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Roberts JD, Murphy NP, Hamilton RM, Lubbers ER, James CA, Kline CF, Gollob MH, Krahn AD, Sturm AC, Musa H, El-Refaey M, Koenig S, Aneq MÅ, Hoorntje ET, Graw SL, Davies RW, Rafiq MA, Koopmann TT, Aafaqi S, Fatah M, Chiasson DA, Taylor MR, Simmons SL, Han M, van Opbergen CJ, Wold LE, Sinagra G, Mittal K, Tichnell C, Murray B, Codima A, Nazer B, Nguyen DT, Marcus FI, Sobriera N, Lodder EM, van den Berg MP, Spears DA, Robinson JF, Ursell PC, Green AK, Skanes AC, Tang AS, Gardner MJ, Hegele RA, van Veen TA, Wilde AA, Healey JS, Janssen PM, Mestroni L, van Tintelen JP, Calkins H, Judge DP, Hund TJ, Scheinman MM, Mohler PJ. Ankyrin-B dysfunction predisposes to arrhythmogenic cardiomyopathy and is amenable to therapy. J Clin Invest 2019; 129:3171-3184. [PMID: 31264976 PMCID: PMC6668697 DOI: 10.1172/jci125538] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 05/14/2019] [Indexed: 01/11/2023] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is an inherited arrhythmia syndrome characterized by severe structural and electrical cardiac phenotypes, including myocardial fibrofatty replacement and sudden cardiac death. Clinical management of ACM is largely palliative, owing to an absence of therapies that target its underlying pathophysiology, which stems partially from our limited insight into the condition. Following identification of deceased ACM probands possessing ANK2 rare variants and evidence of ankyrin-B loss of function on cardiac tissue analysis, an ANK2 mouse model was found to develop dramatic structural abnormalities reflective of human ACM, including biventricular dilation, reduced ejection fraction, cardiac fibrosis, and premature death. Desmosomal structure and function appeared preserved in diseased human and murine specimens in the presence of markedly abnormal β-catenin expression and patterning, leading to identification of a previously unknown interaction between ankyrin-B and β-catenin. A pharmacological activator of the WNT/β-catenin pathway, SB-216763, successfully prevented and partially reversed the murine ACM phenotypes. Our findings introduce what we believe to be a new pathway for ACM, a role of ankyrin-B in cardiac structure and signaling, a molecular link between ankyrin-B and β-catenin, and evidence for targeted activation of the WNT/β-catenin pathway as a potential treatment for this disease.
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Affiliation(s)
- Jason D. Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, UCSF, San Francisco, California, USA
| | - Nathaniel P. Murphy
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Departments of Physiology and Cell Biology and Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Robert M. Hamilton
- The Labatt Family Heart Centre (Department of Pediatrics) and Translational Medicine, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | - Ellen R. Lubbers
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Departments of Physiology and Cell Biology and Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Cynthia A. James
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Crystal F. Kline
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Departments of Physiology and Cell Biology and Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michael H. Gollob
- Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Andrew D. Krahn
- Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amy C. Sturm
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania, USA
| | - Hassan Musa
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mona El-Refaey
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Sara Koenig
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Meriam Åström Aneq
- Department of Clinical Physiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Edgar T. Hoorntje
- Netherlands Heart Institute, Utrecht, Netherlands
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Sharon L. Graw
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Denver, Aurora, Colorado, USA
| | - Robert W. Davies
- Program in Genetics and Genome Biology and The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Muhammad Arshad Rafiq
- The Labatt Family Heart Centre (Department of Pediatrics) and Translational Medicine, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
- Department of Bioscience, COMSATS University, Islamabad, Pakistan
| | - Tamara T. Koopmann
- The Labatt Family Heart Centre (Department of Pediatrics) and Translational Medicine, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | - Shabana Aafaqi
- The Labatt Family Heart Centre (Department of Pediatrics) and Translational Medicine, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | - Meena Fatah
- The Labatt Family Heart Centre (Department of Pediatrics) and Translational Medicine, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | - David A. Chiasson
- Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Matthew R.G. Taylor
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Denver, Aurora, Colorado, USA
| | - Samantha L. Simmons
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Departments of Physiology and Cell Biology and Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mei Han
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Departments of Physiology and Cell Biology and Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Chantal J.M. van Opbergen
- Department of Medical Physiology, Division of Heart and Lungs, University Medical Center, Utrecht, Utrecht University, Utrecht, Netherlands
| | - Loren E. Wold
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Departments of Physiology and Cell Biology and Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Kirti Mittal
- The Labatt Family Heart Centre (Department of Pediatrics) and Translational Medicine, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | - Crystal Tichnell
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Brittney Murray
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alberto Codima
- Department of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Babak Nazer
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Duy T. Nguyen
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, Aurora, Colorado, USA
| | - Frank I. Marcus
- Division of Cardiology, Sarver Heart Center, University of Arizona, Tucson, Arizona, USA
| | - Nara Sobriera
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elisabeth M. Lodder
- Amsterdam University Medical Center, University of Amsterdam, Heart Centre, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Maarten P. van den Berg
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Danna A. Spears
- Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - John F. Robinson
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Anna K. Green
- Departments of Clinical Genetics and Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Allan C. Skanes
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Anthony S. Tang
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Martin J. Gardner
- Division of Cardiology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robert A. Hegele
- Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Toon A.B. van Veen
- Department of Medical Physiology, Division of Heart and Lungs, University Medical Center, Utrecht, Utrecht University, Utrecht, Netherlands
| | - Arthur A.M. Wilde
- Amsterdam University Medical Center, University of Amsterdam, Heart Centre, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Jeff S. Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Paul M.L. Janssen
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Departments of Physiology and Cell Biology and Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Luisa Mestroni
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Denver, Aurora, Colorado, USA
| | - J. Peter van Tintelen
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Clinical Genetics, Amsterdam, Netherlands
- Department of Genetics, University Medical Center Utrecht (UMCU), Utrecht, Netherlands
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Daniel P. Judge
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Thomas J. Hund
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Department of Biomedical Engineering, College of Engineering, The Ohio State University, Columbus, Ohio, USA
| | - Melvin M. Scheinman
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, UCSF, San Francisco, California, USA
| | - Peter J. Mohler
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Departments of Physiology and Cell Biology and Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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52
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Blazeski A, Lowenthal J, Wang Y, Teuben R, Zhu R, Gerecht S, Tomaselli G, Tung L. Engineered Heart Slice Model of Arrhythmogenic Cardiomyopathy Using Plakophilin-2 Mutant Myocytes. Tissue Eng Part A 2019; 25:725-735. [PMID: 30520705 DOI: 10.1089/ten.tea.2018.0272] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPACT STATEMENT Genetic heart diseases such as arrhythmogenic cardiomyopathy (AC), a common genetic cause of sudden cardiac death, can be modeled using patient-specific induced pluripotent stem cell-derived cardiac myocytes (CMs). However, it is important to culture these cells in a multicellular syncytium with exposure to surrounding matrix cues to create more accurate and robust models of the disease due to the importance of cell-cell and cell-matrix interactions. The engineered heart slice, constructed by seeding CMs on intact decellularized matrix slices, allows molecular and functional studies on an aligned multilayered syncytium of CMs. This study reveals the potential for an improved disease-in-a-dish model of AC.
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Affiliation(s)
- Adriana Blazeski
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Justin Lowenthal
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yin Wang
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Roald Teuben
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Renjun Zhu
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sharon Gerecht
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gordon Tomaselli
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Leslie Tung
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland
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53
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Abstract
Activation of the electrical signal and its transmission as a depolarizing wave in the whole heart requires highly organized myocyte architecture and cell-cell contacts. In addition, complex trafficking and anchoring intracellular machineries regulate the proper surface expression of channels and their targeting to distinct membrane domains. An increasing list of proteins, lipids, and second messengers can contribute to the normal targeting of ion channels in cardiac myocytes. However, their precise roles in the electrophysiology of the heart are far from been extensively understood. Nowadays, much effort in the field focuses on understanding the mechanisms that regulate ion channel targeting to sarcolemma microdomains and their organization into macromolecular complexes. The purpose of the present section is to provide an overview of the characterized partners of the main cardiac sodium channel, NaV1.5, involved in regulating the functional expression of this channel both in terms of trafficking and targeting into microdomains.
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54
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Genetics of and pathogenic mechanisms in arrhythmogenic right ventricular cardiomyopathy. Biophys Rev 2018; 10:973-982. [PMID: 29995277 DOI: 10.1007/s12551-018-0437-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 06/28/2018] [Indexed: 02/06/2023] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited heart disease, associated with a high risk of sudden cardiac death. ARVC has been termed a 'disease of the desmosome' based on the fact that in many cases, it is caused by mutations in genes encoding desmosomal proteins at the specialised intercellular junctions between cardiomyocytes, the intercalated discs. Desmosomes maintain the structural integrity of the ventricular myocardium and are also implicated in signal transduction pathways. Mutated desmosomal proteins are thought to cause detachment of cardiac myocytes by the loss of cellular adhesions and also affect signalling pathways, leading to cell death and substitution by fibrofatty adipocytic tissue. However, mutations in desmosomal proteins are not the sole cause for ARVC as mutations in non-desmosomal genes were also implicated in its pathogenesis. This review will consider the pathology, genetic basis and mechanisms of pathogenesis for ARVC.
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55
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Hoorntje ET, Te Rijdt WP, James CA, Pilichou K, Basso C, Judge DP, Bezzina CR, van Tintelen JP. Arrhythmogenic cardiomyopathy: pathology, genetics, and concepts in pathogenesis. Cardiovasc Res 2018; 113:1521-1531. [PMID: 28957532 DOI: 10.1093/cvr/cvx150] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 08/03/2017] [Indexed: 02/06/2023] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a rare, heritable heart disease characterized by fibro-fatty replacement of the myocardium and a high degree of electric instability. It was first thought to be a congenital disorder, but is now regarded as a dystrophic heart muscle disease that develops over time. There is no curative treatment and current treatment strategies focus on attenuating the symptoms, slowing disease progression, and preventing life-threatening arrhythmias and sudden cardiac death. Identification of mutations in genes encoding desmosomal proteins and in other genes has led to insights into the disease pathogenesis and greatly facilitated identification of family members at risk. The disease phenotype is, however, highly variable and characterized by incomplete penetrance. Although the reasons are still poorly understood, sex, endurance exercise and a gene-dosage effect seem to play a role in these phenomena. The discovery of the genes and mutations implicated in ACM has allowed animal and cellular models to be generated, enabling researchers to start unravelling it's underlying molecular mechanisms. Observations in humans and in animal models suggest that reduced cell-cell adhesion affects gap junction and ion channel remodelling at the intercalated disc, and along with impaired desmosomal function, these can lead to perturbations in signalling cascades like the Wnt/β-catenin and Hippo/YAP pathways. Perturbations of these pathways are also thought to lead to fibro-fatty replacement. A better understanding of the molecular processes may lead to new therapies that target specific pathways involved in ACM.
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Affiliation(s)
- Edgar T Hoorntje
- Department of Genetics, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.,Netherlands Heart Institute, Moreelsepark 1, 3511 EP, Utrecht, The Netherlands
| | - Wouter P Te Rijdt
- Department of Genetics, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Cynthia A James
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, USA
| | - Kalliopi Pilichou
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua 35121, Italy
| | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua 35121, Italy
| | - Daniel P Judge
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, USA
| | - Connie R Bezzina
- Department of Clinical and Experimental Cardiology, Heart Centre, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - J Peter van Tintelen
- Netherlands Heart Institute, Moreelsepark 1, 3511 EP, Utrecht, The Netherlands.,Department of Clinical Genetics, Academic Medical Centre Amsterdam, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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56
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Sottas V, Wahl CM, Trache MC, Bartolf-Kopp M, Cambridge S, Hecker M, Ullrich ND. Improving electrical properties of iPSC-cardiomyocytes by enhancing Cx43 expression. J Mol Cell Cardiol 2018; 120:31-41. [PMID: 29777691 DOI: 10.1016/j.yjmcc.2018.05.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 05/14/2018] [Accepted: 05/15/2018] [Indexed: 12/25/2022]
Abstract
The therapeutic potential of induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) is limited by immature functional features including low impulse propagation and reduced cell excitability. Key players regulating electrical activity are voltage-gated Na+ channels (Nav1.5) and gap junctions built from connexin-43 (Cx43). Here we tested the hypothesis that enhanced Cx43 expression increases intercellular coupling and influences excitability by modulating Nav1.5. Using transgenic approaches, Cx43 and Nav1.5 localization and cell coupling were studied by confocal imaging. Nav1.5 currents and action potentials (APs) were measured using the patch-clamp technique. Enhanced sarcolemmal Cx43 expression significantly improved intercellular coupling and accelerated dye transfer kinetics. Furthermore, Cx43 modulated Nav1.5 function leading to significantly higher current and enhanced AP upstroke velocities, thereby improving electrical activity as measured by microelectrode arrays. These findings suggest a mechanistic link between cell coupling and excitability controlled by Cx43 expression in iPSC-CMs. Therefore, we propose Cx43 as novel molecular target for improving electrical properties of iPSC-CMs to match the functional properties of native myocytes.
