# Patent

## Title
Biological pacemakers including mutated hyperpolarization-activated cyclic nucleotide-gated (HCN) channels

## Abstract

A composition for implantation into cardiac tissue includes a biological pacemaker that, when implanted, expresses an effective amount of a mutated hyperpolarization-activated and cyclic nucleotide-gated (HCN) isoform to modify Ih when compared with wild-type HCN. Methods for implementing each of the biologocal pacemakers include implanting each of biologocal pacemakers into cardiac tissue.

## Background
FIELD OF THE INVENTION
The present invention relates to curative therapy for cardiac dysfunction, and, more particularly, to introduction of biological curative therapeutic agents to treat arrhythmias and cardiac pacing dysfunction.
BACKGROUND OF THE INVENTION
Cardiac contraction in a healthy human heart is initiated by spontaneous excitation of the sinoatrial (“SA”) node, which is located in the right atrium. The electric impulse generated by the SA node travels to the atrioventricular (“AV”) node where it is transmitted to the bundle of His and to the Purkinje network. The fibers in the Purkinje network branch out in many directions to facilitate coordinated contraction of the left and right ventricles. In some disease states, the heart loses some of its natural capacity to pace properly. Such dysfunction is commonly treated by implanting a pacemaker.
While effectively improving the lives of many patients, implantable pacemakers have certain technical limitations. For example, implantable pacemakers rely on a self-contained power source such as a battery and consequently have a limited lifetime before the power source is in need of replacement. Hence, an otherwise healthy patient may require multiple surgeries to replace the power source or the entire implantable pacemaker. Also, implantable pacemakers may not directly respond to physiological signals similar to the way the SA node responds to such signals.
Recently, biological methods of influencing a patient's cardiac cells have been developed, some of which include administering biopharmaceutical compositions that affect cardiac pacing. Developments in genetic engineering have produced methods for genetically modifying cardiac cells to modify non-pacemaking cardiac cells to cardiac cells or regenerates the pacing capabilities of cells in the conduction system of the heart. For example, U.S. Pat. No. 6,214,620 describes a method for modulating the excitability of ventricular cells by controlling the regulation of the expression of certain ion channels (e.g. K+ channels). PCT Publication No. WO 02/087419 and WO 05/062890A3 describe methods and systems for modulating electronic behavior of cardiac cells by genetic modification of inwardly rectifying K+ channels (IK1) in quiescent ventricular cells.
Another recent biological approach for moderating cardiac pacing involves implanting into the SA node or other suitable heart regions cells having particular ion channels that are commonly referred to as hyperpolarization-activated and cyclic nucleotide-gated (HCN) channels. For example, see PCT Publication Nos. WO 02/098286 and WO 05/062958A2. Physiologically originating in the SA node, the HCN channels play a prominent role in the control of rhythmic electrical heart activity. Cyclic nucleotides modulate the HCN channel activity, and channel activation occurs upon hyperpolarization rather than depolarization. There are four isoforms of HCN channels (HCN1-4), and each has greater or lesser prevalence in different heart regions. Because the HCN isoforms are directly involved in pacemaker current modulation and activation, implantation of HCN-expressing cells into cardiac tissue that is diseased or experiencing conduction blockage is a viable method for regulating cardiac pacemaker function.
In some situations, implanted wild type HCN isoforms may not produce or regulate sufficiently fast pacing stimuli. A need therefore exists for a biological composition or system that will ensure successful curative therapy for cardiac dysfunction. There is also a need for a method to implement such biological compositions or systems and thereby moderate cardiac pacemaker function.



BRIEF DESCRIPTION OF THE DRAWINGS
The present invention will hereinafter be described in conjunction with the following drawing figures, wherein like numerals denote like elements, and
FIG. 1 is side view depicting the right side of a heart having an anterior-lateral wall peeled back to present a portion of a heart's intrinsic conduction system and chambers of a right atrium and a right ventricle;
FIG. 2 is a cross-sectional view depicting a cardiac cell membrane including a mutated HCN-4 isoform as a HCN channel subunit according to an embodiment of the present invention;
FIG. 3 is a graph depicting superimposed current traces of Ih recorded from individual HEK293 cells transfected with the wild-type HCN-4 isoform;
FIG. 4 is a graph depicting superimposed current traces of Ih recorded from HEK293 cells transfected with the HCN-4 isoform including a T360A mutation according to an embodiment of the present invention;
FIG. 5 is a graph depicting superimposed current traces of Ih recorded from HEK293 cells transfected with the HCN-4 isoform including a TRI360-362KGM mutation according to an embodiment of the present invention;
FIG. 6 is a graph depicting superimposed current traces of Ih recorded from HEK293 cells transfected with the HCN-4 isoform including a TRI360-362AGM, Δ363-367 mutation according to an embodiment of the present invention;
FIG. 7 is a graph depicting a current-voltage relationship for HEK293 cells transfected with wild-type and mutated HCN-4 isoforms, and an inset graph depicting a voltage-clamp protocol used for activation of Ih;
FIG. 8 is a graph depicting a current-voltage relationship for HEK293 cells transfected with wild-type and mutated HCN-4 isoforms, with the data normalized by the maximal current density of the cells transfected with the HCN-4 wild-type isoform;
FIG. 9 is a graph depicting normalized activation conductances of Ih for HEK293 cells transfected with wild-type and mutated HCN-4 isoforms; and
FIG. 10 is a graph depicting activation time constants of Ih at different pulse voltages for HEK293 cells transfected with wild-type and mutated HCN-4 isoforms.



