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Srinivasan N, Gullapalli N, Shah KS. Highlighting the South Asian Heart Failure Epidemic. Card Fail Rev 2024; 10:e07. [PMID: 39144581 PMCID: PMC11322948 DOI: 10.15420/cfr.2023.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 04/18/2024] [Indexed: 08/16/2024] Open
Abstract
Heart failure (HF) remains a progressive syndrome with high morbidity and mortality, and accounts for many hospitalisations globally with a downstream impact of increasing healthcare costs. South Asian individuals account for most of the global burden of non-communicable diseases. In this systematic review, a literature search was performed for all studies focusing on South Asians and HF using PubMed as the primary research tool and citations were included from relevant MEDLINE-indexed journals. Upon identification of relevant studies, pertinent data points were extracted systematically from each eligible study. South Asians have an earlier age of onset of many non-communicable diseases compared to other ethnic groups worldwide, including cardiovascular disease (CVD). Given the large number of South Asians impacted by CVD and both traditional and non-traditional risk factors for CVD, HF has the potential to become an epidemic among South Asians across the world. Individuals of South Asian origin are at elevated risk for CVD compared to many other populations and should be followed closely for the potential development of HF. This review describes what is unique to South Asian individuals at risk for and with established HF, as well as management and prognostic considerations. Future directions and potential policy changes are highlighted that can reduce the HF burden among South Asians globally.
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Affiliation(s)
| | - Nagesh Gullapalli
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Salt Lake City, UT, US
| | - Kevin S Shah
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah Salt Lake City, UT, US
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2
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Bazrafshan S, Sibilia R, Girgla S, Viswanathan SK, Puckelwartz MJ, Sangha KS, Singh RR, Kakroo M, Jandarov R, Harris DM, Rubinstein J, Becker RC, McNally EM, Sadayappan S. South Asian-Specific MYBPC3 Δ25bp Deletion Carriers Display Hypercontraction and Impaired Diastolic Function Under Exercise Stress. Front Cardiovasc Med 2021; 8:766339. [PMID: 35004883 PMCID: PMC8733148 DOI: 10.3389/fcvm.2021.766339] [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: 08/28/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: A 25-base pair (25bp) intronic deletion in the MYBPC3 gene enriched in South Asians (SAs) is a risk allele for late-onset left ventricular (LV) dysfunction, hypertrophy, and heart failure (HF) with several forms of cardiomyopathy. However, the effect of this variant on exercise parameters has not been evaluated. Methods: As a pilot study, 10 asymptomatic SA carriers of the MYBPC3 Δ25bp variant (52.9 ± 2.14 years) and 10 age- and gender-matched non-carriers (NCs) (50.1 ± 2.7 years) were evaluated at baseline and under exercise stress conditions using bicycle exercise echocardiography and continuous cardiac monitoring. Results: Baseline echocardiography parameters were not different between the two groups. However, in response to exercise stress, the carriers of Δ25bp had significantly higher LV ejection fraction (%) (CI: 4.57 ± 1.93; p < 0.0001), LV outflow tract peak velocity (m/s) (CI: 0.19 ± 0.07; p < 0.0001), and higher aortic valve (AV) peak velocity (m/s) (CI: 0.103 ± 0.08; p = 0.01) in comparison to NCs, and E/A ratio, a marker of diastolic compliance, was significantly lower in Δ25bp carriers (CI: 0.107 ± 0.102; p = 0.038). Interestingly, LV end-diastolic diameter (LVIDdia) was augmented in NCs in response to stress, while it did not increase in Δ25bp carriers (CI: 0.239 ± 0.125; p = 0.0002). Further, stress-induced right ventricular systolic excursion velocity s' (m/s), as a marker of right ventricle function, increased similarly in both groups, but tricuspid annular plane systolic excursion increased more in carriers (slope: 0.008; p = 0.0001), suggesting right ventricle functional differences between the two groups. Conclusions: These data support that MYBPC3 Δ25bp is associated with LV hypercontraction under stress conditions with evidence of diastolic impairment.
