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Galante N, Bedeschi MF, Beltrami B, Bailo P, Silva Palomino LA, Piccinini A. Reviewing hereditary connective tissue disorders: Proposals of harmonic medicolegal assessments. Int J Legal Med 2024:10.1007/s00414-024-03290-4. [PMID: 39008115 DOI: 10.1007/s00414-024-03290-4] [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: 03/12/2024] [Accepted: 07/09/2024] [Indexed: 07/16/2024]
Abstract
Hereditary connective tissue disorders (HCTDs) are a heterogeneous group of inherited diseases. These disorders show genetic mutations with loss of function of primary components of connective tissue, such as collagen and elastic fibers. There are more than 200 conditions that involve hereditary connective tissue disorders, while the most known are Marfan syndrome, Osteogenesis Imperfecta, and Ehlers-Danlos syndromes. These disorders need continuous updates, multidisciplinary skills, and specific methodologic evaluations sharing many medicolegal issues. Marfan syndrome and Ehlers-Danlos syndromes show a high risk of early sudden death. As a consequence of this, postmortem genetic testing can identify novel genotype-phenotype correlations which help the clinicians to assess personalized cardiovascular screening programs among the ill subjects. Genetic testing is also essential to identify children suffering from Osteogenesis Imperfecta, especially when a physical abuse is clinically suspected. However, this is a well-known clinical problem even though there are still challenges to interpret genetic data and variants of unknown significance due to the current extensive use of new genetic/genomic techniques. Additionally, the more significant applications and complexities of genomic testing raise novel responsibilities on the clinicians, geneticists, and forensic practitioners as well, increasing potential liability and medical malpractice claims. This systematic review provides a detailed overview on how multidisciplinary skills belonging to clinicians, medicolegal consultants, radiologists, and geneticists can cooperate to manage HCTDs from autopsy or clinical findings to genetic testing. Thus, technical aspects need to be addressed to the medicolegal community since there is no consensus works or guidelines which specifically discuss these issues.
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Affiliation(s)
- Nicola Galante
- Section of Legal Medicine of Milan, University of Milan, Via Luigi Mangiagalli 37, 20133, Milan, Italy.
- Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 37, 20133, Milan, Italy.
| | | | - Benedetta Beltrami
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Medical Genetic Unit, Milan, Italy
| | - Paolo Bailo
- Section of Legal Medicine of Milan, University of Milan, Via Luigi Mangiagalli 37, 20133, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 37, 20133, Milan, Italy
| | | | - Andrea Piccinini
- Section of Legal Medicine of Milan, University of Milan, Via Luigi Mangiagalli 37, 20133, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Via Luigi Mangiagalli 37, 20133, Milan, Italy
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2
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Kotta M, Torchio M, Bayliss P, Cohen MC, Quarrell O, Wheeldon N, Marton T, Gentilini D, Crotti L, Coombs RC, Schwartz PJ. Cardiac Genetic Investigation of Sudden Infant and Early Childhood Death: A Study From Victims to Families. J Am Heart Assoc 2023; 12:e029100. [PMID: 37589201 PMCID: PMC10547337 DOI: 10.1161/jaha.122.029100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/27/2023] [Indexed: 08/18/2023]
Abstract
Background Sudden infant death syndrome (SIDS) is the leading cause of death up to age 1. Sudden unexplained death in childhood (SUDC) is similar but affects mostly toddlers aged 1 to 4. SUDC is rarer than SIDS, and although cardiogenetic testing (molecular autopsy) identifies an underlying cause in a fraction of SIDS, less is known about SUDC. Methods and Results Seventy-seven SIDS and 16 SUDC cases underwent molecular autopsy with 25 definitive-evidence arrhythmia-associated genes. In 18 cases, another 76 genes with varying degrees of evidence were analyzed. Parents were offered cascade screening. Double-blind review of clinical-genetic data established genotype-phenotype correlations. The yield of likely pathogenic variants in the 25 genes was higher in SUDC than in SIDS (18.8% [3/16] versus 2.6% [2/77], respectively; P=0.03), whereas novel/ultra-rare variants of uncertain significance were comparably represented. Rare variants of uncertain significance and likely benign variants were found only in SIDS. In cases with expanded analyses, likely pathogenic/likely benign variants stemmed only from definitive-evidence genes, whereas all other genes contributed only variants of uncertain significance. Among 24 parents screened, variant status and phenotype largely agreed, and 3 cases positively correlated for cardiac channelopathies. Genotype-phenotype correlations significantly aided variant adjudication. Conclusions Genetic yield is higher in SUDC than in SIDS although, in both, it is contributed only by definitive-evidence genes. SIDS/SUDC cascade family screening facilitates establishment or dismissal of a diagnosis through definitive variant adjudication indicating that anonymity is no longer justifiable. Channelopathies may underlie a relevant fraction of SUDC. Binary classifications of genetic causality (pathogenic versus benign) could not always be adequate.
