Introduction

Voltage-gated sodium (NaV) channels mediate the generation and propagation of action potentials in excitable cells1,2. In humans, nine NaV channel subtypes (NaV1.1–1.9) had been identified, which are involved in a broad range of physiological processes due to their tissue-specific distributions in various excitable tissues3,4. Subtype NaV1.6, encoded by the gene SCN8A, is ubiquitously expressed in neurons of both the central nervous system (CNS) and the peripheral nervous system (PNS), especially enriched in the distal end of axon initial segment (AIS) and in the node of Ranvier of myelinated excitatory neurons. The NaV1.6 channel is believed to play a primary role in the initiation and propagation of action potentials in those neurons by lowering the threshold voltage5,6,7,8,9,10,11. Emerging evidence suggests that NaV1.6 is also expressed in some inhibitory interneurons and plays a role in establishing synaptic inhibition in the thalamic networks12,13,14. Compared with other NaV channel subtypes, NaV1.6 possesses unique biophysical properties including activation at more hyperpolarized voltage, higher levels of persistent current and resurgent current, and higher frequency of repetitive neuronal firing in neurons such as cerebellar Purkinje cells15,16,17,18,19,20,21,22,23. These features make NaV1.6 a critical and favorable mediator in regulating neuronal excitability in those neurons. Meanwhile, dozens of mutations in NaV1.6 have been linked to human diseases, most of which exhibit gain-of-function phenotypes, increase neuronal excitability, and cause different types of epileptic encephalopathy24,25,26,27,28; whereas loss-of-function mutations are often associated with later onset seizures, intellectual disability, isolated cognitive impairment and movement disorders29,30,31. Thus, NaV1.6 is an important drug target; effective and subtype-selective therapeutics are eagerly awaited for the treatment of NaV1.6-related epilepsy and other neurological diseases.

Eukaryotic NaV channels are composed of a pore-forming α subunit and auxiliary β subunits32. The four-domain α subunit exerts voltage sensing, gate opening, ion permeation, and inactivation4,33. Meanwhile, one or two β subunits bind to the α subunit to regulate NaV channel kinetics and trafficking. Among the four types of β subunits34,35,36,37, β1 and β3 subunits non-covalently bind to the α subunit, while β2 and β4 subunits are covalently linked to the α subunit via a disulfide bond32,38. To date, high-resolution cryo-electron microscopy (cryo-EM) structures of seven mammalian NaV channels (NaV1.1–1.5, NaV1.7–1.8) have been reported39,40,41,42,43,44,45. Together with the resting-state46, open-state47, and multiple ligand-bound NaV channel structures48,49,50, these structures revealed the general molecular mechanisms of voltage-sensing, electromechanically coupling, fast inactivation, sodium permeation, and ligand modulation. Among those NaV channel modulators, the guanidinium neurotoxin tetrodotoxin (TTX) has long been used as a useful tool to study NaV channels, which can potently inhibit NaV1.1–1.4 and NaV1.6–1.7 at nanomolar level (TTX-sensitive NaV channels), and less potently inhibit NaV1.5, NaV1.8, and NaV1.9 at a micromolar concentration (TTX-insensitive NaV channels). The detailed binding mode of TTX had been revealed in the NaV channel-TTX complex structures44,51. Furthermore, two guanidinium neurotoxin derivatives, ST-2262 and ST-2530, were reported as potent and selective inhibitors for NaV1.7, indicating that TTX analogs could potentially be developed as selective therapeutics52,53. Interestingly, 4,9-anhydro-tetrodotoxin (4,9-ah-TTX), a metabolite of TTX, has been reported to selectively block NaV1.6 with a blocking efficacy of 40- to 160-fold higher than other TTX-sensitive NaV channels54. However, the structure of NaV1.6 and how 4,9-ah-TTX blocks NaV1.6 remain elusive.

In this work, we show a fully-functional shorter-form construct of human NaV1.6 suitable for structural studies, and present cryo-EM structures of NaV1.6/β1/β2 apo-form and in complex with 4,9-ah-TTX. Complemented with electrophysiological results and molecular dynamics (MD) simulations, our structures reveal NaV1.6 structural features, sodium conductance, and pore-blockade by 4,9-ah-TTX.

