151
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Makara MA, Curran J, Little SC, Musa H, Polina I, Smith SA, Wright PJ, Unudurthi SD, Snyder J, Bennett V, Hund TJ, Mohler PJ. Ankyrin-G coordinates intercalated disc signaling platform to regulate cardiac excitability in vivo. Circ Res 2014; 115:929-38. [PMID: 25239140 DOI: 10.1161/circresaha.115.305154] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
RATIONALE Nav1.5 (SCN5A) is the primary cardiac voltage-gated Nav channel. Nav1.5 is critical for cardiac excitability and conduction, and human SCN5A mutations cause sinus node dysfunction, atrial fibrillation, conductional abnormalities, and ventricular arrhythmias. Further, defects in Nav1.5 regulation are linked with malignant arrhythmias associated with human heart failure. Consequently, therapies to target select Nav1.5 properties have remained at the forefront of cardiovascular medicine. However, despite years of investigation, the fundamental pathways governing Nav1.5 membrane targeting, assembly, and regulation are still largely undefined. OBJECTIVE Define the in vivo mechanisms underlying Nav1.5 membrane regulation. METHODS AND RESULTS Here, we define the molecular basis of an Nav channel regulatory platform in heart. Using new cardiac-selective ankyrin-G(-/-) mice (conditional knock-out mouse), we report that ankyrin-G targets Nav1.5 and its regulatory protein calcium/calmodulin-dependent kinase II to the intercalated disc. Mechanistically, βIV-spectrin is requisite for ankyrin-dependent targeting of calcium/calmodulin-dependent kinase II-δ; however, βIV-spectrin is not essential for ankyrin-G expression. Ankyrin-G conditional knock-out mouse myocytes display decreased Nav1.5 expression/membrane localization and reduced INa associated with pronounced bradycardia, conduction abnormalities, and ventricular arrhythmia in response to Nav channel antagonists. Moreover, we report that ankyrin-G links Nav channels with broader intercalated disc signaling/structural nodes, as ankyrin-G loss results in reorganization of plakophilin-2 and lethal arrhythmias in response to β-adrenergic stimulation. CONCLUSIONS Our findings provide the first in vivo data for the molecular pathway required for intercalated disc Nav1.5 targeting/regulation in heart. Further, these new data identify the basis of an in vivo cellular platform critical for membrane recruitment and regulation of Nav1.5.
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Affiliation(s)
- Michael A Makara
- From The Dorothy M. Davis Heart & Lung Research Institute (M.A.M., J.C., S.C.L., H.M., I.P., S.A.S., P.J.W., S.D.U., J.S., T.J.H., P.J.M. ), Departments of Internal Medicine (S.A.S., P.J.M.), and Physiology and Cell Biology (M.A.M., J.C., S.C.L., H.M., I.P., S.A.S., P.J.W., P.J.M.), The Ohio State University Wexner Medical Center, Columbus; Department of Biomedical Engineering, The Ohio State University College of Engineering, Columbus (S.D.U., J.S., T.J.H.); and Howard Hughes Medical Institute, Department of Biochemistry, Duke University Medical Center, Durham, NC (V.B.)
| | - Jerry Curran
- From The Dorothy M. Davis Heart & Lung Research Institute (M.A.M., J.C., S.C.L., H.M., I.P., S.A.S., P.J.W., S.D.U., J.S., T.J.H., P.J.M. ), Departments of Internal Medicine (S.A.S., P.J.M.), and Physiology and Cell Biology (M.A.M., J.C., S.C.L., H.M., I.P., S.A.S., P.J.W., P.J.M.), The Ohio State University Wexner Medical Center, Columbus; Department of Biomedical Engineering, The Ohio State University College of Engineering, Columbus (S.D.U., J.S., T.J.H.); and Howard Hughes Medical Institute, Department of Biochemistry, Duke University Medical Center, Durham, NC (V.B.)
| | - Sean C Little
- From The Dorothy M. Davis Heart & Lung Research Institute (M.A.M., J.C., S.C.L., H.M., I.P., S.A.S., P.J.W., S.D.U., J.S., T.J.H., P.J.M. ), Departments of Internal Medicine (S.A.S., P.J.M.), and Physiology and Cell Biology (M.A.M., J.C., S.C.L., H.M., I.P., S.A.S., P.J.W., P.J.M.), The Ohio State University Wexner Medical Center, Columbus; Department of Biomedical Engineering, The Ohio State University College of Engineering, Columbus (S.D.U., J.S., T.J.H.); and Howard Hughes Medical Institute, Department of Biochemistry, Duke University Medical Center, Durham, NC (V.B.)
| | - Hassan Musa
- From The Dorothy M. Davis Heart & Lung Research Institute (M.A.M., J.C., S.C.L., H.M., I.P., S.A.S., P.J.W., S.D.U., J.S., T.J.H., P.J.M. ), Departments of Internal Medicine (S.A.S., P.J.M.), and Physiology and Cell Biology (M.A.M., J.C., S.C.L., H.M., I.P., S.A.S., P.J.W., P.J.M.), The Ohio State University Wexner Medical Center, Columbus; Department of Biomedical Engineering, The Ohio State University College of Engineering, Columbus (S.D.U., J.S., T.J.H.); and Howard Hughes Medical Institute, Department of Biochemistry, Duke University Medical Center, Durham, NC (V.B.)
| | - Iuliia Polina
- From The Dorothy M. Davis Heart & Lung Research Institute (M.A.M., J.C., S.C.L., H.M., I.P., S.A.S., P.J.W., S.D.U., J.S., T.J.H., P.J.M. ), Departments of Internal Medicine (S.A.S., P.J.M.), and Physiology and Cell Biology (M.A.M., J.C., S.C.L., H.M., I.P., S.A.S., P.J.W., P.J.M.), The Ohio State University Wexner Medical Center, Columbus; Department of Biomedical Engineering, The Ohio State University College of Engineering, Columbus (S.D.U., J.S., T.J.H.); and Howard Hughes Medical Institute, Department of Biochemistry, Duke University Medical Center, Durham, NC (V.B.)
| | - Sakima A Smith
- From The Dorothy M. Davis Heart & Lung Research Institute (M.A.M., J.C., S.C.L., H.M., I.P., S.A.S., P.J.W., S.D.U., J.S., T.J.H., P.J.M. ), Departments of Internal Medicine (S.A.S., P.J.M.), and Physiology and Cell Biology (M.A.M., J.C., S.C.L., H.M., I.P., S.A.S., P.J.W., P.J.M.), The Ohio State University Wexner Medical Center, Columbus; Department of Biomedical Engineering, The Ohio State University College of Engineering, Columbus (S.D.U., J.S., T.J.H.); and Howard Hughes Medical Institute, Department of Biochemistry, Duke University Medical Center, Durham, NC (V.B.)
| | - Patrick J Wright
- From The Dorothy M. Davis Heart & Lung Research Institute (M.A.M., J.C., S.C.L., H.M., I.P., S.A.S., P.J.W., S.D.U., J.S., T.J.H., P.J.M. ), Departments of Internal Medicine (S.A.S., P.J.M.), and Physiology and Cell Biology (M.A.M., J.C., S.C.L., H.M., I.P., S.A.S., P.J.W., P.J.M.), The Ohio State University Wexner Medical Center, Columbus; Department of Biomedical Engineering, The Ohio State University College of Engineering, Columbus (S.D.U., J.S., T.J.H.); and Howard Hughes Medical Institute, Department of Biochemistry, Duke University Medical Center, Durham, NC (V.B.)
| | - Sathya D Unudurthi
- From The Dorothy M. Davis Heart & Lung Research Institute (M.A.M., J.C., S.C.L., H.M., I.P., S.A.S., P.J.W., S.D.U., J.S., T.J.H., P.J.M. ), Departments of Internal Medicine (S.A.S., P.J.M.), and Physiology and Cell Biology (M.A.M., J.C., S.C.L., H.M., I.P., S.A.S., P.J.W., P.J.M.), The Ohio State University Wexner Medical Center, Columbus; Department of Biomedical Engineering, The Ohio State University College of Engineering, Columbus (S.D.U., J.S., T.J.H.); and Howard Hughes Medical Institute, Department of Biochemistry, Duke University Medical Center, Durham, NC (V.B.)
| | - Jed Snyder
- From The Dorothy M. Davis Heart & Lung Research Institute (M.A.M., J.C., S.C.L., H.M., I.P., S.A.S., P.J.W., S.D.U., J.S., T.J.H., P.J.M. ), Departments of Internal Medicine (S.A.S., P.J.M.), and Physiology and Cell Biology (M.A.M., J.C., S.C.L., H.M., I.P., S.A.S., P.J.W., P.J.M.), The Ohio State University Wexner Medical Center, Columbus; Department of Biomedical Engineering, The Ohio State University College of Engineering, Columbus (S.D.U., J.S., T.J.H.); and Howard Hughes Medical Institute, Department of Biochemistry, Duke University Medical Center, Durham, NC (V.B.)
| | - Vann Bennett
- From The Dorothy M. Davis Heart & Lung Research Institute (M.A.M., J.C., S.C.L., H.M., I.P., S.A.S., P.J.W., S.D.U., J.S., T.J.H., P.J.M. ), Departments of Internal Medicine (S.A.S., P.J.M.), and Physiology and Cell Biology (M.A.M., J.C., S.C.L., H.M., I.P., S.A.S., P.J.W., P.J.M.), The Ohio State University Wexner Medical Center, Columbus; Department of Biomedical Engineering, The Ohio State University College of Engineering, Columbus (S.D.U., J.S., T.J.H.); and Howard Hughes Medical Institute, Department of Biochemistry, Duke University Medical Center, Durham, NC (V.B.)
| | - Thomas J Hund
- From The Dorothy M. Davis Heart & Lung Research Institute (M.A.M., J.C., S.C.L., H.M., I.P., S.A.S., P.J.W., S.D.U., J.S., T.J.H., P.J.M. ), Departments of Internal Medicine (S.A.S., P.J.M.), and Physiology and Cell Biology (M.A.M., J.C., S.C.L., H.M., I.P., S.A.S., P.J.W., P.J.M.), The Ohio State University Wexner Medical Center, Columbus; Department of Biomedical Engineering, The Ohio State University College of Engineering, Columbus (S.D.U., J.S., T.J.H.); and Howard Hughes Medical Institute, Department of Biochemistry, Duke University Medical Center, Durham, NC (V.B.)
| | - Peter J Mohler
- From The Dorothy M. Davis Heart & Lung Research Institute (M.A.M., J.C., S.C.L., H.M., I.P., S.A.S., P.J.W., S.D.U., J.S., T.J.H., P.J.M. ), Departments of Internal Medicine (S.A.S., P.J.M.), and Physiology and Cell Biology (M.A.M., J.C., S.C.L., H.M., I.P., S.A.S., P.J.W., P.J.M.), The Ohio State University Wexner Medical Center, Columbus; Department of Biomedical Engineering, The Ohio State University College of Engineering, Columbus (S.D.U., J.S., T.J.H.); and Howard Hughes Medical Institute, Department of Biochemistry, Duke University Medical Center, Durham, NC (V.B.).
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152
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Asimaki A, Saffitz JE. Remodeling of cell-cell junctions in arrhythmogenic cardiomyopathy. ACTA ACUST UNITED AC 2014; 21:13-23. [PMID: 24460198 DOI: 10.3109/15419061.2013.876016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Arrhythmogenic cardiomyopathy (AC) is a primary myocardial disorder characterized by a high incidence of ventricular arrhythmias often preceding the onset of ventricular remodeling and dysfunction. Approximately 50% of patients diagnosed with AC have one or more mutations in genes encoding desmosomal proteins, although non-desmosomal genes have also been associated with the disease. Increasing evidence implicates remodeling of intercalated disk proteins reflecting abnormal responses to mechanical load and aberrant cell signaling pathways in the pathogenesis of AC. This review summarizes recent advances in understanding disease mechanisms in AC that have come from studies of human myocardium and experimental models.
