Structures of TASK-1 and TASK-3 K2P channels provide insight into their gating and dysfunction in disease

TASK-1 and TASK-3 are pH-sensitive Two-Pore Domain (K2P/KCNK) K+ channels. Their functional roles make them promising targets for the treatment of multiple disorders including sleep apnea, pain and atrial fibrillation. Rare genetic mutations in these channels are also associated with neurodevelopmental and hypertensive disorders. A recent crystal structure of TASK-1 revealed a lower 'X-gate' that is a hotspot for missense gain-of-function mutations associated with DDSA (Developmental Delay with Sleep Apnea). However, the structural basis for gating in TASK channels and how they sense extracellular pH to regulate gating have not been fully elucidated. Here, we resolve structures for both the human TASK-1 and TASK-3 channels by cryoEM, as well as for a recurrent TASK-3 variant (G236R) associated with KCNK9 Imprinting Syndrome (formerly referred to as Birk-Barel Syndrome). Combined with functional studies of the X-gating mechanism, these structures not only provide evidence for how a highly-conserved gating mechanism becomes defective in disease, but also provide further insight into the pathway of conformational changes that underlie the pH-dependent inhibition of TASK channel activity.