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Safdar M, Ullah M, Wahab A, Hamayun S, Ur Rehman M, Khan MA, Khan SU, Ullah A, Din FU, Awan UA, Naeem M. Genomic insights into heart health: Exploring the genetic basis of cardiovascular disease. Curr Probl Cardiol 2024; 49:102182. [PMID: 37913933 DOI: 10.1016/j.cpcardiol.2023.102182] [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: 10/23/2023] [Accepted: 10/28/2023] [Indexed: 11/03/2023]
Abstract
Cardiovascular diseases (CVDs) are considered as the leading cause of death worldwide. CVD continues to be a major cause of death and morbidity despite significant improvements in its detection and treatment. Therefore, it is strategically important to be able to precisely characterize an individual's sensitivity to certain illnesses. The discovery of genes linked to cardiovascular illnesses has benefited from linkage analysis and genome-wide association research. The last 20 years have seen significant advancements in the field of molecular genetics, particularly with the development of new tools like genome-wide association studies. In this article we explore the profound impact of genetic variations on disease development, prognosis, and therapeutic responses. And the significance of genetics in cardiovascular risk assessment and the ever-evolving realm of genetic testing, offering insights into the potential for personalized medicine in this domain. Embracing the future of cardiovascular care, the article explores the implications of pharmacogenomics for tailored treatments, the promise of emerging technologies in cardiovascular genetics and therapies, including the transformative influence of nanotechnology. Furthermore, it delves into the exciting frontiers of gene editing, such as CRISPR/Cas9, as a novel approach to combat cardiovascular diseases. And also explore the potential of stem cell therapy and regenerative medicine, providing a holistic view of the dynamic landscape of cardiovascular genomics and its transformative potential for the field of cardiovascular medicine.
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Affiliation(s)
- Mishal Safdar
- Department of Biological Sciences, National University of Medical Sciences (NUMS) Rawalpindi 46000, Punjab, Pakistan
| | - Muneeb Ullah
- Department of Pharmacy, Kohat University of Science, and technology (KUST), Kohat, 26000, Khyber Pakhtunkhwa, Pakistan
| | - Abdul Wahab
- Department of Pharmacy, Kohat University of Science, and technology (KUST), Kohat, 26000, Khyber Pakhtunkhwa, Pakistan
| | - Shah Hamayun
- Department of Cardiology, Pakistan Institute of Medical Sciences (PIMS), Islamabad, 04485 Punjab, Pakistan
| | - Mahboob Ur Rehman
- Department of Cardiology, Pakistan Institute of Medical Sciences (PIMS), Islamabad, 04485 Punjab, Pakistan
| | - Muhammad Amir Khan
- Department of Foreign Medical education, Fergana Medical institute of Public Health, 2A Yangi Turon street, Fergana 150100, Uzbekistan
| | - Shahid Ullah Khan
- Department of Biochemistry, Women Medical and Dental College, Khyber Medical University, Abbottabad, 22080, Khyber Pakhtunkhwa, Pakistan
| | - Aziz Ullah
- Department of Chemical Engineering, Pukyong National University, Busan 48513, Republic of Korea
| | - Fakhar Ud Din
- Department of Pharmacy, Quaid-i-Azam University, 45320, Islamabad, Pakistan
| | - Uzma Azeem Awan
- Department of Biological Sciences, National University of Medical Sciences (NUMS) Rawalpindi 46000, Punjab, Pakistan
| | - Muhammad Naeem
- Department of Biological Sciences, National University of Medical Sciences (NUMS) Rawalpindi 46000, Punjab, Pakistan.
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Patil R, Ashraf F, Dayeh SA, Prakash SK. Genomic Medicine Guidance: A Point-of-Care App for Heritable Thoracic Aortic Diseases. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.22.23299696. [PMID: 38234729 PMCID: PMC10793513 DOI: 10.1101/2023.12.22.23299696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Genetic testing can determine familial and personal risks for heritable thoracic aortic aneurysms and dissections (TAD). The 2022 ACC/AHA guidelines for TAD recommend management decisions based on the specific gene mutation. However, many clinicians lack sufficient comfort or insight to integrate genetic information into clinical practice. We therefore developed the Genomic Medicine Guidance (GMG) app, an interactive point-of care tool to inform clinicians and patients about TAD diagnosis, treatment, and surveillance. GMG is a REDCap-based app that combines publicly available genetic data and clinical recommendations based on the TAD guidelines into one translational education tool. TAD genetic information in GMG was sourced from the Montalcino Aortic Consortium, a worldwide collaboration of TAD centers of excellence, and the NIH genetic repositories ClinVar and ClinGen. The app streamlines data on the 13 most frequently mutated TAD genes with 2,286 unique pathogenic mutations that cause TAD so that users receive comprehensive recommendations for diagnostic testing, imaging, surveillance, medical therapy, preventative surgical repair, as well as guidance for exercise safety and management during pregnancy. The app output can be displayed in a clinician view or exported as an informative pamphlet in a patient-friendly format. The overall goal of the GMG app is to make genomic medicine more accessible to clinicians and patients, while serving as a unifying platform for research. We anticipate that these features will be catalysts for collaborative projects that aim to understand the spectrum of genetic variants that contribute to TAD.
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Affiliation(s)
- Rohan Patil
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Fatima Ashraf
- McWilliams School of Bioinformatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Samer Abu Dayeh
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Siddharth K. Prakash
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
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A Rare Case of the Digenic Inheritance of Long QT Syndrome Type 2 and Type 6. Case Rep Med 2019; 2019:1384139. [PMID: 31320904 PMCID: PMC6610752 DOI: 10.1155/2019/1384139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/11/2019] [Accepted: 05/23/2019] [Indexed: 11/25/2022] Open
Abstract
We report a 37-year-old woman with an out-of-hospital cardiac arrest caused by ventricular fibrillation due to digenic inheritance of long QT syndrome type 2 (KCNH2 gene) and type 6 (KCNE2 gene). During hospitalization, prolonged QTc intervals and frequent episodes of ventricular tachyarrhythmias manifested. Genetic testing identified a mutation of the KCNH2 gene and an unclassified variant, most likely pathogenic, of the KCNE2 gene. This digenic inheritance is extremely rare.