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Affiliation(s)
- Maria‐Christina Kotta
- Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular GeneticsIRCCS Istituto Auxologico ItalianoMilanItaly
| | - Margherita Torchio
- Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular GeneticsIRCCS Istituto Auxologico ItalianoMilanItaly
| | - Pauline Bayliss
- Department of Clinical GeneticsSheffield Children’s NHS Foundation TrustSheffieldUnited Kingdom
| | - Marta C. Cohen
- Department of HistopathologySheffield Children’s NHS Foundation TrustSheffieldUnited Kingdom
| | - Oliver Quarrell
- Sheffield Children’s Hospital NHS Foundation TrustSheffieldUnited Kingdom
- Department of NeurosciencesUniversity of SheffieldSheffieldUnited Kingdom
| | - Nigel Wheeldon
- Cardiothoracic CentreNorthern General Hospital, Sheffield Teaching Hospitals NHS TrustSheffieldUnited Kingdom
| | - Tamás Marton
- Cellular Pathology DepartmentBirmingham Women’s and Children’s HospitalBirminghamUnited Kingdom
| | - Davide Gentilini
- Bioinformatics and Statistical Genetics UnitIRCCS Istituto Auxologico ItalianoMilanItaly
| | - Lia Crotti
- Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular GeneticsIRCCS Istituto Auxologico ItalianoMilanItaly
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanItaly
| | - Robert C. Coombs
- Department of NeonatologySheffield Teaching Hospitals. NHS TrustSheffieldUnited Kingdom
| | - Peter J. Schwartz
- Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular GeneticsIRCCS Istituto Auxologico ItalianoMilanItaly
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3
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Deignan JL, De Castro M, Horner VL, Johnston T, Macaya D, Maleszewski JJ, Reddi HV, Tayeh MK. Points to consider in the practice of postmortem genetic testing: A statement of the American College of Medical Genetics and Genomics (ACMG). Genet Med 2023; 25:100017. [PMID: 36799919 DOI: 10.1016/j.gim.2023.100017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 02/18/2023] Open
Affiliation(s)
- Joshua L Deignan
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA Health, Los Angeles, CA
| | - Mauricio De Castro
- DHA Genetics Reference Laboratory, Air Force Medical Genetics Center, Keesler Air Force Base, Biloxi, MS; Division of Medical Genetics, Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS
| | - Vanessa L Horner
- Department of Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI; Wisconsin State Laboratory of Hygiene, University of Wisconsin, Madison, WI
| | | | | | | | - Honey V Reddi
- Department of Pathology & Laboratory Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Marwan K Tayeh
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
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4
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Martínez-Barrios E, Grassi S, Brión M, Toro R, Cesar S, Cruzalegui J, Coll M, Alcalde M, Brugada R, Greco A, Ortega-Sánchez ML, Barberia E, Oliva A, Sarquella-Brugada G, Campuzano O. Molecular autopsy: Twenty years of post-mortem diagnosis in sudden cardiac death. Front Med (Lausanne) 2023; 10:1118585. [PMID: 36844202 PMCID: PMC9950119 DOI: 10.3389/fmed.2023.1118585] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/30/2023] [Indexed: 02/12/2023] Open
Abstract
In the forensic medicine field, molecular autopsy is the post-mortem genetic analysis performed to attempt to unravel the cause of decease in cases remaining unexplained after a comprehensive forensic autopsy. This negative autopsy, classified as negative or non-conclusive, usually occurs in young population. In these cases, in which the cause of death is unascertained after a thorough autopsy, an underlying inherited arrhythmogenic syndrome is the main suspected cause of death. Next-generation sequencing allows a rapid and cost-effectives genetic analysis, identifying a rare variant classified as potentially pathogenic in up to 25% of sudden death cases in young population. The first symptom of an inherited arrhythmogenic disease may be a malignant arrhythmia, and even sudden death. Early identification of a pathogenic genetic alteration associated with an inherited arrhythmogenic syndrome may help to adopt preventive personalized measures to reduce risk of malignant arrhythmias and sudden death in the victim's relatives, at risk despite being asymptomatic. The current main challenge is a proper genetic interpretation of variants identified and useful clinical translation. The implications of this personalized translational medicine are multifaceted, requiring the dedication of a specialized team, including forensic scientists, pathologists, cardiologists, pediatric cardiologists, and geneticists.
