Heart Failure Disrupted Junctional Membrane Complexes and Hyperactive Ryanodine Receptors After Acute Junctophilin Knockdown in Mice

Background—Excitation-contraction coupling in striated muscle requires proper communication of plasmalemmal voltage-activated Ca 2ϩ channels and Ca 2ϩ release channels on sarcoplasmic reticulum within junctional membrane complexes. Although previous studies revealed a loss of junctional membrane complexes and embryonic lethality in germ-line junctophilin-2 (JPH2) knockout mice, it has remained unclear whether JPH2 plays an essential role in junctional membrane complex formation and the Ca 2ϩ-induced Ca 2ϩ release process in the heart. Our recent work demonstrated loss-of-function mutations in JPH2 in patients with hypertrophic cardiomyopathy. Methods and Results—To elucidate the role of JPH2 in the heart, we developed a novel approach to conditionally reduce JPH2 protein levels using RNA interference. Cardiac-specific JPH2 knockdown resulted in impaired cardiac contractility, which caused heart failure and increased mortality. JPH2 deficiency resulted in loss of excitation-contraction coupling gain, precipitated by a reduction in the number of junctional membrane complexes and increased variability in the plasmalemma–sarcoplasmic reticulum distance. Conclusions—Loss of JPH2 had profound effects on Ca 2ϩ release channel inactivation, suggesting a novel functional role for JPH2 in regulating intracellular Ca 2ϩ release channels in cardiac myocytes. Thus, our novel approach of cardiac-specific short hairpin RNA–mediated knockdown of junctophilin-2 has uncovered a critical role for junctophilin in intracellular Ca 2ϩ release in the heart. E xcitation-contraction (EC) coupling is the fundamental mechanism by which depolarization of the voltage-gated Ca 2ϩ channels (VGCCs) in the plasmalemma triggers a much greater release of Ca 2ϩ from the sarcoplasmic reticulum (SR) via type 2 ryanodine receptors (RyR2), a process known as Ca 2ϩ-induced Ca 2ϩ release (CICR). 1 This Ca 2ϩ release amplification depends on the organization of VGCC and RyR2 within junctional membrane complexes (JMCs), also known as calcium release units. 2 Disruption of JMC structure, as seen in heart failure, profoundly affects CICR and thus cardiac muscle contractility. 3 The molecular mechanisms involved in organizing Ca 2ϩ channels within the JMC remain poorly understood. One family of proteins, known as junctophilins (JPHs), has been proposed to provide a structural bridge between the plasma-lemma and SR, thereby potentially ensuring approximation of VGCC and RyR2. 4 Junctophilin-2 (JPH2) is the major cardiac isoform among the 4 JPH isoforms, which are expressed within JMCs of all excitable cell types. 5 JPH proteins comprise 8 N-terminal " membrane occupation and recognition nexus " domains, a space-spanning ␣-helix, and a C-terminal transmembrane domain. The membrane occupation and recognition nexus domains mediate binding …