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Sivanandam LK, Basani HBR, Sanker V, Roshan S S, Hunjul M, Gupta U. Brugada syndrome unmasked by dengue fever. Clin Case Rep 2023; 11:e8005. [PMID: 37786459 PMCID: PMC10541653 DOI: 10.1002/ccr3.8005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 08/02/2023] [Accepted: 09/19/2023] [Indexed: 10/04/2023] Open
Abstract
Key Clinical Message Understanding the circumstances, leading to unmasking of hidden Brugada syndrome is essential for the practicing clinician and the patients so that they are informed adequately to seek prompt medical attention. Abstract Brugada syndrome is a genetic arrhythmia syndrome characterized by a coved type of ST-segment elevation in the ECG. The patients are usually asymptomatic, with unmasking of the disease under certain conditions. We are reporting the case of a patient diagnosed with Brugada syndrome, which was unmasked during an attack of dengue fever.
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Affiliation(s)
| | | | - Vivek Sanker
- Team ErevnitesTrivandrumIndia
- Noorul Islam Institute of Medical SciencesTrivandrumIndia
| | - Shamal Roshan S
- Team ErevnitesTrivandrumIndia
- Government Medical CollegeThrissurKeralaIndia
| | - Marah Hunjul
- Team ErevnitesTrivandrumIndia
- An Najah National UniversityNablusPalestine
| | - Umang Gupta
- Team ErevnitesTrivandrumIndia
- Nepalgunj Medical CollegeNepaligunjNepal
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2
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Gauvrit S, Bossaer J, Lee J, Collins MM. Modeling Human Cardiac Arrhythmias: Insights from Zebrafish. J Cardiovasc Dev Dis 2022; 9:jcdd9010013. [PMID: 35050223 PMCID: PMC8779270 DOI: 10.3390/jcdd9010013] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/23/2021] [Accepted: 12/25/2021] [Indexed: 12/13/2022] Open
Abstract
Cardiac arrhythmia, or irregular heart rhythm, is associated with morbidity and mortality and is described as one of the most important future public health challenges. Therefore, developing new models of cardiac arrhythmia is critical for understanding disease mechanisms, determining genetic underpinnings, and developing new therapeutic strategies. In the last few decades, the zebrafish has emerged as an attractive model to reproduce in vivo human cardiac pathologies, including arrhythmias. Here, we highlight the contribution of zebrafish to the field and discuss the available cardiac arrhythmia models. Further, we outline techniques to assess potential heart rhythm defects in larval and adult zebrafish. As genetic tools in zebrafish continue to bloom, this model will be crucial for functional genomics studies and to develop personalized anti-arrhythmic therapies.
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3
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Ovics P, Regev D, Baskin P, Davidor M, Shemer Y, Neeman S, Ben-Haim Y, Binah O. Drug Development and the Use of Induced Pluripotent Stem Cell-Derived Cardiomyocytes for Disease Modeling and Drug Toxicity Screening. Int J Mol Sci 2020; 21:E7320. [PMID: 33023024 PMCID: PMC7582587 DOI: 10.3390/ijms21197320] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/23/2020] [Accepted: 09/27/2020] [Indexed: 12/19/2022] Open
Abstract
: Over the years, numerous groups have employed human induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) as a superb human-compatible model for investigating the function and dysfunction of cardiomyocytes, drug screening and toxicity, disease modeling and for the development of novel drugs for heart diseases. In this review, we discuss the broad use of iPSC-CMs for drug development and disease modeling, in two related themes. In the first theme-drug development, adverse drug reactions, mechanisms of cardiotoxicity and the need for efficient drug screening protocols-we discuss the critical need to screen old and new drugs, the process of drug development, marketing and Adverse Drug reactions (ADRs), drug-induced cardiotoxicity, safety screening during drug development, drug development and patient-specific effect and different mechanisms of ADRs. In the second theme-using iPSC-CMs for disease modeling and developing novel drugs for heart diseases-we discuss the rationale for using iPSC-CMs and modeling acquired and inherited heart diseases with iPSC-CMs.
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Affiliation(s)
- Paz Ovics
- Department of Physiology, Biophysics and Systems Biology, The Rappaport Institute, Ruth & Bruce Rappaport Faculty of Medicine, Technion, Haifa 31096, Israel; (P.O.); (D.R.); (P.B.); (M.D.); (Y.S.); (S.N.)
| | - Danielle Regev
- Department of Physiology, Biophysics and Systems Biology, The Rappaport Institute, Ruth & Bruce Rappaport Faculty of Medicine, Technion, Haifa 31096, Israel; (P.O.); (D.R.); (P.B.); (M.D.); (Y.S.); (S.N.)
