Introduction: Mavacamten (MAVA), Blebbistatin (BLEB), and
Omecamtiv mecarbil (OM) are promising drugs directly targeting sarcomere
dynamics, with demonstrated efficacy against hypertrophic cardiomyopathy
(HCM) in clinical trials. However, the molecular mechanism affecting
cardiac contractility regulation, and the diseased cell
mechano-energetics are not fully understood yet. Methods: We
present a new metabolic-sensitive computational model of human induced
pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs)
electromechanics to investigate the pathology of R403Q HCM mutation and
the effect of MAVA, BLEB, and OM on the cell mechano-energetics.
Results: We offer a mechano-energetic HCM calibration of the
model, capturing the prolonged contractile relaxation due to R403Q
mutation (~33%), without assuming any further
modifications such as an additional Ca flux to the
thin filaments. The HCM model variant correctly predicts the negligible
alteration in ATPase activity in R403Q HCM condition compared to normal
hiPSC-CMs. The simulated inotropic effects of MAVA, OM, and BLEB, along
with the ATPase activities in the control and HCM model variant agree
with in vitro results from different labs. The proposed model
recapitulates the tension-Ca relationship and action
potential duration change due to 1uM OM and 5uM BLEB, consistently with
in vitro data. Finally, our model replicates the experimental
dose-dependent effect of OM and BLEB on the normalized isometric
tension. Conclusion: This work is a step toward
deep-phenotyping the mutation-specific HCM pathophysiology, manifesting
as altered interfilament kinetics. Accordingly, the modeling efforts
lend original insights into the MAVA, BLEB, and OM contributions to a
new interfilament balance resulting in a cardioprotective effect.