Although -blockers can be used to eliminate stress-induced ventricular arrhythmias in patients with catecholaminergic polymorphic ventricular tachycardia (CPVT), this treatment is unsuccessful in 25% of cases. generated from this patient and two control individuals expressed comparable levels of excitation-contraction genes, but assessment of the sarcoplasmic reticulum Ca2+ leak and load relationship revealed intracellular Ca2+ homeostasis was altered in the CPVT iPSC-CMs. -adrenergic stimulation potentiated spontaneous Ca2+ waves and unduly frequent, large and prolonged Ca2+ sparks Torcetrapib (CP-529414) manufacture in CPVT compared with control iPSC-CMs, validating the disease phenotype. Pursuant to the patient’s responses, nadolol treatment during -adrenergic stimulation achieved negligible reduction of Ca2+ wave frequency and failed to Torcetrapib (CP-529414) manufacture rescue Ca2+ spark defects in CPVT iPSC-CMs. In contrast, flecainide reduced both frequency and amplitude of Ca2+ waves and restored the frequency, width and duration of Ca2+ sparks to baseline levels. By recapitulating the improved response of an individual with CPVT to flecainide compared with -blocker therapy patient-specific drug response differentials to clinical data. A notable proof-of-principle study for this paradigm demonstrated that CPVT patient-derived iPSC-CMs can replicate individual drug responses to dantrolene in a mutation-specific manner (Penttinen et al., 2015). However, before patient-derived iPSC-CMs can be widely utilized for precision medicine, their capacity to model therapeutic idiosyncrasies must be comprehensively established. The present study sought to determine whether a patient-specific response to therapeutic -blockade can be observed in CPVT iPSC-CMs. To this end, iPSC lines were derived from an individual with CPVT harboring a novel RyR2outcomes, flecainide proved more effective than nadolol in reducing potentially arrhythmogenic Ca2+ release in iPSC-CMs derived from the individual during -AR agonism. Further investigation of the therapeutic effects of flecainide on CPVT CMs following -AR stimulation showed that it successfully improved Ca2+ homeostasis and mitigated electrical instability by reducing the incidence of DADs and asymmetrical beat periods. These results support the hypothesis that iPSC-CMs can capture key components of patient-specific drug responses, and imply that CM-specific factors play a role in determining a patient’s receptiveness to -blocker therapy. RESULTS Flecainide preferentially resolves ventricular arrhythmias in CPVT patient The pedigree of the 12-year-old male individual with CPVT (III-2) selected for this study shows several affected family members demonstrating an autosomal dominant inheritance pattern of the syndrome (Fig.?1A). Genotyping of the individual, his brother and his mother identified a shared novel amino acid missense leucineproline mutation at residue site 3741 in RyR2 (i.e. L3741P), caused by a TC nucleotide substitution at position 11,342 in the coding sequence (i.e. c.T11342C) (Fig.?1B,C). The mutation is located outside the salient hotspot regions where most RyR mutations cluster, which include regions in the N-terminal, central and C-terminal domains (Priori and Napolitano, 2005; Thomas et al., 2010). Echocardiography revealed a structurally normal heart (data not shown) and resting electrocardiogram was unremarkable (Fig.?1D). However, bicycle ergometer exercise stress testing evoked polymorphic ventricular tachycardia during stage 3 exercise at a peak heart rate of Torcetrapib (CP-529414) manufacture 167?bpm (Fig.?1D). The subject received an implantable cardiac defibrillator in addition to -blocker treatment with nadolol (20?mg once daily; 0.74?mg/kg/day). A follow-up exercise stress Torcetrapib (CP-529414) manufacture test at nineteen months revealed that multiform ventricular arrhythmias persisted despite -blockade (Fig.?1D), with ventricular ectopy starting during stage 1 exercise and progressing to couplets during stage 3 exercise at a maximum heart rate of 138?bpm. The comparatively low heart rate during nadolol treatment compared with the diagnostic heart rate at matched exercise intensities demonstrates the patient’s compliance with -blocker therapy and validates the treatment dose. The patient was then started on flecainide (50?mg twice daily; 2.7?mg/kg/day). CD350 In a follow-up stress test three weeks after starting flecainide, the patient was able to exercise to exhaustion with a peak heart rate during stage 3 exercise of 168?bpm and no ventricular ectopy (Fig.?1D). Fig. 1. Flecainide preferentially resolves ventricular arrhythmias in individual with CPVT. (A) Pedigree of the subject (3-2). Dark signs, CPVT-affected people harboring the story RyR2-M3741P mutation; grey signs, CPVT-symptomatic with unverified … Patient-derived cells exhibit lineage-specific indicators Two clonal iPSC lines had been made from the specific with CPVT (CPVT-A and CPVT-B), and two control lines (control A and control C) had been made from two unconnected healthful adult men with distinctive hereditary backdrops. All four lines shown usual iPSC nest morphology and regular 46, XY karyotypes (Fig.?T1). Control and CPVT iPSCs had been positive for pluripotency indicators (Fig.?2A), and exhibited comparable reflection of pluripotency genetics seeing that determined by qRT-PCR (Fig.?2B). Natural difference of Torcetrapib (CP-529414) manufacture control and CPVT iPSC lines lead in embryoid systems (EBs) showing family tree indicators of endoderm (leader fetal proteins; FP), mesoderm (-even muscles actinin; -SMA), and ectoderm (III-tubulin) (Fig.?2C). EB gene reflection evaluation uncovered downregulation of pluripotency genetics concomitant with upregulation of lineage-specific genetics as driven by qRT-PCR (Fig.?2B). Directed differentiation of control and CPVT.