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Mazzaccara C, Lombardi R, Mirra B, Barretta F, Esposito MV, Uomo F, Caiazza M, Monda E, Losi MA, Limongelli G, D’Argenio V, Frisso G. Next-Generation Sequencing Gene Panels in Inheritable Cardiomyopathies and Channelopathies: Prevalence of Pathogenic Variants and Variants of Unknown Significance in Uncommon Genes. Biomolecules 2022; 12:1417. [PMID: 36291626 PMCID: PMC9599286 DOI: 10.3390/biom12101417] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 08/17/2023] Open
Abstract
The diffusion of next-generation sequencing (NGS)-based approaches allows for the identification of pathogenic mutations of cardiomyopathies and channelopathies in more than 200 different genes. Since genes considered uncommon for a clinical phenotype are also now included in molecular testing, the detection rate of disease-causing variants has increased. Here, we report the prevalence of genetic variants detected by using a NGS custom panel in a cohort of 133 patients with inherited cardiomyopathies (n = 77) or channelopathies (n = 56). We identified 82 variants, of which 50 (61%) were identified in genes without a strong or definitive evidence of disease association according to the NIH-funded Clinical Genome Resource (ClinGen; "uncommon genes"). Among these, 35 (70%) were variants of unknown significance (VUSs), 13 (26%) were pathogenic (P) or likely pathogenic (LP) mutations, and 2 (4%) benign (B) or likely benign (LB) variants according to American College of Medical Genetics (ACMG) classifications. These data reinforce the need for the screening of uncommon genes in order to increase the diagnostic sensitivity of the genetic testing of inherited cardiomyopathies and channelopathies by allowing for the identification of mutations in genes that are not usually explored due to a currently poor association with the clinical phenotype.
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Affiliation(s)
- Cristina Mazzaccara
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, 80131 Napoli, Italy
- CEINGE Biotecnologie Avanzate, 80145 Napoli, Italy
| | - Raffaella Lombardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Napoli, Italy
- Department of Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Bruno Mirra
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, 80131 Napoli, Italy
- CEINGE Biotecnologie Avanzate, 80145 Napoli, Italy
| | - Ferdinando Barretta
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, 80131 Napoli, Italy
- CEINGE Biotecnologie Avanzate, 80145 Napoli, Italy
| | | | - Fabiana Uomo
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, 80131 Napoli, Italy
- CEINGE Biotecnologie Avanzate, 80145 Napoli, Italy
| | - Martina Caiazza
- Monaldi Hospital, AO Colli, 80131 Napoli, Italy
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, 81100 Caserta, Italy
| | - Emanuele Monda
- Monaldi Hospital, AO Colli, 80131 Napoli, Italy
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, 81100 Caserta, Italy
| | - Maria Angela Losi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Napoli, Italy
| | - Giuseppe Limongelli
- Monaldi Hospital, AO Colli, 80131 Napoli, Italy
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, 81100 Caserta, Italy
| | - Valeria D’Argenio
- CEINGE Biotecnologie Avanzate, 80145 Napoli, Italy
- Department of Human Sciences and Quality of Life Promotion, San Raffaele Open University, 00166 Roma, Italy
| | - Giulia Frisso
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, 80131 Napoli, Italy
- CEINGE Biotecnologie Avanzate, 80145 Napoli, Italy
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Marian AJ, Tan Y, Li L, Chang J, Syrris P, Hessabi M, Rahbar MH, Willerson JT, Cheong BY, Liu CY, Kleiman NS, Bluemke DA, Nagueh SF. Hypertrophy Regression With N-Acetylcysteine in Hypertrophic Cardiomyopathy (HALT-HCM): A Randomized, Placebo-Controlled, Double-Blind Pilot Study. Circ Res 2018. [PMID: 29540445 DOI: 10.1161/circresaha.117.312647] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
