Hypertrophic cardiomyopathy (HCM) is marked by asymmetric cardiac wall thickening, hypercontractility, diastolic dysfunction, and fibrosis. Pathogenic sarcomere gene variants cause HCM, but comparable abnormalities occur in patients with unexplained disease, albeit with fewer adverse events. To investigate stage- and genotype-specific disease mechanisms, we performed single-nucleus RNA sequencing of cardiac tissues from 47 patients with HCM, spanning obstructive HCM with preserved systolic function and end-stage HCM, and compared them with nonfailing donor and dilated cardiomyopathy hearts. We identified transcriptional programs associated with cardiomyocyte hypertrophy, fibrosis, and vascular remodeling. Pathogenic variant-positive early-stage HCM samples showed reduced cardiomyocyte abundance and expansion of a proarrhythmogenic cardiomyocyte state. We identified proline-rich 16 (PRR16) as a cardiomyocyte growth-associated gene in HCM and validated its increased expression by RNA in situ hybridization and in a human induced pluripotent stem cell-derived cardiomyocyte HCM model. In HCM samples, fibroblast compositional shifts were associated with profibrotic activation and adverse extracellular matrix remodeling, accompanied by reduced collagen IV (COL4A1/COL4A2) expression and ultrastructural basement membrane abnormalities. HCM samples also exhibited extensive vascular alterations, including shifts in endothelial cell subpopulations, reduced pericyte abundance suggestive of microvascular dysfunction, and increased lymphangiogenic vascular endothelial growth factor C signaling. Unsupervised and supervised machine learning approaches distinguished HCM from dilated cardiomyopathy and accurately predicted genotype status in early-stage HCM from cell type-resolved transcriptional profiles, revealing widespread genotype-driven remodeling. Together, our findings uncover multicellular, genotype-associated remodeling programs in HCM, providing insight into mechanisms underlying arrhythmia, fibrosis, microvascular dysfunction, and heart failure progression.
E. Adami, Yuri Kim, Sean L. Zheng et al.· Science Translational Medici...· 1 citation
BACKGROUND
Nx3 (novex-3) is an exceptionally small isoform of the giant protein titin, whose structural and functional roles within the sarcomere remain poorly understood.
METHODS AND RESULTS
We used a comprehensive, multimodal approach to define the key properties of Nx3 in healthy and failing hearts, including its abundance relative to FLT (full-length titin), sarcomeric localization, protein interactions, and functional relevance in mouse and human cardiomyocytes under physiological and pathological conditions. Using Western blotting, quantitative polymerase chain reaction, total RNA sequencing, and ribosome profiling, we show that Nx3 is constitutively expressed from fetal development through adulthood. In adult mouse and human myocardium, Nx3 accounts for ≈20% to 25% of total titin protein, despite representing only ≈8% to 14% at the transcript level. Immunoelectron microscopy and binding studies reveal that Nx3 adopts a nonlinear configuration within the sarcomere: its N terminus is anchored at the Z-disk, although the proximal portion of its unique region encoded by Ttn exon 48, enriched in coiled-coil motifs, engages laterally with adjacent titin or Nx3 molecules at the Z-disk/I-band interface. Its monomeric C terminus extends toward the A-band but remains confined to the Z-/I-band region. This architecture confers enhanced stability and flexibility to the Z-disk under mechanical load. Protein interaction studies, including yeast 2-hybrid screening and coimmunoprecipitation, identified Pin1 (peptidyl-prolyl cis-trans isomerase NIMA-interacting 1) and TBC1D4 (TBC1 domain family member 4) as binding partners of the Nx3 C terminal region, suggesting participation in signaling networks regulating cardiomyocyte metabolism. Genetic ablation of Nx3 in mouse hearts and human induced pluripotent stem cell-derived cardiomyocytes indicates that, although dispensable for sarcomere assembly, Nx3 is required for optimal Z-disk organization and mechanical performance. In end-stage dilated cardiomyopathy, human hearts exhibit dysregulated Nx3 expression, with reduced protein abundance relative to nonfailing controls and focal Z-disk disruption, likely contributing to impaired contractile function.
CONCLUSIONS
Nx3 regulates Z-disk stability and modulates signaling pathways that optimize cardiac performance, and its dysregulation contributes to heart failure pathogenesis.
W. Linke, Lisa Kümper, A. Fomin et al.· Circulation Research· 0 citations
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