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Totten V, Teixido-Tura G, Lopez-Grondona F, Fernandez-Alvarez P, Lasa-Aranzasti A, Muñoz-Cabello P, Kosaki R, Tizzano EF, Dewals W, Borràs E, Cañas EG, Almoguera B, Loeys B, Valenzuena I. Arterial aneurysm and dissection: toward the evolving phenotype of Tatton-Brown-Rahman syndrome. J Med Genet 2024:jmg-2024-109861. [PMID: 38960581 DOI: 10.1136/jmg-2024-109861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 06/17/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Tatton-Brown-Rahman syndrome (TBRS) is a rare disorder, caused by DNMT3A heterozygous pathogenic variants, and first described in 2014. TBRS is characterised by overgrowth, intellectual disability, facial dysmorphism, hypotonia and musculoskeletal features, as well as neurological and psychiatric features. Cardiac manifestations have also been reported, mainly congenital malformations such as atrial septal defect, ventricular septal defect and cardiac valvular disease. Aortic dilatation has rarely been described. METHODS Here we have undertaken a detailed clinical and molecular description of eight previously unreported individuals, who had TBRS and arterial dilatation and/or dissection, mainly thoracic aortic aneurysm (TAA). We have also reviewed the seven previously published cases of TAA in individuals with TBRS to try to better delineate the vascular phenotype and to determine specific follow-up for this condition. RESULTS We include eight new patients with TBRS who presented with arterial aneurysms mainly involving aorta. Three of these patients presented with dissection that required critical surgery. CONCLUSIONS Arterial aneurysms and dissections are a potentially lethal, age-dependent manifestation. The prevalence of aortic disease in individuals with TBRS is far in excess of that expected in the general population. This cohort, together with individuals previously published, illustrates the importance to consider dilatation/dissection, mainly in aorta but also in other arteries. Arterial vascular weakness may therefore also be a cardinal feature of TBRS and vascular surveillance is recommended.
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Affiliation(s)
- Vicken Totten
- Kaweah Health System, Visalia, California, USA
- Kayenta Health Center of the Indian Health Service, Kayenta, Arizona, USA
| | - Gisela Teixido-Tura
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Genetics and Genomics, Hospital Universitario Fundacion Jimenez Diaz (IIS-FJD), Madrid, Spain
| | - Fermina Lopez-Grondona
- European Reference Network for Rare Multisystemic Vascular Disease (VASCERN), HTAD Rare Disease Working Group, Barcelona, Spain
| | - Paula Fernandez-Alvarez
- Department of Clinical and Molecular Genetics, Vall d'Hebron University Hospital. Medicine Genetics Group, Vall d'Hebron Research Institute, Barcelona, Spain
- European Reference Network on Rare Congenital Malformations and Rare Intellectual Disability (ERN-ITHACA), Barcelona, Spain
| | - Amaia Lasa-Aranzasti
- Department of Clinical and Molecular Genetics, Vall d'Hebron University Hospital. Medicine Genetics Group, Vall d'Hebron Research Institute, Barcelona, Spain
- European Reference Network on Rare Congenital Malformations and Rare Intellectual Disability (ERN-ITHACA), Barcelona, Spain
| | - Patricia Muñoz-Cabello
- Department of Clinical and Molecular Genetics, Vall d'Hebron University Hospital. Medicine Genetics Group, Vall d'Hebron Research Institute, Barcelona, Spain
- European Reference Network on Rare Congenital Malformations and Rare Intellectual Disability (ERN-ITHACA), Barcelona, Spain
| | - Rika Kosaki
- Division of Medical Genetics, National Center for Child Health and Development, Tokyo, Japan
| | - Eduardo F Tizzano
- Department of Clinical and Molecular Genetics, Vall d'Hebron University Hospital. Medicine Genetics Group, Vall d'Hebron Research Institute, Barcelona, Spain