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Affiliation(s)
- Valentin Sottas
- Institute of Physiology and Pathophysiology, Division of Cardiovascular Physiology, Heidelberg University, Im Neuenheimer Feld 307, 69120 Heidelberg, Germany
| | - Carl-Mattheis Wahl
- Institute of Physiology and Pathophysiology, Division of Cardiovascular Physiology, Heidelberg University, Im Neuenheimer Feld 307, 69120 Heidelberg, Germany
| | - Mihnea C Trache
- Institute of Physiology and Pathophysiology, Division of Cardiovascular Physiology, Heidelberg University, Im Neuenheimer Feld 307, 69120 Heidelberg, Germany
| | - Michael Bartolf-Kopp
- Institute of Physiology and Pathophysiology, Division of Cardiovascular Physiology, Heidelberg University, Im Neuenheimer Feld 307, 69120 Heidelberg, Germany
| | - Sidney Cambridge
- Institute of Anatomy, Functional Neuroanatomy, Heidelberg University, Im Neuenheimer Feld 307, 69120 Heidelberg, Germany
| | - Markus Hecker
- Institute of Physiology and Pathophysiology, Division of Cardiovascular Physiology, Heidelberg University, Im Neuenheimer Feld 326, 69120 Heidelberg, Germany
| | - Nina D Ullrich
- Institute of Physiology and Pathophysiology, Division of Cardiovascular Physiology, Heidelberg University, Im Neuenheimer Feld 307, 69120 Heidelberg, Germany.
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57
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Basso C, Pilichou K, Bauce B, Corrado D, Thiene G. Diagnostic Criteria, Genetics, and Molecular Basis of Arrhythmogenic Cardiomyopathy. Heart Fail Clin 2018. [DOI: 10.1016/j.hfc.2018.01.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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58
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Affiliation(s)
- Jingjing Zheng
- Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Da Zheng
- Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Terry Su
- Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Jianding Cheng
- Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
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59
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Te Riele ASJM, Agullo-Pascual E, James CA, Leo-Macias A, Cerrone M, Zhang M, Lin X, Lin B, Sobreira NL, Amat-Alarcon N, Marsman RF, Murray B, Tichnell C, van der Heijden JF, Dooijes D, van Veen TAB, Tandri H, Fowler SJ, Hauer RNW, Tomaselli G, van den Berg MP, Taylor MRG, Brun F, Sinagra G, Wilde AAM, Mestroni L, Bezzina CR, Calkins H, Peter van Tintelen J, Bu L, Delmar M, Judge DP. Multilevel analyses of SCN5A mutations in arrhythmogenic right ventricular dysplasia/cardiomyopathy suggest non-canonical mechanisms for disease pathogenesis. Cardiovasc Res 2017; 113:102-111. [PMID: 28069705 DOI: 10.1093/cvr/cvw234] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/21/2016] [Accepted: 11/14/2016] [Indexed: 12/21/2022] Open
Abstract
AIMS Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C) is often associated with desmosomal mutations. Recent studies suggest an interaction between the desmosome and sodium channel protein Nav1.5. We aimed to determine the prevalence and biophysical properties of mutations in SCN5A (the gene encoding Nav1.5) in ARVD/C. METHODS AND RESULTS We performed whole-exome sequencing in six ARVD/C patients (33% male, 38.2 ± 12.1 years) without a desmosomal mutation. We found a rare missense variant (p.Arg1898His; R1898H) in SCN5A in one patient. We generated induced pluripotent stem cell-derived cardiomyocytes (hIPSC-CMs) from the patient's peripheral blood mononuclear cells. The variant was then corrected (R1898R) using Clustered Regularly Interspaced Short Palindromic Repeats/Cas9 technology, allowing us to study the impact of the R1898H substitution in the same cellular background. Whole-cell patch clamping revealed a 36% reduction in peak sodium current (P = 0.002); super-resolution fluorescence microscopy showed reduced abundance of NaV1.5 (P = 0.005) and N-Cadherin (P = 0.026) clusters at the intercalated disc. Subsequently, we sequenced SCN5A in an additional 281 ARVD/C patients (60% male, 34.8 ± 13.7 years, 52% desmosomal mutation-carriers). Five (1.8%) subjects harboured a putatively pathogenic SCN5A variant (p.Tyr416Cys, p.Leu729del, p.Arg1623Ter, p.Ser1787Asn, and p.Val2016Met). SCN5A variants were associated with prolonged QRS duration (119 ± 15 vs. 94 ± 14 ms, P < 0.01) and all SCN5A variant carriers had major structural abnormalities on cardiac imaging. CONCLUSIONS Almost 2% of ARVD/C patients harbour rare SCN5A variants. For one of these variants, we demonstrated reduced sodium current, Nav1.5 and N-Cadherin clusters at junctional sites. This suggests that Nav1.5 is in a functional complex with adhesion molecules, and reveals potential non-canonical mechanisms by which Nav1.5 dysfunction causes cardiomyopathy.
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Affiliation(s)
- Anneline S J M Te Riele
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, USA.,Division of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, the Netherlands.,Netherlands Heart Institute, Moreelsepark 1, Utrecht, the Netherlands
| | - Esperanza Agullo-Pascual
- Leon H. Charney Division of Cardiology, New York University School of Medicine, 550 First Avenue, New York, NY, USA
| | - Cynthia A James
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, USA
| | - Alejandra Leo-Macias
- Leon H. Charney Division of Cardiology, New York University School of Medicine, 550 First Avenue, New York, NY, USA
| | - Marina Cerrone
- Leon H. Charney Division of Cardiology, New York University School of Medicine, 550 First Avenue, New York, NY, USA
| | - Mingliang Zhang
- Leon H. Charney Division of Cardiology, New York University School of Medicine, 550 First Avenue, New York, NY, USA
| | - Xianming Lin
- Leon H. Charney Division of Cardiology, New York University School of Medicine, 550 First Avenue, New York, NY, USA
| | - Bin Lin
- Leon H. Charney Division of Cardiology, New York University School of Medicine, 550 First Avenue, New York, NY, USA
| | - Nara L Sobreira
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Baltimore, MD, USA
| | - Nuria Amat-Alarcon
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, USA
| | - Roos F Marsman
- Heart Centre, Department of Clinical and Experimental Cardiology, Academic Medical Center, Meibergdreef 9, Amsterdam, the Netherlands
| | - Brittney Murray
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, USA
| | - Crystal Tichnell
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, USA
| | - Jeroen F van der Heijden
- Division of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, the Netherlands
| | - Dennis Dooijes
- Department of Medical Genetics, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, the Netherlands
| | - Toon A B van Veen
- Department of Medical Physiology, Division of Heart and Lungs, University Medical Center Utrecht, Yalelaan 50, Utrecht, the Netherlands
| | - Harikrishna Tandri
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, USA
| | - Steven J Fowler
- Leon H. Charney Division of Cardiology, New York University School of Medicine, 550 First Avenue, New York, NY, USA
| | - Richard N W Hauer
- Division of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, the Netherlands.,Netherlands Heart Institute, Moreelsepark 1, Utrecht, the Netherlands
| | - Gordon Tomaselli
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, USA
| | - Maarten P van den Berg
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, the Netherlands
| | - Matthew R G Taylor
- Cardiovascular Institute and Adult Medical Genetics, University of Colorado Denver, 12605 E 16th Avenue, Aurora, CO, USA
| | - Francesca Brun
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Via Farneto 3, Trieste, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Via Farneto 3, Trieste, Italy
| | - Arthur A M Wilde
- Heart Centre, Department of Clinical and Experimental Cardiology, Academic Medical Center, Meibergdreef 9, Amsterdam, the Netherlands
| | - Luisa Mestroni
- Cardiovascular Institute and Adult Medical Genetics, University of Colorado Denver, 12605 E 16th Avenue, Aurora, CO, USA
| | - Connie R Bezzina
- Heart Centre, Department of Clinical and Experimental Cardiology, Academic Medical Center, Meibergdreef 9, Amsterdam, the Netherlands
| | - Hugh Calkins
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, USA
| | - J Peter van Tintelen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, the Netherlands.,Department of Clinical Genetics, Academic Medical Center Amsterdam, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.,Department of Genetics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, the Netherlands
| | - Lei Bu
- Leon H. Charney Division of Cardiology, New York University School of Medicine, 550 First Avenue, New York, NY, USA.,Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, USA
| | - Mario Delmar
- Leon H. Charney Division of Cardiology, New York University School of Medicine, 550 First Avenue, New York, NY, USA.,Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, USA
| | - Daniel P Judge
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD, USA;
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Ye WG, Yue B, Aoyama H, Kim NK, Cameron JA, Chen H, Bai D. Junctional delay, frequency, and direction-dependent uncoupling of human heterotypic Cx45/Cx43 gap junction channels. J Mol Cell Cardiol 2017; 111:17-26. [PMID: 28760564 DOI: 10.1016/j.yjmcc.2017.07.117] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/10/2017] [Accepted: 07/27/2017] [Indexed: 01/15/2023]
Abstract
Gap junction (GJ) channels form low resistance passages between cardiomyocytes and play a role in the rapid propagation of action potentials in the heart. A GJ channel is formed by two properly docked hemichannels and each hemichannel is a hexamer of connexins. Connexin40 (Cx40) and Cx43 are the dominant connexins in atrial myocytes, while Cx45 is mostly expressed in the sinoatrial (SA) and atrioventricular (AV) nodes which directly connect nodal cells with atrial myocytes, possibly via heterotypic Cx40/Cx45 and/or Cx43/Cx45 GJs. However, the functional status and channel properties of human heterotypic Cx40/Cx45 or Cx43/Cx45 GJs have not been studied. Here we investigated human Cx40/Cx45 and Cx43/Cx45 heterotypic GJs by recombinant expression in GJ deficient cells. Unlike the finding on rodent connexins, cell pairs expressing human Cx40 in one and Cx45 in the other failed to form morphological and functional GJs. Modifications in human Cx40 with designed variants (D55N or P193Q, but not P193K) are sufficient to establish morphological and functional heterotypic GJs with Cx45. In contrast, heterotypic human Cx43/Cx45 GJs are functional similar to that described for rodent Cx43/Cx45 GJs. Detailed kinetic characterizations of human heterotypic Cx43/Cx45 GJs revealed a rapid asymmetric Vj-gating and a much slower recovery, which could reduce the GJ conductance in a junctional delay, action potential frequency, and direction dependent manner. Dynamic uncoupling in Cx45-containing GJs might contribute to a slower action potential propagation in the AV node.
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Affiliation(s)
- Willy G Ye
- Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada
| | - Benny Yue
- Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada
| | - Hiroshi Aoyama
- Graduate School of Pharmaceutical Sciences, Osaka University, Osaka, Japan
| | - Nicholas K Kim
- Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada
| | - John A Cameron
- Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada
| | - Honghong Chen
- Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada
| | - Donglin Bai
- Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada.
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61
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Moncayo-Arlandi J, Brugada R. Unmasking the molecular link between arrhythmogenic cardiomyopathy and Brugada syndrome. Nat Rev Cardiol 2017; 14:744-756. [DOI: 10.1038/nrcardio.2017.103] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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62
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Abstract
Myocardial injury, mechanical stress, neurohormonal activation, inflammation, and/or aging all lead to cardiac remodeling, which is responsible for cardiac dysfunction and arrhythmogenesis. Of the key histological components of cardiac remodeling, fibrosis either in the form of interstitial, patchy, or dense scars, constitutes a key histological substrate of arrhythmias. Here we discuss current research findings focusing on the role of fibrosis, in arrhythmogenesis. Numerous studies have convincingly shown that patchy or interstitial fibrosis interferes with myocardial electrophysiology by slowing down action potential propagation, initiating reentry, promoting after-depolarizations, and increasing ectopic automaticity. Meanwhile, there has been increasing appreciation of direct involvement of myofibroblasts, the activated form of fibroblasts, in arrhythmogenesis. Myofibroblasts undergo phenotypic changes with expression of gap-junctions and ion channels thereby forming direct electrical coupling with cardiomyocytes, which potentially results in profound disturbances of electrophysiology. There is strong evidence that systemic and regional inflammatory processes contribute to fibrogenesis (i.e., structural remodeling) and dysfunction of ion channels and Ca2+ homeostasis (i.e., electrical remodeling). Recognizing the pivotal role of fibrosis in the arrhythmogenesis has promoted clinical research on characterizing fibrosis by means of cardiac imaging or fibrosis biomarkers for clinical stratification of patients at higher risk of lethal arrhythmia, as well as preclinical research on the development of antifibrotic therapies. At the end of this review, we discuss remaining key questions in this area and propose new research approaches. © 2017 American Physiological Society. Compr Physiol 7:1009-1049, 2017.
