Loss-of-function W4645R mutation in the RyR2-caffeine binding site: implications for synchrony and arrhythmogenesis

Previous studies have identified RyR2 W4645R mutation, located in the caffeine-binding site, to associate with CPVT1 pathology. Caffeine binding to its site is thought to displace the carboxyl-terminal domain to Ca²⁺-binding, allowing the tryptophan residue (W4645) to regulate Ca²⁺ sensitivity of RyR2. To gain insights into regulation of RyR2 Ca²⁺-binding and its interaction with caffeine-binding site, we introduced W4645R-RyR2 point mutation via CRISPR/Cas9 gene-editing in human induced pluripotent stem cell-derived cardiomyocytes (hiPSCCMs) and characterized their Ca²⁺-signaling phenotype compared to WT hiPSCCMs.

W4645R-RyR2 cardiomyocytes had: (1) no significant change in I_Ca magnitude or voltage-dependence; (2) slightly reduced CICR; (3) altered relaxation kinetics of Ca²⁺-transients with no change in isoproterenol sensitivity; (4) complete loss of caffeine-triggered Ca²⁺ release; (5) larger SR Ca²⁺ leak resulting in 40 % lower SR Ca²⁺ content, as determined by myocytes' response to 4-CmC; (6) lower incidence of calcium sparks and asynchronous spontaneous SR Ca²⁺ releases.

W4645R-RyR2 mutation induces loss of caffeine-triggered SR Ca²⁺ release and enhances SR Ca²⁺ leak that underlie asynchronous spontaneous Ca²⁺ releases, triggering arrhythmia and impairing cardiac function.