Dominant de novo mutations in the co-chaperone BAG3 cause a severe form of
myofibrillar myopathy, exhibiting progressive
muscle weakness, muscle structural failure, and
protein aggregation. To elucidate the mechanism of disease in, and identify
therapies for, BAG3
myofibrillar myopathy, we generated two zebrafish models, one conditionally expressing BAG3P209L and one with a
nonsense mutation in bag3. While transgenic BAG3P209L-expressing fish display
protein aggregation, modeling the early phase of the disease, bag3-/- fish exhibit exercise dependent fiber disintegration, and reduced swimming activity, consistent with later stages of the disease. Detailed characterization of the bag3-/- fish, revealed an impairment in macroautophagic/autophagic activity, a defect we confirmed in BAG3 patient samples. Taken together, our data highlights that while BAG3P209L expression is sufficient to promote
protein aggregation, it is the loss of BAG3 due to its sequestration within aggregates, which results in impaired autophagic activity, and subsequent
muscle weakness. We therefore screened autophagy-promoting compounds for their effectiveness at removing
protein aggregates, identifying nine including
metformin. Further evaluation demonstrated
metformin is not only able to bring about the removal of
protein aggregates in zebrafish and human myoblasts but is also able to rescue the fiber disintegration and swimming deficit observed in the bag3-/- fish. Therefore, repurposing
metformin provides a promising
therapy for BAG3
myopathy.Abbreviations:ACTN:
actinin, alpha; BAG3: BAG cochaperone 3; CRYAB:
crystallin alpha B; DES:
desmin;
DMSO:
dimethyl sulfoxide; DNAJB6: DnaJ
heat shock protein family (Hsp40) member B6; dpf: days post fertilization; eGFP:
enhanced green fluorescent protein; FDA: Food and Drug Administration; FHL1: four and a half LIM domains 1; FLNC:
filamin C; hpf: hours post-fertilization; HSPB8:
heat shock protein family B [small] member 8; LDB3/ZASP: LIM domain binding 3; MYOT: myotilin; TTN:
titin; WT: wild-type.