- European Reference Network on Rare Congenital Malformations and Rare Intellectual Disability (ERN-ITHACA), Barcelona, Spain
| | - Wendy Dewals
- Pediatric Cardiology Department, Antwerp University Hospital, Edegem, Belgium
| | - Emma Borràs
- Molecular Genetics Unit, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Elena Gonzalez Cañas
- Angiology and Vascular Surgery, Hospital Universitari Parc Tauli, Sabadell, Spain
| | - Berta Almoguera
- European Reference Network for Rare Multisystemic Vascular Disease (VASCERN), HTAD Rare Disease Working Group, Barcelona, Spain
- Centro de Investigacion Biomedica en Red de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain
| | - Bart Loeys
- Center for Medical Genetics, Antwerp University Hospital/University of Antwerp, Antwerp, Belgium
| | - Irene Valenzuena
- Department of Clinical and Molecular Genetics, Vall d'Hebron University Hospital. Medicine Genetics Group, Vall d'Hebron Research Institute, Barcelona, Spain
- European Reference Network on Rare Congenital Malformations and Rare Intellectual Disability (ERN-ITHACA), Barcelona, Spain
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Thomas H, Alix T, Renard É, Renaud M, Wourms J, Zuily S, Leheup B, Geneviève D, Dreumont N, Schmitt E, Bronner M, Muller M, Divoux M, Wandzel M, Ravel JM, Dexheimer M, Becker A, Roth V, Willems M, Coubes C, Vieville G, Devillard F, Schaefer É, Baer S, Piton A, Gérard B, Vincent M, Nizon M, Cogné B, Ruaud L, Couque N, Putoux A, Edery P, Lesca G, Chatron N, Till M, Faivre L, Tran-Mau-Them F, Alessandri JL, Lebrun M, Quélin C, Odent S, Dubourg C, David V, Faoucher M, Mignot C, Keren B, Pisan É, Afenjar A, Julia S, Bieth É, Banneau G, Goldenberg A, Husson T, Campion D, Lecoquierre F, Nicolas G, Charbonnier C, De Saint Martin A, Naudion S, Degoutin M, Rondeau S, Michot C, Cormier-Daire V, Oussalah A, Pourié C, Lambert L, Bonnet C. Expanding the genetic and clinical spectrum of Tatton-Brown-Rahman syndrome in a series of 24 French patients. J Med Genet 2024:jmg-2024-110031. [PMID: 38937076 DOI: 10.1136/jmg-2024-110031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 06/18/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Tatton-Brown-Rahman syndrome (TBRS; OMIM 615879), also known as DNA methyltransferase 3 alpha (DNMT3A)-overgrowth syndrome (DOS), was first described by Tatton-Brown in 2014. This syndrome is characterised by overgrowth, intellectual disability and distinctive facial features and is the consequence of germline loss-of-function variants in DNMT3A, which encodes a DNA methyltransferase involved in epigenetic regulation. Somatic variants of DNMT3A are frequently observed in haematological malignancies, including acute myeloid leukaemia (AML). To date, 100 individuals with TBRS with de novo germline variants have been described. We aimed to further characterise this disorder clinically and at the molecular level in a nationwide series of 24 French patients and to investigate the correlation between the severity of intellectual disability and the type of variant. METHODS We collected genetic and medical information from 24 individuals with TBRS using a questionnaire released through the French National AnDDI-Rares Network. RESULTS Here, we describe the first nationwide French cohort of 24 individuals with germline likely pathogenic/pathogenic variants in DNMT3A, including 17 novel variants. We confirmed that the main phenotypic features were intellectual disability (100% of individuals), distinctive facial features (96%) and overgrowth (87%). We highlighted novel clinical features, such as hypertrichosis, and further described the neurological features and EEG results. CONCLUSION This study of a nationwide cohort of individuals with TBRS confirms previously published data and provides additional information and clarifies clinical features to facilitate diagnosis and improve care. This study adds value to the growing body of knowledge on TBRS and broadens its clinical and molecular spectrum.
