cMyBP-C ablation in human engineered cardiac tissue causes progressive Ca²⁺-handling abnormalities

Truncation mutations in cardiac myosin binding protein C (cMyBP-C) are common causes of hypertrophic cardiomyopathy (HCM). Heterozygous carriers present with classical HCM, while homozygous carriers present with early onset HCM that rapidly progress to heart failure. We used CRISPR-Cas9 to introduce heterozygous (cMyBP-C^+/−) and homozygous (cMyBP-C^−/−) frame-shift mutations into MYBPC3 in human iPSCs. Cardiomyocytes derived from these isogenic lines were used to generate cardiac micropatterns and engineered cardiac tissue constructs (ECTs) that were characterized for contractile function, Ca²⁺-handling, and Ca²⁺-sensitivity. While heterozygous frame shifts did not alter cMyBP-C protein levels in 2-D cardiomyocytes, cMyBP-C^+/− ECTs were haploinsufficient. cMyBP-C^−/− cardiac micropatterns produced increased strain with normal Ca²⁺-handling. After 2 wk of culture in ECT, contractile function was similar between the three genotypes; however, Ca²⁺-release was slower in the setting of reduced or absent cMyBP-C. At 6 wk in ECT culture, the Ca²⁺-handling abnormalities became more pronounced in both cMyBP-C^+/− and cMyBP-C^−/− ECTs, and force production became severely depressed in cMyBP-C^−/− ECTs. RNA-seq analysis revealed enrichment of differentially expressed hypertrophic, sarcomeric, Ca²⁺-handling, and metabolic genes in cMyBP-C^+/− and cMyBP-C^−/− ECTs. Our data suggest a progressive phenotype caused by cMyBP-C haploinsufficiency and ablation that initially is hypercontractile, but progresses to hypocontractility with impaired relaxation. The severity of the phenotype correlates with the amount of cMyBP-C present, with more severe earlier phenotypes observed in cMyBP-C^−/− than cMyBP-C^+/− ECTs. We propose that while the primary effect of cMyBP-C haploinsufficiency or ablation may relate to myosin crossbridge orientation, the observed contractile phenotype is Ca²⁺-mediated.