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Heliö K, Brandt E, Vaara S, Weckström S, Harjama L, Kandolin R, Järviö J, Hannula-Jouppi K, Heliö T, Holmström M, Koskenvuo JW. DSP c.6310delA p.(Thr2104Glnfs*12) associates with arrhythmogenic cardiomyopathy, increased trabeculation, curly hair, and palmoplantar keratoderma. Front Cardiovasc Med 2023; 10:1130903. [PMID: 37008330 PMCID: PMC10050721 DOI: 10.3389/fcvm.2023.1130903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/20/2023] [Indexed: 03/17/2023] Open
Abstract
BackgroundPathogenic variants in DSP associate with cardiac and cutaneous manifestations including arrhythmogenic right ventricular cardiomyopathy, dilated cardiomyopathy, curly or wavy hair, and palmoplantar keratoderma (PPK). Episodes of myocardial inflammation associated with DSP cardiomyopathy might be confused in clinical work with myocarditis of other etiologies such as viral. Cardiac magnetic resonance imaging (CMR) may help in differential diagnosis.Methods and resultsThis study comprised 49 Finnish patients: 34 participants from families with suspected DSP cardiomyopathy (9 index patients and 25 family members) and 15 patients with myocarditis. All 34 participants underwent genetic testing and cardiac evaluation, and 29 of them also underwent CMR. Participants with the DSP variant, numbering 22, were dermatologically examined. The 15 patients with myocarditis underwent CMR and were evaluated during their hospitalization.A heterozygous truncating DSP c.6310delA p.(Thr2104Glnfs*12) variant was confirmed in 29 participants. Only participants with the DSP variant had pacemakers and life-threatening ventricular arrhythmias. Of the participants with the DSP variant, 24% fulfilled cardiomyopathy criteria, and the median age at diagnosis was 53. Upon CMR, myocardial edema was found to be more common in patients with myocarditis. Both groups had a substantial percentage of late gadolinium enhancement (LGE). A ring-like LGE and increased trabeculation were observed only in participants with the DSP variant. All the studied participants with the DSP variant had PPK and curly or wavy hair. Hyperkeratosis developed before the age of 20 in most patients.ConclusionsThe DSP c.6310delA p.(Thr2104Glnfs*12) variant associates with curly hair, PPK, and arrhythmogenic cardiomyopathy with increased trabeculation. Cutaneous symptoms developing in childhood and adolescence might help recognize these patients at an earlier stage. CMR, together with dermatologic characteristics, may help in diagnosis.
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Affiliation(s)
- Krista Heliö
- Heart and Lung Center, ERN GUARD-Heart Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Eveliina Brandt
- Department of Dermatology and Allergology, ERN-Skin Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Satu Vaara
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Sini Weckström
- Heart and Lung Center, ERN GUARD-Heart Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Liisa Harjama
- Department of Dermatology and Allergology, ERN-Skin Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Riina Kandolin
- Heart and Lung Center, ERN GUARD-Heart Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Johanna Järviö
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Katariina Hannula-Jouppi
- Department of Dermatology and Allergology, ERN-Skin Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland and Research Programs Unit, Stem Cells and Metabolism Research Program, University of Helsinki, Helsinki, Finland
| | - Tiina Heliö
- Heart and Lung Center, ERN GUARD-Heart Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Miia Holmström
- Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Juha W. Koskenvuo
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
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Heliö K, Kangas-Kontio T, Weckström S, Vanninen SUM, Aalto-Setälä K, Alastalo TP, Myllykangas S, Heliö TM, Koskenvuo JW. DSP p.(Thr2104Glnfs*12) variant presents variably with early onset severe arrhythmias and left ventricular cardiomyopathy. BMC MEDICAL GENETICS 2020; 21:19. [PMID: 32005173 PMCID: PMC6995042 DOI: 10.1186/s12881-020-0955-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 01/20/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Dilated cardiomyopathy (DCM) is a condition characterized by dilatation and systolic dysfunction of the left ventricle in the absence of severe coronary artery disease or abnormal loading conditions. Mutations in the titin (TTN) and lamin A/C (LMNA) genes are the two most significant contributors in familial DCM. Previously mutations in the desmoplakin (DSP) gene have been associated with arrhythmogenic right ventricular cardiomyopathy (ARVC) and more recently with DCM. METHODS We describe the cardiac phenotype related to a DSP mutation which was identified in ten unrelated Finnish index patients using next-generation sequencing. Sanger sequencing was used to verify the presence of this DSP variant in the probands' relatives. Medical records were obtained, and clinical evaluation was performed. RESULTS We identified DSP c.6310delA, p.(Thr2104Glnfs*12) variant in 17 individuals of which 11 (65%) fulfilled the DCM diagnostic criteria. This pathogenic variant presented with left ventricular dilatation, dysfunction and major ventricular arrhythmias. Two patients showed late gadolinium enhancement (LGE) and myocardial edema on cardiac magnetic resonance imaging (MRI) that may suggest inflammatory process at myocardium. CONCLUSIONS The patients diagnosed with DCM showed an arrhythmogenic phenotype as well as SCD at young age supporting the recently proposed concept of arrhythmogenic cardiomyopathy. This study also demonstrates relatively low penetrance of truncating DSP variant in the probands' family members by the age of 40. Further studies are needed to elucidate the possible relations between myocardial inflammation and pathogenic DSP variants.
