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Lauerer AM, Caravia XM, Maier LS, Chemello F, Lebek S. Gene editing in common cardiovascular diseases. Pharmacol Ther 2024; 263:108720. [PMID: 39284367 DOI: 10.1016/j.pharmthera.2024.108720] [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: 05/20/2024] [Revised: 07/29/2024] [Accepted: 09/01/2024] [Indexed: 09/22/2024]
Abstract
Cardiovascular diseases are the leading cause of morbidity and mortality worldwide, highlighting the high socioeconomic impact. Current treatment strategies like compound-based drugs or surgeries are often limited. On the one hand, systemic administration of substances is frequently associated with adverse side effects; on the other hand, they typically provide only short-time effects requiring daily intake. Thus, new therapeutic approaches and concepts are urgently needed. The advent of CRISPR-Cas9 genome editing offers great promise for the correction of disease-causing hereditary mutations. As such mutations are often very rare, gene editing strategies to correct them are not broadly applicable to many patients. Notably, there is recent evidence that gene editing technology can also be deployed to disrupt common pathogenic signaling cascades in a targeted, specific, and efficient manner, which offers a more generalizable approach. However, several challenges remain to be addressed ranging from the optimization of the editing strategy itself to a suitable delivery strategy up to potential immune responses to the editing components. This review article discusses important CRISPR-Cas9-based gene editing approaches with their advantages and drawbacks and outlines opportunities in their application for treatment of cardiovascular diseases.
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Affiliation(s)
- Anna-Maria Lauerer
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Xurde M Caravia
- Department of Molecular Biology, Hamon Center for Regenerative Science and Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Lars S Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Francesco Chemello
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Simon Lebek
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
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Aimo A, Vergaro G, Castiglione V, Fabiani I, Barison A, Gentile F, Ferrari Chen YF, Giorgetti A, Genovesi D, Buda G, Franzini M, Piepoli M, Moscardini S, Rapezzi C, Fontana M, Passino C, Emdin M. Wild-type transthyretin cardiac amyloidosis is not rare in elderly subjects: the CATCH screening study. Eur J Prev Cardiol 2024; 31:1410-1417. [PMID: 38456769 DOI: 10.1093/eurjpc/zwae093] [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: 01/21/2024] [Revised: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 03/09/2024]
Abstract
AIMS Wild-type transthyretin cardiac amyloidosis (ATTRwt-CA) affects older adults and is currently considered as a rare disorder. We investigated for the first time the prevalence of ATTRwt-CA in elderly individuals from the general population. METHODS AND RESULTS General practitioners from Pisa, Italy, proposed a screening for ATTRwt-CA to all their patients aged 65-90 years, until 1000 accepted. The following red flags were searched: interventricular septal thickness ≥ 12 mm, any echocardiographic, electrocardiographic or clinical hallmark of CA, or high-sensitivity troponin T ≥ 14 ng/L. Individuals with at least one red flag (n = 346) were asked to undergo the search for a monoclonal protein and bone scintigraphy, and 216 accepted. Four patients received a non-invasive diagnosis of ATTRwt-CA. All complained of dyspnoea on moderate effort. A woman and a man aged 79 and 85 years, respectively, showed an intense cardiac tracer uptake (Grade 3), left ventricular (LV) wall thickening, Grade 2 and 3 diastolic dysfunction, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) > 1000 ng/L. Two other patients (a man aged 74 years and a woman aged 83 years) showed a Grade 2 uptake, an increased LV septal thickness, but preserved diastolic function, and NT-proBNP < 300 ng/L. The prevalence of ATTR-CA in subjects ≥ 65 years was calculated as 0.46% (i.e. 4 out of the 870 subjects completing the screening, namely 654 not meeting the criteria for Step 2 and 216 progressing to Step 2). CONCLUSION Wild-type transthyretin cardiac amyloidosis is uncommon in elderly subjects from the general population, but more frequent than expected for a rare disease.