| | - Polina Baskin
- Department of Physiology, Biophysics and Systems Biology, The Rappaport Institute, Ruth & Bruce Rappaport Faculty of Medicine, Technion, Haifa 31096, Israel; (P.O.); (D.R.); (P.B.); (M.D.); (Y.S.); (S.N.)
| | - Mor Davidor
- Department of Physiology, Biophysics and Systems Biology, The Rappaport Institute, Ruth & Bruce Rappaport Faculty of Medicine, Technion, Haifa 31096, Israel; (P.O.); (D.R.); (P.B.); (M.D.); (Y.S.); (S.N.)
| | - Yuval Shemer
- Department of Physiology, Biophysics and Systems Biology, The Rappaport Institute, Ruth & Bruce Rappaport Faculty of Medicine, Technion, Haifa 31096, Israel; (P.O.); (D.R.); (P.B.); (M.D.); (Y.S.); (S.N.)
| | - Shunit Neeman
- Department of Physiology, Biophysics and Systems Biology, The Rappaport Institute, Ruth & Bruce Rappaport Faculty of Medicine, Technion, Haifa 31096, Israel; (P.O.); (D.R.); (P.B.); (M.D.); (Y.S.); (S.N.)
| | - Yael Ben-Haim
- Institute of Molecular and Clinical Sciences, St. George’s University of London, London SW17 0RE, UK;
- Cardiology Clinical Academic Group, St. George’s University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | - Ofer Binah
- Department of Physiology, Biophysics and Systems Biology, The Rappaport Institute, Ruth & Bruce Rappaport Faculty of Medicine, Technion, Haifa 31096, Israel; (P.O.); (D.R.); (P.B.); (M.D.); (Y.S.); (S.N.)
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4
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Golubenko M, Mikhailov V, Rusinova V, Shestak A, Zaklyazminskaya E. Lack of association between mitochondrial DNA haplogroups J and T and clinical manifestation in Russian patients with Brugada syndrome. Biomed Rep 2020; 13:16. [PMID: 32765855 DOI: 10.3892/br.2020.1324] [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: 12/03/2019] [Accepted: 04/16/2020] [Indexed: 11/06/2022] Open
Abstract
Brugada syndrome (BrS) is an inherited disorder characterized by specific ST segment elevation in the right precordial leads, pseudo right bundle branch block, and a high risk of sudden cardiac death due to ventricular tachycardia. It was initially described as a monogenic disorder with an autosomal dominant mode of inheritance. It is hypothesized that modifying genetic factors, in addition to disease-causing mutations, may significantly contribute to the clinical symptoms and the risk of sudden cardiac death. These modifying factors can include mitochondrial DNA (mtDNA) variants. In particular, combination of mtDNA m.T4216C, m.A11251G, m.C15452A and m.T16126C variants (defining haplogroups T and J), is considered to be a factor that promotes manifestation of BrS manifestation, with no pro-arrhythmic effects. The aim of the present study was to confirm the reported association of BrS with MtDNA variants in a cohort of Russian patients. mtDNA haplogroups were genotyped in 47 Russian BrS probands and the prevalence of common mtDNA haplogroups was compared with the general population in European part of Russia. The distribution and prevalence of all but the J mtDNA haplogroups were comparable in BrS probands and the general Russian population. The mitochondrial J haplogroup was not found in the BrS cohort. In conclusion, it was shown that the mtDNA polymorphism, m.T4216C (haplogroups J and T) does not contribute significantly to the clinical manifestation of BrS in Russian patients.
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Affiliation(s)
- Maria Golubenko
- Laboratory of Population Genetics, Research Institute of Medical Genetics, Tomsk National Research Medical Centre of The Russian Academy of Sciences, Tomsk 634050, Russia
| | - Vadim Mikhailov
- Petrovsky National Research Centre of Surgery, Moscow 119991, Russia
| | - Valeria Rusinova
- Petrovsky National Research Centre of Surgery, Moscow 119991, Russia
| | - Anna Shestak
- Petrovsky National Research Centre of Surgery, Moscow 119991, Russia
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5
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Szabó Z, Ujvárosy D, Ötvös T, Sebestyén V, Nánási PP. Handling of Ventricular Fibrillation in the Emergency Setting. Front Pharmacol 2020; 10:1640. [PMID: 32140103 PMCID: PMC7043313 DOI: 10.3389/fphar.2019.01640] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 12/16/2019] [Indexed: 12/11/2022] Open
Abstract
Ventricular fibrillation (VF) and sudden cardiac death (SCD) are predominantly caused by channelopathies and cardiomyopathies in youngsters and coronary heart disease in the elderly. Temporary factors, e.g., electrolyte imbalance, drug interactions, and substance abuses may play an additive role in arrhythmogenesis. Ectopic automaticity, triggered activity, and reentry mechanisms are known as important electrophysiological substrates for VF determining the antiarrhythmic therapies at the same time. Emergency need for electrical cardioversion is supported by the fact that every minute without defibrillation decreases survival rates by approximately 7%–10%. Thus, early defibrillation is an essential part of antiarrhythmic emergency management. Drug therapy has its relevance rather in the prevention of sudden cardiac death, where early recognition and treatment of the underlying disease has significant importance. Cardioprotective and antiarrhythmic effects of beta blockers in patients predisposed to sudden cardiac death were highlighted in numerous studies, hence nowadays these drugs are considered to be the cornerstones of the prevention and treatment of life-threatening ventricular arrhythmias. Nevertheless, other medical therapies have not been proven to be useful in the prevention of VF. Although amiodarone has shown positive results occasionally, this was not demonstrated to be consistent. Furthermore, the potential proarrhythmic effects of drugs may also limit their applicability. Based on these unfavorable observations we highlight the importance of arrhythmia prevention, where echocardiography, electrocardiography and laboratory testing play a significant role even in the emergency setting. In the following we provide a summary on the latest developments on cardiopulmonary resuscitation, and the evaluation and preventive treatment possibilities of patients with increased susceptibility to VF and SCD.
