151
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Osmak G, Baulina N, Kiselev I, Favorova O. MiRNA-Regulated Pathways for Hypertrophic Cardiomyopathy: Network-Based Approach to Insight into Pathogenesis. Genes (Basel) 2021; 12:genes12122016. [PMID: 34946964 PMCID: PMC8701189 DOI: 10.3390/genes12122016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 12/26/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common hereditary heart disease. The wide spread of high-throughput sequencing casts doubt on its monogenic nature, suggesting the presence of mechanisms of HCM development independent from mutations in sarcomeric genes. From this point of view, HCM may arise from the interactions of several HCM-associated genes, and from disturbance of regulation of their expression. We developed a bioinformatic workflow to study the involvement of signaling pathways in HCM development through analyzing data on human heart-specific gene expression, miRNA-target gene interactions, and protein-protein interactions, available in open databases. Genes regulated by a pool of miRNAs contributing to human cardiac hypertrophy, namely hsa-miR-1-3p, hsa-miR-19b-3p, hsa-miR-21-5p, hsa-miR-29a-3p, hsa-miR-93-5p, hsa-miR-133a-3p, hsa-miR-155-5p, hsa-miR-199a-3p, hsa-miR-221-3p, hsa-miR-222-3p, hsa-miR-451a, and hsa-miR-497-5p, were considered. As a result, we pinpointed a module of TGFβ-mediated SMAD signaling pathways, enriched by targets of the selected miRNAs, that may contribute to the cardiac remodeling in HCM. We suggest that the developed network-based approach could be useful in providing a more accurate glimpse on pathological processes in the disease pathogenesis.
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Affiliation(s)
- German Osmak
- Laboratory of Functional Genomics of Cardiovascular Disorders, National Medical Research Center for Cardiology, 121552 Moscow, Russia; (N.B.); (I.K.); (O.F.)
- Laboratory of Medical Genomics, Pirogov Russian National Research Medical University, 117997 Moscow, Russia
- Correspondence:
| | - Natalia Baulina
- Laboratory of Functional Genomics of Cardiovascular Disorders, National Medical Research Center for Cardiology, 121552 Moscow, Russia; (N.B.); (I.K.); (O.F.)
- Laboratory of Medical Genomics, Pirogov Russian National Research Medical University, 117997 Moscow, Russia
| | - Ivan Kiselev
- Laboratory of Functional Genomics of Cardiovascular Disorders, National Medical Research Center for Cardiology, 121552 Moscow, Russia; (N.B.); (I.K.); (O.F.)
- Laboratory of Medical Genomics, Pirogov Russian National Research Medical University, 117997 Moscow, Russia
| | - Olga Favorova
- Laboratory of Functional Genomics of Cardiovascular Disorders, National Medical Research Center for Cardiology, 121552 Moscow, Russia; (N.B.); (I.K.); (O.F.)
- Laboratory of Medical Genomics, Pirogov Russian National Research Medical University, 117997 Moscow, Russia
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152
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Miyake W, Minemoto M, Hayama H, Yamamoto M, Okazaki T, Takano K, Mori K, Okazaki A, Arakawa R, Hara H, Takeuchi F, Hiroi Y, Kato N. Case Report of Left Ventricular Noncompaction Cardiomyopathy Characterized by Undulating Phenotypes in Adult Patients. Int Heart J 2021; 62:1420-1429. [PMID: 34853230 DOI: 10.1536/ihj.21-283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Left ventricular noncompaction cardiomyopathy (LVNC) is a heart muscle disorder morphologically characterized by reticulated trabeculations and intertrabecular recesses in the left ventricular (LV) cavity. LVNC is a genetically and phenotypically heterogeneous condition, which has been increasingly recognized with the accumulation of evidence provided by genotype-phenotype correlation analyses. Here, we report 2 sporadic adult cases of LVNC; both developed acute heart failure as an initial clinical manifestation and harbored causal sarcomere gene mutations. One case was a 57-year-old male with digenic heterozygote mutations, p.R1344Q in myosin heavy chain 7 (MYH7) and p.R144W in troponin T2, cardiac type (TNNT2), who showed morphological characteristics of LVNC in the lateral to apical regions of the LV together with a comorbidity of non-transmural myocardial infarction, resulting from a coronary artery stenosis. After the removal of ischemic insult and standard heart failure treatment, LVNC became less clear, and LV function gradually improved. The other case was a 36-year-old male with a heterozygote mutation, p.E334K in myosin binding protein C3 (MYBPC3), who exhibited cardiogenic shock on admission with morphological characteristics of LVNC being most prominent in the apical segment of the LV. The dosage of beta-blocker was deliberately increased in an outpatient clinic over 6 months following hospitalization, which remarkably improved the LV ejection fraction from 21% to 54.3%. Via a combination of imaging and histopathological and genetic tests, we have found that these cases are not compatible with a persistent phenotype of primary cardiomyopathy, but their morphological features are changeable in response to treatment. Thus, we point out phenotypic plasticity or undulation as a noticeable element of LVNC in this case report.
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Affiliation(s)
- Wataru Miyake
- Department of Cardiology, Center Hospital, National Center for Global Health and Medicine
| | - Mayu Minemoto
- Department of Cardiology, Center Hospital, National Center for Global Health and Medicine
| | - Hiromasa Hayama
- Department of Cardiology, Center Hospital, National Center for Global Health and Medicine
| | - Masaya Yamamoto
- Department of Cardiology, Center Hospital, National Center for Global Health and Medicine
| | - Toru Okazaki
- Department of Cardiology, Center Hospital, National Center for Global Health and Medicine
| | - Kozue Takano
- Department of Genomic Medicine, Center Hospital, National Center for Global Health and Medicine.,Medical Genomics Center, Research Institute, National Center for Global Health and Medicine
| | - Kotaro Mori
- Medical Genomics Center, Research Institute, National Center for Global Health and Medicine
| | - Atsuko Okazaki
- Department of Genomic Medicine, Center Hospital, National Center for Global Health and Medicine
| | - Reiko Arakawa
- Department of Genomic Medicine, Center Hospital, National Center for Global Health and Medicine.,Medical Genomics Center, Research Institute, National Center for Global Health and Medicine
| | - Hisao Hara
- Department of Cardiology, Center Hospital, National Center for Global Health and Medicine
| | - Fumihiko Takeuchi
- Medical Genomics Center, Research Institute, National Center for Global Health and Medicine.,Department of Gene Diagnostics and Therapeutics, Research Institute, National Center for Global Health and Medicine
| | - Yukio Hiroi
- Department of Cardiology, Center Hospital, National Center for Global Health and Medicine
| | - Norihiro Kato
- Department of Genomic Medicine, Center Hospital, National Center for Global Health and Medicine.,Medical Genomics Center, Research Institute, National Center for Global Health and Medicine.,Department of Gene Diagnostics and Therapeutics, Research Institute, National Center for Global Health and Medicine
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153
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Gudmundsson S, Singer-Berk M, Watts NA, Phu W, Goodrich JK, Solomonson M, Rehm HL, MacArthur DG, O'Donnell-Luria A. Variant interpretation using population databases: Lessons from gnomAD. Hum Mutat 2021; 43:1012-1030. [PMID: 34859531 PMCID: PMC9160216 DOI: 10.1002/humu.24309] [Citation(s) in RCA: 189] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/02/2021] [Accepted: 11/28/2021] [Indexed: 01/22/2023]
Abstract
Reference population databases are an essential tool in variant and gene interpretation. Their use guides the identification of pathogenic variants amidst the sea of benign variation present in every human genome, and supports the discovery of new disease-gene relationships. The Genome Aggregation Database (gnomAD) is currently the largest and most widely used publicly available collection of population variation from harmonized sequencing data. The data is available through the online gnomAD browser (https://gnomad.broadinstitute.org/) that enables rapid and intuitive variant analysis. This review provides guidance on the content of the gnomAD browser, and its usage for variant and gene interpretation. We introduce key features including allele frequency, per-base expression levels, constraint scores, and variant co-occurrence, alongside guidance on how to use these in analysis, with a focus on the interpretation of candidate variants and novel genes in rare disease.
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Affiliation(s)
- Sanna Gudmundsson
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.,Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Moriel Singer-Berk
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Nicholas A Watts
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
| | - William Phu
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.,Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Julia K Goodrich
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Matthew Solomonson
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
| | | | - Heidi L Rehm
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA.,Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Daniel G MacArthur
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Centre for Population Genomics, Garvan Institute of Medical Research, University of New South Wales Sydney, Sydney, New South Wales, Australia.,Centre for Population Genomics, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Anne O'Donnell-Luria
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.,Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
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154
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Doran MH, Lehman W. The Central Role of the F-Actin Surface in Myosin Force Generation. BIOLOGY 2021; 10:1221. [PMID: 34943138 PMCID: PMC8698748 DOI: 10.3390/biology10121221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 11/17/2022]
Abstract
Actin is one of the most abundant and versatile proteins in eukaryotic cells. As discussed in many contributions to this Special Issue, its transition from a monomeric G-actin to a filamentous F-actin form plays a critical role in a variety of cellular processes, including control of cell shape and cell motility. Once polymerized from G-actin, F-actin forms the central core of muscle-thin filaments and acts as molecular tracks for myosin-based motor activity. The ATP-dependent cross-bridge cycle of myosin attachment and detachment drives the sliding of myosin thick filaments past thin filaments in muscle and the translocation of cargo in somatic cells. The variation in actin function is dependent on the variation in muscle and non-muscle myosin isoform behavior as well as interactions with a plethora of additional actin-binding proteins. Extensive work has been devoted to defining the kinetics of actin-based force generation powered by the ATPase activity of myosin. In addition, over the past decade, cryo-electron microscopy has revealed the atomic-evel details of the binding of myosin isoforms on the F-actin surface. Most accounts of the structural interactions between myosin and actin are described from the perspective of the myosin molecule. Here, we discuss myosin-binding to actin as viewed from the actin surface. We then describe conserved structural features of actin required for the binding of all or most myosin isoforms while also noting specific interactions unique to myosin isoforms.
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Affiliation(s)
- Matthew H. Doran
- Department of Physiology & Biophysics, Boston University School of Medicine, Boston, MA 02118, USA
| | - William Lehman
- Department of Physiology & Biophysics, Boston University School of Medicine, Boston, MA 02118, USA
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155
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Arrhythmogenic Cardiomyopathy—Further Insight into the Clinical Spectrum of Desmoplakin Disease. CARDIOGENETICS 2021. [DOI: 10.3390/cardiogenetics11040022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Arrhythmogenic cardiomyopathy is a familial heart muscle disease characterized by structural, electrical, and pathological abnormalities. Recognition of left ventricular (LV) involvement in arrhythmogenic right ventricular cardiomyopathy (ARVC) has led to the newer term of arrhythmogenic cardiomyopathy (ACM). We report on a family with autosomal dominant desmoplakin (DSP) related ACM to illustrate the broad clinical spectrum of disease. The importance of evaluation of relatives with cardiac magnetic resonance imaging and consideration of genetic testing in the absence of Task Force diagnostic criteria is discussed. The practical and ethical issues of access to the Guthrie collection for deoxyribonucleic acid (DNA) testing are considered.
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156
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Scrocco C, Bezzina CR, Ackerman MJ, Behr ER. Genetics and genomics of arrhythmic risk: current and future strategies to prevent sudden cardiac death. Nat Rev Cardiol 2021; 18:774-784. [PMID: 34031597 DOI: 10.1038/s41569-021-00555-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 02/04/2023]
Abstract
A genetic risk of sudden cardiac arrest and sudden death due to an arrhythmic cause, known as sudden cardiac death (SCD), has become apparent from epidemiological studies in the general population and in patients with ischaemic heart disease. However, genetic susceptibility to sudden death is greatest in young people and is associated with uncommon, monogenic forms of heart disease. Despite comprehensive pathology and genetic evaluations, SCD remains unexplained in a proportion of young people and is termed sudden arrhythmic death syndrome, which poses challenges to the identification of relatives from affected families who might be at risk of SCD. In this Review, we assess the current understanding of the epidemiology and causes of SCD and evaluate both the monogenic and the polygenic contributions to the risk of SCD in the young and SCD associated with drug therapy. Finally, we analyse the potential clinical role of genomic testing in the prevention of SCD in the general population.
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Affiliation(s)
- Chiara Scrocco
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute, St George's University of London and St George's University Hospitals NHS Foundation Trust, London, UK
| | - Connie R Bezzina
- Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Michael J Ackerman
- Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology & Experimental Therapeutics; Divisions of Heart Rhythm Services and Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA.,Windland Smith Rice Genetic Heart Rhythm Clinic and the Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Elijah R Behr
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute, St George's University of London and St George's University Hospitals NHS Foundation Trust, London, UK.
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157
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Comber DA, Davies B, Roberts JD, Tadros R, Green MS, Healey JS, Simpson CS, Sanatani S, Steinberg C, MacIntyre C, Angaran P, Duff H, Hamilton R, Arbour L, Leather R, Seifer C, Fournier A, Atallah J, Kimber S, Makanjee B, Alqarawi W, Cadrin-Tourigny J, Joza J, Gibbs K, Robb L, Zahavich L, Gardner M, Talajic M, Virani A, Krahn AD, Lehman A, Laksman ZWM. Return of Results Policies for Genomic Research: Current Practices & The Hearts in Rhythm Organization Approach. Can J Cardiol 2021; 38:526-535. [PMID: 34715283 DOI: 10.1016/j.cjca.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 11/02/2022] Open
Abstract
Research teams developing biobanks and/or genomic databases must develop policies for the disclosure and reporting of potentially actionable genomic results to research participants. Currently, a broad range of approaches to the return of results exist, with some studies opting for non-disclosure of research results while others follow clinical guidelines for the return of potentially actionable findings from sequencing. In this review, we describe current practices and highlight decisions a research team must make when designing a return of results policy, from informed consent to disclosure practices and clinical validation options. The unique challenges of returning incidental findings in cardiac genes, including reduced penetrance and the lack of clinical screening standards for phenotype-negative individuals are discussed. Lastly, the National Hearts in Rhythm Organization (HiRO) Registry approach is described to provide a rationale for the selective return of field-specific variants to those participating in disease-specific research. Our goal is to provide researchers with a resource when developing a return of results policy tailored for their research program, based on unique factors related to study design, research team composition and availability of clinical resources.
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Affiliation(s)
- Drake A Comber
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Brianna Davies
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, and Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Martin S Green
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | | | | | | | - Christian Steinberg
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Laval University, Quebec City, QC, Canada
| | | | - Paul Angaran
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Henry Duff
- Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
| | - Robert Hamilton
- The Hospital for Sick Children (SickKids), Toronto, ON, Canada
| | - Laura Arbour
- Department of Medical Genetics, University of British Columbia and Island Health, Victoria, BC, Canada
| | | | - Colette Seifer
- Section of Cardiology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Anne Fournier
- Division of Pediatric Cardiology, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Joseph Atallah
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Shane Kimber
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Bhavanesh Makanjee
- Heart Health Institute, Scarborough Health Network, Scarborough, ON, Canada
| | - Wael Alqarawi
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Center, Montreal Heart Institute, and Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Jacqueline Joza
- Division of Cardiology, McGill University Health Centre, Montreal, QC, Canada
| | - Karen Gibbs
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Laura Robb
- Cardiovascular Genetics Center, Montreal Heart Institute, and Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Laura Zahavich
- The Hospital for Sick Children (SickKids), Toronto, ON, Canada
| | | | - Mario Talajic
- Cardiovascular Genetics Center, Montreal Heart Institute, and Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Alice Virani
- Department of Medical Genetics, The University of British, Columbia, Vancouver, British Columbia, Canada
| | - Andrew D Krahn
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anna Lehman
- Department of Medical Genetics, The University of British, Columbia, Vancouver, British Columbia, Canada
| | - Zachary W M Laksman
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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158
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Ion Channel Impairment and Myofilament Ca 2+ Sensitization: Two Parallel Mechanisms Underlying Arrhythmogenesis in Hypertrophic Cardiomyopathy. Cells 2021; 10:cells10102789. [PMID: 34685769 PMCID: PMC8534456 DOI: 10.3390/cells10102789] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/07/2021] [Accepted: 10/13/2021] [Indexed: 11/17/2022] Open
Abstract
Life-threatening ventricular arrhythmias are the main clinical burden in patients with hypertrophic cardiomyopathy (HCM), and frequently occur in young patients with mild structural disease. While massive hypertrophy, fibrosis and microvascular ischemia are the main mechanisms underlying sustained reentry-based ventricular arrhythmias in advanced HCM, cardiomyocyte-based functional arrhythmogenic mechanisms are likely prevalent at earlier stages of the disease. In this review, we will describe studies conducted in human surgical samples from HCM patients, transgenic animal models and human cultured cell lines derived from induced pluripotent stem cells. Current pieces of evidence concur to attribute the increased risk of ventricular arrhythmias in early HCM to different cellular mechanisms. The increase of late sodium current and L-type calcium current is an early observation in HCM, which follows post-translation channel modifications and increases the occurrence of early and delayed afterdepolarizations. Increased myofilament Ca2+ sensitivity, commonly observed in HCM, may promote afterdepolarizations and reentry arrhythmias with direct mechanisms. Decrease of K+-currents due to transcriptional regulation occurs in the advanced disease and contributes to reducing the repolarization-reserve and increasing the early afterdepolarizations (EADs). The presented evidence supports the idea that patients with early-stage HCM should be considered and managed as subjects with an acquired channelopathy rather than with a structural cardiac disease.
