Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada.
Program in Developmental and Stem Cell Biology, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada.
Cell Rep Med. 2024 May 21;5(5):101520. doi: 10.1016/j.xcrm.2024.101520. Epub 2024 Apr 19.
Pathogenic variants in MYH7 and MYBPC3 account for the majority of hypertrophic cardiomyopathy (HCM). Targeted drugs like myosin ATPase inhibitors have not been evaluated in children. We generate patient and variant-corrected iPSC-cardiomyocytes (CMs) from pediatric HCM patients harboring single variants in MYH7 (V606M; R453C), MYBPC3 (G148R) or digenic variants (MYBPC3 P955fs, TNNI3 A157V). We also generate CMs harboring MYBPC3 mono- and biallelic variants using CRISPR editing of a healthy control. Compared with isogenic and healthy controls, variant-positive CMs show sarcomere disorganization, higher contractility, calcium transients, and ATPase activity. However, only MYH7 and biallelic MYBPC3 variant-positive CMs show stronger myosin-actin binding. Targeted myosin ATPase inhibitors show complete rescue of the phenotype in variant-positive CMs and in cardiac Biowires to mirror isogenic controls. The response is superior to verapamil or metoprolol. Myosin inhibitors can be effective in genotypically diverse HCM highlighting the need for myosin inhibitor drug trials in pediatric HCM.
MYH7 和 MYBPC3 的致病变体导致了大多数肥厚型心肌病(HCM)。针对肌球蛋白 ATP 酶抑制剂的靶向药物尚未在儿童中进行评估。我们从患有 MYH7(V606M;R453C)、MYBPC3(G148R)或双基因变体(MYBPC3 P955fs、TNNI3 A157V)的儿科 HCM 患者中生成了携带单个变体的患者和变体校正的 iPSC-心肌细胞(CM)。我们还使用 CRISPR 编辑健康对照来生成携带 MYBPC3 单等位基因和双等位基因变体的 CMs。与同基因和健康对照相比,变体阳性 CMs 显示肌节紊乱、更高的收缩性、钙瞬变和 ATP 酶活性。然而,只有 MYH7 和双等位基因 MYBPC3 变体阳性 CMs 显示出更强的肌球蛋白-肌动蛋白结合。针对肌球蛋白 ATP 酶的抑制剂可完全挽救变体阳性 CMs 中的表型,并在心脏生物线中与同基因对照相匹配。这种反应优于维拉帕米或美托洛尔。肌球蛋白抑制剂在基因型多样化的 HCM 中可能有效,这突出了在儿科 HCM 中进行肌球蛋白抑制剂药物试验的必要性。