Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW) and University Medical Center Utrecht, 3584 CT, Netherlands.
Department of Anatomy and Embryology, University Medical Center, Leiden, 2333 ZA, Netherlands.
Sci Transl Med. 2023 Mar 22;15(688):eadd4248. doi: 10.1126/scitranslmed.add4248.
Arrhythmogenic cardiomyopathy (ACM) is an inherited progressive cardiac disease. Many patients with ACM harbor mutations in desmosomal genes, predominantly in plakophilin-2 (). Although the genetic basis of ACM is well characterized, the underlying disease-driving mechanisms remain unresolved. Explanted hearts from patients with ACM had less PKP2 compared with healthy hearts, which correlated with reduced expression of desmosomal and adherens junction (AJ) proteins. These proteins were also disorganized in areas of fibrotic remodeling. In vitro data from human-induced pluripotent stem cell-derived cardiomyocytes and microtissues carrying the heterozygous pathogenic mutation also displayed impaired contractility. Knockin mice carrying the equivalent heterozygous mutation recapitulated changes in desmosomal and AJ proteins and displayed cardiac dysfunction and fibrosis with age. Global proteomics analysis of 4-month-old heterozygous hearts indicated involvement of the ubiquitin-proteasome system (UPS) in ACM pathogenesis. Inhibition of the UPS in mutant mice increased area composita proteins and improved calcium dynamics in isolated cardiomyocytes. Additional proteomics analyses identified lysine ubiquitination sites on the desmosomal proteins, which were more ubiquitinated in mutant mice. In summary, we show that a plakophilin-2 mutation can lead to decreased desmosomal and AJ protein expression through a UPS-dependent mechanism, which preceded cardiac remodeling. These findings suggest that targeting protein degradation and improving desmosomal protein stability may be a potential therapeutic strategy for the treatment of ACM.
致心律失常性右室心肌病(ACM)是一种遗传性进行性心脏病。许多 ACM 患者携带有桥粒蛋白基因的突变,主要是桥粒斑蛋白-2()。尽管 ACM 的遗传基础已得到很好的描述,但潜在的致病机制仍未解决。与健康心脏相比,ACM 患者的心脏中 PKP2 较少,这与桥粒和黏着连接(AJ)蛋白的表达减少有关。这些蛋白在纤维化重塑区域也出现了紊乱。来自携带杂合致病性突变的人类诱导多能干细胞衍生的心肌细胞和微组织的体外数据也显示出收缩功能受损。携带等效杂合突变的基因敲入小鼠重现了桥粒和 AJ 蛋白的变化,并随年龄增长表现出心脏功能障碍和纤维化。对 4 个月大的杂合突变心脏的全蛋白质组学分析表明,泛素-蛋白酶体系统(UPS)参与了 ACM 的发病机制。在突变小鼠中抑制 UPS 增加了面积复合蛋白,并改善了分离的心肌细胞中的钙动力学。额外的蛋白质组学分析确定了桥粒蛋白上赖氨酸泛素化位点,在突变小鼠中这些位点的泛素化程度更高。总之,我们表明,桥粒斑蛋白-2 突变可通过 UPS 依赖性机制导致桥粒和 AJ 蛋白表达减少,这先于心脏重塑。这些发现表明,靶向蛋白降解和改善桥粒蛋白稳定性可能是 ACM 治疗的潜在治疗策略。