action-panel-new">Create a new collection</label>
</li>
<li>
<input type="radio"
id="collections-action-panel-existing"
class="collections-existing"
name="collections"
value="existing"
checked="true"
data-ga-category="save_share"
data-ga-action="collections"
data-ga-label="collections_radio_existing">
<label for="collections-action-panel-existing">Add to an existing collection</label>
</li>
</ul>
</div>
<div class="controls-wrapper">
<div class="action-panel-control-wrap new-collections-controls">
<label for="collections-action-panel-add-to-new" class="action-panel-label required-field-asterisk">
Name your collection:
</label>
<input
type="text"
name="add-to-new-collection"
id="collections-action-panel-add-to-new"
class="collections-action-add-to-new"
pattern="[^&quot;&amp;=&lt;&gt;\/]*" title="The following characters are not allowed in the Name field: &quot;&amp;=&lt;&gt;/"
maxlength="100"
data-ga-category="save_share"
data-ga-action="create_collection"
data-ga-label="non_favorties_collection">
<div class="collections-new-name-too-long usa-input-error-message selection-validation-message">
Name must be less than 100 characters
</div>
</div>
<div class="action-panel-control-wrap existing-collections-controls">
<label for="collections-action-panel-add-to-existing" class="action-panel-label">
Choose a collection:
</label>
<select id="collections-action-panel-add-to-existing"
class="action-panel-selector collections-action-add-to-existing"
data-ga-category="save_share"
data-ga-action="select_collection"
data-ga-label="($('#collections-action-add-to-existing').val() === 'Favorites') ? 'Favorites' : 'non_favorites_collection'">
</select>
<div class="collections-retry-load-on-error usa-input-error-message selection-validation-message">
Unable to load your collection due to an error<br>
<a href="#">Please try again</a>
</div>
</div>
</div>
<div class="action-panel-actions">
<button class="action-panel-submit"
type="submit"
data-loading-label="Adding..."
data-pinger-ignore
data-ga-category="save_share"
data-ga-action="collections"
data-ga-label="add">
Add
</button>
<button class="action-panel-cancel"
aria-label="Close 'Add to Collections' panel"
ref="linksrc=close_collections_panel"
aria-controls="collections-action-panel"
aria-expanded="false"
data-ga-category="save_share"
data-ga-action="collections"
data-ga-label="cancel">
Cancel
</button>
</div>
</form>
</div>
</div>
<div id="bibliography-action-panel"
class="bibliography-action-panel action-panel in-progress-dots-panel"
aria-hidden="true"
data-bibliography-open-panel-enabled="false"
data-bibliography-open-panel-url-hash="#open-bibliography-panel">
<div class="inner-wrap">
<h3 class="action-panel-heading">
Add to My Bibliography
</h3>
<form id="bibliography-action-panel-form"
class="bibliography-action-panel-form action-panel-content action-form action-panel-smaller-selectors"
data-add-to-bibliography-max-amount="100"
data-add-to-bibliography-batch-size="10"
data-bibliography-delegates-url="/list-bibliography-delegates/"
data-add-to-bibliography-url="/add-to-bibliography/"
data-get-article-ids-by-search-url="/get-article-ids-by-search/"
data-mybib-root-url="https://www.ncbi.nlm.nih.gov/myncbi/collections/mybibliography/">
<input type="hidden" name="csrfmiddlewaretoken" value="aK3t3syfxNe1zLV4YrlTai3O5eD6hBcirxNyGi1B7o1vtc1UBKYVEqzsDiliacKC">
<div class="action-panel-control-wrap bibliographies-controls">
<div class="choice-group">
<ul class="bibliographies-action-add radio-group-items">
<li>
<input name="bibliography" id="my-bibliography" class="my-bibliography" type="radio" checked/>
<label for="my-bibliography">My Bibliography</label>
</li>
</ul>
</div>
</div>
<div class="bibliographies-retry-load-on-error usa-input-error-message selection-validation-message">
Unable to load your delegates due to an error<br>
<a href="#">Please try again</a>
</div>
<div class="action-panel-actions">
<button class="action-panel-submit"
type="submit"
data-loading-label="Adding..."
