title: Whole-exome sequencing of a family with local anesthetic resistance.
abstract: Local anesthetics (LA) work by blocking sodium conductance through voltage-gated sodium channels. Complete local anesthetic resistance is infrequent, and the cause is unknown. Genetic variation in sodium channels is a potential mechanism for local anesthetic resistance. A patient with a history of inadequate loss of sensation following LA administration underwent an ultrasound-guided brachial plexus nerve block with a complete failure of the block. We hypothesized that LA resistance is due to a variant form of voltage-gated sodium channel.
  
  
  
  Whole-Exome Sequencing. The patient and her immediate family provided consent for exome sequencing, and they were screened with a questionnaire to identify family members with a history of LA resistance. Exome sequencing results for four individuals were referenced to the 1000 Genomes Project and the NHLBI ESP to identify variants associated with local anesthetic resistance present in less than 1% of the general population and located in functional regions of the genome.
  
  
  
  Exome sequencing of the four family members identified one genetic variant in the voltage-gated sodium channel shared by the three individuals with LA resistance but not present in the unaffected family member. Specifically, we noted the A572D mutation in the SCN5A gene encoding for Nav1.5.
  
  
  
  We identified a genetic variant that is associated with LA resistance in the gene encoding for Nav1.5. We also demonstrate that Nav1.5 is present in human peripheral nerves to support the plausibility that an abnormal form of the Nav1.5 protein could be responsible for the observed local anesthetic resistance.
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA - Clendenen.steven@mayo.edu.
authors.forename: Nathan
authors.initials: N
authors.lastname: Clendenen
authors.forename: Ashley D
authors.initials: AD
authors.lastname: Cannon
authors.forename: Steven
authors.initials: S
authors.lastname: Porter
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Robards
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Parker
authors.forename: Steven R
authors.initials: SR
authors.lastname: Clendenen
mesh_terms: D000328:Adult; D000779:Anesthetics, Local; D004351:Drug Resistance / Q000235:genetics*; D059472:Exome / Q000235:genetics*; D005190:Family; D005260:Female; D014644:Genetic Variation; D006801:Humans; D008067:Lipoma / Q000601:surgery; D008297:Male; D062554:NAV1.5 Voltage-Gated Sodium Channel / Q000032:analysis / Q000187:drug effects / Q000235:genetics*; D010375:Pedigree; D017933:Peripheral Nervous System / Q000737:chemistry; D024642:Potassium Channels, Voltage-Gated / Q000235:genetics
chemical_list: D000779:Anesthetics, Local; C489619:KCNE2 protein, human; D062554:NAV1.5 Voltage-Gated Sodium Channel; D024642:Potassium Channels, Voltage-Gated; C568320:SCN5A protein, human