1
|
Simonit F, Da Broi U, D'Elia AV, Fabbro D, Mio C, Bussani R, Pinamonti M, Desinan L. Filamin C (FLNC) truncating mutation in a fatal arrhythmogenic left ventricular cardiomyopathy (ALVC). Leg Med (Tokyo) 2024; 69:102438. [PMID: 38547641 DOI: 10.1016/j.legalmed.2024.102438] [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: 11/11/2023] [Revised: 03/13/2024] [Accepted: 03/22/2024] [Indexed: 07/17/2024]
Abstract
Forensic pathologists are frequently asked to investigate cases of sudden death (SD), and identifying the cause of death can be of particular importance, especially where it may be necessary to perform family screening among the relatives of the victim. A multidisciplinary approach inclusive of genetic analysis is therefore strongly recommended. According to forensic practice, arrhythmogenic cardiomyopathy (ACM) is a well-known cause of SD. However, cases of SD caused by a left ventricular pattern of ACM diagnosed at autopsy are rarely reported in the literature. We present the case of an apparently healthy, 37-year-old male found dead at his home. At autopsy, multiple foci of epicardial and mid-wall fibrous and fibro-adipose tissue were observed within the left ventricle and, to a lesser extent, within the interventricular septum. Toxicology was negative, whereas a filamin C truncating mutation was detected through genetic analysis. To our knowledge, this is the first instance of arrhythmogenic left ventricular cardiomyopathy being diagnosed at autopsy.
Collapse
Affiliation(s)
- Francesco Simonit
- Department of Medicine, Legal Medicine, University of Udine, Udine, Italy.
| | - Ugo Da Broi
- Department of Medicine, Legal Medicine, University of Udine, Udine, Italy
| | | | - Dora Fabbro
- Institute of Medical Genetics, ASUFC University Hospital of Udine, Udine, Italy
| | - Catia Mio
- Department of Medicine, University of Udine, Udine, Italy
| | - Rossana Bussani
- Department of Pathological Anatomy Ospedale di Cattinara, Trieste, Italy
| | - Maurizio Pinamonti
- Department of Pathological Anatomy Ospedale di Cattinara, Trieste, Italy
| | - Lorenzo Desinan
- Department of Medicine, Legal Medicine, University of Udine, Udine, Italy
| |
Collapse
|
2
|
Simonit F, Muser D, Morocutti G, Desinan L. Pitfalls in arrhythmogenic left ventricular cardiomyopathy (ALVC). A review of the literature with considerations on a single case of sudden death in a juvenile athlete. J Forensic Leg Med 2021; 82:102208. [PMID: 34218057 DOI: 10.1016/j.jflm.2021.102208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/16/2021] [Accepted: 06/27/2021] [Indexed: 10/21/2022]
Abstract
Sudden cardiac death (SCD) in young athletes represents a challenging issue in forensic practice. The pathologist is frequently asked to establish the cause of death basing upon anatomical findings and to evaluate the role of the physician in preparticipation evaluation (PPE) and eligibility decision. Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a leading cause of SCD during sport activity. However, in the last few years, forms with predominant or even isolated involvement of the left ventricle (LV) have progressively been correlated with a high risk of SCD. We present a case of SCD in an apparently healthy 19-year-old semi-professional football player. Annual PPEs performed in accordance with international and Italian recommendations, were unremarkable. At autopsy, a 1-cm area of subepicardial fibro-fatty replacement was observed at the postero-lateral wall of the LV. The finding was diagnostic of arrhythmogenic left ventricular cardiomyopathy (ALVC). A review of this rare pathology has been performed under a forensic perspective, focusing on the evaluation of the medico-legal responsibility of the physician in the PPE and on the morphological aspects of the disease. Current diagnostic criteria and recommendations result to be focused on the right ventricular pattern, with a risk of misdiagnosis for isolated LV forms. Furthermore, few detailed autopsies cases concerning ALVC have been published. There is a need, therefore, to study this rare disease with a careful and revised approach.
