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Abstract
The past 3 decades have been characterized by an exponential growth in knowledge and advances in the clinical treatment of atrial fibrillation (AF). It is now known that AF genesis requires a vulnerable atrial substrate and that the formation and composition of this substrate may vary depending on comorbid conditions, genetics, sex, and other factors. Population-based studies have identified numerous factors that modify the atrial substrate and increase AF susceptibility. To date, genetic studies have reported 17 independent signals for AF at 14 genomic regions. Studies have established that advanced age, male sex, and European ancestry are prominent AF risk factors. Other modifiable risk factors include sedentary lifestyle, smoking, obesity, diabetes mellitus, obstructive sleep apnea, and elevated blood pressure predispose to AF, and each factor has been shown to induce structural and electric remodeling of the atria. Both heart failure and myocardial infarction increase risk of AF and vice versa creating a feed-forward loop that increases mortality. Other cardiovascular outcomes attributed to AF, including stroke and thromboembolism, are well established, and epidemiology studies have championed therapeutics that mitigate these adverse outcomes. However, the role of anticoagulation for preventing dementia attributed to AF is less established. Our review is a comprehensive examination of the epidemiological data associating unmodifiable and modifiable risk factors for AF and of the pathophysiological evidence supporting the mechanistic link between each risk factor and AF genesis. Our review also critically examines the epidemiological data on clinical outcomes attributed to AF and summarizes current evidence linking each outcome with AF.
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Affiliation(s)
- Laila Staerk
- Cardiovascular Research Centre, Herlev and Gentofte University Hospital, Copenhagen, Denmark
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States
- Boston University and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, United States
| | - Jason A. Sherer
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States
| | - Darae Ko
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States
- Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts, United States
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States
| | - Emelia J. Benjamin
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States
- Boston University and National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, United States
- Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts, United States
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States
- Section of Preventive Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States
| | - Robert H. Helm
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States
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102
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Schumacher K, Dagres N, Hindricks G, Husser D, Bollmann A, Kornej J. Characteristics of PR interval as predictor for atrial fibrillation: association with biomarkers and outcomes. Clin Res Cardiol 2017; 106:767-775. [DOI: 10.1007/s00392-017-1109-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/29/2017] [Indexed: 11/28/2022]
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103
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Abstract
Although sinus node dysfunction (SND) and atrial arrhythmias frequently coexist and interact, the putative mechanism linking the 2 remain unclear. Although SND is accompanied by atrial myocardial structural changes in the right atrium, atrial fibrillation (AF) is a disease of variable interactions between left atrial triggers and substrate most commonly of left atrial origin. Significant advances have been made in our understanding of the genetic and pathophysiologic mechanism underlying the development and progression of SND and AF. Although some patients manifest SND as a result of electric remodeling induced by periods of AF, others develop progressive atrial structural remodeling that gives rise to both conditions together. The treatment strategy will thus vary according to the predominant disease phenotype. Although catheter ablation will benefit patients with predominantly AF and secondary SND, cardiac pacing may be the mainstay of therapy for patients with predominant fibrotic atrial cardiomyopathy. This contemporary review summarizes current knowledge on sinus node pathophysiology with the broader goal of yielding insights into the complex relationship between sinus node disease and atrial arrhythmias.
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Affiliation(s)
- Roy M John
- From Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Saurabh Kumar
- From Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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104
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Current Perspectives in Cardiac Laterality. J Cardiovasc Dev Dis 2016; 3:jcdd3040034. [PMID: 29367577 PMCID: PMC5715725 DOI: 10.3390/jcdd3040034] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/23/2016] [Accepted: 12/05/2016] [Indexed: 12/16/2022] Open
Abstract
The heart is the first organ to break symmetry in the developing embryo and onset of dextral looping is the first indication of this event. Looping is a complex process that progresses concomitantly to cardiac chamber differentiation and ultimately leads to the alignment of the cardiac regions in their final topology. Generation of cardiac asymmetry is crucial to ensuring proper form and consequent functionality of the heart, and therefore it is a highly regulated process. It has long been known that molecular left/right signals originate far before morphological asymmetry and therefore can direct it. The use of several animal models has led to the characterization of a complex regulatory network, which invariably converges on the Tgf-β signaling molecule Nodal and its downstream target, the homeobox transcription factor Pitx2. Here, we review current data on the cellular and molecular bases of cardiac looping and laterality, and discuss the contribution of Nodal and Pitx2 to these processes. A special emphasis will be given to the morphogenetic role of Pitx2 and to its modulation of transcriptional and functional properties, which have also linked laterality to atrial fibrillation.
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105
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Ye J, Tucker NR, Weng LC, Clauss S, Lubitz SA, Ellinor PT. A Functional Variant Associated with Atrial Fibrillation Regulates PITX2c Expression through TFAP2a. Am J Hum Genet 2016; 99:1281-1291. [PMID: 27866707 PMCID: PMC5142106 DOI: 10.1016/j.ajhg.2016.10.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 10/03/2016] [Indexed: 01/22/2023] Open
Abstract
The most significantly associated genetic locus for atrial fibrillation (AF) is in chromosomal region 4q25, where four independent association signals have been identified. Although model-system studies suggest that altered PITX2c expression might underlie the association, the link between specific variants and the direction of effect on gene expression remains unknown for all four signals. In the present study, we analyzed the AF-associated region most proximal to PITX2 at 4q25. First, we identified candidate regulatory variants that might confer AF risk through a combination of mammalian conservation, DNase hypersensitivity, and histone modification from ENCODE and the Roadmap Epigenomics Project, as well as through in vivo analysis of enhancer activity in embryonic zebrafish. Within candidate regions, we then identified a single associated SNP, rs2595104, which displayed dramatically reduced enhancer activity with the AF risk allele. CRISPR-Cas9-mediated deletion of the rs2595104 region and editing of the rs2595104 risk allele in human stem-cell-derived cardiomyocytes resulted in diminished PITX2c expression in comparison to that of the non-risk allele. This differential activity was mediated by activating enhancer binding protein 2 alpha (TFAP2a), which bound robustly to the non-risk allele at rs2595104, but not to the risk allele, in cardiomyocytes. In sum, we found that the AF-associated SNP rs2595104 altered PITX2c expression via interaction with TFAP2a. Such a pathway could ultimately contribute to AF susceptibility at the PITX2 locus associated with AF.
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Affiliation(s)
- Jiangchuan Ye
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA 02129, USA; Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - Nathan R Tucker
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA 02129, USA; Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - Lu-Chen Weng
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA 02129, USA; Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - Sebastian Clauss
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA 02129, USA; Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - Steven A Lubitz
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA 02129, USA; Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - Patrick T Ellinor
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA 02129, USA; Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA.
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106
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Zhao LQ, Zhang GB, Wen ZJ, Huang CK, Wu HQ, Xu J, Qi BZ, Wang ZM, Shi YY, Liu SW. Common variants predict recurrence after nonfamilial atrial fibrillation ablation in Chinese Han population. Int J Cardiol 2016; 227:360-366. [PMID: 27843048 DOI: 10.1016/j.ijcard.2016.11.057] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 08/10/2016] [Accepted: 11/05/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Genome-wide association studies (GWAS) have identified several loci associated with atrial fibrillation (AF) and have been reportedly associated with response to catheter ablation for AF in patients of European ancestry; however, associations between susceptibility loci and clinical recurrence of AF after catheter ablation have not been examined in Chinese Han populations. To the personalization of catheter ablation for AF, we examined whether these single nucleotide polymorphisms (SNPs) can predict clinical outcomes after catheter ablation for AF in Chinese Han population. METHODS AND RESULTS The association between 8 SNPs and AF was studied in 1418 AF patients and 1424 controls by the unconditional logistic regression analysis. The survival analyses were used to compare AT/AF recurrence differences among 438 AF patients, which were classified by the genotype of rs2200733. rs2200733 and rs6590357 were significantly associated with AF in Chinese Han population. In addition, rs2200733 was associated with clinical recurrence of AF after catheter ablation. In Kaplan-Meier survival analysis, the recurrence-free rates for AF with TT and with TC+CC were 35.5% and 61.9%, respectively (P=0.0009). In multivariate Cox regression analysis, rs2200733 was strong independent risk factor for recurrence. CONCLUSION rs2200733 risk allele at the 4q25 predicted impaired clinical response to catheter ablation for AF in Chinese Han population. Our findings suggested rs2200733 polymorphism may be used as a clinical tool for selection of patients for AF catheter ablation.
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Affiliation(s)
- Li-Qun Zhao
- Department of Cardiology, Shanghai First People's Hospital Affiliated to Shanghai JiaoTong University, Shanghai 200080, China
| | - Guo-Bing Zhang
- Department of Cardiology, Shanghai First People's Hospital Affiliated to Shanghai JiaoTong University, Shanghai 200080, China
| | - Zu-Jia Wen
- Bio-X Institutes, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Chun-Kai Huang
- Department of Cardiology, Shanghai First People's Hospital Affiliated to Shanghai JiaoTong University, Shanghai 200080, China
| | - Hai-Qing Wu
- Department of Cardiology, Shanghai First People's Hospital Affiliated to Shanghai JiaoTong University, Shanghai 200080, China
| | - Juan Xu
- Department of Cardiology, Shanghai First People's Hospital Affiliated to Shanghai JiaoTong University, Shanghai 200080, China
| | - Bao-Zhen Qi
- Department of Cardiology, Shanghai First People's Hospital Affiliated to Shanghai JiaoTong University, Shanghai 200080, China
| | - Zhi-Min Wang
- Department of Genetics, Shanghai-MOST Key Laboratory of Health and Disease Genomics, Chinese National Human Genome Center and Shanghai Industrial Technology Institute (SITI), Shanghai 201203, China.
| | - Yong-Yong Shi
- Bio-X Institutes, Shanghai Jiao Tong University, Shanghai, 200030, China.
| | - Shao-Wen Liu
- Department of Cardiology, Shanghai First People's Hospital Affiliated to Shanghai JiaoTong University, Shanghai 200080, China.
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107
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Liu L, Ebana Y, Nitta JI, Takahashi Y, Miyazaki S, Tanaka T, Komura M, Isobe M, Furukawa T. Genetic Variants Associated With Susceptibility to Atrial Fibrillation in a Japanese Population. Can J Cardiol 2016; 33:443-449. [PMID: 28129963 DOI: 10.1016/j.cjca.2016.10.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 10/01/2016] [Accepted: 10/16/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) affects millions of individuals worldwide. The genome-wide association studies have identified robust genetic associations with AF. METHODS We genotyped 5461 participants of Japanese ancestry for 11 AF-related loci and determined the effects of carrying different numbers of risk alleles on disease development and age at disease onset. The weighted genetic risk score (GRS) was calculated, and its ability to predict AF was determined. RESULTS Six single-nucleotide polymorphisms-rs593479 (1q24 in PRRX1), rs1906617 (4q25 near PITX2), rs11773845 (7q31 in CAV1), rs6584555 (10q25 in NEURL), rs6490029 (12q24 in CUX2), and rs12932445 (16q22 in ZFHX3) (P < 1.9 × 10-5)-were confirmed as being associated with AF. Patients with a high total number of risk alleles (9-12) had a younger median age at onset of AF (58 years; 95% confidence interval [CI], 55-60 years) than those with a low total number (1-4) (63 years; 95% CI, 61-64 years) (P = 0.0015). We observed a 4.38-fold (95% CI, 3.69-5.19) difference in risk of AF between individuals with scores in the top and bottom quartiles of the GRS. Receiver operating characteristic analysis indicated an area under the curve of 0.641 (95% CI, 0.628-0.653; P < 0.0001). CONCLUSIONS Six loci were validated as associated with AF in a Japanese population. This study suggests that a combination of common genetic markers modestly facilitates discrimination of AF. This is the first report, to our knowledge, to demonstrate that the age of onset of AF is affected by common risk alleles.
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Affiliation(s)
- Lian Liu
- Department of Bio-informational Pharmacology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yusuke Ebana
- Department of Bio-informational Pharmacology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Jun-Ichi Nitta
- Cardiovascular Division, Saitama Red Cross Hospital, Saitama, Japan
| | | | | | - Toshihiro Tanaka
- Bio-resource Research Center, Research and Industry-University Alliance Organization, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Mitsuaki Isobe
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsushi Furukawa
- Department of Bio-informational Pharmacology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan.