data-pinger-ignore>
Add
</button>
<button class="action-panel-cancel"
aria-label="Close 'Add to bibliography' panel"
ref="linksrc=close_bibliography_panel"
aria-controls="bibliography-action-panel"
aria-expanded="false"
data-ga-category="save_share"
data-ga-action="mybib"
data-ga-label="cancel">
Cancel
</button>
</div>
</form>
</div>
</div>
<div id="saved-search-action-panel" class="saved-search-action-panel action-panel " aria-hidden="true"
data-saved-search-open-panel-enabled="false"
data-saved-search-open-panel-url-hash="#open-saved-search-panel">
<div class="inner-wrap">
<h2 class="action-panel-heading">
Your saved search
</h2>
<form id="saved-search-action-panel-form"
class="saved-search-action-panel-form action-panel-content action-form"
data-create-saved-search-url="/create-saved-search/"
data-try-search-terms-url="/try-search-term/"
data-saved-search-root-url="https://www.ncbi.nlm.nih.gov/myncbi/searches/">
<input type="hidden" name="csrfmiddlewaretoken" value="aK3t3syfxNe1zLV4YrlTai3O5eD6hBcirxNyGi1B7o1vtc1UBKYVEqzsDiliacKC">
<div class="action-panel-control-wrap">
<label for="saved-search-name" class="action-panel-label saved-search-name-label required-field-asterisk">
Name of saved search:
</label>
<input maxlength="200"
type="text"
name="saved-search-name"
id="saved-search-name"
class="saved-search-name"
value=""
required
pattern="[^&quot;&amp;=&lt;&gt;\/]*" title="The following characters are not allowed in the Name field: &quot;&amp;=&lt;&gt;/">
</div>
<div class="action-panel-control-wrap">
<label for="saved-search-term" class="action-panel-label required-field-asterisk">
Search terms:
</label>
<textarea name="saved-search-term" id="saved-search-term" class="saved-search-term" required></textarea>
</div>
<div class="test-search-term-wrap">
<a href="#" class="try-search-term">Test search terms</a>
</div>
<div class="choice-group action-panel-extra-margin-top">
<span class="action-panel-label" id="fieldset-label">
Would you like email updates of new search results?
</span>
<fieldset id="saved-search-alert" aria-describedby="fieldset-label">
<legend class="usa-sr-only">Saved Search Alert Radio Buttons</legend>
<ul class="radio-group-items">
<li>
<input type="radio" id="saved-search-alert-yes" class="saved-search-alert-yes" name="saved-search-alert" value="yes" checked>
<label for="saved-search-alert-yes" class="action-panel-label">Yes</label>
</li>
<li>
<input aria-label="No radio input" type="radio" id="saved-search-alert-no" class="saved-search-alert-no" name="saved-search-alert" value="no">
<label for="saved-search-alert-no" class="action-panel-label">No</label>
</li>
</ul>
</fieldset>
</div>
<div class="alert-schedule-wrap">
<div class="action-panel-control-wrap">
<label class="action-panel-label">
Email:
</label>
<span aria-label="Email address" id="saved-search-email" class="action-panel-label"><span class="action-panel-label-bold"></span> (<a class="myncbi-account-settings" href="https://www.ncbi.nlm.nih.gov/account/settings/">change</a>)</span>
</div>
<div class="action-panel-control-wrap action-panel-extra-margin-top">
<label for="saved-search-frequency" class="action-panel-label">
Frequency:
</label>
<select id="saved-search-frequency" class="no-border-panel-selector saved-search-frequency">
<option value="monthly">Monthly</option>
<option value="weekly">Weekly</option>
<option value="daily">Daily</option>
</select>
</div>
<div class="action-panel-control-wrap saved-search-monthly-additional">
<label for="saved-search-monthly-on-day" class="action-panel-label">
Which day?
</label>
<select id="saved-search-monthly-on-day" class="no-border-panel-selector">
<option value="Sunday">The first Sunday</option>
<option value="Monday">The first Monday</option>
<option value="Tuesday">The first Tuesday</option>
<option value="Wednesday">The first Wednesday</option>
<option value="Thursday">The first Thursday</option>
<option value="Friday">The first Friday</option>
<option value="Saturday">The first Saturday</option>
<option value="day">The first day</option>
<option value="weekday">The first weekday</option>
</select>
</div>
<div class="action-panel-control-wrap saved-search-weekly-additional">
<label for="saved-search-weekly-on-day" class="action-panel-label">
Which day?
