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Sato M, Sato A, Saiki H, Kato K, Ohno S, Horie M. Vasospastic angina preceding diagnosis of arrhythmogenic cardiomyopathy in a young athlete. HeartRhythm Case Rep 2024; 10:577-581. [PMID: 39155900 PMCID: PMC11328590 DOI: 10.1016/j.hrcr.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024] Open
Affiliation(s)
- Maki Sato
- Division of Pediatric Cardiology, Department of Pediatrics, School of Medicine, Iwate Medical University, Shiwa, Japan
| | - Akira Sato
- Division of Pediatric Cardiology, Department of Pediatrics, School of Medicine, Iwate Medical University, Shiwa, Japan
| | - Hirofumi Saiki
- Division of Pediatric Cardiology, Department of Pediatrics, School of Medicine, Iwate Medical University, Shiwa, Japan
| | - Koichi Kato
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Seiko Ohno
- Medical Genome Center, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Minoru Horie
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan
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Yamamoto T, Emoto Y, Murase T, Umehara T, Miura A, Nishiguchi M, Ikematsu K, Nishio H. Molecular autopsy for sudden death in Japan. J Toxicol Pathol 2024; 37:1-10. [PMID: 38283375 PMCID: PMC10811381 DOI: 10.1293/tox.2023-0080] [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: 06/21/2023] [Accepted: 08/17/2023] [Indexed: 01/30/2024] Open
Abstract
Japan has various death investigation systems; however, external examinations, postmortem computed tomography, macroscopic examinations, and microscopic examinations are performed regardless of the system used. These examinations can reveal morphological abnormalities, whereas the cause of death in cases with non-morphological abnormalities can be detected through additional examinations. Molecular autopsy and postmortem genetic analyses are important additional examinations. They are capable of detecting inherited arrhythmias or inherited metabolic diseases, which are representative non-morphological disorders that cause sudden death, especially in infants and young people. In this review, we introduce molecular autopsy reports from Japan and describe our experience with representative cases. The relationships between drug-related deaths and genetic variants are also reviewed. Based on the presented information, molecular autopsy is expected to be used as routine examinations in death investigations because they can provide information to save new lives.
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Affiliation(s)
- Takuma Yamamoto
- Department of Legal Medicine, Hyogo College of Medicine, 1-1
Mukogawa-cho, Nishinomiya-shi, Hyogo 663-8501, Japan
| | - Yuko Emoto
- Department of Legal Medicine, Kansai Medical University,
2-5-1 Shinmachi, Hirakata-shi, Osaka 573-1010, Japan
| | - Takehiko Murase
- Division of Forensic Pathology and Science, Department of
Medical and Dental Sciences, Graduate School of Biomedical Sciences, School of Medicine,
Nagasaki University, 1-12-4 Sakamoto, Nagasaki-shi, Nagasaki 852-8523, Japan
| | - Takahiro Umehara
- Department of Forensic Medicine, School of Medicine,
University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku,
Kitakyushu-shi, Fukuoka 807-8555, Japan
| | - Aya Miura
- Department of Legal Medicine, Hyogo College of Medicine, 1-1
Mukogawa-cho, Nishinomiya-shi, Hyogo 663-8501, Japan
| | - Minori Nishiguchi
- Department of Legal Medicine, Hyogo College of Medicine, 1-1
Mukogawa-cho, Nishinomiya-shi, Hyogo 663-8501, Japan
| | - Kazuya Ikematsu
- Division of Forensic Pathology and Science, Department of
Medical and Dental Sciences, Graduate School of Biomedical Sciences, School of Medicine,
Nagasaki University, 1-12-4 Sakamoto, Nagasaki-shi, Nagasaki 852-8523, Japan
| | - Hajime Nishio
- Department of Legal Medicine, Hyogo College of Medicine, 1-1
Mukogawa-cho, Nishinomiya-shi, Hyogo 663-8501, Japan
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Miura A, Yamamoto T, Funayama K, Koyama A, Takatsuka H, Sato T, Nishio H. Postmortem Identification of Genetic Variations Associated with Sudden Unexpected Death in Young People. Int Heart J 2024; 65:55-62. [PMID: 38296580 DOI: 10.1536/ihj.23-252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Sudden unexpected death in the young (SUDY) is a traumatic occurrence for their family; however, information on the genetic variations associated with the condition is currently lacking. It is important to carry out postmortem genetic analyses in cases of sudden death to provide information for relatives and to allow appropriate genetic counselling and clinical follow-up. This study aimed to investigate the genetic variations associated with the occurrence of SUDY in Japan, using next-generation sequencing (NGS). The study included 18 cases of SUDY (16 males, 2 females; age 15-47 years) who underwent autopsy, including NGS DNA sequencing for molecular analysis. A total of 168 genes were selected from the sequencing panel and filtered, resulting in the identification of 60 variants in cardiac disease-related genes. Many of the cases had several of these genetic variants and some cases had a cardiac phenotype. The identification of genetic variants using NGS provides important information regarding the pathogenicity of sudden death.
