ABSTRACT: Voltage-gated sodium channels (VGSCs) are assembled from two classes of subunits, a pore-bearing ?-subunit (NaV 1) and one or two accessory ?-subunits (NaV ?s). Neurons in mammals can express one or more of seven isoforms of NaV 1 and one or more of four isoforms of NaV ?. The peptide ?-conotoxins, like the guanidinium alkaloids tetrodotoxin (TTX) and saxitoxin (STX), inhibit VGSCs by blocking the pore in NaV 1. Hitherto, the effects of NaV ?-subunit co-expression on the activity of these toxins have not been comprehensively assessed.Four ?-conotoxins (?-TIIIA, ?-PIIIA, ?-SmIIIA and ?-KIIIA), TTX and STX were tested against NaV 1.1, 1.2, 1.6 or 1.7, each co-expressed in Xenopus laevis oocytes with one of NaV ?1, ?2, ?3 or ?4 and, for NaV 1.7, binary combinations of thereof.Co-expression of NaV ?-subunits modifies the block by ?-conotoxins: in general, NaV ?1 or ?3 co-expression tended to increase kon (in the most extreme instance by ninefold), whereas NaV ?2 or ?4 co-expression decreased kon (in the most extreme instance by 240-fold). In contrast, the block by TTX and STX was only minimally, if at all, affected by NaV ?-subunit co-expression. Tests of NaV ?1?:??2 chimeras co-expressed with NaV 1.7 suggest that the extracellular portion of the NaV ? subunit is largely responsible for altering ?-conotoxin kinetics.These results are the first indication that NaV ? subunit co-expression can markedly influence ?-conotoxin binding and, by extension, the outer vestibule of the pore of VGSCs. ?-Conotoxins could, in principle, be used to pharmacologically probe the NaV ? subunit composition of endogenously expressed VGSCs.