</label>
<select id="saved-search-weekly-on-day" class="no-border-panel-selector saved-search-weekly-on-day">
<option value="Sunday">Sunday</option>
<option value="Monday">Monday</option>
<option value="Tuesday">Tuesday</option>
<option value="Wednesday">Wednesday</option>
<option value="Thursday">Thursday</option>
<option value="Friday">Friday</option>
<option value="Saturday">Saturday</option>
</select>
</div>
<div class="action-panel-control-wrap">
<label for="saved-search-report" class="action-panel-label">
Report format:
</label>
<select id="saved-search-report" class="no-border-panel-selector saved-search-report">
<option value="DocSum">Summary</option>
<option value="DocSumText">Summary (text)</option>
<option value="Abstract">Abstract</option>
<option value="AbstractText">Abstract (text)</option>
<option value="MEDLINE">PubMed</option>
</select>
</div>
<div class="action-panel-control-wrap">
<label for="saved-search-amount" class="action-panel-label">
Send at most:
</label>
<select id="saved-search-amount" class="no-border-panel-selector saved-search-amount">
<option value="1">1 item</option>
<option value="5" selected>5 items</option>
<option value="10">10 items</option>
<option value="20">20 items</option>
<option value="50">50 items</option>
<option value="100">100 items</option>
<option value="200">200 items</option>
</select>
</div>
<div>
<input type="checkbox" id="saved-search-send-if-no-result" class="saved-search-send-if-no-result" name="saved-search-send-if-no-result">
<label for="saved-search-send-if-no-result" class="action-panel-label smaller-checkbox">
Send even when there aren't any new results
</label>
</div>
<div class="action-panel-control-wrap option-text-in-email-wrap">
<label for="saved-search-email-text" class="action-panel-label">
Optional text in email:
</label>
<textarea name="saved-search-email-text"
id="saved-search-email-text"
class="saved-search-email-text"></textarea>
</div>
</div>
<div class="action-panel-actions">
<button class="action-panel-submit"
type="submit"
data-loading-label="Saving..."
data-ga-category="save_share"
data-ga-action="alert"
data-ga-label="save">
Save
</button>
<button class="action-panel-cancel"
aria-label="Close 'Your saved search' panel"
ref="linksrc=close_saved_search_panel"
aria-controls="saved-search-action-panel"
aria-expanded="false"
data-ga-category="save_share"
data-ga-action="alert"
data-ga-label="cancel">
Cancel
</button>
</div>
</form>
</div>
</div>
<div id="citation-manager-action-panel" class="citation-manager-action-panel action-panel" aria-hidden="true">
<div class="inner-wrap">
<h2 class="action-panel-heading">
Create a file for external citation management software
</h2>
<form id="citation-manager-action-panel-form"
class="action-panel-content action-form"
action="/results-export-ids/"
data-by-search-action="/results-export-search-data/"
data-by-ids-action="/results-export-ids/"
method="post"
data-by-search-method="post"
data-by-ids-method="post">
<input type="hidden" name="csrfmiddlewaretoken" value="aK3t3syfxNe1zLV4YrlTai3O5eD6hBcirxNyGi1B7o1vtc1UBKYVEqzsDiliacKC">
<input name="results-format" type="hidden" value="pubmed"/>
<div class="action-panel-actions">
<button class="action-panel-submit"
type="submit"
data-loading-label="Sending..."
