National Institutes of Health/National Heart, Lung, and Blood Institute (NIH/NHLBI)
R01 HL145473
United States
Citation
Journal: J Clin Invest / Year: 2025 Title: Structural basis for simvastatin-induced skeletal muscle weakness associated with type 1 ryanodine receptor T4709M mutation. Authors: Gunnar Weninger / Haikel Dridi / Steven Reiken / Qi Yuan / Nan Zhao / Linda Groom / Jennifer Leigh / Yang Liu / Carl Tchagou / Jiayi Kang / Alexander Chang / Estefania Luna-Figueroa / Marco ...Authors: Gunnar Weninger / Haikel Dridi / Steven Reiken / Qi Yuan / Nan Zhao / Linda Groom / Jennifer Leigh / Yang Liu / Carl Tchagou / Jiayi Kang / Alexander Chang / Estefania Luna-Figueroa / Marco C Miotto / Anetta Wronska / Robert T Dirksen / Andrew R Marks / Abstract: Statins lower cholesterol, reducing the risk of heart disease, and are among the most frequently prescribed drugs. Approximately 10% of individuals develop statin-associated muscle symptoms (SAMS; ...Statins lower cholesterol, reducing the risk of heart disease, and are among the most frequently prescribed drugs. Approximately 10% of individuals develop statin-associated muscle symptoms (SAMS; myalgias, rhabdomyolysis, and muscle weakness), often rendering them statin intolerant. The mechanism underlying SAMS remains poorly understood. Patients with mutations in the skeletal muscle ryanodine receptor 1 (RyR1)/calcium release channel can be particularly intolerant of statins. High-resolution structures revealed simvastatin binding sites in the pore region of RyR1. Simvastatin stabilized the open conformation of the pore and activated the RyR1 channel. In a mouse expressing a mutant RyR1-T4709M found in a patient with profound statin intolerance, simvastatin caused muscle weakness associated with leaky RyR1 channels. Cotreatment with a Rycal drug that stabilizes the channel closed state prevented simvastatin-induced muscle weakness. Thus, statin binding to RyR1 can cause SAMS, and patients with RyR1 mutations may represent a high-risk group for statin intolerance.
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