RATIONALE Hypertrophic cardiomyopathy (HCM) is a genetic paradigm of cardiac hypertrophy. Cardiac hypertrophy and interstitial fibrosis are important risk factors for sudden death and morbidity in HCM. Oxidative stress is implicated in the pathogenesis of cardiac hypertrophy and fibrosis. Treatment with antioxidant N-acetylcysteine (NAC) reverses cardiac hypertrophy and fibrosis in animal models of HCM. OBJECTIVE To determine effect sizes of NAC on indices of cardiac hypertrophy and fibrosis in patients with established HCM. METHODS AND RESULTS HALT-HCM (Hypertrophy Regression With N-Acetylcysteine in Hypertrophic Cardiomyopathy) is a double-blind, randomized, sex-matched, placebo-controlled single-center pilot study in patients with HCM. Patients with HCM, who had a left ventricular wall thickness of ≥15 mm, were randomized either to a placebo or to NAC (1:2 ratio, respectively). NAC was titrated ≤2.4 g per day. Clinical evaluation, blood chemistry, and 6-minute walk test were performed every 3 months, and electrocardiography, echocardiography, and cardiac magnetic resonance imaging, the latter whenever not contraindicated, before and after 12 months of treatment. Eighty-five of 232 screened patients met the eligibility criteria, 42 agreed to participate; 29 were randomized to NAC and 13 to placebo groups. Demographic, echocardiographic, and cardiac magnetic resonance imaging phenotypes at the baseline between the 2 groups were similar. WSE in 38 patients identified a spectrum of 42 pathogenic variants in genes implicated in HCM in 26 participants. Twenty-four patients in the NAC group and 11 in the placebo group completed the study. Six severe adverse events occurred in the NAC group but were considered unrelated to NAC. The effect sizes of NAC on the clinical phenotype, echocardiographic, and cardiac magnetic resonance imaging indices of cardiac hypertrophy, function, and extent of late gadolinium enhancement-a surrogate for fibrosis-were small. CONCLUSIONS Treatment with NAC for 12 months had small effect sizes on indices of cardiac hypertrophy or fibrosis. The small sample size of the HALT-HCM study hinders from making firm conclusions about efficacy of NAC in HCM. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01537926.
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Affiliation(s)
- Ali J Marian
- From the Center for Cardiovascular Genetics, Brown Foundation Institute of Molecular Medicine, Texas Heart Institute (A.J.M., Y.T., L.L., J.C., J.T.W., B.Y.C.), Biostatistics/Epidemiology/Research Design Component, Center for Clinical and Translational Sciences (M.H., M.H.R.), Department of Epidemiology, Human Genetics, and Environmental Sciences (M.H.R.), Division of Clinical and Translational Sciences (M.H.R.), and Department of Internal Medicine, University of Texas Health Science Center, Houston (M.H.R.); Institute of Cardiovascular Science, University College London, United Kingdom (P.S.); Department of Radiology, Johns Hopkins Hospital, Baltimore, MD (C.-Y.L.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (D.A.B.); and Department of Medicine, Methodist DeBakey Heart and Vascular Center, Houston, TX (N.S.K., S.F.N.).
| | - Yanli Tan
- From the Center for Cardiovascular Genetics, Brown Foundation Institute of Molecular Medicine, Texas Heart Institute (A.J.M., Y.T., L.L., J.C., J.T.W., B.Y.C.), Biostatistics/Epidemiology/Research Design Component, Center for Clinical and Translational Sciences (M.H., M.H.R.), Department of Epidemiology, Human Genetics, and Environmental Sciences (M.H.R.), Division of Clinical and Translational Sciences (M.H.R.), and Department of Internal Medicine, University of Texas Health Science Center, Houston (M.H.R.); Institute of Cardiovascular Science, University College London, United Kingdom (P.S.); Department of Radiology, Johns Hopkins Hospital, Baltimore, MD (C.-Y.L.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (D.A.B.); and Department of Medicine, Methodist DeBakey Heart and Vascular Center, Houston, TX (N.S.K., S.F.N.)
| | - Lili Li
- From the Center for Cardiovascular Genetics, Brown Foundation Institute of Molecular Medicine, Texas Heart Institute (A.J.M., Y.T., L.L., J.C., J.T.W., B.Y.C.), Biostatistics/Epidemiology/Research Design Component, Center for Clinical and Translational Sciences (M.H., M.H.R.), Department of Epidemiology, Human Genetics, and Environmental Sciences (M.H.R.), Division of Clinical and Translational Sciences (M.H.R.), and Department of Internal Medicine, University of Texas Health Science Center, Houston (M.H.R.); Institute of Cardiovascular Science, University College London, United Kingdom (P.S.); Department of Radiology, Johns Hopkins Hospital, Baltimore, MD (C.-Y.L.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (D.A.B.); and Department of Medicine, Methodist DeBakey Heart and Vascular Center, Houston, TX (N.S.K., S.F.N.)