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Affiliation(s)
- Sholeh Bazrafshan
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, Heart, Lung and Vascular Institute, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Robert Sibilia
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, Heart, Lung and Vascular Institute, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Saavia Girgla
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, Heart, Lung and Vascular Institute, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Shiv Kumar Viswanathan
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, Heart, Lung and Vascular Institute, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Megan J. Puckelwartz
- Center for Genetic Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Kiranpal S. Sangha
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, Heart, Lung and Vascular Institute, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Rohit R. Singh
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, Heart, Lung and Vascular Institute, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Mashhood Kakroo
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, Heart, Lung and Vascular Institute, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Roman Jandarov
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, Heart, Lung and Vascular Institute, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - David M. Harris
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, Heart, Lung and Vascular Institute, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Jack Rubinstein
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, Heart, Lung and Vascular Institute, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Richard C. Becker
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, Heart, Lung and Vascular Institute, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Elizabeth M. McNally
- Center for Genetic Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Sakthivel Sadayappan
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, Heart, Lung and Vascular Institute, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
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Koshy L, Jeemon P, Ganapathi S, Madhavan M, Urulangodi M, Sharma M, Harikrishnan S. Association of South Asian-specific MYBPC3Δ deletion polymorphism and cardiomyopathy: A systematic review and meta-analysis. Meta Gene 2021. [DOI: 10.1016/j.mgene.2021.100883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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4
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Arif M, Nabavizadeh P, Song T, Desai D, Singh R, Bazrafshan S, Kumar M, Wang Y, Gilbert RJ, Dhandapany PS, Becker RC, Kranias EG, Sadayappan S. Genetic, clinical, molecular, and pathogenic aspects of the South Asian-specific polymorphic MYBPC3 Δ25bp variant. Biophys Rev 2020; 12:1065-1084. [PMID: 32656747 PMCID: PMC7429610 DOI: 10.1007/s12551-020-00725-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/03/2020] [Indexed: 02/06/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a cardiac genetic disease characterized by ventricular enlargement, diastolic dysfunction, and increased risk for sudden cardiac death. Sarcomeric genetic defects are the predominant known cause of HCM. In particular, mutations in the myosin-binding protein C gene (MYBPC3) are associated with ~ 40% of all HCM cases in which a genetic basis has been established. A decade ago, our group reported a 25-base pair deletion in intron 32 of MYBPC3 (MYBPC3Δ25bp) that is uniquely prevalent in South Asians and is associated with autosomal dominant cardiomyopathy. Although our studies suggest that this deletion results in left ventricular dysfunction, cardiomyopathies, and heart failure, the precise mechanism by which this variant predisposes to heart disease remains unclear. Increasingly appreciated, however, is the contribution of secondary risk factors, additional mutations, and lifestyle choices in augmenting or modifying the HCM phenotype in MYBPC3Δ25bp carriers. Therefore, the goal of this review article is to summarize the current research dedicated to understanding the molecular pathophysiology of HCM in South Asians with the MYBPC3Δ25bp variant. An emphasis is to review the latest techniques currently applied to explore the MYBPC3Δ25bp pathogenesis and to provide a foundation for developing new diagnostic strategies and advances in therapeutics.
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Affiliation(s)
- Mohammed Arif
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, Heart, Lung and Vascular Institute, University of Cincinnati, College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267-0575, USA.
