TMEM43-S358L mutation enhances NF-κB-TGFβ signal cascade in arrhythmogenic right ventricular dysplasia/cardiomyopathy

Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is a genetic cardiac muscle disease that accounts for approximately 30% sudden cardiac death in young adults. The Ser358Leu mutation of transmembrane protein 43 (TMEM43) was commonly identified in the patients of highly lethal and fully penetrant ARVD subtype, ARVD5. Here, we generated TMEM43 S358L mouse to explore the underlying mechanism. This mouse strain showed the classic pathologies of ARVD patients, including structural abnormalities and cardiac fibrofatty. TMEM43 S358L mutation led to hyper-activated nuclear factor kappa B (NF-kappa B) activation in heart tissues and primary cardiomyocyte cells. Importantly, this hyper activation of NF-kappa B directly drove the expression of pro-fibrotic gene, transforming growth factor beta (TGF beta 1), and enhanced downstream signal, indicating that TMEM43 S358L mutation up-regulates NF-kappa B-TGF beta signal cascade during ARVD cardiac fibrosis. Our study partially reveals the regulatory mechanism of ARVD development.