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Affiliation(s)
- Angeliki Asimaki
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School , Boston, MA , USA
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153
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ERMAKOV SIMON, URSELL PHILIPC, JOHNSON COLLEENJ, MEADOWS ALISON, ZHAO SUSAN, MARCUS GREGORYM, SCHEINMAN MELVIN. Plakoglobin Immunolocalization as a Diagnostic Test for Arrhythmogenic Right Ventricular Cardiomyopathy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:1708-16. [DOI: 10.1111/pace.12492] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 07/01/2014] [Accepted: 07/11/2014] [Indexed: 12/21/2022]
Affiliation(s)
- SIMON ERMAKOV
- School of Medicine; University of California - San Francisco; San Francisco California
| | - PHILIP C. URSELL
- School of Medicine; University of California - San Francisco; San Francisco California
| | - COLLEEN J. JOHNSON
- School of Medicine; University of California - San Francisco; San Francisco California
| | - ALISON MEADOWS
- School of Medicine; University of California - San Francisco; San Francisco California
| | - SUSAN ZHAO
- School of Medicine; University of California - San Francisco; San Francisco California
| | - GREGORY M. MARCUS
- School of Medicine; University of California - San Francisco; San Francisco California
| | - MELVIN SCHEINMAN
- School of Medicine; University of California - San Francisco; San Francisco California
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154
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Groeneweg JA, van der Heijden JF, Dooijes D, van Veen TAB, van Tintelen JP, Hauer RN. Arrhythmogenic cardiomyopathy: diagnosis, genetic background, and risk management. Neth Heart J 2014; 22:316-25. [PMID: 24817548 PMCID: PMC4099433 DOI: 10.1007/s12471-014-0563-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Arrhythmogenic cardiomyopathy (AC), also known as arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C), is a hereditary disease characterised by ventricular arrhythmias, right ventricular and/or left ventricular dysfunction, and fibrofatty replacement of cardiomyocytes. Patients with AC typically present between the second and the fourth decade of life with ventricular tachycardias. However, sudden cardiac death (SCD) may be the first manifestation, often at young age in the concealed stage of disease. AC is diagnosed by a set of clinically applicable criteria defined by an international Task Force. The current Task Force Criteria are the essential standard for a correct diagnosis in individuals suspected of AC. The genetic substrate for AC is predominantly identified in genes encoding desmosomal proteins. In a minority of patients a non-desmosomal mutation predisposes to the phenotype. Risk stratification in AC is imperfect at present. Genotype-phenotype correlation analysis may provide more insight into risk profiles of index patients and family members. In addition to symptomatic treatment, prevention of SCD is the most important therapeutic goal in AC. Therapeutic options in symptomatic patients include antiarrhythmic drugs, catheter ablation, and ICD implantation. Furthermore, patients with AC and also all pathogenic mutation carriers should be advised against practising competitive and endurance sports.
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Affiliation(s)
- J A Groeneweg
- Department of Cardiology, University Medical Center Utrecht, HP Q05.2.314, Heidelberglaan 100, PO Box 85500, 3508 GA, Utrecht, the Netherlands,
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155
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Zhang L, Liu L, Kowey PR, Fontaine GH. The electrocardiographic manifestations of arrhythmogenic right ventricular dysplasia. Curr Cardiol Rev 2014; 10:237-45. [PMID: 24827798 PMCID: PMC4040875 DOI: 10.2174/1573403x10666140514102928] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 06/10/2013] [Accepted: 01/28/2014] [Indexed: 01/21/2023] Open
Abstract
The ECG is abnormal in most patients with arrhythmogenic right ventricular dysplasia (ARVD). Right ventricular parietal block, reduced QRS amplitude, epsilon wave, T wave inversion in V1-3 and ventricular tachycardia in the morphology of left bundle branch block are the characteristic changes that reflect the underlying genetic predetermined pathology and pathoelectrophysiology. Recognizing the characteristic ECG changes in ARVD will be of help in making a correct diagnosis of this rare disease.
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Affiliation(s)
| | | | | | - Guy H Fontaine
- Lankenau Medical Center & Lankenau Institute for Medical Research, 558 MOB East, 100 Lancaster Avenue, Wynnewood, PA 19096, USA.
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156
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Alcalde M, Campuzano O, Berne P, García-Pavía P, Doltra A, Arbelo E, Sarquella-Brugada G, Iglesias A, Alonso-Pulpon L, Brugada J, Brugada R. Stop-gain mutations in PKP2 are associated with a later age of onset of arrhythmogenic right ventricular cardiomyopathy. PLoS One 2014; 9:e100560. [PMID: 24967631 PMCID: PMC4072667 DOI: 10.1371/journal.pone.0100560] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 05/28/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a cardiac disease characterized by the presence of fibrofatty replacement of the right ventricular myocardium, which may cause ventricular arrhythmias and sudden cardiac death. Pathogenic mutations in several genes encoding mainly desmosomal proteins have been reported. Our aim is to perform genotype-phenotype correlations to establish the diagnostic value of genetics and to assess the role of mutation type in age-related penetrance in ARVC. METHODS AND RESULTS Thirty unrelated Spanish patients underwent a complete clinical evaluation. They all were screened for PKP2, DSG2, DSC2, DSP, JUP and TMEM43 genes. A total of 70 relatives of four families were also studied. The 30 patients fulfilled definite disease diagnostic criteria. Genetic analysis revealed a pathogenic mutation in 19 patients (13 in PKP2, 3 in DSG2, 2 in DSP, and 1 in DSC2). Nine of these mutations created a truncated protein due to the generation of a stop codon. Familial assessment revealed 28 genetic carriers among family members. Stop-gain mutations were associated to a later age of onset of ARVC, without differences in the severity of the pathology. CONCLUSIONS Familial genetic analysis helps to identify the cause responsible for the pathology. In discrepancy with previous studies, the presence of a truncating protein does not confer a worse severity. This information could suggest that truncating proteins may be compensated by the normal allele and that missense mutations may act as poison peptides.
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Affiliation(s)
- Mireia Alcalde
- Cardiovascular Genetics Centre, University of Girona-IDIBGI, Girona, Spain
| | - Oscar Campuzano
- Cardiovascular Genetics Centre, University of Girona-IDIBGI, Girona, Spain
| | - Paola Berne
- Arrhythmia Section, Thorax Institute, Hospital Clinic, Barcelona, Spain
| | - Pablo García-Pavía
- Cardiomyopathy Unit, Heart Failure and Heart Transplant Section, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Ada Doltra
- Arrhythmia Section, Thorax Institute, Hospital Clinic, Barcelona, Spain
| | - Elena Arbelo
- Arrhythmia Section, Thorax Institute, Hospital Clinic, Barcelona, Spain
| | | | - Anna Iglesias
- Cardiovascular Genetics Centre, University of Girona-IDIBGI, Girona, Spain
| | - Luis Alonso-Pulpon
- Cardiomyopathy Unit, Heart Failure and Heart Transplant Section, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Josep Brugada
- Arrhythmia Section, Thorax Institute, Hospital Clinic, Barcelona, Spain
| | - Ramon Brugada
- Cardiovascular Genetics Centre, University of Girona-IDIBGI, Girona, Spain
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157
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López-Ayala JM, Gómez-Milanés I, Sánchez Muñoz JJ, Ruiz-Espejo F, Ortíz M, González-Carrillo J, López-Cuenca D, Oliva-Sandoval MJ, Monserrat L, Valdés M, Gimeno JR. Desmoplakin truncations and arrhythmogenic left ventricular cardiomyopathy: characterizing a phenotype. Europace 2014; 16:1838-46. [PMID: 24938629 DOI: 10.1093/europace/euu128] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Risk stratification for sudden death in arrhythmogenic right ventricular cardiomyopathy (ARVC) is challenging in clinical practice. We lack recommendations for the risk stratification of exclusive left-sided phenotypes. The aim of this study was to investigate genotype-phenotype correlations in patients carrying a novel DSP c.1339C>T, and to review the literature on the clinical expression and the outcomes in patients with DSP truncating mutations. METHODS AND RESULTS Genetic screening of the DSP gene was performed in 47 consecutive patients with a phenotype of either an ARVC (n = 24) or an idiopathic dilated cardiomyopathy (DCM), who presented with ventricular arrhythmias or a family history of sudden death (n = 23) (aged 40 ± 19 years, 62% males). Three unrelated probands with DCM were found to be carriers of a novel mutation (c.1339C>T). Cascade family screening led to the identification of 15 relatives who are carriers. Penetrance in c.1339C>T carriers was 83%. Sustained ventricular tachycardia was the first clinical manifestation in six patients and nine patients were diagnosed with left ventricular impairment (two had overt severe disease and seven had a mild dysfunction). Cardiac magnetic resonance revealed left ventricular involvement in nine cases and biventricular disease in three patients. Extensive fibrotic patterns in six and non-compaction phenotype in five patients were the hallmark in imaging. CONCLUSION DSP c.1339C>T is associated with an aggressive clinical phenotype of left-dominant arrhythmogenic cardiomyopathy and left ventricular non-compaction. Truncating mutations in desmoplakin are consistently associated with aggressive phenotypes and must be considered as a risk factor of sudden death. Since ventricular tachycardia occurs even in the absence of severe systolic dysfunction, an implantable cardioverter-defibrillator should be indicated promptly.
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Affiliation(s)
- Jose María López-Ayala
- Department of Cardiology, University of Murcia, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Ivan Gómez-Milanés
- Department of Clinical Analysis, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Juan José Sánchez Muñoz
- Department of Cardiology, University of Murcia, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Francisco Ruiz-Espejo
- Department of Clinical Analysis, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Martín Ortíz
- A Coruña University Hospital, A Coruña Biomedical Research Institute, A Coruña, Spain
| | - Josefa González-Carrillo
- Department of Cardiology, University of Murcia, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - David López-Cuenca
- Department of Cardiology, University of Murcia, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - M J Oliva-Sandoval
- Department of Cardiology, University of Murcia, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Lorenzo Monserrat
- A Coruña University Hospital, A Coruña Biomedical Research Institute, A Coruña, Spain
| | - Mariano Valdés
- Department of Cardiology, University of Murcia, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Juan R Gimeno
- Department of Cardiology, University of Murcia, Virgen de la Arrixaca University Hospital, Murcia, Spain
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158
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Rasmussen TB, Nissen PH, Palmfeldt J, Gehmlich K, Dalager S, Jensen UB, Kim WY, Heickendorff L, Mølgaard H, Jensen HK, Baandrup UT, Bross P, Mogensen J. Truncating Plakophilin-2 Mutations in Arrhythmogenic Cardiomyopathy Are Associated With Protein Haploinsufficiency in Both Myocardium and Epidermis. ACTA ACUST UNITED AC 2014; 7:230-40. [DOI: 10.1161/circgenetics.113.000338] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Arrhythmogenic cardiomyopathy (AC) is a hereditary cardiac condition associated with ventricular arrhythmias, heart failure, and sudden death. The disease is most often caused by mutations in the desmosomal gene for plakophilin-2 (
PKP2
), which is expressed in both myocardial and epidermal tissue. This study aimed to investigate protein expression in myocardial tissue of patients with AC carrying
PKP2
mutations and elucidate whether keratinocytes of the same individuals exhibited a similar pattern of protein expression.
Methods and Results—
Direct sequencing of 5 AC genes in 71 unrelated patients with AC identified 10 different
PKP2
mutations in 12 index patients. One patient, heterozygous for a
PKP2
nonsense mutation, developed severe heart failure and underwent cardiac transplantation. Western blotting and immunohistochemistry of the explanted heart showed a significant decrease in PKP2 protein expression without detectable amounts of truncated PKP2 protein. Cultured keratinocytes of the patient showed a similar reduction in PKP2 protein expression. Nine additional
PKP2
mutations were investigated in both cultured keratinocytes and endomyocardial biopsies from affected individuals. It was evident that
PKP2
mutations introducing a premature termination codon in the reading frame were associated with PKP2 transcript and protein levels reduced to ≈50%, whereas a missense variant did not seem to affect the amount of PKP2 protein.
Conclusions—
The results of this study showed that truncating
PKP2
mutations in AC are associated with low expression of the mutant allele and that the myocardial protein expression of PKP2 is mirrored in keratinocytes. These findings indicate that
PKP2
haploinsufficiency contributes to pathogenesis in AC.
