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Chumakova OS, Baulina NM. Advanced searching for hypertrophic cardiomyopathy heritability in real practice tomorrow. Front Cardiovasc Med 2023; 10:1236539. [PMID: 37583586 PMCID: PMC10425241 DOI: 10.3389/fcvm.2023.1236539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/17/2023] [Indexed: 08/17/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disease associated with morbidity and mortality at any age. As studies in recent decades have shown, the genetic architecture of HCM is quite complex both in the entire population and in each patient. In the rapidly advancing era of gene therapy, we have to provide a detailed molecular diagnosis to our patients to give them the chance for better and more personalized treatment. In addition to emphasizing the importance of genetic testing in routine practice, this review aims to discuss the possibility to go a step further and create an expanded genetic panel that contains not only variants in core genes but also new candidate genes, including those located in deep intron regions, as well as structural variations. It also highlights the benefits of calculating polygenic risk scores based on a combination of rare and common genetic variants for each patient and of using non-genetic HCM markers, such as microRNAs that can enhance stratification of risk for HCM in unselected populations alongside rare genetic variants and clinical factors. While this review is focusing on HCM, the discussed issues are relevant to other cardiomyopathies.
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Affiliation(s)
- Olga S. Chumakova
- Laboratory of Functional Genomics of Cardiovascular Diseases, National Medical Research Centre of Cardiology Named After E.I. Chazov, Moscow, Russia
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2
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Hathaway J, Heliö K, Saarinen I, Tallila J, Seppälä EH, Tuupanen S, Turpeinen H, Kangas-Kontio T, Schleit J, Tommiska J, Kytölä V, Valori M, Muona M, Sistonen J, Gentile M, Salmenperä P, Myllykangas S, Paananen J, Alastalo TP, Heliö T, Koskenvuo J. Diagnostic yield of genetic testing in a heterogeneous cohort of 1376 HCM patients. BMC Cardiovasc Disord 2021; 21:126. [PMID: 33673806 PMCID: PMC7934228 DOI: 10.1186/s12872-021-01927-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 02/22/2021] [Indexed: 12/20/2022] Open
Abstract
Background Genetic testing in hypertrophic cardiomyopathy (HCM) is a published guideline-based recommendation. The diagnostic yield of genetic testing and corresponding HCM-associated genes have been largely documented by single center studies and carefully selected patient cohorts. Our goal was to evaluate the diagnostic yield of genetic testing in a heterogeneous cohort of patients with a clinical suspicion of HCM, referred for genetic testing from multiple centers around the world. Methods A retrospective review of patients with a suspected clinical diagnosis of HCM referred for genetic testing at Blueprint Genetics was undertaken. The analysis included syndromic, myopathic and metabolic etiologies. Genetic test results and variant classifications were extracted from the database. Variants classified as pathogenic (P) or likely pathogenic (LP) were considered diagnostic. Results A total of 1376 samples were analyzed. Three hundred and sixty-nine tests were diagnostic (26.8%); 373 P or LP variants were identified. Only one copy number variant was identified. The majority of diagnostic variants involved genes encoding the sarcomere (85.0%) followed by 4.3% of diagnostic variants identified in the RASopathy genes. Two percent of diagnostic variants were in genes associated with a cardiomyopathy other than HCM or an inherited arrhythmia. Clinical variables that increased the likelihood of identifying a diagnostic variant included: an earlier age at diagnosis (p < 0.0001), a higher maximum wall thickness (MWT) (p < 0.0001), a positive family history (p < 0.0001), the absence of hypertension (p = 0.0002), and the presence of an implantable cardioverter-defibrillator (ICD) (p = 0.0004). Conclusion The diagnostic yield of genetic testing in this heterogeneous cohort of patients with a clinical suspicion of HCM is lower than what has been reported in well-characterized patient cohorts. We report the highest yield of diagnostic variants in the RASopathy genes identified in a laboratory cohort of HCM patients to date. The spectrum of genes implicated in this unselected cohort highlights the importance of pre-and post-test counseling when offering genetic testing to the broad HCM population. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-01927-5.