DETAILED DESCRIPTION OF THE INVENTION
The following detailed description of the invention is merely exemplary in nature and is not intended to limit the invention or the application and uses of the invention. Furthermore, there is no intention to be bound by any theory presented in the preceding background of the invention or the following detailed description of the invention.
A composition is provided for implantation into cardiac tissue. The composition includes a biological pacemaker that, when implanted, expresses an effective amount of a mutated hyperpolarization-activated and cyclic nucleotide-gated (HCN) isoform to modify Ih when compared with wild-type HCN.
Methods are also provided for implementing each of the biological pacemakers. The method includes implanting each of biological pacemakers into cardiac tissue.
FIG. 1 is side view of the right side of a heart having an anterior-lateral wall peeled back to present a portion of a heart's intrinsic conduction system and chambers of a right atrium 16 and a right ventricle 18. Pertinent elements of the heart's intrinsic conduction system include the SA node 36, the AV node 32, the bundle of His 40, the right bundle branch 42, and the Purkinje fibers 46. The left bundle branch is not depicted. The SA node 36 is shown at a junction between a superior vena cava 14 and the right atrium 16. An electric impulse initiated at the SA node 36 travels rapidly through the right atrium 16 and the non-illustrated left atrium to the AV node 32. At the AV node 32, the impulse slows to create a delay before passing on through the bundle of His 40, which branches, in an interventricular septum 17, into the right bundle branch 42 and the non-illustrated left bundle branch and then into the Purkinje fibers 46. The impulse then travels rapidly throughout the right ventricle 18 and the non-illustrated left ventricle. This electric impulse flow creates an orderly sequence of atrial and ventricular contraction to efficiently pump blood through the heart. If a portion of the heart's intrinsic conduction system becomes dysfunctional, efficient pumping is compromised.
A patient whose SA node 36 has become dysfunctional may undergo a pacemaker system implantation, which often includes placing lead electrodes in the right atrial appendage 15. The lead electrode stimulates the right atrium 16 downstream of the dysfunctional SA node 36, and the stimulating pulse travels on to the AV node 32, the bundle of His 40, and the Purkinje fibers 46 to restore physiological contraction of the heart at a regular and physiological rate.
As previously discussed, HCN channels play a prominent role in the control of rhythmic electrical activity of the heart. The HCN channels originate in the SA node and mediate hyperpolarization-activated cation (Na+ and K+) flows, commonly referred to as pacemaker currents and originally termed If for “funny” in the heart and Ih for “hyperpolarization” or Iq for “queer” in neurons. The role of HCN channels in the generation of spontaneous activity and autonomic modulation of the heart has been demonstrated in several reports including Brown et al., Nature 280:235-36 (1979), DiFrancesco, J. Physiol. 314:359-76 (1981), DiFrancesco et al., Nature 351:145-7 (1991), and DiFrancesco, Ann. Rev. Physiol. 55:455-72 (1993). FIG. 2 is a cross-sectional view of a portion of a cardiac cell membrane 50 including a HCN channel subunit. More particularly, the depicted subunit is a HCN-4 isoform. HCN-4 is the most predominant HCN isoform in the SA node, accounting for a great majority of the total HCN mRNA in humans and other mammals. As with the other HCN isoforms (HCN1-3), the HCN-4 isoform has six transmembrane domains S1 to S6, and a cyclic nucleotide-binding domain (CNBD) 58. Both the NH2 and COOH ends are in the intracellular region 54. A pore 56 is established between the S5 and S6 transmembrane domains, and a linker region in the extracellular region 52 between the S5 and S6 domains includes a GYG motif, which is a moderator of ion permeation.
One of many recent goals behind the development of biological pacemakers is increasing local expression of pacemaker currents in the heart. Therefore, recent research has been directed toward overexpression of HCN channels for the treatment of cardiac arrhythmia. Some recent studies demonstrate that overexpression of Ih in myocytes via mouse HCN2 delivery, or implantation of stem cells with overexpression of mouse HCN-2, successfully induced automaticity of a biological pacemaker in arrhythmic animal models (see Qu et al., Circulation 107(8):1106-9 (2003); Plotnikov et al., Circulation 109(4):506-12 (2004); Potapova et al., Circ. Res. 94(7):952-9 (2004); and Rosen et al., Anat. Rec. 280A(2):1046-52 (2004)). However, activation of HCN-4 may be slow or unreliable at physiological membrane potentials, which limits the ability for cells overexpressing HCN-4 to be used as a biological pacemaker. Moreover, HCN-4 is likely the most suitable isoform for creation of a biological pacemaker for numerous reasons. Firstly, HCN-4 is identical to the physiological isoform in the SA node. Furthermore, HCN-4 produces larger If currents than other isoforms. HCN-4 is also, together with HCN2, the isoform most responsive to cAMP (by shifting V1/2, and shifting activation kinetics), hence allowing for superior modulation of heart rates via either increased cAMP levels during sympathetic stimulation (e.g. stress, exercise), or decreased cAMP levels (e.g. sleep, rest). See Biel et al. Trends Cardiovasc. Med. 12(5):206-12 (2002).
In view of the slow or unreliable activation for wild type HCN in cardiac tissue, one aspect of the present invention is to produce and implant into cardiac tissue one or more biological pacemakers. As used herein, the term “biological pacemaker” refers to a polynucleotide composition, or a cell-based composition having a specific modified polynucleotide composition for modulating cardiac contraction to desired levels.
Polynucleotides of choice can be made by traditional PCR-based amplification and known cloning techniques. Alternatively, a polynucleotide of the invention can be made by automated procedures that are well known in the art. A polynucleotide of the invention should include a start codon to initiate transcription and a stop codon to terminate translation. Suitable polynucleotides for use with the invention can be obtained from a variety of public sources including, without limitation, GenBank (National Center for Biotechnology Information (NCBI)), EMBL data library, SWISS-PROT (University of Geneva, Switzerland), the PIR-International database; and the American Type Culture Collection (ATCC) (10801 University Boulevard, Manassas, Va. 20110-2209). See generally, Benson, D. A. et al, Nucl. Acids. Res., 25:1 (1997) for a description of GenBank. The particular polynucleotides useful with the present invention are readily obtained by accessing public information from GenBank.
