Carvedilol suppresses ryanodine receptor-dependent Ca²⁺ bursts in human neurons bearing PSEN1 variants found in early onset Alzheimer’s disease

Seizures are increasingly being recognized as the hallmark of Alzheimer’s disease (AD). Neuronal hyperactivity can be a consequence of neuronal damage caused by abnormal amyloid β (Aß) depositions. However, it can also be a cell-autonomous phenomenon causing AD by Aß-independent mechanisms. Various studies using animal models have shown that Ca²⁺ is released from the endoplasmic reticulum (ER) via type 1 inositol triphosphate receptors (InsP₃R1s) and ryanodine receptors (RyRs). To investigate which is the main pathophysiological mechanism in human neurons, we measured Ca²⁺ signaling in neural cells derived from three early-onset AD patients harboring Presenilin-1 variants (PSEN1 p. A246E, p.L286V, and p.M146L). Of these, it has been reported that PSEN1 p.A246E and p. L286V did not produce a significant amount of abnormal Aß. We found all PSEN1-mutant neurons, but not wild-type, caused abnormal Ca²⁺-bursts in a manner dependent on the calcium channel, Ryanodine Receptor 2 (RyR2). Indeed, carvedilol, an RyR2 inhibitor, and VK-II-86, an analog of carvedilol without the β-blocking effects, sufficiently eliminated the abnormal Ca²⁺ bursts. In contrast, Dantrolene, an inhibitor of RyR1 and RyR3, and Xestospongin c, an IP₃R inhibitor, did not attenuate the Ca²⁺-bursts. The Western blotting showed that RyR2 expression was not affected by PSEN1 p.A246E, suggesting that the variant may activate the RyR2. The RNA-Seq data revealed that ER-stress responsive genes were increased, and mitochondrial Ca²⁺-transporter genes were decreased in PSEN1_A246E cells compared to the WT neurons. Thus, we propose that aberrant Ca²⁺ signaling is a key link between human pathogenic PSEN1 variants and cell-intrinsic hyperactivity prior to deposition of abnormal Aß, offering prospects for the development of targeted prevention strategies for at-risk individuals.