Collapse
Affiliation(s)
- Francesco Simonit
- Dipartimento di Area Medica, Medicina Legale, Università Degli Studi di Udine, Piazzale Santa Maria Della Misericordia 15, 33100, Udine, Italy.
| | - Daniele Muser
- Dipartimento Cardiotoracico, U.O.C. di Cardiologia, Presidio Ospedaliero Universitario "Santa Maria Della Misericordia", Piazzale Santa Maria Della Misericordia 15, 33100, Udine, Italy.
| | - Giorgio Morocutti
- Dipartimento Cardiotoracico, U.O.C. di Cardiologia, Presidio Ospedaliero Universitario "Santa Maria Della Misericordia", Piazzale Santa Maria Della Misericordia 15, 33100, Udine, Italy.
| | - Lorenzo Desinan
- Dipartimento di Area Medica, Medicina Legale, Università Degli Studi di Udine, Piazzale Santa Maria Della Misericordia 15, 33100, Udine, Italy.
| |
Collapse
|
3
|
Rouhi L, Fan S, Cheedipudi SM, Braza-Boïls A, Molina MS, Yao Y, Robertson MJ, Coarfa C, Gimeno JR, Molina P, Gurha P, Zorio E, Marian AJ. The EP300/TP53 pathway, a suppressor of the Hippo and canonical WNT pathways, is activated in human hearts with arrhythmogenic cardiomyopathy in the absence of overt heart failure. Cardiovasc Res 2021; 118:1466-1478. [PMID: 34132777 DOI: 10.1093/cvr/cvab197] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/07/2021] [Accepted: 06/14/2021] [Indexed: 12/21/2022] Open
Abstract
AIM Arrhythmogenic cardiomyopathy (ACM) is a primary myocardial disease that typically manifests with cardiac arrhythmias, progressive heart failure and sudden cardiac death (SCD). ACM is mainly caused by mutations in genes encoding desmosome proteins. Desmosomes are cell-cell adhesion structures and hubs for mechanosensing and mechanotransduction. The objective was to identify the dysregulated molecular and biological pathways in human ACM in the absence of overt heart failure. METHODS AND RESULTS Transcriptomes in the right ventricular endomyocardial biopsy samples from three independent individuals carrying truncating mutations in the DSP gene and 5 control samples were analyzed by RNA-Seq (discovery group). These cases presented with cardiac arrhythmias and had a normal right ventricular function. The RNA-Seq analysis identified ∼5,000 differentially expressed genes (DEGs), which predicted suppression of the Hippo and canonical WNT pathways, among others.Dysregulated genes and pathways, identified by RNA-Seq, were tested for validation in the right and left ventricular tissues from 5 independent autopsy-confirmed ACM cases with defined mutations (validation group), who were victims of SCD and had no history of heart failure. Protein levels and nuclear localization of the cWNT and Hippo pathway transcriptional regulators were reduced in the right and left ventricular validation samples. In contrast, levels of acetyltransferase EP300, known to suppress the Hippo and canonical WNT pathways, were increased and its bona fide target TP53 was acetylated. RNA-Seq data identified apical junction, reflective of cell-cell attachment, as the most disrupted biological pathway, which was corroborated by disrupted desmosomes and intermediate filament structures. Moreover, the DEGs also predicted dysregulation of over a dozen canonical signal transduction pathways, including the Tec kinase and integrin signaling pathways. The changes were associated with increased apoptosis and fibro-adipogenesis in the ACM hearts. CONCLUSION Altered apical junction structures is associated with activation of the EP300-TP53 and suppression of the Hippo/cWNT pathways in human ACM caused by defined mutations in the absence of an overt heart failure. The findings implicate altered mechanotransduction in the pathogenesis of ACM. TRANSLATIONAL PERSPECTIVE The findings suggest that altered mechanosensing at the cell-cell junction instigates a cascade of molecular events through the activation of acetyltransferase EP300/TP53 and suppression of gene expression through the Hippo/canonical WNT pathways in human arrhythmogenic cardiomyopathy (ACM) caused by defined mutations. These molecular changes occur early and in the absence of overt heart failure. Consequently, one may envision cell type-specific interventions to target the dysregulated transcriptional, mechanosensing, and mechanotransduction pathways to prevent the evolving phenotype in human ACM.