Results

Construct optimization of NaV1.6 for cryo-EM study

To conduct structural studies of NaV1.6, human wide-type NaV1.6 (named NaV1.6WT) was co-expressed with human β1 and β2 subunits in HEK293F cells and was purified similarly to previously reported NaV channels41,44. Although the amino acid sequence of NaV1.6 is highly conserved with other NaV channel subtypes (e.g., 70% identity with NaV1.7); however, the purified NaV1.6WT sample exhibited poor quality and did not permit high-resolution structural analysis (Supplementary Fig. 1a, b). Construct optimization had been proven to be successful in improving the sample quality of NaV1.7 and NaV1.555,56, we therefore carried out construct screening of human NaV1.6 by removing unstructured intracellular loops and C-terminus. We found that deletion of S478-G692 between DI and DII (NaV1.6ΔDI-DII), S1115-L1180 between DII and DIII (NaV1.6ΔDII-DIII), or R1932-C1980 of the C-terminus (NaV1.6ΔCter) showed improved sample homogeneity based on the size-exclusion chromatography (SEC) profiles (Supplementary Fig. 1a). Strikingly, when we combined these modifications and deleted all of the three unstructured regions, it displayed a sharp mono-disperse SEC profile, which is much better than that of NaV1.6WT and any of the single-deletion constructs (Fig. 1a, b, Supplementary Fig. 1a). We next examined the functional characteristics of the triple-deletion construct by whole-cell voltage-clamp recording of NaV1.6-expressing HEK293T cells. The candidate construct exhibits typical voltage-dependent activation and inactivation (Fig. 1c). The resulting V1/2 values of the voltage-dependence of activation and steady-state fast inactivation are −31.3 ± 0.3 mV (n = 15) and −77.3 ± 0.2 mV (n = 15), respectively, which are close to the reported V1/2 values of human wide-type NaV1.657,58. These results confirmed that the triple-deletion construct fulfills similar electrophysiological functions to the NaV1.6WT. The preliminary cryo-EM analysis of this triple-deletion construct showed that the micrograph contains a rich distribution of mono-disperse particles, which gave rise to much better 2D class averages with well-resolved features than the NaV1.6WT (Supplementary Fig. 1b, c). Thus, this triple-deletion construct (named NaV1.6EM) was selected for further structural studies.

Fig. 1: Topology and functional characterization of the NaV1.6EM/β1/β2 complex.
figure 1

a Topology of the NaV1.6/β1/β2 complex. The α subunit consists of DI (purple), DII (yellow), DIII (pink), and DIV (cyan) connected by intracellular linkers, a mCherry fluorescent protein tag fused at the C-terminus. Scissors indicate the truncated sites. The β1 fused with a GFP tag at the C-terminus and the β2 subunit are highlighted in light blue and gray, respectively. The same color codes for NaV1.6/β1/β2 are applied throughout the manuscript unless specified. b Size exclusion chromatogram profiles of the purified NaV1.6WT (black) and the NaV1.6EM (red). c Electrophysiological characterization of the NaV1.6EM construct. The voltage protocols and representative current traces are shown on the left panels. To characterize the voltage-dependence of activation, NaV1.6EM expressing HEK293T cells were stimulated by a 100 ms test pulse varying from −80 mV to 10 mV in 5 mV increments from a holding potential of −120 mV, with a stimulus frequency of 0.2 Hz. To measure the steady-state fast inactivation, HEK293T cells were stimulated by a test step to −10 mV after a 500 ms prepulse varying from −130 mV to −20 mV in 5 mV increments, from a holding potential of −120 mV and a stimulus frequency of 0.2 Hz. The resulting normalized conductance-voltage (G/V) relationship (squares, n = 15) and steady-state fast inactivation (circles, n = 15) curves are shown on the right panel. Data are presented as mean ± SEM. n biological independent cells. Source data are provided as a Source data file.

