1
|
Bonilla JC, Parra-Medina R, Chaves JJ, Campuzano O, Sarquella-Brugada G, Brugada R, Brugada J. [Molecular autopsy in sudden cardiac death]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2018; 88:306-312. [PMID: 30030015 DOI: 10.1016/j.acmx.2018.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 06/06/2018] [Accepted: 06/09/2018] [Indexed: 10/28/2022] Open
Abstract
Currently, there are a significant percentage of autopsies left without a conclusive diagnosis of death, especially when this lethal event occurs suddenly. Genetic analysis has been recently incorporated into the field of forensic medicine, especially in patients with sudden death and where no conclusive cause of death is identified after a complete medical-legal autopsy. Inherited arrhythmogenic diseases are the main cause of death in these cases. To date, more than 40 genes have been associated with arrhythmogenic disease, and causing sudden cardiac death has been described. The main arrhythmogenic diseases are Long QT Syndrome, Catecholaminergic Polymorphic Ventricular Tachycardia, Brugada Syndrome, and Short QT Syndrome. These post-mortem genetic studies, not only allow a diagnosis of the cause of death, but also allow a clinical translation in relatives, focusing on the early identification of individuals at risk of syncope, as well as adopting personalised therapeutic measures for the prevention of a lethal arrhythmic episode.
Collapse
Affiliation(s)
- Juan Carlos Bonilla
- Departamento de Patología, Hospital de San José, Hospital Infantil Universitario de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia.
| | - Rafael Parra-Medina
- Departamento de Patología, Hospital de San José, Hospital Infantil Universitario de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia; Instituto de Investigación, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
| | - Juan José Chaves
- Departamento de Patología, Hospital de San José, Hospital Infantil Universitario de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
| | - Oscar Campuzano
- Cardiovascular Genetics Center, Institut d'Investigació Biomèdica Girona (IDIBGI), Universidad de Girona, Girona, España; Department de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares-CIBERCV, Madrid, España
| | | | - Ramón Brugada
- Cardiovascular Genetics Center, Institut d'Investigació Biomèdica Girona (IDIBGI), Universidad de Girona, Girona, España; Department de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares-CIBERCV, Madrid, España; Servicio de Cardiología, Hospital Josep Trueta, Girona, España
| | - Josep Brugada
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares-CIBERCV, Madrid, España; Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universidad de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
| |
Collapse
|
2
|
Campuzano O, Sanchez-Molero O, Fernandez A, Iglesias A, Brugada R. Muerte súbita cardiaca de origen arrítmico: valor del análisis genético post mortem. REVISTA ESPAÑOLA DE MEDICINA LEGAL 2018; 44:32-37. [DOI: 10.1016/j.reml.2017.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
|
3
|
Whole exome sequencing identified a pathogenic mutation in RYR2 in a Chinese family with unexplained sudden death. J Electrocardiol 2017; 51:309-315. [PMID: 29132927 DOI: 10.1016/j.jelectrocard.2017.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study aimed to identify the pathogenic mutation in a Chinese family with unexplained sudden death (USD) or occasional syncope. MATERIALS AND METHODS Whole exome sequencing and target capture sequencing were respectively conducted for two related patients. The genetic data was screened using the 1000 genomes project and SNP database (PubMed), and the identified mutations were assessed for predicted pathogenicity using the SIFT and Polyphen-2 algorithms. RESULTS We identified a heterozygous mutation in the RYR2 gene at c.490C>T (p.P164S), highly conserved across all species, in three family members of USD, syncope and malignant ventricular tachycardias induced by treadmill exercise test, while another heterozygous de novo mutation in SCN5A at c.5576G>A p.R1859H was detected in one family member. Both variants were verified by Sanger sequencing. Importantly, RYR2 p.P164S is associated with the risk of sudden cardiac death, such as in catecholaminergic polymorphic ventricular tachycardia. CONCLUSIONS A pathogenic mutation in RYR2 (p.P164S) is the likely cause of USD in a Chinese family associated with malignant ventricular arrhythmias. Whole exome and target capture sequencing can be useful for discovering the genetic causes of USD.
Collapse
|
4
|
Campuzano O, Sanchez-Molero O, Mademont-Soler I, Coll M, Allegue C, Ferrer-Costa C, Mates J, Perez-Serra A, Del Olmo B, Iglesias A, Sarquella-Brugada G, Brugada J, Borondo JC, Castella J, Medallo J, Brugada R. Genetic analysis in post-mortem samples with micro-ischemic alterations. Forensic Sci Int 2017; 271:120-125. [PMID: 28086167 DOI: 10.1016/j.forsciint.2016.12.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/30/2016] [Accepted: 12/23/2016] [Indexed: 11/30/2022]
Abstract
Sudden cardiac arrest is a leading cause of death worldwide. Most cardiac arrests happen in patients who have previously suffered a myocardial infarct. The risk of sudden death after infarction may increase in people who carry a pathogenic genetic alteration in cardiac ion channels. We hypothesized that micro-ischemia could trigger lethal arrhythmogenesis, thus we sought to identify genetic alterations in cardiac ion channels in patients with micro-ischemic disease. We studied a cohort of 56 post-mortem samples. Autopsy studies identified myocardial infarction as the cause of death in each case. We used both Sanger sequencing and next-generation sequencing to screen candidate genes associated with sudden cardiac death. We identified six rare missense genetic variations in five unrelated patients. Two variants have been previously reported; one is associated with atrial fibrillation (SCN5A_p.H445D), and the other is predicted to be benign (ANK2_p.T2059M). The novel variants were predicted in silico as benign, except for one (RyR2_p.M4019T), which was classified as deleterious. Our post-mortem, micro-infarction cohort displayed a rate of nearly 10% non-common genetic variants. However, the clinical significance of most of the identified variants remains unknown due to lack of family assessment. Further analyses should be performed in large cohorts to clarify the role of ion-channel gene analysis in samples showing microscopic ischemic alterations.