Collapse
Affiliation(s)
- Leila Rouhi
- Center for Cardiovascular Genetics, Institute of Molecular Medicine and Department of Medicine, University of Texas Health Sciences Center at Houston, Texas, 77030
| | - Siyang Fan
- Center for Cardiovascular Genetics, Institute of Molecular Medicine and Department of Medicine, University of Texas Health Sciences Center at Houston, Texas, 77030
| | - Sirisha M Cheedipudi
- Center for Cardiovascular Genetics, Institute of Molecular Medicine and Department of Medicine, University of Texas Health Sciences Center at Houston, Texas, 77030
| | - Aitana Braza-Boïls
- Unidad de Cardiopatías Familiares, Muerte Súbita y Mecanismos de Enfermedad (CaFaMuSMe)., Instituto de Investigación Sanitaria La Fe, Valencia, Spain.,Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Maria Sabater Molina
- Cardiogenetic Laboratory, Instituto Murciano de Investigación Biosanitaria. Murcia. Spain
| | - Yan Yao
- Fuwai Hospital, Peking Union Medical College, Beijing, PR China
| | | | - Cristian Coarfa
- Department of Cell Biology. Baylor College of Medicine, Houston, TX, 77030
| | - Juan R Gimeno
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV), Madrid, Spain.,Unidad CSUR Cardiopatias Familiares, Hospital Universitario Virgen de la Arrixaca. Murcia
| | - Pilar Molina
- Unidad de Cardiopatías Familiares, Muerte Súbita y Mecanismos de Enfermedad (CaFaMuSMe)., Instituto de Investigación Sanitaria La Fe, Valencia, Spain.,Instituto de Medicina Legal y Ciencias Forenses de Valencia, and Histology Unit at the Universitat de València, Spain
| | - Priyatansh Gurha
- Center for Cardiovascular Genetics, Institute of Molecular Medicine and Department of Medicine, University of Texas Health Sciences Center at Houston, Texas, 77030
| | - Esther Zorio
- Unidad de Cardiopatías Familiares, Muerte Súbita y Mecanismos de Enfermedad (CaFaMuSMe)., Instituto de Investigación Sanitaria La Fe, Valencia, Spain.,Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV), Madrid, Spain.,Unidad de Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - A J Marian
- Center for Cardiovascular Genetics, Institute of Molecular Medicine and Department of Medicine, University of Texas Health Sciences Center at Houston, Texas, 77030
| |
Collapse
|
4
|
Priori SG, Mazzanti A. Warning: not all carriers of pathogenic mutations in desmosomal genes should follow the same medical advices! Cardiovasc Res 2021; 116:1085-1088. [PMID: 32129836 DOI: 10.1093/cvr/cvaa049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Silvia G Priori
- Molecular Cardiology, ICS Maugeri, IRCCS, Via Maugeri, 10, 27100 Pavia, Italy.,Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Molecular Cardiology, Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Andrea Mazzanti
- Molecular Cardiology, ICS Maugeri, IRCCS, Via Maugeri, 10, 27100 Pavia, Italy.,Department of Molecular Medicine, University of Pavia, Pavia, Italy
| |
Collapse
|
5
|
Spracklen TF, Chakafana G, Schwartz PJ, Kotta MC, Shaboodien G, Ntusi NAB, Sliwa K. Genetics of Peripartum Cardiomyopathy: Current Knowledge, Future Directions and Clinical Implications. Genes (Basel) 2021; 12:genes12010103. [PMID: 33467574 PMCID: PMC7830587 DOI: 10.3390/genes12010103] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 02/07/2023] Open
Abstract
Peripartum cardiomyopathy (PPCM) is a condition in which heart failure and systolic dysfunction occur late in pregnancy or within months following delivery. Over the last decade, genetic advances in heritable cardiomyopathy have provided new insights into the role of genetics in PPCM. In this review, we summarise current knowledge of the genetics of PPCM and potential avenues for further research, including the role of molecular chaperone mutations in PPCM. Evidence supporting a genetic basis for PPCM has emanated from observations of familial disease, overlap with familial dilated cardiomyopathy, and sequencing studies of PPCM cohorts. Approximately 20% of PPCM patients screened for cardiomyopathy genes have an identified pathogenic mutation, with TTN truncations most commonly implicated. As a stress-associated condition, PPCM may be modulated by molecular chaperones such as heat shock proteins (Hsps). Recent studies have led to the identification of Hsp mutations in a PPCM model, suggesting that variation in these stress-response genes may contribute to PPCM pathogenesis. Although some Hsp genes have been implicated in dilated cardiomyopathy, their roles in PPCM remain to be determined. Additional areas of future investigation may include the delineation of genotype-phenotype correlations and the screening of newly-identified cardiomyopathy genes for their roles in PPCM. Nevertheless, these findings suggest that the construction of a family history may be advised in the management of PPCM and that genetic testing should be considered. A better understanding of the genetics of PPCM holds the potential to improve treatment, prognosis, and family management.
Collapse
Affiliation(s)
- Timothy F. Spracklen
- Hatter Institute for Cardiovascular Research in Africa & CHI, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa; (T.F.S.); (G.C.); (P.J.S.); (G.S.); (N.A.B.N.)
