Forward trafficking of ion channels: what the clinician needs to know

Each heartbeat requires precisely orchestrated action potential propagation through the myocardium, achieved by coordination of about a million ion channels on the surface of each cardiomyocyte. Specific ion channels must occur within discrete subdomains of the sarcolemma to exert their electrophysiological effects with highest efficiency (e.g., voltage-gated Ca(2+) channels at T-tubules and gap junctions at intercalated discs). Regulation of ion channel movement to their appropriate membrane subdomain is an exciting research frontier with opportunity for novel therapeutic manipulation of ion channels in the treatment of heart disease. Although much research has generally focused on internalization and subsequent degradation of ion channels, the field of forward trafficking of de novo ion channels from the cell interior to the sarcolemma has now emerged as a key regulatory step in cardiac electrophysiological function. In this brief review, we provide an overview of the current understanding of the cellular biology governing the forward trafficking of ion channels.