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Affiliation(s)
- Julie Hathaway
- Blueprint Genetics, a Quest Diagnostics Company, 2505 3rd Ave, Suite 204, Seattle, 98121, USA.
| | - Krista Heliö
- Heart and Lung Center, Meilahti Tower Hospital, Helsinki University Hospital, Haartmaninkatu 4, P.O. Box 340, 00029, Helsinki, Finland
| | - Inka Saarinen
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
| | - Jonna Tallila
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
| | - Eija H Seppälä
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
| | - Sari Tuupanen
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
| | - Hannu Turpeinen
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
| | - Tiia Kangas-Kontio
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
| | - Jennifer Schleit
- Blueprint Genetics, a Quest Diagnostics Company, 2505 3rd Ave, Suite 204, Seattle, 98121, USA
| | - Johanna Tommiska
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
| | - Ville Kytölä
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
| | - Miko Valori
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
| | - Mikko Muona
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
| | - Johanna Sistonen
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
| | - Massimiliano Gentile
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
| | - Pertteli Salmenperä
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
| | - Samuel Myllykangas
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
| | - Jussi Paananen
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
| | - Tero-Pekka Alastalo
- Blueprint Genetics, a Quest Diagnostics Company, 2505 3rd Ave, Suite 204, Seattle, 98121, USA
| | - Tiina Heliö
- Heart and Lung Center, Meilahti Tower Hospital, Helsinki University Hospital, Haartmaninkatu 4, P.O. Box 340, 00029, Helsinki, Finland
| | - Juha Koskenvuo
- Blueprint Genetics, a Quest Diagnostics Company, Keilaranta 16 A-B, 02150, Espoo, Finland
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Cowan JR, Salyer L, Wright NT, Kinnamon DD, Amaya P, Jordan E, Bamshad MJ, Nickerson DA, Hershberger RE. SOS1 Gain-of-Function Variants in Dilated Cardiomyopathy. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2020; 13:e002892. [PMID: 32603605 DOI: 10.1161/circgen.119.002892] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Dilated cardiomyopathy (DCM) is a genetically heterogeneous cardiac disease characterized by progressive ventricular enlargement and reduced systolic function. Here, we report genetic and functional analyses implicating the rat sarcoma signaling protein, SOS1 (Son of sevenless homolog 1), in DCM pathogenesis. METHODS Exome sequencing was performed on 412 probands and family members from our DCM cohort, identifying several SOS1 variants with potential disease involvement. As several lines of evidence have implicated dysregulated rat sarcoma signaling in the pathogenesis of DCM, we assessed functional impact of each variant on the activation of ERK (extracellular signal-regulated kinase), AKT (protein kinase B), and JNK (c-Jun N-terminal kinase) pathways. Relative expression levels were determined by Western blot in HEK293T cells transfected with variant or wild-type human SOS1 expression constructs. RESULTS A rare SOS1 variant [c.571G>A, p.(Glu191Lys)] was found to segregate alongside an A-band TTN truncating variant in a pedigree with aggressive, early-onset DCM. Reduced disease severity in the absence of the SOS1 variant suggested its potential involvement as a genetic risk factor for DCM in this family. Exome sequencing identified 5 additional SOS1 variants with potential disease involvement in 4 other families [c.1820T>C, p.(Ile607Thr); c.2156G>C, p.(Gly719Ala); c.2230A>G, p.(Arg744Gly); c.2728G>C, p.(Asp910His); c.3601C>T, p.(Arg1201Trp)]. Impacted amino acids occupied a number of functional domains relevant to SOS1 activity, including the N-terminal histone fold, as well as the C-terminal REM (rat sarcoma exchange motif), CDC25 (cell division cycle 25), and PR (proline-rich) tail domains. Increased phosphorylated ERK expression relative to wild-type levels was seen for all 6 SOS1 variants, paralleling known disease-relevant SOS1 signaling profiles. CONCLUSIONS These data support gain-of-function variation in SOS1 as a contributing factor to isolated DCM.
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Affiliation(s)
- Jason R Cowan
- Dorothy M. Davis Heart and Lung Research Institute (J.R.C., L.S., D.D.K., P.A., E.J., R.E.H.), Department of Internal Medicine, The Ohio State University College of Medicine, Columbus.,Division of Human Genetics (J.R.C., L.S., D.D.K., P.A., E.J., R.E.H.), Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
| | - Lorien Salyer
- Dorothy M. Davis Heart and Lung Research Institute (J.R.C., L.S., D.D.K., P.A., E.J., R.E.H.), Department of Internal Medicine, The Ohio State University College of Medicine, Columbus.,Division of Human Genetics (J.R.C., L.S., D.D.K., P.A., E.J., R.E.H.), Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
| | - Nathan T Wright
- Department of Chemistry and Biochemistry, James Madison University, Harrisonburg, VA (N.T.W.)