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Affiliation(s)
- My-Nhan Nguyen
- Baker Heart and Diabetes Institute, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Helen Kiriazis
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Xiao-Ming Gao
- Baker Heart and Diabetes Institute, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Xiao-Jun Du
- Baker Heart and Diabetes Institute, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
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63
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Wang S, Li L, Tao R, Gao Y. Ion channelopathies associated genetic variants as the culprit for sudden unexplained death. Forensic Sci Int 2017; 275:128-137. [PMID: 28363160 DOI: 10.1016/j.forsciint.2017.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 02/23/2017] [Accepted: 03/13/2017] [Indexed: 11/29/2022]
Abstract
Forensic identification of sudden unexplained death (SUD) has always been a ticklish issue because it used to be defined as sudden death without a conclusive diagnosis after autopsy. However, benefiting from the developments in genome research, a growing body of evidence points to the importance of ion channelopathies associated genetic variants in the pathogenesis of SUD. Genetic diagnosis of the deceased is also a new trend in epidemiological studies, for it enables the undertaking for preventive approach in individuals with high risks. In this review, we briefly discuss the molecular structure of ion channels and the role of genetic variants in regulating their functions as well as the diverse mechanisms underlying the ion channelopathies at gene level.
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Affiliation(s)
- Shouyu Wang
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou 215123, Jiangsu, China
| | - Lijuan Li
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou 215123, Jiangsu, China
| | - Ruiyang Tao
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou 215123, Jiangsu, China
| | - Yuzhen Gao
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou 215123, Jiangsu, China.
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64
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van Opbergen CJM, Delmar M, van Veen TAB. Potential new mechanisms of pro-arrhythmia in arrhythmogenic cardiomyopathy: focus on calcium sensitive pathways. Neth Heart J 2017; 25:157-169. [PMID: 28102477 PMCID: PMC5313453 DOI: 10.1007/s12471-017-0946-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Arrhythmogenic cardiomyopathy, or its most well-known subform arrhythmogenic right ventricular cardiomyopathy (ARVC), is a cardiac disease mainly characterised by a gradual replacement of the myocardial mass by fibrous and fatty tissue, leading to dilatation of the ventricular wall, arrhythmias and progression towards heart failure. ARVC is commonly regarded as a disease of the intercalated disk in which mutations in desmosomal proteins are an important causative factor. Interestingly, the Dutch founder mutation PLN R14Del has been identified to play an additional, and major, role in ARVC patients within the Netherlands. This is remarkable since the phospholamban (PLN) protein plays a leading role in regulation of the sarcoplasmic reticulum calcium load rather than in the establishment of intercellular integrity. In this review we outline the intracellular cardiac calcium dynamics and relate pathophysiological signalling, induced by disturbed calcium handling, with activation of calmodulin dependent kinase II (CaMKII) and calcineurin A (CnA). We postulate a thus far unrecognised role for Ca2+ sensitive signalling proteins in maladaptive remodelling of the macromolecular protein complex that forms the intercalated disk, during pro-arrhythmic remodelling of the heart.
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Affiliation(s)
- C J M van Opbergen
- Department of Medical Physiology, Division of Heart & Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Delmar
- The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, USA
| | - T A B van Veen
- Department of Medical Physiology, Division of Heart & Lungs, University Medical Center Utrecht, Utrecht, The Netherlands.
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65
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Saffitz JE. Molecular mechanisms in the pathogenesis of arrhythmogenic cardiomyopathy. Cardiovasc Pathol 2017; 28:51-58. [PMID: 28319834 DOI: 10.1016/j.carpath.2017.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/06/2017] [Accepted: 02/21/2017] [Indexed: 12/20/2022] Open
Abstract
The article is based on work presented in the Distinguished Achievement Award lecture at the Society for Cardiovascular Pathology meeting in Seattle, WA, in March 2016. It reviews our current understanding of mechanisms responsible for a highly arrhythmogenic, nonischemic cardiomyopathy. It highlights the armamentarium of powerful methods available to the experimental pathologist in efforts to define how complex cardiovascular diseases work. It concludes with acknowledgment of the need for a far more detailed approach as to how we categorize human disease, a task for which pathologists are especially well positioned.
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Affiliation(s)
- Jeffrey E Saffitz
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
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66
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Wu Q, Wu Y, Zhang L, Zheng J, Tang S, Cheng J. GJA1 gene variations in sudden unexplained nocturnal death syndrome in the Chinese Han population. Forensic Sci Int 2016; 270:178-182. [PMID: 27992820 DOI: 10.1016/j.forsciint.2016.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/09/2016] [Accepted: 12/03/2016] [Indexed: 10/20/2022]
Abstract
Sudden unexplained nocturnal death syndrome (SUNDS) is a conundrum to both forensic pathologists and physicians, more than 80% of which the molecular pathogenesis remains unclear. Reported studies on both clinical and genetic phenotypes suggest SUNDS is related to congenital and acquired arrhythmias. Recent researches have linked the mutations of gene gap junction alpha 1 (GJA1) with arrhythmogenic cardiac disorders. In the present study, we investigate the potential correlation between GJA1 gene variations and the occurrence of SUNDS. Genomic DNA was extracted from the blood samples of both 124 sporadic SUNDS patients and 125 healthy controls to screen GJA1 gene for candidate variants using polymerase chain reaction (PCR) and direct DNA sequencing. One novel homozygous variant c.169C>T and one heterozygous SNP c.624C>T (rs530633057) were determined in 124 SUNDS cases (one case for each detected variant) and none of the 125 healthy controls. Base C>T transition at nucleotide position 169 led to termination of protein production after glutamine (Q) at codon 57 which is very likely to result in decreased expression of Cx43 gap junction channels and cause arrhythmic sudden death. This is the first report of GJA1 gene variations in SUNDS in the Chinese Han population, which suggests a novel susceptibility gene for Chinese SUNDS.
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Affiliation(s)
- Qiuping Wu
- Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Yeda Wu
- Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Liyong Zhang
- Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Jinxiang Zheng
- Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Shuangbo Tang
- Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Jianding Cheng
- Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China.
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67
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Sukhacheva TV, Chudinovskikh YA, Eremeeva MV, Serov RA, Bockeria LA. Proliferative Potential of Cardiomyocytes in Hypertrophic Cardiomyopathy: Correlation with Myocardial Remodeling. Bull Exp Biol Med 2016; 162:160-169. [PMID: 27882462 DOI: 10.1007/s10517-016-3566-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Indexed: 01/07/2023]
Affiliation(s)
- T V Sukhacheva
- A. N. Bakulev Scientific Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, Moscow, Russia.
| | - Yu A Chudinovskikh
- A. N. Bakulev Scientific Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - M V Eremeeva
- A. N. Bakulev Scientific Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - R A Serov
- A. N. Bakulev Scientific Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - L A Bockeria
- A. N. Bakulev Scientific Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, Moscow, Russia
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68
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Xu Q, Patel D, Zhang X, Veenstra RD. Changes in cardiac Nav1.5 expression, function, and acetylation by pan-histone deacetylase inhibitors. Am J Physiol Heart Circ Physiol 2016; 311:H1139-H1149. [PMID: 27638876 DOI: 10.1152/ajpheart.00156.2016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 08/24/2016] [Indexed: 12/19/2022]
Abstract
Histone deacetylase (HDAC) inhibitors are small molecule anticancer therapeutics that exhibit limiting cardiotoxicities including QT interval prolongation and life-threatening cardiac arrhythmias. Because the molecular mechanisms for HDAC inhibitor-induced cardiotoxicity are poorly understood, we performed whole cell patch voltage-clamp experiments to measure cardiac sodium currents (INa) from wild-type neonatal mouse ventricular or human-induced pluripotent stem cell-derived cardiomyocytes treated with trichostatin A (TSA), vorinostat (VOR), or romidepsin (FK228). All three pan-HDAC inhibitors dose dependently decreased peak INa density and shifted the voltage activation curve 3- to 8-mV positive. Increases in late INa were not observed despite a moderate slowing of the inactivation rate at low activating potentials (<-40 mV). Scn5a mRNA levels were not significantly altered but NaV1.5 protein levels were significantly reduced. Immunoprecipitation with anti-NaV1.5 and Western blotting with anti-acetyl-lysine antibodies indicated that NaV1.5 acetylation is increased in vivo after HDAC inhibition. FK228 inhibited total cardiac HDAC activity with two apparent IC50s of 5 nM and 1.75 μM, consistent with previous findings with TSA and VOR. FK228 also decreased ventricular gap junction conductance (gj), again consistent with previous findings. We conclude that pan-HDAC inhibition reduces cardiac INa density and NaV1.5 protein levels without affecting late INa amplitude and, thus, probably does not contribute to the reported QT interval prolongation and arrhythmias associated with pan-HDAC inhibitor therapies. Conversely, reductions in gj may enhance the occurrence of triggered activity by limiting electrotonic inhibition and, combined with reduced INa, slow myocardial conduction and increase vulnerability to reentrant arrhythmias.
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Affiliation(s)
- Qin Xu
- Department of Pharmacology, State University of New York (SUNY) Upstate Medical University, Syracuse, New York; and
| | - Dakshesh Patel
- Department of Pharmacology, State University of New York (SUNY) Upstate Medical University, Syracuse, New York; and
| | - Xian Zhang
- Department of Pharmacology, State University of New York (SUNY) Upstate Medical University, Syracuse, New York; and
| | - Richard D Veenstra
- Department of Pharmacology, State University of New York (SUNY) Upstate Medical University, Syracuse, New York; and .,Department of Cell and Molecular Biology, SUNY Upstate Medical University, Syracuse, New York
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69
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Moncayo-Arlandi J, Guasch E, Sanz-de la Garza M, Casado M, Garcia NA, Mont L, Sitges M, Knöll R, Buyandelger B, Campuzano O, Diez-Juan A, Brugada R. Molecular disturbance underlies to arrhythmogenic cardiomyopathy induced by transgene content, age and exercise in a truncated PKP2 mouse model. Hum Mol Genet 2016; 25:3676-3688. [PMID: 27412010 DOI: 10.1093/hmg/ddw213] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 06/27/2016] [Accepted: 06/29/2016] [Indexed: 09/13/2023] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a disorder characterized by a progressive ventricular myocardial replacement by fat and fibrosis, which lead to ventricular arrhythmias and sudden cardiac death. Mutations in the desmosomal gene Plakophilin-2 (PKP2) accounts for >40% of all known mutations, generally causing a truncated protein. In a PKP2-truncated mouse model, we hypothesize that content of transgene, endurance training and aging will be determinant in disease progression. In addition, we investigated the molecular defects associated with the phenotype in this model. We developed a transgenic mouse model containing a truncated PKP2 (PKP2-Ser329) and generated three transgenic lines expressing increasing transgene content. The pathophysiological features of ACM in this model were assessed. While we did not observe fibro-fatty replacement, ultrastructural defects were exhibited. Moreover, we observed transgene content-dependent development of structural (ventricle dilatation and dysfunction) and electrophysiological anomalies in mice (PR interval and QRS prolongation and arrhythmia induction). In concordance with pathological defects, we detected a content reduction and remodeling of the structural proteins Desmocollin-2, Plakoglobin, native Plakophilin-2, Desmin and β-Catenin as well as the electrical coupling proteins Connexin 43 and cardiac sodium channel (Nav1.5). Surprisingly, we observed structural but not electrophysiological abnormalities only in trained and old mice. We demonstrated that truncated PKP2 provokes ACM in the absence of fibro-fatty replacement in the mouse. Transgene dose is essential to reveal the pathology, whereas aging and endurance training trigger limited phenotype. Molecular abnormalities underlay the structural and electrophysiological defects.
