Abstract 13500: An Improved Reporter Identifies Ruxolitinib as a Potent and Cardioprotective CaMKII Inhibitor

Abstract

Background: Ca 2+ /Calmodulin-dependent protein kinase II (CaMKII) hyperactivity is an established driver of cardiac arrhythmias. Despite proven benefits of CaMKII inhibition in numerous preclinical arrhythmia models, translation of CaMKII antagonists into humans has remained unsuccessful, and today, there are no clinically approved CaMKII inhibitors. Our ability to identify potent CaMKII inhibitors has been hamstrung by a lack of a CaMKII biosensor with sufficient sensitivity for high throughput drug discovery. Research question: We hypothesized that development of a CaMKII biosensor with high throughput capabilities would enable identification of CaMKII inhibitors capable of preventing arrhythmias. Methods: To address this problem, we engineered and validated a new genetically encoded CaMKII biosensor: CaMKAR (CaMKII Activity Reporter). CaMKAR enjoys a dynamic range of 227 ± 11.1 %, seconds-scale kinetics, robust specificity, and dual in cellulo and in vitro functionality. This makes CaMKAR the fastest and most sensitive CaMKII biosensor to date and the first that is amenable for in cellulo drug screening. Results: Using CaMKAR, we carried out a drug repurposing screen (4,475 compounds in clinical use) in human cells. This yielded five previously unrecognized CaMKII inhibitors: ruxolitinib, baricitinib, silmitasertib, crenolanib, and abemaciclib (false discovery-adjusted p<3 x 10 -5 ). Stand out among these, ruxolitinib, an FDA-approved Janus kinase inhibitor, blocked CaMKII kinase activity with an inhibitory constant of 23.5 ± 2.2 nM. In patient-derived cardiomyocytes, ruxolitinib ameliorated arrhythmogenic Ca 2+ release events (p<0.0001), and in mice, ruxolitinib prevented catecholaminergic polymorphic ventricular tachycardia (p<0.01) and rescued pre-existing atrial fibrillation (p<0.0001). Conclusion: Our work presents three impactful Conclusions: 1) Our biosensor, CaMKAR, provides the highest CaMKII activity reporting performance to date. 2) Long sought-after CaMKII inhibitors already exist within the human pharmacopeia. 3) Our results demonstrate that ruxolitinib—a drug already in human use—is a cardioprotective CaMKII inhibitor and a suitable candidate for cardiovascular repurposing.