| | - Daniel D Kinnamon
- Dorothy M. Davis Heart and Lung Research Institute (J.R.C., L.S., D.D.K., P.A., E.J., R.E.H.), Department of Internal Medicine, The Ohio State University College of Medicine, Columbus.,Division of Human Genetics (J.R.C., L.S., D.D.K., P.A., E.J., R.E.H.), Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
| | - Pedro Amaya
- Dorothy M. Davis Heart and Lung Research Institute (J.R.C., L.S., D.D.K., P.A., E.J., R.E.H.), Department of Internal Medicine, The Ohio State University College of Medicine, Columbus.,Division of Human Genetics (J.R.C., L.S., D.D.K., P.A., E.J., R.E.H.), Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
| | - Elizabeth Jordan
- Dorothy M. Davis Heart and Lung Research Institute (J.R.C., L.S., D.D.K., P.A., E.J., R.E.H.), Department of Internal Medicine, The Ohio State University College of Medicine, Columbus.,Division of Human Genetics (J.R.C., L.S., D.D.K., P.A., E.J., R.E.H.), Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
| | - Michael J Bamshad
- Department of Pediatrics (M.J.B.), University of Washington, Seattle
| | | | - Ray E Hershberger
- Dorothy M. Davis Heart and Lung Research Institute (J.R.C., L.S., D.D.K., P.A., E.J., R.E.H.), Department of Internal Medicine, The Ohio State University College of Medicine, Columbus.,Division of Human Genetics (J.R.C., L.S., D.D.K., P.A., E.J., R.E.H.), Department of Internal Medicine, The Ohio State University College of Medicine, Columbus.,Division of Cardiovascular Medicine (R.E.H.), Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
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4
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Sudden Cardiac Death and Copy Number Variants: What Do We Know after 10 Years of Genetic Analysis? Forensic Sci Int Genet 2020; 47:102281. [PMID: 32248082 DOI: 10.1016/j.fsigen.2020.102281] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 03/02/2020] [Accepted: 03/18/2020] [Indexed: 02/07/2023]
Abstract
Over the last ten years, analysis of copy number variants has increasingly been applied to the study of arrhythmogenic pathologies associated with sudden death, mainly due to significant advances in the field of massive genetic sequencing. Nevertheless, few published reports have focused on the prevalence of copy number variants associated with sudden cardiac death. As a result, the frequency of these genetic alterations in arrhythmogenic diseases as well as their genetic interpretation and clinical translation has not been established. This review summarizes the current available data concerning copy number variants in sudden cardiac death-related diseases.
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5
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Witkowski L, Dillon MW, Murphy E, S Lebo M, Mason-Suares H. Expanding the Noonan spectrum/RASopathy NGS panel: Benefits of adding NF1 and SPRED1. Mol Genet Genomic Med 2020; 8:e1180. [PMID: 32107864 PMCID: PMC7196473 DOI: 10.1002/mgg3.1180] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 12/28/2019] [Accepted: 01/30/2020] [Indexed: 01/13/2023] Open
Abstract
Background RASopathies are a group of disorders caused by disruptions to the RAS‒MAPK pathway. Despite being in the same pathway, Neurofibromatosis Type 1 (NF1) and Legius syndrome (LS) typically present with phenotypes distinct from Noonan spectrum disorders (NSDs). However, some NF1/LS individuals also exhibit NSD phenotypes, often referred to as Neurofibromatosis‐Noonan syndrome (NFNS), and may be mistakenly evaluated for NSDs, delaying diagnosis, and affecting patient management. Methods A derivation cohort of 28 patients with a prior negative NSD panel and either NFNS or a suspicion of NSD and café‐au‐lait spots underwent NF1 and SPRED1 sequencing. To further determine the utility and burden of adding these genes, a validation cohort of 505 patients with a suspected RASopathy were tested on a 14‐gene RASopathy‐associated panel. Results In the derivation cohort, six (21%) patients had disease‐causing NF1 or SPRED1 variants. In the validation cohort, 11 (2%) patients had disease‐causing variants and 15 (3%) had variants of uncertain significance in NF1 or SPRED1. Of those with disease‐causing variants, 5/17 only had an NSD diagnosis. Conclusions Adding NF1 and SPRED1 to RASopathy panels can speed diagnosis and improve patient management, without significantly increasing the burden of inconclusive results.
