AccScience Publishing / AN / Online First / DOI: 10.36922/an.4509
CASE REPORT

Cognitive and autonomic dysfunction associated with a novel RYR2 variant: A case report

Leilani Miranda1†* Liam Power1† Justin Ho1† Charly Edmiston1† Okeanis Vaou1,2 Anna Hohler1,2
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1 Tufts University School of Medicine, Boston, Massachusetts, United States of America
2 Department of Neurology, St. Elizabeth’s Medical Center, Brighton, Massachusetts, United States of America
Advanced Neurology, 4509 https://doi.org/10.36922/an.4509
Submitted: 13 August 2024 | Accepted: 13 November 2024 | Published: 4 December 2024
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Abstract

Variants in the ryanodine receptor 2 (RYR2) gene are primarily associated with catecholaminergic polymorphic ventricular tachycardia. However, recent studies have also identified potential links to neurological pathologies, including Alzheimer’s disease, benign epilepsy of childhood, and neurodevelopmental disorders. Despite these findings, there is limited data on the association between RYR2 variants and additional neurological symptoms, such as autonomic dysfunction. This case report describes the clinical progression of a father-son pair, who carry a novel pAsn2517Ser variant in the RYR2 gene, identified through genetic studies. The report highlights distinct neurological manifestations in both individuals: the father exhibited Alzheimer’s-like cognitive dysfunction, while the son presented with an autonomic disorder. This case aims to provide additional information on the role of RyR2 in the brain and the symptomatology associated with pathological variants. Given that both father and son share the same RYR2 mutation, the observed neurological manifestations are likely attributable to this genetic alteration. These cases offer novel clinical insights into the role of cytoplasmic calcium regulators and their impact on the neurological system.

Keywords
Ryanodine receptors
RyR2
Autonomic dysfunction
Alzheimer’s disease
Funding
None.
Conflict of interest
The authors declare that they have no competing interests.
References
  1. Lanner JT, Georgiou DK, Joshi AD and Hamilton SL. Ryanodine receptors: Structure, expression, molecular details, and function in calcium release. Cold Spring Harb Perspect Biol. 2010;2(11):a003996. doi: 10.1101/cshperspect.a003996

 

  1. Eisner DA, Caldwell JL, Kistamás K, Trafford AW. Calcium and excitation-contraction coupling in the heart. Circ Res. 2017;121(2):181-195. doi: 10.1161/CIRCRESAHA.117.310230

 

  1. Liu C, Zhang A, Yan N, Song C. Atomistic details of charge/ space competition in the Ca2+ selectivity of ryanodine receptors. J Phys Chem Lett. 2021;12(17):4286-4291. doi: 10.1021/acs.jpclett.1c00681

 

  1. Takeshima H, Nishimura S, Matsumoto T, et al. Primary structure and expression from complementary DNA of skeletal muscle ryanodine receptor. Nature. 1989;339(6224):439-445. doi: 10.1038/339439a0

 

  1. Furuichi T, Furutama D, Hakamata Y, Nakai J, Takeshima H, Mikoshiba K. Multiple types of ryanodine receptor/Ca2+ release channels are differentially expressed in rabbit brain. J Neurosci. 1994;14(8):4794-4805. doi: 10.1523/JNEUROSCI.14-08-04794.1994

 

  1. Tiso N, Stephan DA, Nava A, et al. Identification of mutations in the cardiac ryanodine receptor gene in families affected with arrhythmogenic right ventricular cardiomyopathy type 2 (ARVD2). Hum Mol Genet. 2001;10(3):189-194. doi: 10.1093/hmg/10.3.189

 

  1. Priori SG, Chen SR. Inherited dysfunction of sarcoplasmic reticulum Ca2+ handling and arrhythmogenesis. Circ Res. 2011;108(7):871-883. doi: 10.1161/CIRCRESAHA.110.226845

 