Any suitable DNA vector or delivery vehicle may be utilized to transfer the desired nucleotide sequence to the targeted cardiac cells. For example, the nucleotide sequence may be cloned into a viral vector such as an adenoviral associated vector (AAV) or other viral vectors such as herpes vectors, and retroviral vectors such as lentiviral vectors. The type of viral vector selected is dependent on the target tissue and the length of the sequence to be delivered. For a discussion of viral vectors see Gene Transfer and Expression Protocols, Murray ed., pp. 109-206 (1991). Alternatively, non-viral delivery systems may be utilized. For example, liposome:DNA complexes, plasmid:liposome complexes, naked DNA, DNA-coated particles, or polymer based systems may be used to deliver the desired sequence to the targeted cardiac cells. The above-mentioned delivery systems and protocols therefore are described in Gene Targeting Protocols, Kmeic 2ed. pp. 1-35 (2002), and Gene Transfer and Expression Protocols, Vol. 7, Murray ed. pp 81-89 (1991).
AAV vectors can be constructed using techniques well known in the art. Typically, the vector is constructed so as to provide operatively linked components of control elements. For example, a typical vector includes a transcriptional initiation region, a nucleotide sequence of the protein to be expressed, and a transcriptional termination region. Typically, such an operatively linked construct will be flanked at its 5′ and 3′ regions with AAV ITR sequences, which are required viral cis elements. The control sequences can often be provided from promoters derived from viruses such as, polyoma, Adenovirus 2, cytomegalovirus, and Simian Virus 40. Viral regulatory sequences can be selected to achieve a high level of expression in a variety of cells. Alternatively, ubiquitously expressing promoters, such as the early cytomegalovirus promoter can be utilized to accomplish expression in any cell type. A third alternative is the use of promoters that drive tissue specific expression. This approach is particularly useful where expression of the desired protein in non-target tissue may have deleterious effects. Thus, according to another preferred embodiment, the vector contains the proximal human brain natriuretic brain (hBNP) promoter that functions as a cardiac-specific promoter. For details on construction of such a vector see LaPointe et al., Left Ventricular Targeting of Reporter Gene Expression In Vivo by Human BNP Promoter in an Adenoviral Vector, Am. J. Physiol. Heart Circ. Physiol., 283:H1439-45 (2002).
Vectors may also contain cardiac enhancers to increase the expression of the transgene in the targeted regions of the cardiac conduction system. Such enhancer elements may include the cardiac specific enhancer elements derived from Csx/Nk×2.5 regulatory regions disclosed in the published U.S. Patent Application 20020022259, the teachings of which are herein incorporated by reference.
Therapeutic methods of the present invention include delivery of an effective amount of a genetic construct or genetically engineered cells or unmodified cells with pacemaking activity to the cardiac cells to produce a biological pacemaker that increases the intrinsic pacing rate of such cells. The biological pacemakers may be introduced using genetically engineered vectors, genetically engineered cells, or unmodified cells, which are implanted at a selected location. One delivery method includes the use of a delivery tool, such as a catheter having electric sensing capabilities, which is introduced directly into either the targeted cardiac tissue. The delivery tool may include electrodes for sensing electric activity and delivering pacing stimuli in order to determine the desired location for the biological pacemakers. Once the location is determined, genetically engineered viruses, gene-modified cells or unmodified cells are delivered to the myocardium at that location to form a biological pacemaker. The delivery tool may include an injection device that injects the viruses or cells into the myocardium. One suitable method for injecting a genetic construct directly into the myocardium is described by R. J. Guzman et al., Circ. Res., 73:1202-1207 (1993). Furthermore, a delivery system for delivering genetic material to a targeted heart region is described in U.S. Pat. No. 7,103,418 and PCT Publication No. WO 98/02150, the teachings of which are incorporated herein by reference. Alternatively, genetically engineered cells may be cultured and proliferated on a solid scaffold, and then surgically delivered to the selected heart region together with the scaffold. The scaffold may also be directly injected into the myocardium.
Perfusion protocols that are useful with the inventive methods are often sufficiently capable of delivering a genetic construct to at least about 10% of cardiac myocytes. Infusion volumes of between about 0.01 ml and about 1 ml are useful for direct intramyocardial injection. Also, suitable methods for targeting non-viral vector genetic constructs to the heart are described in U.S. Pat. No. 6,376,471, the teachings of which are hereby incorporated by reference.
When a genetic construct (in contrast to genetically engineered cells) is introduced to the myocardium using any suitable technique, the genetic material is delivered into the cells by, for example, transfection or transduction procedures. Transfection and transduction refer to the acquisition by a cell of new genetic material by incorporation of added nucleic acid molecules. Transfection can occur by physical or chemical methods. Many transfection techniques are known to those of ordinary skill in the art including, without limitation, calcium phosphate DNA co-precipitation, DEAE-dextrin DNA transfection, electroporation, naked plasmid adsorption, and cationic liposome-mediated transfection (commonly known as lipofection). Transduction refers to the process of transferring nucleic acid into a cell using a DNA or RNA virus. Suitable viral vectors for use as transducing agents include, but are not limited to, retroviral vectors, adeno-associated viral vectors, lentiviral vectors, herpes simplex viral vectors, vaccinia viruses, and Semliki Foret virus vectors.
The biological pacemakers of the present invention include mutated HCN isoforms that accelerate activation and deactivation kinetics of the HCN channel that includes the mutated HCN subunit. One recent report, Tsang et al., J Biol Chem. 279(42):43752-9 (2004), discloses that mutations in the S3-S4 linker of HCN-1 subunits in HCN channels alter the kinetics of channel activation and deactivation. Some exemplary embodiments of the present invention include production and implantation of human HCN isoforms having a S3-S4 linker mutation, and of a HCN channel that includes the mutated HCN subunit, to thereby enable the channel to activate at desirable membrane potentials.
According to an exemplary embodiment, one or more biological pacemakers are implanted in, or downstream from in the conduction pathway, a heart region that is experiencing or may experience poor conduction. For example, if cardiac contraction is not being properly initiated by the SA node, the one or more biological pacemakers may be implanted in the myocardium of the SA node or the right atrium to cause the targeted region to depolarize and create electric impulses that will travel to the AV node. Alternatively, if cardiac contraction is not being properly initiated by the SA node then the backup biological pacemakers may be implanted downstream in the conduction pathway from the right atrium, i.e. in the bundle of His, the Purkinje network, or one of the ventricles.
Returning to FIG. 2, the HCN-4 subunit included in the cardiac cell membrane 50 has a mutated S3-S4 linker 60. The wild type amino acid sequence (SEQ. ID. 1) for HCN-4 is listed below. The sequence for the S3-S4 linker is underlined, and spans residues 359-367.