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Affiliation(s)
- Estefanía Martínez-Barrios
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, Barcelona, Spain,European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam, Netherlands,Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Simone Grassi
- Forensic Medical Sciences, Department of Health Science, University of Florence, Florence, Italy
| | - María Brión
- Family Heart Disease Unit, Cardiology Service, Santiago de Compostela University Hospital, Santiago de Compostela, Spain,Cardiovascular Genetics, Santiago de Compostela Health Research Institute, Santiago de Compostela, Spain,Genomic Medicine Group, Universidade de Santiago de Compostela, Santiago de Compostela, Spain,Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain
| | - Rocío Toro
- Medicine Department, School of Medicine, University of Cádiz, Cádiz, Spain
| | - Sergi Cesar
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, Barcelona, Spain,European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam, Netherlands,Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - José Cruzalegui
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, Barcelona, Spain,European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam, Netherlands,Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Mònica Coll
- Medical Science Department, School of Medicine, University of Girona, Girona, Spain,Cardiovascular Genetics Center, Institut d’Investigacions Biomèdiques de Girona (IDIBGI), University of Girona, Girona, Spain
| | - Mireia Alcalde
- Medical Science Department, School of Medicine, University of Girona, Girona, Spain,Cardiovascular Genetics Center, Institut d’Investigacions Biomèdiques de Girona (IDIBGI), University of Girona, Girona, Spain
| | - Ramon Brugada
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain,Medical Science Department, School of Medicine, University of Girona, Girona, Spain,Cardiovascular Genetics Center, Institut d’Investigacions Biomèdiques de Girona (IDIBGI), University of Girona, Girona, Spain,Cardiology Department, Hospital Josep Trueta, Girona, Spain
| | - Andrea Greco
- Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain,Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - María Luisa Ortega-Sánchez
- Forensic Pathology Department, Institut de Medicina Legal i Ciències Forenses de Catalunya (IMLCFC), Barcelona, Spain,School of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallés, Spain
| | - Eneko Barberia
- Forensic Pathology Department, Institut de Medicina Legal i Ciències Forenses de Catalunya (IMLCFC), Barcelona, Spain,School of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Spain
| | - Antonio Oliva
- Section of Legal Medicine, Department of Health Surveillance and Bioethics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Georgia Sarquella-Brugada
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, Barcelona, Spain,European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam, Netherlands,Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain,Medical Science Department, School of Medicine, University of Girona, Girona, Spain,*Correspondence: Georgia Sarquella-Brugada,
| | - Oscar Campuzano
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain,Medical Science Department, School of Medicine, University of Girona, Girona, Spain,Cardiovascular Genetics Center, Institut d’Investigacions Biomèdiques de Girona (IDIBGI), University of Girona, Girona, Spain,Oscar Campuzano,
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5
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Muacevic A, Adler JR. Postmortem Genetic Testing in Sudden Unexpected Death: A Narrative Review. Cureus 2023; 15:e33728. [PMID: 36643077 PMCID: PMC9837602 DOI: 10.7759/cureus.33728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 01/15/2023] Open
Abstract
Sudden unexpected death (SUD) is one of the challenging situations encountered in forensic medicine. As a rule, a comprehensive forensic assessment is performed to identify the cause of death in such cases; however, the absence of findings suggestive of a cause, i.e., a negative autopsy, warrants further investigation such as a molecular autopsy. In this review, we aim to highlight the genetic causes of SUD, tools used in a molecular autopsy, and the role of screening in surviving relatives. As per several guidelines, the most preferred samples for DNA extraction are whole blood and fresh frozen tissues. Furthermore, Sanger sequencing and next-generation sequencing are the technologies that are used for genetic analysis; the latter overcomes the former's drawbacks in terms of cost-effectiveness, time consumption, and the ability to sequence the whole exome. SUD have diverse etiologies; we can generally classify them into cardiac and non-cardiac causes. Regarding cardiac causes, many conditions having an underlying genetic basis are included, such as channelopathies and cardiomyopathies. Regarding non-cardiac causes of SUD, the main etiologies are epilepsy and metabolic disorders. Nevertheless, it has been proposed that there is a genetic overlap between channelopathies, especially long QT syndromes and epilepsy. Additionally, fatty acid oxidation disorders are major metabolic conditions that are caused by certain genetic mutations that can lead to SUD in infancy. Since many SUD causes have an underlying genetic mutation, it is important to understand the genetic variations not only to recognize the cause of death but also to undertake further preventive measures for surviving relatives. In conclusion, a molecular autopsy has a major role in the forensic examination of cases of SUD.