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Kondo T, Hisatome I, Yoshimura S, Mahati E, Notsu T, Li P, Iitsuka K, Kato M, Ogura K, Miake J, Aiba T, Shimizu W, Kurata Y, Sakata S, Nakasone N, Ninomiya H, Nakai A, Higaki K, Kawata Y, Shirayoshi Y, Yoshida A, Yamamoto K. Characterization of the novel mutant A78T-HERG from a long QT syndrome type 2 patient: Instability of the mutant protein and stabilization by heat shock factor 1. J Arrhythm 2016; 32:433-440. [PMID: 27761169 PMCID: PMC5063263 DOI: 10.1016/j.joa.2015.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 09/10/2015] [Accepted: 10/09/2015] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The human ether-a-go-go-related gene (HERG) encodes the α-subunit of rapidly activating delayed-rectifier potassium channels. Mutations in this gene cause long QT syndrome type 2 (LQT2). In most cases, mutations reduce the stability of the channel protein, which can be restored by heat shock (HS). METHODS We identified the novel mutant A78T-HERG in a patient with LQT2. The purpose of the current study was to characterize this mutant protein and test whether HS and heat shock factors (HSFs) could stabilize the mutant protein. A78T-HERG and wild-type HERG (WT-HERG) were expressed in HEK293 cells and analyzed by immunoblotting, immunoprecipitation, immunofluorescence, and whole-cell patch clamping. RESULTS When expressed in HEK293 cells, WT-HERG gave rise to immature and mature forms of the protein at 135 and 155 kDa, respectively. A78T-HERG gave rise only to the immature form, which was heavily ubiquitinated. The proteasome inhibitor MG132 increased the expression of immature A78T-HERG and increased both the immature and mature forms of WT-HERG. WT-HERG, but not A78T-HERG, was expressed on the plasma membrane. In whole-cell patch clamping experiments, depolarizing pulses evoked E4031-sensitive HERG channel currents in cells transfected with WT-HERG, but not in cells transfected with A78T-HERG. The A78V mutant, but not A78G mutant, remained in the immature form similarly to A78T. Maturation of the A78T-HERG protein was facilitated by HS, expression of HSF-1, or exposure to geranyl geranyl acetone. CONCLUSIONS A78T-HERG was characterized by protein instability and reduced expression on the plasma membrane. The stability of the mutant was partially restored by HSF-1, indicating that HSF-1 is a target for the treatment for LQT2 caused by the A78T mutation in HERG.
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Affiliation(s)
- Takehito Kondo
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Japan
| | - Ichiro Hisatome
- Division of Regenerative Medicine and Therapeutics, Tottori University Graduate School of Medical Science, Japan
| | - Shouichi Yoshimura
- Division of Regenerative Medicine and Therapeutics, Tottori University Graduate School of Medical Science, Japan
| | - Endang Mahati
- Division of Regenerative Medicine and Therapeutics, Tottori University Graduate School of Medical Science, Japan
| | - Tomomi Notsu
- Division of Regenerative Medicine and Therapeutics, Tottori University Graduate School of Medical Science, Japan
| | - Peili Li
- Division of Regenerative Medicine and Therapeutics, Tottori University Graduate School of Medical Science, Japan
| | - Kazuhiko Iitsuka
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Japan
| | - Masaru Kato
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Japan
| | - Kazuyoshi Ogura
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Japan
| | - Junichiro Miake
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Japan
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Wataru Shimizu
- Division of Cardiology and Regenerative Medicine, Nippon Medical School, Japan
| | - Yasutaka Kurata
- Department of Physiology II, Kanazawa Medical University, Japan
| | - Shinji Sakata
- Department of Pediatrics, Faculty of Medicine, Tottori University, Japan
| | - Naoe Nakasone
- Department of Biological Regulation, Faculty of Medicine, Tottori University, Japan
| | - Haruaki Ninomiya
- Department of Biological Regulation, Faculty of Medicine, Tottori University, Japan
| | - Akira Nakai
- Department of Biochemistry and Molecular Biology, Yamaguchi University School of Medicine, Japan
| | - Katsumi Higaki
- Division of Functional Genomics, Research Center for Bioscience and Technology, Tottori University, Japan
| | - Yasushi Kawata
- Department of Chemistry and Biotechnology, Graduate School of Engineering, Tottori University, Japan
| | - Yasuaki Shirayoshi
- Division of Regenerative Medicine and Therapeutics, Tottori University Graduate School of Medical Science, Japan
| | - Akio Yoshida
- Division of Regenerative Medicine and Therapeutics, Tottori University Graduate School of Medical Science, Japan
| | - Kazuhiro Yamamoto
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Japan
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Foroughmand AM, Nikkhah E, Galehdari H, Jadbabaee MH. Association Study between Coronary Artery Disease and rs1333049 and rs10757274 Polymorphisms at 9p21 Locus in South-West Iran. CELL JOURNAL 2015; 17:89-98. [PMID: 25870838 PMCID: PMC4393676 DOI: 10.22074/cellj.2015.515] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 03/04/2014] [Indexed: 11/19/2022]
Abstract
Objective Coronary artery disease (CAD) is a multi-factorial and heterogenic disease
with atherosclerosis plaques formation in internal wall of coronary artery. Plaque formation results to limitation of the blood reaching to myocardium leading to appearance of some problems, such as ischemia, sudden thrombosis veins and myocardial
infarction (MI). Several environmental and genetic factors are involved in prevalence
and incident of CAD as follows: hypertension, high low density lipoprotein-cholesterol
(LDL-C), age, diabetes mellitus, family history of early-onset heart disease and smoking. According to genome wide association studies (GWAS), five polymorphisms in the
9p21 locus seem to be associated with the CAD. We aimed to evaluate the remarkable association of two polymorphisms at 9p21 locus, rs1333049 and rs10757274,
with CAD.