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159
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Hassoun R, Budde H, Mügge A, Hamdani N. Cardiomyocyte Dysfunction in Inherited Cardiomyopathies. Int J Mol Sci 2021; 22:11154. [PMID: 34681814 PMCID: PMC8541428 DOI: 10.3390/ijms222011154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/08/2021] [Accepted: 10/13/2021] [Indexed: 01/10/2023] Open
Abstract
Inherited cardiomyopathies form a heterogenous group of disorders that affect the structure and function of the heart. Defects in the genes encoding sarcomeric proteins are associated with various perturbations that induce contractile dysfunction and promote disease development. In this review we aimed to outline the functional consequences of the major inherited cardiomyopathies in terms of myocardial contraction and kinetics, and to highlight the structural and functional alterations in some sarcomeric variants that have been demonstrated to be involved in the pathogenesis of the inherited cardiomyopathies. A particular focus was made on mutation-induced alterations in cardiomyocyte mechanics. Since no disease-specific treatments for familial cardiomyopathies exist, several novel agents have been developed to modulate sarcomere contractility. Understanding the molecular basis of the disease opens new avenues for the development of new therapies. Furthermore, the earlier the awareness of the genetic defect, the better the clinical prognostication would be for patients and the better the prevention of development of the disease.
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Affiliation(s)
- Roua Hassoun
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, 44801 Bochum, Germany
- Department of Cardiology, St. Josef-Hospital and Bergmannsheil, Ruhr University Bochum, 44801 Bochum, Germany
| | - Heidi Budde
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, 44801 Bochum, Germany
- Department of Cardiology, St. Josef-Hospital and Bergmannsheil, Ruhr University Bochum, 44801 Bochum, Germany
| | - Andreas Mügge
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, 44801 Bochum, Germany
- Department of Cardiology, St. Josef-Hospital and Bergmannsheil, Ruhr University Bochum, 44801 Bochum, Germany
| | - Nazha Hamdani
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, 44801 Bochum, Germany
- Department of Cardiology, St. Josef-Hospital and Bergmannsheil, Ruhr University Bochum, 44801 Bochum, Germany
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160
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Filatova EV, Krylova NS, Vlasov IN, Maslova MS, Poteshkina NG, Slominsky PA, Shadrina MI. Targeted exome analysis of Russian patients with hypertrophic cardiomyopathy. Mol Genet Genomic Med 2021; 9:e1808. [PMID: 34598319 PMCID: PMC8606207 DOI: 10.1002/mgg3.1808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 08/23/2021] [Accepted: 08/27/2021] [Indexed: 11/20/2022] Open
Abstract
Background Hypertrophic cardiomyopathy (HCM), described as the presence of hypertrophy of left ventricular, is the most prevalent heritable cardiovascular disease with predominantly an autosomal dominant type of inheritance. However, pathogenic alleles are not identified in at least 25% of patients with HCM, and the spectrum of pathogenic variants that contribute to the development of HCM in Russia has not been fully described. Therefore, the goal of our study was to identify genetic variants associated with the etiopathogenesis of HCM in Russian patients. Methods The study cohort included 98 unrelated adult patients with HCM. We performed targeted exome sequencing, an analysis using various algorithms for prediction of the impact of variants on protein structure and the prediction of pathogenicity using ACMG Guidelines. Results The frequency of pathogenic and likely pathogenic variants in all HCM‐related genes was 8% in our patients. We also identified 20 variants of uncertain significance in all HCM‐related genes. Conclusions The prevalence of individual pathogenic variants in HCM‐related genes in Russian population appears to be lower than in general European population, which could be explained by ethnic features of Russian population, age characteristics of our sample, or unidentified pathogenic variants in genes previously not linked with HCM.
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Affiliation(s)
- Elena V Filatova
- Institute of Molecular Genetics of National Research Centre, Moscow, Russia
| | - Natalia S Krylova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Ivan N Vlasov
- Institute of Molecular Genetics of National Research Centre, Moscow, Russia
| | - Maria S Maslova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - Petr A Slominsky
- Institute of Molecular Genetics of National Research Centre, Moscow, Russia
| | - Maria I Shadrina
- Institute of Molecular Genetics of National Research Centre, Moscow, Russia
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161
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Park J, Packard EA, Levin MG, Judy RL, Damrauer SM, Day SM, Ritchie MD, Rader DJ. A genome-first approach to rare variants in hypertrophic cardiomyopathy genes MYBPC3 and MYH7 in a medical biobank. Hum Mol Genet 2021; 31:827-837. [PMID: 34542152 DOI: 10.1093/hmg/ddab249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/24/2021] [Accepted: 08/19/2021] [Indexed: 11/14/2022] Open
Abstract
'Genome-first' approaches to analyzing rare variants can reveal new insights into human biology and disease. Because pathogenic variants are often rare, new discovery requires aggregating rare coding variants into 'gene burdens' for sufficient power. However, a major challenge is deciding which variants to include in gene burden tests. Pathogenic variants in MYBPC3 and MYH7 are well-known causes of hypertrophic cardiomyopathy (HCM), and focusing on these 'positive control' genes in a genome-first approach could help inform variant selection methods and gene burdening strategies for other genes and diseases. Integrating exome sequences with electronic health records among 41 759 participants in the Penn Medicine BioBank, we evaluated the performance of aggregating predicted loss-of-function (pLOF) and/or predicted deleterious missense (pDM) variants in MYBPC3 and MYH7 for gene burden phenome-wide association studies (PheWAS). The approach to grouping rare variants for these two genes produced very different results: pLOFs but not pDM variants in MYBPC3 were strongly associated with HCM, whereas the opposite was true for MYH7. Detailed review of clinical charts revealed that only 38.5% of patients with HCM diagnoses carrying an HCM-associated variant in MYBPC3 or MYH7 had a clinical genetic test result. Additionally, 26.7% of MYBPC3 pLOF carriers without HCM diagnoses had clear evidence of left atrial enlargement and/or septal/LV hypertrophy on echocardiography. Our study shows the importance of evaluating both pLOF and pDM variants for gene burden testing in future studies to uncover novel gene-disease relationships and identify new pathogenic loss-of-function variants across the human genome through genome-first analyses of healthcare-based populations.
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Affiliation(s)
- Joseph Park
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Institute for Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Elizabeth A Packard
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Michael G Levin
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Renae L Judy
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | | | - Scott M Damrauer
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Sharlene M Day
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Marylyn D Ritchie
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Institute for Biomedical Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Daniel J Rader
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
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162
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Baudhuin LM. Hypertrophic Cardiomyopathy in the General Population: Leveraging the UK Biobank Database and Machine Learning Phenotyping. J Am Coll Cardiol 2021; 78:1111-1113. [PMID: 34503679 DOI: 10.1016/j.jacc.2021.07.036] [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: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Linnea M Baudhuin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
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163
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Patel PN, Ito K, Willcox JAL, Haghighi A, Jang MY, Gorham JM, DePalma SR, Lam L, McDonough B, Johnson R, Lakdawala NK, Roberts A, Barton PJR, Cook SA, Fatkin D, Seidman CE, Seidman JG. Contribution of Noncanonical Splice Variants to TTN Truncating Variant Cardiomyopathy. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2021; 14:e003389. [PMID: 34461741 DOI: 10.1161/circgen.121.003389] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Heterozygous TTN truncating variants cause 10% to 20% of idiopathic dilated cardiomyopathy (DCM). Although variants which disrupt canonical splice signals (ie, invariant dinucleotide of the splice donor site, invariant dinucleotide of the splice acceptor site) at exon-intron junctions are readily recognized as TTN truncating variants, the effects of other nearby sequence variations on splicing and their contribution to disease is uncertain. METHODS Rare variants of unknown significance located in the splice regions of highly expressed TTN exons from 203 DCM cases, 3329 normal subjects, and clinical variant databases were identified. The effects of these variants on splicing were assessed using an in vitro splice assay. RESULTS Splice-altering variants of unknown significance were enriched in DCM cases over controls and present in 2% of DCM patients (P=0.002). Application of this method to clinical variant databases demonstrated 20% of similar variants of unknown significance in TTN splice regions affect splicing. Noncanonical splice-altering variants were most frequently located at position +5 of the donor site (P=4.4×107) and position -3 of the acceptor site (P=0.002). SpliceAI, an emerging in silico prediction tool, had a high positive predictive value (86%-95%) but poor sensitivity (15%-50%) for the detection of splice-altering variants. Alternate exons spliced out of most TTN transcripts frequently lacked the consensus base at +5 donor and -3 acceptor positions. CONCLUSIONS Noncanonical splice-altering variants in TTN explain 1-2% of DCM and offer a 10-20% increase in the diagnostic power of TTN sequencing in this disease. These data suggest rules that may improve efforts to detect splice-altering variants in other genes and may explain the low percent splicing observed for many alternate TTN exons.
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Affiliation(s)
- Parth N Patel
- Department of Genetics (P.N.P., K.I., J.A.L.W., A.H., M.Y.J., J.M.G., S.R.D., L.L., B.M., C.E.S., J.G.S.), Harvard Medical School, Boston, MA.,Department of Medicine, Brigham and Women's Hospital (P.N.P., A.H., M.Y.J.), Harvard Medical School, Boston, MA
| | - Kaoru Ito
- Department of Genetics (P.N.P., K.I., J.A.L.W., A.H., M.Y.J., J.M.G., S.R.D., L.L., B.M., C.E.S., J.G.S.), Harvard Medical School, Boston, MA.,Laboratory for Cardiovascular Genomics and Informatics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan (K.I.)
| | - Jon A L Willcox
- Department of Genetics (P.N.P., K.I., J.A.L.W., A.H., M.Y.J., J.M.G., S.R.D., L.L., B.M., C.E.S., J.G.S.), Harvard Medical School, Boston, MA
| | - Alireza Haghighi
- Department of Genetics (P.N.P., K.I., J.A.L.W., A.H., M.Y.J., J.M.G., S.R.D., L.L., B.M., C.E.S., J.G.S.), Harvard Medical School, Boston, MA.,Department of Medicine, Brigham and Women's Hospital (P.N.P., A.H., M.Y.J.), Harvard Medical School, Boston, MA.,Laboratory for Molecular Medicine, Partners Healthcare Personalized Medicine, Cambridge, MA (A.H.)
| | - Min Young Jang
- Department of Genetics (P.N.P., K.I., J.A.L.W., A.H., M.Y.J., J.M.G., S.R.D., L.L., B.M., C.E.S., J.G.S.), Harvard Medical School, Boston, MA.,Department of Medicine, Brigham and Women's Hospital (P.N.P., A.H., M.Y.J.), Harvard Medical School, Boston, MA
| | - Joshua M Gorham
- Department of Genetics (P.N.P., K.I., J.A.L.W., A.H., M.Y.J., J.M.G., S.R.D., L.L., B.M., C.E.S., J.G.S.), Harvard Medical School, Boston, MA
| | - Steven R DePalma
- Department of Genetics (P.N.P., K.I., J.A.L.W., A.H., M.Y.J., J.M.G., S.R.D., L.L., B.M., C.E.S., J.G.S.), Harvard Medical School, Boston, MA
| | - Lien Lam
- Department of Genetics (P.N.P., K.I., J.A.L.W., A.H., M.Y.J., J.M.G., S.R.D., L.L., B.M., C.E.S., J.G.S.), Harvard Medical School, Boston, MA
| | - Barbara McDonough
- Department of Genetics (P.N.P., K.I., J.A.L.W., A.H., M.Y.J., J.M.G., S.R.D., L.L., B.M., C.E.S., J.G.S.), Harvard Medical School, Boston, MA
| | - Renee Johnson
- Victor Chang Cardiac Research Institute, Darlinghurst (R.J., D.F.).,Faculty of Medicine, UNSW Sydney, Kensington, NSW, Australia (R.J., D.F.)
| | - Neal K Lakdawala
- Division of Cardiovascular Medicine, Brigham and Women's Hospital (N.K.L., C.E.S.)
| | - Amy Roberts
- Department of Cardiology, Boston Children's Hospital, MA (A.R.)
| | - Paul J R Barton
- National Heart and Lung Institute (P.J.R.B., S.A.C.).,Cardiovascular Research Centre, Royal Brompton and Harefield Hospitals, London, United Kingdom (P.J.R.B.)
| | - Stuart A Cook
- National Heart and Lung Institute (P.J.R.B., S.A.C.).,MRC London Institute of Medical Sciences, Imperial College London (S.A.C.).,Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School (S.A.C.).,National Heart Research Institute Singapore, National Heart Centre Singapore (S.A.C.)
| | - Diane Fatkin
- Victor Chang Cardiac Research Institute, Darlinghurst (R.J., D.F.).,Faculty of Medicine, UNSW Sydney, Kensington, NSW, Australia (R.J., D.F.).,Cardiology Department, St Vincent's Hospital, Darlinghurst, NSW, Australia (D.F.)
| | - Christine E Seidman
- Department of Genetics (P.N.P., K.I., J.A.L.W., A.H., M.Y.J., J.M.G., S.R.D., L.L., B.M., C.E.S., J.G.S.), Harvard Medical School, Boston, MA.,Howard Hughes Medical Institute (C.E.S.), Harvard Medical School, Boston, MA.,Division of Cardiovascular Medicine, Brigham and Women's Hospital (N.K.L., C.E.S.)
| | - J G Seidman
- Department of Genetics (P.N.P., K.I., J.A.L.W., A.H., M.Y.J., J.M.G., S.R.D., L.L., B.M., C.E.S., J.G.S.), Harvard Medical School, Boston, MA
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164
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Aguib Y, Allouba M, Walsh R, Ibrahim AM, Halawa S, Afify A, Hosny M, Theotokis PI, Galal A, Elshorbagy S, Roshdy M, Kassem HS, Ellithy A, Buchan R, Whiffin N, Anwer S, Cook SA, Moustafa A, ElGuindy A, Ware JS, Barton PJR, Yacoub M. New Variant With a Previously Unrecognized Mechanism of Pathogenicity in Hypertrophic Cardiomyopathy. Circulation 2021; 144:754-757. [PMID: 34460321 PMCID: PMC8389346 DOI: 10.1161/circulationaha.120.048295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yasmine Aguib
- Aswan Heart Centre, Egypt (Y.A., M.A., A.M.I., S.H., A.A., M.H., A.G., S.E., M.R., A.E., S.A., A. ElGuindy, M.Y.).,National Heart and Lung Institute, Imperial College London, United Kingdom (Y.A., M.A., P.I.T., R.B., N.W., A. ElGuindy, J.S.W., P.J.R.B., M.Y.)
| | - Mona Allouba
- Aswan Heart Centre, Egypt (Y.A., M.A., A.M.I., S.H., A.A., M.H., A.G., S.E., M.R., A.E., S.A., A. ElGuindy, M.Y.).,National Heart and Lung Institute, Imperial College London, United Kingdom (Y.A., M.A., P.I.T., R.B., N.W., A. ElGuindy, J.S.W., P.J.R.B., M.Y.)
| | - Roddy Walsh
- Department of Experimental Cardiology, Amsterdam UMC, the Netherlands (R.W.)
| | - Ayman M Ibrahim
- Aswan Heart Centre, Egypt (Y.A., M.A., A.M.I., S.H., A.A., M.H., A.G., S.E., M.R., A.E., S.A., A. ElGuindy, M.Y.).,Faculty of Science, Cairo University, Egypt (A.M.I.)
| | - Sarah Halawa
- Aswan Heart Centre, Egypt (Y.A., M.A., A.M.I., S.H., A.A., M.H., A.G., S.E., M.R., A.E., S.A., A. ElGuindy, M.Y.).,Biotechnology Graduate Program (S.H., A.M.), American University in Cairo, New Cairo, Egypt
| | - Alaa Afify
- Aswan Heart Centre, Egypt (Y.A., M.A., A.M.I., S.H., A.A., M.H., A.G., S.E., M.R., A.E., S.A., A. ElGuindy, M.Y.)
| | - Mohammed Hosny
- Aswan Heart Centre, Egypt (Y.A., M.A., A.M.I., S.H., A.A., M.H., A.G., S.E., M.R., A.E., S.A., A. ElGuindy, M.Y.).,Cardiology Department, Faculty of Medicine, Cairo University, Egypt (M.H.)
| | - Pantazis I Theotokis
- National Heart and Lung Institute, Imperial College London, United Kingdom (Y.A., M.A., P.I.T., R.B., N.W., A. ElGuindy, J.S.W., P.J.R.B., M.Y.)
| | - Aya Galal
- Aswan Heart Centre, Egypt (Y.A., M.A., A.M.I., S.H., A.A., M.H., A.G., S.E., M.R., A.E., S.A., A. ElGuindy, M.Y.)
| | - Sara Elshorbagy
- Aswan Heart Centre, Egypt (Y.A., M.A., A.M.I., S.H., A.A., M.H., A.G., S.E., M.R., A.E., S.A., A. ElGuindy, M.Y.)
| | - Mohamed Roshdy
- Aswan Heart Centre, Egypt (Y.A., M.A., A.M.I., S.H., A.A., M.H., A.G., S.E., M.R., A.E., S.A., A. ElGuindy, M.Y.)