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Affiliation(s)
- Hortense Thomas
- Laboratoire de Génétique, CHRU de Nancy, Vandœuvre-lès-Nancy, France
- Service de Génétique Clinique, CHRU de Nancy, Nancy, France
| | - Tom Alix
- Laboratoire de Génétique, CHRU de Nancy, Vandœuvre-lès-Nancy, France
- INSERM NGERE U1256, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Émeline Renard
- INSERM NGERE U1256, Université de Lorraine, Vandœuvre-lès-Nancy, France
- Endocrinologie pédiatrique, CHRU de Nancy, Vandœuvre-lès-Nancy, France
| | - Mathilde Renaud
- Service de Génétique Clinique, CHRU de Nancy, Nancy, France
- INSERM NGERE U1256, Université de Lorraine, Vandœuvre-lès-Nancy, France
- Service de Neurologie, CHRU de Nancy, Nancy, France
| | - Justine Wourms
- Service de Génétique Clinique, CHRU de Nancy, Nancy, France
| | - Stéphane Zuily
- Médecine Vasculaire, CHRU de Nancy, Vandœuvre-lès-Nancy, France
- UMR_S 916 DCAC, INSERM, Vandœuvre-lès-Nancy, France
| | - Bruno Leheup
- INSERM NGERE U1256, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - David Geneviève
- Centre de référence anomalies du développement et syndromes malformatifs, Département de Génétique Medicale, Maladies Rares et Médecine Personnalisée, Hôpital Arnaud de Villeneuve, CHU de Montpellier, Montpellier, France
- Inserm U1183, Université Montpellier 1, Faculté de Médecine Montpellier-Nîmes, Montpellier, France
| | - Natacha Dreumont
- INSERM NGERE U1256, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | | | - Myriam Bronner
- Laboratoire de Génétique, CHRU de Nancy, Vandœuvre-lès-Nancy, France
| | - Marc Muller
- Laboratoire de Génétique, CHRU de Nancy, Vandœuvre-lès-Nancy, France
| | - Marion Divoux
- Laboratoire de Génétique, CHRU de Nancy, Vandœuvre-lès-Nancy, France
- INSERM NGERE U1256, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Marion Wandzel
- Laboratoire de Génétique, CHRU de Nancy, Vandœuvre-lès-Nancy, France
| | - Jean-Marie Ravel
- Laboratoire de Génétique, CHRU de Nancy, Vandœuvre-lès-Nancy, France
- INSERM NGERE U1256, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Mylène Dexheimer
- Laboratoire de Génétique, CHRU de Nancy, Vandœuvre-lès-Nancy, France
| | - Aurélie Becker
- Laboratoire de Génétique, CHRU de Nancy, Vandœuvre-lès-Nancy, France
| | - Virginie Roth
- Laboratoire de Génétique, CHRU de Nancy, Vandœuvre-lès-Nancy, France
| | - Marjolaine Willems
- Centre de référence anomalies du développement et syndromes malformatifs, Département de Génétique Medicale, Maladies Rares et Médecine Personnalisée, Hôpital Arnaud de Villeneuve, CHU de Montpellier, Montpellier, France
| | - Christine Coubes
- Centre de référence anomalies du développement et syndromes malformatifs, Département de Génétique Medicale, Maladies Rares et Médecine Personnalisée, Hôpital Arnaud de Villeneuve, CHU de Montpellier, Montpellier, France
| | - Gaëlle Vieville
- Département de Génétique et Procréation, Hôpital Couple Enfant, CHU Grenoble Alpes, Grenoble, France
| | - Françoise Devillard
- Département de Génétique et Procréation, Hôpital Couple Enfant, CHU Grenoble Alpes, Grenoble, France
| | - Élise Schaefer
- Service de Génétique médicale, Institut de Génétique Médicale d'Alsace, CHU de Strasbourg, Strasbourg, France
| | - Sarah Baer
- Service de Génétique médicale, Institut de Génétique Médicale d'Alsace, CHU de Strasbourg, Strasbourg, France
| | - Amélie Piton
- Service de Génétique médicale, Institut de Génétique Médicale d'Alsace, CHU de Strasbourg, Strasbourg, France
| | - Bénédicte Gérard
