Genotype-Phenotype Correlation in Induced Pluripotent Stem Cell (iPSC)Derived Cardiomyocytes Carrying Calmodulin Mutations

Abstract

Background: De novo mutations in calmodulin genes have been recently associated with markedly prolonged QT interval and life-threatening ventricular arrhythmias in infants. Biochemical evidences suggested impaired calcium ion binding to mutant calmodulins. Calcium dependent inactivation (CDI) of L-type calcium channel (ICaL) involves the interaction between Ca2+-calmodulin and the channel protein. Aims: To explore the effects of two CALM1 mutations (F142L and D130G) on electrical activity and ICaL properties in human induced-pluripotent stem cells (iPSC)-derived cardiomyocytes (CM). Methods: Skin fibroblasts of two patients carrying the mutation CALM1-F142L or CALM1-D130G were reprogrammed to generate iPSC and these cells differentiated into CM; a healthy donor was selected as control. Two cell clones for each mutation were analyzed to rule out clone specificity. Patch clamp and micro electrode arrays (MEA) analyses were performed on isolated iPSC-derived CM and beating clusters at about 40 days of differentiation respectively. ICaL was isolated in the presence of calcium or barium ions as charge carriers. Results: CALM1-F142L iPSC-derived CM showed prolonged field potential duration (FPD) with high beta-adrenergic sensitivity; peak ICaL density was unaltered, but CDI was markedly reduced and inactivation incomplete. CALM1-D130G iPSC-derived CM showed higher ICaL density and unaltered CDI. Conclusions: F142L and D130G calmodulin mutations differently affect ICaL properties in human iPSC-derived CM. F142L mutation is consistent with reduced calcium affinity of calmodulin; D130G abnormality suggests ICaL facilitation instead, possibly resulting from upregulation of alternative calmodulin isoforms. Overall, both calmodulin mutations might potentially cause arrhythmogenic calcium overload.