Objectives: We sought to identify a novel gene for dilated cardiomyopathy (DCM). Background: DCM is a heritable, genetically heterogeneous disorder that remains idiopathic in the majority of patients. Familial cases provide an opportunity to discover unsuspected molecular bases of DCM, enabling pre-clinical risk detection. Methods: Two large families with autosomal-dominant DCM were studied. Genome-wide linkage analysis was used to identify a disease locus, followed by fine mapping and positional candidate gene sequencing. Mutation scanning was then performed in 278 unrelated subjects with idiopathic DCM, prospectively identified at the Mayo Clinic. Results: Overlapping loci for DCM were independently mapped to chromosome 10q25-q26. Deoxyribonucleic acid sequencing of affected individuals in each family revealed distinct heterozygous missense mutations in exon 9 of RBM20, encoding ribonucleic acid (RNA) binding motif protein 20. Comprehensive coding sequence analyses identified missense mutations clustered within this same exon in 6 additional DCM families. Mutations segregated with DCM (peak composite logarithm of the odds score >11.49), were absent in 480 control samples, and altered residues within a highly conserved arginine/serine (RS)-rich region. Expression of RBM20 messenger RNA was confirmed in human heart tissue. Conclusions: Our findings establish RBM20 as a DCM gene and reveal a mutation hotspot in the RS domain. RBM20 is preferentially expressed in the heart and encodes motifs prototypical of spliceosome proteins that regulate alternative pre-messenger RNA splicing, thus implicating a functionally distinct gene in human cardiomyopathy. RBM20 mutations are associated with young age at diagnosis, end-stage heart failure, and high mortality.

Chapter 1 of this work focuses on alternative splicing of titin as a proof of concept therapy for treating diastolic dysfunction and restrictive filling in a genetic murine model (Ttn^(ΔIAjxn)). The Ttn^(ΔIAjxn) mouse has increased strain on the spring region of titin and acts as a mechanical analogue of the titin-based increase in passive myocardial stiffness found in patients with heart failure and preserved ejection fraction (HFpEF). HFpEF is a complex disease characterized by diastolic dysfunction, exercise intolerance, and concentric hypertrophic remodeling. Approximately half all of heart failure patients suffer from diastolic dysfunction, however, no effective therapy exists for treating this pervasive syndrome. Titin, the largest known protein and molecular spring in the heart, has emerged as a prime candidate for therapeutic targets aimed at restoring compliance to the sarcomere in order to improve diastolic function. Titin has two main cardiac isoforms that are regulated by alternative splicing; the smaller N2B isoform (~3.0 MDa) and the larger more compliant N2BA isoform (~3.3 MDa). Diastolic stiffness of the left ventricle is dependent upon the N2BA:N2B isoform ratio. In the first half of this work, we modified these two primary isoforms by inhibiting the known titin splicing factor Rbm20. We demonstrate that Rbm20 reduction restores diastolic function, improves exercise tolerance and attenuates afterload induced pathologic remodeling of the left ventricle in Ttn^(ΔIAjxn) mice.The work in chapter 2 is focused on studies using the previously published N2B knock out (KO) murine model. The N2B spring element found in cardiac titin's I-band region has been proposed as a sensor and signaling "hot spot" in the sarcomere. This study investigates the role of titin's cardiac specific N2B element as a mechano-sensor for stress and strain induced remodeling of the heart. The N2B KO mouse was subjected to a variety of stressors including transverse aortic constriction (TAC), aortocaval fistula (ACF), chronic swimming, voluntary running and isoproterenol stimulation. Our data revealed that the N2B element is essential in preload stimulated cardiac hypertrophy as well as remodeling due to beta-adrenergic stress. Cardiac hypertrophy is a common maladaptive feature of heart failure patients and the mechanical triggers that determine pathologic growth are not well understood. My work in the N2B KO mouse reveal titin's important role in cardiac remodeling.

In the first half of this work, titin's role in cardiac function was studied using intact cardiac myocytes. The development of a carbon fiber based cell-attachment system allowed diastolic and systolic function of the isolated intact myocyte to be investigated. Addition of actomyosin inhibitor to the intact myocyte revealed that the majority of the cell's diastolic stiffness is due to titin but that actomyosin interaction exists as well and contributes ~ 30% of total diastolic stiffness. The details of this study are provided in chapter 1. Heart failure with preserved ejection fraction (HFpEF) accounts for up to 50% of total heart failure cases and is characterized by increased diastolic stiffness. An effective treatment for HFpEF does not exist. Reducing titin stiffness as a therapeutic strategy for lowering left ventricular (LV) chamber stiffness in HFpEF is currently under consideration. To understand the functional consequence of reduced titin stiffness on global cardiac function a Rbm20 Δᴿᴿᴹ mouse model was created. The Rbm20 Δᴿᴿᴹ model has deficiency in titin splicing that results in expression of very large and compliant titin isoforms in the sarcomeres. Study of Rbm20 Δᴿᴿᴹ cells revealed that cellular diastolic stiffness was inversely related to the size of titin and was reduced in a graded manner in Rbm20 Δᴿᴿᴹ heterozygous (+/-) and homozygous (-/-) cells. Importantly, reduced titin-based stiffness manifested in vivo as reduced LV chamber stiffness, which could be observed by echocardiography and pressure volume (PV) analysis. The systolic function of Rbm20 Δᴿᴿᴹ was studied by measuring the Frank-Starling mechanism (FSM), first at the intact myocyte level. The FSM was reduced in Rbm20 Δᴿᴿᴹ +/- and -/- with the largest reduction in -/- cells. PV analysis demonstrated a reduced FSM at the LV chamber level, consistent with the result at the cellular level. Surprisingly, exercise testing showed an enhanced exercise performance in cardiac specific Rbm20 Δᴿᴿᴹ +/- mice (relative to wild-type mice). Thus, this work indicates that increasing titin compliance improves diastolic function but negatively impacts systolic function. Importantly, findings suggest that the beneficial effect of improving diastolic function is a dominant effect. This work is described in Chapter 2.