Collapse
Affiliation(s)
- Oscar Campuzano
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain; Medical Science Department, School of Medicine, University of Girona, Girona, Spain
| | | | | | - Monica Coll
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
| | - Catarina Allegue
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
| | | | - Jesus Mates
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
| | | | - Bernat Del Olmo
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
| | - Anna Iglesias
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
| | | | - Josep Brugada
- Arrhythmias Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Juan Carlos Borondo
- Histopathology Unit, Instituto Nacional de Toxicología y Ciencias Forenses (INTCF), Barcelona, Spain
| | - Josep Castella
- Forensic Pathology Service, Institut de Medicina Legal i Ciencies Forenses de Catalunya (IMLCFC), Barcelona, Spain
| | - Jordi Medallo
- Forensic Pathology Service, Institut de Medicina Legal i Ciencies Forenses de Catalunya (IMLCFC), Barcelona, Spain
| | - Ramon Brugada
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain; Medical Science Department, School of Medicine, University of Girona, Girona, Spain; Cardiology Service, Hospital Josep Trueta, Girona, Spain.
| |
Collapse
|
5
|
Abstract
PURPOSE OF REVIEW Recent international expert consensus statements have updated the clinical and genetic diagnoses of patients suffering from arrhythmogenic diseases. However, a lack of genotype-phenotype correlations has hampered the development of a risk stratification scale for sudden cardiac death. RECENT FINDINGS The improvement in the field of genetics has prompted the discovery of new genes associated with sudden cardiac death. Sudden cardiac death is a socially devastating event, especially when it occurs in the pediatric population. Physical activity can often trigger the arrhythmia and sudden death may be the first symptom. These inherited cardiac diseases may be difficult to diagnose, leaving family members also at risk. Thanks to the development of new high-throughput technologies, genetics may be used in the diagnosis of these diseases and even cases that remain unexplained after a comprehensive autopsy. Genetic testing cannot only identify the causative genetic variant in the index case, but it enables the detection of relatives at risk of sudden death, despite remaining clinically asymptomatic. SUMMARY We review the recent advances in the genetics of inherited arrhythmias associated with sudden cardiac death. We focus on the pediatric population, the main group of people suffering from lethal inherited arrhythmias.
Collapse
|
6
|
Campuzano O, Sarquella-Brugada G, Brugada R, Brugada J. Genetics of channelopathies associated with sudden cardiac death. Glob Cardiol Sci Pract 2015; 2015:39. [PMID: 26566530 PMCID: PMC4625210 DOI: 10.5339/gcsp.2015.39] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 06/30/2015] [Indexed: 12/19/2022] Open
Abstract
Recent technological advances in cardiology have resulted in new guidelines for the diagnosis, treatment and prevention of diseases. Despite these improvements, sudden death remains one of the main challenges to clinicians because the majority of diseases associated with sudden cardiac death are characterized by incomplete penetrance and variable expressivity. Hence, patients may be unaware of their illness, and physical activity can be the trigger for syncope as first symptom of the disease. Most common causes of sudden cardiac death are congenital alterations and structural heart diseases, although a significant number remain unexplained after comprehensive autopsy. In these unresolved cases, channelopathies are considered the first potential cause of death. Since all these diseases are of genetic origin, family members could be at risk, despite being asymptomatic. Genetics has also benefited from technological advances, and genetic testing has been incorporated into the sudden death field, identifying the cause in clinically affected patients, asymptomatic family members and post-mortem cases without conclusive diagnosis. This review focuses on recent advances in the genetics of channelopathies associated with sudden cardiac death.
Collapse
Affiliation(s)
- Oscar Campuzano
- Cardiovascular Genetics Center, University of Girona - IDIBGI, Spain ; Department of Medical Sciences, School of Medicine, University of Girona, Spain
| | | | - Ramon Brugada
- Cardiovascular Genetics Center, University of Girona - IDIBGI, Spain ; Department of Medical Sciences, School of Medicine, University of Girona, Spain
| | - Josep Brugada
- Unit of Arrhythmias, Hospital Sant Joan de Deu, University of Barcelona, Spain ; Unit of Arrhythmias, Hospital Clinic de Barcelona, University of Barcelona, Spain
| |
Collapse
|