| | - Jeffrey Chang
- From the Center for Cardiovascular Genetics, Brown Foundation Institute of Molecular Medicine, Texas Heart Institute (A.J.M., Y.T., L.L., J.C., J.T.W., B.Y.C.), Biostatistics/Epidemiology/Research Design Component, Center for Clinical and Translational Sciences (M.H., M.H.R.), Department of Epidemiology, Human Genetics, and Environmental Sciences (M.H.R.), Division of Clinical and Translational Sciences (M.H.R.), and Department of Internal Medicine, University of Texas Health Science Center, Houston (M.H.R.); Institute of Cardiovascular Science, University College London, United Kingdom (P.S.); Department of Radiology, Johns Hopkins Hospital, Baltimore, MD (C.-Y.L.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (D.A.B.); and Department of Medicine, Methodist DeBakey Heart and Vascular Center, Houston, TX (N.S.K., S.F.N.)
| | - Petros Syrris
- From the Center for Cardiovascular Genetics, Brown Foundation Institute of Molecular Medicine, Texas Heart Institute (A.J.M., Y.T., L.L., J.C., J.T.W., B.Y.C.), Biostatistics/Epidemiology/Research Design Component, Center for Clinical and Translational Sciences (M.H., M.H.R.), Department of Epidemiology, Human Genetics, and Environmental Sciences (M.H.R.), Division of Clinical and Translational Sciences (M.H.R.), and Department of Internal Medicine, University of Texas Health Science Center, Houston (M.H.R.); Institute of Cardiovascular Science, University College London, United Kingdom (P.S.); Department of Radiology, Johns Hopkins Hospital, Baltimore, MD (C.-Y.L.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (D.A.B.); and Department of Medicine, Methodist DeBakey Heart and Vascular Center, Houston, TX (N.S.K., S.F.N.)
| | - Manouchehr Hessabi
- From the Center for Cardiovascular Genetics, Brown Foundation Institute of Molecular Medicine, Texas Heart Institute (A.J.M., Y.T., L.L., J.C., J.T.W., B.Y.C.), Biostatistics/Epidemiology/Research Design Component, Center for Clinical and Translational Sciences (M.H., M.H.R.), Department of Epidemiology, Human Genetics, and Environmental Sciences (M.H.R.), Division of Clinical and Translational Sciences (M.H.R.), and Department of Internal Medicine, University of Texas Health Science Center, Houston (M.H.R.); Institute of Cardiovascular Science, University College London, United Kingdom (P.S.); Department of Radiology, Johns Hopkins Hospital, Baltimore, MD (C.-Y.L.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (D.A.B.); and Department of Medicine, Methodist DeBakey Heart and Vascular Center, Houston, TX (N.S.K., S.F.N.)
| | - Mohammad H Rahbar
- From the Center for Cardiovascular Genetics, Brown Foundation Institute of Molecular Medicine, Texas Heart Institute (A.J.M., Y.T., L.L., J.C., J.T.W., B.Y.C.), Biostatistics/Epidemiology/Research Design Component, Center for Clinical and Translational Sciences (M.H., M.H.R.), Department of Epidemiology, Human Genetics, and Environmental Sciences (M.H.R.), Division of Clinical and Translational Sciences (M.H.R.), and Department of Internal Medicine, University of Texas Health Science Center, Houston (M.H.R.); Institute of Cardiovascular Science, University College London, United Kingdom (P.S.); Department of Radiology, Johns Hopkins Hospital, Baltimore, MD (C.-Y.L.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (D.A.B.); and Department of Medicine, Methodist DeBakey Heart and Vascular Center, Houston, TX (N.S.K., S.F.N.)
| | - James T Willerson
- From the Center for Cardiovascular Genetics, Brown Foundation Institute of Molecular Medicine, Texas Heart Institute (A.J.M., Y.T., L.L., J.C., J.T.W., B.Y.C.), Biostatistics/Epidemiology/Research Design Component, Center for Clinical and Translational Sciences (M.H., M.H.R.), Department of Epidemiology, Human Genetics, and Environmental Sciences (M.H.R.), Division of Clinical and Translational Sciences (M.H.R.), and Department of Internal Medicine, University of Texas Health Science Center, Houston (M.H.R.); Institute of Cardiovascular Science, University College London, United Kingdom (P.S.); Department of Radiology, Johns Hopkins Hospital, Baltimore, MD (C.-Y.L.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (D.A.B.); and Department of Medicine, Methodist DeBakey Heart and Vascular Center, Houston, TX (N.S.K., S.F.N.)