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108
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Gollob MH. Toward Translation of Genomic Discovery to Clinical Efficacy in Atrial Fibrillation. J Am Coll Cardiol 2016; 68:1895-1897. [PMID: 27765192 DOI: 10.1016/j.jacc.2016.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 08/22/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Michael H Gollob
- Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
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109
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Syeda F, Holmes AP, Yu TY, Tull S, Kuhlmann SM, Pavlovic D, Betney D, Riley G, Kucera JP, Jousset F, de Groot JR, Rohr S, Brown NA, Fabritz L, Kirchhof P. PITX2 Modulates Atrial Membrane Potential and the Antiarrhythmic Effects of Sodium-Channel Blockers. J Am Coll Cardiol 2016; 68:1881-1894. [PMID: 27765191 PMCID: PMC5075046 DOI: 10.1016/j.jacc.2016.07.766] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 07/05/2016] [Accepted: 07/20/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Antiarrhythmic drugs are widely used to treat patients with atrial fibrillation (AF), but the mechanisms conveying their variable effectiveness are not known. Recent data suggested that paired like homeodomain-2 transcription factor (PITX2) might play an important role in regulating gene expression and electrical function of the adult left atrium (LA). OBJECTIVES After determining LA PITX2 expression in AF patients requiring rhythm control therapy, the authors assessed the effects of Pitx2c on LA electrophysiology and the effect of antiarrhythmic drugs. METHODS LA PITX2 messenger ribonucleic acid (mRNA) levels were measured in 95 patients undergoing thoracoscopic AF ablation. The effects of flecainide, a sodium (Na+)-channel blocker, and d,l-sotalol, a potassium channel blocker, were studied in littermate mice with normal and reduced Pitx2c mRNA by electrophysiological study, optical mapping, and patch clamp studies. PITX2-dependent mechanisms of antiarrhythmic drug action were studied in human embryonic kidney (HEK) cells expressing human Na channels and by modeling human action potentials. RESULTS Flecainide 1 μmol/l was more effective in suppressing atrial arrhythmias in atria with reduced Pitx2c mRNA levels (Pitx2c+/-). Resting membrane potential was more depolarized in Pitx2c+/- atria, and TWIK-related acid-sensitive K+ channel 2 (TASK-2) gene and protein expression were decreased. This resulted in enhanced post-repolarization refractoriness and more effective Na-channel inhibition. Defined holding potentials eliminated differences in flecainide's effects between wild-type and Pitx2c+/- atrial cardiomyocytes. More positive holding potentials replicated the increased effectiveness of flecainide in blocking human Nav1.5 channels in HEK293 cells. Computer modeling reproduced an enhanced effectiveness of Na-channel block when resting membrane potential was slightly depolarized. CONCLUSIONS PITX2 mRNA modulates atrial resting membrane potential and thereby alters the effectiveness of Na-channel blockers. PITX2 and ion channels regulating the resting membrane potential may provide novel targets for antiarrhythmic drug development and companion therapeutics in AF.
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Affiliation(s)
- Fahima Syeda
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Andrew P Holmes
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Ting Y Yu
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Physical Sciences of Imaging in the Biomedical Sciences, School of Chemistry, University of Birmingham, Birmingham, United Kingdom
| | - Samantha Tull
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | | | - Davor Pavlovic
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Daniel Betney
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Genna Riley
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jan P Kucera
- Department of Physiology, University of Bern, Bern, Switzerland
| | - Florian Jousset
- Department of Physiology, University of Bern, Bern, Switzerland
| | - Joris R de Groot
- Heart Center, Department of Cardiology, Academisch Medisch Centrum, Amsterdam, the Netherlands
| | - Stephan Rohr
- Department of Physiology, University of Bern, Bern, Switzerland
| | - Nigel A Brown
- St. George's Hospital Medical School, University of London, London, United Kingdom
| | - Larissa Fabritz
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany; Atrial Fibrillation NETwork, Muenster, Germany; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany; Atrial Fibrillation NETwork, Muenster, Germany; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom.
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110
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The Role of Pharmacogenetics in Atrial Fibrillation Therapeutics: Is Personalized Therapy in Sight? J Cardiovasc Pharmacol 2016; 67:9-18. [PMID: 25970841 DOI: 10.1097/fjc.0000000000000280] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide requiring therapy. Despite recent advances in catheter-based and surgical therapy, antiarrhythmic drugs (AADs) remain the mainstay of treatment for symptomatic AF. However, response in individual patients is highly variable with over half the patients treated with rhythm control therapy experiencing recurrence of AF within a year. Contemporary AADs used to suppress AF are incompletely and unpredictably effective and associated with significant risks of proarrhythmia and noncardiac toxicities. Furthermore, this "one-size" fits all strategy for selecting antiarrhythmics is based largely on minimizing risk of adverse effects rather than on the likelihood of suppressing AF. The limited success of rhythm control therapy is in part due to heterogeneity of the underlying substrate, interindividual differences in disease mechanisms, and our inability to predict response to AADs in individual patients. Genetic studies of AF over the past decade have revealed that susceptibility to and response to therapy for AF is modulated by the underlying genetic substrate. However, the bedside application of these new discoveries to the management of AF patients has thus far been disappointing. This may in part be related to our limited understanding about genetic predictors of drug response in general, the challenges associated with determining efficacy of response to AADs, and lack of randomized genotype-directed clinical trials. Nonetheless, recent studies have shown that common AF susceptibility risk alleles at the chromosome 4q25 locus modulated response to AADs, electrical cardioversion, and ablation therapy. This monograph discusses how genetic approaches to AF have not only provided important insights into underlying mechanisms but also identified AF subtypes that can be better targeted with more mechanism-based "personalized" therapy.
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111
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Zhang W, Liu W, Chew STH, Shen L, Ti LK. A Clinical Prediction Model for Postcardiac Surgery Atrial Fibrillation in an Asian Population. Anesth Analg 2016; 123:283-9. [DOI: 10.1213/ane.0000000000001384] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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112
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Abstract
INTRODUCTION Over the last decade, tremendous progress has been made in defining the genetic architecture of atrial fibrillation (AF). This has in part been driven by poor understanding of the pathophysiology of AF, limitations of current therapies and failure to target therapies to the underlying mechanisms. AREAS COVERED Genetic approaches to AF have identified mutations encoding cardiac ion channels, and signaling proteins linked with AF and genome-wide association studies have uncovered common genetic variants modulating AF risk. These studies have provided important insights into the underlying mechanisms of AF and defined responses to therapies. Common AF-risk alleles at the chromosome 4q25 locus modulate response to antiarrhythmic drugs, electrical cardioversion and catheter ablation. While the translation of these discoveries to the bedside care of individual patients has been limited, emerging evidence supports the hypothesis that genotype-directed approaches that target the underlying mechanisms of AF may not only improve therapeutic efficacy but also minimize adverse effects. Expert commentary: There is an urgent need for randomized controlled trials that are genotype-based for the treatment of AF. Nonetheless, emerging data suggest that selecting therapies for AF that are genotype-directed may soon be upon us.
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Affiliation(s)
- Henry Huang
- a Division of Cardiology, Department of Medicine , University of Illinois at Chicago , Chicago , IL , USA
| | - Dawood Darbar
- a Division of Cardiology, Department of Medicine , University of Illinois at Chicago , Chicago , IL , USA
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113
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Sun L, Tian L, Xu J, Zhang Z, Liu X. Chromosome 4q25 Variants and Age at Onset of Ischemic Stroke. Mol Neurobiol 2016; 54:3388-3394. [PMID: 27170280 DOI: 10.1007/s12035-016-9903-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 05/03/2016] [Indexed: 11/28/2022]
Abstract
Recent genome-wide association studies have identified two variants rs10033464 and rs2200733 on chromosome 4q25, significantly associated with ischemic stroke risk. We conducted this study to investigate whether these two variants were associated with age at onset and prognosis of ischemic stroke in a Chinese population. Genotyping of rs10033464 and rs2200733 was performed by improved multiple ligase detection reaction. One-way ANOVA was used to compare the mean age of ischemic stroke onset for each variant. Combined effects of these two variants on age at ischemic stroke onset were then estimated. Kaplan-Meier method, log-rank test, and the Cox proportional hazards regression models were used to assess the effect of the two variants on ischemic stroke prognosis. A total of 914 ischemic stroke patients were included in the study. Rs10033464 and rs2200733 were not associated with ischemic stroke recurrence (P > 0.05). However, rs10033464 TT genotype was significantly correlated with early age of ischemic stroke onset (60.76 for GG, 61.74 for GT, 55.47 for TT, TT vs. GT: P = 0.043). Combined effects analysis revealed that mean age at ischemic stroke onset decreased with increasing genetic risk score (P = 0.038). The findings indicated that the chromosome 4q25 variants might associate with early age at onset of ischemic stroke. Further larger studies in other populations are warranted to validate our results.
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Affiliation(s)
- Lingli Sun
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305# East Zhongshan Road, Nanjing, 210002, Jiangsu Province, China
| | - Ling Tian
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305# East Zhongshan Road, Nanjing, 210002, Jiangsu Province, China
| | - Jian Xu
- Molecular Oncology Research Institute, Tufts Medical Center, Tufts University, Boston, MA, USA
| | - Zhizhong Zhang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305# East Zhongshan Road, Nanjing, 210002, Jiangsu Province, China.
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305# East Zhongshan Road, Nanjing, 210002, Jiangsu Province, China.
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114
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Abstract
With the impressive advancement in high-throughput 'omics' technologies over the past two decades, epigenetic mechanisms have emerged as the regulatory interface between the genome and environmental factors. These mechanisms include DNA methylation, histone modifications, ATP-dependent chromatin remodeling and RNA-based mechanisms. Their highly interdependent and coordinated action modulates the chromatin structure controlling access of the transcription machinery and thereby regulating expression of target genes. Given the rather limited proliferative capability of human cardiomyocytes, epigenetic regulation appears to play a particularly important role in the myocardium. The highly dynamic nature of the epigenome allows the heart to adapt to environmental challenges and to respond quickly and properly to cardiac stress. It is now becoming evident that histone-modifying and chromatin-remodeling enzymes as well as numerous non-coding RNAs play critical roles in cardiac development and function, while their dysregulation contributes to the onset and development of pathological cardiac remodeling culminating in HF. This review focuses on up-to-date knowledge about the epigenetic mechanisms and highlights their emerging role in the healthy and failing heart. Uncovering the determinants of epigenetic regulation holds great promise to accelerate the development of successful new diagnostic and therapeutic strategies in human cardiac disease.
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Affiliation(s)
- José Marín-García
- The Molecular Cardiology and Neuromuscular Institute, 75 Raritan Ave., Highland Park, NJ, 08904, USA,
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115
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Holmes AP, Kirchhof P. Pitx2 Adjacent Noncoding RNA: A New, Long, Noncoding Kid on the 4q25 Block. Circ Arrhythm Electrophysiol 2016; 9:e003808. [PMID: 26783234 DOI: 10.1161/circep.115.003808] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrew P Holmes
- From the Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom (A.P.H., P.K.); Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom (P.K.); Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom (P.K.); and Department of Cardiovascular Medicine, University Hospital Muenster; and Atrial Fibrillation NETwork, Muenster, Germany (P.K.)
| | - Paulus Kirchhof
- From the Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom (A.P.H., P.K.); Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom (P.K.); Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom (P.K.); and Department of Cardiovascular Medicine, University Hospital Muenster; and Atrial Fibrillation NETwork, Muenster, Germany (P.K.).
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116
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Pérez-Hernández M, Matamoros M, Barana A, Amorós I, Gómez R, Núñez M, Sacristán S, Pinto Á, Fernández-Avilés F, Tamargo J, Delpón E, Caballero R. Pitx2c increases in atrial myocytes from chronic atrial fibrillation patients enhancing IKs and decreasing ICa,L. Cardiovasc Res 2016; 109:431-41. [PMID: 26714926 DOI: 10.1093/cvr/cvv280] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 12/15/2015] [Indexed: 11/12/2022] Open
Abstract
AIMS Atrial fibrillation (AF) produces rapid changes in the electrical properties of the atria (electrical remodelling) that promote its own recurrence. In chronic AF (CAF) patients, up-regulation of the slow delayed rectifier K(+) current (IKs) and down-regulation of the voltage-gated Ca(2+) current (ICa,L) are hallmarks of electrical remodelling and critically contribute to the abbreviation of action potential duration and atrial refractory period. Recent evidences suggested that Pitx2c, a bicoid-related homeodomain transcription factor involved in directing cardiac asymmetric morphogenesis, could play a role in atrial remodelling. However, its effects on IKs and ICa,L are unknown. METHODS AND RESULTS Real-time quantitative polymerase chain reaction analysis showed that Pitx2c mRNA expression was significantly higher in human atrial myocytes from CAF patients than those from sinus rhythm patients. The expression of Pitx2c was positively and negatively correlated with IKs and ICa,L densities, respectively. Expression of Pitx2c in HL-1 cells increased IKs density and reduced ICa,L density. Luciferase assays demonstrated that Pitx2c increased transcriptional activity of KCNQ1 and KCNE1 genes. Conversely, its effects on ICa,L could be mediated by the atrial natriuretic peptide. CONCLUSION Our results demonstrated for the first time that CAF increases Pitx2c expression in isolated human atrial myocytes and suggested that this transcription factor could contribute to the CAF-induced IKs increase and ICa,L reduction observed in humans.