| | - Heba S Kassem
- Clinical Genomics Center, Alexandria Faculty of Medicine, Egypt (H.S.K.)
| | - Amany Ellithy
- Aswan Heart Centre, Egypt (Y.A., M.A., A.M.I., S.H., A.A., M.H., A.G., S.E., M.R., A.E., S.A., A. ElGuindy, M.Y.)
| | - Rachel Buchan
- National Heart and Lung Institute, Imperial College London, United Kingdom (Y.A., M.A., P.I.T., R.B., N.W., A. ElGuindy, J.S.W., P.J.R.B., M.Y.).,Royal Brompton and Harefield Hospitals, London, United Kingdom (R.B., N.W., J.S.W., P.J.R.B.)
| | - Nicola Whiffin
- National Heart and Lung Institute, Imperial College London, United Kingdom (Y.A., M.A., P.I.T., R.B., N.W., A. ElGuindy, J.S.W., P.J.R.B., M.Y.).,Royal Brompton and Harefield Hospitals, London, United Kingdom (R.B., N.W., J.S.W., P.J.R.B.).,Wellcome Centre for Human Genetics, University of Oxford, United Kingdom (N.W.)
| | - Shehab Anwer
- Aswan Heart Centre, Egypt (Y.A., M.A., A.M.I., S.H., A.A., M.H., A.G., S.E., M.R., A.E., S.A., A. ElGuindy, M.Y.)
| | - Stuart A Cook
- Duke-National University of Singapore Medical School (S.A.C.).,National Heart Centre Singapore (S.A.C.).,MRC London Institute of Medical Sciences, United Kingdom (S.A.C., J.S.W., P.J.R.B.)
| | - Ahmed Moustafa
- Biotechnology Graduate Program (S.H., A.M.), American University in Cairo, New Cairo, Egypt.,Department of Biology (A.M.), American University in Cairo, New Cairo, Egypt
| | - Ahmed ElGuindy
- Aswan Heart Centre, Egypt (Y.A., M.A., A.M.I., S.H., A.A., M.H., A.G., S.E., M.R., A.E., S.A., A. ElGuindy, M.Y.).,National Heart and Lung Institute, Imperial College London, United Kingdom (Y.A., M.A., P.I.T., R.B., N.W., A. ElGuindy, J.S.W., P.J.R.B., M.Y.)
| | - James S Ware
- National Heart and Lung Institute, Imperial College London, United Kingdom (Y.A., M.A., P.I.T., R.B., N.W., A. ElGuindy, J.S.W., P.J.R.B., M.Y.).,Royal Brompton and Harefield Hospitals, London, United Kingdom (R.B., N.W., J.S.W., P.J.R.B.).,MRC London Institute of Medical Sciences, United Kingdom (S.A.C., J.S.W., P.J.R.B.)
| | - Paul J R Barton
- National Heart and Lung Institute, Imperial College London, United Kingdom (Y.A., M.A., P.I.T., R.B., N.W., A. ElGuindy, J.S.W., P.J.R.B., M.Y.).,Royal Brompton and Harefield Hospitals, London, United Kingdom (R.B., N.W., J.S.W., P.J.R.B.).,MRC London Institute of Medical Sciences, United Kingdom (S.A.C., J.S.W., P.J.R.B.)
| | - Magdi Yacoub
- Aswan Heart Centre, Egypt (Y.A., M.A., A.M.I., S.H., A.A., M.H., A.G., S.E., M.R., A.E., S.A., A. ElGuindy, M.Y.).,National Heart and Lung Institute, Imperial College London, United Kingdom (Y.A., M.A., P.I.T., R.B., N.W., A. ElGuindy, J.S.W., P.J.R.B., M.Y.).,Harefield Heart Science Centre, United Kingdom (M.Y.)
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165
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Ezekian JE, Rehder C, Kishnani PS, Landstrom AP. Interpretation of Incidental Genetic Findings Localizing to Genes Associated With Cardiac Channelopathies and Cardiomyopathies. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2021; 14:e003200. [PMID: 34384235 DOI: 10.1161/circgen.120.003200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Recent advances in next-genetic sequencing technology have facilitated an expansion in the use of exome and genome sequencing in the research and clinical settings. While this has aided in the genetic diagnosis of individuals with atypical clinical presentations, there has been a marked increase in the number of incidentally identified variants of uncertain diagnostic significance in genes identified as clinically actionable by the American College of Medical Genetics guidelines. Approximately 20 of these genes are associated with cardiac diseases, which carry a significant risk of sudden cardiac death. While identification of at-risk individuals is paramount, increased discovery of incidental variants of uncertain diagnostic significance has placed a burden on the clinician tasked with determining the diagnostic significance of these findings. Herein, we describe the scope of this emerging problem using cardiovascular genetics to illustrate the challenges associated with variants of uncertain diagnostic significance interpretation. We review the evidence for diagnostic weight of these variants, discuss the role of clinical genetics providers in patient care, and put forward general recommendations about the interpretation of incidentally identified variants found with clinical genetic testing.
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Affiliation(s)
- Jordan E Ezekian
- Division of Cardiology, Department of Pediatrics (J.E.E., A.P.L.), Duke University School of Medicine, Durham, NC
| | - Catherine Rehder
- Department of Pathology (C.R.), Duke University School of Medicine, Durham, NC
| | - Priya S Kishnani
- Division of Medical Genetics, Department of Pediatrics (P.S.K.), Duke University School of Medicine, Durham, NC
| | - Andrew P Landstrom
- Division of Cardiology, Department of Pediatrics (J.E.E., A.P.L.), Duke University School of Medicine, Durham, NC.,Department of Cell Biology (A.P.L.), Duke University School of Medicine, Durham, NC
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166
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Girolami F, Spinelli V, Passantino S, Bennati E, Calabri GB, Olivotto I, Favilli S. Hidden familial cardiomyopathies in children: Role of genetic testing. Int J Cardiol 2021; 340:55-58. [PMID: 34384838 DOI: 10.1016/j.ijcard.2021.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/03/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
Pediatric cardiomyopathies harbour significant phenotypic and genetic heterogeneity. Genetic testing is essential for the initial evaluation and the ongoing care of child and family, although challenges remain regarding its appropriate clinical implementation in minors. We here discuss the key role of genetic diagnosis in the clinical management of two patients.
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Affiliation(s)
- F Girolami
- Cardiology Unit, Meyer Children's Hospital, Florence, Italy.
| | - V Spinelli
- Cardiology Unit, Meyer Children's Hospital, Florence, Italy
| | - S Passantino
- Cardiology Unit, Meyer Children's Hospital, Florence, Italy
| | - E Bennati
- Cardiology Unit, Meyer Children's Hospital, Florence, Italy
| | - G B Calabri
- Cardiology Unit, Meyer Children's Hospital, Florence, Italy
| | - I Olivotto
- Cardiomyopathy Unit, University of Florence, Florence, Italy
| | - S Favilli
- Cardiology Unit, Meyer Children's Hospital, Florence, Italy
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167
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L-Type Calcium Channel: Predicting Pathogenic/Likely Pathogenic Status for Variants of Uncertain Clinical Significance. MEMBRANES 2021; 11:membranes11080599. [PMID: 34436362 PMCID: PMC8399957 DOI: 10.3390/membranes11080599] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/01/2021] [Accepted: 08/04/2021] [Indexed: 11/25/2022]
Abstract
(1) Background: Defects in gene CACNA1C, which encodes the pore-forming subunit of the human Cav1.2 channel (hCav1.2), are associated with cardiac disorders such as atrial fibrillation, long QT syndrome, conduction disorders, cardiomyopathies, and congenital heart defects. Clinical manifestations are known only for 12% of CACNA1C missense variants, which are listed in public databases. Bioinformatics approaches can be used to predict the pathogenic/likely pathogenic status for variants of uncertain clinical significance. Choosing a bioinformatics tool and pathogenicity threshold that are optimal for specific protein families increases the reliability of such predictions. (2) Methods and Results: We used databases ClinVar, Humsavar, gnomAD, and Ensembl to compose a dataset of pathogenic/likely pathogenic and benign variants of hCav1.2 and its 20 paralogues: voltage-gated sodium and calcium channels. We further tested the performance of sixteen in silico tools in predicting pathogenic variants. ClinPred demonstrated the best performance, followed by REVEL and MCap. In the subset of 309 uncharacterized variants of hCav1.2, ClinPred predicted the pathogenicity for 188 variants. Among these, 36 variants were also categorized as pathogenic/likely pathogenic in at least one paralogue of hCav1.2. (3) Conclusions: The bioinformatics tool ClinPred and the paralogue annotation method consensually predicted the pathogenic/likely pathogenic status for 36 uncharacterized variants of hCav1.2. An analogous approach can be used to classify missense variants of other calcium channels and novel variants of hCav1.2.
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168
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Bliley JM, Vermeer MCSC, Duffy RM, Batalov I, Kramer D, Tashman JW, Shiwarski DJ, Lee A, Teplenin AS, Volkers L, Coffin B, Hoes MF, Kalmykov A, Palchesko RN, Sun Y, Jongbloed JDH, Bomer N, de Boer RA, Suurmeijer AJH, Pijnappels DA, Bolling MC, van der Meer P, Feinberg AW. Dynamic loading of human engineered heart tissue enhances contractile function and drives a desmosome-linked disease phenotype. Sci Transl Med 2021; 13:13/603/eabd1817. [PMID: 34290054 DOI: 10.1126/scitranslmed.abd1817] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/02/2021] [Indexed: 12/23/2022]
Abstract
The role that mechanical forces play in shaping the structure and function of the heart is critical to understanding heart formation and the etiology of disease but is challenging to study in patients. Engineered heart tissues (EHTs) incorporating human induced pluripotent stem cell (hiPSC)-derived cardiomyocytes have the potential to provide insight into these adaptive and maladaptive changes. However, most EHT systems cannot model both preload (stretch during chamber filling) and afterload (pressure the heart must work against to eject blood). Here, we have developed a new dynamic EHT (dyn-EHT) model that enables us to tune preload and have unconstrained contractile shortening of >10%. To do this, three-dimensional (3D) EHTs were integrated with an elastic polydimethylsiloxane strip providing mechanical preload and afterload in addition to enabling contractile force measurements based on strip bending. Our results demonstrated that dynamic loading improves the function of wild-type EHTs on the basis of the magnitude of the applied force, leading to improved alignment, conduction velocity, and contractility. For disease modeling, we used hiPSC-derived cardiomyocytes from a patient with arrhythmogenic cardiomyopathy due to mutations in the desmoplakin gene. We demonstrated that manifestation of this desmosome-linked disease state required dyn-EHT conditioning and that it could not be induced using 2D or standard 3D EHT approaches. Thus, a dynamic loading strategy is necessary to provoke the disease phenotype of diastolic lengthening, reduction of desmosome counts, and reduced contractility, which are related to primary end points of clinical disease, such as chamber thinning and reduced cardiac output.
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Affiliation(s)
- Jacqueline M Bliley
- Regenerative Biomaterials and Therapeutics Group, Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Mathilde C S C Vermeer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, Netherlands
| | - Rebecca M Duffy
- Regenerative Biomaterials and Therapeutics Group, Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Ivan Batalov
- Regenerative Biomaterials and Therapeutics Group, Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Duco Kramer
- Department of Dermatology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, Netherlands
| | - Joshua W Tashman
- Regenerative Biomaterials and Therapeutics Group, Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Daniel J Shiwarski
- Regenerative Biomaterials and Therapeutics Group, Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Andrew Lee
- Regenerative Biomaterials and Therapeutics Group, Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Alexander S Teplenin
- Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, 2333 ZA Leiden, Netherlands
| | - Linda Volkers
- Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, 2333 ZA Leiden, Netherlands
| | - Brian Coffin
- Department of Materials Science and Engineering, Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Martijn F Hoes
- Department of Cardiology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, Netherlands
| | - Anna Kalmykov
- Regenerative Biomaterials and Therapeutics Group, Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Rachelle N Palchesko
- Regenerative Biomaterials and Therapeutics Group, Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Yan Sun
- Regenerative Biomaterials and Therapeutics Group, Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Jan D H Jongbloed
- Department of Genetics, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, Netherlands
| | - Nils Bomer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, Netherlands
| | - Albert J H Suurmeijer
- Department of Pathology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, Netherlands
| | - Daniel A Pijnappels
- Department of Cardiology, Heart Lung Center Leiden, Leiden University Medical Center, 2333 ZA Leiden, Netherlands
| | - Maria C Bolling
- Department of Dermatology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, Netherlands
| | - Peter van der Meer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, Netherlands.
| | - Adam W Feinberg
- Regenerative Biomaterials and Therapeutics Group, Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA 15213, USA. .,Department of Materials Science and Engineering, Carnegie Mellon University, Pittsburgh, PA 15213, USA
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169
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Düsener S, Flenner F, Maack C, Kohlhaas M, Bay J, Carrier L, Friedrich FW. Ouabain worsens diastolic sarcomere length in myocytes from a cardiomyopathy mouse model. Eur J Pharmacol 2021; 904:174170. [PMID: 33984298 DOI: 10.1016/j.ejphar.2021.174170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/28/2021] [Accepted: 05/06/2021] [Indexed: 12/01/2022]
Abstract
Diastolic dysfunction is a major feature of hypertrophic cardiomyopathy (HCM). Data from patient tissue and animal models associate increased Ca2+ sensitivity of myofilaments with altered Na+ and Ca2+ ion homeostasis in cardiomyocytes with diastolic dysfunction. In this study, we tested the acute effects of ouabain on ventricular myocytes of an HCM mouse model. The effects of ouabain on contractility and Ca2+ transients were tested in intact adult mouse ventricular myocytes (AMVMs) of Mybpc3-targeted knock-in (KI) and wild-type (WT) mice. Concentration-response assessment of contractile function revealed low sensitivity of AMVMs to ouabain (10 μM) compared to literature data on human cardiomyocytes (100 nM). Three hundred μM ouabain increased contraction amplitude (WT ~1.8-fold; KI ~1.5-fold) and diastolic intracellular Ca2+ in both WT and KI (+12-18%), but further decreased diastolic sarcomere length in KI cardiomyocytes (-5%). Western Blot analysis of whole heart protein extracts revealed 50% lower amounts of Na+/K+ ATPase (NKA) in KI than in WT. Ouabain worsened the diastolic phenotype of KI cardiomyocytes at concentrations which did not impair WT diastolic function. Ouabain led to an elevation of intracellular Ca2+, which was poorly tolerated in KI showing already high cytosolic Ca2+ at baseline due to increased myofilament Ca2+ sensitivity. Lower amounts of NKA in KI could amplify the need to exchange excessive intracellular Na+ for Ca2+ and thereby explain the general tendency to higher diastolic Ca2+ in KI.
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Affiliation(s)
- Silke Düsener
- Department of Experimental Pharmacology and Toxicology, Cardiovascular Research Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Frederik Flenner
- Department of Experimental Pharmacology and Toxicology, Cardiovascular Research Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Christoph Maack
- Department of Translational Research, Comprehensive Heart Failure Center (CHFC), University Clinic Würzburg, Würzburg, Germany
| | - Michael Kohlhaas
- Department of Translational Research, Comprehensive Heart Failure Center (CHFC), University Clinic Würzburg, Würzburg, Germany
| | - Johannes Bay
- Department of Pediatrics and Neonatology, Saarland University Hospital, Homburg, Saar, Germany
| | - Lucie Carrier
- Department of Experimental Pharmacology and Toxicology, Cardiovascular Research Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany.
| | - Felix W Friedrich
- Department of Experimental Pharmacology and Toxicology, Cardiovascular Research Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany.
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170
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Kukavica D, Trancuccio A, Arnò C, Latini AC, Mazzanti A, Priori SG. Desmoplakin cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy: two distinct forms of cardiomyopathy? Minerva Cardiol Angiol 2021; 70:217-237. [PMID: 34338490 DOI: 10.23736/s2724-5683.21.05804-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The confirmation of a hypothesis that desmoplakin-related (DSP) cardiomyopathy could represent a distinct clinical entity from the classical, RV-dominant, form of arrhythmogenic cardiomyopathy (ACM), most frequently caused by PKP2 mutations, would without any shadow of doubt signify a turning point in the history of this disease. The concept of gene-specific diseases underneath the umbrella diagnosis of ACM would bring fundamental changes not only in the clinical, diagnostic and therapeutic approach, but also in terms of risk stratification, pushing the scientific community towards a more patient-centred view of the disease, similarly to what has already been done in other inherited arrhythmogenic disease (e.g., Long QT Syndrome; LQTS). We provide a state-of-the-art review, starting with a brief historical framework to give the necessary context and better focus the question. Then, we proceed with a novel, genotype-tophenotype-based comparison of the most important aspects of DSP-related cardiomyopathy with the classical, RV-dominant ACM: this allows us to ascertain not only that the differences between the forms exist, but are also clinically relevant and actionable, leading to the underrecognition of the atypical, DSP-related, LV-dominant forms when applying the current diagnostic criteria. These findings will usher an exciting era, in which the scientific community will try to answer a range of questions, starting from the reasons why different desmosomal mutations cause such different phenotypes.