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Affiliation(s)
- Torsten B. Rasmussen
- From the Department of Cardiology (T.B.R., W.Y.K., H.M., H.K.J., J.M.), Research Unit for Molecular Medicine (T.B.R., J.P., P.B.), Department of Clinical Biochemistry (P.H.N., L.H.), Institute of Pathology (S.D.), Department of Clinical Genetics (U.B.J.), and MR Centre (W.Y.K.), Aarhus University Hospital, Aarhus, Denmark; Clinical Research Center, Vendsyssel Hospital, Aalborg University, Hjørring, Denmark (U.T.B.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of
| | - Peter H. Nissen
- From the Department of Cardiology (T.B.R., W.Y.K., H.M., H.K.J., J.M.), Research Unit for Molecular Medicine (T.B.R., J.P., P.B.), Department of Clinical Biochemistry (P.H.N., L.H.), Institute of Pathology (S.D.), Department of Clinical Genetics (U.B.J.), and MR Centre (W.Y.K.), Aarhus University Hospital, Aarhus, Denmark; Clinical Research Center, Vendsyssel Hospital, Aalborg University, Hjørring, Denmark (U.T.B.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of
| | - Johan Palmfeldt
- From the Department of Cardiology (T.B.R., W.Y.K., H.M., H.K.J., J.M.), Research Unit for Molecular Medicine (T.B.R., J.P., P.B.), Department of Clinical Biochemistry (P.H.N., L.H.), Institute of Pathology (S.D.), Department of Clinical Genetics (U.B.J.), and MR Centre (W.Y.K.), Aarhus University Hospital, Aarhus, Denmark; Clinical Research Center, Vendsyssel Hospital, Aalborg University, Hjørring, Denmark (U.T.B.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of
| | - Katja Gehmlich
- From the Department of Cardiology (T.B.R., W.Y.K., H.M., H.K.J., J.M.), Research Unit for Molecular Medicine (T.B.R., J.P., P.B.), Department of Clinical Biochemistry (P.H.N., L.H.), Institute of Pathology (S.D.), Department of Clinical Genetics (U.B.J.), and MR Centre (W.Y.K.), Aarhus University Hospital, Aarhus, Denmark; Clinical Research Center, Vendsyssel Hospital, Aalborg University, Hjørring, Denmark (U.T.B.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of
| | - Søren Dalager
- From the Department of Cardiology (T.B.R., W.Y.K., H.M., H.K.J., J.M.), Research Unit for Molecular Medicine (T.B.R., J.P., P.B.), Department of Clinical Biochemistry (P.H.N., L.H.), Institute of Pathology (S.D.), Department of Clinical Genetics (U.B.J.), and MR Centre (W.Y.K.), Aarhus University Hospital, Aarhus, Denmark; Clinical Research Center, Vendsyssel Hospital, Aalborg University, Hjørring, Denmark (U.T.B.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of
| | - Uffe B. Jensen
- From the Department of Cardiology (T.B.R., W.Y.K., H.M., H.K.J., J.M.), Research Unit for Molecular Medicine (T.B.R., J.P., P.B.), Department of Clinical Biochemistry (P.H.N., L.H.), Institute of Pathology (S.D.), Department of Clinical Genetics (U.B.J.), and MR Centre (W.Y.K.), Aarhus University Hospital, Aarhus, Denmark; Clinical Research Center, Vendsyssel Hospital, Aalborg University, Hjørring, Denmark (U.T.B.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of
| | - Won Y. Kim
- From the Department of Cardiology (T.B.R., W.Y.K., H.M., H.K.J., J.M.), Research Unit for Molecular Medicine (T.B.R., J.P., P.B.), Department of Clinical Biochemistry (P.H.N., L.H.), Institute of Pathology (S.D.), Department of Clinical Genetics (U.B.J.), and MR Centre (W.Y.K.), Aarhus University Hospital, Aarhus, Denmark; Clinical Research Center, Vendsyssel Hospital, Aalborg University, Hjørring, Denmark (U.T.B.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of
| | - Lene Heickendorff
- From the Department of Cardiology (T.B.R., W.Y.K., H.M., H.K.J., J.M.), Research Unit for Molecular Medicine (T.B.R., J.P., P.B.), Department of Clinical Biochemistry (P.H.N., L.H.), Institute of Pathology (S.D.), Department of Clinical Genetics (U.B.J.), and MR Centre (W.Y.K.), Aarhus University Hospital, Aarhus, Denmark; Clinical Research Center, Vendsyssel Hospital, Aalborg University, Hjørring, Denmark (U.T.B.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of
| | - Henning Mølgaard
- From the Department of Cardiology (T.B.R., W.Y.K., H.M., H.K.J., J.M.), Research Unit for Molecular Medicine (T.B.R., J.P., P.B.), Department of Clinical Biochemistry (P.H.N., L.H.), Institute of Pathology (S.D.), Department of Clinical Genetics (U.B.J.), and MR Centre (W.Y.K.), Aarhus University Hospital, Aarhus, Denmark; Clinical Research Center, Vendsyssel Hospital, Aalborg University, Hjørring, Denmark (U.T.B.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of
| | - Henrik K. Jensen
- From the Department of Cardiology (T.B.R., W.Y.K., H.M., H.K.J., J.M.), Research Unit for Molecular Medicine (T.B.R., J.P., P.B.), Department of Clinical Biochemistry (P.H.N., L.H.), Institute of Pathology (S.D.), Department of Clinical Genetics (U.B.J.), and MR Centre (W.Y.K.), Aarhus University Hospital, Aarhus, Denmark; Clinical Research Center, Vendsyssel Hospital, Aalborg University, Hjørring, Denmark (U.T.B.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of
| | - Ulrik T. Baandrup
- From the Department of Cardiology (T.B.R., W.Y.K., H.M., H.K.J., J.M.), Research Unit for Molecular Medicine (T.B.R., J.P., P.B.), Department of Clinical Biochemistry (P.H.N., L.H.), Institute of Pathology (S.D.), Department of Clinical Genetics (U.B.J.), and MR Centre (W.Y.K.), Aarhus University Hospital, Aarhus, Denmark; Clinical Research Center, Vendsyssel Hospital, Aalborg University, Hjørring, Denmark (U.T.B.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of
| | - Peter Bross
- From the Department of Cardiology (T.B.R., W.Y.K., H.M., H.K.J., J.M.), Research Unit for Molecular Medicine (T.B.R., J.P., P.B.), Department of Clinical Biochemistry (P.H.N., L.H.), Institute of Pathology (S.D.), Department of Clinical Genetics (U.B.J.), and MR Centre (W.Y.K.), Aarhus University Hospital, Aarhus, Denmark; Clinical Research Center, Vendsyssel Hospital, Aalborg University, Hjørring, Denmark (U.T.B.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of
| | - Jens Mogensen
- From the Department of Cardiology (T.B.R., W.Y.K., H.M., H.K.J., J.M.), Research Unit for Molecular Medicine (T.B.R., J.P., P.B.), Department of Clinical Biochemistry (P.H.N., L.H.), Institute of Pathology (S.D.), Department of Clinical Genetics (U.B.J.), and MR Centre (W.Y.K.), Aarhus University Hospital, Aarhus, Denmark; Clinical Research Center, Vendsyssel Hospital, Aalborg University, Hjørring, Denmark (U.T.B.); Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of
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Alcalde M, Campuzano O, Allegue C, Torres M, Arbelo E, Partemi S, Iglesias A, Brugada J, Oliva A, Carracedo A, Brugada R. Sequenom MassARRAY approach in the arrhythmogenic right ventricular cardiomyopathy post-mortem setting: clinical and forensic implications. Int J Legal Med 2014; 129:1-10. [PMID: 24832006 DOI: 10.1007/s00414-014-0996-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 04/16/2014] [Indexed: 01/08/2023]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare cardiac disease characterized by myocardial fibrofatty replacement, which can lead to sudden death. Previous studies have described a reduction of plakoglobin (PKG) protein at the level of intercalated disks as the hallmark of ARVC. The main objective of this study was to investigate the involvement of desmosome mutations in the histological phenotype of ARVC. We performed a genetic analysis of ARVC cases, and histological characterization of ARVC heart tissue samples. We genetically analyzed 48 ARVC cases distributed into two groups: 42 human tissue heart samples with conclusive diagnoses of ARVC after post-mortem examination; and six DNA samples from peripheral blood of living patients who were clinically diagnosed. Sequenom MassARRAY analysis revealed three ARVC-associated variants in three patients in 42 tissue samples (7.14 %). Three individuals carried one single pathogenic mutation, p.R811S _PKP2, p.S824L_DSC2, and p.T526M_PKP2 in postmortem samples. In the living patients group, Sequenom MassARRAY revealed no mutation, however, later Sanger sequencing analysis identified three ARVC mutations in 2/6 patients not included in the Sequenom design. In post-mortem tissue samples we performed immunohistochemical labeling for desmosomal proteins and Connexin 43. This study revealed that PKP2 carriers present either absent or clearly reduced PKG immunolabeling, while the DSC2 carrier showed PKG immunolabeling similar to control samples. Immunolabeling for Cx43 did not show any differences compared to controls. The present Sequenom MassARRAY design is a useful tool for post-mortem genetic diagnosis of ARVC. Plakoglobin reduction occurs at intercalated disks, while other desmosome proteins and Cx43 remain unaltered.
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Affiliation(s)
- M Alcalde
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
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Protein LUMA is a cytoplasmic plaque constituent of various epithelial adherens junctions and composite junctions of myocardial intercalated disks: a unifying finding for cell biology and cardiology. Cell Tissue Res 2014; 357:159-72. [PMID: 24770932 DOI: 10.1007/s00441-014-1865-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 03/06/2014] [Indexed: 10/25/2022]
Abstract
In a series of recent reports, mutations in the gene encoding a protein called LUMA (or TMEM43), widely speculated to be a tetraspan transmembrane protein of the nuclear envelope, have been associated with a specific subtype of cardiomyopathy (arrhythmogenic cardiomyopathies) and cases of sudden death. However, using antibodies of high specificity in immunolocalization experiments, we have discovered that, in mammals, LUMA is a component of zonula adhaerens and punctum adhaerens plaques of diverse epithelia and epithelial cell cultures and is also located in (or in some species associated with) the plaques of composite junctions (CJs) in myocardiac intercalated disks (IDs). In CJs, LUMA often colocalizes with several other CJ marker proteins. In all these cells, LUMA has not been detected in the nuclear envelope. Surprisingly, under certain conditions, similar CJ localizations have also been seen with some antibodies commercially available for some time. The identification of LUMA as a plaque component of myocardiac CJs leads to reconsiderations of the molecular composition and architecture, the development, the functions, and the pathogenic states of CJs and IDs. These findings now also allow the general conclusion that LUMA has to be added to the list of mutations of cardiomyocyte junction proteins that may be involved in cardiomyopathies.
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161
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Vite A, Radice GL. N-cadherin/catenin complex as a master regulator of intercalated disc function. ACTA ACUST UNITED AC 2014; 21:169-79. [PMID: 24766605 DOI: 10.3109/15419061.2014.908853] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Intercellular adhesive junctions are essential for maintaining the physical integrity of tissues; this is particularly true for the heart that is under constant mechanical load. The correct functionality of the heart is dependent on the electrical and mechanical coordination of its constituent cardiomyocytes. The intercalated disc (ID) structure located at the termini of the rod-shaped adult cardiomyocyte contains various junctional proteins responsible for the integration of structural information and cell-cell communication. According to the classical description, the ID consists of three distinct junctional complexes: adherens junction (AJ), desmosome (Des), and gap junction (GJ) that work together to mediate mechanical and electrical coupling of cardiomyocytes. However, recent morphological and molecular studies indicate that AJ and Des components are capable of mixing together resulting in a "hybrid adhering junction" or "area composita." This review summarizes recent progress in understanding the in vivo function(s) of AJ components in cardiac homeostasis and disease.
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Affiliation(s)
- Alexia Vite
- Department of Medicine, Center for Translational Medicine, Thomas Jefferson University , Philadelphia, PA , USA
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McCain ML, Desplantez T, Kléber AG. Engineering Cardiac Cell JunctionsIn Vitroto Study the Intercalated Disc. ACTA ACUST UNITED AC 2014; 21:181-91. [DOI: 10.3109/15419061.2014.905931] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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163
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Patel DM, Green KJ. Desmosomes in the Heart: A Review of Clinical and Mechanistic Analyses. ACTA ACUST UNITED AC 2014; 21:109-28. [DOI: 10.3109/15419061.2014.906533] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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164
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Busardò FP, Cappato R, D'Ovidio C, Frati P, Riezzo I, Fineschi V. Fatal left-dominant arrhythmogenic cardiomyopathy involving a 25-year old professional football player: could it have been prevented? Int J Cardiol 2014; 174:423-5. [PMID: 24768383 DOI: 10.1016/j.ijcard.2014.04.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 04/02/2014] [Indexed: 12/18/2022]
Affiliation(s)
- Francesco Paolo Busardò
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, University of Rome Sapienza, 336 Viale Regina Elena, 00185 Rome, Italy
| | | | | | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, University of Rome Sapienza, 336 Viale Regina Elena, 00185 Rome, Italy
| | - Irene Riezzo
- Department of Forensic Pathology, University of Foggia, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, University of Rome Sapienza, 336 Viale Regina Elena, 00185 Rome, Italy.