No description available.

Phosphorylierung modulieren. Obwohl heute bereits Tausende von Phosphorylierungsstellen annotiert sind, sind entsprechende funktionelle Informationen begrenzt. Dies ist zum Teil darauf zurückzuführen, dass es keine Hochdurchsatzmethoden zur Erforschung der Funktion einer Phosphorylierungsstelle gibt. Um dieser Herausforderung zu begegnen, habe ich eine auf Shotgun-Proteomik basierende Strategie zur Messung der RNA-Bindungsaktivität von RBPs und ihren phosphorylierten Proteoformen entwickelt, die 'quantitative RNA-Interactome Capture (qRIC)' genannt wird. QRIC quantifiziert die Pull-Down-Effizienz von RBPs, die mit Oligo(dT)-Magnetbeads isoliert werden. Diese Effizienz korreliert mit der Anzahl der RNA-Bindungsstellen und der Spezifität der Motivbindung, und spiegelt so die RNA-Bindung in vivo wieder. In einer Gegenüberstellung der Pull-Down-Effizienz verschiedener Proteoformen in unbehandelten Zellen, habe ich qRIC als unvoreingenommenes Screening von regulatorischen Phosphorylierungsstellen in RBPs eingesetzt. Für jede einzelne Phosphorylierungsstelle wurde ein Delta-Effizienzwert berechnet, der den Einfluss auf die RNA-Bindung in vivo reflektiert. Die Effizienzunterschiede spiegelten das erwartete Verhalten von RBPs während der Phasentrennung von membranlosen Organellen und die Ladungsabstoßung zwischen Phosphorylierungsstellen und Nukleotiden bei physiologischem pH-Wert wider. Mithilfe des Delta-Effizienzwertes identifizierte ich mehrere bereits bekannte regulatorische Phosphorylierungsstellen in SF3B1, UPF1 und ELAVL1, sowie neue, bisher unbekannte und möglicherweise regulatorische Phosphorylierungsstellen in SERBP1, LARP1 und RBM20. Phosphomimetische Mutationsvarianten dieser Phosphorylierungsstellen wurden analysiert, um den molekularen Einfluss auf die Regulation der RBP-Funktion zu untersuchen. Es konnte gezeigt werden, dass die Phosphorylierung bestimmter Stellen im Spleißregulator RBM20 dessen nukleo-zytoplasmatische Lokalisierung, die Assoziation mit zytosolischen RNA-Granula und die Spleißfunktion beeinflusst. Diese Erkenntnisse könnten sich beispielsweise auf die Entwicklung neuer Behandlungsmethoden für Patienten mit dysfunktionalen RBM20-Mutationen auswirken, die zu dilatativer Kardiomyopathie führen. QRIC kann als Hochdurchsatzverfahren dazu beitragen, unser Wissen über die Regulierung von Protein-RNA-Interaktionen durch Phosphorylierung zu erweitern. / Post-transcriptional regulation of gene expression is fundamental in health and disease. RNA-binding proteins (RBPs) directly bind and govern the fate of RNAs in cells. At the same time, cell signaling cascades control RBP functions by modulating their physicochemical properties through post-translational modifications, like phosphorylation. Although thousands of phosphorylation sites have been annotated, functional information is limited. This, in part, is due to the lack of high-throughput methods that measure function. To tackle this challenge I developed a shotgun proteomics-based strategy for measuring the RNA-binding activity of RBPs and their phosphorylated proteoforms, named quantitative RNA-interactome capture (qRIC). In qRIC, pull-down efficiency of RBPs isolation with oligo(dT) magnetic beads is quantified in cells at steady state and correlates with the number of RNA-binding sites and motif binding specificity, reflecting a link to RNA-binding in vivo. By contrasting pull-down efficiency of different proteoforms in the cells, I applied qRIC as an unbiased screening of regulatory phosphorylation sites in RBPs affecting pull-down efficiency. A delta efficiency score was calculated for each individual phosphorylation site to denote its influence on RNA-binding in vivo. Efficiency differences globally reflected the expected behavior of RBPs during phase separation of membraneless organelles and charge repulsion between phosphorylation sites and nucleotides in physiological pH. Using the delta efficiency score, I identified several previously known regulatory phosphorylation sites in SF3B1, UPF1 and ELAVL1, plus novel candidate regulatory sites in SERBP1, LARP1 and RBM20. Phosphomimetic mutant variants of these sites were analysed to investigate the molecular mechanism of regulation. Importantly, I show that phosphorylation of candidate sites in the splicing regulator RBM20 affects its nucleo-cytoplasmic localization, association with cytosolic RNA granules, and splicing function. These findings could have implications for the development of novel treatments based on kinase activity for patients with dysfunctional RBM20 mutations leading to congenital dilated cardiomyopathy. I anticipate that qRIC, as a high throughput approach, will help to expand our knowledge about the regulation of protein-RNA interactions and their regulation by phosphorylation.