Intronic CRISPR repair in a preclinical model of Noonan Syndrome-Associated Cardiomyopathy

Background: - Noonan syndrome (NS) is a multisystemic developmental disorder characterized by common, clinically variable symptoms, such as typical facial dysmorphisms, short stature, developmental delay, intellectual disability as well as cardiac hypertrophy. The underlying mechanism is a gain-of-f...

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Hauptverfasser: Hanses, Ulrich (VerfasserIn) , Kleinsorge, Mandy (VerfasserIn) , Roos, Lennart (VerfasserIn) , Yigit, Gökhan (VerfasserIn) , Li, Yun (VerfasserIn) , Barbarics, Boris (VerfasserIn) , El-Battrawy, Ibrahim (VerfasserIn) , Lan, Huan (VerfasserIn) , Tiburcy, Malte (VerfasserIn) , Hindmarsh, Robin (VerfasserIn) , Lenz, Christof (VerfasserIn) , Salinas, Gabriela (VerfasserIn) , Diecke, Sebastian (VerfasserIn) , Müller, Christian (VerfasserIn) , Adham, Ibrahim (VerfasserIn) , Altmüller, Janine (VerfasserIn) , Nürnberg, Peter (VerfasserIn) , Paul, Thomas (VerfasserIn) , Zimmermann, Wolfram-Hubertus (VerfasserIn) , Hasenfuss, Gerd (VerfasserIn) , Wollnik, Bernd (VerfasserIn) , Cyganek, Lukas (VerfasserIn)
Dokumenttyp: Article (Journal)
Sprache:Englisch
Veröffentlicht: September 15, 2020
In: Circulation
Year: 2020, Jahrgang: 142, Heft: 11, Pages: 1059-1076
ISSN:1524-4539
DOI:10.1161/CIRCULATIONAHA.119.044794
Online-Zugang:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1161/CIRCULATIONAHA.119.044794
Verlag, lizenzpflichtig, Volltext: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.044794
Volltext
Verfasserangaben:Ulrich Hanses, Mandy Kleinsorge, Lennart Roos, Gökhan Yigit, Yun Li, Boris Barbarics, Ibrahim El-Battrawy, Huan Lan, Malte Tiburcy, Robin Hindmarsh, Christof Lenz, Gabriela Salinas, Sebastian Diecke, Christian Müller, Ibrahim Adham, Janine Altmüller, Peter Nürnberg, Thomas Paul, Wolfram-Hubertus Zimmermann, Gerd Hasenfuss, Bernd Wollnik, Lukas Cyganek

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520 |a Background: - Noonan syndrome (NS) is a multisystemic developmental disorder characterized by common, clinically variable symptoms, such as typical facial dysmorphisms, short stature, developmental delay, intellectual disability as well as cardiac hypertrophy. The underlying mechanism is a gain-of-function of the RAS-mitogen-activated protein kinase signaling pathway. However, our understanding of the pathophysiological alterations and mechanisms, especially of the associated cardiomyopathy, remains limited and effective therapeutic options are lacking. - Methods: - Here, we present a family with two siblings displaying an autosomal recessive form of NS with massive hypertrophic cardiomyopathy as clinically the most prevalent symptom caused by biallelic mutations within the leucine zipper-like transcription regulator 1 (LZTR1). We generated induced pluripotent stem cell-derived cardiomyocytes of the affected siblings and investigated the patient-specific cardiomyocytes on the molecular and functional level. - Results: - Patients’ induced pluripotent stem cell-derived cardiomyocytes recapitulated the hypertrophic phenotype and uncovered a so-far-not-described causal link between LZTR1 dysfunction, RAS-mitogen-activated protein kinase signaling hyperactivity, hypertrophic gene response and cellular hypertrophy. Calcium channel blockade and MEK inhibition could prevent some of the disease characteristics, providing a molecular underpinning for the clinical use of these drugs in patients with NS, but might not be a sustainable therapeutic option. In a proof-of-concept approach, we explored a clinically translatable intronic CRISPR (clustered regularly interspaced short palindromic repeats) repair and demonstrated a rescue of the hypertrophic phenotype. - Conclusions: - Our study revealed the human cardiac pathogenesis in patient-specific induced pluripotent stem cell-derived cardiomyocytes from NS patients carrying biallelic variants in LZTR1 and identified a unique disease-specific proteome signature. In addition, we identified the intronic CRISPR repair as a personalized and in our view clinically translatable therapeutic strategy to treat NS-associated hypertrophic cardiomyopathy. 
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