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Affiliation(s)
- Aya Miura
- Department of Legal Medicine, Hyogo Medical University
| | | | - Kazuhisa Funayama
- Division of Legal Medicine, Department of Community Preventive Medicine, Niigata University Graduate School of Medicine and Dental Sciences
| | - Akihide Koyama
- Division of Legal Medicine, Department of Community Preventive Medicine, Niigata University Graduate School of Medicine and Dental Sciences
| | - Hisakazu Takatsuka
- Division of Legal Medicine, Department of Community Preventive Medicine, Niigata University Graduate School of Medicine and Dental Sciences
| | - Takako Sato
- Department of Legal Medicine, Osaka Medical and Pharmaceutical University, Osaka
| | - Hajime Nishio
- Department of Legal Medicine, Hyogo Medical University
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4
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Lin Y, Huang J, He S, Feng R, Zhong Z, Liu Y, Ye W, Li X, Liao H, Fei H, Rao F, Shan Z, Deng C, Zhan X, Xue Y, Liu H, Zhang B, Wang K, Zhang Q, Wu S, Lin X. Case report of familial sudden cardiac death caused by a DSG2 p.F531C mutation as genetic background when carrying with heterozygous KCNE5 p.D92E/E93X mutation. BMC MEDICAL GENETICS 2018; 19:148. [PMID: 30129429 PMCID: PMC6102856 DOI: 10.1186/s12881-018-0580-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 04/19/2018] [Indexed: 02/06/2023]
Abstract
Background Sudden cardiac death (SCD) induced by malignant ventricular tachycardia (MVT) among young adults with right ventricular cardiomyopathy/dysplasia (ARVC/D) is a devastating event. Parts of ARVC/D patients have a mutation in genes encoding components of cardiac desmosomes, such as desmoglein-2 (DSG2), plakophilin-2 and desmoplakin. Case presentation Here we report a potentially pathogenic mutation in the DSG2 gene, which was identified in a family with ARVC/D using Whole Exome Sequencing (WES) and Sanger Sequencing. In all, Patient III:1 with ARVC/D carried the compound heterozygous mutations of DSG2 p.F531C and KCNE5 p.D92E/E93X, which were both inherited from her mother (II:2), who died of SCD. Carriers of DSG2p.F531C showed various phenotypes, such as ARVC/D, SCD, MVT and dilated cardiomyopathy. For III:1, there were significant low-voltage regions in the inferior-apical, inferior-lateral wall of the right ventricular epicardium and outflow tracts of the right ventricle. Under the guidance of a three-dimensional mapping system, MVT was successfully ablated with an epicardial–endocardial approach targeting for late, double or fragmental potentials after implantable cardioverter-defibrillator (ICD) electrical storms. No VT recurrence was observed during the one year of follow-up. Conclusions When coexisting with heterozygous KCNE5 p.D92E/E93X, heterozygous DSG2 p.F531C as a genetic background was found to predispose to ARVC/D, SCD and MVT, which were successfully ablated using an epicardial–endocardial approach. Electronic supplementary material The online version of this article (10.1186/s12881-018-0580-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yubi Lin
- Department of Cardiology and Cardiovascular Intervention, Interventional Medical Center, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, People's Republic of China.,Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Affiliated to Medical school of South China University of Technology, Guangzhou, 510080/520006, People's Republic of China
| | - Jiana Huang
- Department of Cardiology and Cardiovascular Intervention, Interventional Medical Center, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, People's Republic of China.,Jinan University, Guangzhou, 510630, China
| | - Siqi He
- Department of Cardiology and Cardiovascular Intervention, Interventional Medical Center, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, People's Republic of China.,Jinan University, Guangzhou, 510630, China
| | - Ruiling Feng
- Department of Cardiology and Cardiovascular Intervention, Interventional Medical Center, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, People's Republic of China.,Jinan University, Guangzhou, 510630, China
| | - ZhiAn Zhong
- Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Affiliated to Medical school of South China University of Technology, Guangzhou, 510080/520006, People's Republic of China