SEQ. ID 1:










   1
MDKLPPSMRK RLYSLPQQVG AKAWIMDEEE DAEEEGAGGR



 


  41
QDPSRRSIRL RPLPSPSPSA AAGGTESRSS ALGAADSEGP


 


  81
ARGAGKSSTN GDCRRFRGSL ASLGSRGGGS GGTGSGSSHG


 


 121
HLHDSAEERR LIAEGDASPG EDRTPPGLAA EPERPGASAQ


 


 161
PAASPPPPQQ PPQPASASCE QPSVDTAIKV EGGAAAGDQI


 


 201
LPEAEVRLGQ AGFMQRQFGA MLQPGVNKFS LRMFGSQKAV


 


 241
EREQERVKSA GFWIIHPYSD FRFYWDLTML LLMVGNLIII


 


 281
PVGITFFKDE NTTPWIVFNV VSDTFFLIDL VLNFRTGIVV


 


 321
EDNTEIILDP QRIKMKYLKS WFMVDFISSI PVDYIFLIVE


 


 361
TRIDSEVYKT ARALRIVRFT KILSLLRLLR LSRLIRYIHQ


 


 401
WEEIFHMTYD LASAVVRIVN LIGMMLLLCH WDGCLQFLVP


 


 441
MLQDFPDDCW VSINNMVNNS WGKQYSYALF KAMSHMLCIG


 


 481
YGRQAPVGMS DVWLTMLSMI VGATCYAMFI GHATALIQSL


 


 521
DSSRRQYQEK YKQVEQYMSF HKLPPDTRQR IHDYYEHRYQ


 


 561
GKMFDEESIL GELSEPLREE IINFNCRKLV ASMPLFANAD


 


 601
PNFVTSMLTK LRFEVFQPGD YIIREGTIGK KMYFIQHGVV


 


 641
SVLTKGNKET KLADGSYFGE ICLLTRGRRT ASVRADTYCR


 


 681
LYSLSVDNFN EVLEEYPMMR RAFETVALDR LDRIGKKNSI


 


 721
LLHKVQHDLN SGVFNYQENE IIQQIVQHDR EMAHCAHRVQ


 


 761
AAASATPTPT PVIWTPLIQA PLQAAAATTS VAIALTHHPR


 


 801
LPAAIFRPPP GSGLGNLGAG QTPRHLKRLQ SLIPSALGSA


 


 841
SPASSPSQVD TPSSSSFHIQ QLAGFSAPAG LSPLLPSSSS


 


 881
SPPPGACGSP SAPTPSAGVA ATTIAGFGHF HKALGGSLSS


 


 921
SDSPLLTPLQ PGARSPQAAQ PSPAPPGARG GLGLPEHFLP


 


 961
PPPSSRSPSS SPGQLGQPPG ELSLGLATGP LSTPETPPRQ


 


1001
PEPPSLVAGA SGGASPVGFT PRGGLSPPGH SPGPPRTFPS


 


1041
APPRASGSHG SLLLPPASSP PPPQVPQRRG TPPLTPGRLT


 


1081
QDLKLISASQ PALPQDGAQT LRRASPHSSG ESMAAFPLFP


 


1121
RAGGGSGGSG SSGGLGPPGR PYGAIPGQHV TLPRKTSSGS


 


1161
LPPPLSLFGA RATSSGGPPL TAGPQREPGA RPEPVRSKLP


 


1201
SNL






According to some exemplary embodiments of the invention, the S3-S4 linker in the HCN-4 isoform is mutated to have a sequence selected from those listed in Table 1 below. Unless otherwise noted, for each of the listed mutations the remaining sequence is identical to that of the wild-type HCN-4. Also, in other exemplary embodiments mutations are made within the S4 segment. These and other similar mutations may also be made to the S3-S4 linker for other HCN isoforms (HCN 1-3). The mutations are tailored to change the HCN channel activity with respect to the pacemaker current Ih. Some mutations are tailored to increase the activation kinetics for the HCN channel. Other mutations are tailored to increase the deactivation kinetics or the V1/2 activation for the HCN channel.












