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The type 1 ryanodine receptor (RyR1) is an intracellular calcium (Ca 2+ ) release channel on the sarcoplasmic/endoplasmic reticulum that is required for skeletal muscle contraction. RyR1 channel activity is modulated by ligands, including the activators Ca 2+  and ATP. Patients with inherited mutations in RyR1 may exhibit muscle weakness as part of a heterogeneous, complex disorder known as  RYR1 -related myopathy ( RYR1 -RM) or more recently termed RYR1-related disorders (RYR1-RD). Guided by high-resolution structures of skeletal muscle RyR1, obtained using cryogenic electron microscopy, we introduced mutations into putative Ca 2+  and ATP binding sites and studied the function of the resulting mutant channels. These mutations confirmed the functional significance of the Ca 2+  and ATP binding sites identified by structural studies based on the effects on channel regulation. Under normal conditions, Ca 2+  activates RyR1 at low concentrations (µM) and inhibits it at high concentrations (mM). Mutations in the Ca 2+ -binding site impaired both activating and inhibitory regulation of the channel, suggesting a single site for both high and low affinity Ca 2+ -dependent regulation of RyR1 function. Mutation of residues that interact with the adenine ring of ATP abrogated ATP binding to the channel, whereas mutating residues that interact with the triphosphate tail only affected the degree of activation. In addition, patients with mutations at the Ca 2+  or ATP binding sites suffer from muscle weakness, therefore impaired RyR1 channel regulation by either Ca 2+  or ATP may contribute to the pathophysiology of  RYR1 -RM in some patients.   Supplementary Information  The online version contains supplementary material available at 10.1186/s40478-021-01287-3.

RyR1-related myopathy mutations in ATP and calcium binding sites impair channel regulation