- Service de Génétique médicale, Institut de Génétique Médicale d'Alsace, CHU de Strasbourg, Strasbourg, France
| | - Marie Vincent
- Service de Génétique Médicale, Centre Hospitalier Universitaire de Nantes, Nantes, France
- CNRS, INSERM, Institut du thorax, Nantes Université, Nantes, France
| | - Mathilde Nizon
- Service de Génétique Médicale, Centre Hospitalier Universitaire de Nantes, Nantes, France
- CNRS, INSERM, Institut du thorax, Nantes Université, Nantes, France
| | - Benjamin Cogné
- Service de Génétique Médicale, Centre Hospitalier Universitaire de Nantes, Nantes, France
- CNRS, INSERM, Institut du thorax, Nantes Université, Nantes, France
| | - Lyse Ruaud
- Département de Génétique, Hôpital Robert Debré, APHP Nord, Paris, France
| | - Nathalie Couque
- Département de Génétique, Hôpital Robert Debré, APHP Nord, Paris, France
| | - Audrey Putoux
- Service de Génétique, Hospices Civils de Lyon, Groupe Hospitalier Est, Bron, France
- CNRS UMR5310, INSERM U1217, Institut NeuroMyoGene PNMG, Université Claude Bernard Lyon 1, Lyon, France
| | - Patrick Edery
- Service de Génétique, Hospices Civils de Lyon, Groupe Hospitalier Est, Bron, France
- CNRS UMR5310, INSERM U1217, Institut NeuroMyoGene PNMG, Université Claude Bernard Lyon 1, Lyon, France
| | - Gaëtan Lesca
- Service de Génétique, Hospices Civils de Lyon, Groupe Hospitalier Est, Bron, France
- CNRS UMR5310, INSERM U1217, Institut NeuroMyoGene PNMG, Université Claude Bernard Lyon 1, Lyon, France
| | - Nicolas Chatron
- Service de Génétique, Hospices Civils de Lyon, Groupe Hospitalier Est, Bron, France
- CNRS UMR5310, INSERM U1217, Institut NeuroMyoGene PNMG, Université Claude Bernard Lyon 1, Lyon, France
| | - Marianne Till
- Service de Génétique, Hospices Civils de Lyon, Groupe Hospitalier Est, Bron, France
- CNRS UMR5310, INSERM U1217, Institut NeuroMyoGene PNMG, Université Claude Bernard Lyon 1, Lyon, France
| | - Laurence Faivre
- Centre de référence anomalies du développement et syndromes malformatifs et Centre de référence Déficiences Intellectuelles de causes rares, FHU TRANSLAD, CHU Dijon Bourgogne, Dijon, France
- UMR1231 GAD, Inserm, Université Bourgogne Franche-Comté, Dijon, France
| | - Frédéric Tran-Mau-Them
- UMR1231 GAD, Inserm, Université Bourgogne Franche-Comté, Dijon, France
- Unité Fonctionnelle Innovation en Diagnostic génomique des maladies rares, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France
| | - Jean-Luc Alessandri
- Service de génétique médicale, CHU de La Réunion, Hôpital Félix Guyon, Bellepierre, Saint-Denis, Réunion
| | - Marine Lebrun
- Département de Génétique, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | - Chloé Quélin
- Département de génétique moléculaire et génomique, CHU Rennes, Rennes, France
| | - Sylvie Odent
- Département de génétique moléculaire et génomique, CHU Rennes, Rennes, France
| | - Christèle Dubourg
- Département de génétique moléculaire et génomique, CHU Rennes, Rennes, France
| | - Véronique David
- Département de génétique moléculaire et génomique, CHU Rennes, Rennes, France
| | - Marie Faoucher
- Département de génétique moléculaire et génomique, CHU Rennes, Rennes, France
| | - Cyril Mignot
- Département de Génétique, Groupe Hospitalier Pitié-Salpêtrière, APHP Sorbonne Université, Paris, France
| | - Boris Keren
- Département de Génétique, Groupe Hospitalier Pitié-Salpêtrière, APHP Sorbonne Université, Paris, France
| | - Élise Pisan
- Département de Génétique, Groupe Hospitalier Pitié-Salpêtrière, APHP Sorbonne Université, Paris, France
