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Kramer RJ, Fatahian AN, Chan A, Mortenson J, Osher J, Sun B, Parker LE, Rosamilia MB, Potter KB, Moore K, Atkins SL, Rosenfeld JA, Birjiniuk A, Jones E, Howard TS, Kim JJ, Scott DA, Lalani S, Rouzbehani OMT, Kaplan S, Hathaway MA, Cohen JL, Asaki SY, Martinez HR, Boudina S, Landstrom AP. PRDM16 Deletion Is Associated With Sex-dependent Cardiomyopathy and Cardiac Mortality: A Translational, Multi-Institutional Cohort Study. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2023; 16:390-400. [PMID: 37395136 PMCID: PMC10528350 DOI: 10.1161/circgen.122.003912] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 05/10/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND 1p36 deletion syndrome can predispose to pediatric-onset cardiomyopathy. Deletion breakpoints are variable and may delete the transcription factor PRDM16. Early studies suggest that deletion of PRDM16 may underlie cardiomyopathy in patients with 1p36 deletion; however, the prognostic impact of PRDM16 loss is unknown. METHODS This retrospective cohort included subjects with 1p36 deletion syndrome from 4 hospitals. Prevalence of cardiomyopathy and freedom from death, cardiac transplantation, or ventricular assist device were analyzed. A systematic review cohort was derived for further analysis. A cardiac-specific Prdm16 knockout mouse (Prdm16 conditional knockout) was generated. Echocardiography was performed at 4 and 6 to 7 months. Histology staining and qPCR were performed at 7 months to assess fibrosis. RESULTS The retrospective cohort included 71 patients. Among individuals with PRDM16 deleted, 34.5% developed cardiomyopathy versus 7.7% of individuals with PRDM16 not deleted (P=0.1). In the combined retrospective and systematic review cohort (n=134), PRDM16 deletion-associated cardiomyopathy risk was recapitulated and significant (29.1% versus 10.8%, P=0.03). PRDM16 deletion was associated with increased risk of death, cardiac transplant, or ventricular assist device (P=0.04). Among those PRDM16 deleted, 34.5% of females developed cardiomyopathy versus 16.7% of their male counterparts (P=0.2). We find sex-specific differences in the incidence and the severity of contractile dysfunction and fibrosis in female Prdm16 conditional knockout mice. Further, female Prdm16 conditional knockout mice demonstrate significantly elevated risk of mortality (P=0.0003). CONCLUSIONS PRDM16 deletion is associated with a significantly increased risk of cardiomyopathy and cardiac mortality. Prdm16 conditional knockout mice develop cardiomyopathy in a sex-biased way. Patients with PRDM16 deletion should be assessed for cardiac disease.
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Affiliation(s)
- Ryan J. Kramer
- Dept of Pediatrics, Division of Pediatric Cardiology, Duke University School of Medicine, Durham, NC
| | - Amir Nima Fatahian
- Dept of Nutrition & Integrative Physiology, University of Utah, Salt Lake City, UT
| | - Alice Chan
- Dept of Pediatrics, Division of Pediatric Cardiology, Duke University School of Medicine, Durham, NC
| | - Jeffery Mortenson
- Dept of Pediatrics, Division of Pediatric Cardiology, University of Tennessee Health Science Center, Memphis, TN
| | - Jennifer Osher
- Dept of Pediatrics, Division of Pediatric Cardiology, University of Tennessee Health Science Center, Memphis, TN
| | - Bo Sun
- Dept of Pediatrics, Division of Pediatric Cardiology, Duke University School of Medicine, Durham, NC
| | - Lauren E. Parker
- Dept of Pediatrics, Division of Pediatric Cardiology, Duke University School of Medicine, Durham, NC
| | - Michael B. Rosamilia
- Dept of Pediatrics, Division of Pediatric Cardiology, Duke University School of Medicine, Durham, NC
| | - Kyra B. Potter
- Dept of Pediatrics, Division of Pediatric Cardiology, Duke University School of Medicine, Durham, NC
| | - Kaila Moore
- Dept of Pediatrics, Division of Pediatric Cardiology, Duke University School of Medicine, Durham, NC
| | - Sage L. Atkins
- Dept of Pediatrics, Division of Pediatric Cardiology, Duke University School of Medicine, Durham, NC
| | - Jill A. Rosenfeld
- Baylor Genetic Laboratories, Baylor College of Medicine, Houston, TX
- Dept of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX
| | - Alona Birjiniuk
- Dept of Pediatrics, Division of Pediatric Cardiology, Northwestern Feinberg School of Medicine, Chicago, IL
| | - Edward Jones
- Dept of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine, Houston, TX
| | - Taylor S. Howard
- Dept of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine, Houston, TX
| | - Jeffrey J. Kim
- Dept of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine, Houston, TX
| | - Daryl A. Scott
- Dept of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX
| | - Seema Lalani
- Dept of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX
| | - Omid MT. Rouzbehani
- Dept of Nutrition & Integrative Physiology, University of Utah, Salt Lake City, UT
| | - Samantha Kaplan
- Medical Center Library & Archives, Duke University School of Medicine, Durham, NC
| | - Marissa A. Hathaway
- Dept of Nutrition & Integrative Physiology, University of Utah, Salt Lake City, UT
| | - Jennifer L. Cohen
- Dept of Pediatrics, Division of Medical Genetics, Duke University School of Medicine, Durham, NC
| | - S. Yukiko Asaki
- Dept of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT
| | - Hugo R. Martinez
- Dept of Pediatrics, Division of Pediatric Cardiology, University of Tennessee Health Science Center, Memphis, TN
| | - Sihem Boudina
- Dept of Nutrition & Integrative Physiology, University of Utah, Salt Lake City, UT
| | - Andrew P. Landstrom
- Dept of Pediatrics, Division of Pediatric Cardiology, Duke University School of Medicine, Durham, NC
- Dept of Cell Biology, Duke University School of Medicine, Durham, NC
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