From patient-specific induced pluripotent stem cells to clinical translation in long QT syndrome Type 2. (6th February 2019)

• Record Type: Journal Article
• Authors: Schwartz, Peter J; Gnecchi, Massimiliano; Dagradi, Federica; Castelletti, Silvia; Parati, Gianfranco; Spazzolini, Carla; Sala, Luca; Crotti, Lia
• Is Part Of: European heart journal. Volume 40:Number 23(2019)
• Page Start: 1832
• Page End: 1836
• Publication Date: 2019-02-06
• Subjects: Long QT syndrome -- Human-induced pluripotent stem cells -- Mutation-specific therapy -- Trafficking defect -- Drug repurposing -- Precision medicine -- Lumacaftor -- Sudden death -- Life-threatening arrhythmias; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehz023
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Aims: Having shown that Lumacaftor rescued the hERG trafficking defect in the induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) of two LQT2 patients, we tested whether the commercial association Lumacaftor + Ivacaftor (LUM + IVA) could shorten the QTc in the same two patients. Methods and results: After hospital admission and 1 day of baseline recordings, half dose LUM + IVA was administered on Day 1, followed by full dose (LUM 800 mg + IVA 500 mg) for 7 days. A continuous 12-lead Holter ECG allowed a large number of blind QTc measurements. Lumacaftor + Ivacaftor shortened QTc significantly in both patients: in V6 from 551 ± 22 ms to 523 ± 35 ms in Patient 1 (Pt1) and from 472 ± 21 ms to 449 ± 20 ms in Patient 2 (Pt2); in DII from 562 ± 25 ms to 549 ± 35 ms in Pt1 and from 485 ± 32 ms to 452 ± 18 ms in Pt2. In both patients, the percentage of QTc values in the lower tertile increased strikingly: in V6 from 33% to 68% and from 33% to 76%; in DII from 33% to 50% and from 33% to 87%. In the wash-out period a rebound in QTc was observed. On treatment, both patients developed diarrhoea, Pt1 more than Pt2. Conclusion: This represents the first attempt to validate in patients the in vitro results of a drug repurposing strategy for cardiovascular disorders. Lumacaftor + Ivacaftor shortened significantly the QTc in the two LQT2 patients with a trafficking defect, largely confirming the findings in their iPSC-CMs but with smaller quantitative changes. The findings are encouraging but immediate translation into clinical practice, without validation in more patients, would be premature.