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Annual Review of Pharmacology and Toxicology

Volume 65, 2025

Inhibitors of Intracellular RyR2 Calcium Release Channels as Therapeutic Agents in Arrhythmogenic Heart Diseases

Abstract

Ryanodine receptor type 2 (RyR2) is the principal intracellular calcium release channel in the cardiac sarcoplasmic reticulum (SR). Pathological RyR2 hyperactivity generates arrhythmia risk in genetic and structural heart diseases. gain-of-function mutations cause catecholaminergic polymorphic ventricular tachycardia. In structural heart diseases (i.e., heart failure), posttranslation modifications render RyR2 channels leaky, resulting in pathologic calcium release during diastole, contributing to arrhythmogenesis and contractile dysfunction. Hence, RyR2 represents a therapeutic target in arrhythmogenic heart diseases. We provide an overview of the structure and function of RyR2, and then review US Food and Drug Administration–approved and investigational RyR2 inhibitors. A therapeutic classification of RyR2 inhibitors is proposed based on their mechanism of action. Class I RyR2 inhibitors (e.g., flecainide) do not change SR calcium content and are primarily antiarrhythmic. Class II RyR2 inhibitors (e.g., dantrolene) increase SR calcium content, making them less effective as antiarrhythmics but preferable in conditions with reduced SR calcium content such as heart failure.

Keyword(s): atrial fibrillation, cardiac calcium handling, catecholaminergic polymorphic ventricular tachycardia, excitation-contraction coupling, heart failure, ryanodine receptor type 2, RyR2 inhibitors
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/content/journals/10.1146/annurev-pharmtox-061724-080739
2025-01-23
2025-04-18
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/content/journals/10.1146/annurev-pharmtox-061724-080739
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Inhibitors of Intracellular RyR2 Calcium Release Channels as Therapeutic Agents in Arrhythmogenic Heart Diseases
Annual Review of Pharmacology and Toxicology 65, 443 (2025); https://doi.org/10.1146/annurev-pharmtox-061724-080739
/content/journals/10.1146/annurev-pharmtox-061724-080739
/content/journals/10.1146/annurev-pharmtox-061724-080739
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