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165
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Philips B, Madhavan S, James CA, te Riele AS, Murray B, Tichnell C, Bhonsale A, Nazarian S, Judge DP, Calkins H, Tandri H, Cheng A. Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy and Cardiac Sarcoidosis. Circ Arrhythm Electrophysiol 2014; 7:230-6. [DOI: 10.1161/circep.113.000932] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Binu Philips
- From the Section of Cardiac Electrophysiology, Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI (B.P.); Section of Cardiac Electrophysiology, Johns Hopkins Medical Institutes, Baltimore, MD (S.M., C.A.J., A.S.J.M.t.R., B.M., C.T., A.B., S.N., D.P.J., H.C., H.T., A.C.); and Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.S.J.M.t.R.)
| | - Srinivasa Madhavan
- From the Section of Cardiac Electrophysiology, Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI (B.P.); Section of Cardiac Electrophysiology, Johns Hopkins Medical Institutes, Baltimore, MD (S.M., C.A.J., A.S.J.M.t.R., B.M., C.T., A.B., S.N., D.P.J., H.C., H.T., A.C.); and Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.S.J.M.t.R.)
| | - Cynthia A. James
- From the Section of Cardiac Electrophysiology, Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI (B.P.); Section of Cardiac Electrophysiology, Johns Hopkins Medical Institutes, Baltimore, MD (S.M., C.A.J., A.S.J.M.t.R., B.M., C.T., A.B., S.N., D.P.J., H.C., H.T., A.C.); and Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.S.J.M.t.R.)
| | - Anneline S.J.M. te Riele
- From the Section of Cardiac Electrophysiology, Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI (B.P.); Section of Cardiac Electrophysiology, Johns Hopkins Medical Institutes, Baltimore, MD (S.M., C.A.J., A.S.J.M.t.R., B.M., C.T., A.B., S.N., D.P.J., H.C., H.T., A.C.); and Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.S.J.M.t.R.)
| | - Brittney Murray
- From the Section of Cardiac Electrophysiology, Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI (B.P.); Section of Cardiac Electrophysiology, Johns Hopkins Medical Institutes, Baltimore, MD (S.M., C.A.J., A.S.J.M.t.R., B.M., C.T., A.B., S.N., D.P.J., H.C., H.T., A.C.); and Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.S.J.M.t.R.)
| | - Crystal Tichnell
- From the Section of Cardiac Electrophysiology, Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI (B.P.); Section of Cardiac Electrophysiology, Johns Hopkins Medical Institutes, Baltimore, MD (S.M., C.A.J., A.S.J.M.t.R., B.M., C.T., A.B., S.N., D.P.J., H.C., H.T., A.C.); and Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.S.J.M.t.R.)
| | - Aditya Bhonsale
- From the Section of Cardiac Electrophysiology, Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI (B.P.); Section of Cardiac Electrophysiology, Johns Hopkins Medical Institutes, Baltimore, MD (S.M., C.A.J., A.S.J.M.t.R., B.M., C.T., A.B., S.N., D.P.J., H.C., H.T., A.C.); and Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.S.J.M.t.R.)
| | - Saman Nazarian
- From the Section of Cardiac Electrophysiology, Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI (B.P.); Section of Cardiac Electrophysiology, Johns Hopkins Medical Institutes, Baltimore, MD (S.M., C.A.J., A.S.J.M.t.R., B.M., C.T., A.B., S.N., D.P.J., H.C., H.T., A.C.); and Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.S.J.M.t.R.)
| | - Daniel P. Judge
- From the Section of Cardiac Electrophysiology, Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI (B.P.); Section of Cardiac Electrophysiology, Johns Hopkins Medical Institutes, Baltimore, MD (S.M., C.A.J., A.S.J.M.t.R., B.M., C.T., A.B., S.N., D.P.J., H.C., H.T., A.C.); and Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.S.J.M.t.R.)
| | - Hugh Calkins
- From the Section of Cardiac Electrophysiology, Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI (B.P.); Section of Cardiac Electrophysiology, Johns Hopkins Medical Institutes, Baltimore, MD (S.M., C.A.J., A.S.J.M.t.R., B.M., C.T., A.B., S.N., D.P.J., H.C., H.T., A.C.); and Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.S.J.M.t.R.)
| | - Harikrishna Tandri
- From the Section of Cardiac Electrophysiology, Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI (B.P.); Section of Cardiac Electrophysiology, Johns Hopkins Medical Institutes, Baltimore, MD (S.M., C.A.J., A.S.J.M.t.R., B.M., C.T., A.B., S.N., D.P.J., H.C., H.T., A.C.); and Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.S.J.M.t.R.)
| | - Alan Cheng
- From the Section of Cardiac Electrophysiology, Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, RI (B.P.); Section of Cardiac Electrophysiology, Johns Hopkins Medical Institutes, Baltimore, MD (S.M., C.A.J., A.S.J.M.t.R., B.M., C.T., A.B., S.N., D.P.J., H.C., H.T., A.C.); and Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (A.S.J.M.t.R.)
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Affiliation(s)
- Yong Hu
- From the Department of Cardiology, Children's Hospital Boston, Boston, MA (Y.H., W.T.P.); and Harvard Stem Cell Institute, Harvard University, Cambridge, MA (W.T.P.)
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167
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Lyon RC, Mezzano V, Wright AT, Pfeiffer E, Chuang J, Banares K, Castaneda A, Ouyang K, Cui L, Contu R, Gu Y, Evans SM, Omens JH, Peterson KL, McCulloch AD, Sheikh F. Connexin defects underlie arrhythmogenic right ventricular cardiomyopathy in a novel mouse model. Hum Mol Genet 2014; 23:1134-50. [PMID: 24108106 PMCID: PMC3919010 DOI: 10.1093/hmg/ddt508] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 09/06/2013] [Accepted: 10/04/2013] [Indexed: 12/27/2022] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) termed a 'disease of the desmosome' is an inherited cardiomyopathy that recently underwent reclassification owing to the identification of left-dominant and biventricular disease forms. Homozygous loss-of-function mutations in the desmosomal component, desmoplakin, are found in patients exhibiting a biventricular form of ARVC; however, no models recapitulate the postnatal hallmarks of the disease as seen in these patients. To gain insights into the homozygous loss-of-function effects of desmoplakin in the heart, we generated cardiomyocyte-specific desmoplakin-deficient mice (DSP-cKO) using ventricular myosin light chain-2-Cre mice. Homozygous DSP-cKO mice are viable but display early ultrastructural defects in desmosomal integrity leading to a cardiomyopathy reminiscent of a biventricular form of ARVC, which includes cell death and fibro-fatty replacement within the ventricle leading to biventricular dysfunction, failure and premature death. DSP-cKO mice also exhibited ventricular arrhythmias that are exacerbated with exercise and catecholamine stimulation. Furthermore, DSP-cKO hearts exhibited right ventricular conduction defects associated with loss of connexin 40 expression and electrical wavefront propagation defects associated with loss of connexin 43 expression. Dose-dependent assessment of the effects of loss of desmoplakin in neonatal ventricular cardiomyocytes revealed primary loss of connexin 43 levels, phosphorylation and function independent of the molecular dissociation of the mechanical junction complex and fibro-fatty manifestation associated with ARVC, suggesting a role for desmoplakin as a primary stabilizer of connexin integrity. In summary, we provide evidence for a novel mouse model, which is reminiscent of the postnatal onset of ARVC while highlighting mechanisms underlying a biventricular form of human ARVC.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Li Cui
- Department of Skaggs School of Pharmacy, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | | | | | - Sylvia M. Evans
- Department of Skaggs School of Pharmacy, University of California-San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
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168
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Agullo-Pascual E, Cerrone M, Delmar M. Arrhythmogenic cardiomyopathy and Brugada syndrome: diseases of the connexome. FEBS Lett 2014; 588:1322-30. [PMID: 24548564 DOI: 10.1016/j.febslet.2014.02.008] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 02/06/2014] [Accepted: 02/06/2014] [Indexed: 11/30/2022]
Abstract
This review summarizes data in support of the notion that the cardiac intercalated disc is the host of a protein interacting network, called "the connexome", where molecules classically defined as belonging to one particular structure (e.g., desmosomes, gap junctions, sodium channel complex) actually interact with others, and together, control excitability, electrical coupling and intercellular adhesion in the heart. The concept of the connexome is then translated into the understanding of the mechanisms leading to two inherited arrhythmia diseases: arrhythmogenic cardiomyopathy, and Brugada syndrome. The cross-over points in these two diseases are addressed to then suggest that, though separate identifiable clinical entities, they represent "bookends" of a spectrum of manifestations that vary depending on the effect that a particular mutation has on the connexome as a whole.
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Affiliation(s)
- Esperanza Agullo-Pascual
- Leon H Charney Division of Cardiology, New York University School of Medicine, 522 First avenue, Smilow 805, New York, NY 10016, United States
| | - Marina Cerrone
- Leon H Charney Division of Cardiology, New York University School of Medicine, 522 First avenue, Smilow 805, New York, NY 10016, United States
| | - Mario Delmar
- Leon H Charney Division of Cardiology, New York University School of Medicine, 522 First avenue, Smilow 805, New York, NY 10016, United States.
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169
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Saguner AM, Duru F, Brunckhorst CB. Arrhythmogenic right ventricular cardiomyopathy: a challenging disease of the intercalated disc. Circulation 2014; 128:1381-6. [PMID: 24043146 DOI: 10.1161/circulationaha.112.001009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Ardan M Saguner
- Cardiovascular Center, University Hospital Zurich (A.M.S., F.D., C.B.B.); and Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland (F.D.)
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170
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Chen SN, Gurha P, Lombardi R, Ruggiero A, Willerson JT, Marian AJ. The hippo pathway is activated and is a causal mechanism for adipogenesis in arrhythmogenic cardiomyopathy. Circ Res 2013; 114:454-68. [PMID: 24276085 DOI: 10.1161/circresaha.114.302810] [Citation(s) in RCA: 209] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
RATIONALE Mutations in the intercalated disc proteins, such as plakophilin 2 (PKP2), cause arrhythmogenic cardiomyopathy (AC). AC is characterized by the replacement of cardiac myocytes by fibro-adipocytes, cardiac dysfunction, arrhythmias, and sudden death. OBJECTIVE To delineate the molecular pathogenesis of AC. METHODS AND RESULTS Localization and levels of selected intercalated disc proteins, including signaling molecules, were markedly reduced in human hearts with AC. Altered protein constituents of intercalated discs were associated with activation of the upstream Hippo molecules in the human hearts, in Nkx2.5-Cre:Dsp(W/F) and Myh6:Jup mouse models of AC, and in the PKP2 knockdown HL-1 myocytes (HL-1(PKP2:shRNA)). Level of active protein kinase C-α isoform, which requires PKP2 for activity, was reduced. In contrast, neurofibromin 2 (or Merlin), a molecule upstream of the Hippo pathway and that is inactivated by protein kinase C-α isoform, was activated. Consequently, the downstream Hippo molecules mammalian STE20-like protein kinases 1/2 (MST1/2), large tumor suppressor kinases 1/2 (LATS1/2), and Yes-associated protein (YAP) (the latter is the effector of the pathway) were phosphorylated. Coimmunoprecipitation detected binding of phosphorylated YAP, phosphorylated β-catenin, and junction protein plakoglobin (the latter translocated from the junction). RNA sequencing, transcript quantitative polymerase chain reaction, and reporter assays showed suppressed activity of SV40 transcriptional enhancer factor domain (TEAD) and transcription factor 7-like 2 (TCF7L2), which are transcription factors of the Hippo and the canonical Wnt signaling, respectively. In contrast, adipogenesis was enhanced. Simultaneous knockdown of Lats1/2, molecules upstream to YAP, rescued inactivation of YAP and β-catenin and adipogenesis in the HL-1(PKP2:shRNA) myocytes. CONCLUSIONS Molecular remodeling of the intercalated discs leads to pathogenic activation of the Hippo pathway, suppression of the canonical Wnt signaling, and enhanced adipogenesis in AC. The findings offer novel mechanisms for the pathogenesis of AC.