TABLE 1









S3-4 Linker




SEQ. ID #
Mutant
(359-367)









 2
Wild-type HCN4
ETRIDSEVY




 



 3
T360A
EARIDSEVY



 



 4
Δ363-367
ETRI



 



 5
T360A, Δ363-367
EARI



 



 6
TRI360-362AGM
EAGMDSEVY



 



 7
TRI360-362KGM
EKGMDSEVY



 



 8
T360A, I362M
EARMDSEVY



 



 9
T360A, Δ365-367
EARIDS



 



10
E365G
ETRIDSGVY



 



11
E365A
ETRIDSAVY



 



12
R361G
ETGIDSEVY



 



13
TR360-361AA
EAAIDSEVY



 



14
I362C
ETRCDSEVY



 



15
I362S
ETRSDSEVY



 



16
I362T
ETRTDSEVY



 



17
TRI360-362AGM, Δ363-
EAGM




367










According to other embodiments, the HCN-4 isoform includes one of the mutations listed in Table 1, and some of the C-terminal region of the amino acid sequence is truncated. For some particular embodiments, the C-terminal region is truncated after 16 amino acid residues from the CNBD toward the C-terminal (i.e. by deleting (Δ) nucleotides 2261-3612 from the 3612 nucleotide coding sequence). The coding sequence for wild type HCN-4 is listed below (SEQ. ID 18), with nucleotides underlined to illustrate the region that is deleted according to particular embodiments. These truncations have been described in WO05062958A2, which is incorporated herein by reference.








SEQ. ID 18:










   1
atggacaagc tgccgccgtc catgcgcaag cggctctaca gcctcccgca gcaggtgggg



 


  61
gccaaggcgt ggatcatgga cgaggaagag gacgccgagg aggagggggc cgggggccgc


 


 121
caagacccca gccgcaggag catccggctg cggccactgc cctcgccctc cccctcggcg


 


 181
gccgcgggtg gcacggagtc ccggagctcg gccctcgggg cagcggacag cgaagggccg


 


 241
gcccgcggcg cgggcaagtc cagcacgaac ggcgactgca ggcgcttccg cgggagcctg


 


 301
gcctcgctgg gcagccgggg cggcggcagc ggcggcacgg ggagcggcag cagtcacgga


 


 361
cacctgcatg actccgcgga ggagcggcgg ctcatcgccg agggcgacgc gtcccccggc


 


 421
gaggacagga cgcccccagg cctggcggcc gagcccgagc gccccggcgc ctcggcgcag


 


 481
cccgcagcct cgccgccgcc gccccagcag ccaccgcagc cggcctccgc ctcctgcgag


 


 541
cagccctcgg tggacaccgc tatcaaagtg gagggaggcg cggctgccgg cgaccagatc


 


 601
ctcccggagg ccgaggtgcg cctgggccag gccggcttca tgcagcgcca gttcggggcc


 


 661
atgctccaac ccggggtcaa caaattctcc ctaaggatgt tcggcagcca gaaagccgtg


 


 721
gagcgcgaac aggagagggt caagtcggcc ggattttgga ttatccaccc ctacagtgac


 


 781
ttcagatttt actgggacct gaccatgctg ctgctgatgg tgggaaacct gattatcatt


 


 841
cctgtgggca tcaccttctt caaggatgag aacaccacac cctggattgt cttcaatgtg


 


 901
gtgtcagaca cattcttcct catcgacttg gtcctcaact tccgcacagg gatcgtggtg


 


 961
gaggacaaca cagagatcat cctggacccg cagcggatta aaatgaagta cctgaaaagc


 


1021
tggttcatgg tagatttcat ttcctccatc cccgtggact acatcttcct cattgtggag


 


1081
acacgcatcg actcggaggt ctacaagact gcccgggccc tgcgcattgt ccgcttcacg


 


1141
aagatcctca gcctcttacg cctgttacgc ctctcccgcc tcattcgata tattcaccag


 


1201
tgggaagaga tcttccacat gacctacgac ctggccagcg ccgtggtgcg catcgtgaac


 


1261
ctcatcggca tgatgctcct gctctgccac tgggacggct gcctgcagtt cctggtaccc


 


1321
atgctacagg acttccctga cgactgctgg gtgtccatca acaacatggt gaacaactcc


 


1381
tgggggaagc agtactccta cgcgctcttc aaggccatga gccacatgct gtgcatcggc


 


1441
tacgggcggc aggcgcccgt gggcatgtcc gacgtctggc tcaccatgct cagcatgatc


 


1501
gtgggtgcca cctgctacgc catgttcatt ggccacgcca ctgccctcat ccagtccctg


 


1561
gactcctccc ggcgccagta ccaggaaaag tacaagcagg tggagcagta catgtccttt


 


1621
cacaagctcc cgcccgacac ccggcagcgc atccacgact actacgagca ccgctaccag


 


1681
ggcaagatgt tcgacgagga gagcatcctg ggcgagctaa gcgagcccct gcgggaggag


 


1741
atcatcaact ttaactgtcg gaagctggtg gcctccatgc cactgtttgc caatgcggac


 


1801
cccaacttcg tgacgtccat gctgaccaag ctgcgtttcg aggtcttcca gcctggggac


 


1861
tacatcatcc gggaaggcac cattggcaag aagatgtact tcatccagca tggcgtggtc


 