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6
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Hernández AMV, Díaz GMM, Zelaya MM. Informed consent of postmortem sampling: Bibliographic review. REVISTA DE CIENCIAS FORENSES DE HONDURAS 2022; 8:26-37. [PMID: 37622086 PMCID: PMC10448928 DOI: 10.5377/rcfh.v8i1.14965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Background Informed consent is based on the principle of personal autonomy, the moral conception of respect for the dignity of the human being and therefore on his freedom. The rest of the universal bioethical principles are articulated in the informed consent process: non-maleficence, justice, and beneficence. Objective Establish the situations in which it is pertinent to apply informed consent in the taking of postmortem samples from a bioethical approach versus a legal approach. Methodology A review was carried out in: SCIELO, LILACS, IBECS, CUMED, NIH, Repository of the Pan American Health Organization; using keywords: informed consent, human rights, autonomy, bioethics, autopsy, post-mortem samples and forensic doctors and a combination of these. The inclusion criteria: articles with a maximum age of five years, in Spanish and English with free access. Results 113 articles were obtained using the keywords and their combinations, plus another 43 additional records identified from other sources such as laws, regulations, etc. By eliminating the sources: duplicates, not relevant, disabled, and incomplete, a total of 49 articles were worked on. Conclusions There is a need to include in the national and international ethical guidelines that regulate scientific research and guidelines to follow on the completion of the informed consent process in studies that involve postmortem samples, after their primary use.
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Affiliation(s)
- Alejandra Marcela Ventura Hernández
- Ministerio Público, Dirección de Medicina Forense, Unidad de Investigación y Docencia, Tegucigalpa, Honduras
- Universidad Nacional Autónoma de Honduras, Posgrado de Medicina Legal y Forense
| | | | - Mireya Matamoros Zelaya
- Ministerio Público, Dirección de Medicina Forense, Unidad de Investigación y Docencia, Tegucigalpa, Honduras
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7
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Schulze-Bahr E, Dettmeyer RB, Klingel K, Kauferstein S, Wolf C, Baba HA, Bohle RM, Gebauer R, Milting H, Schmidt U, Meder B, Rieß O, Paul T, Bajanowski T, Schunkert H. Postmortale molekulargenetische Untersuchungen (molekulare Autopsie) bei kardiovaskulären und bei ungeklärten Todesfällen. KARDIOLOGE 2021. [DOI: 10.1007/s12181-020-00438-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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8
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Rugge M, Sacchi D, Cesaro S, Sbaraglia M, Locatelli F. Ethics in clinical autopsy. J Clin Pathol 2020; 74:jclinpath-2020-206793. [PMID: 33293353 DOI: 10.1136/jclinpath-2020-206793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/02/2020] [Accepted: 07/16/2020] [Indexed: 11/03/2022]
Abstract
This manuscript concerns the ethical aspects of the clinical autopsy procedure. Much of the literature on this topic addresses some of the multifaceted issues potentially involved: religious beliefs and/or cultural traditions coming to bear on the management of autopsies, relations between families and healthcare personnel (physicians and technicians) involved in conducting an autopsy, ethical implications of regulations to follow and procedures for obtaining biological samples for further diagnostics or research. All these issues have ethical implications, particularly in today's globalised cultural domain. To preserve for future generations the teaching and scientific value of the clinical autopsy, scientific societies and academic institutions should endorse educational efforts to promote the ethical management of autopsy procedures.
