ABSTRACT: Voltage-gated Na(+) channels (VGSCs) in mammals contain a pore-forming ? subunit and one or more ? subunits. There are five mammalian ? subunits in total: ?1, ?1B, ?2, ?3, and ?4, encoded by four genes: SCN1B-SCN4B. With the exception of the SCN1B splice variant, ?1B, the ? subunits are type I topology transmembrane proteins. In contrast, ?1B lacks a transmembrane domain and is a secreted protein. A growing body of work shows that VGSC ? subunits are multifunctional. While they do not form the ion channel pore, ? subunits alter gating, voltage-dependence, and kinetics of VGSC? subunits and thus regulate cellular excitability in vivo. In addition to their roles in channel modulation, ? subunits are members of the immunoglobulin superfamily of cell adhesion molecules and regulate cell adhesion and migration. ? subunits are also substrates for sequential proteolytic cleavage by secretases. An example of the multifunctional nature of ? subunits is ?1, encoded by SCN1B, that plays a critical role in neuronal migration and pathfinding during brain development, and whose function is dependent on Na(+) current and ?-secretase activity. Functional deletion of SCN1B results in Dravet Syndrome, a severe and intractable pediatric epileptic encephalopathy. ? subunits are emerging as key players in a wide variety of physiopathologies, including epilepsy, cardiac arrhythmia, multiple sclerosis, Huntington's disease, neuropsychiatric disorders, neuropathic and inflammatory pain, and cancer. ? subunits mediate multiple signaling pathways on different timescales, regulating electrical excitability, adhesion, migration, pathfinding, and transcription. Importantly, some ? subunit functions may operate independently of ? subunits. Thus, ? subunits perform critical roles during development and disease. As such, they may prove useful in disease diagnosis and therapy.