  1. Giannini G, Conti A, Mammarella S, Scrobogna M, Sorrentino V. The ryanodine receptor/calcium channel genes are widely and differentially expressed in murine brain and peripheral tissues. J Cell Biol. 1995;128(5):893-904. doi: 10.1083/jcb.128.5.893

 

  1. Ma MG, Liu XR, Wu Y, et al. RYR2 mutations are associated with benign epilepsy of childhood with centrotemporal spikes with or without arrhythmia. Front Neurosci. 2021;15:629610. doi: 10.3389/fnins.2021.629610

 

  1. Reiken S, Dridi H, Sittenfeld L, Liu X, Marks AR. Alzheimer’s-like remodeling of neuronal ryanodine receptor in COVID-19. Preprint. bioRxiv; 2021. doi: 10.1101/2021.02.18.431811

 

  1. Aiba I, Wehrens XH, Noebels JL. Leaky RyR2 channels unleash a brainstem spreading depolarization mechanism of sudden cardiac death. Proc Natl Acad Sci U S A. 2016;113(33):E4895-E4903. doi: 10.1073/pnas.1605216113

 

  1. Yap SM, Smyth S. Ryanodine receptor 2 (RYR2) mutation: A potentially novel neurocardiac calcium channelopathy manifesting as primary generalised epilepsy. Seizure. 2019;67:11-14. doi: 10.1016/j.seizure.2019.02.017

 

  1. Brainstem Morphological Changes in Alzheimer’s Disease. Available from: https://www-ncbi-nlm-nih-gov.ezproxy. library.tufts.edu/pmc/articles/pmc4415522 [Last accessed on 2024 May 02].

 

  1. Martín-Gallego A, González-García L, Carrasco-Brenes A, et al. Brainstem and autonomic nervous system dysfunction: A neurosurgical point of view. Acta Neurochir Suppl. 2017;124:221-229. doi: 10.1007/978-3-319-39546-3_34

 

  1. Fowler ED, Zissimopoulos S. Molecular, subcellular, and arrhythmogenic mechanisms in genetic RyR2 disease. Biomolecules. 2022;12(8):1030. doi: 10.3390/biom12081030

 

  1. Khoury J, Hoffman-Snyder C, Goodman B. Characterizing the spectrum of autonomic impairment in neurologic disorders with calcium channel antibodies (P2.114). Neurology. 2018;90(15 Suppl):P2.114. doi: 10.1212/WNL.90.15_supplement.P2.114

 

  1. Priori SG, Napolitano C, Tiso N, et al. Mutations in the cardiac ryanodine receptor gene (hRyR2) underlie catecholaminergic polymorphic ventricular tachycardia. Circulation. 2001;103(2):196-200. doi: 10.1161/01.cir.103.2.196

 

  1. Bertan F, Wischhof L, Sosulina L, et al. Loss of ryanodine receptor 2 impairs neuronal activity-dependent remodeling of dendritic spines and triggers compensatory neuronal hyperexcitability [Published correction appears in Cell Death Differ. 2020]. Cell Death Differ. 2020;27(12):3354-3373. doi: 10.1038/s41418-020-0584-2

 

  1. Bruno AM, Huang JY, Bennett DA, Marr RA, Hastings ML, Stutzmann GE. Altered ryanodine receptor expression in mild cognitive impairment and Alzheimer’s disease. Neurobiol Aging. 2012;33(5):1001.e1-1001.e10016. doi: 10.1016/j.neurobiolaging.2011.03.011

 

  1. Lacampagne A, Liu X, Reiken S, et al. Post-translational remodeling of ryanodine receptor induces calcium leak leading to Alzheimer’s disease-like pathologies and cognitive deficits. Acta Neuropathol. 2017;134(5):749-767. doi: 10.1007/s00401-017
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Advanced Neurology, Electronic ISSN: 2810-9619 Print ISSN: 3060-8589, Published by AccScience Publishing