Dear Editor,We performed a comprehensive study to assess the pathogenicity of a cardiac myosin binding protein C3 (MYBPC3) variant (L460fs) and to pinpoint underlying molecular mechanisms by utilizing human-induced pluripotent stem cell-derived cardiomyocyte (iPSC-CM) model. L460fs iPSC-CMs exhibited a variety of deleterious phenotypes in response to angiotensin II (Ang II), including reduced MYBPC3 expression, hypertrophy, arrhythmia and elevated diastolic intracellular Ca 2+ [Ca 2+ ] i . Mechanistically, heat shock protein family A (HSP70) member 8 (HSC70) accelerated MYBPC3 degradation via lysosomal pathway under Ang II stress. The reduced MYBPC3binding ryanodine receptor 2 (RYR2) caused by insufficiency of MYBPC3 protein may give rise to excessive free destabilized RYR2, which in turn promoted RYR2mediated Ca 2+ leak. The resultant elevated Ca 2+ loading may trigger the development of both hypertrophy and arrhythmogenesis, particularly under stress conditions. 1 Hypertrophic cardiomyopathy (HCM), featured by asymmetric ventricular hypertrophy, arrhythmias and sudden cardiac death (SCD), is the most common form of inherited cardiac disease. 2,3 To note, HCM has been repeatedly regarded as a major cause of SCD in young people. 4 MYBPC3, which encodes cardiac myosin-binding protein C, is the most frequent HCM-associated gene, accounting for more than 50% of the HCM patients. 5 However, the exact mechanism of MYBPC3-related HCM remains to be resolved. 6,7 In this study, a MYBPC3 variant (c.1377delC; p.L460fs) was identified in four-unrelated individuals who developed HCM in middle age (Figure 1A,B). The echocardiography and cardiac magnetic resonance imaging exhibited normal ventricular function, severe interventricular septum hypertrophy but without left ventricular outflow tract obstruction (Figure 1C, Figure S1A-D and Table S1). With treatment of β blockers or Ca 2+ channel blockers,This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.