1921
agcgtgctca ccaagggcaa caaggagacc aagctggccg acggctccta ctttggagag


 


1981
atctgcctgc tgacccgggg ccggcgcaca gccagcgtga gggccgacac ctactgccgc


 


2041
ctctactcgc tgagcgtgga caacttcaat gaggtgctgg aggagtaccc catgatgcga


 


2101
agggccttcg agaccgtggc gctggaccgc ctggaccgca ttggcaagaa gaactccatc


 


2161
ctcctccaca aagtccagca cgacctcaac tccggcgtct tcaactacca ggagaatgag


 


2221
atcatccagc agattgtgca gcatgaccgg gagatggccc actgcgcgca ccgcgtccag


 


2281
gctgctgcct ctgccacccc aacccccacg cccgtcatct ggaccccgct gatccaggca


 


2341
ccactgcagg ctgccgctgc caccacttct gtggccatag ccctcaccca ccaccctcgc


 


2401
ctgcctgctg ccatcttccg ccctccccca ggatctgggc tgggcaacct cggtgccggg


 


2461
cagacgccaa ggcacctgaa acggctgcag tccctgatcc cttctgcgct gggctccgcc


 


2521
tcgcccgcca gcagcccgtc ccaggtggac acaccgtctt catcctcctt ccacatccaa


 


2581
cagctggctg gattctctgc ccccgctgga ctgagcccac tcctgccctc atccagctcc


 


2641
tccccacccc ccggggcctg tggctccccc tcggctccca caccatcagc tggcgtagcc


 


2701
gccaccacca tagccgggtt tggccacttc cacaaggcgc tgggtggctc cctgtcctcc


 


2761
tccgactctc ccctgctcac cccgctgcag ccaggcgccc gctccccgca ggctgcccag


 


2821
ccatctcccg cgccacccgg ggcccgggga ggcctgggac tcccggagca cttcctgcca


 


2881
cccccaccct catccagatc cccgtcatct agccccgggc agctgggcca gcctcccggg


 


2941
gagttgtccc taggtctggc cactggccca ctgagcacgc cagagacacc cccacggcag


 


3001
cctgagccgc cgtcccttgt ggcaggggcc tctggggggg cttcccctgt aggctttact


 


3061
ccccgaggag gtctcagccc ccctggccac agcccaggcc ccccaagaac cttcccgagt


 


3121
gccccgcccc gggcctctgg ctcccacgga tccttgctcc tgccacctgc atccagcccc


 


3181
ccaccacccc aggtccccca gcgccggggc acacccccgc tcacccccgg ccgcctcacc


 


3241
caggacctca agctcatctc cgcgtctcag ccagccctgc ctcaggacgg ggcgcagact


 


3301
ctccgcagag cctccccgca ctcctcaggg gagtccatgg ctgccttccc gctcttcccc


 


3361
agggctgggg gtggcagcgg gggcagtggg agcagcgggg gcctcggtcc ccctgggagg


 


3421
ccctatggtg ccatccccgg ccagcacgtc actctgcctc ggaagacatc ctcaggttct


 


3481
ttgccacccc ctctgtcttt gtttggggca agagccacct cttctggggg gccccctctg


 


3541
actgctggac cccagaggga acctggggcc aggcctgagc cagtgcgctc caaactgcca


 


