Phosphorylation of Cardiac Myosin-Binding Protein-C Is a Critical Mediator of Diastolic Function

BACKGROUND: -Heart failure with preserved ejection fraction (HFpEF) accounts for approximately 50% of all cases of heart failure and currently has no effective treatment. Diastolic dysfunction underlies HFpEF; therefore, elucidation of the mechanisms that mediate relaxation can provide new potential targets for treatment. Cardiac myosin binding protein-C (cMyBP-C) is a thick filament protein that modulates cross-bridge cycling rates via alterations in its phosphorylation status. Thus, we hypothesize that phosphorylated cMyBP-C accelerates rate of cross-bridge detachment, thereby enhancing relaxation to mediate diastolic function.\n\nMETHODS AND RESULTS: -We compared mouse models expressing phosphorylation deficient cMyBP-C(S273A/S282A/S302A)-cMyBP-C(t3SA), phosphomimetic cMyBP-C(S273D/S282D/S302D)-cMyBP-C(t3SD), and WT-control cMyBP-C(tWT) to elucidate the functional effects of cMyBP-C phosphorylation. Decreased voluntary running distances, increased lung/body weight ratios, and increased brain natriuretic peptide (BNP) levels in cMyBP-C(t3SA) mice demonstrate that phosphorylation deficiency is associated with signs of heart failure. Echocardiography (ejection fraction, myocardial relaxation velocity) and pressure/volume measurements (-dP/dtmin, pressure decay time constant Tau-Glantz, passive filling stiffness) show that cMyBP-C phosphorylation enhances myocardial relaxation in cMyBP-C(t3SD) mice while deficient cMyBP-C phosphorylation causes diastolic dysfunction with preserved ejection fraction in cMyBP-C(t3SA) mice. Simultaneous force and [Ca(2+)]i measurements on intact papillary muscles show that enhancement of relaxation in cMyBP-C(t3SD) mice and impairment of relaxation in cMyBP-C(t3SA) mice are not due to altered [Ca(2+)]i handling, implicating that altered cross-bridge detachment rates mediate these changes in relaxation rates.\n\nCONCLUSIONS: -cMyBP-C phosphorylation enhances relaxation while deficient phosphorylation causes diastolic dysfunction and phenotypes resembling HFpEF. Thus, cMyBP-C is a potential target for treatment of HFpEF.