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Affiliation(s)
- Krista Heliö
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
| | | | - Sini Weckström
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - Katriina Aalto-Setälä
- Heart Center, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | | | | | - Tiina M Heliö
- Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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Bari O, Skillman S, Lah MD, Haggstrom AN. Compound heterozygous mutations in desmoplakin associated with skin fragility, follicular hyperkeratosis, alopecia, and nail dystrophy. Pediatr Dermatol 2018; 35:e218-e220. [PMID: 29633331 DOI: 10.1111/pde.13498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Desmoplakin mutations are associated with a wide variety of phenotypes affecting the skin, nails, hair, and heart. A 21-month-old boy was born with multiple erosions resembling epidermolysis bullosa, complete alopecia, nail dystrophy, palmoplantar keratoderma, and areas of follicular hyperkeratosis. He was found to have two heterozygous mutations in the desmoplakin gene: c.478 C>T in exon 4 (p.Arg160X) and c.3630T>A in exon 23 (Tyr1210X). This case expands the clinical spectrum associated with desmoplakin mutations and highlights a mutation in exon 23 that has not been previously reported in the literature.
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Affiliation(s)
- Omar Bari
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Sarah Skillman
- Department of Dermatology, MetroDerm P.C., Atlanta, GE, USA
| | - Melissa D Lah
- Department of Medical and Molecular Genetics, School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Anita N Haggstrom
- Department of Dermatology, School of Medicine, Indiana University, Indianapolis, IN, USA
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Polivka L, Bodemer C, Hadj-Rabia S. Combination of palmoplantar keratoderma and hair shaft anomalies, the warning signal of severe arrhythmogenic cardiomyopathy: a systematic review on genetic desmosomal diseases. J Med Genet 2015; 53:289-95. [DOI: 10.1136/jmedgenet-2015-103403] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 08/21/2015] [Indexed: 12/14/2022]
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Tekin B, Yucelten D, Liu L, McGrath JA. Alopecia, palmoplantar keratoderma, skin fragility and follicular hyperkeratoses due to compound heterozygous mutations in desmoplakin. Australas J Dermatol 2015; 58:e17-e19. [DOI: 10.1111/ajd.12385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 07/22/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Burak Tekin
- Department of Dermatology; Marmara University School of Medicine; Istanbul Turkey
| | - Deniz Yucelten
- Department of Dermatology; Marmara University School of Medicine; Istanbul Turkey
| | - Lu Liu
- Viapath; St Thomas' Hospital; London UK
| | - John A McGrath
- Genetic Skin Disease Group; King's College London (Guy's Campus); London UK
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Akinrinade O, Ollila L, Vattulainen S, Tallila J, Gentile M, Salmenperä P, Koillinen H, Kaartinen M, Nieminen MS, Myllykangas S, Alastalo TP, Koskenvuo JW, Heliö T. Genetics and genotype-phenotype correlations in Finnish patients with dilated cardiomyopathy. Eur Heart J 2015; 36:2327-37. [PMID: 26084686 PMCID: PMC4561350 DOI: 10.1093/eurheartj/ehv253] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 05/20/2015] [Indexed: 12/16/2022] Open
Abstract
Genetic analysis among patients with dilated cardiomyopathy (DCM) is becoming an important part of clinical assessment, as it is in hypertrophic cardiomyopathy (HCM). The genetics of DCM is complex and therefore next-generation sequencing strategies are essential when providing genetic diagnostics. To achieve maximum yield, the diagnostic approach should include comprehensive clinical phenotyping combined with high-quality, high-coverage deep sequencing of DCM-associated genes and clinical variant classification as a basis for defining true yield in genetic testing. Our study has combined a novel sequencing strategy and clinical interpretation to analyse the yield and genotype–phenotype correlations among well-phenotyped Finnish DCM patients. Aims Despite our increased understanding of the genetic basis of dilated cardiomyopathy (DCM), the clinical utility and yield of clinically meaningful findings of comprehensive next-generation sequencing (NGS)-based genetic diagnostics in DCM has been poorly described. We utilized a high-quality oligonucleotide-selective sequencing (OS-Seq)-based targeted sequencing panel to investigate the genetic landscape of DCM in Finnish population and to evaluate the utility of OS-Seq technology as a novel comprehensive diagnostic tool. Methods and results Using OS-Seq, we targeted and sequenced the coding regions and splice junctions of 101 genes associated with cardiomyopathies in 145 unrelated Finnish patients with DCM. We developed effective bioinformatic variant filtering strategy and implemented strict variant classification scheme to reveal diagnostic yield and genotype–phenotype correlations. Implemented OS-Seq technology provided high coverage of the target region (median coverage 410× and 99.42% of the nucleotides were sequenced at least 15× read depth). Diagnostic yield was 35.2% (familial 47.6% and sporadic 25.6%, P = 0.004) when both pathogenic and likely pathogenic variants are considered as disease causing. Of these, 20 (53%) were titin (TTN) truncations (non-sense and frameshift) affecting all TTN transcripts. TTN truncations accounted for 20.6% and 14.6% of the familial and sporadic DCM cases, respectively. Conclusion Panel-based, high-quality NGS enables high diagnostic yield especially in the familial form of DCM, and bioinformatic variant filtering is a reliable step in the process of interpretation of genomic data in a clinical setting.