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Affiliation(s)
- Deni Kukavica
- Molecular Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy.,Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Molecular Cardiology, Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Alessandro Trancuccio
- Molecular Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy.,Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Molecular Cardiology, Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Carlo Arnò
- Molecular Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy
| | - Alessia C Latini
- Molecular Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy
| | - Andrea Mazzanti
- Molecular Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy.,Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Molecular Cardiology, Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Silvia G Priori
- Molecular Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy - .,Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Molecular Cardiology, Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
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171
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Waring A, Harper A, Salatino S, Kramer C, Neubauer S, Thomson K, Watkins H, Farrall M. Data-driven modelling of mutational hotspots and in silico predictors in hypertrophic cardiomyopathy. J Med Genet 2021; 58:556-564. [PMID: 32732227 PMCID: PMC8327322 DOI: 10.1136/jmedgenet-2020-106922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/17/2020] [Accepted: 06/20/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although rare missense variants in Mendelian disease genes often cluster in specific regions of proteins, it is unclear how to consider this when evaluating the pathogenicity of a gene or variant. Here we introduce methods for gene association and variant interpretation that use this powerful signal. METHODS We present statistical methods to detect missense variant clustering (BIN-test) combined with burden information (ClusterBurden). We introduce a flexible generalised additive modelling (GAM) framework to identify mutational hotspots using burden and clustering information (hotspot model) and supplemented by in silico predictors (hotspot+ model). The methods were applied to synthetic data and a case-control dataset, comprising 5338 hypertrophic cardiomyopathy patients and 125 748 population reference samples over 34 putative cardiomyopathy genes. RESULTS In simulations, the BIN-test was almost twice as powerful as the Anderson-Darling or Kolmogorov-Smirnov tests; ClusterBurden was computationally faster and more powerful than alternative position-informed methods. For 6/8 sarcomeric genes with strong clustering, Clusterburden showed enhanced power over burden-alone, equivalent to increasing the sample size by 50%. Hotspot+ models that combine burden, clustering and in silico predictors outperform generic pathogenicity predictors and effectively integrate ACMG criteria PM1 and PP3 to yield strong or moderate evidence of pathogenicity for 31.8% of examined variants of uncertain significance. CONCLUSION GAMs represent a unified statistical modelling framework to combine burden, clustering and functional information. Hotspot models can refine maps of regional burden and hotspot+ models can be powerful predictors of variant pathogenicity. The BIN-test is a fast powerful approach to detect missense variant clustering that when combined with burden information (ClusterBurden) may enhance disease-gene discovery.
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Affiliation(s)
- Adam Waring
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Andrew Harper
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Silvia Salatino
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Christopher Kramer
- Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Stefan Neubauer
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Kate Thomson
- Oxford Medical Genetics Laboratories, Churchill Hospital, Oxford, UK
| | - Hugh Watkins
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Martin Farrall
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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172
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Sewanan LR, Park J, Rynkiewicz MJ, Racca AW, Papoutsidakis N, Schwan J, Jacoby DL, Moore JR, Lehman W, Qyang Y, Campbell SG. Loss of crossbridge inhibition drives pathological cardiac hypertrophy in patients harboring the TPM1 E192K mutation. J Gen Physiol 2021; 153:212516. [PMID: 34319370 PMCID: PMC8321830 DOI: 10.1085/jgp.202012640] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/14/2021] [Accepted: 07/09/2021] [Indexed: 01/10/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is an inherited disorder caused primarily by mutations to thick and thinfilament proteins. Although thin filament mutations are less prevalent than their oft-studied thick filament counterparts, they are frequently associated with severe patient phenotypes and can offer important insight into fundamental disease mechanisms. We have performed a detailed study of tropomyosin (TPM1) E192K, a variant of uncertain significance associated with HCM. Molecular dynamics revealed that E192K results in a more flexible TPM1 molecule, which could affect its ability to regulate crossbridges. In vitro motility assays of regulated actin filaments containing TPM1 E192K showed an overall loss of Ca2+ sensitivity. To understand these effects, we used multiscale computational models that suggested a subtle phenotype in which E192K leads to an inability to completely inhibit actin-myosin crossbridge activity at low Ca2+. To assess the physiological impact of the mutation, we generated patient-derived engineered heart tissues expressing E192K. These tissues showed disease features similar to those of the patients, including cellular hypertrophy, hypercontractility, and diastolic dysfunction. We hypothesized that excess residual crossbridge activity could be triggering cellular hypertrophy, even if the overall Ca2+ sensitivity was reduced by E192K. To test this hypothesis, the cardiac myosin-specific inhibitor mavacamten was applied to patient-derived engineered heart tissues for 4 d followed by 24 h of washout. Chronic mavacamten treatment abolished contractile differences between control and TPM1 E192K engineered heart tissues and reversed hypertrophy in cardiomyocytes. These results suggest that the TPM1 E192K mutation triggers cardiomyocyte hypertrophy by permitting excess residual crossbridge activity. These studies also provide direct evidence that myosin inhibition by mavacamten can counteract the hypertrophic effects of mutant tropomyosin.
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Affiliation(s)
- Lorenzo R Sewanan
- Department of Biomedical Engineering, Yale University, New Haven, CT
| | - Jinkyu Park
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale Cardiovascular Research Center, Yale School of Medicine, New Haven, CT.,Yale Stem Cell Center, Yale School of Medicine, New Haven, CT
| | - Michael J Rynkiewicz
- Department of Physiology and Biophysics, Boston University School of Medicine, Boston, MA
| | - Alice W Racca
- Department of Biological Sciences, University of Massachusetts, Lowell, MA
| | - Nikolaos Papoutsidakis
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT
| | - Jonas Schwan
- Department of Biomedical Engineering, Yale University, New Haven, CT
| | - Daniel L Jacoby
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT
| | - Jeffrey R Moore
- Department of Biological Sciences, University of Massachusetts, Lowell, MA
| | - William Lehman
- Department of Physiology and Biophysics, Boston University School of Medicine, Boston, MA
| | - Yibing Qyang
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale Cardiovascular Research Center, Yale School of Medicine, New Haven, CT.,Yale Stem Cell Center, Yale School of Medicine, New Haven, CT.,Vascular Biology and Therapeutics Program, Yale University, New Haven, CT.,Department of Pathology, Yale University, New Haven, CT
| | - Stuart G Campbell
- Department of Biomedical Engineering, Yale University, New Haven, CT.,Department of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT
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173
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Kozek K, Wada Y, Sala L, Denjoy I, Egly C, O'Neill MJ, Aiba T, Shimizu W, Makita N, Ishikawa T, Crotti L, Spazzolini C, Kotta MC, Dagradi F, Castelletti S, Pedrazzini M, Gnecchi M, Leenhardt A, Salem JE, Ohno S, Zuo Y, Glazer AM, Mosley JD, Roden DM, Knollmann BC, Blume JD, Extramiana F, Schwartz PJ, Horie M, Kroncke BM. Estimating the Posttest Probability of Long QT Syndrome Diagnosis for Rare KCNH2 Variants. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2021; 14:e003289. [PMID: 34309407 DOI: 10.1161/circgen.120.003289] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The proliferation of genetic profiling has revealed many associations between genetic variations and disease. However, large-scale phenotyping efforts in largely healthy populations, coupled with DNA sequencing, suggest variants currently annotated as pathogenic are more common in healthy populations than previously thought. In addition, novel and rare variants are frequently observed in genes associated with disease both in healthy individuals and those under suspicion of disease. This raises the question of whether these variants can be useful predictors of disease. To answer this question, we assessed the degree to which the presence of a variant in the cardiac potassium channel gene KCNH2 was diagnostically predictive for the autosomal dominant long QT syndrome. METHODS We estimated the probability of a long QT diagnosis given the presence of each KCNH2 variant using Bayesian methods that incorporated variant features such as changes in variant function, protein structure, and in silico predictions. We call this estimate the posttest probability of disease. Our method was applied to over 4000 individuals heterozygous for 871 missense or in-frame insertion/deletion variants in KCNH2 and validated against a separate international cohort of 933 individuals heterozygous for 266 missense or in-frame insertion/deletion variants. RESULTS Our method was well-calibrated for the observed fraction of heterozygotes diagnosed with long QT syndrome. Heuristically, we found that the innate diagnostic information one learns about a variant from 3-dimensional variant location, in vitro functional data, and in silico predictors is equivalent to the diagnostic information one learns about that same variant by clinically phenotyping 10 heterozygotes. Most importantly, these data can be obtained in the absence of any clinical observations. CONCLUSIONS We show how variant-specific features can inform a prior probability of disease for rare variants even in the absence of clinically phenotyped heterozygotes.
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Affiliation(s)
- Krystian Kozek
- Vanderbilt Center for Arrhythmia Research and Therapeutics (VanCART), Departments of Medicine & Pharmacology (K.K., Y.W., C.E., M.J.O., A.M.G., J.D.M., D.M.R., B.C.K., B.M.K.), Vanderbilt University Medical Center, Nashville, TN
| | - Yuko Wada
- Vanderbilt Center for Arrhythmia Research and Therapeutics (VanCART), Departments of Medicine & Pharmacology (K.K., Y.W., C.E., M.J.O., A.M.G., J.D.M., D.M.R., B.C.K., B.M.K.), Vanderbilt University Medical Center, Nashville, TN.,Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan (Y.W., S.O., M.H.)
| | - Luca Sala
- Laboratory of Cardiovascular Genetics, Istituto Auxologico Italiano IRCCS, Cusano Milanino, Italy (L.S., L.C., C.K., M.P., P.J.S.)
| | - Isabelle Denjoy
- CNMR Maladies Cardiaques Héréditaires Rares, AP-HP, Hôpital Bichat, Paris, France (I.D., A.L., F.E.)
| | - Christian Egly
- Vanderbilt Center for Arrhythmia Research and Therapeutics (VanCART), Departments of Medicine & Pharmacology (K.K., Y.W., C.E., M.J.O., A.M.G., J.D.M., D.M.R., B.C.K., B.M.K.), Vanderbilt University Medical Center, Nashville, TN
| | - Matthew J O'Neill
- Vanderbilt Center for Arrhythmia Research and Therapeutics (VanCART), Departments of Medicine & Pharmacology (K.K., Y.W., C.E., M.J.O., A.M.G., J.D.M., D.M.R., B.C.K., B.M.K.), Vanderbilt University Medical Center, Nashville, TN
| | - Takeshi Aiba
- Department of Cardiovascular Medicine (T.A., N.M., S.O.), National Cerebral and Cardiovascular Center, Suita
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (W.S.)
| | - Naomasa Makita
- Department of Cardiovascular Medicine (T.A., N.M., S.O.), National Cerebral and Cardiovascular Center, Suita.,7Omics Research Center (N.M., T.I.), National Cerebral and Cardiovascular Center, Suita
| | - Taisuke Ishikawa
- 7Omics Research Center (N.M., T.I.), National Cerebral and Cardiovascular Center, Suita
| | - Lia Crotti
- Laboratory of Cardiovascular Genetics, Istituto Auxologico Italiano IRCCS, Cusano Milanino, Italy (L.S., L.C., C.K., M.P., P.J.S.).,Department of Cardiovascular, Neural & Metabolic Sciences, San Luca Hospital (L.C.), Istituto Auxologico Italiano IRCCS.,Center for Cardiac Arrhythmias of Genetic Origin (L.C., C.S., F.D., S.C., P.J.S.), Istituto Auxologico Italiano IRCCS.,Department of Medicine and Surgery, University Milano Bicocca, Milan (L.C.)
| | - Carla Spazzolini
- Center for Cardiac Arrhythmias of Genetic Origin (L.C., C.S., F.D., S.C., P.J.S.), Istituto Auxologico Italiano IRCCS
| | | | - Federica Dagradi
- Center for Cardiac Arrhythmias of Genetic Origin (L.C., C.S., F.D., S.C., P.J.S.), Istituto Auxologico Italiano IRCCS
| | - Silvia Castelletti
- Center for Cardiac Arrhythmias of Genetic Origin (L.C., C.S., F.D., S.C., P.J.S.), Istituto Auxologico Italiano IRCCS
| | - Matteo Pedrazzini
- Laboratory of Cardiovascular Genetics, Istituto Auxologico Italiano IRCCS, Cusano Milanino, Italy (L.S., L.C., C.K., M.P., P.J.S.)
| | - Massimiliano Gnecchi
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia (M.G.).,Intensive Cardiac Care Unit and Lab of Experimental Cardiology for Cell and Molecular Therapy, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (M.G.)
| | - Antoine Leenhardt
- CNMR Maladies Cardiaques Héréditaires Rares, AP-HP, Hôpital Bichat, Paris, France (I.D., A.L., F.E.).,University de Paris (A.L., F.E.)
| | - Joe-Elie Salem
- Division of Cardiovascular Medicine, Cardio-oncology Program (J.-E.S.), Vanderbilt University Medical Center, Nashville, TN.,Sorbonne Université, INSERM CIC-1901, AP-HP, Department of Pharmacology, Regional Pharmacovigilance Center, Pitié-Salpêtrière Hospital, Paris, France (J.-E.S.)
| | - Seiko Ohno
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan (Y.W., S.O., M.H.).,Department of Cardiovascular Medicine (T.A., N.M., S.O.), National Cerebral and Cardiovascular Center, Suita
| | - Yi Zuo
- Department of Biostatistics (Y.Z., J.D.M., D.M.R.), Vanderbilt University, Nashville, TN
| | - Andrew M Glazer
- Vanderbilt Center for Arrhythmia Research and Therapeutics (VanCART), Departments of Medicine & Pharmacology (K.K., Y.W., C.E., M.J.O., A.M.G., J.D.M., D.M.R., B.C.K., B.M.K.), Vanderbilt University Medical Center, Nashville, TN
| | - Jonathan D Mosley
- Vanderbilt Center for Arrhythmia Research and Therapeutics (VanCART), Departments of Medicine & Pharmacology (K.K., Y.W., C.E., M.J.O., A.M.G., J.D.M., D.M.R., B.C.K., B.M.K.), Vanderbilt University Medical Center, Nashville, TN.,Department of Biostatistics (Y.Z., J.D.M., D.M.R.), Vanderbilt University, Nashville, TN.,Biomedical Informatics (J.D.M.), Vanderbilt University, Nashville, TN
| | - Dan M Roden
- Vanderbilt Center for Arrhythmia Research and Therapeutics (VanCART), Departments of Medicine & Pharmacology (K.K., Y.W., C.E., M.J.O., A.M.G., J.D.M., D.M.R., B.C.K., B.M.K.), Vanderbilt University Medical Center, Nashville, TN.,Department of Biostatistics (Y.Z., J.D.M., D.M.R.), Vanderbilt University, Nashville, TN
| | - Bjorn C Knollmann
- Vanderbilt Center for Arrhythmia Research and Therapeutics (VanCART), Departments of Medicine & Pharmacology (K.K., Y.W., C.E., M.J.O., A.M.G., J.D.M., D.M.R., B.C.K., B.M.K.), Vanderbilt University Medical Center, Nashville, TN
| | | | - Fabrice Extramiana
- CNMR Maladies Cardiaques Héréditaires Rares, AP-HP, Hôpital Bichat, Paris, France (I.D., A.L., F.E.).,University de Paris (A.L., F.E.)
| | - Peter J Schwartz
- Laboratory of Cardiovascular Genetics, Istituto Auxologico Italiano IRCCS, Cusano Milanino, Italy (L.S., L.C., C.K., M.P., P.J.S.).,Center for Cardiac Arrhythmias of Genetic Origin (L.C., C.S., F.D., S.C., P.J.S.), Istituto Auxologico Italiano IRCCS
| | - Minoru Horie
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan (Y.W., S.O., M.H.)
| | - Brett M Kroncke
- Vanderbilt Center for Arrhythmia Research and Therapeutics (VanCART), Departments of Medicine & Pharmacology (K.K., Y.W., C.E., M.J.O., A.M.G., J.D.M., D.M.R., B.C.K., B.M.K.), Vanderbilt University Medical Center, Nashville, TN
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174
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Viggiano E, Politano L. X Chromosome Inactivation in Carriers of Fabry Disease: Review and Meta-Analysis. Int J Mol Sci 2021; 22:ijms22147663. [PMID: 34299283 PMCID: PMC8304911 DOI: 10.3390/ijms22147663] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 12/27/2022] Open
Abstract
Anderson-Fabry disease is an X-linked inborn error of glycosphingolipid catabolism caused by a deficiency of α-galactosidase A. The incidence ranges between 1: 40,000 and 1:117,000 of live male births. In Italy, an estimate of incidence is available only for the north-western Italy, where it is of approximately 1:4000. Clinical symptoms include angiokeratomas, corneal dystrophy, and neurological, cardiac and kidney involvement. The prevalence of symptomatic female carriers is about 70%, and in some cases, they can exhibit a severe phenotype. Previous studies suggest a correlation between skewed X chromosome inactivation and symptoms in carriers of X-linked disease, including Fabry disease. In this review, we briefly summarize the disease, focusing on the clinical symptoms of carriers and analysis of the studies so far published in regards to X chromosome inactivation pattern, and manifesting Fabry carriers. Out of 151 records identified, only five reported the correlation between the analysis of XCI in leukocytes and the related phenotype in Fabry carriers, in particular evaluating the Mainz Severity Score Index or cardiac involvement. The meta-analysis did not show any correlation between MSSI or cardiac involvement and skewed XCI, likely because the analysis of XCI in leukocytes is not useful for predicting the phenotype in Fabry carriers.