The overall structure of human NaV1.6

The purified NaV1.6EM/β1/β2 sample was frozen in vitreous ice for cryo-EM data collection (Supplementary Fig. 2). After processing, the final reconstruction map from the best class of ~41 k particles was refined to an overall resolution of 3.4 Å (Fig. 2a, Supplementary Figs. 35). As expected, the resulting NaV1.6EM/β1/β2 structure closely resembles the reported structures of human NaV channels due to high sequence similarity (Fig. 2b). For example, the binding modes of the β subunits are consistent with the structures of human NaV1.7/β1/β2 and NaV1.3/β1/β241,44; the pore-forming α-subunit of NaV1.6EM can be well superimposed with NaV1.7 with a backbone (1107 Cα) root mean square deviation (RMSD) of 1.4 Å (Fig. 2c). However, marked local conformational differences were observed between the two structures, especially in the extracellular loops (ECLs) (Fig. 2c, d). The ECLs are less conserved regions among the nine NaV channel subtypes (Supplementary Fig. 6a), which form the outer mouth of the selectivity filters (SFs) and contribute to the binding of β subunits. Superposition of the Domain I ECLs of NaV1.6EM and NaV1.7 shows that the ECLI of NaV1.6EM lacks the short α2 helix, but instead forms an extended hairpin-like turn (Fig. 2d). Importantly, the ECLI of NaV1.6EM exhibits more N-linked glycosylation modification sites than NaV1.7; N308-linked glycosylation site appears to be unique for NaV1.6 based on the sequence alignment (Supplementary Fig. 6a). Although these structural differences in the ECLs do not affect the binding of β subunits to NaV1.6 (Fig. 2a), the glycosylation and other modifications shape the surface properties of NaV1.6, which play important roles in its trafficking, localization, and pathology59,60. For instance, a unique glycosylation site in the ECLI of NaV1.5 blocks the binding of the β1 subunit to NaV1.543.

Fig. 2: Cryo-EM structure of the NaV1.6EM/β1/β2 complex.
figure 2

a, b The cryo-EM density map (a) and cartoon representation (b) of the NaV1.6EM/β1/β2 complex. c Structural comparison of NaV1.6EM and NaV1.7 (PDB code: 7W9K, colored in gray). The black dashed-line squares indicate the areas shown in panels (d), (e), and (f). d Superimposition of the ECLI between NaV1.6EM and NaV1.7. N-linked glycosylation moieties are shown in sticks. e Comparison of the IFM motif. The IFM motif were depicted side chains in sticks and spheres with half transparency. f Comparison of the intracellular activation gate of NaV1.6EM and NaV1.7 viewed from intracellular side. Key residues from four S6 helices were shown side-chains sticks and spheres with half transparency.

We next compared the fast inactivation gate and intracellular activation gate between NaV1.6EM and NaV1.7, which only display subtle conformational shifts (Fig. 2e, f), indicating that those key structural elements are highly conserved to fulfill their similar biological roles. Consistently, the signature fast inactivation gate, Ile-Phe-Met motif (IFM-motif), binds tightly to its receptor site adjacent to the intracellular activation gate (Fig. 2e), resulting in a non-conductive activation gate constricted by A411, L977, I1464, and I1765 from the four S6 helices, respectively (Fig. 2f). The van der Waals diameter of the activation gate is less than 6 Å, suggesting that the gate is functionally closed (Fig. 3a, b).

Fig. 3: Potential Na+ binding sites in the SF of NaV1.6EM.
figure 3

a The ion conductance path of NaV1.6EM calculated by HOLE. The diagonal repeats of pore domain only including the S5–S6 and pore-helices were shown for clarity. b Plot of the pore radii of NaV1.6EM. The dashed line indicates pore radius at 2 Å. The key residues constituting the selectivity filter (SF) and the intracellular activation gate (AG) were shown as sticks. c The SF of NaV1.6EM viewed from the extracellular side. Potential Na+ ions were shown as blue balls. Black dashed lines represent polar interactions. d, e Comparison of the Na+ binding sites of NaV1.6EM and the Ca2+ binding sites of CaVAb (PDB code: 4MS2, colored in gray). The diagonal repeats of DI and DIII (d), DII and DIV (e) are shown separately for clarity. The EM densities for putative Na+ and key residues are shown in orange meshes contoured at 4 σ and 5 σ, respectively. A third possible Na+ ion with weaker density contoured at 3 σ was shown as a light blue ball with half transparency. Ca2+ ions are shown as green balls.