| | - Alexandra Afenjar
- Département de Génétique, Groupe Hospitalier Pitié-Salpêtrière, APHP Sorbonne Université, Paris, France
| | - Sophie Julia
- Département de Génétique médicale, CHU Toulouse, Toulouse, France
| | - Éric Bieth
- Département de Génétique médicale, CHU Toulouse, Toulouse, France
| | | | - Alice Goldenberg
- Department of Genetics and Reference Center for Developmental Disorders, CHU de Rouen, Rouen, France
- Inserm U1245, Université de Rouen Normandie, Rouen, France
| | - Thomas Husson
- Inserm U1245, Université de Rouen Normandie, Rouen, France
- Department of Psychiatry, CHU de Rouen, Rouen, France
- Department of Research, Centre hospitalier du Rouvray, Sotteville-Lès-Rouen, France
| | - Dominique Campion
- Inserm U1245, Université de Rouen Normandie, Rouen, France
- Department of Psychiatry, CHU de Rouen, Rouen, France
- Department of Research, Centre hospitalier du Rouvray, Sotteville-Lès-Rouen, France
| | - François Lecoquierre
- Department of Genetics and Reference Center for Developmental Disorders, CHU de Rouen, Rouen, France
- Inserm U1245, Université de Rouen Normandie, Rouen, France
| | - Gaël Nicolas
- Department of Genetics and Reference Center for Developmental Disorders, CHU de Rouen, Rouen, France
- Inserm U1245, Université de Rouen Normandie, Rouen, France
| | - Camille Charbonnier
- Inserm U1245, Université de Rouen Normandie, Rouen, France
- Department of Biotatistics, CHU de Rouen, Rouen, France
| | - Anne De Saint Martin
- Centre de Référence des épilepsies Rares, Hopitaux universitaires de Strasbourg, Strasbourg, France
| | - Sophie Naudion
- Service de Génétique Médicale, Centre Hospitalier Universitaire de Bordeaux, Groupe hospitalier Pellegrin, Bordeaux, France
| | - Manon Degoutin
- Service de Génétique Médicale, Centre Hospitalier Universitaire de Bordeaux, Groupe hospitalier Pellegrin, Bordeaux, France
| | - Sophie Rondeau
- Centre de référence des maladies osseuses constitutionnelles, Necker-Enfants Malades Hospitals, Paris, France
- INSERM UMR 1163, Imagine Institute, Paris, France
| | - Caroline Michot
- Centre de référence des maladies osseuses constitutionnelles, Necker-Enfants Malades Hospitals, Paris, France
- INSERM UMR 1163, Imagine Institute, Paris, France
| | - Valérie Cormier-Daire
- Centre de référence des maladies osseuses constitutionnelles, Necker-Enfants Malades Hospitals, Paris, France
- INSERM UMR 1163, Imagine Institute, Paris, France
| | - Abderrahim Oussalah
- INSERM NGERE U1256, Université de Lorraine, Vandœuvre-lès-Nancy, France
- Department of Molecular Medicine, Division of Biochemistry, Molecular Biology, and Nutrition, CHRU de Nancy, Nancy, France
| | - Carine Pourié
- INSERM NGERE U1256, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Laëtitia Lambert
- Service de Génétique Clinique, CHRU de Nancy, Nancy, France
- INSERM NGERE U1256, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Céline Bonnet
- Laboratoire de Génétique, CHRU de Nancy, Vandœuvre-lès-Nancy, France
- INSERM NGERE U1256, Université de Lorraine, Vandœuvre-lès-Nancy, France
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Zebrauskiene D, Sadauskiene E, Dapkunas J, Kairys V, Balciunas J, Konovalovas A, Masiuliene R, Petraityte G, Valeviciene N, Mataciunas M, Barysiene J, Mikstiene V, Tomkuviene M, Preiksaitiene E. Aortic disease and cardiomyopathy in patients with a novel DNMT3A gene variant causing Tatton-Brown-Rahman syndrome. Clin Epigenetics 2024; 16:76. [PMID: 38845031 PMCID: PMC11157947 DOI: 10.1186/s13148-024-01686-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 05/27/2024] [Indexed: 06/09/2024] Open
