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1 a e Na V 1.5 Ad-LacZ Ad- 110KD b Scn5a/ (relative to Ad-LacZ) f p = 0.65 Ad-LacZ Ad- c Heart Lung Kidney Spleen 110KD d fl/fl c -/- DAPI 20 µm Na v KD fl/fl Rabbit IgG DAPI fl/fl Mouse IgG DAPI 40KD fl/fl c -/- fl/fl c -/- 20 µm Supplementary Fig. 1. Effect of overexpression or deletion on Na v 1.5 expression. (a & b) Effect of adenoviral overexpression of on expression of Na v 1.5 at protein (a) or mrna (b) level in rat neonatal cardiac myocytes. n = 4 for Ad-LacZ and Ad-. (c) expression in hearts of c -/- mouse with conditional deletion of cardiomyocyte. (d) Representative photomicrographs showing immunostaining for in the cardiomyocytes isolated from fl/fl and c -/- mouse. (e) Immunoblots showing Na v 1.5 expression in fl/fl and c -/- mouse hearts. (f) Negative controls for immunofluorescence using non-immune mouse (red) and rabbit (green) IgGs. Ad-: adenovirus expressing ; Ad-LacZ: control adenovirus expressing E. Coli LacZ. Uncropped blots are shown in supplementary figure 8. Independent sample t-test was used. For box-and-whiskers plots, center line shows median end of box shows IQR and whiskers show minima and maxima within 1.5 IQR. 1

2 a b Relative currents Na v 1.5 Na v 1.5+S irt1 Na v 1.5+ (H363Y) Relative conductance Relative currents Ex-242 Ex Relative conductance c d Relative currents Na v 1.5 Na v 1.5K 1479A Na v 1.5K 1479A + S irt1 Na v 1.5K 1479A +(H363Y) Relative conductance Relative currents Na v 1.5-W T Na v 1.5-K 1479R Na v 1.5-K 1479Q Relative conductance Membrane potential (mv) Membrane potential (mv) Supplementary Fig. 2. Activation and inactivation plots for wild type, mutant, and native Na v 1.5 with overexpression or inhibition. (a) Effect of and dominant negative (H363Y) expression on steady state activation and inactivation of Na v 1.5 expressed in HEK 293 cells. n =10 cells for Na v 1.5 and Na v 1.5+ (H363Y), n= 11 cells for Na v (b) Effect of inhibitor Ex-243 on steady state activation and inactivation of native Na v 1.5 in rat neonatal cardiac myocytes. n =6 cells for Ex-242, n= 5 cells for Ex-243. (c) Effect of and (H363Y) expression on steady state activation and inactivation currents in HEK 293 cells expressing K1479A-Na v 1.5. n= 8 cells for Na v 1.5, n = 6 cells for Na v 1.5+, and n=7 cells for Na v 1.5-K1479A and Na v 1.5-K1479A+ (H363Y). (d) Effect of K1479R and K1479Q mutations on steady state activation and inactivation currents in HEK 293 cells expressing Na v 1.5-WT, Na v 1.5-K 1479R or Na v 1.5-K 1479Q. n= 8 cells for Na v 1.5-WT, n = 9 cells for Na v 1.5- K 1479R, and n=10 cells for Na v 1.5-K 1479Q. Independent sample t-test was used. In the XY scatter plot data shown as mean and error bar represents s.e.m. Ex-242: inactive isomer of Ex-243. For XY scatter plots data is shown as mean and error bar represents s.e.m. 2

3 a 150 ms b Normalized current 50 ms 50 ms 0.2 mv 0.05 mv fl/fl c -/- 150 ms Late current (I Na, t150ms / I Na, peak ) p = 0.89 fl/fl c -/- c V max (V/s) * APD (ms) * fl/fl c -/- 0 d fl/fl * * c -/- APD 25 APD 50 APD 75 APD 90 * e Resting membrane potential (mv) p = 0.19 fl/fl c -/- Supplementary Fig. 3. Effect of cardiomyocyte deletion on late I Na, V max, cardiac action potential duration, and resting membrane potential. Late sodium current was measured in response to a 200 ms voltage steps to 20 mv from a holding potential of 120 mv. (a) Representative whole-cell I Na in ventricular cardiomyocytes isolated from fl/fl and c -/- mice (Normalized to the peak I Na ). Lower panel shows voltage-expanded view of the I Na. (b) Mean I Na at 150 ms. n = 7 cells for fl/fl and n = 5 cells for c -/-. (c & d) Maximum velocity (V max ) of upstroke of the action potential (AP) (c) and action potential duration (APD) (d) in ventricular myocytes isolated from c -/- compared to control fl/fl mice. P < 0.05, * vs. fl/fl. n = 7 cells for fl/fl and n = 6 cells for c -/-. (e) Resting membrane potential in cardiomyocytes isolated from c -/- and fl/fl mice. n = 11 cells for fl/fl and n = 8 cells for c -/-. Independent sample t-test was used. Data shown as mean and error represents s.e.m. For box-and-whiskers plots, center line shows median, end of box shows IQR, and whiskers show minima and maxima within 1.5 IQR. 3