| | - Yang Liu
- Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Affiliated to Medical school of South China University of Technology, Guangzhou, 510080/520006, People's Republic of China
| | - Weitao Ye
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China
| | - Xin Li
- Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Affiliated to Medical school of South China University of Technology, Guangzhou, 510080/520006, People's Republic of China
| | - Hongtao Liao
- Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Affiliated to Medical school of South China University of Technology, Guangzhou, 510080/520006, People's Republic of China
| | - Hongwen Fei
- Department of Echocardiography, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China
| | - Fang Rao
- Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Affiliated to Medical school of South China University of Technology, Guangzhou, 510080/520006, People's Republic of China
| | - Zhixin Shan
- Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Affiliated to Medical school of South China University of Technology, Guangzhou, 510080/520006, People's Republic of China
| | - Chunyu Deng
- Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Affiliated to Medical school of South China University of Technology, Guangzhou, 510080/520006, People's Republic of China
| | - Xianzhang Zhan
- Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Affiliated to Medical school of South China University of Technology, Guangzhou, 510080/520006, People's Republic of China
| | - Yumei Xue
- Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Affiliated to Medical school of South China University of Technology, Guangzhou, 510080/520006, People's Republic of China
| | - Hui Liu
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People's Republic of China
| | - Bin Zhang
- Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Affiliated to Medical school of South China University of Technology, Guangzhou, 510080/520006, People's Republic of China
| | - Kejian Wang
- Lin He's Academician Workstation of New Medicine and Clinical Translation at The Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, 510150, People's Republic of China
| | - Qianhuan Zhang
- Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Affiliated to Medical school of South China University of Technology, Guangzhou, 510080/520006, People's Republic of China
| | - Shulin Wu
- Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangdong Provincial Key Laboratory of Clinical Pharmacology, Affiliated to Medical school of South China University of Technology, Guangzhou, 510080/520006, People's Republic of China.
| | - Xiufang Lin
- Department of Cardiology and Cardiovascular Intervention, Interventional Medical Center, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, 519000, People's Republic of China.
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Sato T, Nishio H, Suzuki K. Identification of arrhythmogenic right ventricular cardiomyopathy-causing gene mutations in young sudden unexpected death autopsy cases. J Forensic Sci 2015; 60:457-61. [PMID: 25693453 DOI: 10.1111/1556-4029.12657] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 02/25/2014] [Accepted: 03/07/2014] [Indexed: 12/13/2022]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) results in an increased risk of sudden death. We sought mutations of desmoglein-2 (DSG2), desmoplakin (DSP), and plakophilin-2 (PKP2) in 15 cases of sudden death whose causes of death could not be determined at autopsy. In three victims, mutations were identified in DSP. Two of these mutations were novel; one had previously been reported in a patient with ARVC that had been diagnosed clinically. Histological findings were not typical of ARVC; however, it was notable that these mutations were present in three of 15 cases, a relatively high proportion. The causal relationship between the mutations and ARVC is unclear, but the mutations might have been associated with faulty desmosomal proteins resulting in fatal arrhythmia. Combining information gathered by the traditional means of gross and histological examination with postmortem genetic analysis of young victims would assist in identifying their cause of death.
