A SPRY1 domain cardiac ryanodine receptor variant associated with short-coupled torsade de pointes

Sci Rep. 2021 Mar 4;11(1):5243. doi: 10.1038/s41598-021-84373-9.

Abstract

Idiopathic ventricular fibrillation (IVF) causes sudden death in young adult patients without structural or ischemic heart disease. Most IVF cases are sporadic and some patients present with short-coupled torsade de pointes, the genetics of which are poorly understood. A man who had a first syncope at the age of 35 presented with frequent short-coupled premature ventricular beats with bursts of polymorphic ventricular tachycardia and then died suddenly. By exome sequencing, we identified three rare variants: p.I784F in the SPRY1 of the ryanodine receptor 2 (RyR2), p.A96S in connexin 40 (Cx40), reported to affect electrical coupling and cardiac conduction, and a nonsense p.R244X in the cardiac-specific troponin I-interacting kinase (TNNI3K). We assessed intracellular Ca2+ handling in WT and mutant human RYR2 transfected HEK293 cells by fluorescent microscopy and an enhanced store overload-induced Ca2+ release in response to cytosolic Ca2+ was observed in RyR2-I784F cells. In addition, crystal structures and thermal melting temperatures revealed a conformational change in the I784F-SPRY1 domain compared to the WT-domain. The novel RyR2-I784F variant in SPRY1 domain causes a leaky channel under non-stress conditions. The presence of several variants affecting Ca2+ handling and cardiac conduction suggests a possible oligogenic origin for the ectopies originating from Purkinje fibres.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Calcium Signaling / genetics
  • Connexins / genetics
  • Death, Sudden / epidemiology
  • Exome Sequencing
  • Female
  • Gap Junction alpha-5 Protein
  • HEK293 Cells
  • Humans
  • Male
  • Membrane Proteins / genetics*
  • Middle Aged
  • Myocardial Ischemia / genetics*
  • Myocardial Ischemia / pathology
  • Phosphoproteins / genetics*
  • Protein Domains / genetics
  • Protein Serine-Threonine Kinases / genetics*
  • Ryanodine Receptor Calcium Release Channel / genetics*
  • Torsades de Pointes / complications
  • Torsades de Pointes / genetics
  • Torsades de Pointes / pathology
  • Ventricular Fibrillation / genetics*
  • Ventricular Fibrillation / pathology

Substances

  • Connexins
  • Membrane Proteins
  • Phosphoproteins
  • RyR2 protein, human
  • Ryanodine Receptor Calcium Release Channel
  • SPRY1 protein, human
  • Protein Serine-Threonine Kinases
  • TNNI3K protein, human

Supplementary concepts

  • Paroxysmal ventricular fibrillation