Potential Na+ sites in the SF

The ion path of NaV1.6 has two constriction sites, the extracellular SF and intracellular activation gate, respectively (Fig. 3a, b). The sodium selectivity of mammalian NaV channels is determined by the extracellular SF61,62, which is composed of an Asp from DI, Glu from DII, Lys from DIII, and Ala from DIV, known as the DEKA-locus63,64. Based on structural analysis, the acidic residues of the DEKA-locus are believed to act as a high-field strength site, which attracts and coordinates Na+; and the Lys in DIII was proposed as a favorable binding ligand for Na+ which facilitates the ions passing through the SF43,65. In coincidence with other mammalian NaV channels43,44, the SF of NaV1.6EM adopts an asymmetric conformation composed of the DEKA-locus (Fig. 3b, c). No oblivious Na+ binding site had been identified in previous structures of mammalian NaV channels. In contrast, densities for Ca2+ were consistently reported in the structures of bacterial CaVAb channel and mammalian CaV1.1, CaV2.2, and CaV3.1 channels66,67,68,69. Interestingly, two strong blobs of EM densities were observed in the SF of NaV1.6EM (Fig. 3d, e), which are deduced as potential Na+ binding sites because Na+ ions are the only major cations in the solutions throughout the purification processes. The upper site (namely Na1) closely engages E936 of the DEKA-locus and an additional acidic residue E939 (Fig. 3c). The distances of this Na1 to the E936 and E939 are at ~3.5 Å, suggesting that Na+ in Na1 site may still be hydrated. Meanwhile, D370 of the DEKA-locus contributes minorly to this Na+ binding site at a distance of ~7.5 Å (Fig. 3c). This observation is in line with previous studies showing that E936/K1413 of the DEKA-locus are the most prominent residues for Na+ permeation and selectivity, while D370 of the DEKA-locus is not absolutely required63. This potential Na1 site may represent the first step for Na+ conductance, that is, E936 of the DEKA-locus attracts and captures one hydrated Na+ from the extracellular solution with the assistance of E939. The second blob of density is located inside the SF, namely the Na2 site, which is about ~5.3 Å away from the Na1 site (Fig. 3d, e). Interestingly, the Na2 is close to the short side-chain residue A1705 of the DEKA-locus and is coordinated with the strictly conserved E373 at a distance of ~3.3 Å (Fig. 3c, d). We also noticed that D370/E936 of the DEKA-locus contribute negligibly to the Na2 at distances of 5.6–6.6 Å (Fig. 3c). Thus, we hypothesize that the Na2 may represent the second step for sodium conductance, that is, after captured and partially dehydrated in Na1 site, at least partially-dehydrated Na+ can fit into the Na2 site which is going to enter the narrowest asymmetric constriction site of the SF. The possible partial dehydration of Na+ in the Na2 site is reflected by its relatively weaker density compared to the Na1 (Fig. 3d, e). Furthermore, the K1413 points its long side-chain deep into the SF, forming the narrowest part of the SF. It has been proposed that this residue serves as a key coordination ligand in favor of Na+ or Li+ but is unfavorable for other cations43. In line with this hypothesis, Na+ from the Na2 site can quickly pass through the SF and enter the central cavity accelerated by the amino group of the K1413. We found additional elongated density below the K1413 at a distance of ~3.5 Å, which may represent a third Na+ site (namely Na3) (Fig. 3d, e). Consistently, previous MD simulations studies suggested that two Na+ ions spontaneously occupy the symmetric SF of the bacterial NaV channels, and three Na+ sites were proposed in the asymmetric SF of the eukaryotic NaV channel70,71,

Fig. 6: Map** the pathogenic mutations on the NaV1.6EM.
figure 6

Representative pathogenic mutations were mapped on the NaV1.6 structure. Red and blue spheres represent the gain of function mutations (related to epilepsy) and loss of function mutations (related to intellectual disability), respectively.