Deep Mutational Scanning and Functional Analysis of Repolarization Determinants

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PROJECT SUMMARY/ABSTRACT The underpinnings of sudden cardiac death are related to genetic and acquired ion channel abnormalities and many are related to potassium channel variants. Gains in phenotype-genotype correlative studies have revolutionized our understanding of a range of sudden arrhythmic death syndromes, yet currently, identification of coding variants has far outpaced our ability to correctly classify the variant, and for most genes there are more unclassified variants (variants of unknown significance, VUS) than classified. This creates barriers for clinical care, familial cascade screening and, moreover, a functional link to disease. The importance of physiologic and functional analysis for variant classification has been emphasized, yet contemporary methods are cumbersome (time and resources) decreasing efficiency in unraveling the arrhythmic risk associated with genetic variants. Our lab’s work focuses on functional genomics of abnormal cardiac repolarization and cardiac arrhythmic sudden death syndromes, and we have developed high volume assays to understand variant pathogenicity. Yet most variant characterization proceeds in a reactive manner (clinical variant identification followed by functional study) and clinical association is often lacking (siloed research); this creates gaps in optimal and efficient variant classification. We aim to address these major gaps in knowledge by creating a pro-active, data driven and mechanistic variant classification scheme cross-validated with clinical data. In Aim 1, Deep Mutational Scanning (DMS) of Kir2.1, a K+ channel essential for repolarization, and MAVE (multiplexed assay of variant effects) creation will unveil functional annotation of all possible variants simultaneously to create a comprehensive fitness landscape. In Aim 2 MAVE will be applied to all K+ channel variants identified from TOPMed and the UK Biobank that have effects on repolarization to triangularly validate phenomic-genomic-functional data for genetic variant classification. Lastly, in Aim 3 we integrate genetic variant and MAVE results with traditional cellular markers of abnormal repolarization using an iPS-cardiomyocyte model and molecular computational modeling. Our central hypothesis is that DMS will uncover loss of function variants in regulatory regions of Kir2.1, MAVE of low frequency K+ channel coding variants from the TOPMed and UK Biobank will reveal common thematic and mechanistic readouts, and these can be validated in iPS-CMs and computational molecular modeling. The outcomes of this study will allow the field of functional genomics to begin to keep pace with rapidly evolving genetic discovery through high integrity, high throughput, and highly reproducible and unbiased techniques. We will create a methodologic template to catalog all other high-impact repolarization associated variants as a vital step to transition from reactive to proactive classification. Moreover, we will help establish the methodology to correlate clinical findings with variant characterization using parallel mechanistic techniques. This is an innovative proactive, data-driven approach, usable by clinicians and research teams alike to determine actionability of a given variant and to inform predictive models to reveal new structural-functional insights.