Brohus Malene, Busuioc Ana-Octavia, Wimmer Reinhard, Nyegaard Mette, Overgaard Michael Toft
Department of Chemistry and Bioscience, Aalborg University, Aalborg, Denmark.
Department of Health Science and Technology, Aalborg University, Gistrup, Denmark.
Front Pharmacol. 2023 Aug 16;14:1210140. doi: 10.3389/fphar.2023.1210140. eCollection 2023.
Missense variants in genes encoding the Ca-binding protein calmodulin (CaM) cause severe cardiac arrhythmias. The disease mechanisms have been attributed to dysregulation of RyR2, for Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT) and/or Ca1.2, for Long-QT Syndrome (LQTS). Recently, a novel variant, G114R, was identified in a mother and two of her four children, all of whom died suddenly while asleep at a young age. The G114R variant impairs closure of Ca1.2 and RyR2, consistent with a CPVT and/or mild LQTS phenotype. However, the children carrying the G114R variant displayed a phenotype commonly observed with variants in Na1.5 i.e., Brugada Syndrome (BrS) or LQT3, where death while asleep is a common feature. We therefore hypothesized that the G114R variant specifically would interfere with Na1.5 binding. Here, we demonstrate that CaM binding to the Na1.5 IQ-domain is severely impaired for two CaM variants G114R and G114W. The impact was most severe at low and intermediate Ca concentrations (up to 4 µM) resulting in more than a 50-fold reduction in Na1.5 binding affinity, and a smaller 1.5 to 11-fold reduction at high Ca concentrations (25-400 µM). In contrast, the arrhythmogenic CaM-N98S variant only induced a 1.5-fold reduction in Na1.5 binding and only at 4 µM Ca. A non-arrhythmogenic I10T variant in CaM did not impair Na1.5 IQ binding. These data suggest that the interaction between Na1.5 and CaM is decreased with certain CaM variants, which may alter the cardiac sodium current, I. Overall, these results suggest that the phenotypic spectrum of calmodulinopathies may likely expand to include BrS- and/or LQT3-like traits.
编码钙结合蛋白钙调蛋白(CaM)的基因中的错义变异会导致严重的心律失常。疾病机制被认为是由于儿茶酚胺能多形性室性心动过速(CPVT)导致的兰尼碱受体2(RyR2)功能失调和/或长QT综合征(LQTS)导致的Ca1.2功能失调。最近,在一位母亲及其四个孩子中的两个孩子身上发现了一种新的变异体G114R,他们都在年幼时睡觉时突然死亡。G114R变异体损害了Ca1.2和RyR2的关闭,这与CPVT和/或轻度LQTS表型一致。然而,携带G114R变异体的孩子表现出一种常见于Na1.5变异体的表型,即Brugada综合征(BrS)或LQT3,睡眠中死亡是其常见特征。因此,我们推测G114R变异体可能会特异性地干扰Na1.5的结合。在此,我们证明,对于两种CaM变异体G114R和G114W,CaM与Na1.5 IQ结构域的结合严重受损。在低钙和中等钙浓度(高达4µM)时影响最为严重,导致Na1.5结合亲和力降低超过50倍,而在高钙浓度(25 - 400µM)时降低幅度较小,为1.5至11倍。相比之下,致心律失常的CaM - N98S变异体仅在4µM钙时导致Na1.5结合降低1.5倍。CaM中的一种非致心律失常的I10T变异体不会损害Na1.5 IQ结合。这些数据表明,特定的CaM变异体会降低Na1.5与CaM之间的相互作用,这可能会改变心脏钠电流I。总体而言,这些结果表明,钙调蛋白病的表型谱可能会扩大到包括BrS和/或LQT3样特征。