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Affiliation(s)
- Takako Sato
- Department of Legal Medicine, Osaka Medical College, 2-7 Daigaku, Takatsuki, 569-8686, Japan
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Calore M, Lorenzon A, De Bortoli M, Poloni G, Rampazzo A. Arrhythmogenic cardiomyopathy: a disease of intercalated discs. Cell Tissue Res 2014; 360:491-500. [PMID: 25344329 DOI: 10.1007/s00441-014-2015-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 09/18/2014] [Indexed: 01/13/2023]
Abstract
Arrhythmogenic cardiomyopathy (ACM) is an acquired progressive disease having an age-related penetrance and showing clinical manifestations usually during adolescence and young adulthood. It is characterized clinically by a high incidence of severe ventricular tachyarrhythmias and sudden cardiac death and pathologically by degeneration of ventricular cardiomyocytes with replacement by fibro-fatty tissue. Whereas, in the past, the disease was considered to involve only the right ventricle, more recent clinical studies have established that the left ventricle is frequently involved. ACM is an inherited disease in up to 50% of cases, with predominantly an autosomal dominant pattern of transmission, although recessive inheritance has also been described. Since most of the pathogenic mutations have been identified in genes encoding desmosomal proteins, ACM is currently defined as a disease of desmosomes. However, on the basis of the most recent description of the intercalated disc organization and of the identification of a novel ACM gene encoding for an area composita protein, ACM can be considered as a disease of the intercalated disc, rather than only as a desmosomal disease. Despite increasing knowledge of the genetic basis of ACM, we are just beginning to understand early molecular events leading to cardiomyocyte degeneration, fibrosis and fibro-fatty substitution. This review summarizes recent advances in our comprehension of the link between the molecular genetics and pathogenesis of ACM and of the novel role of cardiac intercalated discs.
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Affiliation(s)
- Martina Calore
- Department of Biology, University of Padua, Via G. Colombo 3, 35131, Padua, Italy
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Alcalde M, Campuzano O, Berne P, García-Pavía P, Doltra A, Arbelo E, Sarquella-Brugada G, Iglesias A, Alonso-Pulpon L, Brugada J, Brugada R. Stop-gain mutations in PKP2 are associated with a later age of onset of arrhythmogenic right ventricular cardiomyopathy. PLoS One 2014; 9:e100560. [PMID: 24967631 PMCID: PMC4072667 DOI: 10.1371/journal.pone.0100560] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 05/28/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a cardiac disease characterized by the presence of fibrofatty replacement of the right ventricular myocardium, which may cause ventricular arrhythmias and sudden cardiac death. Pathogenic mutations in several genes encoding mainly desmosomal proteins have been reported. Our aim is to perform genotype-phenotype correlations to establish the diagnostic value of genetics and to assess the role of mutation type in age-related penetrance in ARVC. METHODS AND RESULTS Thirty unrelated Spanish patients underwent a complete clinical evaluation. They all were screened for PKP2, DSG2, DSC2, DSP, JUP and TMEM43 genes. A total of 70 relatives of four families were also studied. The 30 patients fulfilled definite disease diagnostic criteria. Genetic analysis revealed a pathogenic mutation in 19 patients (13 in PKP2, 3 in DSG2, 2 in DSP, and 1 in DSC2). Nine of these mutations created a truncated protein due to the generation of a stop codon. Familial assessment revealed 28 genetic carriers among family members. Stop-gain mutations were associated to a later age of onset of ARVC, without differences in the severity of the pathology. CONCLUSIONS Familial genetic analysis helps to identify the cause responsible for the pathology. In discrepancy with previous studies, the presence of a truncating protein does not confer a worse severity. This information could suggest that truncating proteins may be compensated by the normal allele and that missense mutations may act as poison peptides.