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Affiliation(s)
- Suet Nee Chen
- From the Center for Cardiovascular Genetics, Institute of Molecular Medicine and Department of Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX; and Texas Heart Institute, Houston, TX
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Brodehl A, Dieding M, Klauke B, Dec E, Madaan S, Huang T, Gargus J, Fatima A, Saric T, Cakar H, Walhorn V, Tönsing K, Skrzipczyk T, Cebulla R, Gerdes D, Schulz U, Gummert J, Svendsen JH, Olesen MS, Anselmetti D, Christensen AH, Kimonis V, Milting H. The novel desmin mutant p.A120D impairs filament formation, prevents intercalated disk localization, and causes sudden cardiac death. ACTA ACUST UNITED AC 2013; 6:615-23. [PMID: 24200904 DOI: 10.1161/circgenetics.113.000103] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The intermediate filament protein desmin is encoded by the gene DES and contributes to the mechanical stabilization of the striated muscle sarcomere and cell contacts within the cardiac intercalated disk. DES mutations cause severe skeletal and cardiac muscle diseases with heterogeneous phenotypes. Recently, DES mutations were also found in patients with arrhythmogenic right ventricular cardiomyopathy. Currently, the cellular and molecular pathomechanisms of the DES mutations leading to this disease are not exactly known. METHODS AND RESULTS We identified the 2 novel variants DES-p.A120D (c.359C>A) and DES-p.H326R (c.977A>G), which were characterized by cell culture experiments and atomic force microscopy. Family analysis indicated a broad spectrum of cardiomyopathies with a striking frequency of arrhythmias and sudden cardiac deaths. The in vitro experiments of desmin-p.A120D reveal a severe intrinsic filament formation defect causing cytoplasmic aggregates in cell lines and of the isolated recombinant protein. Model variants of codon 120 indicated that ionic interactions contribute to this filament formation defect. Ex vivo analysis of ventricular tissue slices revealed a loss of desmin staining within the intercalated disk and severe cytoplasmic aggregate formation, whereas z-band localization was not affected. The functional experiments of desmin-p.H326R did not demonstrate any differences from wild type. CONCLUSIONS Because of the functional in vivo and in vitro characterization, DES-p.A120D has to be regarded as a pathogenic mutation and DES-p.H326R as a rare variant with unknown significance. Presumably, the loss of the desmin-p. A120D filament localization at the intercalated disk explains its clinical arrhythmogenic potential.
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172
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Caspi O, Huber I, Gepstein A, Arbel G, Maizels L, Boulos M, Gepstein L. Modeling of arrhythmogenic right ventricular cardiomyopathy with human induced pluripotent stem cells. ACTA ACUST UNITED AC 2013; 6:557-68. [PMID: 24200905 DOI: 10.1161/circgenetics.113.000188] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a primary heart muscle disorder resulting from desmosomal protein mutations. ARVC is characterized pathologically by fibrofatty infiltration and clinically by arrhythmias and sudden cardiac death. We aimed to establish a patient-/disease-specific human induced pluripotent stem cell (hiPSC) model of ARVC. METHODS AND RESULTS Dermal fibroblasts were obtained from 2 patients with ARVC with plakophilin-2 (PKP2) mutations, reprogrammed to generate hiPSCs, coaxed to differentiate into cardiomyocytes (CMs), and then compared with healthy control hiPSC-derived CMs (hiPSC-CMs). Real-time polymerase chain reaction showed a significant decrease in the expression of PKP2 in the ARVC-hiPSC-CMs. Immunostainings revealed reduced densities of PKP2, the associated desmosomal protein plakoglobin, and the gap-junction protein connexin-43. Electrophysiological assessment demonstrated prolonged field potential rise time in the ARVC-hiPSC-CMs. Transmission electron microscopy identified widened and distorted desmosomes in the ARVC-hiPSC-CMs. Clusters of lipid droplets were identified in the ARVC-CMs that displayed the more severe desmosomal pathology. This finding was associated with upregulation of the proadipogenic transcription factor peroxisome proliferator-activated receptor-γ. Exposure of the cells to apidogenic stimuli augmented desmosomal distortion and lipid accumulation. The latter phenomenon was prevented by application of a specific inhibitor of glycogen synthase kinase 3β (6-bromoindirubin-3'-oxime). CONCLUSIONS This study highlights the unique potential of the hiPSC technology for modeling inherited cardiac disorders in general and ARVC specifically. The hiPSC-CMs were demonstrated to recapitulate the ARVC phenotype in the dish, provide mechanistic insights into early disease pathogenesis, and provide a unique platform for drug discovery and testing in this disorder.
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Affiliation(s)
- Oren Caspi
- Sohnis Family Research Laboratory for Cardiac Electrophysiology and Regenerative Medicine, Rappaport Faculty of Medicine and Research Institute, Technion-Israel Institute of Technology, Haifa, Israel
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173
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Groeneweg JA, van der Zwaag PA, Olde Nordkamp LRA, Bikker H, Jongbloed JDH, Jongbloed R, Wiesfeld ACP, Cox MGPJ, van der Heijden JF, Atsma DE, de Boer K, Doevendans PA, Vink A, van Veen TAB, Dooijes D, van den Berg MP, Wilde AAM, van Tintelen JP, Hauer RN. Arrhythmogenic right ventricular dysplasia/cardiomyopathy according to revised 2010 task force criteria with inclusion of non-desmosomal phospholamban mutation carriers. Am J Cardiol 2013; 112:1197-206. [PMID: 23871674 DOI: 10.1016/j.amjcard.2013.06.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 06/06/2013] [Accepted: 06/06/2013] [Indexed: 01/15/2023]
Abstract
Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is frequently associated with desmosomal mutations. However, nondesmosomal mutations may be involved. The aim of this study was to assess the contribution of a phospholamban (PLN) gene mutation to ARVD/C diagnosis according to the revised 2010 task force criteria (TFC). In 142 Dutch patients (106 men, mean age 51 ± 13 years) with proven ARVD/C (fulfillment of 2010 TFC for diagnosis), 5 known desmosomal genes (PKP2, DSP, DSC2, DSG2, and JUP) and the nondesmosomal PLN gene were screened. After genetic analysis, phenotypic characteristics of desmosomal versus PLN mutation carriers were compared. In 59 of 142 patients with ARVD/C (42%), no desmosomal mutation was found. In 19 of 142 patients (13%), the PLN founder mutation c.40_42delAGA (p.Arg14del) was identified. PLN mutation carriers more often had low-voltage electrocardiograms (p = 0.004), inverted T waves in leads V4 to V6 (p <0.001), and additional structural (p = 0.007) or functional (p = 0.017) left ventricular impairment, whereas desmosomal mutation carriers had more solitary right ventricular abnormalities. The revised TFC included 21 of 142 patients with proven ARVD/C who did not meet the 1994 TFC, including 7 PLN mutation carriers. In conclusion, there is a substantial contribution of PLN mutation to ARVD/C diagnosis by the 2010 TFC. In 32% of patients (19 of 59) with genetically unexplained proven ARVD/C, this nondesmosomal mutation was found. PLN mutation carriers have ARVD/C characteristics, including important right ventricular involvement, and additionally more often low-voltage electrocardiograms, inverted T waves in the left precordial leads, and left ventricular involvement.
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Affiliation(s)
- Judith A Groeneweg
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands.
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174
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Vite A, Gandjbakhch E, Prost C, Fressart V, Fouret P, Neyroud N, Gary F, Donal E, Varnous S, Fontaine G, Fornes P, Hidden-Lucet F, Komajda M, Charron P, Villard E. Desmosomal cadherins are decreased in explanted arrhythmogenic right ventricular dysplasia/cardiomyopathy patient hearts. PLoS One 2013; 8:e75082. [PMID: 24086444 PMCID: PMC3781033 DOI: 10.1371/journal.pone.0075082] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 08/12/2013] [Indexed: 11/19/2022] Open
Abstract
Aims Arrhythmogenic right ventricular Dysplasia/cardiomyopathy (ARVD/C) is an autosomal dominant inherited cardiomyopathy associated with ventricular arrhythmia, heart failure and sudden death. Genetic studies have demonstrated the central role of desmosomal proteins in this disease, where 50% of patients harbor a mutation in a desmosmal gene. However, clinical diagnosis of the disease remains difficult and molecular mechanisms appears heterogeneous and poorly understood. The aim of this study was to characterize the expression profile of desmosomal proteins in explanted ARVD/C heart samples, in order to identify common features of the disease. Methods and Results We examined plakophilin-2, desmoglein-2, desmocollin-2, plakoglobin and β-catenin protein expression levels from seven independent ARVD/C heart samples compared to two ischemic, five dilated cardiomyopathy and one healthy heart sample as controls. Ventricular and septum sections were examined by immunoblot analysis of total heart protein extracts and by immunostaining. Immunoblots indicated significant decreases in desmoglein-2 and desmocollin-2, independent of any known underlying mutations, whereas immune-histochemical analysis showed normal localization of all desmosomal proteins. Quantitative RT-PCR revealed normal DSG2 and DSC2 mRNA transcript levels, suggesting increased protein turn-over rather than transcriptional down regulation. Conclusion Reduced cardiac desmoglein-2 and desmocollin-2 levels appear to be specifically associated with ARVD/C, independent of underlying mutations. These findings highlight a key role of desmosomal cadherins in the pathophysiology of ARVD/C. Whether these reductions could be considered as specific markers for ARVD/C requires replication analysis.
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Affiliation(s)
- Alexia Vite
- UPMC, University Paris 06, Hôpital Pitié-Salpêtrière, Paris, France
- INSERM, UMR_S956, ICAN, Hôpital Pitié-Salpêtrière, Paris, France
| | - Estelle Gandjbakhch
- UPMC, University Paris 06, Hôpital Pitié-Salpêtrière, Paris, France
- INSERM, UMR_S956, ICAN, Hôpital Pitié-Salpêtrière, Paris, France
- Institut de Cardiologie (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Catherine Prost
- Laboratoire d’histologie et de thérapie génique, University Paris XIII, Bobigny, France
- Département de Pathologie, University Paris V, Hôpital Necker enfants malades, Paris, France
| | - Veronique Fressart
- Service de Biochimie Métabolique, Unité de Cardiogénétique, Hôpital Pitié-Salpêtrière, Paris, France
| | - Pierre Fouret
- UPMC, University Paris 06, Hôpital Pitié-Salpêtrière, Paris, France
- Service d’Anatomie Pathologique, Hôpital Pitié-Salpêtrière, Paris, France
| | - Nathalie Neyroud
- UPMC, University Paris 06, Hôpital Pitié-Salpêtrière, Paris, France
- INSERM, UMR_S956, ICAN, Hôpital Pitié-Salpêtrière, Paris, France
| | - Françoise Gary
- UPMC, University Paris 06, Hôpital Pitié-Salpêtrière, Paris, France
- INSERM, UMR_S956, ICAN, Hôpital Pitié-Salpêtrière, Paris, France
| | - Erwan Donal
- Département de Cardiologie, Hôpital Pontchaillou, Rennes, France
| | - Shaida Varnous
- Institut de Cardiologie (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Guy Fontaine
- Institut de Cardiologie (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Paul Fornes
- Département de Pathologie, Hôpital universitaire, Reims
| | | | - Michel Komajda
- UPMC, University Paris 06, Hôpital Pitié-Salpêtrière, Paris, France
- INSERM, UMR_S956, ICAN, Hôpital Pitié-Salpêtrière, Paris, France
- Institut de Cardiologie (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Philippe Charron
- UPMC, University Paris 06, Hôpital Pitié-Salpêtrière, Paris, France
- INSERM, UMR_S956, ICAN, Hôpital Pitié-Salpêtrière, Paris, France
- Institut de Cardiologie (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Eric Villard
- UPMC, University Paris 06, Hôpital Pitié-Salpêtrière, Paris, France
- INSERM, UMR_S956, ICAN, Hôpital Pitié-Salpêtrière, Paris, France
- * E-mail:
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175
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Marian AJ. On the diagnostic utility of junction plakoglobin in arrhythmogenic right ventricular cardiomyopathy. Cardiovasc Pathol 2013; 22:309-11. [PMID: 23806441 DOI: 10.1016/j.carpath.2013.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 05/20/2013] [Accepted: 05/20/2013] [Indexed: 01/08/2023] Open
Affiliation(s)
- Ali J Marian
- Center for Cardiovascular Genetics, Institute of Molecular Medicine, University of Texas Health Sciences Center at Houston, and the Texas Heart Institute, Houston, TX 77030, USA.