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Affiliation(s)
- Zoltán Szabó
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Dóra Ujvárosy
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Doctoral School of Health Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Tamás Ötvös
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Doctoral School of Health Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Veronika Sebestyén
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Doctoral School of Health Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Péter P Nánási
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Department of Dental Physiology, Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
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6
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Daimi H, Khelil AH, Neji A, Ben Hamda K, Maaoui S, Aranega A, Be Chibani J, Franco D. Role of SCN5A coding and non-coding sequences in Brugada syndrome onset: What's behind the scenes? Biomed J 2019; 42:252-260. [PMID: 31627867 PMCID: PMC6818142 DOI: 10.1016/j.bj.2019.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 02/20/2019] [Accepted: 03/11/2019] [Indexed: 12/11/2022] Open
Abstract
Background Brugada syndrome (BrS) is a rare inherited cardiac arrhythmia associated with a high risk of sudden cardiac death (SCD) due to ventricular fibrillation (VF). BrS is characterized by coved-type ST-segment elevation in the right precordial leads (V1-V3). Mutations in SCN5A gene coding for the α-subunit of the NaV1.5 cardiac sodium channel are identified in 15–30% of BrS cases. Genetic testing of BrS patients generally involves sequencing of the protein-coding portions and flanking intronic regions of SCN5A. This excludes the 5′UTR and 3′UTR from the routine genetic testing. Methods We here screened the coding sequence, the flanking intronic regions as well as the 5′ and 3′UTR regions of SCN5A gene and further five candidate genes (GPD1L, SCN1B, KCNE3, SCN4B, and MOG1) in a Tunisian family diagnosed with BrS. Results A new SCN5A-Q1000K mutation was identified along with two common polymorphisms (H558R and D1819). Multiple genetic variants were identified on the SCN5A 3′UTR, one of which is predicted to create additional microRNA binding site for miR-1270. Additionally, we identified the hsa-miR-219a-rs107822. No relevant coding sequence variant was identified in the remaining studied candidate genes. Conclusions The absence of genotype-phenotype concordance within all the identified genetic variants in this family gives extra evidences about the complexity of the disease and suggests that the occurrence and prognosis of BrS is most likely controlled by a combination of multiple genetic factors, rather than a single variant. Most SCN5A variants were localized in non-coding regions hypothesizing an impact on the miRNA-target complementarities.
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Affiliation(s)
- Houria Daimi
- Department of Experimental Biology, University of Jaen, Spain; Biochemistry and Molecular Biology Laboratory, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | - Amel Haj Khelil
- Biochemistry and Molecular Biology Laboratory, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | - Ali Neji
- Fattouma Bourguiba Hospital, Monastir, Tunisia
| | | | | | - Amelia Aranega
- Department of Experimental Biology, University of Jaen, Spain
| | - Jemni Be Chibani
- Biochemistry and Molecular Biology Laboratory, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | - Diego Franco
- Department of Experimental Biology, University of Jaen, Spain.
