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Micaglio E, Tondi L, Benedetti S, Schiavo MA, Camporeale A, Disabato G, Attanasio A, Guida G, Carrafiello G, Piepoli M, Spagnolo P, Pappone C, Lombardi M. When Paying Attention Pays Back: Missense Mutation c.1006G>A p. (Val336Ile) in PRKAG2 Gene Causing Left Ventricular Hypertrophy and Conduction Abnormalities in a Caucasian Patient: Case Report and Literature Review. Int J Mol Sci 2024; 25:9171. [PMID: 39273120 PMCID: PMC11395525 DOI: 10.3390/ijms25179171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 08/20/2024] [Accepted: 08/21/2024] [Indexed: 09/15/2024] Open
Abstract
PRKAG2 cardiomyopathy is a rare genetic disorder that manifests early in life with an autosomal dominant inheritance pattern. It harbors left ventricular hypertrophy (LVH), ventricular pre-excitation and progressively worsening conduction system defects. Its estimated prevalence among patients with LVH ranges from 0.23 to about 1%, but it is likely an underdiagnosed condition. We report the association of the PRKAG2 missense variant c.1006G>A p. (Val336Ile) with LVH, conduction abnormalities (short PR interval and incomplete right bundle branch bock) and early-onset arterial hypertension (AH) in a 44-year-old Caucasian patient. While cardiac magnetic resonance (CMR) showed a mild hypertrophic phenotype with maximal wall thickness of 17 mm in absence of tissue alterations, the electric phenotype was relevant including brady-tachy syndrome and recurrent syncope. The same variant has been detected in the patient's sister and daughter, with LVH + early-onset AH and electrocardiographic (ECG) alterations + lipothymic episodes, respectively. Paying close attention to the coexistence of LVH and ECG alterations in the proband has been helpful in directing genetic tests to exclude primary cardiomyopathy. Hence, identifying the genetic basis in the patient allowed for familial screening as well as a proper follow-up and therapeutic management of the affected members. A review of the PRKAG2 cardiomyopathy literature is provided alongside the case report.
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Affiliation(s)
- Emanuele Micaglio
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
- Institute for Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
| | - Lara Tondi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy
| | - Sara Benedetti
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
- Institute for Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
| | - Maria Alessandra Schiavo
- Cardiology Unit IRCCS Azienda, Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine University of Bologna, 40138 Bologna, Italy
| | - Antonia Camporeale
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy
| | - Giandomenico Disabato
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
- Clinical Cardiology, IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
| | - Andrea Attanasio
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
- Clinical Cardiology, IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
| | - Gianluigi Guida
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
- Clinical Cardiology, IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
| | - Gianpaolo Carrafiello
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Massimo Piepoli
- Clinical Cardiology, IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Pietro Spagnolo
- Unit of Radiology, IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
| | - Carlo Pappone
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
- Department of Cardiology, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Massimo Lombardi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
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Tosca L, Drévillon L, Mouka A, Lecerf L, Briand A, Ortonne V, Benoit V, Brisset S, Van Maldergem L, Laudouar Q, Heide S, Goossens M, Giurgea I, Tachdjian G, Métay C. Two new cases of interstitial 7q35q36.1 deletion including CNTNAP2 and KMT2C. Mol Genet Genomic Med 2021; 9:e1645. [PMID: 34582124 PMCID: PMC8606216 DOI: 10.1002/mgg3.1645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 02/19/2021] [Indexed: 11/18/2022] Open
Abstract
Background Terminal deletions of the long arm of chromosome 7 are well known and frequently associated with syndromic holoprosencephaly due to the involvement of the SHH (aliases HHG1, SMMCI, TPT, TPTPS, and MCOPCB5) gene region. However, interstitial deletions including CNTNAP2 (aliases Caspr2, KIAA0868, and NRXN4) and excluding the SHH region are less common. Methods We report the clinical and molecular characterization associated with pure 7q35 and 7q35q36.1 deletion in two unrelated patients as detected by oligonucleotide‐based array‐CGH analysis. Results The common clinical features were abnormal maternal serum screening during first‐trimester pregnancy, low occipitofrontal circumference at birth, hypotonia, abnormal feet, developmental delay, impaired language development, generalized seizures, hyperactive behavior, friendly personality, and cranio‐facial dysmorphism. Both deletions occurred de novo and sequencing of CNTNAP2, a candidate gene for epilepsy and autism showed absence of mutation on the contralateral allele. Conclusion Combined haploinsufficiency of GALNTL5 (alias GalNAc‐T5L), CUL1, SSPO (aliases SCO‐spondin, KIAA0543, and FLJ36112), AOC1(alias DAO), RHEB, and especially KMT2C (alias KIAA1506 and HALR) with monoallelic disruption of CNTNAP2 may explain neurologic abnormalities, hypotonia, and exostoses. Haploinsufficiency of PRKAG2 (aliases AAKG, AAKG2, H91620p, WPWS, and CMH6) and KCNH2 (aliases Kv11.1, HERG, and erg1) genes may be responsible of long QT syndrome observed for one patient.
