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The molecular interactions of the sarcomeric proteins are essential in the regulation of various cardiac functions. Mutations in the gene MYBPC3 coding for cardiac myosin-binding protein-C (cMyBP-C), a multi-domain protein, are the most common cause of hypertrophic cardiomyopathy (HCM). The N-terminal complex, C1-motif-C2 is a central region in cMyBP-C for the regulation of cardiac muscle contraction. However, the mechanism of binding/unbinding of this complex during health and disease is unknown. Here, we study possible mechanisms of unbinding using steered molecular dynamics simulations for the complex in the wild type, in single mutations (E258K in C1, E441K in C2), as well as in a double mutation (E258K in C1 + E441K in C2), which are associated with severe HCM. The observed molecular events and the calculation of force utilized for the unbinding suggest the following: (i) double mutation can encourage the formation of rigid complex that required large amount of force and long-time to unbind, (ii) C1 appears to start to unbind ahead of C2 regardless of the mutation, and (iii) unbinding of C2 requires larger amount of force than C1. This molecular insight suggests that key HCM-causing mutations might significantly modify the native affinity required for the assembly of the domains in cMyBP-C, which is essential for normal cardiac function.

Hereditary hearing loss (HHL) is a common disorder characterized by a huge genetic heterogeneity. The definition of a correct molecular diagnosis is essential for proper genetic counseling, recurrence risk estimation, and therapeutic options. From 20 to 40% of patients carry mutations in GJB2 gene, thus, in more than half of cases it is necessary to look for causative variants in the other genes so far identified (~100). In this light, the use of next-generation sequencing technologies has proved to be the best solution for mutational screening, even though it is not always conclusive. Here we describe a combined approach, based on targeted re-sequencing (TRS) of 96 HHL genes followed by high-density SNP arrays, aimed at the identification of the molecular causes of non-syndromic HHL (NSHL). This strategy has been applied to study 103 Italian unrelated cases, negative for mutations in GJB2, and led to the characterization of 31% of them (i.e., 37% of familial and 26.3% of sporadic cases). In particular, TRS revealed TECTA and ACTG1 genes as major players in the Italian population. Furthermore, two de novo missense variants in ACTG1 have been identified and investigated through protein modeling and molecular dynamics simulations, confirming their likely pathogenic effect. Among the selected patients analyzed by SNP arrays (negative to TRS, or with a single variant in a recessive gene) a molecular diagnosis was reached in ~36% of cases, highlighting the importance to look for large insertions/deletions. Moreover, copy number variants analysis led to the identification of the first case of uniparental disomy involving LOXHD1 gene. Overall, taking into account the contribution of GJB2, plus the results from TRS and SNP arrays, it was possible to reach a molecular diagnosis in ~51% of NSHL cases. These data proved the usefulness of a combined approach for the analysis of NSHL and for the definition of the epidemiological picture of HHL in the Italian population.

Hypertrophic cardiomyopathy is the most common inherited heart diseases associated with a large number of mutations in several sarcomere proteins that regulate striated muscle contraction. The 3-dimensional structural and biophysical consequences of these mutations and their impact on the genotype-phenotype relationship remains poorly understood. Mutations in cardiac TroponinT (cTnT) have been reported to purport an increased risk of sudden cardiac deaths. Mutational hotspots such as codon 102 (Arg92 Moolman et al., 1997) of cTnT have been observed in several populations, including recently by our group in Egypt. In an attempt to explain this observation, we have performed molecular modelling of specific key mutations at codon 102, Arg102. The X-ray structure of the core domain of human cardiac troponin complex (cTnC, cTnI and cTnT) has been used for this study after constructing the missing regions. The resultant structure and the mutants were subjected to structural rigidity analysis and mutational modelling. In addition, molecular dynamics simulations were performed to understand the binding of functionally important calcium ions with the troponin complex. Our results suggest that the location of Arg102 in cTnT is instrumental to create a molecular bridge through hydrogen bonds (Figure) between secondary structural elements, in order to hold the core structure together. The loss of this molecular bridge by the key mutations (such as Arg102Leu) could produce conformational changes and affect natural binding of calcium ions, which are essential for regulation of muscle functions. This mechanism can explain the important structural consequences of mutations in this codon, associated with frequent progression of LV dysfunction, as well as the occurrence of ventricular arrhythmias secondary to the intracellular consequences of profound energetic and Ca++ handling derangement.

The cardiac muscle contraction is regulated by a set of proteins known as sarcomeric proteins, which are components of thick and thin filaments. Mutation in these proteins especially cardiac myosin binding protein-C, a multi-domain (C0-C10) protein, is one of the major causes of hypertrophic cardiomyopathy (HCM). However, structure-function relationship of this protein is unclear. Mutation E258K, which is located in the C-terminal of domain C1, has been shown to be associated with HCM in Egypt. Hence, the purpose of the study was to understand the molecular basis of this missense mutation. Molecular modelling study was performed using the available crystal structure of the domain C1. Here, we have carried out molecular dynamic simulations for both WT and E258K for 10 ns, and the structures that showed major changes were considered for further analyses. Our results suggest that the mutation can change the local structural stability through altering a series of intramolecular interactions. Moreover, as the mutation results in replacement of a negative amino acid by a positive one, thus, it affects the surface electrostatic properties of the domain (Figure). Hence, it might interfere with the binding to neighbouring domains and with the other sarcomeric proteins such as actin and myosin. E258K appears to affect the structural integrity of the domain C1 both directly and indirectly. It is hoped that these findings can help to understand the molecular mechanism of the disease.