4 a IP: Na V 1.5 Ace-K Na V 1.5 Myc- Ad-Lac-Z Ad-SIRT1 (H363Y) 220KD 220KD 110KD b Ace-K Na V 1.5(III-IV) NAM Ace-K Na V 1.5 Supplementary Fig. 4. Sirtuin1 and non-sirtuin HDACs regulate acetylation of Na v 1.5. (a) Effect of inhibition of by adenoviral overexpression of dominant negative (H363Y) on acetylation of endogenous Na v 1.5 in rat neonatal cardiac myocytes. (b) Effect of inhibition of with NAM, overexpression of, and activation of with resveratrol (Resv.) on acetylation of - Na v 1.5 (III-IV) peptide expressed in HEK 293 cells (c) Effect of Sirtuin inhibition with nicotinamide (NAM 10mM) and HDAC inhibition with trichostatin A (TSA 100nM) on K1479 acetylation of Na v 1.5 in HEK 293 cells expressing Na v 1.5. Uncropped blots are shown in supplementary figure 8. Resveratrol c Control NAM TSA 4

5 a Ace-K p Na V (III-IV) + + b Intensity (counts) c Na V 1.5(III-IV) p Relative peak intensity + d Fold specificity Antibody concentration (ng/ml) e Ace.-K Na V 1.5 Na V Na V (acetyl K 1479 ) 0.02 µg 0.20 µg 2.00 µg Antibody concentration (2.5 ng/ml) Amount of peptide Ace.-K Na V 1.5 IB: Na V 1.5(III/IV) pcdna p300/cbp + + Supplementary Fig. 5. Mass spectrometry identifying Lysine 1479 in Na v 1.5 as targeted for deacetylation by ; generation of acetyl-k1479 antibody (a) Effect of p300/cbp and on lysine acetylation of recombinant -Na v 1.5 (III-IV) peptide in vitro. (b) Representative annotated MS/MS fragmentation spectra of -Na v 1.5 (III-IV) peptide treated with p300/cbp. The acetylated K1479-containing peptide in Na v 1.5 identified with LC-MS/MS analysis was not observed in cells not treated with p300/cbp, or in cells which were sequentially treated with after being incubated with p300/cbp. (c) Relative quantities of ionized acetylated peptide in -Na v 1.5 (III-IV) peptide treated with p300 and p (d-f) Specificity and sensitivity of acetyl- K 1479 antibody for acetylated K1479 of Na v 1.5. (d) Fold specificity of acetyl-k1479 antibody by a quantitative immuno-adsorption assay of antibody binding to a membrane pre-coated with nonacetylated or acetylated peptide. Fold specificity = ratio of affinity of antibody to acetylated vs. non-acetylated peptide. Orange-bar represents the concentration range in which antibody was used for western blot and immunohistochemistry experiments. Dotted line indicates background reading. (e) Dot blot of the non-acetylated or K1479 acetylated peptide (a.a ) of Na v 1.5 with the acetyl-k 1479 antibody. (f) Western blot using acetyl-k1479 antibody on recombinant -Na v 1.5 (III-IV) peptide treated with p300/cbp in vitro. Uncropped blots are shown in supplementary figure 8. f + IP: + 5

6 a Connexin 43 b Connexin 43 fl/fl c -/- Vehicle Ex-527 c Ace-K Na V 1.5 d 80 32KD 18KD 45KD Bip Chop Vehicle Ex-527 Vehicle Ex-527 Supplementary Fig. 6. Effect of deletion or inhibition of cardiomyocyte on connexin 43, Na v 1.5 acetylation, and unfolded protein response. (a & b) Immunohistochemistry and immunoblotting for cardiac connexin 43 in hearts from -/- and fl/fl mice (a) or mice treated with the inhibitor Ex-527 (2mg/kg/day, 14 days) (b). (c) K1479 acetylation of Na v 1.5 in the hearts of mice with treated with Ex-527. (d) Bip and Chop expression in the hearts of mice treated with Ex-527. Uncropped blots are shown in supplementary figure 8. 6