| | - Pooneh Nabavizadeh
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, Heart, Lung and Vascular Institute, University of Cincinnati, College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267-0575, USA
| | - Taejeong Song
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, Heart, Lung and Vascular Institute, University of Cincinnati, College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267-0575, USA
| | - Darshini Desai
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, Heart, Lung and Vascular Institute, University of Cincinnati, College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267-0575, USA
| | - Rohit Singh
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, Heart, Lung and Vascular Institute, University of Cincinnati, College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267-0575, USA
| | - Sholeh Bazrafshan
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, Heart, Lung and Vascular Institute, University of Cincinnati, College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267-0575, USA
| | - Mohit Kumar
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, Heart, Lung and Vascular Institute, University of Cincinnati, College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267-0575, USA
| | - Yigang Wang
- Department of Pathology and Laboratory Medicine, University of Cincinnati, College of Medicine, Cincinnati, OH, 45267, USA
| | - Richard J Gilbert
- Research Service, Providence VA Medical Center, Providence, RI, 02908, USA
| | - Perundurai S Dhandapany
- Centre for Cardiovascular Biology and Disease, Institute for Stem Cell Biology and Regenerative Medicine (inStem), Bangalore, India
- The Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA
- Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR, USA
| | - Richard C Becker
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, Heart, Lung and Vascular Institute, University of Cincinnati, College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267-0575, USA
| | - Evangelia G Kranias
- Department of Pharmacology and Systems Physiology, University of Cincinnati, College of Medicine, Cincinnati, OH, 45267, USA
| | - Sakthivel Sadayappan
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, Heart, Lung and Vascular Institute, University of Cincinnati, College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267-0575, USA
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5
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Sadayappan S, Puckelwartz MJ, McNally EM. South Asian-Specific MYBPC3Δ25bp Intronic Deletion and Its Role in Cardiomyopathies and Heart Failure. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2020; 13:e002986. [PMID: 32543992 DOI: 10.1161/circgen.120.002986] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Sakthivel Sadayappan
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, Heart, Lung and Vascular Institute, College of Medicine, University of Cincinnati, OH. Center for Genetic Medicine, Northwestern University, Chicago, IL
| | - Megan J Puckelwartz
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, Heart, Lung and Vascular Institute, College of Medicine, University of Cincinnati, OH. Center for Genetic Medicine, Northwestern University, Chicago, IL
| | - Elizabeth M McNally
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, Heart, Lung and Vascular Institute, College of Medicine, University of Cincinnati, OH. Center for Genetic Medicine, Northwestern University, Chicago, IL
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6
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Harper AR, Bowman M, Hayesmoore JB, Sage H, Salatino S, Blair E, Campbell C, Currie B, Goel A, McGuire K, Ormondroyd E, Sergeant K, Waring A, Woodley J, Kramer CM, Neubauer S, Farrall M, Watkins H, Thomson KL. Reevaluation of the South Asian MYBPC3Δ25bp Intronic Deletion in Hypertrophic Cardiomyopathy. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2020; 13:e002783. [PMID: 32163302 PMCID: PMC7299222 DOI: 10.1161/circgen.119.002783] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/17/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The common intronic deletion, MYBPC3Δ25, detected in 4% to 8% of South Asian populations, is reported to be associated with cardiomyopathy, with ≈7-fold increased risk of disease in variant carriers. Here, we examine the contribution of MYBPC3Δ25 to hypertrophic cardiomyopathy (HCM) in a large patient cohort. METHODS Sequence data from 2 HCM cohorts (n=5393) was analyzed to determine MYBPC3Δ25 frequency and co-occurrence of pathogenic variants in HCM genes. Case-control and haplotype analyses were performed to compare variant frequencies and assess disease association. Analyses were also undertaken to investigate the pathogenicity of a candidate variant MYBPC3 c.1224-52G>A. RESULTS Our data suggest that the risk of HCM, previously attributed to MYBPC3Δ25, can be explained by enrichment of a derived haplotype, MYBPC3Δ25/-52, whereby a small subset of individuals bear both MYBPC3Δ25 and a rare pathogenic variant, MYBPC3 c.1224-52G>A. The intronic MYBPC3 c.1224-52G>A variant, which is not routinely evaluated by gene panel or exome sequencing, was detected in ≈1% of our HCM cohort. CONCLUSIONS The MYBPC3 c.1224-52G>A variant explains the disease risk previously associated with MYBPC3Δ25 in the South Asian population and is one of the most frequent pathogenic variants in HCM in all populations; genotyping services should ensure coverage of this deep intronic mutation. Individuals carrying MYBPC3Δ25 alone are not at increased risk of HCM, and this variant should not be tested in isolation; this is important for the large majority of the 100 million individuals of South Asian ancestry who carry MYBPC3Δ25 and would previously have been declared at increased risk of HCM.
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Affiliation(s)
- Andrew R. Harper
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.R.H., A.G., E.O., S.N., M.F., H.W., K.L.T.)
- Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (A.R.H., A.G., E.O., S.N., M.F., H.W., K.L.T.)
