Serine biosynthesis as a novel therapeutic target for dilated cardiomyopathy

Item Type:	Article
Title:	Serine biosynthesis as a novel therapeutic target for dilated cardiomyopathy
Creators Name:	Perea-Gil, I. and Seeger, T. and Bruyneel, A.A.N. and Termglinchan, V. and Monte, E. and Lim, E.W. and Vadgama, N. and Furihata, T. and Gavidia, A.A. and Arthur Ataam, J. and Bharucha, N. and Martinez-Amador, N. and Ameen, M. and Nair, P. and Serrano, R. and Kaur, B. and Feyen, D.A.M. and Diecke, S. and Snyder, M.P. and Metallo, C.M. and Mercola, M. and Karakikes, I.
Abstract:	AIMS: Genetic dilated cardiomyopathy (DCM) is a leading cause of heart failure. Despite significant progress in understanding the genetic aetiologies of DCM, the molecular mechanisms underlying the pathogenesis of familial DCM remain unknown, translating to a lack of disease-specific therapies. The discovery of novel targets for the treatment of DCM was sought using phenotypic sceening assays in induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) that recapitulate the disease phenotypes in vitro. METHODS AND RESULTS: Using patient-specific iPSCs carrying a pathogenic TNNT2 gene mutation (p.R183W) and CRISPR-based genome editing, a faithful DCM model in vitro was developed. An unbiased phenotypic screening in TNNT2 mutant iPSC-derived cardiomyocytes (iPSC-CMs) with small molecule kinase inhibitors (SMKIs) was performed to identify novel therapeutic targets. Two SMKIs, Gö 6976 and SB 203580, were discovered whose combinatorial treatment rescued contractile dysfunction in DCM iPSC-CMs carrying gene mutations of various ontologies (TNNT2, TTN, LMNA, PLN, TPM1, LAMA2). The combinatorial SMKI treatment upregulated the expression of genes that encode serine, glycine, and one-carbon metabolism enzymes and significantly increased the intracellular levels of glucose-derived serine and glycine in DCM iPSC-CMs. Furthermore, the treatment rescued the mitochondrial respiration defects and increased the levels of the tricarboxylic acid cycle metabolites and ATP in DCM iPSC-CMs. Finally, the rescue of the DCM phenotypes was mediated by the activating transcription factor 4 (ATF4) and its downstream effector genes, phosphoglycerate dehydrogenase (PHGDH), which encodes a critical enzyme of the serine biosynthesis pathway, and Tribbles 3 (TRIB3), a pseudokinase with pleiotropic cellular functions. CONCLUSIONS: A phenotypic screening platform using DCM iPSC-CMs was established for therapeutic target discovery. A combination of SMKIs ameliorated contractile and metabolic dysfunction in DCM iPSC-CMs mediated via the ATF4-dependent serine biosynthesis pathway. Together, these findings suggest that modulation of serine biosynthesis signalling may represent a novel genotype-agnostic therapeutic strategy for genetic DCM.
Keywords:	Induced Pluripotent Stem Cells, Cardiomyocytes, Drug Screening, Dilated Cardiomyopathy, Clinical-Trial-in-a-Dish, Precision Medicine, Phenotypic Screens
Source:	European Heart Journal
ISSN:	0195-668X
Publisher:	Oxford University Press
Volume:	43
Number:	36
Page Range:	3477-3489
Date:	21 September 2022
Additional Information:	Copyright © The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com
Official Publication:	https://doi.org/10.1093/eurheartj/ehac305
External Fulltext:	View full text on PubMed Central
PubMed:	View item in PubMed

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