Malignant hyperthermia is a potentially fatal hypermetabolic disorder triggered by halogenated anesthetics and the myorelaxant succinylcholine in genetically predisposed individuals.Approximately 50% of Malignant Hyperthermia susceptible individuals carry dominant, gain of function mutations in RYR1 (which encodes ryanodine receptor type 1), though they have normal muscle function and no overt clinical symptoms. RyR1 is predominantly expressed in skeletal muscle but also to a lower extent in some immune and smooth muscle cells, suggesting that RYR1 mutations may have a wider range of effects than previously suspected. Consistently, reports describing mild bleeding abnormalities in patients with malignant hyperthermia carrying gain of function RYR1 mutations have appeared. In the present report we sought to determine the 3 frequency and molecular basis for this symptom. We found that some patients with specific RYR1 mutations had abnormally high bleeding scores, whereas their healthy relatives did not. Knock-in mice with the Malignant Hyperthermia Susceptibility RYR1 mutation Y522S (MHS RYR1 Y522S ) had bleeding times that were 3 times longer than their wild-type littermates. Primary vascular smooth muscle cells from RYR1 Y522S knock-in mice exhibited a higher frequency of subplasmalemmal Ca 2+ sparks leading to a more negative resting membrane potential. The bleeding defect of RYR1 Y522S mice and of one patient was reversed by treatment with the RYR1 antagonist dantrolene, and Ca 2+ sparks in primary vascular smooth muscle cells from the MHS RYR1 Y522S mice were blocked by ryanodine or dantrolene. Thus, RYR1 mutations may lead to prolonged bleeding by altering vascular smooth muscle cell function. The reversibility of the bleeding phenotype emphasizes the potential therapeutic value of dantrolene in the treatment of such bleeding disorders.4