7 Fig. 1a Fig. 1c Fig. 1d Fig. 2a IP: N-IgG IP: Na V 1.5 IP: N-IgG IP: Na V 1.5 cmyc IP: Na V 1.5 IB: Ace-K IP: Na V 1.5 IB: Ace-K Na V 1.5 Rat neonatal CM Na V 1.5 Mouse heart Na v 1.5 Na v 1.5+ Na v 1.5+ (H363Y) Rat neonatal CM IP: Na V 1.5 IB: Na V 1.5 Ex-242 Ex-243 Na V 1.5 (GFP) Control Resv. Fig. 2b Fig. 2c Fig. 2d Fig. 2e -Na V 1.5 (III-IV)+p300 Exp-2 -Na V 1.5(III-IV) -Na V 1.5 (III-IV)+p300 Exp-1 -Na V 1.5(III-IV) Ace-K Ace-K 1479 Na v 1.5 Ace-K 1479 Na v KD 110KD Na v KD Fig. 2f Ace-K 1479 Na v Na V 1.5(III-IV) Ace-CoA p SIRT1 NAD KD 40KD pcdna (H363Y) Fig. 2h Fig. 4f Ace-K 1479 Na v ETN Ace-K 1479 Na v 1.5 GAPDH 100KD 75KD 42KD 34KD SIRT1 Na v 1.5 (N-term) 250KD GAPDH c -/- WT ID No ID No GAPDH ID No Control samples Supplementary Fig. 7. Uncropped immunoblots of indicated figures. 7

8 Suppl. Fig. 1c 110KD Suppl. Fig. 1e Na v 1.5 (N-term) 250KD fl/fl Heart Lung Kidney Spleen c -/- fl/fl Suppl. Fig. 6b c -/- Connexin 43 Vehicle Suppl. Fig. 6c Ace-K 1479 Na v 1.5 Ex-527 Vehicle Ex-527 Suppl. Fig. 4a IP: Na V 1.5 IB: Ace-K IP: Na V 1.5 IB: Na V 1.5 Myc- Suppl. Fig. 4b IP: IB: Ace-K IP: IB: Suppl. Fig. 6d Bip Untreat. NAM Ad-Lac-Z Resveratrol Ad-SIRT1 (H363Y) 220KD 220KD 110KD Suppl. Fig. 5e Ace.-K Na V 1.5 Na V Na V (acetyl K 1479 ) Suppl. Fig. 4c IB: Ace.-K Na V µg 0.20 µg Suppl. Fig. 5a IP: IB: Ace-K IP: IB: -Na V 1.5 (III-IV) -Na V 1.5 (III-IV) Amount of peptide µg p Suppl. Fig. 5f IP: IB: Ace.-K Na V 1.5 IB: Chop 2.00 µg - Na V 1.5(III/IV) pcdna p300/cbp Vehicle Ex-527 Supplementary Fig. 8. Uncropped immunoblots of indicated figures. 8

9 Supplementary Table 1. Kinetics of I Na conducted by wild type or K1479A Na v 1.5 in HEK 293 cells expressing wild type or dominant negative (H363Y), and of I Na conducted by native Na v 1.5 in rat neonatal cardiac myocytes treated with Ex-242 or Ex-243. HEK 293 cells Steady State Activation (V 50, mv) Steady State Inactivation (V 50, mv) Development of Slow Inactivation (ms) Na v ± ± ± 35.2 Recovery from Slow & Fast Inactivation (ms) Slow;174.6 ± 18.6 Fast;10.4 ± 15.0 Mean cell Capacitance (pf) 9.36±0.58 Na v ± ± ± 41.0 Slow;208.9 ± 40.4 Fast;6.4 ± ±0.51 Na v (H363Y) ± ± ± 47.4 K1479A-Na v ± ± ± 41.7 K1479A-Na v K1479A-Na v (H363Y) ± ± ± ± ± ± 25.9 Slow; ± 23.5 Fast;13.9 ± 2.6 Slow;166.8 ± 28.3 Fast;12.8 ± 3.6 Slow;193.8 ± 15.4 Fast;18.3 ± 1.6 Slow;158.6 ± 32.7 Fast; 14.3 ± ± ± ± ±0.88 Rat neonatal cardiac myocytes Ex ± ± ±0.78 Ex ± ± ±0.91 Rat neonatal cardiac myocytes were treated with inhibitor Ex-243 or its inactive control isomer Ex-242. Data shown as mean and error bar represents s.e.m. 9