- Wellcome Centre for Human Genetics, Oxford, United Kingdom (A.R.H., S.S., A.G., A.W., M.F., H.W., K.L.T.)
| | - Michael Bowman
- Oxford Medical Genetics Laboratories, Churchill Hospital, Oxford, United Kingdom (M.B., J.B.G.H., H.S., C.C., B.C., K.M., K.S., K.L.T.)
| | - Jesse B.G. Hayesmoore
- Oxford Medical Genetics Laboratories, Churchill Hospital, Oxford, United Kingdom (M.B., J.B.G.H., H.S., C.C., B.C., K.M., K.S., K.L.T.)
| | - Helen Sage
- Oxford Medical Genetics Laboratories, Churchill Hospital, Oxford, United Kingdom (M.B., J.B.G.H., H.S., C.C., B.C., K.M., K.S., K.L.T.)
| | - Silvia Salatino
- Wellcome Centre for Human Genetics, Oxford, United Kingdom (A.R.H., S.S., A.G., A.W., M.F., H.W., K.L.T.)
| | - Edward Blair
- Oxford Centre for Genomic Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom (E.B.)
| | - Carolyn Campbell
- Oxford Medical Genetics Laboratories, Churchill Hospital, Oxford, United Kingdom (M.B., J.B.G.H., H.S., C.C., B.C., K.M., K.S., K.L.T.)
| | - Bethany Currie
- Oxford Medical Genetics Laboratories, Churchill Hospital, Oxford, United Kingdom (M.B., J.B.G.H., H.S., C.C., B.C., K.M., K.S., K.L.T.)
| | - Anuj Goel
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.R.H., A.G., E.O., S.N., M.F., H.W., K.L.T.)
- Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (A.R.H., A.G., E.O., S.N., M.F., H.W., K.L.T.)
- Wellcome Centre for Human Genetics, Oxford, United Kingdom (A.R.H., S.S., A.G., A.W., M.F., H.W., K.L.T.)
| | - Karen McGuire
- Oxford Medical Genetics Laboratories, Churchill Hospital, Oxford, United Kingdom (M.B., J.B.G.H., H.S., C.C., B.C., K.M., K.S., K.L.T.)
| | - Elizabeth Ormondroyd
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.R.H., A.G., E.O., S.N., M.F., H.W., K.L.T.)
- Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (A.R.H., A.G., E.O., S.N., M.F., H.W., K.L.T.)
| | - Kate Sergeant
- Oxford Medical Genetics Laboratories, Churchill Hospital, Oxford, United Kingdom (M.B., J.B.G.H., H.S., C.C., B.C., K.M., K.S., K.L.T.)
| | - Adam Waring
- Wellcome Centre for Human Genetics, Oxford, United Kingdom (A.R.H., S.S., A.G., A.W., M.F., H.W., K.L.T.)
| | - Jessica Woodley
- West Midlands Regional Genetics Laboratory, Birmingham Woman’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom (J.W.)
| | | | - Stefan Neubauer
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.R.H., A.G., E.O., S.N., M.F., H.W., K.L.T.)
- Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (A.R.H., A.G., E.O., S.N., M.F., H.W., K.L.T.)
| | | | - Martin Farrall
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.R.H., A.G., E.O., S.N., M.F., H.W., K.L.T.)
- Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (A.R.H., A.G., E.O., S.N., M.F., H.W., K.L.T.)
- Wellcome Centre for Human Genetics, Oxford, United Kingdom (A.R.H., S.S., A.G., A.W., M.F., H.W., K.L.T.)
| | - Hugh Watkins
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.R.H., A.G., E.O., S.N., M.F., H.W., K.L.T.)
- Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (A.R.H., A.G., E.O., S.N., M.F., H.W., K.L.T.)
- Wellcome Centre for Human Genetics, Oxford, United Kingdom (A.R.H., S.S., A.G., A.W., M.F., H.W., K.L.T.)
| | - Kate L. Thomson
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom (A.R.H., A.G., E.O., S.N., M.F., H.W., K.L.T.)
- Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom (A.R.H., A.G., E.O., S.N., M.F., H.W., K.L.T.)
- Wellcome Centre for Human Genetics, Oxford, United Kingdom (A.R.H., S.S., A.G., A.W., M.F., H.W., K.L.T.)
- Oxford Medical Genetics Laboratories, Churchill Hospital, Oxford, United Kingdom (M.B., J.B.G.H., H.S., C.C., B.C., K.M., K.S., K.L.T.)