data-ga-category="save_share"
data-ga-action="citation_manager"
data-ga-label="save">
Create file
</button>
<button class="action-panel-cancel"
aria-label="Close 'Send citations to citation manager' panel"
ref="linksrc=close_citation_manager_panel"
aria-controls="citation-manager-action-panel"
aria-expanded="false"
data-ga-category="save_share"
data-ga-action="citation_manager"
data-ga-label="cancel">
Cancel
</button>
</div>
</form>
</div>
</div>
<div id="rss-action-panel" class="rss-action-panel action-panel " aria-hidden="true">
<div class="inner-wrap">
<h2 class="action-panel-heading">
Your RSS Feed
</h2>
<form id="rss-action-panel-form"
class="rss-action-panel-form action-panel-content action-form"
data-create-rss-feed-url="/create-rss-feed-url/"
data-search-form-term-value="">
<input type="hidden" name="csrfmiddlewaretoken" value="aK3t3syfxNe1zLV4YrlTai3O5eD6hBcirxNyGi1B7o1vtc1UBKYVEqzsDiliacKC">
<div class="action-panel-control-wrap">
<label for="rss-name" class="action-panel-label required-field-asterisk">
Name of RSS Feed:
</label>
<input maxlength="200"
placeholder="Name"
type="text"
name="rss-name"
id="rss-name"
class="rss-name"
value=''
required
pattern="[^&quot;&amp;=&lt;&gt;\/]*" title="The following characters are not allowed in the Name field: &quot;&amp;=&lt;&gt;/">
</div>
<div class="rss-limit-wrap">
<div class="action-panel-control-wrap action-panel-extra-margin-top">
<label for="rss-limit" class="action-panel-label">
Number of items displayed:
</label>
<select id="rss-limit" class="no-border-panel-selector rss-limit">
<option value="5">5</option>
<option value="10">10</option>
<option value="15" selected="selected">15</option>
<option value="20">20</option>
<option value="50">50</option>
<option value="100">100</option>
</select>
</div>
</div>
<div class="action-panel-actions">
<button class="action-panel-submit"
type="submit"
data-loading-label="Creating..."
data-ga-category="save_share"
data-ga-action="alert"
data-ga-label="save">
Create RSS
</button>
<button class="action-panel-cancel"
aria-label="Close 'Your RSS' panel"
ref="linksrc=close_rss_panel"
aria-controls="rss-action-panel"
aria-expanded="false"
data-ga-category="save_share"
data-ga-action="alert"
data-ga-label="cancel">
Cancel
</button>
</div>
<div class="action-panel-control-wrap rss-link-copy-wrap">
<label for="rss-link" class="usa-sr-only">RSS Link</label>
<input placeholder="Your RSS Feed Link" type="text" name="rss-link" id="rss-link" class="rss-link" title="RSS Link">
<button
type="button"
disabled
class="rss-link-copy-button disabled"
data-ga-category="save_share"
data-ga-action="rss"
data-ga-label="copy">
Copy
</button>
</div>
</form>
</div>
</div>
</div>
</div>
<div class="article-page" id="article-page" data-article-pmid="19557861">
<aside class="page-sidebar">
<div class="inner-wrap">
<div class="full-text-links">
<div class="full-view">
<h3 class="title">
Full text links
</h3>
<div class="full-text-links-list">
<a class="link-item
dialog-focus"
href="https://doi.org/10.1002/ana.21678"
target="_blank"
rel="noopener"
ref="linksrc=fulltextorjournal_fulltext&amp;is_pmc=False&amp;PrId=3058&amp;itool=Abstract-def&amp;log$=linkouticon&amp;uid=19557861&amp;db=pubmed&amp;nlmid=7707449"
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><img src="https://cdn.ncbi.nlm.nih.gov/corehtml/query/egifs/http:--media.wiley.com-assets-7388-69-wiley-full-text.png" alt="Wiley full text link"><span class="text">
Wiley
</span></a><a class="link-item
pmc
"
href="https://pmc.ncbi.nlm.nih.gov/articles/pmid/19557861/"
target="_blank"
rel="noopener"
ref="linksrc=fulltextorjournal_fulltext&amp;is_pmc=True&amp;PrId=3494&amp;itool=Abstract-def&amp;log$=linkouticon&amp;uid=19557861&amp;db=pubmed&amp;nlmid=7707449"
title="Free full text at PubMed Central"
data-ga-category="full_text"
data-ga-action="PMC"
data-ga-label="19557861"
><span class="text">
Free PMC article
</span></a>
</div>
</div>
<div class="short-view">
<a href="#" class="full-text-links-button full-text-links-dialog-trigger">
Full text links
</a>
</div>
</div>
<div class="actions-buttons sidebar"><h3 class="title">Actions</h3><div class="inner-wrap"><button class="citation-button citation-dialog-trigger"
aria-label="Open dialog with citation text in different styles"
data-ga-category="save_share"
data-ga-action="cite"
data-ga-label="open"
data-all-citations-url="/19557861/citations/"
data-citation-style="nlm"
data-pubmed-format-link="/19557861/export/"><span class="button-label">Cite</span></button><link type="text/css" href="ncbi-overlay-block/src/overlay-block.css"><div class="collections-button-container" data-article-id="19557861" data-article-db="pubmed"><button class="collections-button collections-dialog-trigger"
aria-label="Save article in MyNCBI collections."