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7
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Singh M, Morin DP, Link MS. Sudden cardiac death in Long QT syndrome (LQTS), Brugada syndrome, and catecholaminergic polymorphic ventricular tachycardia (CPVT). Prog Cardiovasc Dis 2019; 62:227-234. [DOI: 10.1016/j.pcad.2019.05.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
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8
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Warpechowski Neto S, Leiria TLL, Ley LLG, Ley ALG, Dutra LZ, Pires LM, Kruse ML, Lima GGD. Cohort of Patients Referred for Brugada Syndrome Investigation in an Electrophysiology Service - 19-Year Registry. Arq Bras Cardiol 2018; 111:13-18. [PMID: 29898017 PMCID: PMC6078360 DOI: 10.5935/abc.20180094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/22/2018] [Indexed: 11/20/2022] Open
Abstract
Background Brugada syndrome (SBr) is an arrhythmic condition characterized by ST-T
segment abnormalities in the right precordial leads associated with a high
risk of ventricular arrhythmias and sudden death. Local data regarding the
clinical characteristics of patients with a typical electrocardiographic
(ECG) pattern undergoing electrophysiological study are scarce. Objective To evaluate patients with an ECG pattern suggestive of SBr referred for
electrophysiological evaluation in a specialized center. Methods Cohort study of patients referred for electrophysiological study because of
an ECG pattern compatible with SBr between January 1998 and March 2017. Results Of the 5506 procedures, 35 (0.64%) were for SBr investigation, 25 of which
(71.42%) were performed in men. The mean age was 43.89 ± 13.1 years.
The ECG patterns were as follows: type I, 22 (62.85%); type II, 12 (34.30%);
and type III, 1 (2.85%). Twenty-three patients (65.7%) were asymptomatic, 6
(17.14%) had palpitations, 5 (14.3%) had syncope, and 3 (8.6%) had a family
history of sudden death. Electrophysiological study induced ventricular
tachyarrhythmias in 16 cases (45.7%), the mean ventricular refractory period
being 228 ± 36 ms. Ajmaline / procainamide was used in 11 cases
(31.4%), changing the ECG pattern to type I in 7 (63.6%). Sixteen cases
(45.7%) received an implantable cardioverter defibrillator (ICD). In a mean
5-year follow-up, 1 of the 16 patients (6.25%) with ICD had appropriate
therapy for ventricular fibrillation. There was no death. Other arrhythmias
occurred in 4 (11.4%) cases. Conclusions Most patients are men, and a type I ECG pattern is the main indication for
electrophysiological study. Class IA drugs have a high ECG conversion rate.
The ICD event rate was 6%.
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Affiliation(s)
- Stefan Warpechowski Neto
- Instituto de Cardiologia - Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, RS - Brazil
| | - Tiago Luiz Luz Leiria
- Instituto de Cardiologia - Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, RS - Brazil
| | - Laura Lessa Gaudie Ley
- Instituto de Cardiologia - Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, RS - Brazil
| | - Antonio Lessa Gaudie Ley
- Instituto de Cardiologia - Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, RS - Brazil
| | - Luiza Zwan Dutra
- Instituto de Cardiologia - Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, RS - Brazil
| | - Leonardo Martins Pires
- Instituto de Cardiologia - Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, RS - Brazil
| | - Marcelo Lapa Kruse
- Instituto de Cardiologia - Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, RS - Brazil
| | - Gustavo Glotz de Lima
- Instituto de Cardiologia - Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, RS - Brazil
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9
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Proost D, Saenen J, Vandeweyer G, Rotthier A, Alaerts M, Van Craenenbroeck EM, Van Crombruggen J, Mortier G, Wuyts W, Vrints C, Del Favero J, Loeys B, Van Laer L. Targeted Next-Generation Sequencing of 51 Genes Involved in Primary Electrical Disease. J Mol Diagn 2017; 19:445-459. [DOI: 10.1016/j.jmoldx.2017.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 01/11/2017] [Indexed: 01/18/2023] Open
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10
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Embryonic type Na + channel β-subunit, SCN3B masks the disease phenotype of Brugada syndrome. Sci Rep 2016; 6:34198. [PMID: 27677334 PMCID: PMC5039759 DOI: 10.1038/srep34198] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 09/09/2016] [Indexed: 12/13/2022] Open
Abstract
SCN5A is abundant in heart and has a major role in INa. Loss-of-function mutation in SCN5A results in Brugada syndrome (BrS), which causes sudden death in adults. It remains unclear why disease phenotype does not manifest in the young even though mutated SCN5A is expressed in the young. The aim of the present study is to elucidate the timing of the disease manifestation in BrS. A gain-of-function mutation in SCN5A also results in Long QT syndrome type 3 (LQTS3), leading to sudden death in the young. Induced pluripotent stem cells (iPSCs) were generated from a patient with a mixed phenotype of LQTS3 and BrS with the E1784K SCN5A mutation. Here we show that electrophysiological analysis revealed that LQTS3/BrS iPSC-derived cardiomyocytes recapitulate the phenotype of LQTS3 but not BrS. Each β-subunit of the sodium channel is differentially expressed in embryonic and adult hearts. SCN3B is highly expressed in embryonic hearts and iPSC-derived cardiomyocytes. A heterologous expression system revealed that INa of mutated SCN5A is decreased and SCN3B augmented INa of mutated SCN5A. Knockdown of SCN3B in LQTS3/BrS iPSC-derived cardiomyocytes successfully unmasked the phenotype of BrS. Isogenic control of LQTS3/BrS (corrected-LQTS3/BrS) iPSC-derived cardiomyocytes gained the normal electrophysiological properties.
