Background:
CaM (calmodulin), encoded by 3 separate genes (
CALM1
,
CALM2
, and
CALM3
), is a multifunctional Ca
2+
-binding protein involved in many signal transduction events including ion channel regulation. CaM variants may present with early-onset long QT syndrome (LQTS), catecholaminergic polymorphic ventricular tachycardia, or sudden cardiac death. Most reported variants occurred de novo. We identified a novel
CALM3
variant, p.Asn138Lys (N138K), in a 4-generation family segregating with LQTS. The aim of this study was to elucidate its pathogenicity and to compare it with that of p.D130G-CaM—a variant associated with a severe LQTS phenotype.
Methods:
We performed whole exome sequencing for a large, 4-generation family affected by LQTS. To assess the effect of the detected
CALM3
variant, the intrinsic Ca
2+
-binding affinity was measured by stoichiometric Ca
2+
titrations and equilibrium titrations. L-type Ca
2+
and slow delayed rectifier potassium currents (I
CaL
and I
Ks
) were recorded by whole-cell patch-clamp. Cav1.2 and Kv7.1 membrane expression were determined by optical fluorescence assays.
Results:
We identified 14 p.N138K-CaM carriers in a family where 2 sudden deaths occurred in children. Several members were only mildly affected compared with CaM-LQTS patients to date described in literature. The intrinsic Ca
2+
-binding affinity of the CaM C-terminal domain was 10-fold lower for p.N138K-CaM compared with WT-CaM. I
CaL
inactivation was slowed in cells expressing p.N138K-CaM but less than in p.D130G-CaM cells. Unexpectedly, a larger I
Ks
current density was observed in cells expressing p.N138K-CaM, but not for p.D130G-CaM, compared with WT-CaM.
Conclusions:
The p.N138K
CALM3
variant impairs Ca
2+
-binding affinity of CaM and I
CaL
inactivation but potentiates I
Ks
. The variably expressed phenotype of this variant compared with previously published de novo LQTS-CaM variants is likely explained by a milder impairment of I
CaL
inactivation combined with I
Ks
augmentation.