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176
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Basso C, Pilichou K, Thiene G. Is it time for plakoglobin immune-histochemical diagnostic test for arrhythmogenic cardiomyopathy in the routine pathology practice? Cardiovasc Pathol 2013; 22:312-3. [DOI: 10.1016/j.carpath.2013.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 06/02/2013] [Accepted: 06/05/2013] [Indexed: 10/26/2022] Open
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177
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Abstract
Despite the striking advances in medical and surgical therapy, the morbidity, mortality, and economic burden of heart failure (HF) remain unacceptably high. There is increasing evidence that the risk and course of HF depend on genetic predisposition; however, the genetic contribution to HF is heterogeneous and complex. At one end of the spectrum are the familial monogenic HF syndromes in which causative mutations are rare but highly penetrant. At the other, HF susceptibility and course may be influenced by more common, less penetrant genetic variants. As detailed in this review, efforts to unravel the basis of the familial cardiomyopathies at the mendelian end of the spectrum already have begun to deliver on the promise of informative mechanisms, novel gene-based diagnostics, and therapies for distinct subtypes of HF. However, continued progress requires the differentiation of pathogenic mutations, disease modifiers, and rare, benign variants in the deluge of data emerging from increasingly accessible novel sequencing technologies. This represents a significant challenge and demands a sustained effort in analysis of extended family pedigrees, diligent clinical phenotyping, and systematic annotation of human genetic variation.
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Affiliation(s)
- Thomas J. Cahill
- From the Department of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Houman Ashrafian
- From the Department of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Hugh Watkins
- From the Department of Cardiovascular Medicine, University of Oxford, Oxford, UK
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178
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Tong LJ, Flach EJ, Sheppard MN, Pocknell A, Banerjee AA, Boswood A, Bouts T, Routh A, Feltrer Y. Fatal arrhythmogenic right ventricular cardiomyopathy in 2 related subadult chimpanzees (Pan troglodytes). Vet Pathol 2013; 51:858-67. [PMID: 23988399 DOI: 10.1177/0300985813501333] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cardiovascular disease is increasingly recognized as an important cause of morbidity and mortality in captive chimpanzees (Pan troglodytes). This report records 2 cases of sudden cardiac death in closely related subadult captive chimpanzees with marked replacement fibrosis and adipocyte infiltration of the myocardium, which resemble specific atypical forms of the familial human disease arrhythmogenic right ventricular cardiomyopathy. Changes were consistent with left-dominant and biventricular subtypes, which are both phenotypic variants found within human families with familial arrhythmogenic right ventricular cardiomyopathy. Previously reported fibrosing cardiomyopathies in chimpanzees were characterized by nonspecific interstitial fibrosis, in contrast to the replacement fibrofatty infiltration with predilection for the outer myocardium seen in these 2 cases. To the authors' knowledge, this case report is the first to describe cardiomyopathy resembling arrhythmogenic right ventricular cardiomyopathy in nonhuman primates and the first to describe left-dominant arrhythmogenic cardiomyopathy-type lesions in an animal.
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Affiliation(s)
- L J Tong
- Zoological Society of London, Veterinary Department, London Zoo, Regents Park, London, UK Veterinary Pathology Diagnostic Services, Faculty of Veterinary Science, Sydney University, Australia
| | - E J Flach
- Zoological Society of London, Veterinary Department, London Zoo, Regents Park, London, UK
| | - M N Sheppard
- Cardiac Pathology Unit, Imperial College, London, UK
| | - A Pocknell
- Zoological Society of London, Veterinary Department, London Zoo, Regents Park, London, UK Finn Pathologists, One Eyed Lane, Weybread, Norfolk, UK
| | - A A Banerjee
- Royal Veterinary College, University of London, Hertfordshire, UK
| | - A Boswood
- Royal Veterinary College, University of London, Hertfordshire, UK
| | - T Bouts
- Whipsnade Zoo, Dunstable, Bedfordshire, UK Al Wabra Wildlife Preservation, Al Shahaniya, Qatar
| | - A Routh
- Zoological Society of London, Veterinary Department, London Zoo, Regents Park, London, UK Durrell Wildlife Conservation Trust, Jersey, Channel Islands
| | - Y Feltrer
- Zoological Society of London, Veterinary Department, London Zoo, Regents Park, London, UK
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179
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Valchanov K, Goddard M, Ghosh S. Anesthesia for heart transplantation in patients with arrhythmogenic right ventricular dysplasia. J Cardiothorac Vasc Anesth 2013; 28:355-7. [PMID: 23994174 DOI: 10.1053/j.jvca.2013.02.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Kamen Valchanov
- Department of Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, United Kingdom.
| | - Martin Goddard
- Department of Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, United Kingdom
| | - Sunit Ghosh
- Department of Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, United Kingdom
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180
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Abstract
Arrhythmogenic right ventricular dysplasia (ARVD) is an inherited cardiomyopathy and is also called ARVD/C. In most cases, ARVD is inherited in an autosomal-dominant pattern and clinically is characterized by ventricular arrhythmias with an increased risk of sudden death. Although it is prominently a disease of the right ventricle (RV), involvement of the left ventricle is not uncommon. Pathologically, there is RV myocardial atrophy with thinning of the wall, aneurysm, and global RV dilatation. Genetic testing and magnetic resonance imaging of the RV are an increasing aspect of the diagnosis. Diagnosis relies on a scoring system with major or minor criteria. Prevention of sudden death is the primary goal of management. Pharmacologic treatment of arrhythmias, catheter ablation of ventricular tachycardia, and implantable cardioverter defibrillator are the mainstay of treatment of ARVD/C.
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181
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Agullo-Pascual E, Reid DA, Keegan S, Sidhu M, Fenyö D, Rothenberg E, Delmar M. Super-resolution fluorescence microscopy of the cardiac connexome reveals plakophilin-2 inside the connexin43 plaque. Cardiovasc Res 2013; 100:231-40. [PMID: 23929525 DOI: 10.1093/cvr/cvt191] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Cell function requires formation of molecular clusters localized to discrete subdomains. The composition of these interactomes, and their spatial organization, cannot be discerned by conventional microscopy given the resolution constraints imposed by the diffraction limit of light (∼200-300 nm). Our aims were (i) Implement single-molecule imaging and analysis tools to resolve the nano-scale architecture of cardiac myocytes. (ii) Using these tools, to map two molecules classically defined as components 'of the desmosome' and 'of the gap junction', and defined their spatial organization. METHODS AND RESULTS We built a set-up on a conventional inverted microscope using commercially available optics. Laser illumination, reducing, and oxygen scavenging conditions were used to manipulate the blinking behaviour of individual fluorescent reporters. Movies of blinking fluorophores were reconstructed to generate subdiffraction images at ∼20 nm resolution. With this method, we characterized clusters of connexin43 (Cx43) and of 'the desmosomal protein' plakophilin-2 (PKP2). In about half of Cx43 clusters, we observed overlay of Cx43 and PKP2 at the Cx43 plaque edge. SiRNA-mediated loss of Ankyrin-G expression yielded larger Cx43 clusters, of less regular shape, and larger Cx43-PKP2 subdomains. The Cx43-PKP2 subdomain was validated by a proximity ligation assay (PLA) and by Monte-Carlo simulations indicating an attraction between PKP2 and Cx43. CONCLUSIONS (i) Super-resolution fluorescence microscopy, complemented with Monte-Carlo simulations and PLAs, allows the study of the nanoscale organization of an interactome in cardiomyocytes. (ii) PKP2 and Cx43 share a common hub that permits direct physical interaction. Its relevance to excitability, electrical coupling, and arrhythmogenic right ventricular cardiomyopathy, is discussed.
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Affiliation(s)
- Esperanza Agullo-Pascual
- The Leon H Charney Division of Cardiology, New York University School of Medicine, 522 First Avenue, Smilow 805, New York, NY 10016, USA
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182
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Al-Jassar C, Bikker H, Overduin M, Chidgey M. Mechanistic basis of desmosome-targeted diseases. J Mol Biol 2013; 425:4006-22. [PMID: 23911551 PMCID: PMC3807649 DOI: 10.1016/j.jmb.2013.07.035] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 07/23/2013] [Accepted: 07/24/2013] [Indexed: 11/21/2022]
Abstract
Desmosomes are dynamic junctions between cells that maintain the structural integrity of skin and heart tissues by withstanding shear forces. Mutations in component genes cause life-threatening conditions including arrhythmogenic right ventricular cardiomyopathy, and desmosomal proteins are targeted by pathogenic autoantibodies in skin blistering diseases such as pemphigus. Here, we review a set of newly discovered pathogenic alterations and discuss the structural repercussions of debilitating mutations on desmosomal proteins. The architectures of native desmosomal assemblies have been visualized by cryo-electron microscopy and cryo-electron tomography, and the network of protein domain interactions is becoming apparent. Plakophilin and desmoplakin mutations have been discovered to alter binding interfaces, structures, and stabilities of folded domains that have been resolved by X-ray crystallography and NMR spectroscopy. The flexibility within desmoplakin has been revealed by small-angle X-ray scattering and fluorescence assays, explaining how mechanical stresses are accommodated. These studies have shown that the structural and functional consequences of desmosomal mutations can now begin to be understood at multiple levels of spatial and temporal resolution. This review discusses the recent structural insights and raises the possibility of using modeling for mechanism-based diagnosis of how deleterious mutations alter the integrity of solid tissues.
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Affiliation(s)
- Caezar Al-Jassar
- School of Cancer Sciences, University of Birmingham, Birmingham B15 2TT, UK
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183
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Gerull B, Kirchner F, Chong JX, Tagoe J, Chandrasekharan K, Strohm O, Waggoner D, Ober C, Duff HJ. Homozygous Founder Mutation in Desmocollin-2 (
DSC2
) Causes Arrhythmogenic Cardiomyopathy in the Hutterite Population. ACTA ACUST UNITED AC 2013; 6:327-36. [DOI: 10.1161/circgenetics.113.000097] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Dominant mutations in cellular junction proteins are the major cause of arrhythmogenic cardiomyopathy, whereas recessive mutations in those proteins cause cardiocutaneous syndromes such as Naxos and Carvajal syndrome. The Hutterites are distinct genetic isolates who settled in North America in 1874. Descended from <100 founders, they trace their origins to 16th-century Europe.
Methods and Results—
We clinically and genetically evaluated 2 large families of the Alberta Hutterite population with a history of sudden death and found several individuals with severe forms of biventricular cardiomyopathy characterized by mainly left-sided localized aneurysms, regions of wall thinning with segmental akinesis, in addition to typical electric and histological features known for arrhythmogenic right ventricular cardiomyopathy. We identified a homozygous truncation mutation, c.1660C>T (p.Q554X) in desmocollin-2 (
DSC2
), in affected individuals and determined a carrier frequency of this mutation of 9.4% (1 in 10.6) among 1535 Schmiedeleut Hutterites, suggesting a common founder in that subgroup. Immunohistochemistry of endomyocardial biopsy samples revealed altered expression of the truncated DSC2 protein at the intercalated discs but only minor changes in immunoreactivity of other desmosomal proteins. Recombinant expressed mutant DSC2 protein in cells confirmed a stable, partially processed truncated protein with cytoplasmic and membrane localization.
Conclusions—
A homozygous truncation mutation in
DSC2
leads to a cardiac-restricted phenotype of an early onset biventricular arrhythmogenic cardiomyopathy. The truncated protein remains partially stable and localized at the intercalated discs. These data suggest that the processed DSC2 protein plays a role in maintaining desmosome integrity and function.