Materials and Methods This experimental study was conducted in Golestan, Aria Hospitals and Genetics Lab of Shahid Chamran University in the city of Ahvaz, Iran, in 2010-
2011. The collected blood samples belonging to 170 CAD patients (case group) and 100
healthy individuals (control group) were analyzed by tetra-primer amplification refractory
mutation system (ARMS)-polymerase chain reaction (PCR) technique. The results were
analyzed using software package used for statistical analysis (SPSS; SPSS Inc., USA)
version 16. A value of p<0.05 and an odd ratio (OR) with 95% confidence intervals (CI)
were considered significant.
Results The frequencies of CC, CG and GG genotypes for rs1333049 polymorphism
in patients were 18.2, 65.3 and 16.5%, while in controls, the related values were 25,
67 and 8%, respectively. GG genotypes of rs1333049 polymorphism in CAD patients
were more than control cases (OR: 0.354, 95%CI: 0.138-0.912, p=0.032). The frequencies of AA, AG and GG genotypes for rs10757274 in CAD patients were 8.2, 58.3
and 33.5%, while in controls, the related values were 35, 63 and 2%, respectively. GG
Genotype in rs10757274 polymorphism in CAD patients was found more than control
cases (OR: 0.014, 95% CI: 0.003 -0.065, p=0.0001).
Conclusion The rs1333049 polymorphism at 9p21 locus shows a weak association with
CAD, whereas rs10757274 polymorphism reveals a significant association with CAD.
These variants may help the identification of patients with increased risk for coronary
artery disease.
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Affiliation(s)
| | - Emad Nikkhah
- Department of Genetics, Shahid Chamran University, Ahvaz, Iran
| | - Hamid Galehdari
- Department of Genetics, Shahid Chamran University, Ahvaz, Iran
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Cemin R, Janardhanan R, Donazzan L, Daves M. Peripartum cardiomyopathy: moving towards a more central role of genetics. Curr Cardiol Rev 2014; 9:179-84. [PMID: 23909634 PMCID: PMC3780342 DOI: 10.2174/1573403x113099990029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 12/12/2012] [Indexed: 11/22/2022] Open
Abstract
Peripartum cardiomyopathy (PCM) is a relatively rare disease with potentially devasting consequences requiring prompt identification and correct treatment. Overall prognosis is good in majority of the cases, although some patients may progress to irreversible heart failure. Early diagnosis is important and effective treatment reduces mortality rates and increases the chance of complete recovery of ventricular systolic function. The aetiology and pathogenesis seems to be multifactorial and poorly understood, with the available literature rather conflicting. In recent years, there has been increased interest in the role played by genetic predisposition in the development of PCM. It probably develops as a result of a complex interaction of pregnancy-associated factors and genetic factors and recently there have been many observations pointing out the central role played by a genetic predisposition. The direct and indirect observations on genetic susceptibility may offer new insights into the pathogenesis of PCM. However, larger studies are needed before advising routine genetic testing in these patients.
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Affiliation(s)
- Roberto Cemin
- Department of Cardiology, San Maurizio Regional Hospital of Bolzano, Italy.
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8
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Miller EM, Hinton RB. A pediatric approach to family history of cardiovascular disease: diagnosis, risk assessment, and management. Pediatr Clin North Am 2014; 61:187-205. [PMID: 24267465 DOI: 10.1016/j.pcl.2013.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The medical family history is a comprehensive and dynamic record of illnesses and other pertinent health information among family members. Family history is used to facilitate diagnosis, to identify family members at risk for developing a particular disease, and increasingly to manage disease. This article reviews the application of family history to pediatric cardiovascular disease. As more is learned about the genetic basis of cardiovascular disease, the family history will play an increasingly central role in management. Improved understanding of the causes of pediatric cardiovascular disease promises the opportunity to develop new diagnostic and therapeutic strategies.
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Affiliation(s)
- Erin M Miller
- Division of Cardiology, The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
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9
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Phan JH, Quo CF, Wang MD. Cardiovascular genomics: a biomarker identification pipeline. ACTA ACUST UNITED AC 2012; 16:809-22. [PMID: 22614726 DOI: 10.1109/titb.2012.2199570] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Genomic biomarkers are essential for understanding the underlying molecular basis of human diseases such as cardiovascular disease. In this review, we describe a biomarker identification pipeline for cardiovascular disease, which includes 1) high-throughput genomic data acquisition, 2) preprocessing and normalization of data, 3) exploratory analysis, 4) feature selection, 5) classification, and 6) interpretation and validation of candidate biomarkers. We review each step in the pipeline, presenting current and widely used bioinformatics methods. Furthermore, we analyze several publicly available cardiovascular genomics datasets to illustrate the pipeline. Finally, we summarize the current challenges and opportunities for further research.
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Affiliation(s)
- John H Phan
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30332, USA.
