Abstract Body: Background: Hypertrophic cardiomyopathy (HCM) is an inherited disease characterized by the thickening of the heart muscle. Mutations in contractile proteins, such as myosin binding protein C (MYBPC3) and β-myosin heavy chain (MYH7), account for over half of patients with familial HCM. HCM is the leading cause of sudden cardiac death among young adults and athletes, with these mutations potentially leading to hypercontractility and arrhythmias culminating in sudden cardiac death. MicroRNAs (miRNAs) are pivotal regulators of gene expression that may influence disease progression. Despite their potential significance, there is a scarcity of published data on miRNA expression in HCM. Induced pluripotent stem cells (iPSCs) have emerged as valuable tools for modeling various cardiovascular diseases, including HCM. However, the miRNA expression profiles associated with HCM remain largely unexplored within iPSC models. Investigating the differential expression of miRNAs in HCM patients offers a promising avenue to identify potential therapeutic targets for individuals affected by this condition.

Methods: We performed an unbiased screen using a microarray (NanoString Technologies) that contained 798 miRNAs to identify differentially expressed miRNAs in induced pluripotent stem cell (iPSC)-CM and myocardial tissues derived from healthy donors and HCM patients with MYBPC3 and MYH7 mutations.

Results: We identified 5 differentially expressed miRNAs that are significantly downregulated in both mutant MYBPC3 iPSC-CM and myocardial tissue (miR-9-5p, -4443, -367-3p, -302c-3p, and -129-2-3p) (p ≤ 0.05). In mutant MYH7 iPSC-CM and myocardial tissue, 3 miRNAs that were significantly downregulated (miR-9-5p, -151a-3p, -129-2-3p), and 1 was significantly upregulated (miR-331-5p) (p ≤ 0.05). KEGG pathway analysis of gene targets using miRTarBase and g:Profiler revealed that miR-9-5p regulates genes in the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor resistance pathway (p = 3.99x10^-9), which is involved in hypercontractility associated with HCM.

Conclusion: This work represents the first description of miRNA expression patterns in iPSC-CMs derived from patients with HCM with additional validation from primary myocardial tissue, the current gold standard. We identified the miR-9-5p/EGFR tyrosine kinase inhibitor resistance axis as a potential therapeutic target responsible for mitigating the hypercontractile phenotype exhibited in HCM.