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Apremilast improves cardiomyocyte cohesion and arrhythmia in different models for arrhythmogenic cardiomyopathy

Konstanze Stangner¹, Orsela Dervishi¹, Janina Kuhnert¹

¹Chair of Vegetative Anatomy, Institute of Anatomy, Faculty of Medicine, Ludwig-Maximilians-University (LMU) Munich, Pettenkoferstrasse 11, 80336, Munich, Germany.

Stem Cell Research & Therapy

|November 4, 2025

Insights

Apremilast improves cardiomyocyte cohesion and reduces arrhythmias in arrhythmogenic cardiomyopathy (ACM) models. This drug preserves desmosome function, offering a new therapeutic strategy for this genetic heart disease.

Area of Science:

Cardiovascular Research
Genetics
Pharmacology

Background:

Arrhythmogenic cardiomyopathy (ACM) is a genetic desmosome disorder causing life-threatening arrhythmias and sudden cardiac death.
Current ACM treatments focus on symptom management, lacking disease-modifying options.
Apremilast has shown potential in stabilizing cell adhesion in other desmosome-related conditions.

Purpose of the Study:

To investigate the therapeutic potential of apremilast for arrhythmogenic cardiomyopathy (ACM).
To determine if apremilast can restore desmosome function and improve cardiomyocyte cohesion in ACM models.

Main Methods:

Utilized human induced pluripotent stem cells (hiPSC) from ACM patients and healthy controls.
Employed cell culture, Western blotting, ELISA, and dissociation assays in cardiomyocytes and cardiac slices.
Assessed arrhythmia and heart rate variability using microelectrode array (MEA) and Langendorff perfusion in murine models.

Main Results:

Apremilast rescued the loss of cardiomyocyte cohesion in ACM-hiPSC-derived cardiomyocytes.
Treatment strengthened cardiomyocyte cohesion in various models, associated with plakoglobin (PG) phosphorylation.
Apremilast reduced arrhythmia and heart rate variability in both in vitro and ex vivo models.

Conclusions:

Apremilast enhances cardiomyocyte cohesion and desmosome function in ACM models.
The drug demonstrates a novel therapeutic strategy for ACM by targeting desmosome integrity.
Findings suggest apremilast could be a promising treatment for arrhythmogenic cardiomyopathy.

Read full analysis

Abstract

Background:

Arrhythmogenic cardiomyopathy (ACM) is a genetically inherited desmosome heart disease leading to life-threatening arrhythmias and sudden cardiac death. Currently, ACM treatment paradigms are merely symptom targeting. Recently, apremilast was shown to stabilize keratinocyte adhesion in the desmosomal disease pemphigus vulgaris. Therefore, this study investigated whether apremilast can be a therapeutic option for ACM.

Methods:

Human induced pluripotent stem cells from a healthy control (hiPSC) and an ACM index patient (ACM-hiPSC) carrying a heterozygous desmoplakin (DSP) gene mutation (c.2854G > T, p.Glu952Ter), confirmed by whole exome sequencing (WES), were established. Cyclic-AMP ELISA, dissociation assay, immunostaining, and Western blotting analyses were performed in human iPSC-derived cardiomyocytes (hiPSC-CMs), murine HL-1 cardiomyocytes, and cardiac slices derived from wild-type (WT) mice, plakoglobin (PG, Jup) knockout (Jup^-/-) (murine ACM model) or PG Serine 665 phosphodeficient (JUP-S665A) mice. Microelectrode array (MEA) analyses in ventricular cardiac slices and Langendorff heart perfusion were performed to analyze heart rate variability and arrhythmia.

Results:

ACM-hiPSC derived cardiomyocytes (ACM-hiPSC-CMs) revealed a significant loss of cohesion, which was rescued by apremilast. Further, treatment with apremilast strengthened basal cardiomyocyte cohesion in HL-1 cells and WT murine cardiac slices, paralleled by phosphorylation of PG at Serine 665 in human and murine models. In HL-1 cells, apremilast in addition activated ERK1/2, inhibition of which abolished apremilast-enhanced cardiomyocyte cohesion. Further, dissociation assays in slice cultures from JUP-S665A and Jup^-/- mice revealed that PG is crucial for apremilast-enhanced cardiomyocyte cohesion. In parallel to enhanced cell adhesion, MEA and Langendorff measurements from WT and Jup^-/- mice demonstrated decreased heart rate variability and arrhythmia after apremilast treatment.

Conclusions:

Apremilast improves loss of cardiomyocyte cohesion, enhances localization of DSG2, and reduces arrhythmia in human and/or murine models of ACM ex vivo and in vitro, providing a novel treatment strategy for ACM by preserving desmosome function.

Keywords:

Apremilast Arrhythmia Arrhythmogenic cardiomyopathy Desmoplakin and desmoglein 2

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