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Hershberger RE, Siegfried JD. Update 2011: clinical and genetic issues in familial dilated cardiomyopathy. J Am Coll Cardiol 2011; 57:1641-9. [PMID: 21492761 DOI: 10.1016/j.jacc.2011.01.015] [Citation(s) in RCA: 265] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 12/27/2010] [Accepted: 01/31/2011] [Indexed: 11/19/2022]
Abstract
A great deal of progress has recently been made in the discovery and understanding of the genetics of familial dilated cardiomyopathy (FDC). A consensus has emerged that with a new diagnosis of idiopathic dilated cardiomyopathy (IDC), the clinical screening of first-degree family members will reveal FDC in at least 20% to 35% of those family members. Point mutations in 31 autosomal and 2 X-linked genes representing diverse gene ontogeny have been implicated in causing FDC but account for only 30% to 35% of genetic causes. Next-generation sequencing methods have dramatically decreased sequencing costs, making clinical genetic testing feasible for extensive panels of dilated cardiomyopathy genes. Next-generation sequencing also provides opportunities to discover additional genetic causes of FDC and IDC. Guidelines for evaluation and testing of FDC and IDC are now available, and when combined with FDC genetic testing and counseling, will bring FDC/IDC genetics to the forefront of cardiovascular genetic medicine.
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Affiliation(s)
- Ray E Hershberger
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, 1501 NW 10th Avenue, Miami, FL 33136, USA.
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11
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Tester DJ, Ackerman MJ. Genetic testing for potentially lethal, highly treatable inherited cardiomyopathies/channelopathies in clinical practice. Circulation 2011; 123:1021-37. [PMID: 21382904 PMCID: PMC3073829 DOI: 10.1161/circulationaha.109.914838] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- David J Tester
- Long QT Syndrome Clinic and the Mayo Clinic Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN 55905, USA
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12
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Meder B, Haas J, Keller A, Heid C, Just S, Borries A, Boisguerin V, Scharfenberger-Schmeer M, Stähler P, Beier M, Weichenhan D, Strom TM, Pfeufer A, Korn B, Katus HA, Rottbauer W. Targeted next-generation sequencing for the molecular genetic diagnostics of cardiomyopathies. ACTA ACUST UNITED AC 2011; 4:110-22. [PMID: 21252143 DOI: 10.1161/circgenetics.110.958322] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Today, mutations in more than 30 different genes have been found to cause inherited cardiomyopathies, some associated with very poor prognosis. However, because of the genetic heterogeneity and limitations in throughput and scalability of current diagnostic tools up until now, it is hardly possible to genetically characterize patients with cardiomyopathy in a fast, comprehensive, and cost-efficient manner. METHODS AND RESULTS We established an array-based subgenomic enrichment followed by next-generation sequencing to detect mutations in patients with hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM). With this approach, we show that the genomic region of interest can be enriched by a mean factor of 2169 compared with the coverage of the whole genome, resulting in high sequence coverage of selected disease genes and allowing us to define the genetic pathogenesis of cardiomyopathies in a single sequencing run. In 6 patients, we detected disease-causing mutations, 2 microdeletions, and 4 point mutations. Furthermore, we identified several novel nonsynonymous variants, which are predicted to be harmful, and hence, might be potential disease mutations or modifiers for DCM or HCM. CONCLUSIONS The approach presented here allows for the first time a comprehensive genetic screening in patients with hereditary DCM or HCM in a fast and cost-efficient manner.
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Affiliation(s)
- Benjamin Meder
- Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany
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Voelkerding KV, Dames S, Durtschi JD. Next generation sequencing for clinical diagnostics-principles and application to targeted resequencing for hypertrophic cardiomyopathy: a paper from the 2009 William Beaumont Hospital Symposium on Molecular Pathology. J Mol Diagn 2011; 12:539-51. [PMID: 20805560 DOI: 10.2353/jmoldx.2010.100043] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
During the past five years, new high-throughput DNA sequencing technologies have emerged; these technologies are collectively referred to as next generation sequencing (NGS). By virtue of sequencing clonally amplified DNA templates or single DNA molecules in a massively parallel fashion in a flow cell, NGS provides both qualitative and quantitative sequence data. This combination of information has made NGS the technology of choice for complex genetic analyses that were previously either technically infeasible or cost prohibitive. As a result, NGS has had a fundamental and broad impact on many facets of biomedical research. In contrast, the dissemination of NGS into the clinical diagnostic realm is in its early stages. Though NGS is powerful and can be envisioned to have multiple applications in clinical diagnostics, the technology is currently complex. Successful adoption of NGS into the clinical laboratory will require expertise in both molecular biology techniques and bioinformatics. The current report presents principles that underlie NGS including sequencing library preparation, sequencing chemistries, and an introduction to NGS data analysis. These concepts are subsequently further illustrated by showing representative results from a case study using NGS for targeted resequencing of genes implicated in hypertrophic cardiomyopathy.
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Ferrero-Miliani L, Holst AG, Pehrson S, Morling N, Bundgaard H. Strategy for clinical evaluation and screening of sudden cardiac death relatives. Fundam Clin Pharmacol 2011; 24:619-35. [PMID: 20698891 DOI: 10.1111/j.1472-8206.2010.00864.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Sudden cardiac death (SCD) may be the first and final manifestation of several heart diseases. In the young, SCD is often caused by a hereditary cardiac disease. As the most frequently seen inherited cardiac diseases have an autosomal-dominant pattern of inheritance, half of the first-degree relatives are at risk of having or developing the same disease. Therefore, screening of these high-risk relatives is a rational approach to reduce the incidence of SCD. To offer family screening and counseling, the cause of death should be carefully established. Autopsy is only performed in a limited number of cases. We advocate for systematic autopsies in SCD, because positive findings are crucial for choosing the optimal screening program for the relatives. A negative autopsy makes identification of at-risk population difficult. However, this finding also provides clues to the cardiologist, because a limited number of inherited cardiac diseases associated with SCD are without any structural changes. In other cases, the autopsy may reveal noncardiac causes of death, which is also important for reassuring the relatives. However, in cases with no autopsy or negative findings, thorough clinical examinations and selective genetic screening of relatives may identify a likely diagnosis in more than 50% of affected families. There is a need for consensus regarding routine evaluation of SCD cases and the ethical and legal framework related to postmortem testing. We propose an algorithm that narrows the diagnostic possibilities in apparently healthy relatives of young SCD victims. Molecular autopsy may play an important role.