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Affiliation(s)
- Marta Pérez-Hernández
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Marcos Matamoros
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Adriana Barana
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Irene Amorós
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Ricardo Gómez
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Mercedes Núñez
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Sandra Sacristán
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Ángel Pinto
- Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain Cardiology and Cardiovascular Surgery Services, Hospital General Universitario Gregorio Marañón, Madrid 28007, Spain
| | - Francisco Fernández-Avilés
- Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain Cardiology and Cardiovascular Surgery Services, Hospital General Universitario Gregorio Marañón, Madrid 28007, Spain
| | - Juan Tamargo
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Eva Delpón
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
| | - Ricardo Caballero
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, Madrid 28040, Spain Instituto de Investigación Sanitaria Gregorio Marañón, School of Medicine, Universidad Complutense, Madrid 28040, Spain
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Franco D, Lozano-Velasco E, Aranega A. Gene regulatory networks in atrial fibrillation. World J Med Genet 2016; 6:1-16. [DOI: 10.5496/wjmg.v6.i1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/15/2015] [Accepted: 02/17/2016] [Indexed: 02/06/2023] Open
Abstract
Atrial fibrillation (AF) is the most frequent arrhythmogenic syndrome in humans. With an estimate incidence of 1%-2% in the general population, AF raises up to almost 10%-12% in 80+ years. Thus, AF represents nowadays a highly prevalent medical problem generating a large economic burden. At the electrophysiological level, distinct mechanisms have been elucidated. Yet, despite its prevalence, the genetic and molecular culprits of this pandemic cardiac electrophysiological abnormality have remained largely obscure. Molecular genetics of AF familiar cases have demonstrated that single nucleotide mutations in distinct genes encoding for ion channels underlie the onset of AF, albeit such alterations only explain a minor subset of patients with AF. In recent years, analyses by means of genome-wide association studies have unraveled a more complex picture of the etiology of AF, pointing out to distinct cardiac-enriched transcription factors, as well as to other regulatory genes. Furthermore a new layer of regulatory mechanisms have emerged, i.e., post-transcriptional regulation mediated by non-coding RNA, which have been demonstrated to exert pivotal roles in cardiac electrophysiology. In this manuscript, we aim to provide a comprehensive review of the genetic regulatory networks that if impaired exert electrophysiological abnormalities that contribute to the onset, and subsequently, on self-perpetuation of AF.
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118
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Li N, Dobrev D, Wehrens XHT. PITX2: a master regulator of cardiac channelopathy in atrial fibrillation? Cardiovasc Res 2016; 109:345-7. [PMID: 26782118 DOI: 10.1093/cvr/cvw008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Na Li
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, USA Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Xander H T Wehrens
- Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, USA Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, USA Department of Medicine (Cardiology), Baylor College of Medicine, Houston, TX, USA Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, BCM 335, Houston, TX 77030, USA
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119
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Lozano-Velasco E, Hernández-Torres F, Daimi H, Serra SA, Herraiz A, Hove-Madsen L, Aránega A, Franco D. Pitx2 impairs calcium handling in a dose-dependent manner by modulating Wnt signalling. Cardiovasc Res 2016; 109:55-66. [PMID: 26243430 DOI: 10.1093/cvr/cvv207] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 07/16/2015] [Indexed: 01/02/2023] Open
Abstract
AIMS Atrial fibrillation (AF) is the most common type of arrhythmia in humans, yet the genetic cause of AF remains elusive. Genome-wide association studies (GWASs) have reported risk variants in four distinct genetic loci, and more recently, a meta-GWAS has further implicated six new loci in AF. However, the functional role of these AF GWAS-related genes in AF and their inter-relationship remain elusive. METHODS AND RESULTS To get further insights into the molecular mechanisms driven by Pitx2, calcium handling and novel AF GWAS-associated gene expression were analysed in two distinct Pitx2 loss-of-function models with distinct basal electrophysiological defects; a novel Pitx2 conditional mouse line, Sox2CrePitx2, and our previously reported atrial-specific NppaCrePitx2 line. Molecular analyses of the left atrial appendage in NppaCrePitx2(+/-) and NppaCrePitx2(-/-) adult mice demonstrate that AF GWAS-associated genes such as Zfhx3, Kcnn3, and Wnt8a are severely impaired but not Cav1, Synpo2l, nor Prrx1. In addition, multiple calcium-handling genes such as Atp2a2, Casq2, and Plb are severely altered in atrial-specific NppaCrePitx2 mice in a dose-dependent manner. Functional assessment of calcium homeostasis further underscores these findings. In addition, multiple AF-related microRNAs are also impaired. In vitro over-expression of Wnt8, but not Zfhx3, impairs calcium handling and modulates microRNA expression signature identified in Pitx2 loss-of-function models. CONCLUSION Our data demonstrate a dose-dependent relation between Pitx2 expression and the expression of AF susceptibility genes, calcium handling, and microRNAs and identify a complex regulatory network orchestrated by Pitx2 with large impact on atrial arrhythmogenesis susceptibility.
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Affiliation(s)
- Estefanía Lozano-Velasco
- Cardiovascular Development Group, Department of Experimental Biology, University of Jaén, Jaén, Spain
| | | | - Houria Daimi
- Cardiovascular Development Group, Department of Experimental Biology, University of Jaén, Jaén, Spain
| | - Selma A Serra
- Cardiac Rhythm and Contraction Group, Cardiovascular Research Centre CSIC-ICCC and IIB Sant Pau, Barcelona, Spain
| | - Adela Herraiz
- Cardiac Rhythm and Contraction Group, Cardiovascular Research Centre CSIC-ICCC and IIB Sant Pau, Barcelona, Spain
| | - Leif Hove-Madsen
- Cardiac Rhythm and Contraction Group, Cardiovascular Research Centre CSIC-ICCC and IIB Sant Pau, Barcelona, Spain
| | - Amelia Aránega
- Cardiovascular Development Group, Department of Experimental Biology, University of Jaén, Jaén, Spain
| | - Diego Franco
- Cardiovascular Development Group, Department of Experimental Biology, University of Jaén, Jaén, Spain
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120
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Gene-guided therapy for catheter-ablation of atrial fibrillation: are we there yet? J Interv Card Electrophysiol 2015; 45:3-5. [PMID: 26660272 DOI: 10.1007/s10840-015-0086-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
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121
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Dzeshka MS, Lip GYH, Snezhitskiy V, Shantsila E. Cardiac Fibrosis in Patients With Atrial Fibrillation: Mechanisms and Clinical Implications. J Am Coll Cardiol 2015; 66:943-59. [PMID: 26293766 DOI: 10.1016/j.jacc.2015.06.1313] [Citation(s) in RCA: 360] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 06/18/2015] [Accepted: 06/22/2015] [Indexed: 02/06/2023]
Abstract
Atrial fibrillation (AF) is associated with structural, electrical, and contractile remodeling of the atria. Development and progression of atrial fibrosis is the hallmark of structural remodeling in AF and is considered the substrate for AF perpetuation. In contrast, experimental and clinical data on the effect of ventricular fibrotic processes in the pathogenesis of AF and its complications are controversial. Ventricular fibrosis seems to contribute to abnormalities in cardiac relaxation and contractility and to the development of heart failure, a common finding in AF. Given that AF and heart failure frequently coexist and that both conditions affect patient prognosis, a better understanding of the mutual effect of fibrosis in AF and heart failure is of particular interest. In this review paper, we provide an overview of the general mechanisms of cardiac fibrosis in AF, differences between fibrotic processes in atria and ventricles, and the clinical and prognostic significance of cardiac fibrosis in AF.
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Affiliation(s)
- Mikhail S Dzeshka
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom; Grodno State Medical University, Grodno, Belarus
| | - Gregory Y H Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom; Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Eduard Shantsila
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom.
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Ferrari R, Bertini M, Blomstrom-Lundqvist C, Dobrev D, Kirchhof P, Pappone C, Ravens U, Tamargo J, Tavazzi L, Vicedomini GG. An update on atrial fibrillation in 2014: From pathophysiology to treatment. Int J Cardiol 2015; 203:22-9. [PMID: 26490502 DOI: 10.1016/j.ijcard.2015.10.089] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 10/06/2015] [Accepted: 10/12/2015] [Indexed: 11/17/2022]
Abstract
Atrial fibrillation (AF) is the most frequently encountered cardiac arrhythmia. The trigger for initiation of AF is generally an enhanced vulnerability of pulmonary vein cardiomyocyte sleeves to either focal or re-entrant activity. The maintenance of AF is based on a "driver" mechanism in a vulnerable substrate. Cardiac mapping technology is providing further insight into these extremely dynamic processes. AF can lead to electrophysiological and structural remodelling, thereby promoting the condition. The management includes prevention of stroke by oral anticoagulation or left atrial appendage (LAA) occlusion, upstream therapy of concomitant conditions, and symptomatic improvement using rate control and/or rhythm control. Nonpharmacological strategies include electrical cardioversion and catheter ablation. There are substantial geographical variations in the management of AF, though European data indicate that 80% of patients receive adequate anticoagulation and 79% adequate rate control. High rates of morbidity and mortality weigh against perceived difficulties in management. Clinical research and growing experience are helping refine clinical indications and provide better technical approaches. Active research in cardiac electrophysiology is producing new antiarrhythmic agents that are reaching the experimental clinical arena, inhibiting novel ion channels. Future research should give better understanding of the underlying aetiology of AF and identification of drug targets, to help the move toward patient-specific therapy.
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Affiliation(s)
- R Ferrari
- Department of Cardiology, LTTA Centre, University Hospital of Ferrara, Ferrara, Italy; Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy.
| | - M Bertini
- Department of Cardiology, LTTA Centre, University Hospital of Ferrara, Ferrara, Italy
| | | | - D Dobrev
- Institute of Pharmacology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - P Kirchhof
- University of Birmingham, Centre for Cardiovascular Sciences, Birmingham, UK; Department of Cardiology and Angiology, University of Münster, Germany
| | - C Pappone
- Policlinico San Donato, Department of Arrhythmology, University of Milan, Italy
| | - U Ravens
- Department of Pharmacology and Toxicology, Technical University of Dresden, Dresden, Germany
| | - J Tamargo
- Department of Pharmacology, School of Medicine Universidad Complutense, Madrid, Spain
| | - L Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy
| | - G G Vicedomini
- Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy
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123
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Zhao L, Chen XG, Liu Y, Fang Z, Zhang F. Association of rs17042171 with chromosome 4q25 with atrial fibrillation in Chinese Han populations. Anatol J Cardiol 2015; 16:165-9. [PMID: 26467376 PMCID: PMC5336801 DOI: 10.5152/akd.2015.5999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: A recent genome-wide association study (GWAS) identified a susceptibility single nucleotide polymorphism (SNP), rs17042171 on 4q25 for atrial fibrillation (AF). The aim of the present study was to investigate whether this association between rs17042171 and AF also exists in Chinese Han populations. Methods: It was a case-control study. We enrolled a total of 1,593 Chinese Han origin individuals in the study, including 597 AF patients and 996 AF-free controls. Genotyping was performed using the TaqMan allelic discrimination Assay. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated in logistic regression models. Results: There was strongly significant difference between AF patients and control subjects regarding rs17042171 assumption of additive model (OR=2.20, 95% CI: 1.88-2.57, p=2.00 × 10-22), dominant model (OR=2.99; 95% CI: 2.19-4.09; p=6.47 × 10-12) and a recessive (OR=2.75; 95% CI: 2.21-3.43; p=1.30 10-19). In the stratification analysis based on age, gender, hypertension, diabetes and coronary artery disease, there was no significant difference of the associations for rs17042171 among the subgroups. Conclusion: Our results indicated that rs17042171 confers an increased risk of AF in Chinese Han Populations and expanded the association to non-European ancestry populations for the first time. (Anatol J Cardiol 2016; 16: 165-9)
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Affiliation(s)
- Liyan Zhao
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University; Nanjing-China.