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Affiliation(s)
- Mireia Alcalde
- Cardiovascular Genetics Centre, University of Girona-IDIBGI, Girona, Spain
| | - Oscar Campuzano
- Cardiovascular Genetics Centre, University of Girona-IDIBGI, Girona, Spain
| | - Paola Berne
- Arrhythmia Section, Thorax Institute, Hospital Clinic, Barcelona, Spain
| | - Pablo García-Pavía
- Cardiomyopathy Unit, Heart Failure and Heart Transplant Section, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Ada Doltra
- Arrhythmia Section, Thorax Institute, Hospital Clinic, Barcelona, Spain
| | - Elena Arbelo
- Arrhythmia Section, Thorax Institute, Hospital Clinic, Barcelona, Spain
| | | | - Anna Iglesias
- Cardiovascular Genetics Centre, University of Girona-IDIBGI, Girona, Spain
| | - Luis Alonso-Pulpon
- Cardiomyopathy Unit, Heart Failure and Heart Transplant Section, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Josep Brugada
- Arrhythmia Section, Thorax Institute, Hospital Clinic, Barcelona, Spain
| | - Ramon Brugada
- Cardiovascular Genetics Centre, University of Girona-IDIBGI, Girona, Spain
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Rickelt S, Pieperhoff S. Mutations with pathogenic potential in proteins located in or at the composite junctions of the intercalated disk connecting mammalian cardiomyocytes: a reference thesaurus for arrhythmogenic cardiomyopathies and for Naxos and Carvajal diseases. Cell Tissue Res 2012; 348:325-33. [PMID: 22450909 PMCID: PMC3349860 DOI: 10.1007/s00441-012-1365-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 02/03/2012] [Indexed: 01/30/2023]
Abstract
In the past decade, an avalanche of findings and reports has correlated arrhythmogenic ventricular cardiomyopathies (ARVC) and Naxos and Carvajal diseases with certain mutations in protein constituents of the special junctions connecting the polar regions (intercalated disks) of mature mammalian cardiomyocytes. These molecules, apparently together with some specific cytoskeletal proteins, are components of (or interact with) composite junctions. Composite junctions contain the amalgamated fusion products of the molecules that, in other cell types and tissues, occur in distinct separate junctions, i.e. desmosomes and adherens junctions. As the pertinent literature is still in an expanding phase and is obviously becoming important for various groups of researchers in basic cell and molecular biology, developmental biology, histology, physiology, cardiology, pathology and genetics, the relevant references so far recognized have been collected and are presented here in the following order: desmocollin-2 (Dsc2, DSC2), desmoglein-2 (Dsg2, DSG2), desmoplakin (DP, DSP), plakoglobin (PG, JUP), plakophilin-2 (Pkp2, PKP2) and some non-desmosomal proteins such as transmembrane protein 43 (TMEM43), ryanodine receptor 2 (RYR2), desmin, lamins A and C, striatin, titin and transforming growth factor-β3 (TGFβ3), followed by a collection of animal models and of reviews, commentaries, collections and comparative studies.
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Affiliation(s)
- Steffen Rickelt
- Helmholtz Group for Cell Biology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, Building TP4, 69120 Heidelberg, Germany
- Progen Biotechnik, Heidelberg, Germany
| | - Sebastian Pieperhoff
- BHF Centre for Cardiovascular Science, The Queen’s Medical Research Institute, University of Edinburgh, 47 Little France Crescent, EH164TJ Edinburgh, Scotland UK
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