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Affiliation(s)
- Laura Ferrero-Miliani
- Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health Sciences, University of Copenhagen, Frederik V's Vej 11, DK-2100 Copenhagen, Denmark.
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Charron P, Arad M, Arbustini E, Basso C, Bilinska Z, Elliott P, Helio T, Keren A, McKenna WJ, Monserrat L, Pankuweit S, Perrot A, Rapezzi C, Ristic A, Seggewiss H, van Langen I, Tavazzi L. Genetic counselling and testing in cardiomyopathies: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 2010; 31:2715-26. [PMID: 20823110 DOI: 10.1093/eurheartj/ehq271] [Citation(s) in RCA: 339] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Advances in molecular genetics present new opportunities and challenges for cardiologists who manage patients and families with cardiomyopathies. The aims of this position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases are to review the general issues related to genetic counselling, family screening and genetic testing in families with a cardiomyopathy, and to provide key messages and suggestions for clinicians involved in their management.
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Affiliation(s)
- Philippe Charron
- UPMC Univ Paris 6, AP-HP, Hôpital Pitié-Salpêtrière, Centre de Référence Maladies cardiaques héréditaires, Paris, France
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16
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ALOX5AP gene variants show differential association with coronary artery disease in different populations. J Community Genet 2010; 1:107-15. [PMID: 22460243 DOI: 10.1007/s12687-010-0015-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 08/03/2010] [Indexed: 10/19/2022] Open
Abstract
Coronary artery disease (CAD) is a complex disease with various components, genetic as well as environmental. Previous reports correlating ALOX5AP gene variants and CAD showed conflicting results depending on the population studied. In this study, we examined the contribution of ALOX5AP genetic predisposition to CAD in a group of CAD patients and controls carefully selected from the Lebanese population. We genotyped SNPs for ALOX5AP variants in 289 catheterized patients aged ≤52 years with >50% stenosis in at least one main coronary artery and 227 catheterized control subjects aged 60 years and above with 0% stenosis. Chi-square (χ (2)) tests and logistic regression showed no significant difference in the allele and genotype frequencies between the CAD or myocardial infarction (MI) cases and the healthy controls. Haplotype analysis using PHASE showed that the distribution of the risk haplotypes among cases and controls were not significantly different and had no attributable risk to CAD (P = 1.00 and P = 0.5, respectively) or MI (P = 0.2 and P = 0.5, respectively). Our data revealed that ALOX5AP gene variants are not predictors of CAD risk or MI risk among Lebanese patients.
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Ruiter JS, Berkenbosch-Nieuwhof K, van den Berg MP, van Dijk R, Middel B, van Tintelen JP. The importance of the family history in caring for families with long QT syndrome and dilated cardiomyopathy. Am J Med Genet A 2010; 152A:607-12. [PMID: 20186837 DOI: 10.1002/ajmg.a.33270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In potentially inherited cardiac diseases, the family history is of great importance. We looked at the way cardiologists take a family history in patients with idiopathic dilated cardiomyopathy (DCM) or long QT syndrome (LQTS) and whether this led to screening of relatives or other follow-up. We performed retrospective cross-sectional analyses of adult index patients with DCM or LQTS in a general hospital (GH) or a University Medical Center (UMC). We identified 82 index patients with DCM (34 GH; 48 UMC) and 20 with LQTS (all UMC) between 1996 and 2005. Mean follow-up was 58 months. A family history was recorded in 90% of both LQTS and DCM patients most of the cases restricted to first-degree family members. The genetic aspects, counseling and screening of family members was discussed significantly more often with LQTS than DCM patients (all P < 0.05). Also follow-up (screening of family members, DNA analysis and referral) was performed significantly more often in LQTS than DCM patients. Cardiologists in the UMC referred DCM index patients for genetic counseling more often than those in the GH (25% vs. 6%; P < 0.05). Only a few index patients with DCM were referred to a clinical genetics department. One-third of DCM cases and nearly all LQTS cases are familial. Since early recognition and treatment may reduce morbidity and mortality we recommend cardiologists take a more thorough family history and always consider referring to a clinical genetics department in such index patients.
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Affiliation(s)
- Jolien S Ruiter
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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18
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Linnenbringer E, Roberts JS, Hiraki S, Cupples LA, Green RC. "I know what you told me, but this is what I think:" perceived risk of Alzheimer disease among individuals who accurately recall their genetics-based risk estimate. Genet Med 2010; 12:219-27. [PMID: 20139767 PMCID: PMC2921681 DOI: 10.1097/gim.0b013e3181cef9e1] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE This study evaluates the Alzheimer disease risk perceptions of individuals who accurately recall their genetics-based Alzheimer disease risk assessment. METHODS Two hundred forty-six unaffected first-degree relatives of patients with Alzheimer disease were enrolled in a multisite randomized controlled trial examining the effects of communicating APOE genotype and lifetime Alzheimer disease risk information. RESULTS Among the 158 participants who accurately recalled their Alzheimer disease risk assessment 6 weeks after risk disclosure, 75 (47.5%) believed their Alzheimer disease risk was more than 5% points different from the Alzheimer disease risk estimate they were given. Within this subgroup, 69.3% believed that their Alzheimer disease risk was higher than what they were told (discordant high), whereas 30.7% believed that their Alzheimer disease risk was lower (discordant low). Participants with a higher baseline risk perception were more likely to have a discordant-high risk perception (P < 0.05). Participants in the discordant-low group were more likely to be APOE epsilon4 positive (P < 0.05) and to score higher on an Alzheimer disease controllability scale (P < 0.05). CONCLUSION Our results indicate that even among individuals who accurately recall their Alzheimer disease risk assessment, many people do not take communicated risk estimates at face value. Further exploration of this clinically relevant response to risk information is warranted.