10 Supplementary Table 2. Voltage-gating of I Na in cardiomyocytes isolated from c -/- and fl/fl mice. Mouse ventricular cardiomyocytes Steady State Inactivation (V 50, mv) Time Constants of the Decay Phase of I Na (ms) fl/fl ± 1.3 (n=7) 1.7 ± 0.1 (n=7) Recovery from Slow & Fast Inactivation (ms) Slow;137.6 ± 31.9 (n=4) Fast;5.6 ± 0.3 c -/ ± 1.8, (n=5) 1.3 ± 0.3 (n=4) Slow;165.1 ± 60.3 (n=4) Fast;4.6 ± 1.6 p ns ns ns ns; p > 0.05 vs. fl/fl. Independent sample t-test was used. Data shown as mean and error bar represents s.e.m. 10

11 Supplementary Table 3. Kinetic properties of wild type, K1479A, and K1479Q Na v 1.5 expressed in HEK 293 cells. Steady State Activation (V 50, mv) Steady State Inactivation (V 50, mv) Na v 1.5-WT (n) Na v 1.5-K 1479R (n) p value Na v 1.5-K 1479Q (n) p value ± 2.7 (8) ± 1.7 (10) ± 2.1(10) ± 2.0 (9) ± 2.0 (9) ± 1.5 (11)

12 Supplementary Table 4. EKG features of c -/- mice and fl/fl mice. Genotype Age (months) N Sex (% Male) HR (min -1 ) PR (msec) QRS (msec) QT (msec) QTc (msec) fl/fl 4.2 ± ± ± ± ± 3 59 ± 3 c -/- 4.4 ± ± ± ± ± 5 54 ± 3 fl/fl 8.3 ± ± ± ± ± 5 49 ± 3 c -/- 9.2 ± ± ± ± 1.0* 74 ± 4* 63 ± 3* * p < 0.05 vs. fl/fl. Independent sample t-test was used. Data shown as mean and error bar represents s.e.m. 12

13 Supplementary Table 5. Effect of inhibition with Ex-527 on EKG features in Scn5a +/+ and Scn5a +/- mice. Scn5a +/+ Mice Basal Ex-527 N 5 4 Age (months) 10.6 ± 0.4 p value RR interval (ms) PR interval (ms) QRS interval (ms) 121 ± ± ± ± ± ± QTc duration (ms) 50.9 ± ± Scn5a +/- Mice Basal Ex-527 N 8 8 Age (months) 11.1 ± 0.2 RR interval (ms) PR interval (ms) QRS interval (ms) 125 ± ± ± ± ± ± QTc duration (ms) 66.5 ± ±

14 Supplementary Table 6. Ambulatory telemetry of c -/- and fl/fl mice. Parameters fl/fl c -/- p value N Age (Months) 7.2 ± ± Sex (male/female) 3/7 8/ Maximum heart rate (beats/min) 751 ± ± Minimum heart rate (beats/min) 360 ± ± Mice with nonsustained VT Longest ventricular pause (msec) 331 ± ± Frequent sinus pauses (>5/hr) o Degree heart block (in 12 hrs) 1.3 ± ± Nonsustained VT, 3 consecutive ventricular beats; Sinus pause, cycle length increase of >50% to >150 msec. Independent sample t-test was used. Data shown as mean and error bar represents s.e.m. 14

15 Supplementary Table 7. General, gross, and echocardiographic features of male fl/fl and c -/- mice. General Parameters fl/fl c -/- p value n 5 6 Age (Months) 5.6 ± ± Heart weight (mg) 157 ± ± Lung weight (mg) 180 ± ± Body weight (grams) 32.7 ± ± Heart weight/body weight ± ± Lung weight/body weight ± ± Echocardiogram Parameters fl/fl c -/- p value n 5 7 Age (Months) 5.6 ± ± Heart rate (beats/minute) 612 ± ± End diastolic Volume (µl) 40 ± 4 51 ± End systolic Volume (µl) 8 ± 2 18 ± LV ejection fraction (%) 80 ± 4 63 ± Cardiac output (µl/minute) 19.4 ± ± Independent sample t-test was used. Data shown as mean and error bar represents s.e.m. 15

16 Supplementary Table 8. Demographic, gross, EKG, and echocardiographic features of hearts from normal donors and patients with idiopathic dilated cardiomyopathy. Normal Parameters Cardiomyopathy Donors Diagnosis Normal Idiopathic Dilated N 4 7 Conduction abnormality - 5 Heart rate ± 8.2 p value PR interval (ms) ± 15.9 Normal <200 QRS interval (ms) ± 13.8 Normal <120 QTc interval (ms) ± 16.3 Normal <450 Ethnicity (% Caucasian) Patient Weight (kg) 70.8 ± ± Patient Height (cm) ± ± Age (Y) 51.0 ± ± Heart Weight (g) ± ± LVEF % 66.3 ± ± 2.5 < CMP; Cardiomyopathy, LVEF%; left ventricular ejection fraction. Independent sample t-test was used. Data shown as mean and error represents s.e.m. 16

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