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Affiliation(s)
- Massimo Rugge
- Department of Medicine, Pathology and Cytopathology Unit, Università degli Studi di Padova, Padova, Veneto, Italy
- Department of Medicine DIMED, Universita degli Studi di Padova, Padova, Veneto, Italy
| | - Diana Sacchi
- Department of Medicine DIMED, Universita degli Studi di Padova, Padova, Veneto, Italy
| | - Sonia Cesaro
- Department of Medicine DIMED, Universita degli Studi di Padova, Padova, Veneto, Italy
| | - Marta Sbaraglia
- Department of Medicine DIMED, Universita degli Studi di Padova, Padova, Veneto, Italy
| | - Franco Locatelli
- Hemato-oncology, Sapienza University of Rome, Roma, Lazio, Italy
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9
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Gatter K. Informed Consent for Genetic Testing in Autopsy. Arch Pathol Lab Med 2020; 144:674-676. [PMID: 31986078 DOI: 10.5858/arpa.2019-0315-ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ken Gatter
- From the Department of Pathology, Oregon Health Sciences University, School of Medicine, Portland, Oregon
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10
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Prakash SK, San Roman AK, Crenshaw M, Flink B, Earle K, Los E, Bonnard Å, Lin AE. "Donating our bodies to science": A discussion about autopsy and organ donation in Turner syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2019; 181:36-42. [PMID: 30633443 DOI: 10.1002/ajmg.c.31671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 12/14/2022]
Abstract
At the Third Turner Resource Network Symposium, a working group presented the results of collaborative discussions about the importance of autopsy in Turner syndrome (TS). Considerable gaps in understanding the causes of death in TS can only be closed by more frequent death investigations and autopsies. The presentation included an overview of autopsy methods, strategies for utilizing autopsy, and biobanking to address research questions about TS, and the role of palliative care in the context of autopsy. This review highlights strategies to promote autopsy and tissue donation, culminating with an action plan to increase autopsy rates in the TS community.
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Affiliation(s)
- Siddharth K Prakash
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | | | - Melissa Crenshaw
- Division of Genetics, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Barbara Flink
- Turner Syndrome Society of the United States, Houston, Texas
| | - Kimberly Earle
- Department of Pediatrics, Division of Neonatology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas.,Division of Geriatrics, Hospice and Palliative Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Evan Los
- Department of Pediatrics, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee
| | - Åsa Bonnard
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
| | - Angela E Lin
- Genetics Unit, MassGeneral Hospital for Children, Boston, Massachusetts
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11
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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.
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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
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12
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Gulino SP, Burns K, Gunther WM, MacLeod H. Improving Forensic Pathologic Investigation of Sudden Death in the Young: Tools, Guidance, and Methods of Cardiovascular Dissection from the Sudden Death in the Young Case Registry. Acad Forensic Pathol 2018; 8:347-391. [PMID: 31240048 DOI: 10.1177/1925362118782077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/18/2018] [Indexed: 11/16/2022]
Abstract
The Sudden Death in the Young (SDY) Case Registry, a prospective, population-based registry active in ten states, has developed tools to aid pathologists and death investigators in the evaluation and autopsy of unexplained, natural sudden deaths in the pediatric population. The tools were developed by a team of experts representing forensic pathology; pediatric-, cardiac-, and neuropathology; cardiology; neurology/epileptology; pediatrics; genetic counseling; and public health. These tools focus on collecting data relevant to determination of cause of death with a focus on dissection of the cardiovascular system. The tools provide an objective checklist format for ease of use and data extraction. By sharing the tools here and highlighting the examination of the cardiovascular system, the SDY Case Registry encourages a standardized approach to death investigation, autopsy, and data collection for sudden, unexpected deaths in the young towards a goal of informing prevention efforts. Acad Forensic Pathol. 2018 8(2): 347-391.
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Rueda M, Wagner JL, Phillips TC, Topol SE, Muse ED, Lucas JR, Wagner GN, Topol EJ, Torkamani A. Molecular Autopsy for Sudden Death in the Young: Is Data Aggregation the Key? Front Cardiovasc Med 2017; 4:72. [PMID: 29181379 PMCID: PMC5694161 DOI: 10.3389/fcvm.2017.00072] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 10/27/2017] [Indexed: 12/18/2022] Open
Abstract
The Scripps molecular autopsy study seeks to incorporate genetic testing into the postmortem examination of cases of sudden death in the young (<45 years old). Here, we describe the results from the first 2 years of the study, which consisted of whole exome sequencing (WES) of a cohort of 50 cases predominantly from San Diego County. Apart from the individual description of cases, we analyzed the data at the cohort-level, which brought new perspectives on the genetic causes of sudden death. We investigated the advantages and disadvantages of using WES compared to a gene panel for cardiac disease (usually the first genetic test used by medical examiners). In an attempt to connect complex clinical phenotypes with genotypes, we classified samples by their genetic fingerprint. Finally, we studied the benefits of analyzing the mitochondrial DNA genome. In this regard, we found that half of the cases clinically diagnosed as sudden infant death syndrome had an increased ratio of heteroplasmic variants, and that the variants were also present in the mothers. We believe that community-based data aggregation and sharing will eventually lead to an improved classification of variants. Allele frequencies for the all cases can be accessed via our genomics browser at https://genomics.scripps.edu/browser.