3601
tccaatctat ga






It follows that additional exemplary embodiments include a HCN-4 channel including the isoform having the sequence of SEQ. ID. 18, with either mutation T360A, mutation TRI360-362KGM or TRI360-362AGM, Δ363-367, along with truncation of HCN-4 after the CNBD. Any of such plasmids may be cloned into an adeno-associated virus (AAV) vector such as the AAV 2/9 vector, with either a cardiac specific promoter or constitutive promoters such as CMV or CAG. Such constructs are suitable for a biological pacemaker application, as AAV 2/9 has been demonstrated to have high specificity to cardiac tissue, and high efficiency in cardiac transduction (see Circ. Res. 18; 99(4):e3-9 (2006). The truncation of the C-terminus would allow packaging of HCN-4 mutations T360A, TRI360-362KGM, or TRI360-362AGM, Δ363-367 into the MV 2/9 expression cassette. MV 2/9 means that the vector contains a rep protein derived from MV 2, and a cap (capsid) protein from MV 9 serotype.
Example
Wild-type HCN-4 and S3-S4 linker mutants were tranfected into 50% confluent human embryonic kidney (HEK293) cells using known transfection reagents and standard methods. The selected S3-S4 linker mutants were T360A, TRI360-362KGM, and TRI360-362AGM, Δ363-367, the amino acid sequences for each being listed in Table 1. After transfection was completed, the cells were replated and cultured. The electrophysiologic properties of each mutant were examined using the so-called “whole-cell patch-clamp technique,” which is described in Hamill et al., Pflugers Arch. 391 (2):85-100 (1981).
For the cells expressing the wild-type HCN-4, and also for the cells expressing the S3-S4 linker mutants, the hyperpolarization-activated cyclic nucleotide-gated inward current (Ih) was evoked by 5 s hyperpolarizing steps to potentials ranging from 0 to −140 mV, with a holding potential set at −40 mV. The reversal potential of Ih was evaluated by tail currents recorded by 3 s ‘tail’ steps to membrane potentials ranging from −80 to 20 mV in 10 mV increments followed a 5 s conditioning potential step to −130 mV every 15 s, with the holding potential set at −40 mV. The activation of Ih was elicited by 3 s ‘tail’ pulses to −130 mV followed by 5 s conditioning pulses from 0 mV to −140 mV in 10 mV increments, with the membrane holding potential set at −40 mV and a pulse rate of every 30 s. Ih was evaluated at a point near the end of each test pulse. The current amplitudes were normalized with respect to corresponding membrane capacitance (Cm) values to minimize current differences due to cell size. A single-exponential fit of current traces allowed derivation of time constants for current activation and deactivation. Some data were fitted by a Boltzmann equation {1/[1+exp(V1/2−V)/k], where V1/2 is the half-inactivation potential, V is the voltage potential, and k is the slope factor (in mV/e-fold change in current)}. The best-fit procedure was performed with a commercial software program (Origin 7.0, MicrocalTM Software Inc.).
FIGS. 3 to 6 are graphs including superimposed current traces of Ih for the cells transfected with either the HCN-4 wild-type isoform or with one of the three mutants. As seen from the graphs, the cells transfected with the T360A or the TRI360-362AGM, Δ363-367 mutation had more currents at particular negative voltages than the cells transfected with the HCN-4 wild-type isoform. FIG. 7 is a graph of the current-voltage relationship that was plotted according to the current density (pA/pF) of each test pulse. The inset graph in FIG. 7 depicts the voltage-clamp protocol used for activation of Ih. To measure the current-voltage relationship, each test pulse was measured at the end of the 5-s pulse, particularly at the first vertical dotted line (◯) from the inset graph. For each of FIGS. 7 to 10, the trace designated with the ▪ marker corresponds to the cells transfected with the HCN-4 wild-type isoform, the trace designated with the ♦ marker corresponds to the cells transfected with the HCN-4 isoform with the T360A mutation, the trace with the ▴ marker corresponds to the cells transfected with the HCN-4 isoform with the TRI360-362KGM mutation, and the trace designated with the ▾ marker corresponds to the cells transfected with the HCN-4 isoform with the TRI360-362AGM, Δ363-367 mutation. FIG. 8 is a graph depicting the current-voltage relationship for each type of transfected cells, with the data normalized by the maximal current density of the cells transfected with the HCN-4 wild-type isoform. FIG. 9 is a graph depicting the normalized activation conductances of Ih for each type of transfected cells. The activation conductance curves were obtained by plotting the normalized values measured at the second dotted vertical line (●) of tail currents from the inset graph in FIG. 7 against the conditioning voltages. FIG. 10 is a graph depicting the activation time constants of Ih at different pulse voltages for each type of transfected cells.
Table 2 lists each of the mutants (T360A, TRI360-362KGM, and TRI360-362AGM, Δ363-367) that were transfected into the HEK293 cells, and the Ih test results for each S3-S4 linker mutant. More particularly, Table 2 summarizes the current densities and activation kinetics for the wild type and mutant cells corresponding to the test pulses from −40 to −130 mV.











TABLE 2






Density

Activation
Deactivation


Mutant
(pA/pF)
V1/2
Kinetics
Kinetics







T360A
−90.4 ± 19.8
Unchanged
Faster
Unchanged


TR1360-
−74.5 ± 11.9
Unchanged
Faster
Unchanged


362KGM


TR1360-
−107.6 ± 15.5 
Unchanged
Faster
Unchanged


362AGM,


Δ363-367









Compared to the HCN-4 wildtype, there were some shifts of the activation curves for each of the three mutants. None of the voltage values of V1/2 activation for any of the three mutants was significantly different from that of the wild-type HCN-4, and deactivation kinetics were not significantly changed for any of the three mutants. Compared to the HCN-4 wildtype, activation of Ih at several voltages for T360A, TRI360-362KGM, and TRI360-362AGM, Δ363-367 was significantly faster.
While at least one exemplary embodiment has been presented in the foregoing detailed description of the invention, it should be appreciated that a vast number of variations exist. It should also be appreciated that the exemplary embodiment or exemplary embodiments are only examples, and are not intended to limit the scope, applicability, or configuration of the invention in any way. Rather, the foregoing detailed description will provide those skilled in the art with a convenient road map for implementing an exemplary embodiment of the invention, it being understood that various changes may be made in the function and arrangement of elements described in an exemplary embodiment without departing from the scope of the invention as set forth in the appended claims and their legal equivalents.

## Claims

1. A composition for implantation into cardiac tissue, comprising a biological pacemaker comprising a polynucleotide sequence encoding a mutated hyperpolarization-activated and cyclic nucleotide-gated (HCN) isoform that, when implanted, expresses an effective amount of the mutated HCN isoform to modify Ih activation kinetics, wherein the HCN isoform is HCN-4, the mutation comprises a S3-S4 linker mutation, and the mutated HCN-4 demonstrates increased Ih activation kinetics compared to wild type HCN-4.

2. The composition according to claim 1, comprising genetically engineered cells comprising the polynucleotide sequence encoding the mutated HCN-4 isoform.

3. The composition according to claim 1, wherein the S3-S4 linker mutation is selected from the group consisting of T360A, Δ363-367, T360A+Δ363-367, TRI360-362AGM, TRI360-362KGM, T360A+I362M, T360A+Δ365-367, E365G, E365A, R361G, TR360-361AA, 1362C, I362S, I362T, and TRI360-362AGM+Δ363-367.

4. The composition according to claim 1, wherein the polynucleotide sequence encoding the mutated HCN-4 isoform further comprises a delivery vector.

5. The composition according to claim 4, wherein the delivery vector is an adeno-associated virus (AAV) vector.

6. The composition according to claim 1, wherein the mutated HCN-4 isoform further comprises a C-terminal region truncation.

