Arrhythmogenesis in a catecholaminergic polymorphic ventricular tachycardia mutation that depresses ryanodine receptor function
Proceedings of the National Academy of Sciences, 2015•pnas.org
Current mechanisms of arrhythmogenesis in catecholaminergic polymorphic ventricular
tachycardia (CPVT) require spontaneous Ca2+ release via cardiac ryanodine receptor
(RyR2) channels affected by gain-of-function mutations. Hence, hyperactive RyR2 channels
eager to release Ca2+ on their own appear as essential components of this arrhythmogenic
scheme. This mechanism, therefore, appears inadequate to explain lethal arrhythmias in
patients harboring RyR2 channels destabilized by loss-of-function mutations. We aimed to …
tachycardia (CPVT) require spontaneous Ca2+ release via cardiac ryanodine receptor
(RyR2) channels affected by gain-of-function mutations. Hence, hyperactive RyR2 channels
eager to release Ca2+ on their own appear as essential components of this arrhythmogenic
scheme. This mechanism, therefore, appears inadequate to explain lethal arrhythmias in
patients harboring RyR2 channels destabilized by loss-of-function mutations. We aimed to …
Current mechanisms of arrhythmogenesis in catecholaminergic polymorphic ventricular tachycardia (CPVT) require spontaneous Ca2+ release via cardiac ryanodine receptor (RyR2) channels affected by gain-of-function mutations. Hence, hyperactive RyR2 channels eager to release Ca2+ on their own appear as essential components of this arrhythmogenic scheme. This mechanism, therefore, appears inadequate to explain lethal arrhythmias in patients harboring RyR2 channels destabilized by loss-of-function mutations. We aimed to elucidate arrhythmia mechanisms in a RyR2-linked CPVT mutation (RyR2-A4860G) that depresses channel activity. Recombinant RyR2-A4860G protein was expressed equally as wild type (WT) RyR2, but channel activity was dramatically inhibited, as inferred by [3H]ryanodine binding and single channel recordings. Mice heterozygous for the RyR2-A4860G mutation (RyR2-A4860G+/−) exhibited basal bradycardia but no cardiac structural alterations; in contrast, no homozygotes were detected at birth, suggesting a lethal phenotype. Sympathetic stimulation elicited malignant arrhythmias in RyR2-A4860G+/− hearts, recapitulating the phenotype originally described in a human patient with the same mutation. In isoproterenol-stimulated ventricular myocytes, the RyR2-A4860G mutation decreased the peak of Ca2+ release during systole, gradually overloading the sarcoplasmic reticulum with Ca2+. The resultant Ca2+ overload then randomly caused bursts of prolonged Ca2+ release, activating electrogenic Na+-Ca2+ exchanger activity and triggering early afterdepolarizations. The RyR2-A4860G mutation reveals novel pathways by which RyR2 channels engage sarcolemmal currents to produce life-threatening arrhythmias.
pnas.org