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Affiliation(s)
- Brenda Gerull
- From the Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta (B.G., K.C., O.S., H.J.D.), and Department of Medical Genetics (B.G., J.T.), University of Calgary, Calgary, AB, Canada; Max Delbrück Center for Molecular Medicine, Berlin, Germany (F.K.); Department of Human Genetics, The University of Chicago, Chicago, IL (J.X.C., D.W., C.O.); and Centre for Cardiology, Baden-Baden, Germany (O.S.)
| | - Florian Kirchner
- From the Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta (B.G., K.C., O.S., H.J.D.), and Department of Medical Genetics (B.G., J.T.), University of Calgary, Calgary, AB, Canada; Max Delbrück Center for Molecular Medicine, Berlin, Germany (F.K.); Department of Human Genetics, The University of Chicago, Chicago, IL (J.X.C., D.W., C.O.); and Centre for Cardiology, Baden-Baden, Germany (O.S.)
| | - Jessica X. Chong
- From the Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta (B.G., K.C., O.S., H.J.D.), and Department of Medical Genetics (B.G., J.T.), University of Calgary, Calgary, AB, Canada; Max Delbrück Center for Molecular Medicine, Berlin, Germany (F.K.); Department of Human Genetics, The University of Chicago, Chicago, IL (J.X.C., D.W., C.O.); and Centre for Cardiology, Baden-Baden, Germany (O.S.)
| | - Julia Tagoe
- From the Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta (B.G., K.C., O.S., H.J.D.), and Department of Medical Genetics (B.G., J.T.), University of Calgary, Calgary, AB, Canada; Max Delbrück Center for Molecular Medicine, Berlin, Germany (F.K.); Department of Human Genetics, The University of Chicago, Chicago, IL (J.X.C., D.W., C.O.); and Centre for Cardiology, Baden-Baden, Germany (O.S.)
| | - Kumaran Chandrasekharan
- From the Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta (B.G., K.C., O.S., H.J.D.), and Department of Medical Genetics (B.G., J.T.), University of Calgary, Calgary, AB, Canada; Max Delbrück Center for Molecular Medicine, Berlin, Germany (F.K.); Department of Human Genetics, The University of Chicago, Chicago, IL (J.X.C., D.W., C.O.); and Centre for Cardiology, Baden-Baden, Germany (O.S.)
| | - Oliver Strohm
- From the Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta (B.G., K.C., O.S., H.J.D.), and Department of Medical Genetics (B.G., J.T.), University of Calgary, Calgary, AB, Canada; Max Delbrück Center for Molecular Medicine, Berlin, Germany (F.K.); Department of Human Genetics, The University of Chicago, Chicago, IL (J.X.C., D.W., C.O.); and Centre for Cardiology, Baden-Baden, Germany (O.S.)
| | - Darrel Waggoner
- From the Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta (B.G., K.C., O.S., H.J.D.), and Department of Medical Genetics (B.G., J.T.), University of Calgary, Calgary, AB, Canada; Max Delbrück Center for Molecular Medicine, Berlin, Germany (F.K.); Department of Human Genetics, The University of Chicago, Chicago, IL (J.X.C., D.W., C.O.); and Centre for Cardiology, Baden-Baden, Germany (O.S.)
| | - Carole Ober
- From the Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta (B.G., K.C., O.S., H.J.D.), and Department of Medical Genetics (B.G., J.T.), University of Calgary, Calgary, AB, Canada; Max Delbrück Center for Molecular Medicine, Berlin, Germany (F.K.); Department of Human Genetics, The University of Chicago, Chicago, IL (J.X.C., D.W., C.O.); and Centre for Cardiology, Baden-Baden, Germany (O.S.)
| | - Henry J. Duff
- From the Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta (B.G., K.C., O.S., H.J.D.), and Department of Medical Genetics (B.G., J.T.), University of Calgary, Calgary, AB, Canada; Max Delbrück Center for Molecular Medicine, Berlin, Germany (F.K.); Department of Human Genetics, The University of Chicago, Chicago, IL (J.X.C., D.W., C.O.); and Centre for Cardiology, Baden-Baden, Germany (O.S.)
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184
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James CA, Calkins H. Update on Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C). CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2013; 15:476-87. [PMID: 23728845 DOI: 10.1007/s11936-013-0251-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OPINION STATEMENT Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is an inherited cardiomyopathy characterized by life-threatening ventricular arrhythmias and slowly progressive ventricular dysfunction. Treatment for families with ARVD/C is directed toward prevention of sudden cardiac death, prevention or delay of disease progression, and adjustment to life with a lifelong chronic genetic disease. As there have been no randomized trials of ARVD/C treatments or screening regimens, treatment decisions are based on clinical expertise, results of retrospective registry-based studies, and understanding of pathologic mechanisms of disease. The first step for treatment is securing an accurate diagnosis through careful application of the diagnostic Task Force criteria. Following diagnosis in an index case, family members are screened. We advise affected individuals and gene carriers to dramatically reduce exercise and strongly recommend that ARVD/C patients discontinue competitive athletics. We generally recommend implantable cardioverter defibrillator (ICD) placement in all probands who meet Task Force criteria, especially if they have a history of sustained ventricular tachycardia (VT), arrhythmogenic syncope, or frequent ventricular ectopy and/or nonsustained VT. We are more circumspect about recommending implantation of an ICD in a family member who has been diagnosed with ARVD/C through family screening, as these individuals are now being identified at a much earlier stage in their disease than was possible previously. Anti-arrhythmic medications and catheter ablation are used to decrease the frequency of ventricular tachycardia and associated implantable cardioverter defibrillator therapies. Epicardial ablation is offered if endocardial ablation fails or as part of an initial combined endocaridal/epicardial ablation strategy, depending on patient preference. We attempt to initiate beta-blocker therapy and therapy with angiotensin-converting enzyme inhibitors to limit structural progression and prevent ventricular arrhythmias. Unaffected family members are screened for disease onset regularly from adolescence through noninvasive cardiac testing. Support to families is provided through ongoing genetic counseling, patient-family web-based support, and in-person seminars for families.
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Affiliation(s)
- Cynthia A James
- Johns Hopkins Hospital, Johns Hopkins ARVD Program - Blalock 545, 600 N. Wolfe Street, Baltimore, MD, 21287, USA,
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185
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Iyer VR, Chin AJ. Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D). AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2013; 163C:185-97. [PMID: 23824749 DOI: 10.1002/ajmg.c.31368] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is a progressive genetic cardiomyopathy characterized by progressive fatty and fibrous replacement of ventricular myocardium. The clinical presentation is marked by ventricular arrhythmias, some fatal. The disease has evolved from a primary electrical/electrophysiological disorder (in the 1980s-1990s) to a diagnostic imaging conundrum (in the 2000s) to the current day understanding of a genetic cardiomyopathy caused by defects in cell-cell adhesion proteins or intracellular signaling components. The pathogenesis, clinical presentation, and the genetics of the disease are discussed in this review.
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Affiliation(s)
- V Ramesh Iyer
- Perelman School of Medicine, University of Pennsylvania, PA, USA
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186
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Baskin B, Skinner JR, Sanatani S, Terespolsky D, Krahn AD, Ray PN, Scherer SW, Hamilton RM. TMEM43 mutations associated with arrhythmogenic right ventricular cardiomyopathy in non-Newfoundland populations. Hum Genet 2013; 132:1245-52. [DOI: 10.1007/s00439-013-1323-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 06/09/2013] [Indexed: 11/30/2022]
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187
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Thiene G, Bruneval P, Veinot J, Leone O. Diagnostic use of the endomyocardial biopsy: a consensus statement. Virchows Arch 2013; 463:1-5. [DOI: 10.1007/s00428-013-1430-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 05/10/2013] [Accepted: 05/17/2013] [Indexed: 11/24/2022]
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188
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Mavrogeni S, Protonotarios N, Tsatsopoulou A, Papachristou P, Sfendouraki E, Papadopoulos G. Naxos disease evolution mimicking acute myocarditis: The role of cardiovascular magnetic resonance imaging. Int J Cardiol 2013; 166:e14-5. [DOI: 10.1016/j.ijcard.2012.12.078] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 12/25/2012] [Indexed: 01/04/2023]
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189
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van der Heijden JF, Hassink RJ. The phospholamban p.Arg14del founder mutation in Dutch patients with arrhythmogenic cardiomyopathy. Neth Heart J 2013; 21:284-5. [PMID: 23595706 PMCID: PMC3661881 DOI: 10.1007/s12471-013-0413-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- J F van der Heijden
- Department of Cardiology, University Medical Center Utrecht, Huispostnummer: E03.511, Heidelberglaan 100, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands,
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190
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Noorman M, Hakim S, Asimaki A, Vreeker A, van Rijen HVM, van der Heyden MAG, de Jonge N, de Weger RA, Hauer RNW, Saffitz JE, van Veen TAB. Reduced plakoglobin immunoreactivity in arrhythmogenic cardiomyopathy: methodological considerations. Cardiovasc Pathol 2013; 22:314-8. [PMID: 23688911 DOI: 10.1016/j.carpath.2013.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 04/03/2013] [Accepted: 04/06/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Arrhythmogenic cardiomyopathy (AC) primarily is considered to be a desmosomal disease with a predominant right ventricular phenotype. Reduced signal intensity for junctional plakoglobin (JUP) at the intercalated disks has been proposed as a marker that contributes to diagnosis of the disease. In this technical study, we investigated how methodology-related differences caused by tissue preservation and antibody dilutions affect an appropriate diagnosis. METHODS Autopsy and biopsy material was available from a total of 7 control and 25 AC patients that fulfilled the diagnostic Task Force Criteria as proposed in 2010. Immunohistochemical analysis was performed on cryosections and formalin-fixed material using antibodies against JUP and N-Cadherin. RESULTS Immunohistochemistry (1:1000 antibody dilution) on formalin-fixed material showed a reduced signal for JUP in 7/10 AC patients in a bidirectional, double-blinded exchange experiment in which 77% of individuals were correctly classified. Unmasking this disturbed JUP pattern was highly dependent on tissue preservation and antibody dilution since on cryosections the disturbed pattern in patients could only be unmasked at a very strong antibody dilution of 1:100000. CONCLUSIONS Reduced immunoreactive signal of JUP at the intercalated disks can be observed in a majority of AC patients. These changes can comparably be detected on both cryo- (74%) and formalin-fixed material (70%) but demand a different, highly defined, and uniformly used approach.
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Affiliation(s)
- Maartje Noorman
- Department of Medical Physiology, University Medical Center Utrecht, 3584CM Utrecht, The Netherlands; Interuniversity Cardiology Institute, The Netherlands
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191
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Meens MJ, Pfenniger A, Kwak BR, Delmar M. Regulation of cardiovascular connexins by mechanical forces and junctions. Cardiovasc Res 2013; 99:304-14. [PMID: 23612582 DOI: 10.1093/cvr/cvt095] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Connexins form a family of transmembrane proteins that consists of 20 members in humans and 21 members in mice. Six connexins assemble into a connexon that can function as a hemichannel or connexon that can dock to a connexon expressed by a neighbouring cell, thereby forming a gap junction channel. Such intercellular channels synchronize responses in multicellular organisms through direct exchange of ions, small metabolites, and other second messenger molecules between the cytoplasms of adjacent cells. Multiple connexins are expressed in the cardiovascular system. These connexins not only experience the different biomechanical forces within this system, but may also act as effector proteins in co-ordinating responses within groups of cells towards these forces. This review discusses recent insights regarding regulation of cardiovascular connexins by mechanical forces and junctions. It specifically addresses effects of (i) shear stress on endothelial connexins, (ii) hypertension on vascular connexins, and (iii) changes in afterload and the composition of myocardial mechanical junctions on cardiac connexins.
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Affiliation(s)
- Merlijn J Meens
- Department of Pathology and Immunology, Foundation for Medical Research, University of Geneva, 2nd floor, 64 Avenue de Roseraie, 1211 Geneva, Switzerland
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192
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Sudden cardiac death due to arrhythmogenic right ventricular cardiomyopathy and cystic tumor of the AV node. Forensic Sci Med Pathol 2013; 9:407-12. [PMID: 23564062 DOI: 10.1007/s12024-013-9434-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2013] [Indexed: 10/27/2022]
Abstract
An 18-year-old white male collapsed suddenly in his home and died. At autopsy, the right ventricle of the decedent was noted to be dilated with marked thinning of the wall focally. Microscopically, the myocardium of the right ventricle was noted to be significantly thinned focally, where transmural infiltration with fibroadipose tissue was noted. Depending on the criteria utilized to render such a diagnosis, these findings were consistent with arrhythmogenic right ventricular cardiomyopathy (ARVC). Subsequent microscopic examination of the SA and AV node, however, revealed the presence of a cystic tumor of the AV node (CTAVN), a known cause of sudden death from arrhythmia. The case represents the first reported case of ARVC and CTAVN occurring together in the same individual.
