BACKGROUND: As next generation sequencing for the genetic diagnosis of cardiovascular disorders becomes more widely used, establishing causality for putative disease causing variants becomes increasingly relevant. Diseases of the cardiac sarcomere provide a particular challenge in this regard because of the complexity of assaying the effect of genetic variants in human cardiac contractile proteins.
RESULTS: In this study we identified a novel variant R205Q in the cardiac troponin T gene (TNNT2). Carriers of the variant allele exhibited increased chamber volumes associated with decreased left ventricular ejection fraction. To clarify the causal role of this variant, we generated recombinant variant human protein and examined its calcium kinetics as well as the maximally activated ADP release of human β-cardiac myosin with regulated thin filaments containing the mutant troponin T. We found that the R205Q mutation significantly decreased the calcium sensitivity of the thin filament by altering the effective calcium dissociation kinetics.
CONCLUSIONS: The development of moderate throughput post-genomic assays is an essential step in the realization of the potential of next generation sequencing. Although technically challenging, biochemical and functional assays of human cardiac contractile proteins of the thin filament can be achieved and provide an orthogonal source of information to inform the question of causality for individual variants.
Bibliographical noteFunding Information:
This work was funded by NIH Grant GM33289 and Human Frontier Science Program Research Grant Program (RGP0054/2009-C) to J.A.S., Stanford Interdisciplinary Graduate Fellowship awarded to R.F.S., and Stanford Dean’s Postdoctoral Fellowship to S.N. In addition, the authors would like to thank Drs. Daniel Bernstein, David Rosenthal, Dimple Sureka, and Gulnar Pothiawala for their assistance in the diagnosis and clinical care of the family described herein. Written consent was obtained from the patients and their relatives for publication of study.