Calmodulin-1
calcium ion binding
Genetic Mosaicism in Calmodulinopathy.
<h4>Background</h4>CaM (calmodulin) mutations are associated with congenital arrhythmia susceptibility (calmodulinopathy) and are most often de novo. In this report, we sought to broaden the genotype-phenotype spectrum of calmodulinopathies with 2 novel calmodulin mutations and to investigate mosaicism in 2 affected families.<h4>Methods</h4>CaM mutations were identified in 4 independent cases by DNA sequencing. Biochemical and electrophysiological studies were performed to determine functional consequences of each mutation.<h4>Results</h4>Genetic studies identified 2 novel CaM variants (<i>CALM3</i>-E141K in 2 cases; <i>CALM1</i>-E141V) and one previously reported CaM pathogenic variant (<i>CALM3</i>-D130G) among 4 probands with shared clinical features of prolonged QTc interval (range 505-725 ms) and documented ventricular arrhythmia. A fatal outcome occurred for 2 of the cases. The parents of all probands were asymptomatic with normal QTc duration. However, 2 of the families had multiple affected offspring or multiple occurrences of intrauterine fetal demise. The mother from the family with recurrent intrauterine fetal demise exhibited the <i>CALM3</i>-E141K mutant allele in 25% of next-generation sequencing reads indicating somatic mosaicism, whereas <i>CALM3</i>-D130G was present in 6% of captured molecules of the paternal DNA sample, also indicating mosaicism. Two novel mutations (E141K and E141V) impaired Ca<sup>2+</sup> binding affinity to the C-domain of CaM. Human-induced pluripotent stem cell-derived cardiomyocytes overexpressing mutant or wild-type CaM showed that both mutants impaired Ca<sup>2+</sup>-dependent inactivation of L-type Ca<sup>2+</sup> channels and prolonged action potential duration.<h4>Conclusions</h4>We report 2 families with somatic mosaicism associated with arrhythmogenic calmodulinopathy, and demonstrate dysregulation of L-type Ca<sup>2+</sup> channels by 2 novel CaM mutations affecting the same residue. Parental mosaicism should be suspected in families with unexplained fetal arrhythmia or fetal demise combined with a documented CaM mutation.