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124
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Hirsh BJ, Copeland-Halperin RS, Halperin JL. Fibrotic atrial cardiomyopathy, atrial fibrillation, and thromboembolism: mechanistic links and clinical inferences. J Am Coll Cardiol 2015; 65:2239-51. [PMID: 25998669 DOI: 10.1016/j.jacc.2015.03.557] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 03/23/2015] [Accepted: 03/24/2015] [Indexed: 12/12/2022]
Abstract
The association of atrial fibrillation (AF) with ischemic stroke has long been recognized; yet, the pathogenic mechanisms underlying this relationship are incompletely understood. Clinical schemas, such as the CHA2DS2-VASc (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65 to 74 years, sex category) score, incompletely account for thromboembolic risk, and emerging evidence suggests that stroke can occur in patients with AF even after sinus rhythm is restored. Atrial fibrosis correlates with both the persistence and burden of AF, and gadolinium-enhanced magnetic resonance imaging is gaining utility for detection and quantification of the fibrotic substrate, but methodological challenges limit its use. Factors related to evolution of the thrombogenic fibrotic atrial cardiomyopathy support the view that AF is a marker of stroke risk regardless of whether or not the arrhythmia is sustained. Antithrombotic therapy should be guided by a comprehensive assessment of intrinsic risk rather than the presence or absence of AF at a given time.
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125
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Hoit BD. Refining the Risk for Atrial Fibrillation. Circ Cardiovasc Imaging 2015; 8:e003807. [DOI: 10.1161/circimaging.115.003807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Brian D. Hoit
- From the Case Western Reserve University, Cleveland, OH; and Harrington Heart and Vascular Institute, University Hospital Case Medical Center, Cleveland, OH
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126
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Huang Y, Wang C, Yao Y, Zuo X, Chen S, Xu C, Zhang H, Lu Q, Chang L, Wang F, Wang P, Zhang R, Hu Z, Song Q, Yang X, Li C, Li S, Zhao Y, Yang Q, Yin D, Wang X, Si W, Li X, Xiong X, Wang D, Huang Y, Luo C, Li J, Wang J, Chen J, Wang L, Wang L, Han M, Ye J, Chen F, Liu J, Liu Y, Wu G, Yang B, Cheng X, Liao Y, Wu Y, Ke T, Chen Q, Tu X, Elston R, Rao S, Yang Y, Xia Y, Wang QK. Molecular Basis of Gene-Gene Interaction: Cyclic Cross-Regulation of Gene Expression and Post-GWAS Gene-Gene Interaction Involved in Atrial Fibrillation. PLoS Genet 2015; 11:e1005393. [PMID: 26267381 PMCID: PMC4534423 DOI: 10.1371/journal.pgen.1005393] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/25/2015] [Indexed: 01/08/2023] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia at the clinic. Recent GWAS identified several variants associated with AF, but they account for <10% of heritability. Gene-gene interaction is assumed to account for a significant portion of missing heritability. Among GWAS loci for AF, only three were replicated in the Chinese Han population, including SNP rs2106261 (G/A substitution) in ZFHX3, rs2200733 (C/T substitution) near PITX2c, and rs3807989 (A/G substitution) in CAV1. Thus, we analyzed the interaction among these three AF loci. We demonstrated significant interaction between rs2106261 and rs2200733 in three independent populations and combined population with 2,020 cases/5,315 controls. Compared to non-risk genotype GGCC, two-locus risk genotype AATT showed the highest odds ratio in three independent populations and the combined population (OR=5.36 (95% CI 3.87-7.43), P=8.00×10-24). The OR of 5.36 for AATT was significantly higher than the combined OR of 3.31 for both GGTT and AACC, suggesting a synergistic interaction between rs2106261 and rs2200733. Relative excess risk due to interaction (RERI) analysis also revealed significant interaction between rs2106261 and rs2200733 when exposed two copies of risk alleles (RERI=2.87, P<1.00×10-4) or exposed to one additional copy of risk allele (RERI=1.29, P<1.00×10-4). The INTERSNP program identified significant genotypic interaction between rs2106261 and rs2200733 under an additive by additive model (OR=0.85, 95% CI: 0.74-0.97, P=0.02). Mechanistically, PITX2c negatively regulates expression of miR-1, which negatively regulates expression of ZFHX3, resulting in a positive regulation of ZFHX3 by PITX2c; ZFHX3 positively regulates expression of PITX2C, resulting in a cyclic loop of cross-regulation between ZFHX3 and PITX2c. Both ZFHX3 and PITX2c regulate expression of NPPA, TBX5 and NKX2.5. These results suggest that cyclic cross-regulation of gene expression is a molecular basis for gene-gene interactions involved in genetics of complex disease traits.
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Affiliation(s)
- Yufeng Huang
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Chuchu Wang
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Yufeng Yao
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyu Zuo
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Shanshan Chen
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Chengqi Xu
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Hongfu Zhang
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Qiulun Lu
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Le Chang
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Fan Wang
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Pengxia Wang
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Rongfeng Zhang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhenkun Hu
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Qixue Song
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaowei Yang
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Cong Li
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Sisi Li
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Yuanyuan Zhao
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Qin Yang
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Dan Yin
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaojing Wang
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Wenxia Si
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Xiuchun Li
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Xin Xiong
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Dan Wang
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Yuan Huang
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Chunyan Luo
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Jia Li
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Jingjing Wang
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Chen
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Longfei Wang
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Li Wang
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Meng Han
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Jian Ye
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Feifei Chen
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jingqiu Liu
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ying Liu
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Gang Wu
- Department of Cardiology, People’s Hospital, Wuhan University, Wuhan, China
| | - Bo Yang
- Department of Cardiology, People’s Hospital, Wuhan University, Wuhan, China
| | - Xiang Cheng
- Department of Cardiology, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yuhua Liao
- Department of Cardiology, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yanxia Wu
- Department of Cardiology, the First Affiliated Hospital of Wuhan City, Wuhan, China
| | - Tie Ke
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Qiuyun Chen
- Center for Cardiovascular Genetics, Department of Molecular Cardiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- Department of Molecular Medicine, Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Xin Tu
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
| | - Robert Elston
- Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Shaoqi Rao
- Institute of Medical Systems Biology and Department of Medical Statistics and Epidemiology, School of Public Health, Guangdong Medical College, Dongguan, China
| | - Yanzong Yang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yunlong Xia
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qing K. Wang
- Key Laboratory of Molecular Biophysics of the Ministry of Education, Cardio-X Center, College of Life Science and Technology and Center for Human Genome Research, Huazhong University of Science and Technology, Wuhan, China
- Center for Cardiovascular Genetics, Department of Molecular Cardiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- Department of Molecular Medicine, Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, Ohio, United States of America
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Faustino RS, Wyles SP, Groenendyk J, Michalak M, Terzic A, Perez-Terzic C. Systems biology surveillance decrypts pathological transcriptome remodeling. BMC SYSTEMS BIOLOGY 2015; 9:36. [PMID: 26179794 PMCID: PMC4504166 DOI: 10.1186/s12918-015-0177-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 06/05/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Pathological cardiac development is precipitated by dysregulation of calreticulin, an endoplasmic reticulum (ER)-resident calcium binding chaperone and critical contributor to cardiogenesis and embryonic viability. However, pleiotropic phenotype derangements induced by calreticulin deficiency challenge the identification of specific downstream transcriptome elements that direct proper cardiac formation. Here, differential transcriptome navigation was used to diagnose high priority calreticulin domain-specific gene expression changes and decrypt complex cardiac-specific molecular responses elicited by discrete functional regions of calreticulin. METHODS Wild type (WT), calreticulin-deficient (CALR(-/-)), and calreticulin truncation variant (CALR(-/-)-NP and CALR(-/-)-PC) pluripotent stem cells were used to investigate molecular remodeling underlying a model of cardiopathology. Bioinformatic deconvolution of isolated transcriptomes was performed to identify predominant expression trends, gene ontology prioritizations, and molecular network features characteristic of discrete cell types. RESULTS Stem cell lines with wild type (WT), calreticulin-deficient (CALR(-/-)) genomes, as well as calreticulin truncation variants exclusively expressing either the chaperoning (CALR(-/-)-NP) or the calcium binding (CALR(-/-)-PC) domain exhibited characteristic molecular signatures determined by unsupervised agglomerative clustering. Kohonen mapping of RNA expression changes identified transcriptome dynamics that segregated into 12 discrete gene expression meta-profiles which were enriched for regulation of Eukaryotic Initiation Factor 2 (EIF2) signaling. Focused examination of domain-specific gene ontology remodeling revealed a general enrichment of Cardiovascular Development in the truncation variants, with unique prioritization of "Cardiovascular Disease" exclusive to the cohort of down regulated genes of the PC truncation variant. Molecular cartography of genes that comprised this cardiopathological category revealed uncharacterized and novel gene relationships, with identification of Pitx2 as a critical hub within the topology of a CALR(-/-) compromised network. CONCLUSIONS Diagnostic surveillance, through an algorithm that integrates pluripotent stem cell transcriptomes with advanced high throughput assays and computational bioinformatics, revealed collective gene expression network changes that underlie differential phenotype development. Stem cell transcriptomes provide a deep collective molecular index that reflects ad hoc robustness of the pluripotent gene network. Remodeling events such as monogenic lesions provide a background by which high priority candidate disease effectors and regulators can be identified, demonstrated here by a molecular profiling algorithm that decrypts pluripotent wild type versus disrupted genomes.
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Affiliation(s)
- Randolph S Faustino
- Division of Cardiovascular Diseases, Departments of Medicine, Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Saranya P Wyles
- Division of Cardiovascular Diseases, Departments of Medicine, Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Jody Groenendyk
- Department of Biochemistry, University of Alberta, Edmonton, AB, Canada.
| | - Marek Michalak
- Department of Biochemistry, University of Alberta, Edmonton, AB, Canada.
| | - Andre Terzic
- Division of Cardiovascular Diseases, Departments of Medicine, Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Carmen Perez-Terzic
- Division of Cardiovascular Diseases, Departments of Medicine, Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, MN, USA.
- Rehabilitation Medicine Research Center, Rochester, MN, USA.
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128
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Chromosome 4q25 Variants rs2200733, rs10033464, and rs1906591 Contribute to Ischemic Stroke Risk. Mol Neurobiol 2015; 53:3882-3890. [DOI: 10.1007/s12035-015-9332-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 07/01/2015] [Indexed: 12/28/2022]
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129
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Christophersen IE, Ellinor PT. Genetics of atrial fibrillation: from families to genomes. J Hum Genet 2015; 61:61-70. [DOI: 10.1038/jhg.2015.44] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 03/27/2015] [Accepted: 04/07/2015] [Indexed: 12/19/2022]
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130
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Mints Y, Yarmohammadi H, Khurram IM, Hoyt H, Hansford R, Zimmerman SL, Steinberg SJ, Judge DP, Tomaselli GF, Calkins H, Zipunnikov V, Nazarian S. Association of common variations on chromosome 4q25 and left atrial volume in patients with atrial fibrillation. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2015; 9:39-45. [PMID: 26005361 PMCID: PMC4431477 DOI: 10.4137/cmc.s21712] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 02/01/2015] [Accepted: 02/09/2015] [Indexed: 01/08/2023]
Abstract
AIMS Recent studies have shown that several genetic variants near the PITX2 locus on chromosome 4q25 are associated with atrial fibrillation (AF). However, the mechanism that mediates this association remains unclear. Basic murine studies suggest that reduced PITX2 expression is associated with left atrial dilatation. We sought to examine the association between single nucleotide polymorphisms (SNPs) near PITX2 and left atrial size in patients with AF. METHODS We prospectively enrolled 96 consecutive patients (mean age 60 ± 10 years, 72% male) with drug-resistant AF (57% paroxysmal, 38% persistent, and 5% long-standing persistent) who underwent catheter ablation. Following DNA extraction from blood obtained pre-operatively, SNPs rs10033464 and rs2200733 were genotyped using the Sequenom MassARRAY. Left atrial volume (LAV) was determined using three-dimensional imaging (CT or MRI prior to first ablation) and by investigators blinded to genotype results. RESULTS The minor allele frequencies at SNPs rs10033464 and rs2200733 were 0.14 and 0.25, respectively. Using multivariable linear regression, homozygosity for the minor allele at rs10033464 (recessive model) was independently associated with larger LAV (P = 0.002) after adjustment for age, gender, BMI, height, type, and duration of AF, left ventricular ejection fraction, history of hypertension, valve disease, and antiarrhythmic drug use. The strength of the association was reconfirmed in a bootstrap study with 1000 resamplings. In contrast, no association was found between rs2200733 variant alleles and LAV. CONCLUSION SNP rs10033464 near the PITX2 locus on 4q25 is associated with LAV. Left atrial dilatation may mediate the association of common variants at 4q25 with AF.
