EL20, a potent antiarrhythmic compound, selectively inhibits calmodulin-deficient ryanodine receptor type 2

Heart Rhythm. 2018 Apr;15(4):578-586. doi: 10.1016/j.hrthm.2017.12.017. Epub 2017 Dec 14.


Background: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an arrhythmogenic disorder caused by mutations in the cardiac ryanodine receptor RyR2 that increase diastolic calcium cation (Ca2+) leak from the sarcoplasmic reticulum (SR). Calmodulin (CaM) dissociation from RyR2 has been associated with diastolic Ca2+ leak in heart failure.

Objective: Determine whether the tetracaine-derivative compound EL20 inhibits abnormal Ca2+ release from RyR2 in a CPVT model and investigate the underlying mechanism of inhibition.

Methods: Spontaneous Ca2+ sparks in cardiomyocytes and inducible ventricular tachycardia were assessed in a CPVT mouse model, which is heterozygous for the R176Q mutation in RyR2 (R176Q/+ mice) in the presence of EL20 or vehicle. Single-channel studies using sheep cardiac SR or purified RyR2 reconstituted into proteoliposomes with and without exogenous CaM were used to assess mechanisms of inhibition.

Results: EL20 potently inhibits abnormal Ca2+ release in R176Q/+ myocytes (half-maximal inhibitory concentration = 35.4 nM) and diminishes arrhythmia in R176Q/+ mice. EL20 inhibition of single-channel activity of purified RyR2 occurs in a similar range as seen in R176Q/+ myocytes (half-maximal inhibitory concentration = 8.2 nM). Inhibition of single-channel activity for cardiac SR or purified RyR2 supplemented with 100-nM or 1-μM CaM shows a 200- to 1000-fold reduction in potency.

Conclusion: This work provides a potential therapeutic mechanism for the development of antiarrhythmic compounds that inhibit leaky RyR2 resulting from CaM dissociation, which is often associated with failing hearts. Our data also suggest that CaM dissociation may contribute to the pathogenesis of arrhythmias with the CPVT-linked R176Q mutation.

Keywords: Antiarrhythmic; CPVT; Calcium sparks; Calmodulin; Cardiac ryanodine receptor; Reconstituted single channel.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Anti-Arrhythmia Agents / pharmacology*
  • Calcium / metabolism
  • Calmodulin / deficiency*
  • DNA / genetics*
  • DNA Mutational Analysis
  • Disease Models, Animal
  • Mice
  • Mice, Mutant Strains
  • Mutation*
  • Myocytes, Cardiac / metabolism*
  • Myocytes, Cardiac / pathology
  • Ryanodine Receptor Calcium Release Channel / genetics*
  • Ryanodine Receptor Calcium Release Channel / metabolism
  • Sarcoplasmic Reticulum
  • Sheep
  • Tachycardia, Ventricular / genetics*
  • Tachycardia, Ventricular / metabolism
  • Tachycardia, Ventricular / pathology


  • Anti-Arrhythmia Agents
  • Calmodulin
  • Ryanodine Receptor Calcium Release Channel
  • ryanodine receptor 2. mouse
  • DNA
  • Calcium

Supplementary concepts

  • Polymorphic catecholergic ventricular tachycardia