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Sarcomeric Gene Variants and Their Role with Left Ventricular Dysfunction in Background of Coronary Artery Disease. Biomolecules 2020; 10:biom10030442. [PMID: 32178433 PMCID: PMC7175236 DOI: 10.3390/biom10030442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 03/11/2020] [Indexed: 12/18/2022] Open
Abstract
: Cardiovascular diseases are one of the leading causes of death in developing countries, generally originating as coronary artery disease (CAD) or hypertension. In later stages, many CAD patients develop left ventricle dysfunction (LVD). Left ventricular ejection fraction (LVEF) is the most prevalent prognostic factor in CAD patients. LVD is a complex multifactorial condition in which the left ventricle of the heart becomes functionally impaired. Various genetic studies have correlated LVD with dilated cardiomyopathy (DCM). In recent years, enormous progress has been made in identifying the genetic causes of cardiac diseases, which has further led to a greater understanding of molecular mechanisms underlying each disease. This progress has increased the probability of establishing a specific genetic diagnosis, and thus providing new opportunities for practitioners, patients, and families to utilize this genetic information. A large number of mutations in sarcomeric genes have been discovered in cardiomyopathies. In this review, we will explore the role of the sarcomeric genes in LVD in CAD patients, which is a major cause of cardiac failure and results in heart failure.
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Viswanathan SK, Puckelwartz MJ, Mehta A, Ramachandra CJA, Jagadeesan A, Fritsche-Danielson R, Bhat RV, Wong P, Kandoi S, Schwanekamp JA, Kuffel G, Pesce LL, Zilliox MJ, Durai UNB, Verma RS, Molokie RE, Suresh DP, Khoury PR, Thomas A, Sanagala T, Tang HC, Becker RC, Knöll R, Shim W, McNally EM, Sadayappan S. Association of Cardiomyopathy With MYBPC3 D389V and MYBPC3Δ25bpIntronic Deletion in South Asian Descendants. JAMA Cardiol 2019; 3:481-488. [PMID: 29641836 DOI: 10.1001/jamacardio.2018.0618] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Importance The genetic variant MYBPC3Δ25bp occurs in 4% of South Asian descendants, with an estimated 100 million carriers worldwide. MYBPC3 Δ25bp has been linked to cardiomyopathy and heart failure. However, the high prevalence of MYBPC3Δ25bp suggests that other stressors act in concert with MYBPC3Δ25bp. Objective To determine whether there are additional genetic factors that contribute to the cardiomyopathic expression of MYBPC3Δ25bp. Design, Setting, andParticipants South Asian individuals living in the United States were screened for MYBPC3Δ25bp, and a subgroup was clinically evaluated using electrocardiograms and echocardiograms at Loyola University, Chicago, Illinois, between January 2015 and July 2016. Main Outcomes and Measures Next-generation sequencing of 174 cardiovascular disease genes was applied to identify additional modifying gene mutations and correlate genotype-phenotype parameters. Cardiomyocytes derived from human-induced pluripotent stem cells were established and examined to assess the role of MYBPC3Δ25bp. Results In this genotype-phenotype study, individuals of South Asian descent living in the United States from both sexes (36.23% female) with a mean population age of 48.92 years (range, 18-84 years) were recruited. Genetic screening of 2401 US South Asian individuals found an MYBPC3Δ25bpcarrier frequency of 6%. A higher frequency of missense TTN variation was found in MYBPC3Δ25bp carriers compared with noncarriers, identifying distinct genetic backgrounds within the MYBPC3Δ25bp carrier group. Strikingly, 9.6% of MYBPC3Δ25bp carriers also had a novel MYBPC3 variant, D389V. Family studies documented D389V was in tandem on the same allele as MYBPC3Δ25bp, and D389V was only seen in the presence of MYBPC3Δ25bp. In contrast to MYBPC3Δ25bp, MYBPC3Δ25bp/D389V was associated with hyperdynamic left ventricular performance (mean [SEM] left ventricular ejection fraction, 66.7 [0.7%]; left ventricular fractional shortening, 36.6 [0.6%]; P < .03) and stem cell-derived cardiomyocytes exhibited cellular hypertrophy with abnormal Ca2+ transients. Conclusions and Relevance MYBPC3Δ25bp/D389V is associated with hyperdynamic features, which are an early finding in hypertrophic cardiomyopathy and thought to reflect an unfavorable energetic state. These findings support that a subset of MYBPC3Δ25bp carriers, those with D389V, account for the increased risk attributed to MYBPC3Δ25bp.