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11
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Medico-legal perspectives on sudden cardiac death in young athletes. Int J Legal Med 2016; 131:393-409. [PMID: 27654714 DOI: 10.1007/s00414-016-1452-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 09/08/2016] [Indexed: 01/11/2023]
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Abstract
Brugada syndrome is an inherited disease characterized by an increased risk of sudden cardiac death owing to ventricular arrhythmias in the absence of structural heart disease. Since the first description of the syndrome >20 years ago, considerable advances have been made in our understanding of the underlying mechanisms involved and the strategies to stratify at-risk patients. The development of repolarization-depolarization abnormalities in patients with Brugada syndrome can involve genetic alterations, abnormal neural crest cell migration, improper gap junctional communication, or connexome abnormalities. A common phenotype observed on the electrocardiogram of patients with Brugada syndrome might be the result of different pathophysiological mechanisms. Furthermore, risk stratification of this patient cohort is critical, and although some risk factors for Brugada syndrome have been frequently reported, several others remain unconfirmed. Current clinical guidelines offer recommendations for patients at high risk of developing sudden cardiac death, but the management of those at low risk has not yet been defined. In this Review, we discuss the proposed mechanisms that underlie the development of Brugada syndrome and the current risk stratification and therapeutic options available for these patients.
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Affiliation(s)
- Juan Sieira
- Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium.,Cardiology Department, University Hospital Erasme, Route de Lennik 808, 1070 Brussels, Belgium
| | - Gregory Dendramis
- Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium.,Cardiovascular Division, University Hospital "Paolo Giaccone", Via Del Vespro 127. 90127 Palermo, Italy
| | - Pedro Brugada
- Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium
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13
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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.
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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
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14
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Abriel H, Rougier JS, Jalife J. Ion channel macromolecular complexes in cardiomyocytes: roles in sudden cardiac death. Circ Res 2015; 116:1971-88. [PMID: 26044251 DOI: 10.1161/circresaha.116.305017] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The movement of ions across specific channels embedded on the membrane of individual cardiomyocytes is crucial for the generation and propagation of the cardiac electric impulse. Emerging evidence over the past 20 years strongly suggests that the normal electric function of the heart is the result of dynamic interactions of membrane ion channels working in an orchestrated fashion as part of complex molecular networks. Such networks work together with exquisite temporal precision to generate each action potential and contraction. Macromolecular complexes play crucial roles in transcription, translation, oligomerization, trafficking, membrane retention, glycosylation, post-translational modification, turnover, function, and degradation of all cardiac ion channels known to date. In addition, the accurate timing of each cardiac beat and contraction demands, a comparable precision on the assembly and organizations of sodium, calcium, and potassium channel complexes within specific subcellular microdomains, where physical proximity allows for prompt and efficient interaction. This review article, part of the Compendium on Sudden Cardiac Death, discusses the major issues related to the role of ion channel macromolecular assemblies in normal cardiac electric function and the mechanisms of arrhythmias leading to sudden cardiac death. It provides an idea of how these issues are being addressed in the laboratory and in the clinic, which important questions remain unanswered, and what future research will be needed to improve knowledge and advance therapy.
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Affiliation(s)
- Hugues Abriel
- From the Department of Clinical Research, University of Bern, Bern, Switzerland (H.A., J.-S.R.); Center for Arrhythmia Research, Department of Internal Medicine, University of Michigan, Ann Arbor (J.J.); and Area of Myocardial Pathophysiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain (J.J.)
| | - Jean-Sébastien Rougier
- From the Department of Clinical Research, University of Bern, Bern, Switzerland (H.A., J.-S.R.); Center for Arrhythmia Research, Department of Internal Medicine, University of Michigan, Ann Arbor (J.J.); and Area of Myocardial Pathophysiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain (J.J.)
| | - José Jalife
- From the Department of Clinical Research, University of Bern, Bern, Switzerland (H.A., J.-S.R.); Center for Arrhythmia Research, Department of Internal Medicine, University of Michigan, Ann Arbor (J.J.); and Area of Myocardial Pathophysiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain (J.J.).
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15
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Abstract
The Brugada syndrome is characterized by unique 'coved-type' ST-segment elevation in the right precordial leads of electrocardiogram and ventricular fibrillation, and is responsible for 4 to 12% of sudden cardiac death in the general population. The frequency is higher in Southeast Asia including Japan compared with Western countries. Brugada syndrome is an inherited disease usually transmitted in an autosomal-dominant manner, and incomplete penetrance is frequently seen within affected families. To date, 20 genes have been associated with Brugada syndrome, but pathogenic mutations in the genes are identified in only about 30% of patients. The genetic background includes mutations in genes encoding sodium channel, calcium channels and potassium channels, as well as proteins affecting ion channels. Mutations in SCN5A, encoding the cardiac predominant sodium channel α-subunit, account for 20 to 30% of patients with Brugada syndrome and mutations in other genes only account for about 5% of patients. Furthermore, a recent genome-wide association study has identified new loci associated with the susceptibility of Brugada syndrome.