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Affiliation(s)
- Javier Moncayo-Arlandi
- Cardiovascular Genetic Centre, Institute of Biomedical Research of Girona (IDIBGI), Girona, Spain
- Department of Biochemistry and Molecular Biology, University of Valencia, Valencia, Spain
| | - Eduard Guasch
- Arrhythmia Unit, Cardiology Department, Hospital Clínic, Universitat de Barcelona and IDIBAPS
| | - Maria Sanz-de la Garza
- Imaging Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona and IDIBAPS, Barcelona, Catalonia, Spain
| | - Marta Casado
- Institute of Biomedicine of Valencia, IBV-CSIC, Valencia, Spain
| | - Nahuel Aquiles Garcia
- Mixed unit for Cardiovascular Repair, Instituto de Investigación Sanitaria La Fe-Centro de Investigación Príncipe Felipe, Valencia, Spain
| | - Lluis Mont
- Arrhythmia Unit, Cardiology Department, Hospital Clínic, Universitat de Barcelona and IDIBAPS
| | - Marta Sitges
- Imaging Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona and IDIBAPS, Barcelona, Catalonia, Spain
| | - Ralph Knöll
- Department of Medicine, Integrated Cardio Metabolic Centre (ICMC), Karolinska Institutet, Huddinge, Sweden
| | - Byambajav Buyandelger
- Department of Medicine, Integrated Cardio Metabolic Centre (ICMC), Karolinska Institutet, Huddinge, Sweden
| | - Oscar Campuzano
- Cardiovascular Genetic Centre, Institute of Biomedical Research of Girona (IDIBGI), Girona, Spain
- Medical Science Department, School of Medicine, University of Girona
| | | | - Ramon Brugada
- Cardiovascular Genetic Centre, Institute of Biomedical Research of Girona (IDIBGI), Girona, Spain,
- Medical Science Department, School of Medicine, University of Girona
- Cardiovascular Genetics Clinic, Hospital Josep Trueta, Girona, Spain
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70
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Akdis D, Brunckhorst C, Duru F, Saguner AM. Arrhythmogenic Cardiomyopathy: Electrical and Structural Phenotypes. Arrhythm Electrophysiol Rev 2016; 5:90-101. [PMID: 27617087 PMCID: PMC5013177 DOI: 10.15420/aer.2016.4.3] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 08/03/2016] [Indexed: 12/12/2022] Open
Abstract
This overview gives an update on the molecular mechanisms, clinical manifestations, diagnosis and therapy of arrhythmogenic cardiomyopathy (ACM). ACM is mostly hereditary and associated with mutations in genes encoding proteins of the intercalated disc. Three subtypes have been proposed: the classical right-dominant subtype generally referred to as ARVC/D, biventricular forms with early biventricular involvement and left-dominant subtypes with predominant LV involvement. Typical symptoms include palpitations, arrhythmic (pre)syncope and sudden cardiac arrest due to ventricular arrhythmias, which typically occur in athletes. At later stages, heart failure may occur. Diagnosis is established with the 2010 Task Force Criteria (TFC). Modern imaging tools are crucial for ACM diagnosis, including both echocardiography and cardiac magnetic resonance imaging for detecting functional and structural alternations. Of note, structural findings often become visible after electrical alterations, such as premature ventricular beats, ventricular fibrillation (VF) and ventricular tachycardia (VT). 12-lead ECG is important to assess for depolarisation and repolarisation abnormalities, including T-wave inversions as the most common ECG abnormality. Family history and the detection of causative mutations, mostly affecting the desmosome, have been incorporated in the TFC, and stress the importance of cascade family screening. Differential diagnoses include idiopathic right ventricular outflow tract (RVOT) VT, sarcoidosis, congenital heart disease, myocarditis, dilated cardiomyopathy, athlete's heart, Brugada syndrome and RV infarction. Therapeutic strategies include restriction from endurance and competitive sports, β-blockers, antiarrhythmic drugs, heart failure medication, implantable cardioverter-defibrillators and endocardial/epicardial catheter ablation.
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Affiliation(s)
- Deniz Akdis
- Department of Cardiology, University Heart Center, Zurich, Switzerland
| | | | - Firat Duru
- Department of Cardiology, University Heart Center, Zurich, Switzerland; Center for Integrative Human Physiology, University of Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center, Zurich, Switzerland
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71
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Progressive cardiac conduction disease associated with a DSP gene mutation. Int J Cardiol 2016; 216:188-9. [DOI: 10.1016/j.ijcard.2016.04.164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 04/29/2016] [Indexed: 11/19/2022]
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72
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Ortega A, Gil-Cayuela C, Tarazón E, García-Manzanares M, Montero JA, Cinca J, Portolés M, Rivera M, Roselló-Lletí E. New Cell Adhesion Molecules in Human Ischemic Cardiomyopathy. PCDHGA3 Implications in Decreased Stroke Volume and Ventricular Dysfunction. PLoS One 2016; 11:e0160168. [PMID: 27472518 PMCID: PMC4966940 DOI: 10.1371/journal.pone.0160168] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/14/2016] [Indexed: 11/25/2022] Open
Abstract
Background Intercalated disks are unique structures in cardiac tissue, in which adherens junctions, desmosomes, and GAP junctions co-localize, thereby facilitating cardiac muscle contraction and function. Protocadherins are involved in these junctions; however, their role in heart physiology is poorly understood. We aimed to analyze the transcriptomic profile of adhesion molecules in patients with ischemic cardiomyopathy (ICM) and relate the changes uncovered with the hemodynamic alterations and functional depression observed in these patients. Methods and Results Twenty-three left ventricular tissue samples from patients diagnosed with ICM (n = 13) undergoing heart transplantation and control donors (CNT, n = 10) were analyzed using RNA sequencing. Forty-two cell adhesion genes involved in cellular junctions were differentially expressed in ICM myocardium. Notably, the levels of protocadherin PCDHGA3 were related with the stroke volume (r = –0.826, P = 0.003), ejection fraction (r = –0.793, P = 0.004) and left ventricular end systolic and diastolic diameters (r = 0.867, P = 0.001; r = 0.781, P = 0.005, respectively). Conclusions Our results support the importance of intercalated disks molecular alterations, closely involved in the contractile function, highlighting its crucial significance and showing gene expression changes not previously described. Specifically, altered PCDHGA3 gene expression was strongly associated with reduced stroke volume and ventricular dysfunction in ICM, suggesting a relevant role in hemodynamic perturbations and cardiac performance for this unexplored protocadherin.
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Affiliation(s)
- Ana Ortega
- Cardiocirculatory Unit, The Health Research Institute La Fe, Valencia, Spain
| | | | - Estefanía Tarazón
- Cardiocirculatory Unit, The Health Research Institute La Fe, Valencia, Spain
| | | | - José Anastasio Montero
- Cardiovascular Surgery Service, University and Polytechnic La Fe Hospital, Valencia, Spain
| | - Juan Cinca
- Cardiology Service of Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | - Manuel Portolés
- Cardiocirculatory Unit, The Health Research Institute La Fe, Valencia, Spain
| | - Miguel Rivera
- Cardiocirculatory Unit, The Health Research Institute La Fe, Valencia, Spain
| | - Esther Roselló-Lletí
- Cardiocirculatory Unit, The Health Research Institute La Fe, Valencia, Spain
- * E-mail:
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73
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Asimaki A, Protonotarios A, James CA, Chelko SP, Tichnell C, Murray B, Tsatsopoulou A, Anastasakis A, te Riele A, Kléber AG, Judge DP, Calkins H, Saffitz JE. Characterizing the Molecular Pathology of Arrhythmogenic Cardiomyopathy in Patient Buccal Mucosa Cells. Circ Arrhythm Electrophysiol 2016; 9:e003688. [PMID: 26850880 DOI: 10.1161/circep.115.003688] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Analysis of myocardium has revealed mechanistic insights into arrhythmogenic cardiomyopathy but cardiac samples are difficult to obtain from probands and especially from family members. To identify a potential surrogate tissue, we characterized buccal mucosa cells. METHODS AND RESULTS Buccal cells from patients, mutation carriers, and controls were immunostained and analyzed in a blinded fashion. In additional studies, buccal cells were grown in vitro and incubated with SB216763. Immunoreactive signals for the desmosomal protein plakoglobin and the major cardiac gap junction protein Cx43 were markedly diminished in buccal mucosa cells from arrhythmogenic cardiomyopathy patients with known desmosomal mutations when compared with controls. Plakoglobin and Cx43 signals were also reduced in most family members who carried disease alleles but showed no evidence of heart disease. Signal for the desmosomal protein plakophilin-1 was reduced in buccal mucosa cells in patients with PKP2 mutations but not in those with mutations in other desmosomal genes. Signal for the desmosomal protein desmoplakin was reduced in buccal mucosa cells from patients with mutations in DSP, DSG2, or DSC2 but not in PKP2 or JUP. Abnormal protein distributions were reversed in cultured cells incubated with SB216763, a small molecule that rescues the disease phenotype in cardiac myocytes. CONCLUSIONS Buccal mucosa cells from arrhythmogenic cardiomyopathy patients exhibit changes in the distribution of cell junction proteins similar to those seen in the heart. These cells may prove useful in future studies of disease mechanisms and drug screens for effective therapies in arrhythmogenic cardiomyopathy.
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Affiliation(s)
- Angeliki Asimaki
- From the Department of Pathology, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA (A. Asimaki, A.G.K., J.E.S.); Nikos Protonotarios Medical Center, Naxos, Greece (A.P., A.T.); Department of Medicine/Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (C.A.J., S.P.C., C.T., B.M., A.t.R., D.P.J., H.C.); and First Department of Cardiology, University of Athens Medical School, Athens, Greece (A. Anastasakis)
| | - Alexandros Protonotarios
- From the Department of Pathology, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA (A. Asimaki, A.G.K., J.E.S.); Nikos Protonotarios Medical Center, Naxos, Greece (A.P., A.T.); Department of Medicine/Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (C.A.J., S.P.C., C.T., B.M., A.t.R., D.P.J., H.C.); and First Department of Cardiology, University of Athens Medical School, Athens, Greece (A. Anastasakis)
| | - Cynthia A James
- From the Department of Pathology, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA (A. Asimaki, A.G.K., J.E.S.); Nikos Protonotarios Medical Center, Naxos, Greece (A.P., A.T.); Department of Medicine/Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (C.A.J., S.P.C., C.T., B.M., A.t.R., D.P.J., H.C.); and First Department of Cardiology, University of Athens Medical School, Athens, Greece (A. Anastasakis)
| | - Stephen P Chelko
- From the Department of Pathology, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA (A. Asimaki, A.G.K., J.E.S.); Nikos Protonotarios Medical Center, Naxos, Greece (A.P., A.T.); Department of Medicine/Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (C.A.J., S.P.C., C.T., B.M., A.t.R., D.P.J., H.C.); and First Department of Cardiology, University of Athens Medical School, Athens, Greece (A. Anastasakis)
| | - Crystal Tichnell
- From the Department of Pathology, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA (A. Asimaki, A.G.K., J.E.S.); Nikos Protonotarios Medical Center, Naxos, Greece (A.P., A.T.); Department of Medicine/Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (C.A.J., S.P.C., C.T., B.M., A.t.R., D.P.J., H.C.); and First Department of Cardiology, University of Athens Medical School, Athens, Greece (A. Anastasakis)
| | - Brittney Murray
- From the Department of Pathology, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA (A. Asimaki, A.G.K., J.E.S.); Nikos Protonotarios Medical Center, Naxos, Greece (A.P., A.T.); Department of Medicine/Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (C.A.J., S.P.C., C.T., B.M., A.t.R., D.P.J., H.C.); and First Department of Cardiology, University of Athens Medical School, Athens, Greece (A. Anastasakis)
| | - Adalena Tsatsopoulou
- From the Department of Pathology, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA (A. Asimaki, A.G.K., J.E.S.); Nikos Protonotarios Medical Center, Naxos, Greece (A.P., A.T.); Department of Medicine/Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (C.A.J., S.P.C., C.T., B.M., A.t.R., D.P.J., H.C.); and First Department of Cardiology, University of Athens Medical School, Athens, Greece (A. Anastasakis)
| | - Aris Anastasakis
- From the Department of Pathology, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA (A. Asimaki, A.G.K., J.E.S.); Nikos Protonotarios Medical Center, Naxos, Greece (A.P., A.T.); Department of Medicine/Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (C.A.J., S.P.C., C.T., B.M., A.t.R., D.P.J., H.C.); and First Department of Cardiology, University of Athens Medical School, Athens, Greece (A. Anastasakis)
| | - Anneline te Riele
- From the Department of Pathology, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA (A. Asimaki, A.G.K., J.E.S.); Nikos Protonotarios Medical Center, Naxos, Greece (A.P., A.T.); Department of Medicine/Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (C.A.J., S.P.C., C.T., B.M., A.t.R., D.P.J., H.C.); and First Department of Cardiology, University of Athens Medical School, Athens, Greece (A. Anastasakis)
| | - André G Kléber
- From the Department of Pathology, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA (A. Asimaki, A.G.K., J.E.S.); Nikos Protonotarios Medical Center, Naxos, Greece (A.P., A.T.); Department of Medicine/Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (C.A.J., S.P.C., C.T., B.M., A.t.R., D.P.J., H.C.); and First Department of Cardiology, University of Athens Medical School, Athens, Greece (A. Anastasakis)
| | - Daniel P Judge
- From the Department of Pathology, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA (A. Asimaki, A.G.K., J.E.S.); Nikos Protonotarios Medical Center, Naxos, Greece (A.P., A.T.); Department of Medicine/Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (C.A.J., S.P.C., C.T., B.M., A.t.R., D.P.J., H.C.); and First Department of Cardiology, University of Athens Medical School, Athens, Greece (A. Anastasakis)
| | - Hugh Calkins
- From the Department of Pathology, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA (A. Asimaki, A.G.K., J.E.S.); Nikos Protonotarios Medical Center, Naxos, Greece (A.P., A.T.); Department of Medicine/Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (C.A.J., S.P.C., C.T., B.M., A.t.R., D.P.J., H.C.); and First Department of Cardiology, University of Athens Medical School, Athens, Greece (A. Anastasakis)
| | - Jeffrey E Saffitz
- From the Department of Pathology, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA (A. Asimaki, A.G.K., J.E.S.); Nikos Protonotarios Medical Center, Naxos, Greece (A.P., A.T.); Department of Medicine/Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (C.A.J., S.P.C., C.T., B.M., A.t.R., D.P.J., H.C.); and First Department of Cardiology, University of Athens Medical School, Athens, Greece (A. Anastasakis).