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Affiliation(s)
- Shiv Kumar Viswanathan
- Heart, Lung and Vascular Institute, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio.,Department of Cell and Molecular Physiology, Loyola University Chicago, Maywood, Illinois
| | | | - Ashish Mehta
- National Heart Research Institute Singapore.,Cardiovascular Academic Clinical Program, DUKE-NUS Medical School, Singapore.,PSC and Phenotyping Laboratory, Victor Chang Cardiac Research Institute, Sydney, Australia
| | | | | | - Regina Fritsche-Danielson
- Cardiovascular and Metabolic Disease Innovative Medicines and Early Development Unit, AstraZeneca Research and Development, Gothenburg, Sweden
| | - Ratan V Bhat
- Cardiovascular and Metabolic Disease Innovative Medicines and Early Development Unit, AstraZeneca Research and Development, Gothenburg, Sweden
| | - Philip Wong
- National Heart Research Institute Singapore.,Cardiovascular and Metabolic Disorders Program, DUKE-NUS Medical School, Singapore.,Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Sangeetha Kandoi
- Heart, Lung and Vascular Institute, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio.,Department of Cell and Molecular Physiology, Loyola University Chicago, Maywood, Illinois.,Department of Biotechnology, Indian Institute of Technology Madras, Chennai, Tamilnadu, India
| | - Jennifer A Schwanekamp
- Heart, Lung and Vascular Institute, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Gina Kuffel
- Department of Public Health Sciences, Loyola University Chicago, Maywood, Illinois
| | - Lorenzo L Pesce
- Computation Institute, The University of Chicago, Chicago, Illinois
| | - Michael J Zilliox
- Department of Public Health Sciences, Loyola University Chicago, Maywood, Illinois
| | - U Nalla B Durai
- Divison of Hematology and Oncology, University of Illinois at Chicago
| | - Rama Shanker Verma
- Department of Biotechnology, Indian Institute of Technology Madras, Chennai, Tamilnadu, India
| | - Robert E Molokie
- Divison of Hematology and Oncology, University of Illinois at Chicago
| | | | - Philip R Khoury
- Heart Institute, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Annie Thomas
- Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, Illinois
| | - Thriveni Sanagala
- Department of Cardiology and Echocardiography and Cardiographics, Loyola University Chicago, Maywood, Illinois
| | - Hak Chiaw Tang
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Richard C Becker
- Heart, Lung and Vascular Institute, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Ralph Knöll
- Cardiovascular and Metabolic Disease Innovative Medicines and Early Development Unit, AstraZeneca Research and Development, Gothenburg, Sweden.,Integrated Cardio-Metabolic Centre, Myocardial Genetics, Karolinska Institutet, University Hospital, Heart and Vascular Theme, Stockholm, Sweden
| | - Winston Shim
- National Heart Research Institute Singapore.,Cardiovascular and Metabolic Disorders Program, DUKE-NUS Medical School, Singapore
| | - Elizabeth M McNally
- Center for Genetic Medicine, Northwestern University, Chicago, Illinois.,Associate Editor for Translational Science
| | - Sakthivel Sadayappan
- Heart, Lung and Vascular Institute, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio.,Department of Cell and Molecular Physiology, Loyola University Chicago, Maywood, Illinois
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Chen R, He J, Wang Y, Guo Y, Zhang J, Peng L, Wang D, Lin Q, Zhang J, Guo Z, Li L. Qualitative transcriptional signatures for evaluating the maturity degree of pluripotent stem cell-derived cardiomyocytes. Stem Cell Res Ther 2019; 10:113. [PMID: 30925936 PMCID: PMC6440140 DOI: 10.1186/s13287-019-1205-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/22/2019] [Accepted: 03/03/2019] [Indexed: 12/29/2022] Open
Abstract
Background Pluripotent stem cell-derived cardiomyocytes (PSC-CMs) are widely used models for regenerative medicine and disease research. However, PSC-CMs are usually immature in morphology and functionality and the maturity of PSC-CMs could not be determined accurately. In order to reasonably interpret the experimental results obtained by PSC-CMs, it is necessary to evaluate the maturity of PSC-CMs and find the key genes related to maturation. Methods Using the gene expression profiles of normal adult cardiac tissue and embryonic stem cell (ESC) samples, we identified gene pairs with identically relative expression orderings (REOs) within adult cardiac tissue but reversely identical in ESCs. Then, for a PSC-CM model, we calculated the maturity score as the percentage of these gene pairs that exhibit the same REOs in adult cardiac tissue. Lastly, the CellComp method was used to identify the maturation-related genes. Results The maturity score increased gradually from 0.8401 for 18-week fetal cardiac tissue to 0.9997 for adult cardiac tissue. For four human PSC-CM models, the mature scores increased with prolonged culture time but were all below 0.8. The genes involved in energy metabolism, angiogenesis, immunity, and proliferation were dysregulated in the 1-year PSC-CMs compared with adult cardiac tissue. Conclusion We proposed a qualitative transcriptional signature to score the maturity degree of PSC-CMs. This score can reasonably track the maturity of PSC-CMs and be used to compare different PSC-CM culture methods. Electronic supplementary material The online version of this article (10.1186/s13287-019-1205-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rou Chen