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Affiliation(s)
- Hiroshi Watanabe
- Department of Cardiovascular Biology and Medicine, Division of Cardiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Division of Cardiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Brugada R, Campuzano O, Sarquella-Brugada G, Brugada J, Brugada P. Brugada syndrome. Methodist Debakey Cardiovasc J 2015; 10:25-8. [PMID: 24932359 DOI: 10.14797/mdcj-10-1-25] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Brugada syndrome is a rare cardiac arrhythmia characterized by electrocardiographic right bundle branch block and persistent ST-segment elevation in the right precordial leads. It is associated with ventricular fibrillation and a high risk for sudden cardiac death, predominantly in younger males with structurally normal hearts. Patients can remain asymptomatic, and electrocardiographic patterns can occur both spontaneously or after pharmacological induction. So far, several pathogenic genes have been identified as associated with the disease, but SCN5A is the most prevalent one. Two consensus reports to define the diagnostic criteria, risk stratification, and management of patients have been published in the last few years. This brief review focuses on the recent clinical diagnosis, genetic basis, and advances in pharmacological treatment of Brugada syndrome.
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Affiliation(s)
| | | | | | - Josep Brugada
- Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain
| | - Pedro Brugada
- UZ Brussel-Vrije Universiteit Brussel, Brussels, Belgium
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Campuzano O, Allegue C, Fernandez A, Iglesias A, Brugada R. Determining the pathogenicity of genetic variants associated with cardiac channelopathies. Sci Rep 2015; 5:7953. [PMID: 25608792 PMCID: PMC4302303 DOI: 10.1038/srep07953] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 12/22/2014] [Indexed: 01/08/2023] Open
Abstract
Advancements in genetic screening have generated massive amounts of data on genetic variation; however, a lack of clear pathogenic stratification has left most variants classified as being of unknown significance. This is a critical limitation for translating genetic data into clinical practice. Genetic screening is currently recommended in the guidelines for diagnosis and treatment of cardiac channelopathies, which are major contributors to sudden cardiac death in young people. We propose to characterize the pathogenicity of genetic variants associated with cardiac channelopathies using a stratified scoring system. The development of this system was considered by using all of the tools currently available to define pathogenicity. The use of this scoring system could help clinicians to understand the limitations of genetic associations with a disease, and help them better define the role that genetics can have in their clinical routine.
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Affiliation(s)
- Oscar Campuzano
- 1] Cardiovascular Genetics Center, Institut d'Investigació Biomèdica de Girona (IDIBGI) and Universitat de Girona (UdG), Girona, Spain [2] Medical Science Department, School of Medicine, University of Girona, Girona, Spain
| | - Catarina Allegue
- Cardiovascular Genetics Center, Institut d'Investigació Biomèdica de Girona (IDIBGI) and Universitat de Girona (UdG), Girona, Spain
| | - Anna Fernandez
- Cardiovascular Genetics Center, Institut d'Investigació Biomèdica de Girona (IDIBGI) and Universitat de Girona (UdG), Girona, Spain
| | - Anna Iglesias
- Cardiovascular Genetics Center, Institut d'Investigació Biomèdica de Girona (IDIBGI) and Universitat de Girona (UdG), Girona, Spain
| | - Ramon Brugada
- 1] Cardiovascular Genetics Center, Institut d'Investigació Biomèdica de Girona (IDIBGI) and Universitat de Girona (UdG), Girona, Spain [2] Medical Science Department, School of Medicine, University of Girona, Girona, Spain [3] Cardiology Service, Hospital Josep Trueta, Girona, Spain
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Dohadwala M, Link MS. Implantable Defibrillators in Long QT Syndrome, Brugada Syndrome, Hypertrophic Cardiomyopathy, and Arrhythmogenic Right Ventricular Cardiomyopathy. Cardiol Clin 2014; 32:305-18. [DOI: 10.1016/j.ccl.2013.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Dysrhythmia in infancy: common diagnosis or obscure genetic syndrome? J Pediatr Health Care 2013; 27:385-9. [PMID: 23267725 DOI: 10.1016/j.pedhc.2012.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 10/07/2012] [Accepted: 10/10/2012] [Indexed: 11/22/2022]