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Campuzano O, Fernández-Falgueras A, Iglesias A, Brugada R. Brugada Syndrome and PKP2: Evidences and uncertainties. Int J Cardiol 2016; 214:403-5. [PMID: 27085656 DOI: 10.1016/j.ijcard.2016.03.194] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 03/27/2016] [Indexed: 01/09/2023]
Abstract
Common electrocardiographic patterns in Brugada Syndrome and Arrhythmogenic Cardiomyopathy have been reported despite phenotypic alterations during its clinical course. Recently, potentially pathogenic variants in the PKP2 gene, the most prevalent gene associated with Arrhythmogenic Cardiomyopathy, have been associated with Brugada Syndrome. In addition, in vitro studies demonstrated the interaction between plakophilin-2 and sodium channel, the most prevalent gene associated with Brugada Syndrome. All these facts reinforce the suggested overlapping between both entities but little is known about the pathophysiological mechanisms. We have performed a comprehensive genetic revision of all PKP2 genetic variants currently associated with Brugada Syndrome. In all variants we identified a lack of solid evidences in order to establish a definite genotype-phenotype association. Hence, despite we believe that PKP2 analysis should be considered as a part of molecular genetic testing in Brugada Syndrome patients, comprehensive clinical and molecular studies should be performed before establish pathogenic association. Therefore, PKP2 variants in Brugada Syndrome cases should be interpreted carefully and additional studies including family segregation should be performed before translation into clinical practice.
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Affiliation(s)
- Oscar Campuzano
- Cardiovascular Genetics Center, IDIBGI - University of Girona, Spain; Medical Sciences Department, School of Medicine, University of Girona, Spain
| | | | - Anna Iglesias
- Cardiovascular Genetics Center, IDIBGI - University of Girona, Spain
| | - Ramon Brugada
- Cardiovascular Genetics Center, IDIBGI - University of Girona, Spain; Medical Sciences Department, School of Medicine, University of Girona, Spain; Familial Cardiomyopathies Unit, Hospital Josep Trueta, Girona, Spain.
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75
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Pilichou K, Thiene G, Bauce B, Rigato I, Lazzarini E, Migliore F, Perazzolo Marra M, Rizzo S, Zorzi A, Daliento L, Corrado D, Basso C. Arrhythmogenic cardiomyopathy. Orphanet J Rare Dis 2016; 11:33. [PMID: 27038780 PMCID: PMC4818879 DOI: 10.1186/s13023-016-0407-1] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 03/16/2016] [Indexed: 01/16/2023] Open
Abstract
Arrhythmogenic cardiomyopathy (AC) is a heart muscle disease clinically characterized by life-threatening ventricular arrhythmias and pathologically by an acquired and progressive dystrophy of the ventricular myocardium with fibro-fatty replacement. Due to an estimated prevalence of 1:2000-1:5000, AC is listed among rare diseases. A familial background consistent with an autosomal-dominant trait of inheritance is present in most of AC patients; recessive variants have also been reported, either or not associated with palmoplantar keratoderma and woolly hair. AC-causing genes mostly encode major components of the cardiac desmosome and up to 50 % of AC probands harbor mutations in one of them. Mutations in non-desmosomal genes have been also described in a minority of AC patients, predisposing to the same or an overlapping disease phenotype. Compound/digenic heterozygosity was identified in up to 25 % of AC-causing desmosomal gene mutation carriers, in part explaining the phenotypic variability. Abnormal trafficking of intercellular proteins to the intercalated discs of cardiomyocytes and Wnt/beta catenin and Hippo signaling pathways have been implicated in disease pathogenesis. AC is a major cause of sudden death in the young and in athletes. The clinical picture may include a sub-clinical phase; an overt electrical disorder; and right ventricular or biventricular pump failure. Ventricular fibrillation can occur at any stage. Genotype-phenotype correlation studies led to identify biventricular and dominant left ventricular variants, thus supporting the use of the broader term AC. Since there is no “gold standard” to reach the diagnosis of AC, multiple categories of diagnostic information have been combined and the criteria recently updated, to improve diagnostic sensitivity while maintaining specificity. Among diagnostic tools, contrast enhanced cardiac magnetic resonance is playing a major role in detecting left dominant forms of AC, even preceding morpho-functional abnormalities. The main differential diagnoses are idiopathic right ventricular outflow tract tachycardia, myocarditis, sarcoidosis, dilated cardiomyopathy, right ventricular infarction, congenital heart diseases with right ventricular overload and athlete heart. A positive genetic test in the affected AC proband allows early identification of asymptomatic carriers by cascade genetic screening of family members. Risk stratification remains a major clinical challenge and antiarrhythmic drugs, catheter ablation and implantable cardioverter defibrillator are the currently available therapeutic tools. Sport disqualification is life-saving, since effort is a major trigger not only of electrical instability but also of disease onset and progression. We review the current knowledge of this rare cardiomyopathy, suggesting a flowchart for primary care clinicians and geneticists.
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Affiliation(s)
- Kalliopi Pilichou
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Gaetano Thiene
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Barbara Bauce
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Ilaria Rigato
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Elisabetta Lazzarini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Federico Migliore
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | | | - Stefania Rizzo
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Luciano Daliento
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
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76
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Corrado D, Zorzi A, Cerrone M, Rigato I, Mongillo M, Bauce B, Delmar M. Relationship Between Arrhythmogenic Right Ventricular Cardiomyopathy and Brugada Syndrome: New Insights From Molecular Biology and Clinical Implications. Circ Arrhythm Electrophysiol 2016; 9:e003631. [PMID: 26987567 PMCID: PMC4800833 DOI: 10.1161/circep.115.003631] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/01/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Domenico Corrado
- From the Departments of Cardiac, Thoracic, and Vascular Sciences (D.C., A.Z., I.R., B.B.) and Biomedical Sciences (M.M.), University of Padua, Padova, Italy; and The Leon H. Charney Division of Cardiology, New York University School of Medicine (M.C., M.D.).
| | - Alessandro Zorzi
- From the Departments of Cardiac, Thoracic, and Vascular Sciences (D.C., A.Z., I.R., B.B.) and Biomedical Sciences (M.M.), University of Padua, Padova, Italy; and The Leon H. Charney Division of Cardiology, New York University School of Medicine (M.C., M.D.)
| | - Marina Cerrone
- From the Departments of Cardiac, Thoracic, and Vascular Sciences (D.C., A.Z., I.R., B.B.) and Biomedical Sciences (M.M.), University of Padua, Padova, Italy; and The Leon H. Charney Division of Cardiology, New York University School of Medicine (M.C., M.D.)
| | - Ilaria Rigato
- From the Departments of Cardiac, Thoracic, and Vascular Sciences (D.C., A.Z., I.R., B.B.) and Biomedical Sciences (M.M.), University of Padua, Padova, Italy; and The Leon H. Charney Division of Cardiology, New York University School of Medicine (M.C., M.D.)
| | - Marco Mongillo
- From the Departments of Cardiac, Thoracic, and Vascular Sciences (D.C., A.Z., I.R., B.B.) and Biomedical Sciences (M.M.), University of Padua, Padova, Italy; and The Leon H. Charney Division of Cardiology, New York University School of Medicine (M.C., M.D.)
| | - Barbara Bauce
- From the Departments of Cardiac, Thoracic, and Vascular Sciences (D.C., A.Z., I.R., B.B.) and Biomedical Sciences (M.M.), University of Padua, Padova, Italy; and The Leon H. Charney Division of Cardiology, New York University School of Medicine (M.C., M.D.)
| | - Mario Delmar
- From the Departments of Cardiac, Thoracic, and Vascular Sciences (D.C., A.Z., I.R., B.B.) and Biomedical Sciences (M.M.), University of Padua, Padova, Italy; and The Leon H. Charney Division of Cardiology, New York University School of Medicine (M.C., M.D.)
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MAST THOMASP, TESKE ARCOJ, TE RIELE ANNELINESJM, GROENEWEG JUDITHA, VAN DER HEIJDEN JEROENF, VELTHUIS BIRGITTAK, LOH PETER, DOEVENDANS PIETERA, VAN VEEN TOONA, DOOIJES DENNIS, DE BAKKER JACQUESM, HAUER RICHARDN, CRAMER MAARTENJ. Prolonged Electromechanical Interval Unmasks Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy in the Subclinical Stage. J Cardiovasc Electrophysiol 2016; 27:303-14. [DOI: 10.1111/jce.12882] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/07/2015] [Accepted: 11/10/2015] [Indexed: 01/26/2023]
Affiliation(s)
- THOMAS P. MAST
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - ARCO J. TESKE
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - ANNELINE SJM TE RIELE
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
- Division of Cardiology, Department of Medicine; Johns Hopkins University School of Medicine; Baltimore Maryland USA
| | - JUDITH A. GROENEWEG
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
| | | | - BIRGITTA K. VELTHUIS
- Department of Radiology; University Medical Centre Utrecht; Utrecht The Netherlands
| | - PETER LOH
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - PIETER A. DOEVENDANS
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - TOON A. VAN VEEN
- Department of Medical Physiology and Cardiology; University Medical Center Utrecht; The Netherlands
| | - DENNIS DOOIJES
- Department of Medical Genetics; University Medical Center Utrecht; Utrecht The Netherlands
| | - JACQUES M. DE BAKKER
- Department of Medical Physiology and Cardiology; University Medical Center Utrecht; The Netherlands
- Department of Experimental Cardiology; Heart Center; Academic Medical Center; Amsterdam The Netherlands
- ICIN-Netherlands Heart Institute; Utrecht The Netherlands
| | - RICHARD N. HAUER
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
- ICIN-Netherlands Heart Institute; Utrecht The Netherlands
| | - MAARTEN J. CRAMER
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
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Kant S, Krusche CA, Gaertner A, Milting H, Leube RE. Loss of plakoglobin immunoreactivity in intercalated discs in arrhythmogenic right ventricular cardiomyopathy: protein mislocalization versus epitope masking. Cardiovasc Res 2015; 109:260-71. [PMID: 26676851 DOI: 10.1093/cvr/cvv270] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 11/27/2015] [Indexed: 01/13/2023] Open
Abstract
AIMS To examine the relevance and cause of reduced plakoglobin IF in intercalated discs for arrhythmogenic right ventricular cardiomyopathy (ARVC) and ARVC-like disease in mouse and human. METHODS AND RESULTS Normalized semi-quantitative IF measurements were performed in a standardized format in desmoglein 2-mutant mice with an ARVC-like phenotype (n = 6) and in cardiac biopsies from humans with ARVC and non-ARVC heart disease (n = 10). Reduced plakoglobin staining was detectable in ARVC only with one antibody directed against a defined epitope but not with three other antibodies reacting with different epitopes of plakoglobin. CONCLUSIONS Reduced plakoglobin staining in intercalated discs of heart tissue from human ARVC patients and in a murine ARVC model is caused by alterations in epitope accessibility and not by protein relocalization.