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Affiliation(s)
- Alberto Aimo
- Interdisciplinary Center for Health Science, Scuola Superiore Sant'Anna, piazza Martiri della Libertà 33, Pisa 56127, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, via Moruzzi 1, Pisa 56124, Italy
| | - Giuseppe Vergaro
- Interdisciplinary Center for Health Science, Scuola Superiore Sant'Anna, piazza Martiri della Libertà 33, Pisa 56127, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, via Moruzzi 1, Pisa 56124, Italy
| | - Vincenzo Castiglione
- Interdisciplinary Center for Health Science, Scuola Superiore Sant'Anna, piazza Martiri della Libertà 33, Pisa 56127, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, via Moruzzi 1, Pisa 56124, Italy
| | - Iacopo Fabiani
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, via Moruzzi 1, Pisa 56124, Italy
| | - Andrea Barison
- Interdisciplinary Center for Health Science, Scuola Superiore Sant'Anna, piazza Martiri della Libertà 33, Pisa 56127, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, via Moruzzi 1, Pisa 56124, Italy
| | - Francesco Gentile
- Interdisciplinary Center for Health Science, Scuola Superiore Sant'Anna, piazza Martiri della Libertà 33, Pisa 56127, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, via Moruzzi 1, Pisa 56124, Italy
| | - Yu Fu Ferrari Chen
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, via Moruzzi 1, Pisa 56124, Italy
| | - Assuero Giorgetti
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, via Moruzzi 1, Pisa 56124, Italy
| | - Dario Genovesi
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, via Moruzzi 1, Pisa 56124, Italy
| | - Gabriele Buda
- Hematology Division, University Hospital of Pisa, Pisa, Italy
| | - Maria Franzini
- Pathology Division, University Hospital of Pisa, Pisa, Italy
| | - Massimo Piepoli
- Clinical Cardiology, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese, Milan 20097, Italy
| | | | - Claudio Rapezzi
- Cardiology Centre, University of Ferrara, Ferrara, Italy
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Marianna Fontana
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, UK
| | - Claudio Passino
- Interdisciplinary Center for Health Science, Scuola Superiore Sant'Anna, piazza Martiri della Libertà 33, Pisa 56127, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, via Moruzzi 1, Pisa 56124, Italy
| | - Michele Emdin
- Interdisciplinary Center for Health Science, Scuola Superiore Sant'Anna, piazza Martiri della Libertà 33, Pisa 56127, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, via Moruzzi 1, Pisa 56124, Italy
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Gallone G, Bongiovanni C, Bruno F, Landra F, Andreis A, Fava A, Scudeler L, DE Filippo O, Califaretti E, Cioffi M, Pidello S, Vairo A, Raineri C, Frea S, Giorgi M, Alunni G, Casoni R, Salizzoni S, Conrotto F, D'Ascenzo F, Rinaldi M, DE Ferrari GM. Transthyretin cardiac amyloidosis in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement: experience of a single center. Minerva Cardiol Angiol 2024; 72:87-94. [PMID: 37405712 DOI: 10.23736/s2724-5683.23.06175-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
BACKGROUND Even if prevalent among patients with severe aortic stenosis (AS), the clinical suspicion for transthyretin cardiac amyloidosis (ATTR-CA) remains difficult in this subset. We report our single center experience on ATTR-CA detection among TAVR candidates to provide insights on the prevalence and clinical features of dual pathology as compared to lone AS. METHODS Consecutive severe AS patients undergoing transcatheter aortic valve replacement (TAVR) evaluation at a single center were prospectively included. Those with suspected ATTR-CA based on clinical assessment underwent 99m Tc-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) bone scintigraphy. The RAISE score, a novel screening tool with high sensitivity for ATTR-CA in AS, was retrospectively calculated to rule-out ATTR-CA in the remaining patients. Patients were categorized as follow: "ATTR-CA+": patients with confirmed ATTR-CA at DPD bone scintigraphy; "ATTR-CA-": patients with negative DPD bone scintigraphy or a negative RAISE score; "ATTR-CA indeterminate": patients not undergoing ATTR-CA assessment with a positive RAISE score. The characteristics of ATTR-CA+ and ATTR-CA- patients were compared. RESULTS Of 107 included patients, ATTR-CA