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Affiliation(s)
- Lucie Tosca
- Service d'Histologie, Embryologie et Cytogénétique, AP-HP. Université Paris Saclay, Hôpital Antoine Béclère, Clamart, France
| | - Loïc Drévillon
- Service d'Histologie, Embryologie et Cytogénétique, AP-HP. Université Paris Saclay, Hôpital Antoine Béclère, Clamart, France
| | - Aurélie Mouka
- Service d'Histologie, Embryologie et Cytogénétique, AP-HP. Université Paris Saclay, Hôpital Antoine Béclère, Clamart, France
| | - Laure Lecerf
- Service de Biochimie et Génétique, AP-HP. Hôpitaux Universitaires Henri Mondor, Hôpital Henri Mondor, Créteil, France.,Institut National de la Santé et de la Recherche Médicale, U955, Créteil, France.,Faculté de Médecine, Université Paris-Est, Créteil, France
| | - Audrey Briand
- Service de Biochimie et Génétique, AP-HP. Hôpitaux Universitaires Henri Mondor, Hôpital Henri Mondor, Créteil, France
| | - Valérie Ortonne
- Service de Biochimie et Génétique, AP-HP. Hôpitaux Universitaires Henri Mondor, Hôpital Henri Mondor, Créteil, France
| | - Virginie Benoit
- Service d'Histologie, Embryologie et Cytogénétique, AP-HP. Université Paris Saclay, Hôpital Antoine Béclère, Clamart, France
| | - Sophie Brisset
- Service d'Histologie, Embryologie et Cytogénétique, AP-HP. Université Paris Saclay, Hôpital Antoine Béclère, Clamart, France
| | | | - Quitterie Laudouar
- Service de Réanimation Néonatale, AP-HP. Université Paris Saclay, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Solveig Heide
- UF Génétique Clinique, AP-HP. Sorbonne Université, Hôpital universitaire Pitié-Salpêtrière, Paris, France
| | - Michel Goossens
- Service de Biochimie et Génétique, AP-HP. Hôpitaux Universitaires Henri Mondor, Hôpital Henri Mondor, Créteil, France
| | - Irina Giurgea
- Département de Génétique Médicale, INSERM Childhood Genetic Diseases, AP-HP. Sorbonne Université, Hôpital Trousseau, Paris, France
| | - Gérard Tachdjian
- Service d'Histologie, Embryologie et Cytogénétique, AP-HP. Université Paris Saclay, Hôpital Antoine Béclère, Clamart, France
| | - Corinne Métay
- Service de Biochimie et Génétique, AP-HP. Hôpitaux Universitaires Henri Mondor, Hôpital Henri Mondor, Créteil, France
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Di Stolfo G, Accadia M, Mastroianno S, Leone MP, Palumbo O, Palumbo P, Potenza D, Maccarone P, Sacco M, Russo A, Carella M. Long QT syndrome in chromosome 7q35q36.3 deletion involving KCNH2 gene: Warning for chlorpheniramine prescription. Mol Genet Genomic Med 2019; 7:e855. [PMID: 31347270 PMCID: PMC6732270 DOI: 10.1002/mgg3.855] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 05/12/2019] [Accepted: 06/17/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The deletion of the distal 7q region is a rare chromosomal syndrome characterized by wide phenotypic manifestations including growth and psychomotor delay, facial dysmorphisms, and genitourinary malformations. METHODS We describe a 6-year-old child with a 12-Mb deletion of the region 7q35q36.3. RESULTS Among the deleted genes, two genes have cardiac implications: PRKAG2 (OMIM #602743), associated with hypertrophic cardiomyopathy, cardiac conduction disease, and sudden death, and KCNH2 (OMIM #152427), coding for a cardiac potassium channel involved in long QT syndrome, unmasked by the chlorpheniramine treatment. At same time, the SHH gene (OMIM #600725), encoding sonic hedgehog, a secreted protein that is involved in the embryonic development, is deleted. CONCLUSION Our report underlines potential cardiac complications linked to the common pharmacological treatment in this rare multiorgan and proteiform disease.
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Affiliation(s)
- Giuseppe Di Stolfo
- Cardiovascular Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Maria Accadia
- Medical Genetics Service, Hospital "Cardinale G. Panico", Tricase, Lecce, Italy
| | - Sandra Mastroianno
- Cardiovascular Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Maria P Leone
- Division of Medical Genetics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Orazio Palumbo
- Division of Medical Genetics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Pietro Palumbo
- Division of Medical Genetics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Domenico Potenza
- Cardiovascular Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Pasquale Maccarone
- Paediatric Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Michele Sacco
- Paediatric Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Aldo Russo
- Cardiovascular Department, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Massimo Carella
- Division of Medical Genetics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
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