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Affiliation(s)
- Yuliya Mints
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Hirad Yarmohammadi
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Irfan M Khurram
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Hana Hoyt
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Rozann Hansford
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | | | - Steven J Steinberg
- Department of Neurology and Institute of Genetic Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel P Judge
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Gordon F Tomaselli
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Hugh Calkins
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Vadim Zipunnikov
- Department of Biostatistics, Johns Hopkins University, Baltimore, MD, USA
| | - Saman Nazarian
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA. ; Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
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131
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Aguirre LA, Alonso ME, Badía-Careaga C, Rollán I, Arias C, Fernández-Miñán A, López-Jiménez E, Aránega A, Gómez-Skarmeta JL, Franco D, Manzanares M. Long-range regulatory interactions at the 4q25 atrial fibrillation risk locus involve PITX2c and ENPEP. BMC Biol 2015; 13:26. [PMID: 25888893 PMCID: PMC4416339 DOI: 10.1186/s12915-015-0138-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 04/10/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Recent genome-wide association studies have uncovered genomic loci that underlie an increased risk for atrial fibrillation, the major cardiac arrhythmia in humans. The most significant locus is located in a gene desert at 4q25, approximately 170 kilobases upstream of PITX2, which codes for a transcription factor involved in embryonic left-right asymmetry and cardiac development. However, how this genomic region functionally and structurally relates to PITX2 and atrial fibrillation is unknown. RESULTS To characterise its function, we tested genomic fragments from 4q25 for transcriptional activity in a mouse atrial cardiomyocyte cell line and in transgenic mouse embryos, identifying a non-tissue-specific potentiator regulatory element. Chromosome conformation capture revealed that this region physically interacts with the promoter of the cardiac specific isoform of Pitx2. Surprisingly, this regulatory region also interacts with the promoter of the next neighbouring gene, Enpep, which we show to be expressed in regions of the developing mouse heart essential for cardiac electrical activity. CONCLUSIONS Our data suggest that de-regulation of both PITX2 and ENPEP could contribute to an increased risk of atrial fibrillation in carriers of disease-associated variants, and show the challenges that we face in the functional analysis of genome-wide disease associations.
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Affiliation(s)
- Luis A Aguirre
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain.
| | - M Eva Alonso
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain.
| | - Claudio Badía-Careaga
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain.
| | - Isabel Rollán
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain.
| | - Cristina Arias
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain.
| | - Ana Fernández-Miñán
- Centro Andaluz de Biología del Desarrollo (CABD), CSIC-Universidad Pablo de Olavide-Junta de Andalucía, ctra. de Utrera km1, 41013, Seville, Spain.
| | - Elena López-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain.
| | - Amelia Aránega
- Department of Experimental Biology, Faculty of Experimental Sciences, University of Jaen, Paraje de las Lagunillas s/n, 23071, Jaén, Spain.
| | - José Luis Gómez-Skarmeta
- Centro Andaluz de Biología del Desarrollo (CABD), CSIC-Universidad Pablo de Olavide-Junta de Andalucía, ctra. de Utrera km1, 41013, Seville, Spain.
| | - Diego Franco
- Department of Experimental Biology, Faculty of Experimental Sciences, University of Jaen, Paraje de las Lagunillas s/n, 23071, Jaén, Spain.
| | - Miguel Manzanares
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro 3, 28029, Madrid, Spain.
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132
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Roberts JD, Gollob MH. A contemporary review on the genetic basis of atrial fibrillation. Methodist Debakey Cardiovasc J 2015; 10:18-24. [PMID: 24932358 DOI: 10.14797/mdcj-10-1-18] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Atrial fibrillation is the most common sustained cardiac arrhythmia, and affected individuals suffer from increased rates of heart failure, stroke, and death. Despite the enormous clinical burden that it exerts on patients and health care systems, contemporary treatment strategies have only modest efficacy that likely stems from our limited understanding of its underlying pathophysiology. Epidemiological studies have provided unequivocal evidence that the arrhythmia has a substantial heritable component. Subsequent investigations into the genetics underlying atrial fibrillation have suggested that there is considerable interindividual variability in the pathophysiology characterizing the arrhythmia. This heterogeneity may partly account for the poor treatment efficacy of current therapies. Subdividing atrial fibrillation into mechanistic subtypes on the basis of genotype illustrates the heterogeneous nature of the arrhythmia and may ultimately help guide treatment strategies. A pharmacogenetic approach to the management of atrial fibrillation may lead to dramatic improvements in treatment efficacy and improved patient outcomes.
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Shoemaker MB, Bollmann A, Lubitz SA, Ueberham L, Saini H, Montgomery J, Edwards T, Yoneda Z, Sinner MF, Arya A, Sommer P, Delaney J, Goyal SK, Saavedra P, Kanagasundram A, Whalen SP, Roden DM, Hindricks G, Ellis CR, Ellinor PT, Darbar D, Husser D. Common genetic variants and response to atrial fibrillation ablation. Circ Arrhythm Electrophysiol 2015; 8:296-302. [PMID: 25684755 DOI: 10.1161/circep.114.001909] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 01/29/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND Common single nucleotide polymorphisms (SNPs) at chromosomes 4q25 (rs2200733, rs10033464 near PITX2), 1q21 (rs13376333 in KCNN3), and 16q22 (rs7193343 in ZFHX3) have consistently been associated with the risk of atrial fibrillation (AF). Single-center studies have shown that 4q25 risk alleles predict recurrence of AF after catheter ablation of AF. Here, we performed a meta-analysis to test the hypothesis that these 4 AF susceptibility SNPs modulate response to AF ablation. METHODS AND RESULTS Patients underwent de novo AF ablation between 2008 and 2012 at Vanderbilt University, the Heart Center Leipzig, and Massachusetts General Hospital. The primary outcome was 12-month recurrence, defined as an episode of AF, atrial flutter, or atrial tachycardia lasting >30 seconds after a 3-month blanking period. Multivariable analysis of the individual cohorts using a Cox proportional hazards model was performed. Summary statistics from the 3 centers were analyzed using fixed effects meta-analysis. A total of 991 patients were included (Vanderbilt University, 245; Heart Center Leipzig, 659; and Massachusetts General Hospital, 87). The overall single procedure 12-month recurrence rate was 42%. The overall risk allele frequency for these SNPs ranged from 12% to 35%. Using a dominant genetic model, the 4q25 SNP, rs2200733, predicted a 1.4-fold increased risk of recurrence (adjusted hazard ratio,1.3 [95% confidence intervals, 1.1-1.6]; P=0.011). The remaining SNPs, rs10033464 (4q25), rs13376333 (1q21), and rs7193343 (16q22) were not significantly associated with recurrence. CONCLUSIONS Among the 3 genetic loci most strongly associated with AF, the chromosome 4q25 SNP rs2200733 is significantly associated with recurrence of atrial arrhythmias after catheter ablation for AF.
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Affiliation(s)
- M Benjamin Shoemaker
- From the Department of Medicine, Vanderbilt University, Nashville, TN (M.B.S., J.M., T.E., Z.Y., J.D., S.K.G., P.S., A.K., S.P.W., D.M.R., C.R.E., D.D.); Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany (A.B., L.U., A.A., P.S., G.H., D.H.); Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., H.S., P.T.E.); and Department of Medicine, University Hospital Munich, Munich, Germany (M.F.S.).
| | - Andreas Bollmann
- From the Department of Medicine, Vanderbilt University, Nashville, TN (M.B.S., J.M., T.E., Z.Y., J.D., S.K.G., P.S., A.K., S.P.W., D.M.R., C.R.E., D.D.); Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany (A.B., L.U., A.A., P.S., G.H., D.H.); Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., H.S., P.T.E.); and Department of Medicine, University Hospital Munich, Munich, Germany (M.F.S.)
| | - Steven A Lubitz
- From the Department of Medicine, Vanderbilt University, Nashville, TN (M.B.S., J.M., T.E., Z.Y., J.D., S.K.G., P.S., A.K., S.P.W., D.M.R., C.R.E., D.D.); Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany (A.B., L.U., A.A., P.S., G.H., D.H.); Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., H.S., P.T.E.); and Department of Medicine, University Hospital Munich, Munich, Germany (M.F.S.)
| | - Laura Ueberham
- From the Department of Medicine, Vanderbilt University, Nashville, TN (M.B.S., J.M., T.E., Z.Y., J.D., S.K.G., P.S., A.K., S.P.W., D.M.R., C.R.E., D.D.); Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany (A.B., L.U., A.A., P.S., G.H., D.H.); Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., H.S., P.T.E.); and Department of Medicine, University Hospital Munich, Munich, Germany (M.F.S.)
| | - Harsimran Saini
- From the Department of Medicine, Vanderbilt University, Nashville, TN (M.B.S., J.M., T.E., Z.Y., J.D., S.K.G., P.S., A.K., S.P.W., D.M.R., C.R.E., D.D.); Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany (A.B., L.U., A.A., P.S., G.H., D.H.); Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., H.S., P.T.E.); and Department of Medicine, University Hospital Munich, Munich, Germany (M.F.S.)
| | - Jay Montgomery
- From the Department of Medicine, Vanderbilt University, Nashville, TN (M.B.S., J.M., T.E., Z.Y., J.D., S.K.G., P.S., A.K., S.P.W., D.M.R., C.R.E., D.D.); Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany (A.B., L.U., A.A., P.S., G.H., D.H.); Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., H.S., P.T.E.); and Department of Medicine, University Hospital Munich, Munich, Germany (M.F.S.)
| | - Todd Edwards
- From the Department of Medicine, Vanderbilt University, Nashville, TN (M.B.S., J.M., T.E., Z.Y., J.D., S.K.G., P.S., A.K., S.P.W., D.M.R., C.R.E., D.D.); Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany (A.B., L.U., A.A., P.S., G.H., D.H.); Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., H.S., P.T.E.); and Department of Medicine, University Hospital Munich, Munich, Germany (M.F.S.)
| | - Zachary Yoneda
- From the Department of Medicine, Vanderbilt University, Nashville, TN (M.B.S., J.M., T.E., Z.Y., J.D., S.K.G., P.S., A.K., S.P.W., D.M.R., C.R.E., D.D.); Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany (A.B., L.U., A.A., P.S., G.H., D.H.); Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., H.S., P.T.E.); and Department of Medicine, University Hospital Munich, Munich, Germany (M.F.S.)
| | - Moritz F Sinner
- From the Department of Medicine, Vanderbilt University, Nashville, TN (M.B.S., J.M., T.E., Z.Y., J.D., S.K.G., P.S., A.K., S.P.W., D.M.R., C.R.E., D.D.); Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany (A.B., L.U., A.A., P.S., G.H., D.H.); Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., H.S., P.T.E.); and Department of Medicine, University Hospital Munich, Munich, Germany (M.F.S.)
| | - Arash Arya
- From the Department of Medicine, Vanderbilt University, Nashville, TN (M.B.S., J.M., T.E., Z.Y., J.D., S.K.G., P.S., A.K., S.P.W., D.M.R., C.R.E., D.D.); Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany (A.B., L.U., A.A., P.S., G.H., D.H.); Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., H.S., P.T.E.); and Department of Medicine, University Hospital Munich, Munich, Germany (M.F.S.)
| | - Philipp Sommer
- From the Department of Medicine, Vanderbilt University, Nashville, TN (M.B.S., J.M., T.E., Z.Y., J.D., S.K.G., P.S., A.K., S.P.W., D.M.R., C.R.E., D.D.); Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany (A.B., L.U., A.A., P.S., G.H., D.H.); Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., H.S., P.T.E.); and Department of Medicine, University Hospital Munich, Munich, Germany (M.F.S.)
| | - Jessica Delaney
- From the Department of Medicine, Vanderbilt University, Nashville, TN (M.B.S., J.M., T.E., Z.Y., J.D., S.K.G., P.S., A.K., S.P.W., D.M.R., C.R.E., D.D.); Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany (A.B., L.U., A.A., P.S., G.H., D.H.); Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., H.S., P.T.E.); and Department of Medicine, University Hospital Munich, Munich, Germany (M.F.S.)
| | - Sandeep K Goyal
- From the Department of Medicine, Vanderbilt University, Nashville, TN (M.B.S., J.M., T.E., Z.Y., J.D., S.K.G., P.S., A.K., S.P.W., D.M.R., C.R.E., D.D.); Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany (A.B., L.U., A.A., P.S., G.H., D.H.); Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., H.S., P.T.E.); and Department of Medicine, University Hospital Munich, Munich, Germany (M.F.S.)
| | - Pablo Saavedra
- From the Department of Medicine, Vanderbilt University, Nashville, TN (M.B.S., J.M., T.E., Z.Y., J.D., S.K.G., P.S., A.K., S.P.W., D.M.R., C.R.E., D.D.); Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany (A.B., L.U., A.A., P.S., G.H., D.H.); Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., H.S., P.T.E.); and Department of Medicine, University Hospital Munich, Munich, Germany (M.F.S.)