7. The composition according to claim 6, wherein the truncation begins 16 amino acid residues past the cyclic nucleotide-binding domain (CNBD).

8. The composition according to claim 6, wherein the truncated, mutated HCN-4 isoform comprises a cyclic nucleotide-binding domain (CNBD) and is truncated past the CNBD.

9. A method for modifying pacemaker current in cardiac tissue, comprising implanting into heart tissue of a subject in need a composition of claim 1.

10. A method for modifying pacemaker current in cardiac tissue, the method comprising implanting into heart tissue of a subject in need a composition according to claim 2.

11. The method according to claim 9, wherein the S3-S4 linker mutation is selected from the group consisting of T360A, Δ363-367, T360A+Δ363-367, TRI360-362AGM, TRI360-362KGM, T360A+I362M, T360A+Δ365-367, E365G, E365A, R361G, TR360-361AA, I362C, I362S, I362T, and TRI360-362AGM +Δ363-367.

12. The method according to claim 9, wherein the polynucleotide sequence encoding the mutated HCN-4 isoform further comprises a delivery vector.

13. The method according to claim 12, wherein the delivery vector comprises an adeno-associated virus (AAV) vector.

14. The method according to claim 9, wherein the mutated HCN-4 isoform further comprises a C-terminal region truncation.

15. The method according to claim 14, wherein the truncated HCN-4 isoform includes a cyclic nucleotide-binding domain (CNBD) and is truncated past the CNBD.

16. The method according to claim 15, wherein the HCN-4 is truncated 16 amino acid residues past the CNBD.

17. A composition for implantation into cardiac tissue, comprising a biologocal pacemaker comprising a polynucleotide sequence encoding a mutated hyperpolarization-activated and cyclic nucleotide-gated (HCN) isoform that, when implanted, expresses an effective amount of the mutated HCN isoform to modify Ih activation kinetics, wherein the HCN isoform is HCN-4 and the mutation comprises a S3-S4 linker mutation and wherein the mutated HCN-4 demonstrates increased Ih activation kinetics compared to wild type HCN-4 and demonstrates V1/2 kinetics that are unchanged compared to wild type HCN-4.

18. The composition according to claim 17, wherein the mutated HCN-4 comprises a S3-S4 linker mutation selected from the group consisting of T360A, T360A+Δ363-367, TRI360-362KGM, and TRI360-362AGM+Δ363-367.

19. A method for modifying pacemaker current in cardiac tissue, comprising implanting into heart tissue of a subject in need a composition according to claim 17.

20. The composition of claim 17 wherein the mutated HCN-4 further demonstrates deactivation kinetics that are unchanged compared to wild type HCN-4.

21. A composition for implantation into cardiac tissue comprising a polynucleotide sequence encoding a mutated hyperpolarization-activated and cyclic nucleotide-gated-4 (HCN-4) isoform, wherein the mutated HCN-4 comprises a S3-S4 linker mutation selected from the group consisting of T360A, T360A+Δ363-367, TRI360-362KGM, and TRI360-362AGM+Δ363-367.

22. A method for modifying pacemaker current in cardiac tissue, comprising implanting into heart tissue of a subject in need a composition according to claim 21.

23. The composition according to claim 21, wherein the mutated HCN-4 comprises the S3-S4 linker mutation T360A+Δ363-367.

24. The composition according to claim 21, wherein the mutated HCN-4 isoform further comprises a C-terminal region truncation.

25. The composition according to claim 23, wherein the mutated HCN-4 isoform further comprises a C-terminal region truncation.

26. The composition according to claim 23, wherein the polynucleotide sequence encoding the mutated HCN-4 isoform further comprises a delivery vector.

27. An isolated polynucleotide sequence that encodes a mutated HCN-4 comprising a S3-S4 linker mutation selected from the group consisting of T360A, T360A+Δ363-367, TRI360-362KGM, and TRI360-362AGM +66 363-367.

28. The isolated polynucleotide sequence of claim 27, wherein the mutated HCN-4 further comprises a C-terminal region truncation.

29. A method for modifying pacemaker current in cardiac tissue, the method comprising implanting into heart tissue of a subject in need an isolated polynucleotide sequence of claim 27.

30. The isolated polynucleotide sequence of claim 27, wherein the isolated polynucleotide sequence further comprises a delivery vector.

31. The isolated polynucleotide sequence of claim 30, wherein the delivery vector comprises an adeno-associated virus (AAV) vector.

32. An isolated genetically engineered cell comprising the isolated polynucleotide sequence of claim 27.

33. The isolated polynucleotide sequence of claim 28, wherein the truncation begins 16 amino acid residues past the cyclic nucleotide-binding domain (CNBD).

34. The isolated polynucleotide sequence of claim 28, wherein the truncated, mutated HCN-4 comprises a cyclic nucleotide-binding domain (CNBD) and is truncated past the CNBD.

35. The isolated polynucleotide sequence of claim 28, wherein the isolated polynucleotide sequence further comprises a delivery vector.

36. The isolated polynucleotide sequence of claim 35, wherein the delivery vector comprises an adeno-associated virus (AAV) vector.

37. The isolated polynucleotide sequence of claim 33, wherein the isolated polynucleotide sequence further comprises a delivery vector.

38. The isolated polynucleotide sequence of claim 37, wherein the delivery vector comprises an adeno-associated virus (AAV) vector.

39. The isolated polynucleotide sequence of claim 34, wherein the isolated polynucleotide sequence further comprises a delivery vector.

40. The isolated polynucleotide sequence of claim 39, wherein the delivery vector comprises an adeno-associated virus (AAV) vector.