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Brugada J, Blom N, Sarquella-Brugada G, Blomstrom-Lundqvist C, Deanfield J, Janousek J, Abrams D, Bauersfeld U, Brugada R, Drago F, de Groot N, Happonen JM, Hebe J, Yen Ho S, Marijon E, Paul T, Pfammatter JP, Rosenthal E. Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-Arrhythmia Working Group joint consensus statement. ACTA ACUST UNITED AC 2013; 15:1337-82. [DOI: 10.1093/europace/eut082] [Citation(s) in RCA: 217] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Kim GH. MicroRNA regulation of cardiac conduction and arrhythmias. Transl Res 2013; 161:381-92. [PMID: 23274306 PMCID: PMC3619003 DOI: 10.1016/j.trsl.2012.12.004] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 12/04/2012] [Accepted: 12/06/2012] [Indexed: 01/01/2023]
Abstract
MicroRNAs are now recognized as important regulators of cardiovascular genes with critical roles in normal development and physiology, as well as disease development. MicroRNAs (miRNAs) are small noncoding RNAs approximately 22 nucleotides in length that regulate expression of target genes through sequence-specific hybridization to the 3' untranslated region of messenger RNAs and either block translation or direct degradation of their target messenger RNA. They have been shown to participate in cardiovascular disease pathogenesis including atherosclerosis, coronary artery disease, myocardial infarction, heart failure, and cardiac arrhythmias. Broadly defined, cardiac arrhythmias are a variation from the normal heart rate or rhythm. Arrhythmias are common and result in significant morbidity and mortality. Ventricular arrhythmias constitute a major cause for cardiac death, particularly sudden cardiac death in the setting of myocardial infarction and heart failure. As advances in pharmacologic, device, and ablative therapy continue to evolve, the molecular insights into the basis of arrhythmia is growing with the ambition of providing additional therapeutic options. Electrical remodeling and structural remodeling are identified mechanisms underlying arrhythmia generation; however, published studies focusing on miRNAs and cardiac conduction are sparse. Recent studies have highlighted the role of miRNAs in cardiac rhythm through regulation of key ion channels, transporters, and cellular proteins in arrhythmogenic conditions. This article aims to review the studies linking miRNAs to cardiac excitability and other processes pertinent to arrhythmia.
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Affiliation(s)
- Gene H Kim
- University of Chicago, Institute for Cardiovascular Research, Chicago, IL 60637, USA.
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Noris M, Carrillo A, Campuzano O, Santaella A, Brugada R, García-Niebla J, Fiol M. Syncope and polymorphic ventricular tachycardia in the setting of a febrile illness. J Electrocardiol 2013; 46:666-9. [PMID: 23522323 DOI: 10.1016/j.jelectrocard.2013.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Indexed: 10/27/2022]
Abstract
An asymptomatic woman with no clinical history consulted for pneumonia-induced fever; she then presented episodes of syncope due to polymorphic ventricular tachycardia and ECG alterations compatible with Brugada syndrome. Genetic studies showed no alterations in the SCN5A gene but other polymorphisms were observed. Further genetic studies are required to elucidate the pathophysiological mechanisms of fever and the function of sodium channels.
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Affiliation(s)
- Marta Noris
- Hospital Universitario Son Espases. Unidad Coronaria. Palma de Mallorca, España
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Abriel H, Zaklyazminskaya EV. Cardiac channelopathies: genetic and molecular mechanisms. Gene 2012; 517:1-11. [PMID: 23266818 DOI: 10.1016/j.gene.2012.12.061] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 12/03/2012] [Indexed: 12/20/2022]
Abstract
Channelopathies are diseases caused by dysfunctional ion channels, due to either genetic or acquired pathological factors. Inherited cardiac arrhythmic syndromes are among the most studied human disorders involving ion channels. Since seminal observations made in 1995, thousands of mutations have been found in many of the different genes that code for cardiac ion channel subunits and proteins that regulate the cardiac ion channels. The main phenotypes observed in patients carrying these mutations are congenital long QT syndrome (LQTS), Brugada syndrome (BrS), catecholaminergic polymorphic ventricular tachycardia (CPVT), short QT syndrome (SQTS) and variable types of conduction defects (CD). The goal of this review is to present an update of the main genetic and molecular mechanisms, as well as the associated phenotypes of cardiac channelopathies as of 2012.
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Affiliation(s)
- Hugues Abriel
- Department of Clinical Research, University of Bern, Switzerland.