| | - Arvindh Kanagasundram
- From the Department of Medicine, Vanderbilt University, Nashville, TN (M.B.S., J.M., T.E., Z.Y., J.D., S.K.G., P.S., A.K., S.P.W., D.M.R., C.R.E., D.D.); Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany (A.B., L.U., A.A., P.S., G.H., D.H.); Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., H.S., P.T.E.); and Department of Medicine, University Hospital Munich, Munich, Germany (M.F.S.)
| | - S Patrick Whalen
- From the Department of Medicine, Vanderbilt University, Nashville, TN (M.B.S., J.M., T.E., Z.Y., J.D., S.K.G., P.S., A.K., S.P.W., D.M.R., C.R.E., D.D.); Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany (A.B., L.U., A.A., P.S., G.H., D.H.); Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., H.S., P.T.E.); and Department of Medicine, University Hospital Munich, Munich, Germany (M.F.S.)
| | - Dan M Roden
- From the Department of Medicine, Vanderbilt University, Nashville, TN (M.B.S., J.M., T.E., Z.Y., J.D., S.K.G., P.S., A.K., S.P.W., D.M.R., C.R.E., D.D.); Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany (A.B., L.U., A.A., P.S., G.H., D.H.); Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., H.S., P.T.E.); and Department of Medicine, University Hospital Munich, Munich, Germany (M.F.S.)
| | - Gerhard Hindricks
- From the Department of Medicine, Vanderbilt University, Nashville, TN (M.B.S., J.M., T.E., Z.Y., J.D., S.K.G., P.S., A.K., S.P.W., D.M.R., C.R.E., D.D.); Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany (A.B., L.U., A.A., P.S., G.H., D.H.); Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., H.S., P.T.E.); and Department of Medicine, University Hospital Munich, Munich, Germany (M.F.S.)
| | - Christopher R Ellis
- From the Department of Medicine, Vanderbilt University, Nashville, TN (M.B.S., J.M., T.E., Z.Y., J.D., S.K.G., P.S., A.K., S.P.W., D.M.R., C.R.E., D.D.); Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany (A.B., L.U., A.A., P.S., G.H., D.H.); Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., H.S., P.T.E.); and Department of Medicine, University Hospital Munich, Munich, Germany (M.F.S.)
| | - Patrick T Ellinor
- From the Department of Medicine, Vanderbilt University, Nashville, TN (M.B.S., J.M., T.E., Z.Y., J.D., S.K.G., P.S., A.K., S.P.W., D.M.R., C.R.E., D.D.); Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany (A.B., L.U., A.A., P.S., G.H., D.H.); Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., H.S., P.T.E.); and Department of Medicine, University Hospital Munich, Munich, Germany (M.F.S.)
| | - Dawood Darbar
- From the Department of Medicine, Vanderbilt University, Nashville, TN (M.B.S., J.M., T.E., Z.Y., J.D., S.K.G., P.S., A.K., S.P.W., D.M.R., C.R.E., D.D.); Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany (A.B., L.U., A.A., P.S., G.H., D.H.); Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., H.S., P.T.E.); and Department of Medicine, University Hospital Munich, Munich, Germany (M.F.S.)
| | - Daniela Husser
- From the Department of Medicine, Vanderbilt University, Nashville, TN (M.B.S., J.M., T.E., Z.Y., J.D., S.K.G., P.S., A.K., S.P.W., D.M.R., C.R.E., D.D.); Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany (A.B., L.U., A.A., P.S., G.H., D.H.); Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, Boston (S.A.L., H.S., P.T.E.); and Department of Medicine, University Hospital Munich, Munich, Germany (M.F.S.)
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Rollo J, Knight S, May HT, Anderson JL, Muhlestein JB, Bunch TJ, Carlquist J. Incidence of dementia in relation to genetic variants at PITX2, ZFHX3, and ApoE ε4 in atrial fibrillation patients. Pacing Clin Electrophysiol 2015; 38:171-7. [PMID: 25494715 DOI: 10.1111/pace.12537] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 09/05/2014] [Accepted: 10/19/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Mechanisms underlying atrial fibrillation (AF) and dementia are unknown. Some genetic risk factors convey risk for AF and cerebral ischemic events. These markers may identify AF patients at risk for dementia either directly or through a gene-gene interaction with the ApoE ε4 variant, a known marker of dementia risk. METHODS Caucasian patients with AF and a subsequent dementia diagnosis (n = 112) were matched 1:2 on sex, AF onset age, and follow-up period to AF patients without dementia. AF patients with dementia and AF patients without dementia were matched 1:1 on sex and age at dementia diagnosis (n = 112). Genotyping employed Taqman real-time polymerase chain reaction. Multivariable conditional logistic regression was used to examine associations between AF/dementia groups and single nucleotide polymorphism (SNP), as well as gene-gene interactions. RESULTS In dementia patients, there was an association between the PITX2 loci and AF (rs2634073: odds ratio [OR] = 2.11; P = 0.025 and rs2200733: OR = 2.27; P = 0.029). In patients with AF, there was an association between PITX2 loci, rs2200733, and dementia (OR = 2.15, P = 0.008). There was no association between ApoE ε4 allele and AF in patients with dementia, although confirmation of the association between the carriage of ApoE ε4 allele and dementia was found (OR = 1.79; P = 0.026) in patients with AF. There were no significant interactions between ApoE ε4 allele and both the PITX2 loci and ZFHX3. CONCLUSIONS These findings support prior studies of ApoE risk of noncerebral vascular accident-related dementia/Alzheimer's risk in the Caucasians and provide support to suggest an association between PITX2-related SNPs and dementia, which may in part be attributed to silent cerebral ischemic events, a hypothesis deserving further testing.
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Affiliation(s)
- Jeffrey Rollo
- Intermountain Heart Institute, Intermountain Medical Center, Murray, Utah
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Scridon A, Fouilloux-Meugnier E, Loizon E, Rome S, Julien C, Barrès C, Chevalier P. Long-standing arterial hypertension is associated with Pitx2 down-regulation in a rat model of spontaneous atrial tachyarrhythmias. Europace 2015; 17:160-5. [PMID: 24908044 DOI: 10.1093/europace/euu139] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIMS The timecourse of left atrial Pitx2 down-regulation in the setting of atrial tachyarrhythmias remains unknown. Accordingly, we aimed to assess the age dependency of left atrial Pitx2 expression in an experimental model of spontaneous atrial tachyarrhythmias in rats. METHODS AND RESULTS Atrial sampling was performed in three groups (n = 4 each) of young (14-week-old), adult (24-week-old), and ageing (48-week-old) spontaneously hypertensive rats (SHRs), in which we previously demonstrated the age dependency of spontaneous atrial tachyarrhythmias, and three groups (n = 4 each) of age-matched normotensive Wistar-Kyoto (WKY) rats. mRNA expression of Pitx2 was studied using real-time polymerase chain reaction. Ageing SHRs presented significantly lower left atrial Pitx2 expressions compared with age-matched WKY rats (P = 0.02), while no significant difference was observed between young or adult SHRs and age-matched WKY rats (both P > 0.05). Among SHRs, Pitx2 expressions showed a progressive, age-dependent decrease (34.9 ± 6.7 in young SHRs, 17.1 ± 3.6 in adult SHRs, and 10.7 ± 1.7 in ageing SHRs, P = 0.04) and were significantly negatively correlated with both age (Spearman r = -0.86, P < 0.01) and heart weight (Spearman r = -0.76, P < 0.01). CONCLUSION The present study suggests the presence of age-dependent left atrial Pitx2 down-regulation in SHRs. The strong negative correlation between left atrial Pitx2 expression and heart weight among SHRs may indicate a link between long-standing arterial hypertension and Pitx2-related atrial arrhythmogenicity.
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Affiliation(s)
- Alina Scridon
- Physiology Department, University of Medicine and Pharmacy of Tîrgu Mureş, Tîrgu Mureş 540139, Romania Unité de Neurocardiologie, EA 4612, Université Lyon 1, Lyon F-69008, France
| | | | | | - Sophie Rome
- Unité 1060 INSERM CarMen, Université Lyon 1, Lyon F-69008, France
| | - Claude Julien
- Unité de Neurocardiologie, EA 4612, Université Lyon 1, Lyon F-69008, France
| | - Christian Barrès
- Unité de Neurocardiologie, EA 4612, Université Lyon 1, Lyon F-69008, France
| | - Philippe Chevalier
- Unité de Neurocardiologie, EA 4612, Université Lyon 1, Lyon F-69008, France Service de Rythmologie, Hospices Civils de Lyon, Hôpital Louis Pradel, 28 Avenue du Doyen Lépine, Bron Cedex 69500, France
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Deshmukh A, Barnard J, Sun H, Newton D, Castel L, Pettersson G, Johnston D, Roselli E, Gillinov AM, McCurry K, Moravec C, Smith JD, Van Wagoner DR, Chung MK. Left atrial transcriptional changes associated with atrial fibrillation susceptibility and persistence. Circ Arrhythm Electrophysiol 2014; 8:32-41. [PMID: 25523945 DOI: 10.1161/circep.114.001632] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Prior transcriptional studies of atrial fibrillation (AF) have been limited to specific transcripts, animal models, chronic AF, right atria, or small samples. We sought to characterize the left atrial transcriptome in human AF to distinguish changes related to AF susceptibility and persistence. METHODS AND RESULTS Left atrial appendages from 239 patients stratified by coronary artery disease, valve disease, and AF history (no history of AF, AF history in sinus rhythm at surgery, and AF history in AF at surgery) were selected for genome-wide mRNA microarray profiling. Transcripts were examined for differential expression with AF phenotype group. Enrichment in differentially expressed genes was examined in 3 gene set collections: a transcription factor collection, defined by shared conserved cis-regulatory motifs, a miRNA collection, defined by shared 3' untranslated region motifs, and a molecular function collection, defined by shared Gene Ontology molecular function. AF susceptibility was associated with decreased expression of the targets of CREB/ATF family, heat-shock factor 1, ATF6, SRF, and E2F1 transcription factors. Persistent AF activity was associated with decreased expression in genes and gene sets related to ion channel function consistent with reported functional changes. CONCLUSIONS AF susceptibility was associated with decreased expression of targets of several transcription factors related to inflammation, oxidation, and cellular stress responses. In contrast, changes in ion channel expression were associated with AF activity but were limited in AF susceptibility. Our results suggest that significant transcriptional remodeling marks susceptibility to AF, whereas remodeling of ion channel expression occurs later in the progression or as a consequence of AF.
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Affiliation(s)
- Amrish Deshmukh
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - John Barnard
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - Han Sun
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - David Newton
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - Laurie Castel
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - Gosta Pettersson
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - Douglas Johnston
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - Eric Roselli
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - A Marc Gillinov
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - Kenneth McCurry
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - Christine Moravec
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - Jonathan D Smith
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - David R Van Wagoner
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.)
| | - Mina K Chung
- From the Department of Medicine, University of Chicago, IL (A.D.); Department of Quantitative Health Sciences (J.B; H.S.), Department of Molecular Cardiology (L.C., D.R.V.W., M.K.C.), and Department of Cellular and Molecular Medicine, Cleveland Clinic (J.D.S.), Lerner Research Institute, OH; Department of Cardiovascular Medicine (D.N., C.M., J.D.S., M.K.C.) and Department of Cardiovascular Medicine and Thoracic and Cardiovascular Surgery (G.P., D.J., E.R., A.M.G., K.M.), Heart and Vascular Institute, Cleveland, OH; and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH (C.M., J.D.S., D.R.V.W., M.K.C.).
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Abstract
Atrial fibrillation (AF), the most common sustained arrhythmia in clinical practice, is an important contributor to cardiac morbidity and mortality. Pharmacological approaches currently available to treat patients with AF lack sufficient efficacy and are associated with potential adverse effects. Even though ablation is generally more effective than pharmacotherapy, this invasive procedure has considerable potential complications and is limited by long-term recurrences. Novel therapies based on the underlying molecular mechanisms of AF can provide useful alternatives to current treatments. MicroRNAs (miRNAs), endogenous short RNA sequences that regulate gene expression, have been implicated in the control of AF, providing novel insights into the molecular basis of the pathogenesis of AF and suggesting miRNA targeting as a potential approach for the management of this common arrhythmia. In this Review, we provide a comprehensive analysis of the current experimental evidence supporting miRNAs as important factors in AF and discuss their therapeutic implications. We first provide background information on the pathophysiology of AF and the biological determinants of miRNA synthesis and action, followed by experimental evidence for miRNA-mediated regulation of AF, and finally provide a comprehensive overview of miRNAs as potential novel therapeutic targets for AF.
