Beschreibung:
<jats:sec>
<jats:title>Background:</jats:title>
<jats:p>
More than 90% of individuals with Noonan syndrome (NS) with mutations clustered in the CR2 domain of
<jats:italic>RAF1</jats:italic>
present with severe and often lethal hypertrophic cardiomyopathy (HCM). The signaling pathways by which NS
<jats:italic>RAF1</jats:italic>
mutations promote HCM remain elusive, and so far, there is no known treatment for NS-associated HCM.
</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods:</jats:title>
<jats:p>
We used patient-derived
<jats:italic>
RAF1
<jats:sup>S257L/+</jats:sup>
</jats:italic>
and CRISPR-Cas9–generated isogenic control inducible pluripotent stem cell (iPSC)–derived cardiomyocytes to model NS
<jats:italic>RAF1</jats:italic>
-associated HCM and to further delineate the molecular mechanisms underlying the disease.
</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results:</jats:title>
<jats:p>
We show that mutant iPSC–derived cardiomyocytes phenocopy the pathology seen in hearts of patients with NS by exhibiting hypertrophy and structural defects. Through pharmacological and genetic targeting, we identify 2 perturbed concomitant pathways that, together, mediate HCM in
<jats:italic>RAF1</jats:italic>
mutant iPSC–derived cardiomyocytes. Hyperactivation of mitogen-activated protein kinase kinase 1/2 (MEK1/2), but not extracellular regulated kinase 1/2, causes myofibrillar disarray, whereas the enlarged cardiomyocyte phenotype is a direct consequence of increased extracellular regulated kinase 5 (ERK5) signaling, a pathway not previously known to be involved in NS. RNA-sequencing reveals genes with abnormal expression in
<jats:italic>RAF1</jats:italic>
mutant iPSC–derived cardiomyocytes and identifies subsets of genes dysregulated by aberrant MEK1/2 or ERK5 pathways that could contribute to the NS-associated HCM.
</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusions:</jats:title>
<jats:p>
Taken together, the results of our study identify the molecular mechanisms by which NS
<jats:italic>RAF1</jats:italic>
mutations cause HCM and reveal downstream effectors that could serve as therapeutic targets for treatment of NS and perhaps other, more common, congenital HCM disorders.
</jats:p>
</jats:sec>