Abstract
Tatton-Brown-Rahman syndrome (TBRS) is a rare congenital genetic disorder caused by autosomal dominant pathogenic variants in the DNA methyltransferase DNMT3A gene. Typical TBRS clinical features are overgrowth, intellectual disability, and minor facial anomalies. However, since the syndrome was first described in 2014, a widening spectrum of abnormalities is being described. Cardiovascular abnormalities are less commonly reported but can be a major complication of the syndrome. This article describes a family of three individuals diagnosed with TBRS in adulthood and highlights the variable expression of cardiovascular features. A 34-year-old proband presented with progressive aortic dilatation, mitral valve (MV) regurgitation, left ventricular (LV) dilatation, and ventricular arrhythmias. The affected family members (mother and brother) were diagnosed with MV regurgitation, LV dilatation, and arrhythmias. Exome sequencing and computational protein analysis suggested that the novel familial DNMT3A mutation Ser775Tyr is located in the methyltransferase domain, however, distant from the active site or DNA-binding loops. Nevertheless, this bulky substitution may have a significant effect on DNMT3A protein structure, dynamics, and function. Analysis of peripheral blood cfDNA and transcriptome showed shortened mononucleosome fragments and altered gene expression in a number of genes related to cardiovascular health and of yet undescribed function, including several lncRNAs. This highlights the importance of epigenetic regulation by DNMT3A on cardiovascular system development and function. From the clinical perspective, we suggest that new patients diagnosed with congenital DNMT3A variants and TBRS require close examination and follow-up for aortic dilatation and valvular disease because these conditions can progress rapidly. Moreover, personalized treatments, based on the specific DNMT3A variants and the different pathways of their function loss, can be envisioned in the future.
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Affiliation(s)
- Dovile Zebrauskiene
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Santariskiu 2, 08661, Vilnius, Lithuania.
| | - Egle Sadauskiene
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Justas Dapkunas
- Department of Bioinformatics, Institute of Biotechnology, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Visvaldas Kairys
- Department of Bioinformatics, Institute of Biotechnology, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Joris Balciunas
- Department of Biological DNA Modification, Institute of Biotechnology, Life Sciences Center, Vilnius University, Sauletekio 7, 10257, Vilnius, Lithuania
| | | | | | - Gunda Petraityte
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Santariskiu 2, 08661, Vilnius, Lithuania
| | - Nomeda Valeviciene
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Vilnius University Faculty of Medicine, Vilnius, Lithuania
| | - Mindaugas Mataciunas
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Vilnius University Faculty of Medicine, Vilnius, Lithuania
| | - Jurate Barysiene
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Violeta Mikstiene
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Santariskiu 2, 08661, Vilnius, Lithuania
| | - Migle Tomkuviene
- Department of Biological DNA Modification, Institute of Biotechnology, Life Sciences Center, Vilnius University, Sauletekio 7, 10257, Vilnius, Lithuania.
