Abstract 13171: The Role of Novel Brugada Syndrome Gene MAPRE2 in Maintaining Normal Cardiac Electrophysiology

Abstract

Introduction: Brugada syndrome (BrS) is a significant cause of sudden cardiac death yet only ~20% of patients are found with a loss-of-function variant in SCN5A encoding the cardiac Na + channel, leaving ~80% genetically undiagnosed. A recent genome-wide association study found 12 loci associated with BrS, including one in MAPRE2 encoding microtubule end-binding protein 2 (EB2). Hypothesis: MAPRE2 loss-of-function contributes to BrS and is necessary in maintaining normal cardiac electrophysiology (EP). Methods: Using CRISPR/Cas9, we generated two mapre2 loss-of-function mutants in zebrafish: a full knock-out and a mutant lacking the unique N-terminus of EB2 (delN). Cardiac EP was assessed using optical mapping in larvae, surface ECG in adults, and patch clamping in ventricular myocytes. Cardiac structure was assessed using videomicroscopy, histology, and confocal microscopy. Transcriptional changes were assessed using RNA-seq. Results: No gross changes in cardiac structure were observed with mapre2 loss-of-function. However, in both mutants, voltage mapping showed decreased ventricular conduction velocity and action potential upstroke velocity (V max ) and ECGs showed prolonged QRS, P wave, and corrected QT. Patch clamp of delN ventricular myocytes revealed reduced Na + current density without changes in gating properties consistent with the reduced V max . RNA-seq of larvel hearts suggested disruption of cell adhesion, confirmed by confocal microscopy, whereas Ca 2+ imaging found an increase in Ca 2+ transient amplitude. RNA-seq of adult hearts showed disruption in the Wnt signaling pathway and treatment with GSK3β inhibitor SB217673 rescued mutant ECG abnormalities. Conclusions: Our study supports MAPRE2 as a novel contributing gene in BrS pathogenesis and conduction slowing in general. Beyond its effect on Na + channel function, mapre2 and in particularly its unique N-terminal segment may play a broader role in cellular organization via the microtubule network affecting cellular EP in multiple ways. Our study also implicates for the first time the Wnt signaling pathway in BrS, suggesting not only shared biology with arrhythmogenic cardiomyopathies, but also the possibility of GSK3β modulation as a novel therapeutic approach.