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Affiliation(s)
- Emanuela Viggiano
- Department of Prevention, UOC Hygiene Service and Public Health, ASL Roma 2, 00142 Rome, Italy
- Correspondence: (E.V.); (L.P.)
| | - Luisa Politano
- Cardiomyology and Medical Genetics, Department of Experimental Medicine, Luigi Vanvitelli University, 80138 Naples, Italy
- Correspondence: (E.V.); (L.P.)
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175
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Cao X, Jahng JWS, Lee C, Zha Y, Wheeler MT, Sallam K, Wu JC. Generation of three induced pluripotent stem cell lines from hypertrophic cardiomyopathy patients carrying MYH7 mutations. Stem Cell Res 2021; 55:102455. [PMID: 34352619 DOI: 10.1016/j.scr.2021.102455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/01/2021] [Accepted: 07/01/2021] [Indexed: 11/30/2022] Open
Abstract
MYH7 heterozygous mutations are common genetic causes of hypertrophic cardiomyopathy (HCM). HCM is characterized by hypertrophy of the left ventricle and diastolic dysfunction. We generated three human induced pluripotent stem cell (iPSC) lines from three HCM patients each carrying a single heterozygous mutation in MYH7, c.2167C > T, c.4066G > A, and c.5135G > A, respectively. All lines expressed high levels of pluripotent markers, had normal karyotype, and possessed capability of differentiation into derivatives of the three germ layers, which can serve as valuable tools for modeling HCM in vitro and investigating the pathological mechanisms related to MYH7 mutations.
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Affiliation(s)
- Xu Cao
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - James W S Jahng
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Chelsea Lee
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Yanjun Zha
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Matthew T Wheeler
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Karim Sallam
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Joseph C Wu
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, CA 94305, USA.
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176
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Jordan E, Peterson L, Ai T, Asatryan B, Bronicki L, Brown E, Celeghin R, Edwards M, Fan J, Ingles J, James CA, Jarinova O, Johnson R, Judge DP, Lahrouchi N, Lekanne Deprez RH, Lumbers RT, Mazzarotto F, Medeiros Domingo A, Miller RL, Morales A, Murray B, Peters S, Pilichou K, Protonotarios A, Semsarian C, Shah P, Syrris P, Thaxton C, van Tintelen JP, Walsh R, Wang J, Ware J, Hershberger RE. Evidence-Based Assessment of Genes in Dilated Cardiomyopathy. Circulation 2021; 144:7-19. [PMID: 33947203 PMCID: PMC8247549 DOI: 10.1161/circulationaha.120.053033] [Citation(s) in RCA: 219] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 03/13/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Each of the cardiomyopathies, classically categorized as hypertrophic cardiomyopathy, dilated cardiomyopathy (DCM), and arrhythmogenic right ventricular cardiomyopathy, has a signature genetic theme. Hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy are largely understood as genetic diseases of sarcomere or desmosome proteins, respectively. In contrast, >250 genes spanning >10 gene ontologies have been implicated in DCM, representing a complex and diverse genetic architecture. To clarify this, a systematic curation of evidence to establish the relationship of genes with DCM was conducted. METHODS An international panel with clinical and scientific expertise in DCM genetics evaluated evidence supporting monogenic relationships of genes with idiopathic DCM. The panel used the Clinical Genome Resource semiquantitative gene-disease clinical validity classification framework with modifications for DCM genetics to classify genes into categories on the basis of the strength of currently available evidence. Representation of DCM genes on clinically available genetic testing panels was evaluated. RESULTS Fifty-one genes with human genetic evidence were curated. Twelve genes (23%) from 8 gene ontologies were classified as having definitive (BAG3, DES, FLNC, LMNA, MYH7, PLN, RBM20, SCN5A, TNNC1, TNNT2, TTN) or strong (DSP) evidence. Seven genes (14%; ACTC1, ACTN2, JPH2, NEXN, TNNI3, TPM1, VCL) including 2 additional ontologies were classified as moderate evidence; these genes are likely to emerge as strong or definitive with additional evidence. Of these 19 genes, 6 were similarly classified for hypertrophic cardiomyopathy and 3 for arrhythmogenic right ventricular cardiomyopathy. Of the remaining 32 genes (63%), 25 (49%) had limited evidence, 4 (8%) were disputed, 2 (4%) had no disease relationship, and 1 (2%) was supported by animal model data only. Of the 16 evaluated clinical genetic testing panels, most definitive genes were included, but panels also included numerous genes with minimal human evidence. CONCLUSIONS In the curation of 51 genes, 19 had high evidence (12 definitive/strong, 7 moderate). It is notable that these 19 genes explain only a minority of cases, leaving the remainder of DCM genetic architecture incompletely addressed. Clinical genetic testing panels include most high-evidence genes; however, genes lacking robust evidence are also commonly included. We recommend that high-evidence DCM genes be used for clinical practice and that caution be exercised in the interpretation of variants in variable-evidence DCM genes.
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Affiliation(s)
- Elizabeth Jordan
- Division of Human Genetics (E.J., L.P., T.A., R.E.H.), Department of Internal Medicine, Wexner Medical Center, The Ohio State University, Columbus
| | - Laiken Peterson
- Division of Human Genetics (E.J., L.P., T.A., R.E.H.), Department of Internal Medicine, Wexner Medical Center, The Ohio State University, Columbus
| | - Tomohiko Ai
- Division of Human Genetics (E.J., L.P., T.A., R.E.H.), Department of Internal Medicine, Wexner Medical Center, The Ohio State University, Columbus
| | - Babken Asatryan
- Department for Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (B.A.)
| | - Lucas Bronicki
- Department of Genetics, Children’s Hospital of Eastern Ontario, Ottawa, Canada (L.B., O.J.)
- Department of Laboratory and Pathology Medicine, University of Ottawa, Ontario, Canada (L.B., O.J.)
| | - Emily Brown
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (E.B., C.A.J., B.M.)
| | - Rudy Celeghin
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Italy (R.C., K.P.)
| | - Matthew Edwards
- Clinical Genetics and Genomics Laboratory, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (M.E.)
| | - Judy Fan
- Department of Medicine, University of California, Los Angeles (J.F., J. Wang)
| | - Jodie Ingles
- Cardio Genomics Program at Centenary Institute, University of Sydney, Australia (J.I.)
| | - Cynthia A. James
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (E.B., C.A.J., B.M.)
| | - Olga Jarinova
- Department of Genetics, Children’s Hospital of Eastern Ontario, Ottawa, Canada (L.B., O.J.)
- Department of Laboratory and Pathology Medicine, University of Ottawa, Ontario, Canada (L.B., O.J.)
| | - Renee Johnson
- Victor Chang Cardiac Research Institute, Sydney, Australia (R.J.)
- Department of Medicine, University of New South Wales, Sydney, Australia (R.J.)
| | - Daniel P. Judge
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston (D.P.J.)
| | - Najim Lahrouchi
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam Universitair Medische Centra, University of Amsterdam, the Netherlands (N.L., R.W.)
| | - Ronald H. Lekanne Deprez
- Department of Clinical Genetics, Amsterdam University Medical Center location Academic Medical Center, the Netherlands (R.H.L.D.)
| | - R. Thomas Lumbers
- Institute of Health Informatics, University College London, London, UK (R.T.L.)
- Health Data Research UK London, University College London, UK (R.T.L.)
- University College London British Heart Foundation Research Accelerator, London, United Kingdom (R.T.L.)
| | - Francesco Mazzarotto
- Cardiovascular Research Center, Royal Brompton and Harefield Hospitals, National Health Service Foundation Trust, London, United Kingdom (F.M., J. Ware)
- National Heart and Lung Institute, Imperial College London, United Kingdom (F.M., J. Ware)
- Department of Clinical and Experimental Medicine, University of Florence, Italy (F.M.)
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy (F.M.)
| | | | - Rebecca L. Miller
- Cardiovascular Genomics Center, Inova Heart and Vascular Institute, Falls Church, VA (R.L.M., P. Shah)
| | | | - Brittney Murray
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (E.B., C.A.J., B.M.)
| | - Stacey Peters
- Department of Cardiology and Genomic Medicine, Royal Melbourne Hospital, Australia (S.P.)
| | - Kalliopi Pilichou
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Italy (R.C., K.P.)
| | - Alexandros Protonotarios
- Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, United Kingdom (A.P., P. Syrris)
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, University of Sydney, Australia (C.S.)
| | - Palak Shah
- Cardiovascular Genomics Center, Inova Heart and Vascular Institute, Falls Church, VA (R.L.M., P. Shah)
| | - Petros Syrris
- Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, United Kingdom (A.P., P. Syrris)
| | - Courtney Thaxton
- Department of Genetics, University of North Carolina, Chapel Hill (C.T.)
| | - J. Peter van Tintelen
- Department of Genetics, University Medical Center Utrecht, University of Utrecht, The Netherlands (J.P.v.T.)
| | - Roddy Walsh
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam Universitair Medische Centra, University of Amsterdam, the Netherlands (N.L., R.W.)
| | - Jessica Wang
- Department of Medicine, University of California, Los Angeles (J.F., J. Wang)
| | - James Ware
- Cardiovascular Research Center, Royal Brompton and Harefield Hospitals, National Health Service Foundation Trust, London, United Kingdom (F.M., J. Ware)
- National Heart and Lung Institute, Imperial College London, United Kingdom (F.M., J. Ware)
- Medical Research Council London Institute for Medical Sciences, Imperial College London, United Kingdom (J. Ware)
| | - Ray E. Hershberger
- Division of Human Genetics (E.J., L.P., T.A., R.E.H.), Department of Internal Medicine, Wexner Medical Center, The Ohio State University, Columbus
- Division of Cardiovascular Medicine (R.E.H.), Department of Internal Medicine, Wexner Medical Center, The Ohio State University, Columbus
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177
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Suay-Corredera C, Pricolo MR, Herrero-Galán E, Velázquez-Carreras D, Sánchez-Ortiz D, García-Giustiniani D, Delgado J, Galano-Frutos JJ, García-Cebollada H, Vilches S, Domínguez F, Molina MS, Barriales-Villa R, Frisso G, Sancho J, Serrano L, García-Pavía P, Monserrat L, Alegre-Cebollada J. Protein haploinsufficiency drivers identify MYBPC3 variants that cause hypertrophic cardiomyopathy. J Biol Chem 2021; 297:100854. [PMID: 34097875 PMCID: PMC8260873 DOI: 10.1016/j.jbc.2021.100854] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/21/2021] [Accepted: 06/03/2021] [Indexed: 02/06/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disease. Variants in MYBPC3, the gene encoding cardiac myosin-binding protein C (cMyBP-C), are the leading cause of HCM. However, the pathogenicity status of hundreds of MYBPC3 variants found in patients remains unknown, as a consequence of our incomplete understanding of the pathomechanisms triggered by HCM-causing variants. Here, we examined 44 nontruncating MYBPC3 variants that we classified as HCM-linked or nonpathogenic according to cosegregation and population genetics criteria. We found that around half of the HCM-linked variants showed alterations in RNA splicing or protein stability, both of which can lead to cMyBP-C haploinsufficiency. These protein haploinsufficiency drivers associated with HCM pathogenicity with 100% and 94% specificity, respectively. Furthermore, we uncovered that 11% of nontruncating MYBPC3 variants currently classified as of uncertain significance in ClinVar induced one of these molecular phenotypes. Our strategy, which can be applied to other conditions induced by protein loss of function, supports the idea that cMyBP-C haploinsufficiency is a fundamental pathomechanism in HCM.
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Affiliation(s)
| | - Maria Rosaria Pricolo
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, Naples, Italy
| | | | | | | | | | - Javier Delgado
- EMBL/CRG Systems Biology Research Unit, Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Juan José Galano-Frutos
- Departamento de Bioquímica y Biología Molecular y Celular, Facultad de Ciencias, Universidad de Zaragoza, Zaragoza, Spain; Biocomputation and Complex Systems Physics Institute (BIFI). Joint Units BIFI-IQFR (CSIC) and GBs-CSIC, Universidad de Zaragoza, Zaragoza, Spain
| | - Helena García-Cebollada
- Departamento de Bioquímica y Biología Molecular y Celular, Facultad de Ciencias, Universidad de Zaragoza, Zaragoza, Spain; Biocomputation and Complex Systems Physics Institute (BIFI). Joint Units BIFI-IQFR (CSIC) and GBs-CSIC, Universidad de Zaragoza, Zaragoza, Spain
| | - Silvia Vilches
- Heart Failure and Inherited Cardiac Diseases Unit. Department of Cardiology. Hospital Universitario Puerta de Hierro, Madrid, Spain; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-HEART), Madrid, Spain
| | - Fernando Domínguez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Heart Failure and Inherited Cardiac Diseases Unit. Department of Cardiology. Hospital Universitario Puerta de Hierro, Madrid, Spain; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-HEART), Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - María Sabater Molina
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-HEART), Madrid, Spain; Hospital C. Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Roberto Barriales-Villa
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Unidad de Cardiopatías Familiares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde (SERGAS), Universidade da Coruña, A Coruña, Spain
| | - Giulia Frisso
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, Naples, Italy; CEINGE Biotecnologie Avanzate, scarl, Naples, Italy
| | - Javier Sancho
- Departamento de Bioquímica y Biología Molecular y Celular, Facultad de Ciencias, Universidad de Zaragoza, Zaragoza, Spain; Biocomputation and Complex Systems Physics Institute (BIFI). Joint Units BIFI-IQFR (CSIC) and GBs-CSIC, Universidad de Zaragoza, Zaragoza, Spain; Aragon Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - Luis Serrano
- EMBL/CRG Systems Biology Research Unit, Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Pablo García-Pavía
- Heart Failure and Inherited Cardiac Diseases Unit. Department of Cardiology. Hospital Universitario Puerta de Hierro, Madrid, Spain; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-HEART), Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcón, Madrid, Spain
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178
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Tayal U, Ware JS, Lakdawala NK, Heymans S, Prasad SK. Understanding the genetics of adult-onset dilated cardiomyopathy: what a clinician needs to know. Eur Heart J 2021; 42:2384-2396. [PMID: 34153989 DOI: 10.1093/eurheartj/ehab286] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/10/2021] [Accepted: 05/19/2021] [Indexed: 12/28/2022] Open
Abstract
There is increasing understanding of the genetic basis to dilated cardiomyopathy and in this review, we offer a practical primer for the practising clinician. We aim to help all clinicians involved in the care of patients with dilated cardiomyopathy to understand the clinical relevance of the genetic basis of dilated cardiomyopathy, introduce key genetic concepts, explain which patients and families may benefit from genetic testing, which genetic tests are commonly performed, how to interpret genetic results, and the clinical applications of results. We conclude by reviewing areas for future research in this dynamic field.
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Affiliation(s)
- Upasana Tayal
- National Heart Lung Institute, Imperial College London, UK.,Cardiovascular Research Centre, Royal Brompton & Harefield Hospitals, London, UK
| | - James S Ware
- National Heart Lung Institute, Imperial College London, UK.,Cardiovascular Research Centre, Royal Brompton & Harefield Hospitals, London, UK.,MRC London Institute of Medical Sciences, London, UK
| | - Neal K Lakdawala
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stephane Heymans
- Department of Cardiology, CARIM School for Cardiovascular Diseases Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands.,Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology, Leuven, KU, Belgium.,The Netherlands Heart Institute, Nl-HI, Utrecht, The Netherlands
| | - Sanjay K Prasad
- National Heart Lung Institute, Imperial College London, UK.,Cardiovascular Research Centre, Royal Brompton & Harefield Hospitals, London, UK
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179
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Suay-Corredera C, Pricolo MR, Velázquez-Carreras D, Pathak D, Nandwani N, Pimenta-Lopes C, Sánchez-Ortiz D, Urrutia-Irazabal I, Vilches S, Dominguez F, Frisso G, Monserrat L, García-Pavía P, de Sancho D, Spudich JA, Ruppel KM, Herrero-Galán E, Alegre-Cebollada J. Nanomechanical Phenotypes in Cardiac Myosin-Binding Protein C Mutants That Cause Hypertrophic Cardiomyopathy. ACS NANO 2021; 15:10203-10216. [PMID: 34060810 PMCID: PMC8514129 DOI: 10.1021/acsnano.1c02242] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is a disease of the myocardium caused by mutations in sarcomeric proteins with mechanical roles, such as the molecular motor myosin. Around half of the HCM-causing genetic variants target contraction modulator cardiac myosin-binding protein C (cMyBP-C), although the underlying pathogenic mechanisms remain unclear since many of these mutations cause no alterations in protein structure and stability. As an alternative pathomechanism, here we have examined whether pathogenic mutations perturb the nanomechanics of cMyBP-C, which would compromise its modulatory mechanical tethers across sliding actomyosin filaments. Using single-molecule atomic force spectroscopy, we have quantified mechanical folding and unfolding transitions in cMyBP-C domains targeted by HCM mutations that do not induce RNA splicing alterations or protein thermodynamic destabilization. Our results show that domains containing mutation R495W are mechanically weaker than wild-type at forces below 40 pN and that R502Q mutant domains fold faster than wild-type. None of these alterations are found in control, nonpathogenic variants, suggesting that nanomechanical phenotypes induced by pathogenic cMyBP-C mutations contribute to HCM development. We propose that mutation-induced nanomechanical alterations may be common in mechanical proteins involved in human pathologies.