data-ga-category="collections_button"
data-ga-action="click"
data-ga-label="collections_button"
data-collections-open-dialog-enabled="false"
data-collections-open-dialog-url="https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F19557861%2F%23open-collections-dialog"
data-in-collections="false"><span class="button-label">Collections</span></button><div class="overlay" role="dialog"><div id="collections-action-dialog"
class="dialog collections-dialog"
aria-hidden="true"><div class="title">Add to Collections</div><div class="collections-action-panel action-panel"><form id="collections-action-dialog-form"
class="collections-action-panel-form action-panel-content action-form action-panel-smaller-selectors"
data-existing-collections-url="/list-existing-collections/"
data-add-to-existing-collection-url="/add-to-existing-collection/"
data-create-and-add-to-new-collection-url="/create-and-add-to-new-collection/"
data-myncbi-max-collection-name-length="100"
data-collections-root-url="https://www.ncbi.nlm.nih.gov/myncbi/collections/"><input type="hidden" name="csrfmiddlewaretoken" value="aK3t3syfxNe1zLV4YrlTai3O5eD6hBcirxNyGi1B7o1vtc1UBKYVEqzsDiliacKC"><div class="choice-group" role="radiogroup"><ul class="radio-group-items"><li><input type="radio"
id="collections-action-dialog-new"
class="collections-new"
name="collections"
value="new"
data-ga-category="collections_button"
data-ga-action="click"
data-ga-label="collections_radio_new"><label for="collections-action-dialog-new">Create a new collection</label></li><li><input type="radio"
id="collections-action-dialog-existing"
class="collections-existing"
name="collections"
value="existing"
checked="true"
data-ga-category="collections_button"
data-ga-action="click"
data-ga-label="collections_radio_existing"><label for="collections-action-dialog-existing">Add to an existing collection</label></li></ul></div><div class="controls-wrapper"><div class="action-panel-control-wrap new-collections-controls"><label for="collections-action-dialog-add-to-new" class="action-panel-label required-field-asterisk">
Name your collection:
</label><input
type="text"
name="add-to-new-collection"
id="collections-action-dialog-add-to-new"
class="collections-action-add-to-new"
pattern="[^&quot;&amp;=&lt;&gt;\/]*" title="The following characters are not allowed in the Name field: &quot;&amp;=&lt;&gt;/"
maxlength="100"
data-ga-category="collections_button"
data-ga-action="create_collection"
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Abstract
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<p>
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Objective:
</strong>
Human and animal studies have shown that Na(v)1.7 sodium channels, which are preferentially expressed within nociceptors and sympathetic neurons, play a major role in inflammatory and neuropathic pain. Inherited erythromelalgia (IEM) has been linked to gain-of-function mutations of Na(v)1.7. We now report a novel mutation (V400M) in a three-generation Canadian family in which pain is relieved by carbamazepine (CBZ).
</p>
<p>
<strong class="sub-title">
Methods:
</strong>
We extracted genomic DNA from blood samples of eight members of the family, and the sequence of SCN9A coding exons was compared with the reference Na(v)1.7 complementary DNA. Wild-type Na(v)1.7 and V400M cell lines were then analyzed using whole-cell patch-clamp recording for changes in activation, deactivation, steady-state inactivation, and ramp currents.
</p>
<p>
<strong class="sub-title">
Results:
</strong>
Whole-cell patch-clamp studies of V400M demonstrate changes in activation, deactivation, steady-state inactivation, and ramp currents that can produce dorsal root ganglia neuron hyperexcitability that underlies pain in these patients. We show that CBZ, at concentrations in the human therapeutic range, normalizes the voltage dependence of activation and inactivation of this inherited erythromelalgia mutation in Na(v)1.7 but does not affect these parameters in wild-type Na(v)1.7.