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193
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Deletion of the last five C-terminal amino acid residues of connexin43 leads to lethal ventricular arrhythmias in mice without affecting coupling via gap junction channels. Basic Res Cardiol 2013; 108:348. [PMID: 23558439 DOI: 10.1007/s00395-013-0348-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 03/08/2013] [Accepted: 03/25/2013] [Indexed: 10/27/2022]
Abstract
The cardiac intercalated disc harbors mechanical and electrical junctions as well as ion channel complexes mediating propagation of electrical impulses. Cardiac connexin43 (Cx43) co-localizes and interacts with several of the proteins located at intercalated discs in the ventricular myocardium. We have generated conditional Cx43D378stop mice lacking the last five C-terminal amino acid residues, representing a binding motif for zonula occludens protein-1 (ZO-1), and investigated the functional consequences of this mutation on cardiac physiology and morphology. Newborn and adult homozygous Cx43D378stop mice displayed markedly impaired and heterogeneous cardiac electrical activation properties and died from severe ventricular arrhythmias. Cx43 and ZO-1 were co-localized at intercalated discs in Cx43D378stop hearts, and the Cx43D378stop gap junction channels showed normal coupling properties. Patch clamp analyses of isolated adult Cx43D378stop cardiomyocytes revealed a significant decrease in sodium and potassium current densities. Furthermore, we also observed a significant loss of Nav1.5 protein from intercalated discs in Cx43D378stop hearts. The phenotypic lethality of the Cx43D378stop mutation was very similar to the one previously reported for adult Cx43 deficient (Cx43KO) mice. Yet, in contrast to Cx43KO mice, the Cx43 gap junction channel was still functional in the Cx43D378stop mutant. We conclude that the lethality of Cx43D378stop mice is independent of the loss of gap junctional intercellular communication, but most likely results from impaired cardiac sodium and potassium currents. The Cx43D378stop mice reveal for the first time that Cx43 dependent arrhythmias can develop by mechanisms other than impairment of gap junction channel function.
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194
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Tavora F, Zhang M, Cresswell N, Li L, Fowler D, Franco M, Burke A. Quantitative Immunohistochemistry of Desmosomal Proteins (Plakoglobin, Desmoplakin and Plakophilin), Connexin-43, and N-cadherin in Arrhythmogenic Cardiomyopathy: An Autopsy Study. Open Cardiovasc Med J 2013; 7:28-35. [PMID: 23802019 PMCID: PMC3680985 DOI: 10.2174/1874192401307010028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Revised: 02/23/2013] [Accepted: 02/24/2013] [Indexed: 12/19/2022] Open
Abstract
Background: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic disorder related to mutations in desmosomal proteins. The current study tests the hypothesis that immunohistochemical staining for desmosomal proteins is of diagnostic utility by studying autopsy-confirmed cases of ARVC. Methods and Results: We studied 23 hearts from patients dying suddenly with ARVC. Control subject tissues were 21 hearts from people dying from non-cardiac causes (n=15), dilated cardiomyopathy (n=3) and coronary artery disease (n=3). Areas free of fibrofatty change or scarring were assessed on 50 sections from ARVC (24 left ventricle, 26 right ventricle) and 28 sections from controls. Immunohistochemical stains against plakoglobin, plakophilin, desmoplakin, connexin-43, and N-cadherin were applied and area expression analyzed by computerized morphometry. Desmin was stained as a control for fixation and similarly analyzed. The mean area of desmin expression was similar in controls and ARVC (86% vs. 85%, p=0.6). Plakoglobin expression was 4.9% ± 0.3% in controls, vs. 4.6% ± 0.3% in ARVC (p=0.3). Plakophilin staining was 4.8% ± 0.3% in controls vs. 4.4% ± 03% in ARVC (p=0.3). Desmoplakin staining was 3.4% in controls vs. 3.2 ± 0.2% in ARVC (p=0.6). There were no significant differences when staining was compared between right and left ventricles (all p > 0.1). For non-desmosomal proteins, the mean area of connexin-43 staining showed no significant difference by presence of disease. Conclusions: The small and insignificant decrease in junction protein expression in ARVC suggests that immunohistochemistry is not a useful tool for the diagnosis.
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Affiliation(s)
- Fabio Tavora
- Escola Paulista de Medicina/UNIFESP, Sao Paulo, Brazil
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195
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Rasmussen TB, Palmfeldt J, Nissen PH, Magnoni R, Dalager S, Jensen UB, Kim WY, Heickendorff L, Mølgaard H, Jensen HK, Baandrup UT, Bross P, Mogensen J. Mutated desmoglein-2 proteins are incorporated into desmosomes and exhibit dominant-negative effects in arrhythmogenic right ventricular cardiomyopathy. Hum Mutat 2013; 34:697-705. [PMID: 23381804 DOI: 10.1002/humu.22289] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 01/28/2013] [Indexed: 01/29/2023]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a hereditary cardiac condition associated with ventricular arrhythmias, heart failure, and sudden death. The most frequent ARVC genes encode desmosomal proteins of which mutations in desmoglein-2 (DSG2), account for 10%-20% of cases. This study aimed to investigate how DSG2 mutations contribute to the pathogenesis of ARVC. Initial mutation analysis of DSG2 in 71 probands identified the first family reported with recessively inherited ARVC due to a missense mutation. In addition, three recognized DSG2 mutations were identified in 12 families. These results and further mutation analyses of four additional desmosomal genes indicated that ARVC caused by DSG2 mutations is often transmitted by recessive or digenic inheritance. Because desmosomal proteins are also expressed in skin tissue, keratinocytes served as a cell model to investigate DSG2 protein expression by Western blotting, 2D-PAGE, and liquid chromatography-mass spectrometry. The results showed that heterozygous mutation carriers expressed both mutated and wild-type DSG2 proteins. These findings were consistent with the results obtained by immunohistochemistry of endomyocardial biopsies and epidermal tissue of mutation carriers, which indicated a normal cellular distribution of DSG2. The results suggested a dominant-negative effect of the mutated DSG2 proteins because they were incorporated into the desmosomes.
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196
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Noorman M, Hakim S, Kessler E, Groeneweg J, Cox MGPJ, Asimaki A, van Rijen HVM, van Stuijvenberg L, Chkourko H, van der Heyden MAG, Vos MA, de Jonge N, van der Smagt JJ, Dooijes D, Vink A, de Weger RA, Varro A, de Bakker JMT, Saffitz JE, Hund TJ, Mohler PJ, Delmar M, Hauer RNW, van Veen TAB. Remodeling of the cardiac sodium channel, connexin43, and plakoglobin at the intercalated disk in patients with arrhythmogenic cardiomyopathy. Heart Rhythm 2013; 10:412-9. [PMID: 23178689 PMCID: PMC3608196 DOI: 10.1016/j.hrthm.2012.11.018] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Arrhythmogenic cardiomyopathy (AC) is closely associated with desmosomal mutations in a majority of patients. Arrhythmogenesis in patients with AC is likely related to remodeling of cardiac gap junctions and increased levels of fibrosis. Recently, using experimental models, we also identified sodium channel dysfunction secondary to desmosomal dysfunction. OBJECTIVE To assess the immunoreactive signal levels of the sodium channel protein NaV1.5, as well as connexin43 (Cx43) and plakoglobin (PKG), in myocardial specimens obtained from patients with AC. METHODS Left and right ventricular free wall postmortem material was obtained from 5 patients with AC and 5 controls matched for age and sex. Right ventricular septal biopsies were taken from another 15 patients with AC. All patients fulfilled the 2010 revised Task Force Criteria for the diagnosis of AC. Immunohistochemical analyses were performed using antibodies against Cx43, PKG, NaV1.5, plakophilin-2, and N-cadherin. RESULTS N-cadherin and desmoplakin immunoreactive signals and distribution were normal in patients with AC compared to controls. Plakophilin-2 signals were unaffected unless a plakophilin-2 mutation predicting haploinsufficiency was present. Distribution was unchanged compared to that in controls. Immunoreactive signal levels of PKG, Cx43, and NaV1.5 were disturbed in 74%, 70%, and 65% of the patients, respectively. CONCLUSIONS A reduced immunoreactive signal of PKG, Cx43, and NaV1.5 at the intercalated disks can be observed in a large majority of the patients. Decreased levels of Nav1.5 might contribute to arrhythmia vulnerability and, in the future, potentially could serve as a new clinically relevant tool for risk assessment strategies.
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Affiliation(s)
- Maartje Noorman
- Department of Medical Physiology, University Medical Center Utrecht, The Netherlands
- Interuniversity Cardiology Institute of the Netherlands
| | - Sara Hakim
- Department of Medical Physiology, University Medical Center Utrecht, The Netherlands
| | - Elise Kessler
- Department of Medical Physiology, University Medical Center Utrecht, The Netherlands
| | - Judith Groeneweg
- Department of Cardiology, University Medical Center Utrecht, The Netherlands
- Interuniversity Cardiology Institute of the Netherlands
| | - Moniek GPJ Cox
- Department of Cardiology, University Medical Center Utrecht, The Netherlands
- Interuniversity Cardiology Institute of the Netherlands
| | - Angeliki Asimaki
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
| | - Harold VM van Rijen
- Department of Medical Physiology, University Medical Center Utrecht, The Netherlands
| | | | - Halina Chkourko
- The Leon H Charney Division of Cardiology, New York University School of Medicine, New York, NY, USA
| | | | - Marc A Vos
- Department of Medical Physiology, University Medical Center Utrecht, The Netherlands
| | - Nicolaas de Jonge
- Department of Cardiology, University Medical Center Utrecht, The Netherlands
| | | | - Dennis Dooijes
- Department of Genetics, University Medical Center Utrecht, The Netherlands
| | - Aryan Vink
- Department of Pathology, University Medical Center Utrecht, The Netherlands
| | - Roel A de Weger
- Department of Pathology, University Medical Center Utrecht, The Netherlands
| | - Andras Varro
- Department of Pharmacology & Pharmacotherapy, Faculty of Medicine, University of Szeged, Hungary
| | | | - Jeffrey E Saffitz
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
| | - Thomas J Hund
- The Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University College of Engineering, Department of Biomedical Engineering, The Ohio State University, Columbus, OH 43210
| | - Peter J Mohler
- The Dorothy M. Davis Heart and Lung Research Institute, Department of Internal Medicine, Division of Cardiovascular Medicine; Department of Physiology & Cell Biology, The Ohio State University Medical Center, Columbus, OH 43210
| | - Mario Delmar
- The Leon H Charney Division of Cardiology, New York University School of Medicine, New York, NY, USA
| | - Richard NW Hauer
- Department of Cardiology, University Medical Center Utrecht, The Netherlands
- Interuniversity Cardiology Institute of the Netherlands
| | - Toon AB van Veen
- Department of Medical Physiology, University Medical Center Utrecht, The Netherlands
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197
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Noorman M, Groeneweg JA, Asimaki A, Rizzo S, Papegaaij M, van Stuijvenberg L, de Jonge N, Dooijes D, Basso C, Saffitz JE, van Veen TA, Vink A, Hauer RN. End stage of arrhythmogenic cardiomyopathy with severe involvement of the interventricular septum. Heart Rhythm 2013; 10:283-9. [DOI: 10.1016/j.hrthm.2012.10.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Indexed: 10/27/2022]
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198
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Affiliation(s)
- Calum A MacRae
- Harvard Medical School, Brigham and Women's Hospital, Cardiovascular Division,
75 Francis Street, Boston, MA 02115, P-857 307 0301, F-857 307 0300, USA
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199
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Cadherin defects in inherited human diseases. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2013; 116:361-84. [PMID: 23481203 DOI: 10.1016/b978-0-12-394311-8.00016-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The tight control of cell-cell connectivity mediated by cadherins is a key issue in human health and disease. The human genome contains over 115 genes encoding cadherins and cadherin-like proteins. Defects in about 21 of these proteins (8 classical, 5 desmosomal, 8 atypical cadherins) have been linked to inherited disorders in humans, including skin and hair disorders, cardiomyopathies, sensory defects associated with deafness and blindness, and psychiatric disorders. With the advent of exome and genome sequencing techniques, we can anticipate the discovery of yet more evidence for the involvement of additional cadherins. Elucidation of the related physiopathological mechanisms underlying these conditions should help to clarify the roles played by these cadherins in tissues and the ways in which defects in different cadherins cause such a wide spectrum of associated phenotypes. These disorders also constitute disparate model systems for investigations of the relative contributions of mechanical adhesive strength and intracellular signaling pathways to the pathogenic process for a given cadherin.
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