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Ferrán A, Alegret JM, Subirana I, Aragonès G, Lluis-Ganella C, Romero-Menor C, Planas F, Joven J, Elosua R. Asociación de los polimorfismos rs2200733 y rs7193343 con la fibrilación auricular en población española y metanálisis de la evidencia existente. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ferrán A, Alegret JM, Subirana I, Aragonès G, Lluis-Ganella C, Romero-Menor C, Planas F, Joven J, Elosua R. Association between rs2200733 and rs7193343 genetic variants and atrial fibrillation in a Spanish population, and meta-analysis of previous studies. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2014; 67:822-9. [PMID: 25262128 DOI: 10.1016/j.rec.2013.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 12/19/2013] [Indexed: 02/03/2023]
Abstract
INTRODUCTION AND OBJECTIVES The objectives of this study were to analyze the association between two genetic variants (rs2200733 and rs7193343) in a Spanish population and the risk of developing atrial fibrillation, and to carry out a systematic review and meta-analysis of these associations. METHODS We performed a case-control study involving 257 case patients with atrial fibrillation and 379 controls. The case patients were individuals who had donated samples to the Spanish National DNA Bank; the controls were participating in a population-based cross-sectional study. Genotyping was carried out using a TaqMan assay. We conducted a systematic literature search in which 2 independent reviewers extracted the necessary information. The study involved a meta-analysis, a heterogeneity analysis, and a meta-regression analysis to identify the variables that explain the heterogeneity across studies. RESULTS In our population, the presence of atrial fibrillation was found to be associated with rs2200733 (odds ratio = 1.87; 95% confidence interval, 1.30-2.70), but not with rs7193343 (odds ratio = 1.18; 95% confidence interval, 0.80-1.73). In the meta-analysis, we observed an association between atrial fibrillation and both variants: odds ratio = 1.71 (95% confidence interval, 1.54-1.90) for rs2200733 and odds ratio = 1.18 (95% confidence interval, 1.11-1.25) for rs7193343. We observed heterogeneity among the studies dealing with the association between rs2200733 and atrial fibrillation, partially related to the study design, and the strength of association was greater in case-control studies (odds ratio = 1.83) than in cohort studies (odds ratio = 1.41). CONCLUSIONS Variants rs2200733 and rs7193343 are associated with a higher risk of atrial fibrillation. Case-control studies tend to overestimate the strength of association between these genetic variants and atrial fibrillation.
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Affiliation(s)
- Albert Ferrán
- Grupo de Investigación en Epidemiología y Genética Cardiovascular, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain
| | - José María Alegret
- Sección de Cardiología, Hospital Universitari de Sant Joan, Grup de Recerca Cardiovascular, IISPV, Universitat Rovira i Virgili, Reus, Tarragona, Spain
| | - Isaac Subirana
- Grupo de Investigación en Epidemiología y Genética Cardiovascular, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain; CIBER de Epidemiología y Salud Pública, Barcelona, Spain
| | - Gerard Aragonès
- Sección de Cardiología, Hospital Universitari de Sant Joan, Grup de Recerca Cardiovascular, IISPV, Universitat Rovira i Virgili, Reus, Tarragona, Spain; Centre for Omic Sciences, Servei de Recursos Científics i Tècnics, Universitat Rovira i Virgili, Tarragona, Spain
| | - Carla Lluis-Ganella
- Grupo de Investigación en Epidemiología y Genética Cardiovascular, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain
| | - César Romero-Menor
- Servicio de Cardiología, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Francesc Planas
- Servicio de Cardiología, Hospital Municipal de Badalona, Badalona, Barcelona, Spain
| | - Jorge Joven
- Unidad de Investigación Biomédica (URB-CRB), IISPV, Hospital Universitari de Sant Joan, Universitat Rovira i Virgili, Reus, Tarragona, Spain
| | - Roberto Elosua
- Grupo de Investigación en Epidemiología y Genética Cardiovascular, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain.
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Small engine, big power: microRNAs as regulators of cardiac diseases and regeneration. Int J Mol Sci 2014; 15:15891-911. [PMID: 25207600 PMCID: PMC4200826 DOI: 10.3390/ijms150915891] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 08/27/2014] [Accepted: 08/27/2014] [Indexed: 12/20/2022] Open
Abstract
Cardiac diseases are the predominant cause of human mortality in the United States and around the world. MicroRNAs (miRNAs) are small non-coding RNAs that have been shown to modulate a wide range of biological functions under various pathophysiological conditions. miRNAs alter target expression by post-transcriptional regulation of gene expression. Numerous studies have implicated specific miRNAs in cardiovascular development, pathology, regeneration and repair. These observations suggest that miRNAs are potential therapeutic targets to prevent or treat cardiovascular diseases. This review focuses on the emerging role of miRNAs in cardiac development, pathogenesis of cardiovascular diseases, cardiac regeneration and stem cell-mediated cardiac repair. We also discuss the novel diagnostic and therapeutic potential of these miRNAs and their targets in patients with cardiac diseases.
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141
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Mahida S. Genetic Discoveries in Atrial Fibrillation and Implications for Clinical Practice. Arrhythm Electrophysiol Rev 2014; 3:69-75. [PMID: 26835069 DOI: 10.15420/aer.2014.3.2.69] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 07/04/2014] [Indexed: 11/04/2022] Open
Abstract
Atrial fibrillation (AF) is an arrhythmia with a genetic basis. Over the past decade, rapid advances in genotyping technology have revolutionised research regarding the genetic basis of AF. While AF genetics research was previously largely restricted to familial forms of AF, recent studies have begun to characterise the genetic architecture underlying the form of AF encountered in everyday clinical practice. These discoveries could have a significant impact on the management of AF. However, much work remains before genetic findings can be translated to clinical practice. This review summarises results of studies in AF genetics to date and discusses the potential implications of these findings in clinical practice.
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Abstract
Atrial fibrillation (AF) is a highly prevalent arrhythmia with pronounced morbidity and mortality. Genetics analysis has established electrophysiological substrates, which determine individual vulnerability to AF occurrence and maintenance. MicroRNAs (miRNAs) found in virtually all organisms function as negative regulators of protein-coding genes. Several studies have suggested a role for miRNAs in the regulation of cardiac excitability and arrhythmogenesis. This review is based on 18 studies conducted between 2009 and 2013 to investigate the association of miRNAs with AF. miRNAs are discussed here as candidate biomarkers for AF in blood and cardiac tissues and as potential targets for AF therapy.
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143
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Martin RIR, Pogoryelova O, Koref MS, Bourke JP, Teare MD, Keavney BD. Atrial fibrillation associated with ivabradine treatment: meta-analysis of randomised controlled trials. Heart 2014; 100:1506-10. [PMID: 24951486 PMCID: PMC4174120 DOI: 10.1136/heartjnl-2014-305482] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective To quantify any risk of atrial fibrillation (AF) associated with ivabradine treatment by meta-analysis of clinical trial data. Methods Medline, Embase, Web of Knowledge and the Cochrane central register of controlled trials were searched for double-blinded randomised controlled trials of ivabradine with a minimum follow-up period of 4 weeks. For studies where AF data were unpublished, safety data were obtained from the European Medicines Agency (EMeA) website and personal communications. Studies were appraised for risk of bias using components recommended by the Cochrane Collaboration. Meta-analyses were performed of relative risk of AF and absolute risk difference of AF per year of treatment. The main outcome measure was incident AF during the follow-up period. Results AF data were available from 11 studies: one from the published report, six from the EMeA and four from personal communications. Ivabradine treatment was associated with a relative risk of AF of 1.15 (95% CI 1.07 to 1.24, p=0.0027) among 21 571 patients in the meta-analysis. From this we estimated that the number needed to harm for ivabradine would be 208 (95% CI 122 to 667) per year of treatment. Conclusions AF is a substantially more common side effect of ivabradine treatment than one patient in 10 000, the risk presently reported in the product literature. The incidence of AF has not routinely been reported in clinical trials of ivabradine.
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Affiliation(s)
- Ruairidh I R Martin
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK Department of Cardiology, Freeman Hospital, Newcastle, UK
| | - Oksana Pogoryelova
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | | | - John P Bourke
- Department of Cardiology, Freeman Hospital, Newcastle, UK
| | - M Dawn Teare
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Bernard D Keavney
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
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144
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Abstract
Atrial fibrillation (AF) is the most common arrhythmia and is associated with increased morbidity. As the population ages and the prevalence of AF continues to rise, the socioeconomic consequences of AF will become increasingly burdensome. Although there are well-defined clinical risk factors for AF, a significant heritable component is also recognized. To identify the molecular basis for the heritability of AF, investigators have used a combination of classical Mendelian genetics, candidate gene screening, and genome-wide association studies. However, these avenues have, as yet, failed to define the majority of the heritability of AF. The goal of this review is to describe the results from both candidate gene and genome-wide studies, as well as to outline potential future avenues for creating a more complete understanding of AF genetics. Ultimately, a more comprehensive view of the genetic underpinnings for AF will lead to the identification of novel molecular pathways and improved risk prediction of this complex arrhythmia.
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Affiliation(s)
- Nathan R Tucker
- From the Cardiovascular Research Center, Massachusetts General Hospital, Boston
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145
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Heijman J, Voigt N, Nattel S, Dobrev D. Cellular and molecular electrophysiology of atrial fibrillation initiation, maintenance, and progression. Circ Res 2014; 114:1483-99. [PMID: 24763466 DOI: 10.1161/circresaha.114.302226] [Citation(s) in RCA: 478] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Atrial fibrillation (AF) is the most common clinically relevant arrhythmia and is associated with increased morbidity and mortality. The incidence of AF is expected to continue to rise with the aging of the population. AF is generally considered to be a progressive condition, occurring first in a paroxysmal form, then in persistent, and then long-standing persistent (chronic or permanent) forms. However, not all patients go through every phase, and the time spent in each can vary widely. Research over the past decades has identified a multitude of pathophysiological processes contributing to the initiation, maintenance, and progression of AF. However, many aspects of AF pathophysiology remain incompletely understood. In this review, we discuss the cellular and molecular electrophysiology of AF initiation, maintenance, and progression, predominantly based on recent data obtained in human tissue and animal models. The central role of Ca(2+)-handling abnormalities in both focal ectopic activity and AF substrate progression is discussed, along with the underlying molecular basis. We also deal with the ionic determinants that govern AF initiation and maintenance, as well as the structural remodeling that stabilizes AF-maintaining re-entrant mechanisms and finally makes the arrhythmia refractory to therapy. In addition, we highlight important gaps in our current understanding, particularly with respect to the translation of these concepts to the clinical setting. Ultimately, a comprehensive understanding of AF pathophysiology is expected to foster the development of improved pharmacological and nonpharmacological therapeutic approaches and to greatly improve clinical management.
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Affiliation(s)
- Jordi Heijman
- From the Institute of Pharmacology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany (J.H., N.V., D.D.); Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada (S.N.); and Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada (S.N.)
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146
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Andrade J, Khairy P, Dobrev D, Nattel S. The clinical profile and pathophysiology of atrial fibrillation: relationships among clinical features, epidemiology, and mechanisms. Circ Res 2014; 114:1453-68. [PMID: 24763464 DOI: 10.1161/circresaha.114.303211] [Citation(s) in RCA: 825] [Impact Index Per Article: 82.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia (estimated lifetime risk, 22%-26%). The aim of this article is to review the clinical epidemiological features of AF and to relate them to underlying mechanisms. Long-established risk factors for AF include aging, male sex, hypertension, valve disease, left ventricular dysfunction, obesity, and alcohol consumption. Emerging risk factors include prehypertension, increased pulse pressure, obstructive sleep apnea, high-level physical training, diastolic dysfunction, predisposing gene variants, hypertrophic cardiomyopathy, and congenital heart disease. Potential risk factors are coronary artery disease, kidney disease, systemic inflammation, pericardial fat, and tobacco use. AF has substantial population health consequences, including impaired quality of life, increased hospitalization rates, stroke occurrence, and increased medical costs. The pathophysiology of AF centers around 4 general types of disturbances that promote ectopic firing and reentrant mechanisms, and include the following: (1) ion channel dysfunction, (2) Ca(2+)-handling abnormalities, (3) structural remodeling, and (4) autonomic neural dysregulation. Aging, hypertension, valve disease, heart failure, myocardial infarction, obesity, smoking, diabetes mellitus, thyroid dysfunction, and endurance exercise training all cause structural remodeling. Heart failure and prior atrial infarction also cause Ca(2+)-handling abnormalities that lead to focal ectopic firing via delayed afterdepolarizations/triggered activity. Neural dysregulation is central to atrial arrhythmogenesis associated with endurance exercise training and occlusive coronary artery disease. Monogenic causes of AF typically promote the arrhythmia via ion channel dysfunction, but the mechanisms of the more common polygenic risk factors are still poorly understood and under intense investigation. Better recognition of the clinical epidemiology of AF, as well as an improved appreciation of the underlying mechanisms, is needed to develop improved methods for AF prevention and management.