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Affiliation(s)
- Erin Linnenbringer
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan 48106-1248, USA.
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19
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Nozyński J, Zakliczyński M, Konecka-Mrówka D, Zegleń S, Przybylski R, Zembala M, Lange D, Zembala-Nozyńska E, Mecik-Kronenberg T, Dabrówka K. Pivotal karyometric measurements in different types of cardiomyopathic morphology: study of hearts explanted from transplant recipients. Transplant Proc 2010; 41:3179-84. [PMID: 19857705 DOI: 10.1016/j.transproceed.2009.07.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Morphometric studies based on the measurement of cardiocyte nuclei have focused on progressive hypertrophy rather than shape, which is a deciding factor for the diagnosis of hypertrophy in myocardial diseases. The aim of this research was to demonstrate how the digital morphology of cardiocyte nuclei change correlated with the type of myocardial pathology. MATERIALS AND METHODS The study groups encompassed 7 hearts with dilated cardiomyopathy (DCM) and 8 hearts with ischemic heart disease (IHD) which were explanted. A comparative group consisting of myocardial hypertrophy was contrasted with a control group of donor heart fragments. Cardiocyte nuclei were evaluated morphometrically on histologic slides. We calculated the nuclear area, length, breadth, perimeter, roundness, elongation, fullness factors, and nuclear chromatin mean gray level. The results were subjected to discriminant analysis. RESULTS All karyometric measurements analyzed by backward discriminant analysis showed only 2 powerful factors: nuclear breadth and chromatin mean gray level. The Mahalanobis distance showed the proximity of control and hypertrophy groups, whereas differences between IHD and DCM were nonsignificant. CONCLUSION The lack of karyometric differences between IHD and DCM suggested a common morphologic response for long-lasting progressive injury. The main morphologic differences were dependent on nuclear chromatin activity/stainability and nuclear breadth, suggesting darker and thinned nuclei in normal and adaptative stages and irregular brighter nuclei in cardiomyopathies.
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Affiliation(s)
- J Nozyński
- Silesian Centre for Heart Diseases, 41-800 Zabrze, Poland
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20
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Abstract
According to the World Health Organization classification of cardiomyopathies, left ventricular noncompaction is still an unclassified cardiomyopathy. In 2006, the American Heart Association classified this entity as a primary cardiomyopathy of genetic origin. In 2008, the European Society of Cardiology updated the classification scheme similar to the World Health Organization classification. At present, there is no consensus on the diagnostic criteria, and diagnosis is based on the morphologic features identified by cardiac imaging studies or at autopsy. Due to lack of standardization of the diagnostic criteria and little awareness of this condition among clinicians, the true prevalence of this disease is not clear. There is no specific therapy for this condition. However, it seems prognosis is much better than initially reported. The current status of diagnosis, prognosis, and management of isolated noncompaction in adults is discussed in this review.
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Affiliation(s)
- Radha J Sarma
- ABIM, Internal Medicine and Cardiovascular Diseases, University of Southern California, Keck School of Medicine, Division of Cardiovascular Medicine, Los Angeles, CA 90033, USA.
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21
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Nozyński J, Zakliczyński M, Konecka-Mrówka D, Zegleń S, Przybylski R, Zembala M, Lange D, Zembala-Nozyńska E, Mecik-Kronenberg T, Dabrówka K. Differences in antiapoptotic, proliferative activities and morphometry in dilated and ischemic cardiomyopathy: study of hearts explanted from transplant recipients. Transplant Proc 2009; 41:3171-8. [PMID: 19857704 DOI: 10.1016/j.transproceed.2009.09.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Antiapoptotic as well as replacement and proliferative mechanisms take place in the myocardium in dilated cardiomyopathy (DCM) and ischemic heart disease (IHD). We sought to estimate antiapoptotic, proliferative and replacement activities in cardiomyopathies. MATERIALS The study groups included seven hearts with DCM and eight with IHD, which had been explanted at the time of transplantation. The comparator group consisted of cases of myocardial hypertrophy and the control group, donor fragments. METHODS Antiapoptotic and proliferative responses were determined immunohistochemically as Bcl-2 and Ki67 expression by semiquantitative assessment of the intensity of staining. We also measured and statistically analyzed the integrative morphometric measurements of the fraction of fibrosis area, the nucleosarcoplasmic ratio, and cardiocyte diameter. RESULTS No Bcl-2 expression was observed in the controls. The strongest reaction was seen in the DCM group, then in the IHD, and in the comparator group of myocardial hypertrophy. Proliferative activity was seen only in endocardial and interstitial fibroblasts in DCM and IHD cases. The cardiocyte diameter showed no statistical association between myocardial hypertrophy and IHD, or IHD and DCM, whereas the nucleosarcoplasmic ratios were significantly different from control groups for all comparisons. Myocardial fibrosis showed the highest values in DCM and IHD. Discriminant analysis showed the value of interstitial fibrosis and cardiocyte diameter to categorize the analyzed groups. CONCLUSIONS Antiapoptotic Bcl-2 activity seemed to play an important role in cardiocyte preservation, while proliferative activity was resticted to interstitial connective tissue cells as a replacement process. Myocardial Bcl-2 expression, the extent of myocardial fibrosis, and cardiocyte diameter may serve as additional diagnostic tools to differentiate cardiomyopathies.