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Affiliation(s)
| | - Maria Rosaria Pricolo
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029, Madrid, Spain
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, 80131, Naples, Italy
| | | | - Divya Pathak
- Department of Biochemistry, Stanford University School of Medicine, Stanford, California 94305, United States
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California 94305, United States
| | - Neha Nandwani
- Department of Biochemistry, Stanford University School of Medicine, Stanford, California 94305, United States
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California 94305, United States
| | | | - David Sánchez-Ortiz
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029, Madrid, Spain
| | | | - Silvia Vilches
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, 28222, Madrid, Spain
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-HEART, http://guardheart.ern-net.eu/), 28222, Madrid, Spain
| | - Fernando Dominguez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029, Madrid, Spain
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, 28222, Madrid, Spain
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-HEART, http://guardheart.ern-net.eu/), 28222, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), 28029, Madrid, Spain
| | - Giulia Frisso
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, 80131, Naples, Italy
- CEINGE Biotecnologie Avanzate, scarl, 80145, Naples, Italy
| | | | - Pablo García-Pavía
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, 28222, Madrid, Spain
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-HEART, http://guardheart.ern-net.eu/), 28222, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), 28029, Madrid, Spain
- Universidad Francisco de Vitoria (UFV), 28223, Pozuelo de Alarcón, Madrid, Spain
| | - David de Sancho
- Polimero eta Material Aurreratuak: Fisika, Kimika eta Teknologia, Kimika Fakultatea, Euskal Herriko Unibertsitatea UPV/EHU, 20018, Donostia-San Sebastián, Spain
- Donostia International Physics Center (DIPC), 20018, Donostia-San Sebastián, Spain
| | - James A Spudich
- Department of Biochemistry, Stanford University School of Medicine, Stanford, California 94305, United States
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California 94305, United States
| | - Kathleen M Ruppel
- Department of Biochemistry, Stanford University School of Medicine, Stanford, California 94305, United States
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California 94305, United States
| | - Elías Herrero-Galán
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029, Madrid, Spain
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180
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Pathogenic Intronic Splice-Affecting Variants in MYBPC3 in Three Patients with Hypertrophic Cardiomyopathy. CARDIOGENETICS 2021. [DOI: 10.3390/cardiogenetics11020009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Genetic variants in MYBPC3 are one of the most common causes of hypertrophic cardiomyopathy (HCM). While variants in MYBPC3 affecting canonical splice site dinucleotides are a well-characterised cause of HCM, only recently has work begun to investigate the pathogenicity of more deeply intronic variants. Here, we present three patients with HCM and intronic splice-affecting MYBPC3 variants and analyse the impact of variants on splicing using in vitro minigene assays. We show that the three variants, a novel c.927-8G>A variant and the previously reported c.1624+4A>T and c.3815-10T>G variants, result in MYBPC3 splicing errors. Analysis of blood-derived patient RNA for the c.3815-10T>G variant revealed only wild type spliced product, indicating that mis-spliced transcripts from the mutant allele are degraded. These data indicate that the c.927-8G>A variant of uncertain significance and likely benign c.3815-10T>G should be reclassified as likely pathogenic. Furthermore, we find shortcomings in commonly applied bioinformatics strategies to prioritise variants impacting MYBPC3 splicing and re-emphasise the need for functional assessment of variants of uncertain significance in diagnostic testing.
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181
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Guo L, Torii S, Fernandez R, Braumann RE, Fuller DT, Paek KH, Gadhoke NV, Maloney KA, Harris K, Mayhew CM, Zarpak R, Stevens LM, Gaynor BJ, Jinnouchi H, Sakamoto A, Sato Y, Mori H, Kutyna MD, Lee PJ, Weinstein LM, Collado-Rivera CJ, Ali BB, Atmakuri DR, Dhingra R, Finn ELB, Bell MW, Lynch M, Cornelissen A, Kuntz SH, Park JH, Kutys R, Park JE, Wang L, Hong SN, Gupta A, Hall JL, Kolodgie FD, Romero ME, Jeng LJB, Mitchell BD, Surve D, Fowler DR, Hong CC, Virmani R, Finn AV. Genetic Variants Associated With Unexplained Sudden Cardiac Death in Adult White and African American Individuals. JAMA Cardiol 2021; 6:1013-1022. [PMID: 34076677 DOI: 10.1001/jamacardio.2021.1573] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance Unexplained sudden cardiac death (SCD) describes SCD with no cause identified. Genetic testing helps to diagnose inherited cardiac diseases in unexplained SCD; however, the associations between pathogenic or likely pathogenic (P/LP) variants of inherited cardiomyopathies (CMs) and arrhythmia syndromes and the risk of unexplained SCD in both White and African American adults living the United States has never been systematically examined. Objective To investigate cases of unexplained SCD to determine the frequency of P/LP genetic variants of inherited CMs and arrhythmia syndromes. Design, Setting, and Participants This genetic association study included 683 African American and White adults who died of unexplained SCD and were included in an autopsy registry. Overall, 413 individuals had DNA of acceptable quality for genetic sequencing. Data were collected from January 1995 to December 2015. A total of 30 CM genes and 38 arrhythmia genes were sequenced, and variants in these genes, curated as P/LP, were examined to study their frequency. Data analysis was performed from June 2018 to March 2021. Main Outcomes and Measures The frequency of P/LP variants for CM or arrhythmia in individuals with unexplained SCD. Results The median (interquartile range) age at death of the 413 included individuals was 41 (29-48) years, 259 (62.7%) were men, and 208 (50.4%) were African American adults. A total of 76 patients (18.4%) with unexplained SCD carried variants considered P/LP for CM and arrhythmia genes. In total, 52 patients (12.6%) had 49 P/LP variants for CM, 22 (5.3%) carried 23 P/LP variants for arrhythmia, and 2 (0.5%) had P/LP variants for both CM and arrhythmia. Overall, 41 P/LP variants for hypertrophic CM were found in 45 patients (10.9%), 9 P/LP variants for dilated CM were found in 11 patients (2.7%), and 10 P/LP variants for long QT syndrome were found in 11 patients (2.7%). No significant difference was found in clinical and heart characteristics between individuals with or without P/LP variants. African American and White patients were equally likely to harbor P/LP variants. Conclusions and Relevance In this large genetic association study of community cases of unexplained SCD, nearly 20% of patients carried P/LP variants, suggesting that genetics may contribute to a significant number of cases of unexplained SCD. Our findings regarding both the association of unexplained SCD with CM genes and race-specific genetic variants suggest new avenues of study for this poorly understood entity.
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Affiliation(s)
- Liang Guo
- CVPath Institute, Gaithersburg, Maryland.,currently with Bioscience Cardiovascular Research and Early Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals Research and Development, AstraZeneca, Gaithersburg, Maryland
| | - Sho Torii
- CVPath Institute, Gaithersburg, Maryland.,currently with Department of Cardiology, Tokai University School of Medicine, Kanagawa, Japan
| | | | | | | | | | | | - Kristin A Maloney
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kathryn Harris
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | | | | | - Laura M Stevens
- Institute for Precision Cardiovascular Medicine, American Heart Association, Dallas, Texas
| | - Brady J Gaynor
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | | | | | - Yu Sato
- CVPath Institute, Gaithersburg, Maryland
| | - Hiroyoshi Mori
- CVPath Institute, Gaithersburg, Maryland.,currently with Department of Internal Medicine, Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | | | - Parker J Lee
- CVPath Institute, Gaithersburg, Maryland.,Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | | | | | - Bakr B Ali
- CVPath Institute, Gaithersburg, Maryland
| | | | | | | | - Mack W Bell
- CVPath Institute, Gaithersburg, Maryland.,Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Megan Lynch
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | | | | | | | | | - Ji-Eun Park
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Libin Wang
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Susie N Hong
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Anuj Gupta
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jennifer L Hall
- Institute for Precision Cardiovascular Medicine, American Heart Association, Dallas, Texas
| | | | | | - Linda J B Jeng
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Braxton D Mitchell
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - David R Fowler
- Office of the Chief Medical Examiner, Baltimore, Maryland
| | - Charles C Hong
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Aloke V Finn
- CVPath Institute, Gaithersburg, Maryland.,Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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182
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Richmond CM, James PA, Pantaleo SJ, Chong B, Lunke S, Tan TY, Macciocca I. Clinical and laboratory reporting impact of ACMG-AMP and modified ClinGen variant classification frameworks in MYH7-related cardiomyopathy. Genet Med 2021; 23:1108-1115. [PMID: 33568804 DOI: 10.1038/s41436-021-01107-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 12/29/2022] Open
Abstract
PURPOSE ClinGen provides gene-specific guidance for interpretation of sequence variants in MYH7. We assessed laboratory and clinical impact of reclassification by the American College of Medical Genetics and Genomics-Association for Molecular Pathology (ACMG-AMP) and ClinGen recommendations in 43 MYH7 variants reported by a diagnostic laboratory between 2013 and 2017. METHODS Fifty-two proband reports containing MYH7 variants were reinterpreted by original ACMG-AMP and ClinGen guidelines. Evidence items were compared across schemes and reasons for classification differences recorded. Laboratory impact was assessed by number of recommended report reissues, and reclassifications coded as clinically "actionable" or "equivalent." Available pedigrees were reviewed to describe projected cascade impact. RESULTS ClinGen produced a higher proportion of diagnostic classifications (65% of variants) compared with ACMG-AMP (54%) and fewer variants of uncertain significance (30% versus 42%). ClinGen classification resulted in actionable changes in 18% of variants with equal upgrades and downgrades from original report. ClinGen's revisions to PM1 and PS4 contributed to classification differences in 21% and 19% of variants respectively. Each classification change per proband report impacted, on average, 3.1 cascade reports with a further 6.3 first- and second-degree relatives potentially available for genotyping per family. CONCLUSION ClinGen's gene-specific criteria provide expert-informed guidance for interpretation of MYH7 sequence variants. Periodic re-evaluation improves diagnostic confidence and should be considered by clinical and laboratory teams.
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Affiliation(s)
- Christopher M Richmond
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Genetic Health Queensland, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia.,School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Paul A James
- Genomic Medicine Department, Royal Melbourne Hospital, Melbourne, VIC, Australia.,University of Melbourne, Parkville, VIC, Australia
| | - Sarah-Jane Pantaleo
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Belinda Chong
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Sebastian Lunke
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, VIC, Australia.,University of Melbourne, Parkville, VIC, Australia
| | - Tiong Y Tan
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, VIC, Australia. .,University of Melbourne, Parkville, VIC, Australia.
| | - Ivan Macciocca
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, VIC, Australia.
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183
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Walsh R, Tadros R, Bezzina CR. When genetic burden reaches threshold. Eur Heart J 2021; 41:3849-3855. [PMID: 32350504 PMCID: PMC7599032 DOI: 10.1093/eurheartj/ehaa269] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/07/2020] [Accepted: 04/01/2020] [Indexed: 12/15/2022] Open
Abstract
Rare cardiac genetic diseases have generally been considered to be broadly Mendelian in nature, with clinical genetic testing for these conditions predicated on the detection of a primary causative rare pathogenic variant that will enable cascade genetic screening in families. However, substantial variability in penetrance and disease severity among carriers of pathogenic variants, as well as the inability to detect rare Mendelian variants in considerable proportions of patients, indicates that more complex aetiologies are likely to underlie these diseases. Recent findings have suggested genetic variants across a range of population frequencies and effect sizes may combine, along with non-genetic factors, to determine whether the threshold for expression of disease is reached and the severity of the phenotype. The availability of increasingly large genetically characterized cohorts of patients with rare cardiac diseases is enabling the discovery of common genetic variation that may underlie both variable penetrance in Mendelian diseases and the genetic aetiology of apparently non-Mendelian rare cardiac conditions. It is likely that the genetic architecture of rare cardiac diseases will vary considerably between different conditions as well as between patients with similar phenotypes, ranging from near-Mendelian disease to models more akin to common, complex disease. Uncovering the broad range of genetic factors that predispose patients to rare cardiac diseases offers the promise of improved risk prediction and more focused clinical management in patients and their families.
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Affiliation(s)
- Roddy Walsh
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Rafik Tadros
- Department of Medicine, Cardiovascular Genetics Center, Montreal Heart Institute and Faculty of Medicine, Université de Montréal, 5000 Belanger, Montreal, QC H1T 1C8, Canada
| | - Connie R Bezzina
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
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184
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Hershberger RE, Cowan J, Jordan E, Kinnamon DD. The Complex and Diverse Genetic Architecture of Dilated Cardiomyopathy. Circ Res 2021; 128:1514-1532. [PMID: 33983834 DOI: 10.1161/circresaha.121.318157] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our insight into the diverse and complex nature of dilated cardiomyopathy (DCM) genetic architecture continues to evolve rapidly. The foundations of DCM genetics rest on marked locus and allelic heterogeneity. While DCM exhibits a Mendelian, monogenic architecture in some families, preliminary data from our studies and others suggests that at least 20% to 30% of DCM may have an oligogenic basis, meaning that multiple rare variants from different, unlinked loci, determine the DCM phenotype. It is also likely that low-frequency and common genetic variation contribute to DCM complexity, but neither has been examined within a rare variant context. Other types of genetic variation are also likely relevant for DCM, along with gene-by-environment interaction, now established for alcohol- and chemotherapy-related DCM. Collectively, this suggests that the genetic architecture of DCM is broader in scope and more complex than previously understood. All of this elevates the impact of DCM genetics research, as greater insight into the causes of DCM can lead to interventions to mitigate or even prevent it and thus avoid the morbid and mortal scourge of human heart failure.
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Affiliation(s)
- Ray E Hershberger
- Divisions of Cardiovascular Medicine (R.E.H.), The Ohio State University Wexner Medical Center, Columbus.,Human Genetics (R.E.H., J.C., E.J., D.D.K.), The Ohio State University Wexner Medical Center, Columbus.,Department of Internal Medicine and the Davis Heart and Lung Research Institute (R.E.H., J.C., E.J., D.D.K.), The Ohio State University Wexner Medical Center, Columbus
| | - Jason Cowan
- Human Genetics (R.E.H., J.C., E.J., D.D.K.), The Ohio State University Wexner Medical Center, Columbus.,Department of Internal Medicine and the Davis Heart and Lung Research Institute (R.E.H., J.C., E.J., D.D.K.), The Ohio State University Wexner Medical Center, Columbus
| | - Elizabeth Jordan
- Human Genetics (R.E.H., J.C., E.J., D.D.K.), The Ohio State University Wexner Medical Center, Columbus.,Department of Internal Medicine and the Davis Heart and Lung Research Institute (R.E.H., J.C., E.J., D.D.K.), The Ohio State University Wexner Medical Center, Columbus
| | - Daniel D Kinnamon
- Human Genetics (R.E.H., J.C., E.J., D.D.K.), The Ohio State University Wexner Medical Center, Columbus.,Department of Internal Medicine and the Davis Heart and Lung Research Institute (R.E.H., J.C., E.J., D.D.K.), The Ohio State University Wexner Medical Center, Columbus
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185
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Sewanan LR, Jacoby DL. Novel Myosin-Based Therapies in Hypertrophic Cardiomyopathy. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00921-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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186
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Shiba M, Higo S, Kondo T, Li J, Liu L, Ikeda Y, Kohama Y, Kameda S, Tabata T, Inoue H, Nakamura S, Takeda M, Ito E, Takashima S, Miyagawa S, Sawa Y, Hikoso S, Sakata Y. Phenotypic recapitulation and correction of desmoglein-2-deficient cardiomyopathy using human-induced pluripotent stem cell-derived cardiomyocytes. Hum Mol Genet 2021; 30:1384-1397. [PMID: 33949662 PMCID: PMC8283207 DOI: 10.1093/hmg/ddab127] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/09/2021] [Accepted: 04/28/2021] [Indexed: 01/09/2023] Open
Abstract
Desmoglein-2, encoded by DSG2, is one of the desmosome proteins that maintain the structural integrity of tissues, including heart. Genetic mutations in DSG2 cause arrhythmogenic cardiomyopathy, mainly in an autosomal dominant manner. Here, we identified a homozygous stop-gain mutations in DSG2 (c.C355T, p.R119X) that led to complete desmoglein-2 deficiency in a patient with severe biventricular heart failure. Histological analysis revealed abnormal deposition of desmosome proteins, disrupted intercalated disk structures in the myocardium. Induced pluripotent stem cells (iPSCs) were generated from the patient (R119X-iPSC), and the mutated DSG2 gene locus was heterozygously corrected to a normal allele via homology-directed repair (HDR-iPSC). Both isogenic iPSCs were differentiated into cardiomyocytes [induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs)]. Multielectrode array analysis detected abnormal excitation in R119X-iPSC-CMs but not in HDR-iPSC-CMs. Micro-force testing of three-dimensional self-organized tissue rings (SOTRs) revealed tissue fragility and a weak maximum force in SOTRs from R119X-iPSC-CMs. Notably, these phenotypes were significantly recovered in HDR-iPSC-CMs. Myocardial fiber structures in R119X-iPSC-CMs were severely aberrant, and electron microscopic analysis confirmed that desmosomes were disrupted in these cells. Unexpectedly, the absence of desmoglein-2 in R119X-iPSC-CMs led to decreased expression of desmocollin-2 but no other desmosome proteins. Adeno-associated virus-mediated replacement of DSG2 significantly recovered the contraction force in SOTRs generated from R119X-iPSC-CMs. Our findings confirm the presence of a desmoglein-2-deficient cardiomyopathy among clinically diagnosed dilated cardiomyopathies. Recapitulation and correction of the disease phenotype using iPSC-CMs provide evidence to support the development of precision medicine and the proof of concept for gene replacement therapy for this cardiomyopathy.