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Affiliation(s)
- Sebastian Kant
- Institute of Molecular and Cellular Anatomy, RWTH Aachen University, Wendlingweg 2, Aachen 52074, Germany
| | - Claudia A Krusche
- Institute of Molecular and Cellular Anatomy, RWTH Aachen University, Wendlingweg 2, Aachen 52074, Germany
| | - Anna Gaertner
- Herz- und Diabeteszentrum NRW, Klinik für Thorax- und Kardiovaskularchirurgie, Erich und Hanna Klessmann-Institut für Kardiovaskuläre Forschung und Entwicklung, Bad Oeynhausen, Germany
| | - Hendrik Milting
- Herz- und Diabeteszentrum NRW, Klinik für Thorax- und Kardiovaskularchirurgie, Erich und Hanna Klessmann-Institut für Kardiovaskuläre Forschung und Entwicklung, Bad Oeynhausen, Germany
| | - Rudolf E Leube
- Institute of Molecular and Cellular Anatomy, RWTH Aachen University, Wendlingweg 2, Aachen 52074, Germany
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79
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Sommariva E, Brambilla S, Carbucicchio C, Gambini E, Meraviglia V, Dello Russo A, Farina FM, Casella M, Catto V, Pontone G, Chiesa M, Stadiotti I, Cogliati E, Paolin A, Ouali Alami N, Preziuso C, d'Amati G, Colombo GI, Rossini A, Capogrossi MC, Tondo C, Pompilio G. Cardiac mesenchymal stromal cells are a source of adipocytes in arrhythmogenic cardiomyopathy. Eur Heart J 2015; 37:1835-46. [PMID: 26590176 PMCID: PMC4912024 DOI: 10.1093/eurheartj/ehv579] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 10/07/2015] [Indexed: 01/21/2023] Open
Abstract
AIM Arrhythmogenic cardiomyopathy (ACM) is a genetic disorder mainly due to mutations in desmosomal genes, characterized by progressive fibro-adipose replacement of the myocardium, arrhythmias, and sudden death. It is still unclear which cell type is responsible for fibro-adipose substitution and which molecular mechanisms lead to this structural change. Cardiac mesenchymal stromal cells (C-MSC) are the most abundant cells in the heart, with propensity to differentiate into several cell types, including adipocytes, and their role in ACM is unknown. The aim of the present study was to investigate whether C-MSC contributed to excess adipocytes in patients with ACM. METHODS AND RESULTS We found that, in ACM patients' explanted heart sections, cells actively differentiating into adipocytes are of mesenchymal origin. Therefore, we isolated C-MSC from endomyocardial biopsies of ACM and from not affected by arrhythmogenic cardiomyopathy (NON-ACM) (control) patients. We found that both ACM and control C-MSC express desmosomal genes, with ACM C-MSC showing lower expression of plakophilin (PKP2) protein vs. CONTROLS Arrhythmogenic cardiomyopathy C-MSC cultured in adipogenic medium accumulated more lipid droplets than controls. Accordingly, the expression of adipogenic genes was higher in ACM vs. NON-ACM C-MSC, while expression of cell cycle and anti-adipogenic genes was lower. Both lipid accumulation and transcription reprogramming were dependent on PKP2 deficiency. CONCLUSIONS Cardiac mesenchymal stromal cells contribute to the adipogenic substitution observed in ACM patients' hearts. Moreover, C-MSC from ACM patients recapitulate the features of ACM adipogenesis, representing a novel, scalable, patient-specific in vitro tool for future mechanistic studies.
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Affiliation(s)
- E Sommariva
- Vascular Biology and Regenerative Medicine Unit, Centro Cardiologico Monzino IRCCS, via Parea 4, Milan 20138, Italy
| | - S Brambilla
- Vascular Biology and Regenerative Medicine Unit, Centro Cardiologico Monzino IRCCS, via Parea 4, Milan 20138, Italy
| | - C Carbucicchio
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - E Gambini
- Vascular Biology and Regenerative Medicine Unit, Centro Cardiologico Monzino IRCCS, via Parea 4, Milan 20138, Italy
| | - V Meraviglia
- Center for Biomedicine, European Academy Bozen/Bolzano (EURAC), Bolzano, Italy - Affiliated Institute of the University of Lübeck, Lübeck, Germany
| | - A Dello Russo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - F M Farina
- Vascular Biology and Regenerative Medicine Unit, Centro Cardiologico Monzino IRCCS, via Parea 4, Milan 20138, Italy
| | - M Casella
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - V Catto
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - G Pontone
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - M Chiesa
- Immunology and Functional Genomics Unit, Centro Cardiologico Monzino IRCCS, Milan, Italy Electrical Computer and Biomedical Engineering, Università degli Studi di Pavia, Pavia, Italy
| | - I Stadiotti
- Vascular Biology and Regenerative Medicine Unit, Centro Cardiologico Monzino IRCCS, via Parea 4, Milan 20138, Italy
| | - E Cogliati
- Tissue Bank of Veneto Region, Ca' Foncello Hospital, Treviso, Italy
| | - A Paolin
- Tissue Bank of Veneto Region, Ca' Foncello Hospital, Treviso, Italy
| | - N Ouali Alami
- Vascular Biology and Regenerative Medicine Unit, Centro Cardiologico Monzino IRCCS, via Parea 4, Milan 20138, Italy
| | - C Preziuso
- Department of Radiological, Oncological and Pathologic Sciences, La Sapienza University, Rome, Italy
| | - G d'Amati
- Department of Radiological, Oncological and Pathologic Sciences, La Sapienza University, Rome, Italy
| | - G I Colombo
- Immunology and Functional Genomics Unit, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - A Rossini
- Center for Biomedicine, European Academy Bozen/Bolzano (EURAC), Bolzano, Italy - Affiliated Institute of the University of Lübeck, Lübeck, Germany
| | - M C Capogrossi
- Laboratory of Vascular Pathology, Istituto Dermopatico dell'Immacolata IRCCS, Rome, Italy
| | - C Tondo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - G Pompilio
- Vascular Biology and Regenerative Medicine Unit, Centro Cardiologico Monzino IRCCS, via Parea 4, Milan 20138, Italy Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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80
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Saffitz JE. Protein trafficking in cardiovascular disease: How the science has evolved and where it must go. Trends Cardiovasc Med 2015; 25:390-1. [DOI: 10.1016/j.tcm.2015.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 01/06/2015] [Indexed: 02/06/2023]
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81
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Abstract
Cardiomyocytes are connected by mechanical and electrical junctions located at the intercalated discs (IDs). Although these structures have long been known, it is becoming increasingly clear that their components interact. This review describes the involvement of the ID in electrical disturbances of the heart and focuses on the role of the gap junctional protein connexin 43 (Cx43). Current evidence shows that Cx43 plays a crucial role in organizing microtubules at the intercalated disc and thereby regulating the trafficking of the cardiac sodium channel NaV1.5 to the membrane.
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82
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Kessler EL, van Veen TAB. A fishing trip to cure arrhythmogenic cardiomyopathy? ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:90. [PMID: 26015932 DOI: 10.3978/j.issn.2305-5839.2015.01.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 01/16/2015] [Indexed: 11/14/2022]
Abstract
The paper entitled "Identification of a New Modulator of the Intercalated Disc in a Zebrafish Model of Arrhythmogenic Cardiomyopathy", as published in 2014 in Science Translational Medicine, examined the effects of the newly discovered drug SB216763 (SB21) on arrhythmogenic cardiomyopathy (ACM). In this paper, the authors focused on mechanisms underlying ACM and the accompanying molecular and cellular alterations. Most importantly they showed that SB21 was able to rescue and partly reverse the ACM phenotype in three different experimental models: (I) a zebrafish model of Naxos disease induced by the overexpression of the 2057del2 mutation in plakoglobin (PKG); (II) neonatal rat cardiomyocytes overexpressing the same mutation in PKG; (III) cardiomyocytes derived from induced pluripotent stem cells expressing two different forms of mutations in plakophilin-2. This editorial will focus on the potency and possible restrictions concerning SB21 treatment as a potential intervention for ACM and the usefulness of the applied zebrafish models in general.
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Affiliation(s)
- Elise L Kessler
- Department of Medical Physiology, Division of Heart & Lungs, University Medical Center Utrecht Utrecht, The Netherlands
| | - Toon A B van Veen
- Department of Medical Physiology, Division of Heart & Lungs, University Medical Center Utrecht Utrecht, The Netherlands
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83
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Wen JY, Wei CY, Shah K, Wong J, Wang C, Chen HSV. Maturation-Based Model of Arrhythmogenic Right Ventricular Dysplasia Using Patient-Specific Induced Pluripotent Stem Cells. Circ J 2015; 79:1402-8. [PMID: 25971409 DOI: 10.1253/circj.cj-15-0363] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Cellular reprogramming of somatic cells to patient-specific induced pluripotent stem cells (iPSCs) enables in-vitro modeling of human cardiac disorders for pathogenic and therapeutic investigations. However, using iPSC-derived cardiomyocytes (iPSC-CMs) to model an adult-onset heart disease remains challenging because of the uncertainty regarding the ability of relatively immature iPSC-CMs to fully recapitulate adult disease phenotypes. Arrhythmogenic right ventricular dysplasia (ARVD) is an inherited cardiomyopathy characterized by pathological fibrofatty infiltration and cardiomyocyte (CM) loss predominantly in the right ventricle (RV), leading to heart failure and lethal arrhythmias. Over 50% of affected individuals have desmosome gene mutations, most commonly inPKP2encoding plakophilin-2. Using Yamanaka's pluripotent factors, we generated iPSC lines from ARVD patients withPKP2mutations. We first developed a method to induce metabolic maturation of iPSC-CMs and showed that induction of adult-like metabolic energetics from an embryonic/glycolytic state is essential to model an adult-onset cardiac disease using patient-specific iPSCs. Furthermore, we showed that coactivation of normal peroxisome proliferator-activated receptor (PPAR)-α and abnormal PPARγ pathways in ARVD iPSC-CMs resulted in exaggerated CM lipogenesis, CM apoptosis, Na(+)channel downregulation and defective intracellular calcium handling, recapitulating the pathological signatures of ARVD. Using this model, we revealed novel pathogenic insights that metabolic derangement in an adult-like metabolic milieu underlies ARVD pathologies, enabling us to propose novel disease-modifying therapeutic strategies.
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Affiliation(s)
- Jian-Yan Wen
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital
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84
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Abstract
Arrhythmogenic cardiomyopathy (ACM) is a primary myocardial disease. It is characterized by frequent ventricular arrhythmias and increased risk of sudden cardiac death typically arising as an early manifestation before the onset of significant myocardial remodelling. Myocardial degeneration, often confined to the right ventricular free wall, with replacement by fibrofatty scar tissue, develops in many patients. ACM is a familial disease but genetic penetrance can be low and disease expression is highly variable. Inflammation might promote disease progression. It also appears that exercise increases disease penetrance and accelerates its development. More than 60% of probands harbour mutations in genes that encode desmosomal proteins, which has raised the possibility that defective cell-cell adhesion might play a role in disease pathogenesis. Recent advances have implicated changes in the canonical wingless-type mouse mammary tumour virus integration site (Wnt)/β-catenin and Hippo signalling pathways and defects in forwarding trafficking of ion channels and other proteins to the intercalated disk in cardiac myocytes. In this review we summarize the current understanding of the pathogenesis of ACM and highlight future research directions.
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Affiliation(s)
- Angeliki Asimaki
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Andre G Kleber
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey E Saffitz
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.
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85
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Exercise Triggers ARVC Phenotype in Mice Expressing a Disease-Causing Mutated Version of Human Plakophilin-2. J Am Coll Cardiol 2015; 65:1438-50. [DOI: 10.1016/j.jacc.2015.01.045] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 01/27/2015] [Accepted: 01/29/2015] [Indexed: 11/23/2022]
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86
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Asimaki A, Kapoor S, Plovie E, Karin Arndt A, Adams E, Liu Z, James CA, Judge DP, Calkins H, Churko J, Wu JC, MacRae CA, Kléber AG, Saffitz JE. Identification of a new modulator of the intercalated disc in a zebrafish model of arrhythmogenic cardiomyopathy. Sci Transl Med 2015; 6:240ra74. [PMID: 24920660 DOI: 10.1126/scitranslmed.3008008] [Citation(s) in RCA: 196] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Arrhythmogenic cardiomyopathy (ACM) is characterized by frequent cardiac arrhythmias. To elucidate the underlying mechanisms and discover potential chemical modifiers, we created a zebrafish model of ACM with cardiac myocyte-specific expression of the human 2057del2 mutation in the gene encoding plakoglobin. A high-throughput screen identified SB216763 as a suppressor of the disease phenotype. Early SB216763 therapy prevented heart failure and reduced mortality in the fish model. Zebrafish ventricular myocytes that expressed 2057del2 plakoglobin exhibited 70 to 80% reductions in I(Na) and I(K1) current densities, which were normalized by SB216763. Neonatal rat ventricular myocytes that expressed 2057del2 plakoglobin recapitulated pathobiological features seen in patients with ACM, all of which were reversed or prevented by SB216763. The reverse remodeling observed with SB216763 involved marked subcellular redistribution of plakoglobin, connexin 43, and Nav1.5, but without changes in their total cellular content, implicating a defect in protein trafficking to intercalated discs. In further support of this mechanism, we observed SB216763-reversible, abnormal subcellular distribution of SAP97 (a protein known to mediate forward trafficking of Nav1.5 and Kir2.1) in rat cardiac myocytes expressing 2057del2 plakoglobin and in cardiac myocytes derived from induced pluripotent stem cells from two ACM probands with plakophilin-2 mutations. These observations pinpoint aberrant trafficking of intercalated disc proteins as a central mechanism in ACM myocyte injury and electrical abnormalities.
