Abstract P1089: Short-QT & Long-QT Associated Trpm4 Mutations

Cardiac arrhythmias are responsible for 200-300 thousand deaths/year. Despite considerable research effort, much remains to be elucidated concerning the underlying mechanisms of arrhythmogenesis. Mutations in transient receptor potential melastatin 4 (TRPM4), a widely expressed Ca 2+ -activated nonselective cation channel, have been associated with causing cardiac arrhythmias. However, direct genotype-phenotype correlation of arrhythmogenic TRPM4 mutant variants are often complicated, as this channel is not primary to the cardiac action potential. Here, we assessed the electrophysiological and post-transcriptional molecular properties of a single mutation (R892C)-TRPM4 associated with short QT syndrome (SQTS) and a triple mutation (R250C|A432T|G582S)-TRPM4 associated with long QT syndrome (LQTS), using stably transfected HEK293 cells. Overall, protein expression of the triple mutant was found to be significantly reduced, with increased proteasomal degradation, but enhanced SUMOylation, as compared to either WT or the single R892 mutant TRPM4 channel. Consequently, expression of R250C|A432T|G582S-TRPM4 was significantly lower at the cellular membrane than either R892C- and WT-TRPM4. In contrast, while total expression of TRPM4 was not significantly different between WT and the R892C single mutant, although the R892C exhibited increase aggregation. Patch-clamp cellular electrophysiology experiments indicated that both single and triple TRPM4 mutant channels could be activated by lower Ca 2+ concentrations compared to WT. However, R892C-TRPM4 channels inactivated faster, while R250C|A432T|G582S-TRPM4 channels inactivated much slower compared to WT. These data as obtained in our homologous recombinant overexpression system reveal that while the R892C-TRPM4 mutant variant exhibited normal-to-higher levels of expression and increased Ca 2+ -activation sensitivity, its tendency to aggregate combined with faster inactivation can result in overall loss-of-function compared to WT, correlative with SQTS. Conversely, while the R250C|A432T|G582S-TRPM4 mutant variant exhibited reduced expression and perturbed trafficking, its increased Ca 2+ -activation sensitivity and slow inactivation can result in overall gain-of-function compared to WT, correlative with LQTS.

aYAP modRNA reduces cardiac inflammation and hypertrophy in a murine ischemia-reperfusion model

Myocardial recovery from ischemia-reperfusion (IR) is shaped by the interaction of many signaling pathways and tissue repair processes, including the innate immune response. We and others previously showed that sustained expression of the transcriptional co-activator yes-associated protein (YAP) improves survival and myocardial outcome after myocardial infarction. Here, we asked whether transient YAP expression would improve myocardial outcome after IR injury. After IR, we transiently activated YAP in the myocardium with modified mRNA encoding a constitutively active form of YAP (aYAP modRNA). Histological studies 2 d after IR showed that aYAP modRNA reduced cardiomyocyte (CM) necrosis and neutrophil infiltration. 4 wk after IR, aYAP modRNA-treated mice had better heart function as well as reduced scar size and hypertrophic remodeling. In cultured neonatal and adult CMs, YAP attenuated H2O2- or LPS-induced CM necrosis. TLR signaling pathway components important for innate immune responses were suppressed by YAP/TEAD1. In summary, our findings demonstrate that aYAP modRNA treatment reduces CM necrosis, cardiac inflammation, and hypertrophic remodeling after IR stress.

Abstract 252: Activated Fibroblast-specific Deletion of RhoA Reduces Cardiac Fibrosis Through Regulation of the Non-canonical p38-MAPK Signaling Pathway

Objective: Heart failure is a progressive disease characterized by cardiomyocyte (CM) loss, interstitial fibrosis, loss of ventricular compliance and chamber remodeling. Role of cardiac fibroblasts is implicated in the process, but specific molecular mechanisms regulating their function remain unclear. Previously, we showed that in mice, in response to stress, CM-specific deletion of RhoA, a Ras-related small G protein, accelerated cardiac dilation, with significant loss of contractile function, but it also significantly reduced cardiac fibrosis. Therefore, here, we focused on understanding the role of RhoA specifically in myofibroblast transformation and the fibrotic response.

