Structural basis for the severe adverse interaction of sofosbuvir and amiodarone on L-type Cav channels

Xia Yao, Shuai Gao, Jixin Wang, Zhangqiang Li, Jian Huang, Yan Wang, Zhifei Wang, Jiaofeng Chen, Xiao Fan, Weipeng Wang, Xueqin Jin, Xiaojing Pan, Yong Yu, Armando Lagrutta, Nieng Yan

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Drug-drug interaction of the antiviral sofosbuvir and the antiarrhythmics amiodarone has been reported to cause fatal heartbeat slowing. Sofosbuvir and its analog, MNI-1, were reported to potentiate the inhibition of cardiomyocyte calcium handling by amiodarone, which functions as a multi-channel antagonist, and implicate its inhibitory effect on L-type Cav channels, but the molecular mechanism has remained unclear. Here we present systematic cryo-EM structural analysis of Cav1.1 and Cav1.3 treated with amiodarone or sofosbuvir alone, or sofosbuvir/MNI-1 combined with amiodarone. Whereas amiodarone alone occupies the dihydropyridine binding site, sofosbuvir is not found in the channel when applied on its own. In the presence of amiodarone, sofosbuvir/MNI-1 is anchored in the central cavity of the pore domain through specific interaction with amiodarone and directly obstructs the ion permeation path. Our study reveals the molecular basis for the physical, pharmacodynamic interaction of two drugs on the scaffold of Cav channels.

Original languageEnglish (US)
Pages (from-to)4801-4810.e13
Issue number25
StatePublished - Dec 8 2022

All Science Journal Classification (ASJC) codes

  • General Biochemistry, Genetics and Molecular Biology


  • Ca1.1
  • Ca1.3
  • L-type Ca channels
  • amiodarone
  • cryo-EM
  • drug safety
  • drug-drug interactions
  • severe bradycardia
  • sofosbuvir
  • voltage-gated calcium channels


Dive into the research topics of 'Structural basis for the severe adverse interaction of sofosbuvir and amiodarone on L-type Cav channels'. Together they form a unique fingerprint.

Cite this