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Affiliation(s)
- Angeliki Asimaki
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
| | - Sudhir Kapoor
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
| | - Eva Plovie
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Harvard Stem Cell Institute, and Broad Institute of Harvard and MIT, Boston, MA 02115, USA
| | - Anne Karin Arndt
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Harvard Stem Cell Institute, and Broad Institute of Harvard and MIT, Boston, MA 02115, USA
| | - Edward Adams
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Harvard Stem Cell Institute, and Broad Institute of Harvard and MIT, Boston, MA 02115, USA
| | - ZhenZhen Liu
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Harvard Stem Cell Institute, and Broad Institute of Harvard and MIT, Boston, MA 02115, USA
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Daniel P Judge
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Jared Churko
- Stanford Cardiovascular Institute, Departments of Medicine and Radiology, Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Joseph C Wu
- Stanford Cardiovascular Institute, Departments of Medicine and Radiology, Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Calum A MacRae
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Harvard Stem Cell Institute, and Broad Institute of Harvard and MIT, Boston, MA 02115, USA
| | - André G Kléber
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
| | - Jeffrey E Saffitz
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
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87
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Kessler EL, Boulaksil M, van Rijen HVM, Vos MA, van Veen TAB. Passive ventricular remodeling in cardiac disease: focus on heterogeneity. Front Physiol 2014; 5:482. [PMID: 25566084 PMCID: PMC4273631 DOI: 10.3389/fphys.2014.00482] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 11/24/2014] [Indexed: 12/20/2022] Open
Abstract
Passive ventricular remodeling is defined by the process of molecular ventricular adaptation to different forms of cardiac pathophysiology. It includes changes in tissue architecture, such as hypertrophy, fiber disarray, alterations in cell size and fibrosis. Besides that, it also includes molecular remodeling of gap junctions, especially those composed by Connexin43 proteins (Cx43) in the ventricles that affect cell-to-cell propagation of the electrical impulse, and changes in the sodium channels that modify excitability. All those alterations appear mainly in a heterogeneous manner, creating irregular and inhomogeneous electrical and mechanical coupling throughout the heart. This can predispose to reentry arrhythmias and adds to a further deterioration into heart failure. In this review, passive ventricular remodeling is described in Hypertrophic Cardiomyopathy (HCM), Dilated Cardiomyopathy (DCM), Ischemic Cardiomyopathy (ICM), and Arrhythmogenic Cardiomyopathy (ACM), with a main focus on the heterogeneity of those alterations mentioned above.
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Affiliation(s)
- Elise L Kessler
- Division of Heart and Lungs, Department of Medical Physiology, University Medical Center Utrecht Utrecht, Netherlands
| | - Mohamed Boulaksil
- Division of Heart and Lungs, Department of Medical Physiology, University Medical Center Utrecht Utrecht, Netherlands ; Department of Cardiology, Radboud University Medical Center Nijmegen, Netherlands
| | - Harold V M van Rijen
- Division of Heart and Lungs, Department of Medical Physiology, University Medical Center Utrecht Utrecht, Netherlands
| | - Marc A Vos
- Division of Heart and Lungs, Department of Medical Physiology, University Medical Center Utrecht Utrecht, Netherlands
| | - Toon A B van Veen
- Division of Heart and Lungs, Department of Medical Physiology, University Medical Center Utrecht Utrecht, Netherlands
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88
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Franke WW, Rickelt S, Zimbelmann R, Dörflinger Y, Kuhn C, Frey N, Heid H, Rosin-Arbesfeld R. Striatins as plaque molecules of zonulae adhaerentes in simple epithelia, of tessellate junctions in stratified epithelia, of cardiac composite junctions and of various size classes of lateral adherens junctions in cultures of epithelia- and carcinoma-derived cells. Cell Tissue Res 2014; 359:779-97. [PMID: 25501894 PMCID: PMC4341017 DOI: 10.1007/s00441-014-2053-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 11/05/2014] [Indexed: 11/29/2022]
Abstract
Proteins of the striatin family (striatins 1–4; sizes ranging from 90 to 110 kDa on SDS-polyacrylamide gel electrophoresis) are highly homologous in their amino acid sequences but can differ in their cell-type-specific gene expression patterns and biological functions. In various cell types, we have found one, two or three polypeptides of this evolutionarily old and nearly ubiquitous family of proteins known to serve as scaffold proteins for diverse protein complexes. Light and electron microscopic immunolocalization methods have revealed striatins in mammalian cell-cell adherens junctions (AJs). In simple epithelia, we have localized striatins as constitutive components of the plaques of the subapical zonulae adhaerentes of cells, including intestinal, glandular, ductal and urothelial cells and hepatocytes. Striatins colocalize with E-cadherin or E–N-cadherin heterodimers and with the plaque proteins α- and β-catenin, p120 and p0071. In some epithelia and carcinomas and in cultured cells derived therefrom, striatins are also seen in lateral AJs. In stratified epithelia and in corresponding squamous cell carcinomas, striatins can be found in plaques of some forms of tessellate junctions. Moreover, striatins are major plaque proteins of composite junctions (CJs; areae compositae) in the intercalated disks connecting cardiomyocytes, colocalizing with other CJ molecules, including plectin and ankyrin-G. We discuss the “multimodulator” scaffold roles of striatins in the initiation and regulation of the formation of various complex particles and structures. We propose that striatins are included in the diagnostic candidate list of proteins that, in the CJs of human hearts, can occur in mutated forms in the pathogeneses of hereditary cardiomyopathies, as seen in some types of genetically determined heart damage in boxer dogs.
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Affiliation(s)
- Werner W Franke
- Helmholtz Group for Cell Biology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany,
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89
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Abstract
Arrhythmogenic cardiomyopathy (ACM) is a primary myocardial disorder characterized by the early appearance of ventricular arrhythmias often out of proportion to the degree of ventricular remodeling and dysfunction. ACM typically presents in adolescence or early adulthood. It accounts for 10% of sudden cardiac deaths in individuals under the age of 18 years. Although there has been significant progress in recognizing the genetic determinants of ACM, how specific gene mutations cause the disease remains poorly understood. Here, we review insights gained from studying the human disease as well as in vivo and in vitro experimental models. These observations have advanced our understanding of the molecular mechanisms underlying the pathogenesis of ACM and may lead to development of new mechanism-based therapies.
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90
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Rampazzo A, Calore M, van Hengel J, van Roy F. Intercalated Discs and Arrhythmogenic Cardiomyopathy. ACTA ACUST UNITED AC 2014; 7:930-40. [DOI: 10.1161/circgenetics.114.000645] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Alessandra Rampazzo
- From the Department of Biology, University of Padua, Padua, Italy (A.R., M.C.); Molecular Cell Biology Unit, Inflammation Research Center (IRC), VIB-Ghent University, Ghent, Belgium (J.v.H., F.v.R.); and Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium (J.v.H., F.v.R.)
| | - Martina Calore
- From the Department of Biology, University of Padua, Padua, Italy (A.R., M.C.); Molecular Cell Biology Unit, Inflammation Research Center (IRC), VIB-Ghent University, Ghent, Belgium (J.v.H., F.v.R.); and Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium (J.v.H., F.v.R.)
| | - Jolanda van Hengel
- From the Department of Biology, University of Padua, Padua, Italy (A.R., M.C.); Molecular Cell Biology Unit, Inflammation Research Center (IRC), VIB-Ghent University, Ghent, Belgium (J.v.H., F.v.R.); and Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium (J.v.H., F.v.R.)
| | - Frans van Roy
- From the Department of Biology, University of Padua, Padua, Italy (A.R., M.C.); Molecular Cell Biology Unit, Inflammation Research Center (IRC), VIB-Ghent University, Ghent, Belgium (J.v.H., F.v.R.); and Department of Biomedical Molecular Biology, Ghent University, Ghent, Belgium (J.v.H., F.v.R.)
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91
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Abstract
Sodium current in the heart flows principally through the pore protein NaV1.5, which is part of a complex of interacting proteins that serve both to target and localize the complex in the membrane, and to modulate function by such post-translational modifications as phosphorylation and nitrosylation. Multiple mutations in seven different NaV1.5 interacting proteins have been associated with dysfunctional sodium current and inherited cardiac diseases, including long QT syndrome, Brugada syndrome, atrial fibrillation, and cardiomyopathy, as well as sudden infant death syndrome (SIDS). Mutations in as yet unidentified interacting proteins may account for cardiac disease for which a genetic basis has not yet been established. Characterizing the mechanisms by which these mutations cause disease may give insight into etiologies and treatments of more common acquired cardiac disease, such as ischemia and heart failure.
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Affiliation(s)
- John W Kyle
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin, Madison, Wisconsin, USA 53792
| | - Jonathan C Makielski
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin, Madison, Wisconsin, USA 53792
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92
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Shy D, Gillet L, Abriel H. Targeting the Sodium Channel Na
V
1.5 to Specific Membrane Compartments of Cardiac Cells. Circ Res 2014; 115:901-3. [DOI: 10.1161/circresaha.114.305305] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Diana Shy
- From the Department of Clinical Research, Ion Channel Research Group, University of Bern, Bern, Switzerland
| | - Ludovic Gillet
- From the Department of Clinical Research, Ion Channel Research Group, University of Bern, Bern, Switzerland
| | - Hugues Abriel
- From the Department of Clinical Research, Ion Channel Research Group, University of Bern, Bern, Switzerland
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93
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Asimaki A, Saffitz JE. Remodeling of cell-cell junctions in arrhythmogenic cardiomyopathy. ACTA ACUST UNITED AC 2014; 21:13-23. [PMID: 24460198 DOI: 10.3109/15419061.2013.876016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Arrhythmogenic cardiomyopathy (AC) is a primary myocardial disorder characterized by a high incidence of ventricular arrhythmias often preceding the onset of ventricular remodeling and dysfunction. Approximately 50% of patients diagnosed with AC have one or more mutations in genes encoding desmosomal proteins, although non-desmosomal genes have also been associated with the disease. Increasing evidence implicates remodeling of intercalated disk proteins reflecting abnormal responses to mechanical load and aberrant cell signaling pathways in the pathogenesis of AC. This review summarizes recent advances in understanding disease mechanisms in AC that have come from studies of human myocardium and experimental models.
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Affiliation(s)
- Angeliki Asimaki
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School , Boston, MA , USA
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94
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Abstract
Cardiomyopathies (ie, diseases of the heart muscle) are major causes of morbidity and mortality. A significant percentage of patients with cardiomyopathies have genetic-based, inheritable disease and, over the past 2 decades the genetic causes of these disorders have been increasingly discovered. The genes causing these disorders when they are mutated appear to encode proteins that frame a "final common pathway" for that specific disorder, but the specifics of the phenotype, including age of onset, severity, and outcome is variable for reasons not yet understood. The "final common pathways" for the classified forms of cardiomyopathy include the sarcomere in the primarily diastolic dysfunction disorders hypertrophic cardiomyopathy and restrictive cardiomyopathy, the linkage of the sarcomere and sarcolemma in the systolic dysfunction disorder dilated cardiomyopathy, and the desmosome in arrhythmogenic cardiomyopathy. Left ventricular noncompaction cardiomyopathy (LVNC) is an overlap disorder and it appears that any of these "final common pathways" can be involved depending on the specific form of LVNC. The genetics and mechanisms responsible for these clinical phenotypes will be described.
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Affiliation(s)
- Jeffrey A Towbin
- The Heart Institute, Cincinnati Children's Hospital Medical Center
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95
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Affiliation(s)
- Elise Balse
- Sorbonne Universités, UPMC, UMR_S 1166-ICAN, INSERM UMR_S 1166-ICAN, Institute of Cardiometabolism and Nutrition, ICAN, Pitié-Salpêtrière Hospital, Paris F-75013, France
| | - Stéphane N Hatem
- Sorbonne Universités, UPMC, UMR_S 1166-ICAN, INSERM UMR_S 1166-ICAN, Institute of Cardiometabolism and Nutrition, ICAN, Pitié-Salpêtrière Hospital, Paris F-75013, France Assistance Publique Hôpitaux de Paris, Heart and Metabolism Department, Pitié-Salpêtrière Hospital, Paris F-75013, France
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96
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Rasmussen TB, Nissen PH, Palmfeldt J, Gehmlich K, Dalager S, Jensen UB, Kim WY, Heickendorff L, Mølgaard H, Jensen HK, Baandrup UT, Bross P, Mogensen J. Truncating Plakophilin-2 Mutations in Arrhythmogenic Cardiomyopathy Are Associated With Protein Haploinsufficiency in Both Myocardium and Epidermis. ACTA ACUST UNITED AC 2014; 7:230-40. [DOI: 10.1161/circgenetics.113.000338] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Arrhythmogenic cardiomyopathy (AC) is a hereditary cardiac condition associated with ventricular arrhythmias, heart failure, and sudden death. The disease is most often caused by mutations in the desmosomal gene for plakophilin-2 (
PKP2
), which is expressed in both myocardial and epidermal tissue. This study aimed to investigate protein expression in myocardial tissue of patients with AC carrying
PKP2
mutations and elucidate whether keratinocytes of the same individuals exhibited a similar pattern of protein expression.
Methods and Results—
Direct sequencing of 5 AC genes in 71 unrelated patients with AC identified 10 different
PKP2
mutations in 12 index patients. One patient, heterozygous for a
PKP2
nonsense mutation, developed severe heart failure and underwent cardiac transplantation. Western blotting and immunohistochemistry of the explanted heart showed a significant decrease in PKP2 protein expression without detectable amounts of truncated PKP2 protein. Cultured keratinocytes of the patient showed a similar reduction in PKP2 protein expression. Nine additional
PKP2
mutations were investigated in both cultured keratinocytes and endomyocardial biopsies from affected individuals. It was evident that
PKP2
mutations introducing a premature termination codon in the reading frame were associated with PKP2 transcript and protein levels reduced to ≈50%, whereas a missense variant did not seem to affect the amount of PKP2 protein.
