DspS311Aknock-in mice replicate the clinical-pathological features of dominant and recessive forms of Desmoplakin-related cardiomyopathies
Authors: Di Bona Anna , Guazzo Anna , Vanaja Induja Perumal , Bariani Riccardo , Disalvo Maria C. , Albiero Mattia , Kuperwasser Nicolas , David Pierre , Celeghin Rudy , Di Mauro Vittoria , Scalco Arianna , López-Moreno María , De Gaspari Monica , Barbera Mila Della , Rizzo Stefania , Corrado Domenico , Bauce Barbara , Zanotti Giuseppe , Thiene Gaetano , Pilichou Kalliopi , Perez Pomares José Maria , Pende Mario , Basso Cristina , Mongillo Marco , Zaglia Tania 
Published: January 2025

Background/Purpose

Desmoplakin (DSP) mutations are linked to familial cardiomyopathies with a very high arrhythmogenic propensity. While autosomal recessive inheritance forms manifest in the cardio-cutaneous Carvajal syndrome, the dominant-inheritance variants associate to DSP-cardiomyopathy (DSP-CM). This latter is a subtype of Arrhythmogenic Cardiomyopathy characterized by frequent myocarditis-like episodes, dominant left ventricular (LV) remodeling, recurrent premature ventricular contractions and life-threatening arrhythmias, frequently preceding LV dysfunction and dilation. Notably, DSP-CM evades the diagnostic identifiers of Arrhythmogenic Cardiomyopathy, further complicating risk-stratification and prediction. At the time being, the pathogenetic mechanisms underlying DSP-related cardiomyopathies are largely obscure and their elucidation is urgently required.

Methods

To this end, we employed CRISPR-Cas9 to generate a novel knock-in mouse model harboring a point mutation at the murine ortholog of human Serine-299, a mutation site previously identified in a family affected by left dominant-Arrhythmogenic Cardiomyopathy. In both heterozygotes and homozygotes, cardiac function was assessed by echocardiography and telemetry-ECG, at different ages. Results were correlated with heart structure, which was assessed by ultrastructural, histopathological and molecular/biochemical assays. The effects of moderate exercise on disease manifestations were tested.

Results

The homo- and hetero-zygous expression of mutantDspS311Aallele replicated the human cardiac phenotypes of Carvajal syndrome and DSP-CM, respectively. Indeed,DspS311A/S311Amice featured precocious dilated cardiomyopathy with biventricular fibrotic remodeling, aneurisms, systolic dysfunction, increased arrhythmic vulnerability, sudden death and, remarkably, cutaneous defects. Differently,DspWT/S311Amice did not show evident cutaneous alterations, and myocardial remodeling and contractile dysfunction developed later and were associated to increased cell death, inflammatory response and patchy fibrosis predominantly in the LV. Notably, as observed in certain patient subgroups,DspWT/S311Amice had electrophysiological alterations (i.e. QRS prolongation, distal conduction defects and sustained ventricular arrhythmias) prior to developing contractile dysfunction. Furthermore, in both genotypes, exercise accelerated myocardial remodeling and increased the incidence of arrhythmic mortality.

Conclusions

Our novelDspS311Amice recapitulate the clinical and pathological features of the respective dominant (i.e. DSP-CM) and recessive (i.e. Carvajal syndrome) forms of DSP-related cardiomyopathies. Thus,DspS311Amice are a novel experimental model of human diseases, suited to test therapeutic interventions aimed at reducing the burden of stress-dependent SD.