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Affiliation(s)
- Manuel Rueda
- The Scripps Translational Science Institute, Scripps Health, The Scripps Research Institute, La Jolla, CA, United States
| | - Jennifer L Wagner
- The Scripps Translational Science Institute, Scripps Health, The Scripps Research Institute, La Jolla, CA, United States
| | - Tierney C Phillips
- The Scripps Translational Science Institute, Scripps Health, The Scripps Research Institute, La Jolla, CA, United States
| | - Sarah E Topol
- The Scripps Translational Science Institute, Scripps Health, The Scripps Research Institute, La Jolla, CA, United States
| | - Evan D Muse
- The Scripps Translational Science Institute, Scripps Health, The Scripps Research Institute, La Jolla, CA, United States.,Division of Cardiology, Scripps Clinic, La Jolla, CA, United States
| | - Jonathan R Lucas
- Medical Examiner Department, San Diego County, San Diego, CA, United States
| | - Glenn N Wagner
- Medical Examiner Department, San Diego County, San Diego, CA, United States
| | - Eric J Topol
- The Scripps Translational Science Institute, Scripps Health, The Scripps Research Institute, La Jolla, CA, United States.,Division of Cardiology, Scripps Clinic, La Jolla, CA, United States
| | - Ali Torkamani
- The Scripps Translational Science Institute, Scripps Health, The Scripps Research Institute, La Jolla, CA, United States
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Methner DNR, Scherer SE, Welch K, Walkiewicz M, Eng CM, Belmont JW, Powell MC, Korchina V, Doddapaneni HV, Muzny DM, Gibbs RA, Wolf DA, Sanchez LA, Kahn R. Postmortem genetic screening for the identification, verification, and reporting of genetic variants contributing to the sudden death of the young. Genome Res 2016; 26:1170-7. [PMID: 27435932 PMCID: PMC5052040 DOI: 10.1101/gr.195800.115] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 07/15/2016] [Indexed: 12/30/2022]
Abstract
Each year in the United States, thousands of cases of sudden and unexpected deaths of infants, children, and young adults are assigned an undetermined cause of death after postmortem investigation and autopsy. Heritable genetic variants have been suggested as the cause of up to a third of sudden death (SD) cases. Elucidation of the genetic variants involved in SD cases is important to not only help establish cause and manner of death of these individuals, but to also aid in determining whether familial genetic testing should be considered. Previously, these types of postmortem screenings have not been a feasible option for most county medical examiners' and coroners' offices. We sequenced full exons of 64 genes associated with SD in the largest known cohort (351) of infant and young SD decedents using massively parallel sequencing at <$600 per sample. Genetic variants were assessed through literature review and clinical evaluation by a multidisciplinary consortium of experts. Thirteen individuals (3.7%), eight infants (2.8% of those <1 yr of age) and five children/young adults (7.0% of those >1 yr of age), were found to have a reportable genetic variant contributing to SD. These percentages represent an estimate lower than those previously reported. Overall yields and results likely vary between studies due to differences in evaluation techniques and reporting. Additionally, we recommend ongoing assessment of data, including nonreported novel variants, as technology and literature continually advance. This study demonstrates a strategy to implement molecular autopsies in medicolegal investigations of young SD decedents.
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Affiliation(s)
| | - Steven E Scherer
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Katherine Welch
- Harris County Institute of Forensic Sciences, Houston, Texas 77054, USA
| | - Magdalena Walkiewicz
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Christine M Eng
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030, USA
| | - John W Belmont
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030, USA; Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Mark C Powell
- Harris County Institute of Forensic Sciences, Houston, Texas 77054, USA
| | - Viktoriya Korchina
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | | | - Donna M Muzny
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Richard A Gibbs
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Dwayne A Wolf
- Harris County Institute of Forensic Sciences, Houston, Texas 77054, USA
| | - Luis A Sanchez
- Harris County Institute of Forensic Sciences, Houston, Texas 77054, USA
| | - Roger Kahn
- Harris County Institute of Forensic Sciences, Houston, Texas 77054, USA
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