| | - Benjamin Y Cheong
- From the Center for Cardiovascular Genetics, Brown Foundation Institute of Molecular Medicine, Texas Heart Institute (A.J.M., Y.T., L.L., J.C., J.T.W., B.Y.C.), Biostatistics/Epidemiology/Research Design Component, Center for Clinical and Translational Sciences (M.H., M.H.R.), Department of Epidemiology, Human Genetics, and Environmental Sciences (M.H.R.), Division of Clinical and Translational Sciences (M.H.R.), and Department of Internal Medicine, University of Texas Health Science Center, Houston (M.H.R.); Institute of Cardiovascular Science, University College London, United Kingdom (P.S.); Department of Radiology, Johns Hopkins Hospital, Baltimore, MD (C.-Y.L.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (D.A.B.); and Department of Medicine, Methodist DeBakey Heart and Vascular Center, Houston, TX (N.S.K., S.F.N.)
| | - Chia-Ying Liu
- From the Center for Cardiovascular Genetics, Brown Foundation Institute of Molecular Medicine, Texas Heart Institute (A.J.M., Y.T., L.L., J.C., J.T.W., B.Y.C.), Biostatistics/Epidemiology/Research Design Component, Center for Clinical and Translational Sciences (M.H., M.H.R.), Department of Epidemiology, Human Genetics, and Environmental Sciences (M.H.R.), Division of Clinical and Translational Sciences (M.H.R.), and Department of Internal Medicine, University of Texas Health Science Center, Houston (M.H.R.); Institute of Cardiovascular Science, University College London, United Kingdom (P.S.); Department of Radiology, Johns Hopkins Hospital, Baltimore, MD (C.-Y.L.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (D.A.B.); and Department of Medicine, Methodist DeBakey Heart and Vascular Center, Houston, TX (N.S.K., S.F.N.)
| | - Neal S Kleiman
- From the Center for Cardiovascular Genetics, Brown Foundation Institute of Molecular Medicine, Texas Heart Institute (A.J.M., Y.T., L.L., J.C., J.T.W., B.Y.C.), Biostatistics/Epidemiology/Research Design Component, Center for Clinical and Translational Sciences (M.H., M.H.R.), Department of Epidemiology, Human Genetics, and Environmental Sciences (M.H.R.), Division of Clinical and Translational Sciences (M.H.R.), and Department of Internal Medicine, University of Texas Health Science Center, Houston (M.H.R.); Institute of Cardiovascular Science, University College London, United Kingdom (P.S.); Department of Radiology, Johns Hopkins Hospital, Baltimore, MD (C.-Y.L.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (D.A.B.); and Department of Medicine, Methodist DeBakey Heart and Vascular Center, Houston, TX (N.S.K., S.F.N.)
| | - David A Bluemke
- From the Center for Cardiovascular Genetics, Brown Foundation Institute of Molecular Medicine, Texas Heart Institute (A.J.M., Y.T., L.L., J.C., J.T.W., B.Y.C.), Biostatistics/Epidemiology/Research Design Component, Center for Clinical and Translational Sciences (M.H., M.H.R.), Department of Epidemiology, Human Genetics, and Environmental Sciences (M.H.R.), Division of Clinical and Translational Sciences (M.H.R.), and Department of Internal Medicine, University of Texas Health Science Center, Houston (M.H.R.); Institute of Cardiovascular Science, University College London, United Kingdom (P.S.); Department of Radiology, Johns Hopkins Hospital, Baltimore, MD (C.-Y.L.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (D.A.B.); and Department of Medicine, Methodist DeBakey Heart and Vascular Center, Houston, TX (N.S.K., S.F.N.)
| | - Sherif F Nagueh
- From the Center for Cardiovascular Genetics, Brown Foundation Institute of Molecular Medicine, Texas Heart Institute (A.J.M., Y.T., L.L., J.C., J.T.W., B.Y.C.), Biostatistics/Epidemiology/Research Design Component, Center for Clinical and Translational Sciences (M.H., M.H.R.), Department of Epidemiology, Human Genetics, and Environmental Sciences (M.H.R.), Division of Clinical and Translational Sciences (M.H.R.), and Department of Internal Medicine, University of Texas Health Science Center, Houston (M.H.R.); Institute of Cardiovascular Science, University College London, United Kingdom (P.S.); Department of Radiology, Johns Hopkins Hospital, Baltimore, MD (C.-Y.L.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (D.A.B.); and Department of Medicine, Methodist DeBakey Heart and Vascular Center, Houston, TX (N.S.K., S.F.N.)
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