| | - Egle Preiksaitiene
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Santariskiu 2, 08661, Vilnius, Lithuania
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7
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Ittiwut C, Mahasirimongkol S, Srisont S, Ittiwut R, Chockjamsai M, Durongkadech P, Sawaengdee W, Khunphon A, Larpadisorn K, Wattanapokayakit S, Wetchaphanphesat S, Arunotong S, Srimahachota S, Pittayawonganon C, Thammawijaya P, Sutdan D, Doungngern P, Khongphatthanayothin A, Kerr SJ, Shotelersuk V. Genetic basis of sudden death after COVID-19 vaccination in Thailand. Heart Rhythm 2022; 19:1874-1879. [PMID: 35934244 PMCID: PMC9352648 DOI: 10.1016/j.hrthm.2022.07.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 vaccination reduces morbidity and mortality associated with coronavirus disease 2019 (COVID-19); unfortunately, it is associated with serious adverse events, including sudden unexplained death (SUD). OBJECTIVE We aimed to study the genetic basis of SUD after COVID-19 vaccination in Thailand. METHODS From April to December 2021, cases with natural but unexplained death within 7 days of COVID-19 vaccination were enrolled for whole exome sequencing. RESULTS Thirteen were recruited, aged between 23 and 72 years; 10 (77%) were men, 12 were Thai; and 1 was Australian. Eight (61%) died after receiving the first dose of vaccine, and 7 (54%) died after receiving ChAdOx1 nCoV-19; however, there were no significant correlations between SUD and either the number or the type of vaccine. Fever was self-reported in 3 cases. Ten (77%) and 11 (85%) died within 24 hours and 3 days of vaccination, respectively. Whole exome sequencing analysis revealed that 5 cases harbored SCN5A variants that had previously been identified in patients with Brugada syndrome, giving an SCN5A variant frequency of 38% (5 of 13). This is a significantly higher rate than that observed in Thai SUD cases occurring 8-30 days after COVID-19 vaccination during the same period (10% [1 of 10]), in a Thai SUD cohort studied before the COVID-19 pandemic (12% [3 of 25]), and in our in-house exome database (12% [386 of 3231]). CONCLUSION These findings suggest that SCN5A variants may be associated with SUD within 7 days of COVID-19 vaccination, regardless of vaccine type, number of vaccine dose, and presence of underlying diseases or postvaccine fever.
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Affiliation(s)
- Chupong Ittiwut
- Center of Excellence for Medical Genomics, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Excellence Center for Genomics and Precision Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Surakameth Mahasirimongkol
- Medical Life Sciences Institute, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | - Smith Srisont
- Forensic Division, Pathology Department, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Rungnapa Ittiwut
- Center of Excellence for Medical Genomics, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Excellence Center for Genomics and Precision Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Manoch Chockjamsai
- Forensic Department, Faculty of Medicine, Chiangmai University, Chiangmai, Thailand
| | | | - Waritta Sawaengdee
- Division of Genomic Medicine and Innovation Support, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | - Athiwat Khunphon
- Division of Genomic Medicine and Innovation Support, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | - Kanidsorn Larpadisorn
- Medical Life Sciences Institute, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | - Sukanya Wattanapokayakit
- Division of Genomic Medicine and Innovation Support, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | - Suppachok Wetchaphanphesat
- Strategy and Planning Division, Office of the Permanent Secretary, Ministry of Public Health, Nonthaburi, Thailand
| | - Surachet Arunotong
- Office of Disease Prevention and Control Region 1 Chiang Mai, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | | | - Chakrarat Pittayawonganon
- Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Panithee Thammawijaya
- Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Derek Sutdan
- Strategy and Planning Division, Office of the Permanent Secretary, Ministry of Public Health, Nonthaburi, Thailand
| | - Pawinee Doungngern
- Division of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Apichai Khongphatthanayothin
- Center of Excellence in Arrhythmia Research, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Stephen J Kerr
- Center of Excellence for Biostatistics, Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Vorasuk Shotelersuk
- Center of Excellence for Medical Genomics, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Excellence Center for Genomics and Precision Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.
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