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Affiliation(s)
- J Nozyński
- Silesian Centre for Heart Diseases, 41-800 Zabrze, Poland
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22
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Hershberger RE, Cowan J, Morales A, Siegfried JD. Progress with genetic cardiomyopathies: screening, counseling, and testing in dilated, hypertrophic, and arrhythmogenic right ventricular dysplasia/cardiomyopathy. Circ Heart Fail 2009; 2:253-61. [PMID: 19808347 DOI: 10.1161/circheartfailure.108.817346] [Citation(s) in RCA: 145] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This review focuses on the genetic cardiomyopathies: principally dilated cardiomyopathy, with salient features of hypertrophic cardiomyopathy and arrhythmogenic right ventricular dysplasia/cardiomyopathy, regarding genetic etiology, genetic testing, and genetic counseling. Enormous progress has recently been made in identifying genetic causes for each cardiomyopathy, and key phenotype and genotype information is reviewed. Clinical genetic testing is rapidly emerging with a principal rationale of identifying at-risk asymptomatic or disease-free relatives. Knowledge of a disease-causing mutation can guide clinical surveillance for disease onset, thereby enhancing preventive and treatment interventions. Genetic counseling is also indicated for patients and their family members regarding the symptoms of their cardiomyopathy, its inheritance pattern, family screening recommendations, and genetic testing options and possible results.
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Affiliation(s)
- Ray E Hershberger
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Fla 33136, USA.
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23
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Brauch KM, Karst ML, Herron KJ, de Andrade M, Pellikka PA, Rodeheffer RJ, Michels VV, Olson TM. Mutations in ribonucleic acid binding protein gene cause familial dilated cardiomyopathy. J Am Coll Cardiol 2009; 54:930-41. [PMID: 19712804 DOI: 10.1016/j.jacc.2009.05.038] [Citation(s) in RCA: 257] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 04/07/2009] [Accepted: 05/10/2009] [Indexed: 12/19/2022]
Abstract
OBJECTIVES We sought to identify a novel gene for dilated cardiomyopathy (DCM). BACKGROUND DCM is a heritable, genetically heterogeneous disorder that remains idiopathic in the majority of patients. Familial cases provide an opportunity to discover unsuspected molecular bases of DCM, enabling pre-clinical risk detection. METHODS Two large families with autosomal-dominant DCM were studied. Genome-wide linkage analysis was used to identify a disease locus, followed by fine mapping and positional candidate gene sequencing. Mutation scanning was then performed in 278 unrelated subjects with idiopathic DCM, prospectively identified at the Mayo Clinic. RESULTS Overlapping loci for DCM were independently mapped to chromosome 10q25-q26. Deoxyribonucleic acid sequencing of affected individuals in each family revealed distinct heterozygous missense mutations in exon 9 of RBM20, encoding ribonucleic acid (RNA) binding motif protein 20. Comprehensive coding sequence analyses identified missense mutations clustered within this same exon in 6 additional DCM families. Mutations segregated with DCM (peak composite logarithm of the odds score >11.49), were absent in 480 control samples, and altered residues within a highly conserved arginine/serine (RS)-rich region. Expression of RBM20 messenger RNA was confirmed in human heart tissue. CONCLUSIONS Our findings establish RBM20 as a DCM gene and reveal a mutation hotspot in the RS domain. RBM20 is preferentially expressed in the heart and encodes motifs prototypical of spliceosome proteins that regulate alternative pre-messenger RNA splicing, thus implicating a functionally distinct gene in human cardiomyopathy. RBM20 mutations are associated with young age at diagnosis, end-stage heart failure, and high mortality.
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Affiliation(s)
- Katharine M Brauch
- Cardiovascular Genetics Laboratory, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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24
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Blockade of the IKs potassium channel: An overlooked cardiovascular liability in drug safety screening? J Pharmacol Toxicol Methods 2009; 60:1-10. [DOI: 10.1016/j.vascn.2009.04.197] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Accepted: 04/25/2009] [Indexed: 12/25/2022]
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25
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Guay-Woodford LM, Knoers NV. Genetic Testing: Considerations for Pediatric Nephrologists. Semin Nephrol 2009; 29:338-48. [DOI: 10.1016/j.semnephrol.2009.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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26
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Kubistova Z, Mrazek F, Petrek M. POLYMORPHISMS OF THE IMMUNE RESPONSE GENES:SELECTED BIOLOGICAL, METHODICAL AND MEDICAL ASPECTS. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2009; 153:93-102. [DOI: 10.5507/bp.2009.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Colombo MG, Botto N, Vittorini S, Paradossi U, Andreassi MG. Clinical utility of genetic tests for inherited hypertrophic and dilated cardiomyopathies. Cardiovasc Ultrasound 2008; 6:62. [PMID: 19099557 PMCID: PMC2630295 DOI: 10.1186/1476-7120-6-62] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Accepted: 12/19/2008] [Indexed: 12/29/2022] Open
Abstract
Genetic testing has become an increasingly important part of medical practice for heritable form of cardiomyopathies. Hypertrophic cardiomyopathy and about 50% of idiopathic dilatative cardiomyopathy are familial diseases, with an autosomal dominant pattern of inheritance. Some genotype-phenotype correlations can provide important information to target DNA analyses in specific genes. Genetic testing may clarify diagnosis and help the optimal treatment strategies for more malignant phenotypes. In addition, genetic screening of first-degree relatives can help early identification and diagnosis of individuals at greatest risk for developing cardiomyopathy, allowing to focus clinical resources on high-risk family members. This paper provides a concise overview of the genetic etiology as well as the clinical utilities and limitations of genetic testing for the heritable cardiomyopathies.
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Affiliation(s)
- Maria Giovanna Colombo
- Genetics Research Unit G, Monasterio Foundation, CNR-Regione Toscana, CNR Institute of Clinical Physiology, Massa, Italy.
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28
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Cellular properties of C-terminal KCNH2 long QT syndrome mutations: Description and divergence from clinical phenotypes. Heart Rhythm 2008; 5:1159-67. [DOI: 10.1016/j.hrthm.2008.04.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Accepted: 04/15/2008] [Indexed: 11/22/2022]
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29
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Abstract
Genetics has transformed the use of family history information and has led to the reemergence of the detailed genetic family history. It is critical that public and professional educational efforts to increase family history awareness and working knowledge are prioritized. Patient maintenance of the pedigree provides increased patient awareness and facilitates some of the limitations associated with conventional medical history ascertainment, ultimately improving health care and research. The increasing use of genetic screening promises to cultivate a paradigm shift in medical treatment emphasizing primary prevention and early intervention. Appreciation of the family history is necessary to make this important advance.