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Affiliation(s)
- Mikio Shiba
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Shuichiro Higo
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan.,Department of Medical Therapeutics for Heart Failure, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Takumi Kondo
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Junjun Li
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan.,Department of Design for Tissue Regeneration, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Li Liu
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan.,Department of Design for Tissue Regeneration, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Yoshihiko Ikeda
- Department of Pathology, National Cerebral and Cardiovascular Center, Suita, Osaka 564-8565, Japan
| | - Yasuaki Kohama
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Satoshi Kameda
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Tomoka Tabata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Hiroyuki Inoue
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Satoki Nakamura
- Department of Medical Therapeutics for Heart Failure, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan.,Department of Medical Biochemistry, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Maki Takeda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Emiko Ito
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Seiji Takashima
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
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187
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Ware SM, Wilkinson JD, Tariq M, Schubert JA, Sridhar A, Colan SD, Shi L, Canter CE, Hsu DT, Webber SA, Dodd DA, Everitt MD, Kantor PF, Addonizio LJ, Jefferies JL, Rossano JW, Pahl E, Rusconi P, Chung WK, Lee T, Towbin JA, Lal AK, Bhatnagar S, Aronow B, Dexheimer PJ, Martin LJ, Miller EM, Sleeper LA, Razoky H, Czachor J, Lipshultz SE. Genetic Causes of Cardiomyopathy in Children: First Results From the Pediatric Cardiomyopathy Genes Study. J Am Heart Assoc 2021; 10:e017731. [PMID: 33906374 PMCID: PMC8200745 DOI: 10.1161/jaha.120.017731] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Pediatric cardiomyopathy is a genetically heterogeneous disease with substantial morbidity and mortality. Current guidelines recommend genetic testing in children with hypertrophic, dilated, or restrictive cardiomyopathy, but practice variations exist. Robust data on clinical testing practices and diagnostic yield in children are lacking. This study aimed to identify the genetic causes of cardiomyopathy in children and to investigate clinical genetic testing practices. Methods and Results Children with familial or idiopathic cardiomyopathy were enrolled from 14 institutions in North America. Probands underwent exome sequencing. Rare sequence variants in 37 known cardiomyopathy genes were assessed for pathogenicity using consensus clinical interpretation guidelines. Of the 152 enrolled probands, 41% had a family history of cardiomyopathy. Of 81 (53%) who had undergone clinical genetic testing for cardiomyopathy before enrollment, 39 (48%) had a positive result. Genetic testing rates varied from 0% to 97% between sites. A positive family history and hypertrophic cardiomyopathy subtype were associated with increased likelihood of genetic testing (P=0.005 and P=0.03, respectively). A molecular cause was identified in an additional 21% of the 63 children who did not undergo clinical testing, with positive results identified in both familial and idiopathic cases and across all phenotypic subtypes. Conclusions A definitive molecular genetic diagnosis can be made in a substantial proportion of children for whom the cause and heritable nature of their cardiomyopathy was previously unknown. Practice variations in genetic testing are great and should be reduced. Improvements can be made in comprehensive cardiac screening and predictive genetic testing in first‐degree relatives. Overall, our results support use of routine genetic testing in cases of both familial and idiopathic cardiomyopathy. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01873963.
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Affiliation(s)
- Stephanie M Ware
- Departments of Pediatrics and Medical and Molecular Genetics Indiana University School of Medicine Indianapolis IN
| | | | - Muhammad Tariq
- Faculty of Applied Medical Sciences University of Tabuk Kingdom of Saudi Arabia
| | - Jeffrey A Schubert
- Departments of Pediatrics and Medical and Molecular Genetics Indiana University School of Medicine Indianapolis IN
| | - Arthi Sridhar
- Departments of Pediatrics and Medical and Molecular Genetics Indiana University School of Medicine Indianapolis IN
| | - Steven D Colan
- Department of Cardiology and Harvard Medical School Boston Children's Hospital Boston MA
| | - Ling Shi
- New England Research Institutes Watertown MA
| | | | - Daphne T Hsu
- Albert Einstein College of Medicine and Children's Hospital at Montefiore Bronx NY
| | - Steven A Webber
- Monroe Carell Jr. Children's Hospital at Vanderbilt Nashville TN
| | - Debra A Dodd
- Monroe Carell Jr. Children's Hospital at Vanderbilt Nashville TN
| | | | - Paul F Kantor
- Keck School of Medicine and Children's Hospital Los Angeles University of Southern California Los Angeles CA
| | | | | | | | - Elfriede Pahl
- Ann and Robert H. Lurie Children's Hospital Chicago IL
| | - Paolo Rusconi
- University of Miami Miller School of Medicine Miami FL
| | | | - Teresa Lee
- Columbia University Medical Center New York NY
| | | | | | - Surbhi Bhatnagar
- University of Cincinnati School of Medicine and Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Bruce Aronow
- University of Cincinnati School of Medicine and Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Phillip J Dexheimer
- University of Cincinnati School of Medicine and Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Lisa J Martin
- University of Cincinnati School of Medicine and Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Erin M Miller
- University of Cincinnati School of Medicine and Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Lynn A Sleeper
- Department of Cardiology and Harvard Medical School Boston Children's Hospital Boston MA
| | - Hiedy Razoky
- Wayne State University School of Medicine Detroit MI
| | - Jason Czachor
- Wayne State University School of Medicine Detroit MI
| | - Steven E Lipshultz
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo NY.,John R. Oishei Children's Hospital Buffalo NY
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188
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Arrhythmogenic Cardiomyopathy: Mechanisms, Genetics, and Their Clinical Implications. CURRENT CARDIOVASCULAR RISK REPORTS 2021. [DOI: 10.1007/s12170-021-00669-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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189
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Cava F, Cristiano E, Musumeci MB, Savio C, Germani A, Monaco ML, Petrucci S, Torrisi MR, Autore C, Rubattu S, Piane M. TNNI3 and KCNQ1 co-inherited variants in a family with hypertrophic cardiomyopathy and long QT phenotypes: A case report. Mol Genet Metab Rep 2021; 27:100743. [PMID: 33777698 PMCID: PMC7985525 DOI: 10.1016/j.ymgmr.2021.100743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/26/2021] [Accepted: 03/04/2021] [Indexed: 10/27/2022] Open
Abstract
QTc prolongation is reported in patients with hypertrophic cardiomyopathy (HCM). However, the causes of the QTc interval increase remain unclear. The main contribution to QTc prolongation in HCM is attributed to the myocardial hypertrophy and related structural damage. In a 24-year-old male proband, affected by HCM and long QTc, we identified by Next Generation Sequencing a pathogenic variant in gene TNNI3 co-inherited with a damaging variant in KCNQ1 gene. This evidence suggests the possibility that QTc interval prolongation and its dispersion in HCM could be associated not only to the severity of left ventricular hypertrophy but also to the co-inheritance of pathogenic variants related to both long QT Syndrome (LQTS) and HCM. Although the simultaneous presence of pathogenic variants in genes related to different heart diseases is extremely rare, counseling and genetic testing appear crucial for the clinical diagnosis. Screening of LQTS genes should be considered in HCM patients to clarify the origin of long QTc, to provide more information about the clinical presentation and to evaluate the incidence of the co-existence of LQTS/HCM gene variants that could occur more frequently than so far reported.
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Affiliation(s)
- Francesco Cava
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, "Sapienza" University of Rome, Rome 00189, Italy
| | - Ernesto Cristiano
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, "Sapienza" University of Rome, Rome 00189, Italy
| | - Maria Beatrice Musumeci
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, "Sapienza" University of Rome, Rome 00189, Italy
| | - Camilla Savio
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, "Sapienza" University of Rome, Rome 00189, Italy
| | - Aldo Germani
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, "Sapienza" University of Rome, Rome 00189, Italy.,Sant'Andrea University Hospital, Rome 00100, Italy
| | - Maria Lo Monaco
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, "Sapienza" University of Rome, Rome 00189, Italy
| | - Simona Petrucci
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, "Sapienza" University of Rome, Rome 00189, Italy.,Sant'Andrea University Hospital, Rome 00100, Italy
| | - Maria Rosaria Torrisi
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, "Sapienza" University of Rome, Rome 00189, Italy.,Sant'Andrea University Hospital, Rome 00100, Italy
| | - Camillo Autore
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, "Sapienza" University of Rome, Rome 00189, Italy
| | - Speranza Rubattu
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, "Sapienza" University of Rome, Rome 00189, Italy.,IRCCS Neuromed, Pozzilli, IS 86077, Italy
| | - Maria Piane
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, "Sapienza" University of Rome, Rome 00189, Italy.,Sant'Andrea University Hospital, Rome 00100, Italy
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190
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The Role of Z-disc Proteins in Myopathy and Cardiomyopathy. Int J Mol Sci 2021; 22:ijms22063058. [PMID: 33802723 PMCID: PMC8002584 DOI: 10.3390/ijms22063058] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/07/2021] [Accepted: 03/11/2021] [Indexed: 12/11/2022] Open
Abstract
The Z-disc acts as a protein-rich structure to tether thin filament in the contractile units, the sarcomeres, of striated muscle cells. Proteins found in the Z-disc are integral for maintaining the architecture of the sarcomere. They also enable it to function as a (bio-mechanical) signalling hub. Numerous proteins interact in the Z-disc to facilitate force transduction and intracellular signalling in both cardiac and skeletal muscle. This review will focus on six key Z-disc proteins: α-actinin 2, filamin C, myopalladin, myotilin, telethonin and Z-disc alternatively spliced PDZ-motif (ZASP), which have all been linked to myopathies and cardiomyopathies. We will summarise pathogenic variants identified in the six genes coding for these proteins and look at their involvement in myopathy and cardiomyopathy. Listing the Minor Allele Frequency (MAF) of these variants in the Genome Aggregation Database (GnomAD) version 3.1 will help to critically re-evaluate pathogenicity based on variant frequency in normal population cohorts.
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191
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Discordant clinical features of identical hypertrophic cardiomyopathy twins. Proc Natl Acad Sci U S A 2021; 118:2021717118. [PMID: 33658374 PMCID: PMC7958207 DOI: 10.1073/pnas.2021717118] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a disease of heart muscle, which affects ∼1 in 500 individuals and is characterized by increased left ventricular wall thickness. While HCM is caused by pathogenic variants in any one of eight sarcomere protein genes, clinical expression varies considerably, even among patients with the same pathogenic variant. To determine whether background genetic variation or environmental factors drive these differences, we studied disease progression in 11 pairs of monozygotic HCM twins. The twin pairs were followed for 5 to 14 y, and left ventricular wall thickness, left atrial diameter, and left ventricular ejection fraction were collected from echocardiograms at various time points. All nine twin pairs with sarcomere protein gene variants and two with unknown disease etiologies had discordant morphologic features of the heart, demonstrating the influence of nonhereditable factors on clinical expression of HCM. Whole genome sequencing analysis of the six monozygotic twins with discordant HCM phenotypes did not reveal notable somatic genetic variants that might explain their clinical differences. Discordant cardiac morphology of identical twins highlights a significant role for epigenetics and environment in HCM disease progression.
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192
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Carruth ED, Beer D, Alsaid A, Schwartz MLB, McMinn M, Kelly MA, Buchanan AH, Nevius CD, Calkins H, James CA, Murray B, Tichnell C, Matsumura ME, Kirchner HL, Fornwalt BK, Sturm AC, Haggerty CM. Clinical Findings and Diagnostic Yield of Arrhythmogenic Cardiomyopathy Through Genomic Screening of Pathogenic or Likely Pathogenic Desmosome Gene Variants. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2021; 14:e003302. [PMID: 33684294 DOI: 10.1161/circgen.120.003302] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Genomic screening holds great promise for presymptomatic identification of hidden disease, and prevention of dramatic events, including sudden cardiac death associated with arrhythmogenic cardiomyopathy (ACM). Herein, we present findings from clinical follow-up of carriers of ACM-associated pathogenic/likely pathogenic desmosome variants ascertained through genomic screening. METHODS Of 64 548 eligible participants in Geisinger MyCode Genomic Screening and Counseling program (2015-present), 92 individuals (0.14%) identified with pathogenic/likely pathogenic desmosome variants by clinical laboratory testing were referred for evaluation. We reviewed preresult medical history, patient-reported family history, and diagnostic testing results to assess both arrhythmogenic right ventricular cardiomyopathy and left-dominant ACM. RESULTS One carrier had a prior diagnosis of dilated cardiomyopathy with arrhythmia; no other related diagnoses or diagnostic family history criteria were reported. Fifty-nine carriers (64%) had diagnostic testing in follow-up. Excluding the variant, 21/59 carriers satisfied at least one arrhythmogenic right ventricular cardiomyopathy task force criterion, 11 (52%) of whom harbored DSP variants, but only 5 exhibited multiple criteria. Six (10%) carriers demonstrated evidence of left-dominant ACM, including high rates of atypical late gadolinium enhancement by magnetic resonance imaging and nonsustained ventricular tachycardia. Two individuals received new cardiomyopathy diagnoses and received defibrillators for primary prevention. CONCLUSIONS Genomic screening for pathogenic/likely pathogenic variants in desmosome genes can uncover both left- and right-dominant ACM. Findings of overt cardiomyopathy were limited but were most common in DSP-variant carriers and notably absent in PKP2-variant carriers. Consideration of the pathogenic/likely pathogenic variant as a major criterion for diagnosis is inappropriate in the setting of genomic screening.
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Affiliation(s)
- Eric D Carruth
- Department of Translational Data Science and Informatics (E.D.C., C.D.N., B.K.F., C.M.H.), Geisinger, Danville, PA
| | - Dominik Beer
- The Heart Institute (D.B., A.A., M.E.M., B.K.F., A.C.S., C.M.H.), Geisinger, Danville, PA
| | - Amro Alsaid
- The Heart Institute (D.B., A.A., M.E.M., B.K.F., A.C.S., C.M.H.), Geisinger, Danville, PA
| | - Marci L B Schwartz
- Genomic Medicine Institute (M.L.B.S., M.M., M.A.K., A.H.B., A.C.S.), Geisinger, Danville, PA
| | - Megan McMinn
- Genomic Medicine Institute (M.L.B.S., M.M., M.A.K., A.H.B., A.C.S.), Geisinger, Danville, PA
| | - Melissa A Kelly
- Genomic Medicine Institute (M.L.B.S., M.M., M.A.K., A.H.B., A.C.S.), Geisinger, Danville, PA
| | - Adam H Buchanan
- Genomic Medicine Institute (M.L.B.S., M.M., M.A.K., A.H.B., A.C.S.), Geisinger, Danville, PA
| | - Christopher D Nevius
- Department of Translational Data Science and Informatics (E.D.C., C.D.N., B.K.F., C.M.H.), Geisinger, Danville, PA
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Center, Baltimore, MD (H.C., C.A.J., B.M., C.T.)
