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Increasing L-type calcium channel (LTCC) activity deteriorates heart function; however, myocardial RRAD knockout (cRAD\u0394\/\u0394) instills tonic modulated LTCC current (ICa,L) that preserves healthy myocardium. Thus, we chose to challenge the dogma that enhanced trigger Ca2+ is maladaptive. The study objective was to test the hypothesis that modulated ICa,L in cRAD\u0394\/\u0394 mice rescues dilated cardiomyopathy by providing tonic modulated trigger Ca2+.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Mouse and human models were tested. The muscle lim protein knockout mouse (MLPKO) is a murine model of dilated cardiomyopathy (DCM) and HFrEF. The experimental timeline was to induce cRAD\u0394\/\u0394 after onset of DCM (2.5 months of age) and follow subjects for up to 1-year. Longitudinal echocardiography and cardiac magnetic resonance imaging (CMR) showed that cRAD\u0394\/\u0394 intervention rescued systolic function. Patch clamp recordings of isolated cardiomyocytes of MLPKO with cRAD\u0394\/\u0394 demonstrated augmented LTCC activity, along with rescue of dysfunctional Ca2+ handling and sarcomere function. Bulk RNAseq of hearts demonstrated down-regulated pathological signalling cascades and pro-hypertrophic gene expression which comported with the reduction in eccentric hypertrophy observed with gravimetrics, CMR, and echocardiography. RRAD knockdown effects translate from mouse to human heart. Ventricle slices from HFrEF patients were treated with lentiviral shRNA targeting RRAD and recapitulated the inotropic and lusitropic effects observed in the mouse model of DCM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Induction of cardiomyocyte-restricted RAD knockout in MLPKO mice after onset of DCM rescued cardiac dysfunction and attenuated pathological remodelling. cRAD\u0394\/\u0394 intervention provided positive inotropy and lusitropy and reverted transcriptional signatures towards healthy myocardium. This study introduces targeting myocardial RAD regulation of the LTCC as a novel therapeutic strategy for systolic heart failure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cvr\/cvaf169","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T12:10:51Z","timestamp":1759320651000},"page":"2204-2221","source":"Crossref","is-referenced-by-count":1,"title":["RRAD-reduction reveals efficacy of targeting L-type calcium channel regulation for treatment of heart failure"],"prefix":"10.1093","volume":"121","author":[{"given":"Garrett","family":"Elmore","sequence":"first","affiliation":[{"name":"Department of Physiology, University of Kentucky , 741 S. Limestone, Lexington, KY 40536-0298, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarisha S","family":"Lohano","sequence":"additional","affiliation":[{"name":"Department of Physiology, University of Kentucky , 741 S. 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Limestone, Lexington, KY 40536-0298, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven W","family":"Leung","sequence":"additional","affiliation":[{"name":"Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY 40506 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riham R E","family":"Abouleisa","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Surgery, Baylor College of Medicine, Houston, TX 77030 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pretty R","family":"Mathew","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Surgery, Baylor College of Medicine, Houston, TX 77030 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Austin","family":"Wellette-Hunsucker","sequence":"additional","affiliation":[{"name":"Department of Physiology, University of Kentucky , 741 S. Limestone, Lexington, KY 40536-0298, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Austin T","family":"Minton","sequence":"additional","affiliation":[{"name":"Department of Physiology, University of Kentucky , 741 S. Limestone, Lexington, KY 40536-0298, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth S","family":"Campbell","sequence":"additional","affiliation":[{"name":"Department of Physiology, University of Kentucky , 741 S. Limestone, Lexington, KY 40536-0298, USA"},{"name":"Department of Medicine\/Cardiology, University of Kentucky HealthCare, Lexington, KY 40506 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Solomon W","family":"Harrar","sequence":"additional","affiliation":[{"name":"Department of Statistics, University of Kentucky, Lexington, KY 40506 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad","family":"Mehri","sequence":"additional","affiliation":[{"name":"Department of Mechanical and Aerospace Engineering, University of Kentucky, Lexington, KY 40506 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan F","family":"Wenk","sequence":"additional","affiliation":[{"name":"Department of Mechanical and Aerospace Engineering, University of Kentucky, Lexington, KY 40506 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tamer M A","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Surgery, Baylor College of Medicine, Houston, TX 77030 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas A","family":"Andres","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, University of Kentucky, Lexington, KY 40506 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9198-8349","authenticated-orcid":false,"given":"Jonathan","family":"Satin","sequence":"additional","affiliation":[{"name":"Department of Physiology, University of Kentucky , 741 S. 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