Conclusions—
The results of this study showed that truncating
PKP2
mutations in AC are associated with low expression of the mutant allele and that the myocardial protein expression of PKP2 is mirrored in keratinocytes. These findings indicate that
PKP2
haploinsufficiency contributes to pathogenesis in AC.
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Affiliation(s)
- Torsten B. Rasmussen
- From the Department of Cardiology (T.B.R., W.Y.K., H.M., H.K.J., J.M.), Research Unit for Molecular Medicine (T.B.R., J.P., P.B.), Department of Clinical Biochemistry (P.H.N., L.H.), Institute of Pathology (S.D.), Department of Clinical Genetics (U.B.J.), and MR Centre (W.Y.K.), Aarhus University Hospital, Aarhus, Denmark; Clinical Research Center, Vendsyssel Hospital, Aalborg University, Hjørring, Denmark (U.T.B.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of
| | - Peter H. Nissen
- From the Department of Cardiology (T.B.R., W.Y.K., H.M., H.K.J., J.M.), Research Unit for Molecular Medicine (T.B.R., J.P., P.B.), Department of Clinical Biochemistry (P.H.N., L.H.), Institute of Pathology (S.D.), Department of Clinical Genetics (U.B.J.), and MR Centre (W.Y.K.), Aarhus University Hospital, Aarhus, Denmark; Clinical Research Center, Vendsyssel Hospital, Aalborg University, Hjørring, Denmark (U.T.B.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of
| | - Johan Palmfeldt
- From the Department of Cardiology (T.B.R., W.Y.K., H.M., H.K.J., J.M.), Research Unit for Molecular Medicine (T.B.R., J.P., P.B.), Department of Clinical Biochemistry (P.H.N., L.H.), Institute of Pathology (S.D.), Department of Clinical Genetics (U.B.J.), and MR Centre (W.Y.K.), Aarhus University Hospital, Aarhus, Denmark; Clinical Research Center, Vendsyssel Hospital, Aalborg University, Hjørring, Denmark (U.T.B.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of
| | - Katja Gehmlich
- From the Department of Cardiology (T.B.R., W.Y.K., H.M., H.K.J., J.M.), Research Unit for Molecular Medicine (T.B.R., J.P., P.B.), Department of Clinical Biochemistry (P.H.N., L.H.), Institute of Pathology (S.D.), Department of Clinical Genetics (U.B.J.), and MR Centre (W.Y.K.), Aarhus University Hospital, Aarhus, Denmark; Clinical Research Center, Vendsyssel Hospital, Aalborg University, Hjørring, Denmark (U.T.B.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of
| | - Søren Dalager
- From the Department of Cardiology (T.B.R., W.Y.K., H.M., H.K.J., J.M.), Research Unit for Molecular Medicine (T.B.R., J.P., P.B.), Department of Clinical Biochemistry (P.H.N., L.H.), Institute of Pathology (S.D.), Department of Clinical Genetics (U.B.J.), and MR Centre (W.Y.K.), Aarhus University Hospital, Aarhus, Denmark; Clinical Research Center, Vendsyssel Hospital, Aalborg University, Hjørring, Denmark (U.T.B.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of
| | - Uffe B. Jensen
- From the Department of Cardiology (T.B.R., W.Y.K., H.M., H.K.J., J.M.), Research Unit for Molecular Medicine (T.B.R., J.P., P.B.), Department of Clinical Biochemistry (P.H.N., L.H.), Institute of Pathology (S.D.), Department of Clinical Genetics (U.B.J.), and MR Centre (W.Y.K.), Aarhus University Hospital, Aarhus, Denmark; Clinical Research Center, Vendsyssel Hospital, Aalborg University, Hjørring, Denmark (U.T.B.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of
| | - Won Y. Kim
- From the Department of Cardiology (T.B.R., W.Y.K., H.M., H.K.J., J.M.), Research Unit for Molecular Medicine (T.B.R., J.P., P.B.), Department of Clinical Biochemistry (P.H.N., L.H.), Institute of Pathology (S.D.), Department of Clinical Genetics (U.B.J.), and MR Centre (W.Y.K.), Aarhus University Hospital, Aarhus, Denmark; Clinical Research Center, Vendsyssel Hospital, Aalborg University, Hjørring, Denmark (U.T.B.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of
| | - Lene Heickendorff
- From the Department of Cardiology (T.B.R., W.Y.K., H.M., H.K.J., J.M.), Research Unit for Molecular Medicine (T.B.R., J.P., P.B.), Department of Clinical Biochemistry (P.H.N., L.H.), Institute of Pathology (S.D.), Department of Clinical Genetics (U.B.J.), and MR Centre (W.Y.K.), Aarhus University Hospital, Aarhus, Denmark; Clinical Research Center, Vendsyssel Hospital, Aalborg University, Hjørring, Denmark (U.T.B.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of
| | - Henning Mølgaard
- From the Department of Cardiology (T.B.R., W.Y.K., H.M., H.K.J., J.M.), Research Unit for Molecular Medicine (T.B.R., J.P., P.B.), Department of Clinical Biochemistry (P.H.N., L.H.), Institute of Pathology (S.D.), Department of Clinical Genetics (U.B.J.), and MR Centre (W.Y.K.), Aarhus University Hospital, Aarhus, Denmark; Clinical Research Center, Vendsyssel Hospital, Aalborg University, Hjørring, Denmark (U.T.B.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of
| | - Henrik K. Jensen
- From the Department of Cardiology (T.B.R., W.Y.K., H.M., H.K.J., J.M.), Research Unit for Molecular Medicine (T.B.R., J.P., P.B.), Department of Clinical Biochemistry (P.H.N., L.H.), Institute of Pathology (S.D.), Department of Clinical Genetics (U.B.J.), and MR Centre (W.Y.K.), Aarhus University Hospital, Aarhus, Denmark; Clinical Research Center, Vendsyssel Hospital, Aalborg University, Hjørring, Denmark (U.T.B.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of
| | - Ulrik T. Baandrup
- From the Department of Cardiology (T.B.R., W.Y.K., H.M., H.K.J., J.M.), Research Unit for Molecular Medicine (T.B.R., J.P., P.B.), Department of Clinical Biochemistry (P.H.N., L.H.), Institute of Pathology (S.D.), Department of Clinical Genetics (U.B.J.), and MR Centre (W.Y.K.), Aarhus University Hospital, Aarhus, Denmark; Clinical Research Center, Vendsyssel Hospital, Aalborg University, Hjørring, Denmark (U.T.B.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of
| | - Peter Bross
- From the Department of Cardiology (T.B.R., W.Y.K., H.M., H.K.J., J.M.), Research Unit for Molecular Medicine (T.B.R., J.P., P.B.), Department of Clinical Biochemistry (P.H.N., L.H.), Institute of Pathology (S.D.), Department of Clinical Genetics (U.B.J.), and MR Centre (W.Y.K.), Aarhus University Hospital, Aarhus, Denmark; Clinical Research Center, Vendsyssel Hospital, Aalborg University, Hjørring, Denmark (U.T.B.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of
| | - Jens Mogensen
- From the Department of Cardiology (T.B.R., W.Y.K., H.M., H.K.J., J.M.), Research Unit for Molecular Medicine (T.B.R., J.P., P.B.), Department of Clinical Biochemistry (P.H.N., L.H.), Institute of Pathology (S.D.), Department of Clinical Genetics (U.B.J.), and MR Centre (W.Y.K.), Aarhus University Hospital, Aarhus, Denmark; Clinical Research Center, Vendsyssel Hospital, Aalborg University, Hjørring, Denmark (U.T.B.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of
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Saguner AM, Brunckhorst C, Duru F. Arrhythmogenic ventricular cardiomyopathy: A paradigm shift from right to biventricular disease. World J Cardiol 2014; 6:154-174. [PMID: 24772256 PMCID: PMC3999336 DOI: 10.4330/wjc.v6.i4.154] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 01/29/2014] [Accepted: 03/17/2014] [Indexed: 02/06/2023] Open
Abstract
Arrhythmogenic ventricular cardiomyopathy (AVC) is generally referred to as arrhythmogenic right ventricular (RV) cardiomyopathy/dysplasia and constitutes an inherited cardiomyopathy. Affected patients may succumb to sudden cardiac death (SCD), ventricular tachyarrhythmias (VTA) and heart failure. Genetic studies have identified causative mutations in genes encoding proteins of the intercalated disk that lead to reduced myocardial electro-mechanical stability. The term arrhythmogenic RV cardiomyopathy is somewhat misleading as biventricular involvement or isolated left ventricular (LV) involvement may be present and thus a broader term such as AVC should be preferred. The diagnosis is established on a point score basis according to the revised 2010 task force criteria utilizing imaging modalities, demonstrating fibrous replacement through biopsy, electrocardiographic abnormalities, ventricular arrhythmias and a positive family history including identification of genetic mutations. Although several risk factors for SCD such as previous cardiac arrest, syncope, documented VTA, severe RV/LV dysfunction and young age at manifestation have been identified, risk stratification still needs improvement, especially in asymptomatic family members. Particularly, the role of genetic testing and environmental factors has to be further elucidated. Therapeutic interventions include restriction from physical exercise, beta-blockers, sotalol, amiodarone, implantable cardioverter-defibrillators and catheter ablation. Life-long follow-up is warranted in symptomatic patients, but also asymptomatic carriers of pathogenic mutations.
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McCain ML, Desplantez T, Kléber AG. Engineering Cardiac Cell JunctionsIn Vitroto Study the Intercalated Disc. ACTA ACUST UNITED AC 2014; 21:181-91. [DOI: 10.3109/15419061.2014.905931] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Veeraraghavan R, Poelzing S, Gourdie RG. Intercellular electrical communication in the heart: a new, active role for the intercalated disk. ACTA ACUST UNITED AC 2014; 21:161-7. [PMID: 24735129 DOI: 10.3109/15419061.2014.905932] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Cardiac conduction is the propagation of electrical excitation through the heart and is responsible for triggering individual myocytes to contract in synchrony. Canonically, this process has been thought to occur electrotonically, by means of direct flow of ions from cell to cell. The intercalated disk (ID), the site of contact between adjacent myocytes, has been viewed as a structure composed of mechanical junctions that stabilize the apposition of cell membranes and gap junctions which constitute low resistance pathways between cells. However, emerging evidence suggests a more active role for structures within the ID in mediating intercellular electrical communication by means of non-canonical ephaptic mechanisms. This review will discuss the role of the ID in the context of the canonical, electrotonic view of conduction and highlight new, emerging possibilities of its playing a more active role in ephaptic coupling between cardiac myocytes.
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Affiliation(s)
- Rengasayee Veeraraghavan
- Center for Cardiovascular and Regenerative Biology, Virginia Tech Carilion Research Institute , Roanoke, VA , USA
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Assembly of the cardiac intercalated disk during pre- and postnatal development of the human heart. PLoS One 2014; 9:e94722. [PMID: 24733085 PMCID: PMC3986238 DOI: 10.1371/journal.pone.0094722] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 03/17/2014] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND In cardiac muscle, the intercalated disk (ID) at the longitudinal cell-edges of cardiomyocytes provides as a macromolecular infrastructure that integrates mechanical and electrical coupling within the heart. Pathophysiological disturbance in composition of this complex is well known to trigger cardiac arrhythmias and pump failure. The mechanisms underlying assembly of this important cellular domain in human heart is currently unknown. METHODS We collected 18 specimens from individuals that died from non-cardiovascular causes. Age of the specimens ranged from a gestational age of 15 weeks through 11 years postnatal. Immunohistochemical labeling was performed against proteins comprising desmosomes, adherens junctions, the cardiac sodium channel and gap junctions to visualize spatiotemporal alterations in subcellular location of the proteins. RESULTS Changes in spatiotemporal localization of the adherens junction proteins (N-cadherin and ZO-1) and desmosomal proteins (plakoglobin, desmoplakin and plakophilin-2) were identical in all subsequent ages studied. After an initial period of diffuse and lateral labelling, all proteins were fully localized in the ID at approximately 1 year after birth. Nav1.5 that composes the cardiac sodium channel and the gap junction protein Cx43 follow a similar pattern but their arrival in the ID is detected at (much) later stages (two years for Nav1.5 and seven years for Cx43, respectively). CONCLUSION Our data on developmental maturation of the ID in human heart indicate that generation of the mechanical junctions at the ID precedes that of the electrical junctions with a significant difference in time. In addition arrival of the electrical junctions (Nav1.5 and Cx43) is not uniform since sodium channels localize much earlier than gap junction channels.
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