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Center, Baltimore, MD (H.C., C.A.J., B.M., C.T.)
| | - Brittney Murray
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Center, Baltimore, MD (H.C., C.A.J., B.M., C.T.)
| | - Crystal Tichnell
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Center, Baltimore, MD (H.C., C.A.J., B.M., C.T.)
| | - Martin E Matsumura
- The Heart Institute (D.B., A.A., M.E.M., B.K.F., A.C.S., C.M.H.), Geisinger, Danville, PA
| | - H Lester Kirchner
- Department of Population Health Sciences (H.L.K.), Geisinger, Danville, PA
| | - Brandon K Fornwalt
- Department of Translational Data Science and Informatics (E.D.C., C.D.N., B.K.F., C.M.H.), Geisinger, Danville, PA.,The Heart Institute (D.B., A.A., M.E.M., B.K.F., A.C.S., C.M.H.), Geisinger, Danville, PA.,Department of Radiology (B.K.F.), Geisinger, Danville, PA
| | - Amy C Sturm
- The Heart Institute (D.B., A.A., M.E.M., B.K.F., A.C.S., C.M.H.), Geisinger, Danville, PA.,Genomic Medicine Institute (M.L.B.S., M.M., M.A.K., A.H.B., A.C.S.), Geisinger, Danville, PA
| | - Christopher M Haggerty
- Department of Translational Data Science and Informatics (E.D.C., C.D.N., B.K.F., C.M.H.), Geisinger, Danville, PA.,The Heart Institute (D.B., A.A., M.E.M., B.K.F., A.C.S., C.M.H.), Geisinger, Danville, PA
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193
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Hathaway J, Heliö K, Saarinen I, Tallila J, Seppälä EH, Tuupanen S, Turpeinen H, Kangas-Kontio T, Schleit J, Tommiska J, Kytölä V, Valori M, Muona M, Sistonen J, Gentile M, Salmenperä P, Myllykangas S, Paananen J, Alastalo TP, Heliö T, Koskenvuo J. Diagnostic yield of genetic testing in a heterogeneous cohort of 1376 HCM patients. BMC Cardiovasc Disord 2021; 21:126. [PMID: 33673806 PMCID: PMC7934228 DOI: 10.1186/s12872-021-01927-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 02/22/2021] [Indexed: 12/20/2022] Open
Abstract
Background Genetic testing in hypertrophic cardiomyopathy (HCM) is a published guideline-based recommendation. The diagnostic yield of genetic testing and corresponding HCM-associated genes have been largely documented by single center studies and carefully selected patient cohorts. Our goal was to evaluate the diagnostic yield of genetic testing in a heterogeneous cohort of patients with a clinical suspicion of HCM, referred for genetic testing from multiple centers around the world. Methods A retrospective review of patients with a suspected clinical diagnosis of HCM referred for genetic testing at Blueprint Genetics was undertaken. The analysis included syndromic, myopathic and metabolic etiologies. Genetic test results and variant classifications were extracted from the database. Variants classified as pathogenic (P) or likely pathogenic (LP) were considered diagnostic. Results A total of 1376 samples were analyzed. Three hundred and sixty-nine tests were diagnostic (26.8%); 373 P or LP variants were identified. Only one copy number variant was identified. The majority of diagnostic variants involved genes encoding the sarcomere (85.0%) followed by 4.3% of diagnostic variants identified in the RASopathy genes. Two percent of diagnostic variants were in genes associated with a cardiomyopathy other than HCM or an inherited arrhythmia. Clinical variables that increased the likelihood of identifying a diagnostic variant included: an earlier age at diagnosis (p < 0.0001), a higher maximum wall thickness (MWT) (p < 0.0001), a positive family history (p < 0.0001), the absence of hypertension (p = 0.0002), and the presence of an implantable cardioverter-defibrillator (ICD) (p = 0.0004). Conclusion The diagnostic yield of genetic testing in this heterogeneous cohort of patients with a clinical suspicion of HCM is lower than what has been reported in well-characterized patient cohorts. We report the highest yield of diagnostic variants in the RASopathy genes identified in a laboratory cohort of HCM patients to date. The spectrum of genes implicated in this unselected cohort highlights the importance of pre-and post-test counseling when offering genetic testing to the broad HCM population. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-01927-5.
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Affiliation(s)
- Julie Hathaway
- Blueprint Genetics, a Quest Diagnostics Company, 2505 3rd Ave, Suite 204, Seattle, 98121, USA.
| | - Krista Heliö
- Heart and Lung Center, Meilahti Tower Hospital, Helsinki University Hospital, Haartmaninkatu 4, P.O. Box 340, 00029, Helsinki, Finland
| | - Inka Saarinen
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
| | - Jonna Tallila
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
| | - Eija H Seppälä
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
| | - Sari Tuupanen
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
| | - Hannu Turpeinen
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
| | - Tiia Kangas-Kontio
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
| | - Jennifer Schleit
- Blueprint Genetics, a Quest Diagnostics Company, 2505 3rd Ave, Suite 204, Seattle, 98121, USA
| | - Johanna Tommiska
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
| | - Ville Kytölä
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
| | - Miko Valori
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
| | - Mikko Muona
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
| | - Johanna Sistonen
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
| | - Massimiliano Gentile
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
| | - Pertteli Salmenperä
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
| | - Samuel Myllykangas
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
| | - Jussi Paananen
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
| | - Tero-Pekka Alastalo
- Blueprint Genetics, a Quest Diagnostics Company, 2505 3rd Ave, Suite 204, Seattle, 98121, USA
| | - Tiina Heliö
- Heart and Lung Center, Meilahti Tower Hospital, Helsinki University Hospital, Haartmaninkatu 4, P.O. Box 340, 00029, Helsinki, Finland
| | - Juha Koskenvuo
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
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194
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Tobacman LS, Cammarato A. Cardiomyopathic troponin mutations predominantly occur at its interface with actin and tropomyosin. J Gen Physiol 2021; 153:e202012815. [PMID: 33492345 PMCID: PMC7836260 DOI: 10.1085/jgp.202012815] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 12/23/2020] [Indexed: 01/09/2023] Open
Abstract
Reversible Ca2+ binding to troponin is the primary on-off switch of the contractile apparatus of striated muscles, including the heart. Dominant missense mutations in human cardiac troponin genes are among the causes of hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy. Structural understanding of troponin action has recently advanced considerably via electron microscopy and molecular dynamics studies of the thin filament. As a result, it is now possible to examine cardiomyopathy-inducing troponin mutations in thin-filament structural context, and from that to seek new insight into pathogenesis and into the troponin regulatory mechanism. We compiled from consortium reports a representative set of troponin mutation sites whose pathogenicity was determined using standardized clinical genetics criteria. Another set of sites, apparently tolerant of amino acid substitutions, was compiled from the gnomAD v2 database. Pathogenic substitutions occurred predominantly in the areas of troponin that contact actin or tropomyosin, including, but not limited to, two regions of newly proposed structure and long-known implication in cardiomyopathy: the C-terminal third of troponin I and a part of the troponin T N terminus. The pathogenic mutations were located in troponin regions that prevent contraction under low Ca2+ concentration conditions. These regions contribute to Ca2+-regulated steric hindrance of myosin by the combined effects of troponin and tropomyosin. Loss-of-function mutations within these parts of troponin result in loss of inhibition, consistent with the hypercontractile phenotype characteristic of HCM. Notably, pathogenic mutations are absent in our dataset from the Ca2+-binding, activation-producing troponin C (TnC) N-lobe, which controls contraction by a multi-faceted mechanism. Apparently benign mutations are also diminished in the TnC N-lobe, suggesting mutations are poorly tolerated in that critical domain.
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Affiliation(s)
- Larry S. Tobacman
- Departments of Medicine and of Physiology and Biophysics, University of Illinois at Chicago, Chicago, IL
| | - Anthony Cammarato
- Departments of Medicine and of Physiology, Johns Hopkins University, Baltimore, MD
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195
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Rare Variants Associated with Arrhythmogenic Cardiomyopathy: Reclassification Five Years Later. J Pers Med 2021; 11:jpm11030162. [PMID: 33652588 PMCID: PMC7996798 DOI: 10.3390/jpm11030162] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 12/17/2022] Open
Abstract
Genetic interpretation of rare variants associated with arrhythmogenic cardiomyopathy (ACM) is essential due to their diagnostic implications. New data may relabel previous variant classifications, but how often reanalysis is necessary remains undefined. Five years ago, 39 rare ACM-related variants were identified in patients with features of cardiomyopathy. These variants were classified following the American College of Medical Genetics and Genomics’ guidelines. In the present study, we reevaluated these rare variants including novel available data. All cases carried one rare variant classified as being of ambiguous significance (82.05%) or likely pathogenic (17.95%) in 2016. In our comprehensive reanalysis, the classification of 30.77% of these variants changed, mainly due to updated global frequencies. As in 2016, nowadays most variants were classified as having an uncertain role (64.1%), but the proportion of variants with an uncertain role was significantly decreased (17.95%). The percentage of rare variants classified as potentially deleterious increased from 17.95% to 23.07%. Moreover, 83.33% of reclassified variants gained certainty. We propose that periodic genetic reanalysis of all rare variants associated with arrhythmogenic cardiomyopathy should be undertaken at least once every five years. Defining the roles of rare variants may help clinicians obtain a definite diagnosis.
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196
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de Feria AE, Kott AE, Becker JR. Sarcomere mutation negative hypertrophic cardiomyopathy is associated with ageing and obesity. Open Heart 2021; 8:openhrt-2020-001560. [PMID: 33637569 PMCID: PMC7919593 DOI: 10.1136/openhrt-2020-001560] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/29/2021] [Accepted: 02/05/2021] [Indexed: 11/05/2022] Open
Abstract
Background Despite advances in our understanding of the genetic causes of hypertrophic cardiomyopathy (HCM), a large portion of this patient population do not carry sarcomere gene mutations when screened. It remains largely unknown why patients without sarcomere mutations develop asymmetric myocardial hypertrophy. Methods We performed a retrospective analysis of probands with HCM who underwent genetic testing to determine if clinical phenotypes were different depending on sarcomere mutation status. A medical history, three generation family history and clinical phenotyping were performed on 127 probands with HCM. Genetic screening was performed using clinically available HCM genetic testing panels. Results We found that probands with HCM with pathogenic sarcomere mutations were over three times more likely to have a family history of HCM (66% vs 17%, p<0.0001) and were diagnosed with HCM at a much younger age (32 vs 51 years old, p<0.0001). In contrast, probands with HCM without sarcomere mutations were significantly more obese (body surface area p=0.003, body mass index p=0.04 adjusted for age) and were more likely to present with left ventricular outflow tract obstruction (p=0.0483). Conclusion Patients with sarcomere mutation negative HCM present at an older age and are more obese compared with patients with sarcomere mutation positive HCM. The role of ageing and obesity in asymmetric myocardial hypertrophy warrants further investigation.
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Affiliation(s)
- Alejandro E de Feria
- Division of Cardiology, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Andrew E Kott
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Jason R Becker
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA .,Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine and UPMC, Pittsburgh, PA, USA
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197
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 3101] [Impact Index Per Article: 1033.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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198
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Harmonizing the Collection of Clinical Data on Genetic Testing Requisition Forms to Enhance Variant Interpretation in Hypertrophic Cardiomyopathy (HCM): A Study from the ClinGen Cardiomyopathy Variant Curation Expert Panel. J Mol Diagn 2021; 23:589-598. [PMID: 33631351 PMCID: PMC8188618 DOI: 10.1016/j.jmoldx.2021.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/04/2020] [Accepted: 01/25/2021] [Indexed: 11/23/2022] Open
Abstract
Diagnostic laboratories gather phenotypic data through requisition forms, but there is no consensus as to which data are essential for variant interpretation. The ClinGen Cardiomyopathy Variant Curation Expert Panel defined a phenotypic data set for hypertrophic cardiomyopathy (HCM) variant interpretation, with the goal of standardizing requisition forms. Phenotypic data elements listed on requisition forms from nine leading cardiomyopathy testing laboratories were compiled to assess divergence in data collection. A pilot of 50 HCM cases was implemented to determine the feasibility of harmonizing data collection. Laboratory directors were surveyed to gauge potential for adoption of a minimal data set. Wide divergence was observed in the phenotypic data fields in requisition forms. The 50-case pilot showed that although demographics and assertion of a clinical diagnosis of HCM had 86% to 98% completion, specific phenotypic features, such as degree of left ventricular hypertrophy, ejection fraction, and suspected syndromic disease, were completed only 24% to 44% of the time. Nine data elements were deemed essential for variant classification by the expert panel. Participating laboratories unanimously expressed a willingness to adopt these data elements in their requisition forms. This study demonstrates the value of comparing and sharing best practices through an expert group, such as the ClinGen Program, to enhance variant interpretation, providing a foundation for leveraging cumulative case-level data in public databases and ultimately improving patient care.
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199
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Narducci ML, Cammarano M, Novelli V, Bisignani A, Pavone C, Perna F, Bencardino G, Pinnacchio G, Bianco M, Zeppilli P, Palmieri V, Pelargonio G. Diagnostic Workflow in Competitive Athletes with Ventricular Arrhythmias and Suspected Concealed Cardiomyopathies. Medicina (B Aires) 2021; 57:medicina57020182. [PMID: 33672601 PMCID: PMC7924041 DOI: 10.3390/medicina57020182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/12/2021] [Accepted: 02/14/2021] [Indexed: 11/16/2022] Open
Abstract
The diagnosis of structural heart disease in athletes with ventricular arrhythmias (VAs) and an apparently normal heart can be very challenging. Several pieces of evidence demonstrate the importance of an extensive diagnostic work-up in apparently healthy young patients for the characterization of concealed cardiomyopathies. This study shows the various diagnostic levels and tools to help identify which athletes need deeper investigation in order to unmask possible underlying heart disease.
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Affiliation(s)
- Maria Lucia Narducci
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.P.); (G.B.); (G.P.); (G.P.)
- Correspondence:
| | - Michela Cammarano
- Unità Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.C.); (M.B.); (P.Z.); (V.P.)
| | - Valeria Novelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Genetica Medica, 00168 Rome, Italy;
- Istituto di Medicina Genomica, Università del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Antonio Bisignani
- Istituto di Cardiologia, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy; (A.B.); (C.P.)
| | - Chiara Pavone
- Istituto di Cardiologia, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy; (A.B.); (C.P.)
| | - Francesco Perna
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.P.); (G.B.); (G.P.); (G.P.)
| | - Gianluigi Bencardino
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.P.); (G.B.); (G.P.); (G.P.)
| | - Gaetano Pinnacchio
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.P.); (G.B.); (G.P.); (G.P.)
- Istituto di Cardiologia, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy; (A.B.); (C.P.)
| | - Massimiliano Bianco
- Unità Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.C.); (M.B.); (P.Z.); (V.P.)
| | - Paolo Zeppilli
- Unità Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.C.); (M.B.); (P.Z.); (V.P.)
| | - Vincenzo Palmieri
- Unità Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.C.); (M.B.); (P.Z.); (V.P.)
| | - Gemma Pelargonio
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (F.P.); (G.B.); (G.P.); (G.P.)
- Istituto di Cardiologia, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy; (A.B.); (C.P.)
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200
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Koskenvuo JW, Saarinen I, Ahonen S, Tommiska J, Weckström S, Seppälä EH, Tuupanen S, Kangas-Kontio T, Schleit J, Heliö K, Hathaway J, Gummesson A, Dahlberg P, Ojala TH, Vepsäläinen V, Kytölä V, Muona M, Sistonen J, Salmenperä P, Gentile M, Paananen J, Myllykangas S, Alastalo TP, Heliö T. Biallelic loss-of-function in NRAP is a cause of recessive dilated cardiomyopathy. PLoS One 2021; 16:e0245681. [PMID: 33534821 PMCID: PMC7857588 DOI: 10.1371/journal.pone.0245681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 01/05/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Familial dilated cardiomyopathy (DCM) is typically a monogenic disorder with dominant inheritance. Although over 40 genes have been linked to DCM, more than half of the patients undergoing comprehensive genetic testing are left without molecular diagnosis. Recently, biallelic protein-truncating variants (PTVs) in the nebulin-related anchoring protein gene (NRAP) were identified in a few patients with sporadic DCM. METHODS AND RESULTS We determined the frequency of rare NRAP variants in a cohort of DCM patients and control patients to further evaluate role of this gene in cardiomyopathies. A retrospective analysis of our internal variant database consisting of 31,639 individuals who underwent genetic testing (either panel or direct exome sequencing) was performed. The DCM group included 577 patients with either a confirmed or suspected DCM diagnosis. A control cohort of 31,062 individuals, including 25,912 individuals with non-cardiac (control group) and 5,150 with non-DCM cardiac indications (Non-DCM cardiac group). Biallelic (n = 6) or two (n = 5) NRAP variants (two PTVs or PTV+missense) were identified in 11 unrelated probands with DCM (1.9%) but none of the controls. None of the 11 probands had an alternative molecular diagnosis. Family member testing supports co-segregation. Biallelic or potentially biallelic NRAP variants were enriched in DCM vs. controls (OR 1052, p<0.0001). Based on the frequency of NRAP PTVs in the gnomAD reference population, and predicting full penetrance, biallelic NRAP variants could explain 0.25%-2.46% of all DCM cases. CONCLUSION Loss-of-function in NRAP is a cause for autosomal recessive dilated cardiomyopathy, supporting its inclusion in comprehensive genetic testing.
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Affiliation(s)
- Juha W. Koskenvuo
- Blueprint Genetics, a Quest Diagnostics Company, Espoo, Finland
- * E-mail:
| | - Inka Saarinen
- Blueprint Genetics, a Quest Diagnostics Company, Espoo, Finland
| | - Saija Ahonen
- Blueprint Genetics, a Quest Diagnostics Company, Espoo, Finland
| | | | - Sini Weckström
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Eija H. Seppälä
- Blueprint Genetics, a Quest Diagnostics Company, Espoo, Finland
| | - Sari Tuupanen
- Blueprint Genetics, a Quest Diagnostics Company, Espoo, Finland
| | | | | | - Krista Heliö
- Blueprint Genetics, a Quest Diagnostics Company, Espoo, Finland
| | - Julie Hathaway
- Blueprint Genetics Inc, a Quest Diagnostics Company, Seattle, Washington, United States of America
| | - Anders Gummesson
- Department of Clinical Genetics and Genomics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pia Dahlberg
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tiina H. Ojala
- Department of Pediatric Cardiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Ville Kytölä
- Blueprint Genetics, a Quest Diagnostics Company, Espoo, Finland
| | - Mikko Muona
- Blueprint Genetics, a Quest Diagnostics Company, Espoo, Finland
| | | | | | | | - Jussi Paananen
- Blueprint Genetics, a Quest Diagnostics Company, Espoo, Finland
| | | | - Tero-Pekka Alastalo
- Blueprint Genetics Inc, a Quest Diagnostics Company, Seattle, Washington, United States of America
| | - Tiina Heliö
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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