The second PI(3,5)P 2 binding site in the S0 helix of KCNQ1 stabilizes PIP 2 -at the primary PI1 site with potential consequences on intermediate-to-open state transition.

The Phosphatidylinositol 3-phosphate 5-kinase Type III PIKfyve is the main source for selectively generated phosphatidylinositol 3,5-bisphosphate (PI(3,5)P), a known regulator of membrane protein trafficking. PI(3,5)P facilitates the cardiac KCNQ1/KCNE1 channel plasma membrane abundance and therewith increases the macroscopic current amplitude. Functional-physical interaction of PI(3,5)P with membrane proteins and its structural impact is not sufficiently understood. This study aimed to identify molecular interaction sites and stimulatory mechanisms of the KCNQ1/KCNE1 channel via the PIKfyve-PI(3,5)P axis. Mutational scanning at the intracellular membrane leaflet and nuclear magnetic resonance (NMR) spectroscopy identified two PI(3,5)P binding sites, the known PIP site and the newly identified N-terminal α-helix as relevant for functional PIKfyve effects. Cd coordination to engineered cysteines and molecular modeling suggest that repositioning of stabilizes the channel s open state, an effect strictly dependent on parallel binding of PI(3,5)P to both sites.