</p>
<p>
<strong class="sub-title">
Interpretation:
</strong>
Our results demonstrate a normalizing effect of CBZ on mutant Na(v)1.7 channels in this kindred with CBZ-responsive inherited erythromelalgia. The selective effect of CBZ on the mutant Na(v)1.7 channel appears to explain the ameliorative response to treatment in this kindred. Our results suggest that functional expression and pharmacological studies may provide mechanistic insights into hereditary painful disorders.
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<p xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:p1="http://pubmed.gov/pub-one">Potential conflict of interest: Nothing to report.</p>
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<p> Fig 1 </p>
</strong>
<div class="figure-caption-contents"><p> Inheritance pattern of the V400M… </p></div>
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<p> Fig 1 </p>
</strong>
<div class="figure-caption-contents"><p> Inheritance pattern of the V400M mutation in Na <sub> v </sub> 1.7 associated with carbamazepine… </p></div>
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Fig 1
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<div class="figure-caption-contents">Inheritance pattern of the V400M mutation in Na<sub>v</sub>1.7 associated with carbamazepine (CBZ)-responsive inherited erythromelalgia (IEM). A three-generation Canadian family with the affected patients all having similar symptoms; the proband is indicated by an <i>arrow. Circles</i> denote female subjects; <i>squares</i> denote male subjects; <i>black symbols</i> indicate subjects affected with inherited erythromelalgia; <i>plus signs</i> denote subjects heterozygous for the V400M mutation in exon 9; and <i>minus sign</i> denotes subjects without the mutation. CBZ+ = pain relief from CBZ treatment; CBZ ND = the effect of CBZ on the patients symptoms is unknown.</div>
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<p> Fig 2 </p>
</strong>
<div class="figure-caption-contents"><p> V400M mutation shifts activation. (A,… </p></div>
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<div class="figure-caption-medium figure-caption-text" aria-hidden="true">
<strong class="figure-label">
<p> Fig 2 </p>
</strong>
<div class="figure-caption-contents"><p> V400M mutation shifts activation. (A, B) Representative traces from human embryonic kidney (HEK)… </p></div>
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<figcaption id="figure-caption-1" class="figure-caption-full figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="description">
<strong class="figure-label">
Fig 2
</strong>
<div class="figure-caption-contents">V400M mutation shifts activation. (A, B) Representative traces from human embryonic kidney (HEK) 293 cells stably expressing wild-type (WT; A) and V400M (B) mutant Na<sub>v</sub>1.7 channels resulting from voltage steps for generation of activation curves as described in Subjects and Methods. (C) Normalized current-voltage relations generated from activation curves from cells expressing V400M (n = 18; <i>black squares</i>) or WT (n = 15; <i>blue circles</i>) Na<sub>v</sub>1.7 channels. (D) Voltage-dependent hyperpolarizing shift in activation is demonstrated by Boltzmann fits of activation curves from cells expressing V400M (n = 18) or WT (n = 15) Na<sub>v</sub>1.7 channels (V400M: V<sub>1/2</sub> = 50.4 ± 1.64mV; WT: V<sub>1/2</sub> = 43.9 ± 1.47mV; <i>p</i> &lt; 0.01).</div>
</figcaption>
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<strong class="figure-label">
<p> Fig 3 </p>
</strong>
<div class="figure-caption-contents"><p> Further characterization of the V400M… </p></div>
</div>
</div>
<div class="figure-caption-medium figure-caption-text" aria-hidden="true">
<strong class="figure-label">
<p> Fig 3 </p>
</strong>
<div class="figure-caption-contents"><p> Further characterization of the V400M mutation. (A) Voltage dependence of steady-state inactivation shows… </p></div>
</div>
<figcaption id="figure-caption-2" class="figure-caption-full figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="description">