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
| | - Graham Chakafana
- Hatter Institute for Cardiovascular Research in Africa & CHI, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa; (T.F.S.); (G.C.); (P.J.S.); (G.S.); (N.A.B.N.)
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
| | - Peter J. Schwartz
- Hatter Institute for Cardiovascular Research in Africa & CHI, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa; (T.F.S.); (G.C.); (P.J.S.); (G.S.); (N.A.B.N.)
- Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy;
| | - Maria-Christina Kotta
- Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Istituto Auxologico Italiano, IRCCS, 20135 Milan, Italy;
| | - Gasnat Shaboodien
- Hatter Institute for Cardiovascular Research in Africa & CHI, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa; (T.F.S.); (G.C.); (P.J.S.); (G.S.); (N.A.B.N.)
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
| | - Ntobeko A. B. Ntusi
- Hatter Institute for Cardiovascular Research in Africa & CHI, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa; (T.F.S.); (G.C.); (P.J.S.); (G.S.); (N.A.B.N.)
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
- Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa & CHI, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa; (T.F.S.); (G.C.); (P.J.S.); (G.S.); (N.A.B.N.)
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
- Correspondence:
| |
Collapse
|
6
|
Pigolkin YI, Todorov SS, Berezovsky DP, Kolomoyets IA, Oganesyan NS. [Forensic diagnosis of sudden death of young people based on morphological analysis of the cardiac conduction system]. Sud Med Ekspert 2020; 63:39-42. [PMID: 32930533 DOI: 10.17116/sudmed20206305139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The aim of study was to develop a comprehensive assessment of the central and peripheral parts of the nervous system with a determination of degree of severity of alterative changes in comparison with the condition of myocardial contractile apparatus. Own observations on modern methods of morphological study of the cardiac conduction system in the sudden death of young people are presented. Particular attention is paid to the technique of isolating and coloring the nervous structures of sympathetic and parasympathetic parts of the autonomic nervous system, including the medulla oblongata, sinus-atrial and atrial-ventricular nodes, atrioventricular bundle (the His bundle), Purkinje fibers. The features of morphological changes in the nerve structures of the heart, due to various etiological factors are highlighted.
Collapse
Affiliation(s)
- Yu I Pigolkin
- First Moscow State Medical University named after I.M. Sechenov (Sechenov University) of Ministry of Health of Russia, Moscow, Russia
| | - S S Todorov
- Rostov State Medical University of the Ministry of Health of Russia, Rostov-on-Don, Russia
| | - D P Berezovsky
- First Moscow State Medical University named after I.M. Sechenov (Sechenov University) of Ministry of Health of Russia, Moscow, Russia
| | - I A Kolomoyets
- Rostov State Medical University of the Ministry of Health of Russia, Rostov-on-Don, Russia
| | - N S Oganesyan
- First Moscow State Medical University named after I.M. Sechenov (Sechenov University) of Ministry of Health of Russia, Moscow, Russia
| |
Collapse
|
7
|
Lou JQ, Cao Y, Yu YJ, Hu L, Mao ZS, Huang P, Hua X, Chen F. Investigation of heart lipid changes in acute β-AR activation-induced sudden cardiac death by time-of-flight secondary ion mass spectrometry. Analyst 2020; 145:5889-5896. [DOI: 10.1039/d0an00768d] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
ToF-SIMS, PCA and PLS-DA were combined to compare lipid profiles of myocardial tissue in sudden cardiac death and normal, mice and humans. SIMS imaging was utilized to correlate the composition and structural changes.
Collapse
Affiliation(s)
- Jia-Qian Lou
- Department of Forensic Medicine
- Nanjing Medical University
- Nanjing
- China
| | - Yue Cao
- Department of Forensic Medicine
- Nanjing Medical University
- Nanjing
- China
| | - You-Jia Yu
- Department of Forensic Medicine
- Nanjing Medical University
- Nanjing
- China
| | - Li Hu
- Department of Forensic Medicine
- Nanjing Medical University
- Nanjing
- China
| | - Zheng-Sheng Mao
- Department of Forensic Medicine
- Nanjing Medical University
- Nanjing
- China
| | - Ping Huang
- Shanghai Key Laboratory of Forensic Medicine
- Shanghai Forensic Service Platform
- Academy of Forensic Science
- Shanghai
- China
| | - Xin Hua
- Department of Chemistry
- East China University of Science and Technology
- Shanghai
- China
| | - Feng Chen
- Department of Forensic Medicine
- Nanjing Medical University
- Nanjing
- China
- Key Laboratory of Targeted Intervention of Cardiovascular Disease
| |
Collapse
|