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Affiliation(s)
- Oyediran Akinrinade
- Children's Hospital, Institute of Clinical Medicine, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland Institute of Biomedicine, University of Helsinki, Helsinki, Finland
| | - Laura Ollila
- Heart and Lung Center HUCH, University of Helsinki, Helsinki, Finland
| | - Sanna Vattulainen
- Children's Hospital, Institute of Clinical Medicine, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
| | | | | | | | - Hannele Koillinen
- Department of Genetics, University Hospital Helsinki, Helsinki, Finland
| | - Maija Kaartinen
- Heart and Lung Center HUCH, University of Helsinki, Helsinki, Finland
| | - Markku S Nieminen
- Heart and Lung Center HUCH, University of Helsinki, Helsinki, Finland
| | - Samuel Myllykangas
- Institute of Biomedicine, University of Helsinki, Helsinki, Finland Blueprint Genetics, Helsinki, Finland
| | - Tero-Pekka Alastalo
- Children's Hospital, Institute of Clinical Medicine, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland Blueprint Genetics, Helsinki, Finland
| | - Juha W Koskenvuo
- Blueprint Genetics, Helsinki, Finland Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Central Hospital and University of Helsinki, Helsinki 00290, Finland
| | - Tiina Heliö
- Heart and Lung Center HUCH, University of Helsinki, Helsinki, Finland
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Ramot Y, Molho-Pessach V, Meir T, Alper-Pinus R, Siam I, Tams S, Babay S, Zlotogorski A. Mutation in KANK2, encoding a sequestering protein for steroid receptor coactivators, causes keratoderma and woolly hair. J Med Genet 2014; 51:388-94. [PMID: 24671081 DOI: 10.1136/jmedgenet-2014-102346] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The combination of palmoplantar keratoderma and woolly hair is uncommon and reported as part of Naxos and Carvajal syndromes, both caused by mutations in desmosomal proteins and associated with cardiomyopathy. We describe two large consanguineous families with autosomal-recessive palmoplantar keratoderma and woolly hair, without cardiomyopathy and with no mutations in any known culprit gene. The aim of this study was to find the mutated gene in these families. METHODS AND RESULTS Using whole-exome sequencing, we identified a homozygous missense c.2009C>T mutation in KANK2 in the patients (p.Ala670Val). KANK2 encodes the steroid receptor coactivator (SRC)-interacting protein (SIP), an ankyrin repeat containing protein, which sequesters SRCs in the cytoplasm and controls transcription activation of steroid receptors, among others, also of the vitamin D receptor (VDR). The mutation in KANK2 is predicted to abolish the sequestering abilities of SIP. Indeed, vitamin D-induced transactivation was increased in patient's keratinocytes. Furthermore, SRC-2 and SRC-3, coactivators of VDR and important components of epidermal differentiation, are localised to the nucleus of epidermal basal cells in patients, in contrast to the cytoplasmic distribution in the heterozygous control. CONCLUSIONS These findings provide evidence that keratoderma and woolly hair can be caused by a non-desmosomal mechanism and further underline the importance of VDR for normal hair and skin phenotypes.
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Affiliation(s)
- Yuval Ramot
- Department of Dermatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel The Center for Genetic Diseases of The Skin and Hair, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Vered Molho-Pessach
- Department of Dermatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel The Center for Genetic Diseases of The Skin and Hair, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Tomer Meir
- Department of Nephrology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ruslana Alper-Pinus
- Department of Dermatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ihab Siam
- Department of Dermatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Spiro Tams
- Faculty of Medicine, The Palestinian Al Quds University, Abu Dis, The Palestinian Authority
| | - Sofia Babay
- The Center for Genetic Diseases of The Skin and Hair, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Abraham Zlotogorski
- Department of Dermatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel The Center for Genetic Diseases of The Skin and Hair, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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