<strong class="figure-label">
Fig 3
</strong>
<div class="figure-caption-contents">Further characterization of the V400M mutation. (A) Voltage dependence of steady-state inactivation shows a depolarizing shift in cells expressing V400M mutants (n = 19; <i>black squares</i>) as compared with wild-type (WT) channels (n = 25; <i>blue circles</i>) (V400M: V<sub>1/2</sub> = 82.8 ± 1.44mV; WT: V<sub>1/2</sub> = 90.1 ± 1.44mV; <i>p</i> &lt; 0.001). (B) Composite graph showing Boltzmann fits of activation and steady-state inactivation curves of V400M mutant versus WT channels shows an increase in overlap window current (enlarged in C: blue represents WT and black represent V400M). (D) Kinetics of fast inactivation as measured by fits of the time constant (τ) are unchanged in cells expressing V400M mutants (n = 18; <i>black squares</i>) versus WT (n = 15; <i>blue circles</i>) channels (not significant). (E) Progressive slowing of the deactivation time constant (τ) is observed in cells expressing V400M mutant channels (n = 20) compared with WT channels (n = 24) (**<i>p</i> &lt; 0.0005; *<i>p</i> &lt; 0.005; <sup>++</sup><i>p</i> &lt; 0.02; <sup>+</sup><i>p</i> &lt; 0.05). (inset) Representative currents and prolonged deactivation at 50mV. <i>Blue solid line</i> represents 1.7R WT; <i>black dashed line</i> represents 1.7R V400M. (F) Voltage dependence of slow inactivation is unchanged in cells expressing V400M mutant channels (n = 18; <i>black squares</i>) versus WT channels (n = 16; <i>blue circles</i>) (V400M: V<sub>1/2</sub> = 76.2 ± 3.9mV; WT: V<sub>1/2</sub> = 73.9 ± 3.9 mV; <i>p</i> value is not significant).</div>
</figcaption>
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data-image-alt="Fig 4"
data-pmc-id="PMC4103031"
data-figure-id="F4">
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id="article-image-3"
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<strong class="figure-label">
<p> Fig 4 </p>
</strong>
<div class="figure-caption-contents"><p> Response to slow-voltage-ramp currents was… </p></div>
</div>
</div>
<div class="figure-caption-medium figure-caption-text" aria-hidden="true">
<strong class="figure-label">
<p> Fig 4 </p>
</strong>
<div class="figure-caption-contents"><p> Response to slow-voltage-ramp currents was assessed in human embryonic kidney (HEK) cells expressing… </p></div>
</div>
<figcaption id="figure-caption-3" class="figure-caption-full figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="description">
<strong class="figure-label">
Fig 4
</strong>
<div class="figure-caption-contents">Response to slow-voltage-ramp currents was assessed in human embryonic kidney (HEK) cells expressing V400M mutant channels <i>(black line)</i> or wild-type (WT; <i>blue line</i>) channels. Shown are representative traces of inward currents (expressed as percentage of peak current obtained with the activation protocol) in response to slow-voltage depolarization from 120 to 20mV over a 600-millisecond time course (0.23mV/msec).</div>
</figcaption>
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<p> Fig 5 </p>
</strong>
<div class="figure-caption-contents"><p> Block of wild-type (WT) and… </p></div>
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<div class="figure-caption-medium figure-caption-text" aria-hidden="true">
<strong class="figure-label">
<p> Fig 5 </p>
</strong>
<div class="figure-caption-contents"><p> Block of wild-type (WT) and V400M mutant Na currents by carbamazepine (CBZ). (A)… </p></div>
</div>
<figcaption id="figure-caption-4" class="figure-caption-full figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="description">
<strong class="figure-label">
Fig 5
</strong>