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Affiliation(s)
- Leora Witkowski
- Departments of Pathology, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA.,Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge, MA, USA
| | - Mitchell W Dillon
- Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge, MA, USA
| | - Elissa Murphy
- Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge, MA, USA
| | - Matthew S Lebo
- Departments of Pathology, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA.,Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge, MA, USA
| | - Heather Mason-Suares
- Departments of Pathology, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA.,Laboratory for Molecular Medicine, Partners HealthCare Personalized Medicine, Cambridge, MA, USA
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6
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Cunningham KS, Spears DA, Care M. Evaluation of cardiac hypertrophy in the setting of sudden cardiac death. Forensic Sci Res 2019; 4:223-240. [PMID: 31489388 PMCID: PMC6713129 DOI: 10.1080/20961790.2019.1633761] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 01/06/2023] Open
Abstract
Ventricular hypertrophy is a common pathological finding at autopsy that can act as a substrate for arrhythmogenesis. Pathologists grapple with the significance of ventricular hypertrophy when assessing the sudden and unexpected deaths of young people and what it could mean for surviving family members. The pathological spectrum of left ventricular hypertrophy (LVH) is reviewed herein. This article is oriented to the practicing autopsy pathologist to help make sense of various patterns of increased heart muscle, particularly those that are not clearly cardiomyopathic, yet present in the setting of sudden cardiac death. The article also reviews factors influencing arrhythmogenesis as well as genetic mutations most commonly associated with ventricular hypertrophy, especially those associated with hypertrophic cardiomyopathy (HCM).
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Affiliation(s)
- Kristopher S. Cunningham
- Department of Laboratory Medicine and Pathobiology, Ontario Forensic Pathology Service, University of Toronto, Toronto, Canada
| | - Danna A. Spears
- University Health Network, Division of Cardiology – Electrophysiology, University of Toronto, Toronto, Canada
| | - Melanie Care
- Fred A. Litwin Family Centre in Genetic Medicine and Inherited Arrhythmia Clinic, University Health Network & Mount Sinai Hospital, University of Toronto, Toronto, Canada
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7
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Baban A, Olivini N, Lepri FR, Calì F, Mucciolo M, Digilio MC, Calcagni G, di Mambro C, Dallapiccola B, Adorisio R, Novelli A, Drago F. SOS1 mutations in Noonan syndrome: Cardiomyopathies and not only congenital heart defects! Report of six patients including two novel variants and literature review. Am J Med Genet A 2019; 179:2083-2090. [PMID: 31368652 DOI: 10.1002/ajmg.a.61312] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 05/27/2019] [Accepted: 07/16/2019] [Indexed: 12/17/2022]
Abstract
Noonan syndrome (NS) is caused by mutations in more than 10 genes, mainly PTPN11, SOS1, RAF1, and RIT1. Congenital heart defects and cardiomyopathy (CMP) are associated with significant morbidity and mortality in NS. Although hypertrophic CMP has "classically" been reported in association to RAF1, RIT1, and PTPN11 variants, SOS1 appears to be poorly related to CMP. Patients with NS attending our Center from January 2013 to June 2018 were eligible for inclusion if they carried SOS1 variants and presented with-or developed-CMP. Literature review describing the co-existence of SOS1 mutation and CMP was also performed. We identified six patients with SOS1 variants and CMP (male to female ratio 2:1) including two novel variants. CMP spectrum encompassed: (a) dilated CMP, (b) nonobstructive hypertrophic CMPs, and (c) obstructive hypertrophic CMPs. Survival is 100%. Literature review included 16 SOS1 mutated in CMP. CMP, mainly hypertrophic, has been often reported in association to RAF1, RIT1, and PTPN11 variants. Differently from previous reports, due to the frequent association of SOS1 variants and CMP in our single center experience, we suggest potential underestimated proportion of SOS1 in pediatric CMPs.