- Key Laboratory of Arrhythmias, Ministry of Education, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jun He
- Fujian Key Laboratory of Medical Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian, China
| | - Yumei Wang
- Key Laboratory of Arrhythmias, Ministry of Education, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - You Guo
- Medical Big Data and Bioinformatics Research Center, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Juan Zhang
- Fujian Key Laboratory of Medical Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian, China
| | - Luying Peng
- Key Laboratory of Arrhythmias, Ministry of Education, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Duo Wang
- Key Laboratory of Arrhythmias, Ministry of Education, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qin Lin
- Key Laboratory of Arrhythmias, Ministry of Education, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jie Zhang
- Key Laboratory of Arrhythmias, Ministry of Education, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zheng Guo
- Fujian Key Laboratory of Medical Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, Fujian, China.
| | - Li Li
- Key Laboratory of Arrhythmias, Ministry of Education, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to present our current understanding of the genetic etiologies that may cause or predispose to heart failure. We highlight known phenotypes for which a genetic evaluation has clinical utility. RECENT FINDINGS The literature continues to demonstrate and confirm a genetic basis for conditions that cause heart failure. Evidence suggests a genetic model involving rare and common variants of strong or weak effect, in combination with environmental factors that may manifest as familial or simplex disease. Clinical genetic testing is available for several phenotypes, which can aid in the diagnosis and identification of at-risk family members. The evaluation of heart failure should include investigating etiologies with a genetic basis. Conducting a genetic evaluation in patients with heart failure requires the ability to identify possible genetic etiologies in an individual's phenotype, obtain relevant family history, and clinically interpret genetic testing results.
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Barefield DY, Lynch TL, Jagadeesan A, Sanagala T, Sadayappan S. High-Throughput Diagnostic Assay for a Highly Prevalent Cardiomyopathy-Associated MYBPC3 Variant. ACTA ACUST UNITED AC 2016; 7. [PMID: 27990320 PMCID: PMC5160998 DOI: 10.4172/2155-9929.1000303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A 25-basepair deletion variant of MYBPC3 occurs at high frequency in individuals of South Asian descent and is estimated to affect 55 million people worldwide, carrying an increased likelihood of cardiomyopathy. Since this variant is prevalent and severe in this subpopulation, quick and affordable screening to provide risk-assessment to guide treatment for these patients is critical. An RNaseH qPCR assay was developed to quickly and specifically diagnose the presence of the 25-basepair deletion variant in MYBPC3. RNAseH-blocked nucleotide primers were designed to identify the presence or absence of the wild type MYBPC3 allele or the genomic sequence containing the 25-basepair deletion. Using this assay, three blinded operators were able to accurately determine the genotype from human genomic DNA samples from blood and saliva using a qPCR thermocycler. Furthermore, positive variant subjects were examined by both electrocardiography and echocardiography for the presence of cardiomyopathy. A simple, robust assay was established, verified and validated that can be automated to detect the presence of the highly prevalent 25-basepair deletion MYBPC3 variant using both blood and saliva samples. The assay will provide quick and accurate prescreening of individuals at high risk for cardiomyopathies and allow for better clinical identification of 25-basepair deletion MYBPC3 carriers in large cohort epidemiological studies.
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Affiliation(s)
- David Y Barefield
- Department of Cell and Molecular Physiology, Loyola University, Chicago, USA; Center for Genetic Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Thomas L Lynch
- Department of Cell and Molecular Physiology, Loyola University, Chicago, USA
| | | | - Thriveni Sanagala
- Department of Cardiology and Echocardiography and Cardiographics, Loyola University, Chicago, USA
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