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Wilders R. Cardiac ion channelopathies and the sudden infant death syndrome. ISRN CARDIOLOGY 2012; 2012:846171. [PMID: 23304551 PMCID: PMC3529486 DOI: 10.5402/2012/846171] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 10/23/2012] [Indexed: 12/13/2022]
Abstract
The sudden infant death syndrome (SIDS) causes the sudden death of an apparently healthy infant, which remains unexplained despite a thorough investigation, including the performance of a complete autopsy. The triple risk model for the pathogenesis of SIDS points to the coincidence of a vulnerable infant, a critical developmental period, and an exogenous stressor. Primary electrical diseases of the heart, which may cause lethal arrhythmias as a result of dysfunctioning cardiac ion channels (“cardiac ion channelopathies”) and are not detectable during a standard postmortem examination, may create the vulnerable infant and thus contribute to SIDS. Evidence comes from clinical correlations between the long QT syndrome and SIDS as well as genetic analyses in cohorts of SIDS victims (“molecular autopsy”), which have revealed a large number of mutations in ion channel-related genes linked to inheritable arrhythmogenic syndromes, in particular the long QT syndrome, the short QT syndrome, the Brugada syndrome, and catecholaminergic polymorphic ventricular tachycardia. Combining data from population-based cohort studies, it can be concluded that at least one out of five SIDS victims carries a mutation in a cardiac ion channel-related gene and that the majority of these mutations are of a known malignant phenotype.
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Affiliation(s)
- Ronald Wilders
- Department of Anatomy, Embryology and Physiology, Heart Failure Research Center, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands
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Nardi A, Damann N, Hertrampf T, Kless A. Advances in targeting voltage-gated sodium channels with small molecules. ChemMedChem 2012; 7:1712-40. [PMID: 22945552 DOI: 10.1002/cmdc.201200298] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 07/30/2012] [Indexed: 12/19/2022]
Abstract
Blockade of voltage-gated sodium channels (VGSCs) has been used successfully in the clinic to enable control of pathological firing patterns that occur in conditions as diverse as chronic pain, epilepsy, and arrhythmias. Herein we review the state of the art in marketed sodium channel inhibitors, including a brief compendium of their binding sites and of the cellular and molecular biology of sodium channels. Despite the preferential action of this drug class toward over-excited cells, which significantly limits potential undesired side effects on other cells, the need to develop a second generation of sodium channel inhibitors to overcome their critical clinical shortcomings is apparent. Current approaches in drug discovery to deliver novel and truly innovative sodium channel inhibitors is next presented by surveying the most recent medicinal chemistry breakthroughs in the field of small molecules and developments in automated patch-clamp platforms. Various strategies aimed at identifying small molecules that target either particular isoforms of sodium channels involved in specific diseases or anomalous sodium channel currents, irrespective of the isoform by which they have been generated, are critically discussed and revised.
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Affiliation(s)
- Antonio Nardi
- Global Drug Discovery, Department of Medicinal Chemistry, Grünenthal, Zieglerstrasse 6, 52078 Aachen, Germany.
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Wilde AA, Brugada R. Phenotypical Manifestations of Mutations in the Genes Encoding Subunits of the Cardiac Sodium Channel. Circ Res 2011; 108:884-97. [DOI: 10.1161/circresaha.110.238469] [Citation(s) in RCA: 171] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Arthur A.M. Wilde
- From the Heart Research Centre (A.A.M.W.), Department of Clinical and Experimental Cardiology, Academic Medical Center, University Medical Center, University of Amsterdam, The Netherlands; and the Institut d'Investigació Biomèdica Girona-IdIBGi (R.B.), Universitat de Girona, Giona Spain
| | - Ramon Brugada
- From the Heart Research Centre (A.A.M.W.), Department of Clinical and Experimental Cardiology, Academic Medical Center, University Medical Center, University of Amsterdam, The Netherlands; and the Institut d'Investigació Biomèdica Girona-IdIBGi (R.B.), Universitat de Girona, Giona Spain
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Novelli G, Predazzi IM, Mango R, Romeo F, Mehta JL. Role of genomics in cardiovascular medicine. World J Cardiol 2010; 2:428-36. [PMID: 21191544 PMCID: PMC3011138 DOI: 10.4330/wjc.v2.i12.428] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Revised: 10/25/2010] [Accepted: 11/01/2010] [Indexed: 02/06/2023] Open
Abstract
As all branches of science grow and new experimental techniques become readily accessible, our knowledge of medicine is likely to increase exponentially in the coming years. Recently developed technologies have revolutionized our analytical capacities, leading to vast knowledge of many genes or genomic regions involved in the pathogenesis of congenital heart diseases, which are often associated with other genetic syndromes, coronary artery disease and non-ischemic cardiomyopathies and channelopathies. The knowledge-base of the genesis of cardiovascular diseases is likely going to be further revolutionized in this new era of genomic medicine. Here, we review the advances that have been made over the last several years in this field and discuss different genetic mechanisms that have been shown to underlie a variety of cardiovascular diseases.
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Affiliation(s)
- Giuseppe Novelli
- Giuseppe Novelli, Irene M Predazzi, Department of Biopathology and Diagnostic Imaging, Section of Medical Genetics, School of Medicine, Tor Vergata University, Via Montpellier 1, 00133 Rome, Italy
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