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Affiliation(s)
- Robert B Hinton
- Division of Cardiology, MLC 2003, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
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30
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Cowan J, Morales A, Dagua J, Hershberger RE. Genetic testing and genetic counseling in cardiovascular genetic medicine: overview and preliminary recommendations. ACTA ACUST UNITED AC 2008; 14:97-105. [PMID: 18401220 DOI: 10.1111/j.1751-7133.2008.08217.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In this emerging era of cardiovascular genetic medicine, increasing responsibility will be placed on cardiovascular practitioners to be aware of the latest clinical genetic testing methods and the knowledge base needed to interpret genetic test results. Some cardiovascular specialists will develop the expertise within the field to order genetic testing and interpret results, while other practitioners will refer patients to centers of excellence in cardiovascular genetic medicine. A previous article in the Cardiovascular Genetic Medicine: Clinical Perspectives and Future Applications series(1) highlighted an increasing recognition of the cardiomyopathies (hypertrophic [HCM], dilated [DCM], arrhythmogenic right ventricular dysplasia [ARVD]) and channelopathies (long QT syndrome [LQTS] and others) as genetic diseases, and focused on the importance of a targeted family history as a critical part of patient evaluation. The goal of this article, second in the series, is to provide a general framework for understanding the principles of genetic testing and genetic counseling. We review the growing number of genetic tests currently available to cardiac specialists, the selection of an appropriate test, and the numerous genetic counseling issues raised by the testing process. We also provide our preliminary recommendations for genetic testing in cardiovascular genetic medicine.
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Affiliation(s)
- Jason Cowan
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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31
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Hershberger RE. Cardiovascular genetic medicine: evolving concepts, rationale, and implementation. J Cardiovasc Transl Res 2008; 1:137-43. [PMID: 20559908 DOI: 10.1007/s12265-008-9031-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Accepted: 04/09/2008] [Indexed: 10/22/2022]
Abstract
Cardiovascular genetic medicine is devoted to the identification and understanding of cardiac conditions resulting from genetic and genomic mechanisms and to the development and validation of diagnostic and treatment algorithms and guidelines. Cardiovascular genetic medicine clinics now provide expert cardiovascular subspecialty care, genetic counseling and clinical genetic testing, and will eventually provide disease-specific gene or genetic therapies. Currently, the most tractable diagnoses for cardiovascular genetic medicine are the single-gene disorders: the cardiomyopathies, the channelopathies, and others. The recent explosion of genetic knowledge within the single-gene disorders and consequent rapid proliferation of genetic testing enables far greater numbers of individuals to directly benefit from this progress. A compelling rationale exists for this approach: cardiovascular single-gene diseases commonly present with life-threatening events (e.g., sudden cardiac death, heart failure, stroke, etc.), but identification, evaluation, and treatment of individuals with presymptomatic genetic risk has the promise to prevent or ameliorate cardiovascular morbidity and mortality. Cardiovascular genetic medicine programs also anchor training and research, thereby enabling the next generation of academic specialists in cardiovascular genetic medicine to continue to improve cardiovascular health.
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Affiliation(s)
- Ray E Hershberger
- Cardiovascular Division, Clinical Research Building, Miller School of Medicine, University of Miami, Miami, FL 33101, USA.
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32
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Nauman D, Morales A, Cowan J, Dagua J, Hershberger RE. The family history as a tool to identify patients at risk for dilated cardiomyopathy. ACTA ACUST UNITED AC 2008; 23:41-4. [PMID: 18326985 DOI: 10.1111/j.1751-7117.2008.08223.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Deirdre Nauman
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
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33
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Morales A, Cowan J, Dagua J, Hershberger RE. Family History: An Essential Tool for Cardiovascular Genetic Medicine. ACTA ACUST UNITED AC 2008; 14:37-45. [DOI: 10.1111/j.1751-7133.2008.08201.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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34
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Tang WW, Francis GS. The Year in Heart Failure. J Am Coll Cardiol 2007; 50:2344-51. [DOI: 10.1016/j.jacc.2007.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2007] [Revised: 08/31/2007] [Accepted: 09/07/2007] [Indexed: 12/24/2022]
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35
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Schwartz M, Kipnis J. Self and non-self discrimination is needed for the existence rather than deletion of autoimmunity: the role of regulatory T cells in protective autoimmunity. Cell Mol Life Sci 2004; 61:2285-9. [PMID: 15378200 PMCID: PMC11138711 DOI: 10.1007/s00018-004-4233-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Autoimmune T cells have been viewed for decades as an outcome of immune system malfunction, and specifically as a failure to distinguish between components of self and non-self. The need for discrimination between self and non-self as a way to avoid autoimmunity has been repeatedly debated over the years. Recent studies suggest that autoimmunity, at least in the nervous system, is the body's defense mechanism against deviations from the normal. The ability to harness neuroprotective autoimmunity upon need is evidently allowed by naturally occurring CD4+CD25+ regulatory T cells, which are themselves controlled by brain-derived compounds. These findings challenge widely accepted concepts of the need for discrimination between self and non-self, as they suggest that while such discrimination is indeed required, it is needed not as a way to avoid an anti-self response but to ensure its proper regulation. Whereas a response to non-self can be self-limited by a decreased presence of the relevant antigen, the response to self needs a mechanism for strict control, such as that provided by the naturally occurring regulatory T cells.
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Affiliation(s)
- M Schwartz
- Department of Neurobiology, The Weizmann Institute of Science, Rehovot, Israel.
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