Calcium Transients Closely Reflect Prolonged Action Potentials in iPSC Models of Inherited Cardiac Arrhythmia

Long-QT syndrome mutations can cause syncope and sudden death by prolonging the cardiac action potential (AP). Ion channels affected by mutations are various, and the influences of cellular calcium cycling on LQTS cardiac events are unknown. To better understand LQTS arrhythmias, we performed current-clamp and intracellular calcium ([Ca2+]i) measurements on cardiomyocytes differentiated from patient-derived induced pluripotent stem cells (iPS-CM). In myocytes carrying an LQT2 mutation (HERG-A422T), APs and [Ca2+]i transients were prolonged in parallel. APs were abbreviated by nifedipine exposure and further lengthened upon releasing intracellularly stored Ca2+. Validating this model, control iPS-CM treated with HERG-blocking drugs recapitulated the LQT2 phenotype. In LQT3 iPS-CM, expressing NaV1.5-N406K, APs and [Ca2+]i transients were markedly prolonged. AP prolongation was sensitive to tetrodotoxin and to inhibiting Na+-Ca2+ exchange. These results suggest that LQTS mutations act partly on cytosolic Ca2+ cycling, potentially providing a basis for functionally targeted interventions regardless of the specific mutation site. •The long-QT syndrome is a malignant cause of human inherited cardiac arrhythmias•Heart cells reprogrammed from two types of LQTS had very prolonged contractions•Long-QT cardiomyocytes were controlled by drugs affecting calcium transients•Drugs targeting calcium transients might remedy multiple types of LQTS The differentiation of patient-derived induced pluripotent stem cells (iPSCs) into cardiomyocytes provides unprecedented opportunities for investigating inherited cardiac arrhythmia syndromes in native tissue. Here, Conklin and colleagues used cardiomyocytes derived from patients carrying dissimilar variants of long-QT syndrome to reveal a common arrhythmogenic cellular pathway. The findings support functionally targeted therapy that is independent of the specific causal mutations.