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Affiliation(s)
- Jason Andrade
- From Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada (J.A., P.K., S.N.); Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (J.A.); and Faculty of Medicine, Institute of Pharmacology, University Duisburg-Essen, Essen, Germany (D.D.)
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147
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Abstract
Driven by innovative technologies, novel analytical methods, and collaborations unimaginable not long ago, our understanding of the role of genetic variation in stroke has advanced substantially in recent years. However, a vast amount of data have accumulated quickly, and increasingly complex methodologies used in studies make keeping up to date on relevant findings difficult. In addition to well known, highly penetrant rare mutations that cause mendelian disorders related to stroke, several common genetic variants have been associated with common stroke subtypes, some of which also affect disease severity and clinical outcome. Furthermore, common genetic variations in biological pathways that have an important role in the pathophysiology of cerebrovascular diseases-such as blood pressure and oxidative phosphorylation-have been implicated in stroke. Clinical and translational applications of these and future discoveries in stroke genetics include identification of novel targets for treatment and development of personalised approaches to stroke prevention and management.
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148
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Yao M, Cao Y, Zhu H, Chen Y, Zhu T, Xiao J. Paired-like homeodomain 2: a novel therapeutic target for atrial fibrillation? Front Genet 2014; 5:74. [PMID: 24782888 PMCID: PMC3997000 DOI: 10.3389/fgene.2014.00074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 03/24/2014] [Indexed: 01/19/2023] Open
Affiliation(s)
- Mengchao Yao
- Regeneration Lab and Experimental Center of Life Sciences, School of Life Science, Shanghai University Shanghai, China ; Shanghai Key Laboratory of Bio-Energy Crops, School of Life Science, Shanghai University Shanghai, China
| | - Yujie Cao
- Regeneration Lab and Experimental Center of Life Sciences, School of Life Science, Shanghai University Shanghai, China ; Shanghai Key Laboratory of Bio-Energy Crops, School of Life Science, Shanghai University Shanghai, China
| | - Hui Zhu
- Regeneration Lab and Experimental Center of Life Sciences, School of Life Science, Shanghai University Shanghai, China ; Shanghai Key Laboratory of Bio-Energy Crops, School of Life Science, Shanghai University Shanghai, China
| | - Yao Chen
- Regeneration Lab and Experimental Center of Life Sciences, School of Life Science, Shanghai University Shanghai, China ; Shanghai Key Laboratory of Bio-Energy Crops, School of Life Science, Shanghai University Shanghai, China
| | - Tianhao Zhu
- Regeneration Lab and Experimental Center of Life Sciences, School of Life Science, Shanghai University Shanghai, China ; Shanghai Key Laboratory of Bio-Energy Crops, School of Life Science, Shanghai University Shanghai, China
| | - Junjie Xiao
- Regeneration Lab and Experimental Center of Life Sciences, School of Life Science, Shanghai University Shanghai, China ; Shanghai Key Laboratory of Bio-Energy Crops, School of Life Science, Shanghai University Shanghai, China ; Innovative Drug Research Center of Shanghai University Shanghai, China
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149
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Magnani JW, Yin X, McManus DD, Chuang ML, Cheng S, Lubitz SA, Arora G, Manning WJ, Ellinor PT, Benjamin EJ. Genetic loci associated with atrial fibrillation: relation to left atrial structure in the Framingham Heart Study. J Am Heart Assoc 2014; 3:e000616. [PMID: 24695651 PMCID: PMC4187503 DOI: 10.1161/jaha.113.000616] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Atrial fibrillation (AF) results in significant morbidity and mortality. Genome‐wide association studies (GWAS) have identified genetic variants associated with AF. Whether genetic variants associated with AF are also associated with atrial structure, an intermediate phenotype for AF, has had limited investigation. We sought to investigate associations between single nucleotide polymorphisms (SNPs) and atrial structure obtained by cardiovascular imaging in the Framingham Heart Study. Methods and Results We selected 11 SNPs that have been associated with AF in GWAS. We examined the SNPs' relations to cross‐sectional left atrial (LA) dimensions (determined by transthoracic echocardiography) and LA volume (determined by cardiovascular magnetic resonance [CMR]) employing linear regression. The total sample included 1555 participants with CMR LA volume (age 60±9 years, 53% women) and 6861 participants with echocardiographic LA diameter (age 48±13 years, 52% women) measured. We employed a significance threshold of P<0.0023 to account for multiple testing of the 11 SNPs and 2 LA measures. In a primary analysis, no SNPs were significantly related to the LA measures. Likewise, in secondary analyses excluding individuals with prevalent AF (n=77, CMR sample; n=105, echocardiography sample) no SNPs were related to LA volume or diameter. Conclusion In a community‐based cohort, we did not identify a statistically significant association between selected SNPs associated with AF and measures of LA anatomy. Further investigations with larger longitudinally assessed samples and a broader array of SNPs may be necessary to determine the relation between genetic loci associated with AF and atrial structure.
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Affiliation(s)
- Jared W Magnani
- National Heart, Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA
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150
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Lubitz SA, Lunetta KL, Lin H, Arking DE, Trompet S, Li G, Krijthe BP, Chasman DI, Barnard J, Kleber ME, Dörr M, Ozaki K, Smith AV, Müller-Nurasyid M, Walter S, Agarwal SK, Bis JC, Brody JA, Chen LY, Everett BM, Ford I, Franco OH, Harris TB, Hofman A, Kääb S, Mahida S, Kathiresan S, Kubo M, Launer LJ, MacFarlane PW, Magnani JW, McKnight B, McManus DD, Peters A, Psaty BM, Rose LM, Rotter JI, Silbernagel G, Smith JD, Sotoodehnia N, Stott DJ, Taylor KD, Tomaschitz A, Tsunoda T, Uitterlinden AG, Van Wagoner DR, Völker U, Völzke H, Murabito JM, Sinner MF, Gudnason V, Felix SB, März W, Chung M, Albert CM, Stricker BH, Tanaka T, Heckbert SR, Jukema JW, Alonso A, Benjamin EJ, Ellinor PT. Novel genetic markers associate with atrial fibrillation risk in Europeans and Japanese. J Am Coll Cardiol 2014; 63:1200-1210. [PMID: 24486271 PMCID: PMC4009240 DOI: 10.1016/j.jacc.2013.12.015] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 11/10/2013] [Accepted: 12/03/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study sought to identify nonredundant atrial fibrillation (AF) genetic susceptibility signals and examine their cumulative relations with AF risk. BACKGROUND AF-associated loci span broad genomic regions that may contain multiple susceptibility signals. Whether multiple signals exist at AF loci has not been systematically explored. METHODS We performed association testing conditioned on the most significant, independently associated genetic markers at 9 established AF loci using 2 complementary techniques in 64,683 individuals of European ancestry (3,869 incident and 3,302 prevalent AF cases). Genetic risk scores were created and tested for association with AF in Europeans and an independent sample of 11,309 individuals of Japanese ancestry (7,916 prevalent AF cases). RESULTS We observed at least 4 distinct AF susceptibility signals on chromosome 4q25 upstream of PITX2, but not at the remaining 8 AF loci. A multilocus score comprised 12 genetic markers demonstrated an estimated 5-fold gradient in AF risk. We observed a similar spectrum of risk associated with these markers in Japanese. Regions containing AF signals on chromosome 4q25 displayed a greater degree of evolutionary conservation than the remainder of the locus, suggesting that they may tag regulatory elements. CONCLUSIONS The chromosome 4q25 AF locus is architecturally complex and harbors at least 4 AF susceptibility signals in individuals of European ancestry. Similar polygenic AF susceptibility exists between Europeans and Japanese. Future work is necessary to identify causal variants, determine mechanisms by which associated loci predispose to AF, and explore whether AF susceptibility signals classify individuals at risk for AF and related morbidity.
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Affiliation(s)
- Steven A. Lubitz
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kathryn L. Lunetta
- Boston University and National Heart, Lung and Blood Institute's Framingham Heart Study, Framingham, Massachusetts, USA
- Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Honghuang Lin
- Boston University and National Heart, Lung and Blood Institute's Framingham Heart Study, Framingham, Massachusetts, USA
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Dan E. Arking
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Stella Trompet
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Guo Li
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Bouwe P. Krijthe
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Netherlands Consortium on Healthy Aging (NCHA), The Netherlands
| | - Daniel I. Chasman
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - John Barnard
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marcus E. Kleber
- Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Greifswald, Germany
| | - Kouichi Ozaki
- Laboratory for Cardiovascular Diseases, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Albert V. Smith
- Icelandic Heart Association, Kopavogur Iceland and University of Iceland Reykjavik, Iceland
| | - Martina Müller-Nurasyid
- Department of Medicine I, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich, Germany
- Institute of Genetic Epidemiology, Helmholtz Zentrum Munich, German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Medical Informatics, Biometry and Epidemiology, Chair of Genetic Epidemiology, Ludwig-Maximilians University, Munich, Germany
| | - Stefan Walter
- Department of Society, Human Development & Health, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Sunil K. Agarwal
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Joshua C. Bis
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Jennifer A. Brody
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Lin Y. Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Brendan M. Everett
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ian Ford
- Robertson Center for Biostatistics, University of Glasgow, United Kingdom
| | - Oscar H. Franco
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Netherlands Consortium on Healthy Aging (NCHA), The Netherlands
| | - Tamara B. Harris
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Netherlands Consortium on Healthy Aging (NCHA), The Netherlands
| | - Stefan Kääb
- Department of Medicine I, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich, Germany
- Deutsches Forschungszentrum für Herz-Kreislauferkrankungen (DZHK), Partner site Munich Heart Alliance, Munich, Germany
| | - Saagar Mahida
- Leeds General Infirmary, Great George Street, Leeds, UK
| | - Sekar Kathiresan
- Center for Human Genetic Research and Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michiaki Kubo
- Laboratory for Genotyping Development, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Lenore J. Launer
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Peter W. MacFarlane
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Jared W. Magnani
- Boston University and National Heart, Lung and Blood Institute's Framingham Heart Study, Framingham, Massachusetts, USA
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Barbara McKnight
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - David D. McManus
- Departments of Medicine and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Annette Peters
- Deutsches Forschungszentrum für Herz-Kreislauferkrankungen (DZHK), Partner site Munich Heart Alliance, Munich, Germany
- Institute of Epidemiology II, Helmholtz Zentrum Munich, German Research Center for Environmental Health, Neuherberg, Germany
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Health Services, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington, USA
| | - Lynda M. Rose
- Division of Preventive Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jerome I. Rotter
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, Calif, USA
| | - Guenther Silbernagel
- Department of Angiology, Swiss Cardiovascular Centre, Bern University Hospital, Bern, Switzerland
| | - Jonathan D. Smith
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, USA
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - David J. Stott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Kent D. Taylor
- Medical Genetics Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Tatsuhiko Tsunoda
- Laboratory for Medical Science Mathematics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Andre G. Uitterlinden
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Netherlands Consortium on Healthy Aging (NCHA), The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - David R. Van Wagoner
- Department of Molecular Cardiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Uwe Völker
- DZHK (German Centre for Cardiovascular Research), Partner site Greifswald, Germany
- Interfaculty Institute for Genetics and Functional Genomics, Ernst Moritz Arndt University Greifswald, Greifswald, Germany
| | - Henry Völzke
- DZHK (German Centre for Cardiovascular Research), Partner site Greifswald, Germany
- Institute for Community Medicine, Ernst Moritz Arndt University Greifswald, Greifswald, Germany
| | - Joanne M. Murabito
- Boston University and National Heart, Lung and Blood Institute's Framingham Heart Study, Framingham, Massachusetts, USA
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Moritz F. Sinner
- Department of Medicine I, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur Iceland and University of Iceland Reykjavik, Iceland
| | - Stephan B. Felix
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Greifswald, Germany
| | - Winfried März
- Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
- Synlab Academy, Synlab Services GmbH, Mannheim, Germany
| | - Mina Chung
- Department of Molecular Cardiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Christine M. Albert
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Preventive Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Bruno H. Stricker
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Netherlands Consortium on Healthy Aging (NCHA), The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Inspectorate for Health Care, the Hague, The Netherlands
| | - Toshihiro Tanaka
- Laboratory for Cardiovascular Diseases, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Department of Human Genetics and Disease Diversity, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Susan R. Heckbert
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington, USA
| | - J. Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands and Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
| | - Alvaro Alonso
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, USA
| | - Emelia J. Benjamin
- Boston University and National Heart, Lung and Blood Institute's Framingham Heart Study, Framingham, Massachusetts, USA
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA
- Preventive Medicine Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Patrick T. Ellinor
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
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