<div class="figure-caption-contents">Block of wild-type (WT) and V400M mutant Na currents by carbamazepine (CBZ). (A) The holding potential was set to 120mV to maintain the channels in the resting (closed) state; then the current available for activation was elicited by a 20-millisecond pulse to 0mV. The fractional block is given by dividing the current measured in the presence of the indicated concentration of CBZ by the current elicited in the same cell just before compound addition. The IC<sub>50</sub> fitted to the WT data <i>(blue circles)</i> is 1,350 ± 230µM (adjusted <i>R</i><sup>2</sup> = 0.98). The IC<sub>50</sub> fitted to the V400M data <i>(black squares)</i> is 970 ± 30µM (adjusted <i>R</i><sup>2</sup> = 0.99). (B) To evaluate block of inactivated Na channels, we applied a 10-second conditioning pulse to 50mV followed by a 100-millisecond pulse to 120mV to recover from fast inactivation; then the test pulse to 0mV was applied. The IC<sub>50</sub> fitted to the WT data <i>(blue circles)</i> is 1,100 ± 80µM (adjusted <i>R</i><sup>2</sup> = 0.98). The IC<sub>50</sub> fitted to the V400M data <i>(black squares)</i> is 1,030 ± 160µM (adjusted <i>R</i><sup>2</sup> = 0.89).</div>
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<p> Fig 6 </p>
</strong>
<div class="figure-caption-contents"><p> Carbamazepine (CBZ) normalizes the gating… </p></div>
</div>
</div>
<div class="figure-caption-medium figure-caption-text" aria-hidden="true">
<strong class="figure-label">
<p> Fig 6 </p>
</strong>
<div class="figure-caption-contents"><p> Carbamazepine (CBZ) normalizes the gating properties of the V400M mutation. (A) Depolarizing shifts… </p></div>
</div>
<figcaption id="figure-caption-5" class="figure-caption-full figure-caption-text" itemtype="http://schema.org/ImageObject" itemprop="description">
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Fig 6
</strong>
<div class="figure-caption-contents">Carbamazepine (CBZ) normalizes the gating properties of the V400M mutation. (A) Depolarizing shifts in the voltage dependence of activation are observed in human embryonic kidney (HEK) 293 cells stably expressing the V400M mutation in response to increasing concentrations of CBZ (V<sub>1/2 DMSO</sub> = 47.9 ± 2.93mV; V<sub>1/2 10µM CBZ</sub> = 36.9 ± 1.2mV; V<sub>1/2 100µM CBZ</sub> = 37.3 ± 2.72mV). <i>Black circles</i> designate V400M + DMSO (n = 6); <i>green upward triangles</i> designate V400M + 10µM CBZ (n = 19); <i>blue downward triangles</i> designate V400M + 100µM CBZ (n = 8). (B) CBZ treatment of HEK 293 cells expressing wild-type channels does not affect the voltage dependence of activation (V<sub>1/2 DMSO</sub> = 36.6 ± 2.63mV; V<sub>1/2 10µM CBZ</sub> = 37.9 ± 1.7mV; V<sub>1/2 100µM CBZ</sub> = 40.5 ± 3.28mV). <i>Black squares</i> designate WT + DMSO (n = 9); <i>orange circles</i> designate WT + 10µM CBZ (n = 10); <i>blue upward triangles</i> designate V400M + 100µM CBZ (n = 7). (C) Hyperpolarizing shifts in the voltage dependence of steadystate fast inactivation are observed with CBZ treatment of V400M-expressing cells (V<sub>1/2 DMSO</sub> = 87.2 ± 1.97mV; V<sub>1/2 10µM CBZ</sub> = 91.7 ± 1.5mV; V<sub>1/2 100µM CBZ</sub> = 92.9 ± 2.65mV). <i>Black circles</i> designate V400M + DMSO (n = 8); <i>green upward triangles</i> designate V400M + 10µM CBZ (n = 19); <i>blue downward triangles</i> designate V400M + 100µM CBZ (n = 8). (D) Voltage dependence of steady-state fast inactivation is unchanged by CBZ treatment of cells expressing wild-type channels (V<sub>1/2 DMSO</sub> = 93.1 ± 3.32mV; V<sub>1/2 10µM CBZ</sub> = 94.1 ± 0.76mV; V<sub>1/2 100µM CBZ</sub> = 94.7 ± 1.63mV). <i>Black squares</i> designate WT + DMSO (n = 5); <i>orange circles</i> designate WT + 10µM CBZ (n = 9); <i>blue upward triangles</i> designate V400M + 100µM CBZ (n = 8). (E) The concentrationresponse curve for the CBZ-induced shifts of the V<sub>1/2</sub> of activation is plotted for a range of CBZ pretreatment concentrations. Data points are the averages of the activation V<sub>1/2</sub> values obtained by fitting a Boltzmann function to the GV (conductance-voltage) curves (n = 519). A logistic fit of the data suggests that the EC<sub>50</sub> for CBZ to normalize the V<sub>1/2</sub> of V400M toward the WT value is 3.4 ± 0.5µM (adjusted <i>R</i><sup>2</sup> = 0.98) with a power coefficient of 3.7. DMSO = dimethylsulfoxide.</div>
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