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Affiliation(s)
- Anwar Baban
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Nicole Olivini
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Francesca Romana Lepri
- Medical Genetics Laboratory, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Federica Calì
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Mafalda Mucciolo
- Medical Genetics Laboratory, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Maria C Digilio
- Medical Genetics Laboratory, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Giulio Calcagni
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Corrado di Mambro
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Bruno Dallapiccola
- Scientific Directorate, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Rachele Adorisio
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Antonio Novelli
- Medical Genetics Laboratory, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Fabrizio Drago
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
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8
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Aljeaid D, Sanchez AI, Wakefield E, Chadwell SE, Moore N, Prada CE, Zhang W. Prevalence of pathogenic and likely pathogenic variants in the RASopathy genes in patients who have had panel testing for cardiomyopathy. Am J Med Genet A 2019; 179:608-614. [DOI: 10.1002/ajmg.a.61072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Deema Aljeaid
- Division of Human Genetics; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
- Department of Genetics Medicine, Faculty of Medicine; King Abdulaziz University; Jeddah Saudi Arabia
| | - Ana Isabel Sanchez
- Division of Human Genetics; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
- Instituto de Genética Humana; Pontificia Universidad Javeriana; Bogotá Colombia
| | - Emily Wakefield
- Division of Human Genetics; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
- RASopathies Program; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - Sarah E. Chadwell
- Division of Human Genetics; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
- RASopathies Program; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - Nicole Moore
- Heart Institute Diagnostic Laboratory; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - Carlos E. Prada
- Division of Human Genetics; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
- RASopathies Program; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
- Department of Pediatrics; University of Cincinnati College of Medicine; Cincinnati Ohio
- Division de Genetica, Departamento de Pediatría; Hospital Internacional de Colombia; Bucaramanga Colombia
| | - Wenying Zhang
- Division of Human Genetics; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
- Heart Institute Diagnostic Laboratory; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
- Department of Pediatrics; University of Cincinnati College of Medicine; Cincinnati Ohio
- Laboratory of Genetics and Genomics; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
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9
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Chen H, Li X, Liu X, Wang J, Zhang Z, Wu J, Huang M, Guo Y, Li F, Wang X, Fu L. Clinical and mutation profile of pediatric patients with RASopathy-associated hypertrophic cardiomyopathy: results from a Chinese cohort. Orphanet J Rare Dis 2019; 14:29. [PMID: 30732632 PMCID: PMC6367752 DOI: 10.1186/s13023-019-1010-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 01/25/2019] [Indexed: 11/10/2022] Open
Abstract
Background The RASopathies are a class of developmental disorders caused by germline mutations in the RAS-mitogen-activated protein kinase (MAPK) pathway. Hypertrophic cardiomyopathy (HCM) has been frequently described in children with RASopathy, but only a minority of patients have received formal genotyping. The purpose of this study was to evaluate the genetic basis and clinical outcome of pediatric patients with RASopathy-associated HCM. Methods We retrospectively reviewed the mutation spectrum and clinical outcome of all the patients with RASopathy derived from 168 pediatric HCM cases referred to our institution between January 2012 and July 2018. Results A heterozygous missense mutation in one of known RASopathy genes was identified in 46 unrelated children with HCM. Mutations in the PTPN11 gene were the most prevalent (19/46); this was followed by mutations in RAF1 (11/46), KRAS (5/46), RIT1 (4/46), BRAF (3/46), SOS1 (2/46), HRAS (1/46), and SHOC2 (1/46). Moreover, two compound heterozygous missense mutations in the LZTR1 gene were identified in one patient with the Noonan syndrome phenotype and HCM. The median age at the diagnosis of HCM was 3.0 months (range 0 months to 8.1 years). Twenty-one of the patients had significant left ventricular outflow tract obstruction and 32 had concomitant congenital heart disease. Three patients with a mutation in exon 13 of the PTPN11 gene died of cardiac failure at the ages of 3.0, 3.5, and 6.0 months. The remaining 44 patients were alive after an average follow-up time of 3.9 years (0.5 to 17.1 years, median 2.9 years) from the initial diagnosis of HCM, including 5 patients with spontaneous regression of their cardiac hypertrophy. Conclusions RASopathy-associated HCM is a heterogeneous genetic condition characterized by early-onset cardiac hypertrophy and a high prevalence of co-existing congenital heart disease, which is most frequently related to specific mutations in the PTPN11 gene. Rapidly progressive HCM, resulting in an early death, is uncommon in RASopathy patients except those with specific mutations in exon 13 of the PTPN11 gene.
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Affiliation(s)
- Hao Chen
- Department of Cardiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Xin Li
- Department of Endocrinology and Metabolism, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China
| | - Xiaoliang Liu
- Department of Cardiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.,Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Sichuan, 610041, China
| | - Jian Wang
- Research Division of Birth Defects, Shanghai Children's Medical Center, Pediatric Translational Medicine Institute, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China
| | - Zhen Zhang
- Shanghai Children's Medical Center, Shanghai Pediatric Congenital Heart Disease Institute and Pediatric Translational Medicine Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Jinjin Wu
- Department of Cardiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Meirong Huang
- Department of Cardiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Ying Guo
- Department of Cardiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Fen Li
- Department of Cardiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Xiumin Wang
- Department of Endocrinology and Metabolism, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China.
| | - Lijun Fu
- Department of Cardiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China. .,Shanghai Children's Medical Center, Shanghai Pediatric Congenital Heart Disease Institute and Pediatric Translational Medicine Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
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10
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Genome Sequencing in Hypertrophic Cardiomyopathy. J Am Coll Cardiol 2018; 72:430-433. [DOI: 10.1016/j.jacc.2018.05.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 05/24/2018] [Accepted: 05/24/2018] [Indexed: 11/20/2022]
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