Results: We generated mice with activated fibroblast-specific deletion of RhoA using a tamoxifen (TMX) inducible periostin-cre promoter (RhoAfl/fl::PSTN Cre/+). 10-wk-old male RhoAfl/fl::PSTN Cre/+ or control mice were treated with angiotensin-phenylephrine (AngPE) or saline for 4 wk using osmotic minipumps and fed either with TMX or regular diet. Following TMX-AngPE treatment, the RhoAfl/fl::PSTN Cre/+ mice showed significantly decreased cardiac fibrosis, as compared to controls (0.9% vs. 3.2%, respectively). Moreover, while overall cardiac function following AngPE treatment was similar at 4 wk in all groups, hearts from the TMX-RhoAfl/fl::PSTN Cre/+ mice had significantly reduced septal thickness, as compared to controls. Expression of fetal genes, ANF, BNP, and β-MHC, as well as markers of fibrosis, including α-SMA and CTGF, were similarly induced in control and TMX-RhoAfl/fl::PSTN Cre/+ mice. However, TMX-RhoAfl/fl::PSTN Cre/+ mice had reduced expression of TGF-β1, thrombospondin-5 and Col1a2. Finally, RhoA deletion in activated fibroblasts did not affect the canonical TGFβ signaling pathway, as expected; instead, we found TMX-RhoAfl/fl::PSTN Cre/+ hearts had reduced non-canonical p38-MAPK signaling, suggestive of cellular-specific effects of RhoA regulation in the onset of cardiac disease and fibrosis.

Conclusions: These data confirm the primacy of the RhoA pathway in the fibrotic response in vivo and identify potential novel downstream targets and possible therapeutic strategies for treatment of cardiac fibrosis and heart failure.

Abstract 397: Generation of Raf1 Mutant and Crispr-cas9 Corrected Isogenic iPSC-derived Cardiomyocytes to Model Hypertrophic Cardiomyopathy in Noonan Syndrome

Background: Hypertrophic cardiomyopathy (HCM) is a major cause of death in infants and children. Noonan Syndrome (NS), an autosomal dominant RASopathy disorder, is characterized by multiple defects, including short stature, facial dysmorphia, and congenital heart defects that include HCM. RASopathies are caused by germ-line mutations that affect the canonical RAS-MAPK pathway. Indeed, 95% of NS patients with a mutation in Raf1 , a gene that plays an integral role in this signaling cascade, exhibit HCM. However, the molecular mechanisms that elicit HCM in these patients remain poorly understood.

Objective: To generate human NS Raf1 induced-pluripotent stem cells (iPSCs), correct the mutation by genome editing and subsequently differentiate isogenic iPSC lines into cardiomyocytes to characterize the molecular and genetic basis of HCM in NS patients.

Results: We generated iPSCs from skin fibroblasts obtained from a NS pediatric patient with a single point mutation in the Raf1 gene. Using electroporation of four episomal vectors containing the Yamanaka factors, we obtained several iPSC clones with normal karyotypes and strong expression of pluripotent markers (Nanog, Oct4, Lin28, Sox2) as detected by RT-qPCR and immunofluorescence. We next corrected the mutation in the NS Raf1 iPSCs using genome editing CRISPR-Cas9 nickase technology. Correction of the Raf1 mutation was determined at the clonal level by PCR followed by Restriction Fragment Length Polymorphism and confirmed by Sanger sequencing. In addition, by inducing a Cas9 nickase-dependent frame shift mutation we also generated an isogenic iPSC line where Raf1 gene was knockout (KO), as demonstrated at the RNA level by RT-qPCR and at the protein level by Western Blot. We next differentiated these multiple iPSC lines (mutant, corrected and KO) into isogenic beating cardiomyocytes, with more >98% of the cells positive for specific cardiomyocyte markers (α-actinin and cardiac TroponinT).

Conclusion: We have successfully generated human NS Raf1 isogenic iPSC lines and corresponding cardiomyocytes. Currently, we are in progress of characterizing these cardiac cells to determine the molecular basis of NS-dependent HCM. Ultimately, our work should reveal new targets to treat HCM in NS patients.

The third international meeting on genetic disorders in the RAS/MAPK pathway: towards a therapeutic approach

"The Third International Meeting on Genetic Disorders in the RAS/MAPK Pathway: Towards a Therapeutic Approach" was held at the Renaissance Orlando at SeaWorld Hotel (August 2-4, 2013). Seventy-one physicians and scientists attended the meeting, and parallel meetings were held by patient advocacy groups (CFC International, Costello Syndrome Family Network, NF Network and Noonan Syndrome Foundation). Parent and patient advocates opened the meeting with a panel discussion to set the stage regarding their hopes and expectations for therapeutic advances. In keeping with the theme on therapeutic development, the sessions followed a progression from description of the phenotype and definition of therapeutic endpoints, to definition of genomic changes, to identification of therapeutic targets in the RAS/MAPK pathway, to preclinical drug development and testing, to clinical trials. These proceedings will review the major points of discussion.