suspicion was posed in 13 patients and confirmed in six. Patients were categorized as follow: 6 (5.6%) ATTR-CA+, 79 (73.8%) ATTR-CA-, 22 (20.6%) ATTR-CA indeterminate. Excluding ATTR-CA indeterminate patients, the prevalence of ATTR-CA was 7.1% (95% CI 2.6-14.7%). As compared to ATTR-CA - patients, ATTR-CA + patients were older, had higher procedural risk and more extensive myocardial and renal damage. They had higher left ventricle mass index and lower ECG voltages, translating into a lower voltage to mass ratio. Moreover, we describe for the first time bifascicular block as an ECG feature highly specific of patients with dual pathology (50.0% vs. 2.7%, P<0.001). Of note, pericardial effusion was rarely found in patients with lone AS (16.7% vs. 1.2%, P=0.027). No difference in procedural outcomes was observed between groups. CONCLUSIONS Among severe AS patients, ATTR-CA is prevalent and presents with phenotypic features that may aid to differentiate it from lone AS. A clinical approach based on routine search of amyloidosis features might lead to selective DPD bone scintigraphy with a satisfactory positive predictive value.
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Affiliation(s)
- Guglielmo Gallone
- Città della Salute e della Scienza, University of Turin, Turin, Italy -
| | | | - Francesco Bruno
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Federico Landra
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Antonella Fava
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Luca Scudeler
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Ovidio DE Filippo
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Elena Califaretti
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Martina Cioffi
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Stefano Pidello
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Alessandro Vairo
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Claudia Raineri
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Simone Frea
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Mauro Giorgi
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Gianluca Alunni
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Roberta Casoni
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Stefano Salizzoni
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Federico Conrotto
- Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Mauro Rinaldi
- Città della Salute e della Scienza, University of Turin, Turin, Italy
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Fassler M, Tshori S, Barac Y, Bowles DE, Benaim C, George J. Dual Targeting of Soluble Oligomeric and Aggregated Transthyretin with a Monoclonal Antibody Ameliorates Experimental Neuropathy. BIOLOGY 2022; 11:biology11101509. [PMID: 36290413 PMCID: PMC9598441 DOI: 10.3390/biology11101509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/08/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022]
Abstract
ATTR amyloidosis comprises a spectrum of multiple clinical presentations, including, predominantly, neuropathy and cardiomyopathy. The common triggering pathogenic protein is misfolded transthyretin, a carrier protein that destabilizes misfolds and assembles into mature amyloid fibrils. The current management of ATTR amyloidosis includes the use of agents that stabilize TTR or attenuate its liver inducible production. Herein, we tested the hypothesis that a monoclonal antibody targeting the soluble oligomeric as well as the aggregated TTR would influence experimental neuropathy. We have shown that Ab-A, our previously described humanized IgG monoclonal antibody, dose-dependently ameliorates the toxicity to neurons triggered by misfolded TTR oligomers. Furthermore, the antibody that exhibits wide misTTR epitope recognition that includes the oligomeric and aggregated forms of the protein dose-dependently enhances the uptake of misfolded TTR to microglia, the resident predominant cells of the innate immune system within the CNS. These in vitro mechanistic properties of the antibody were corroborated by experimental in vivo data showing that the antibody rapidly clears human TTR amyloid extracts infiltrated to the sciatic nerves of rats. Thus, the monoclonal antibody targeting soluble and aggregated TTR is effective in experimental neuropathy, likely due its ability to act as a neuroprotective agent, as well its misTTR-mediated clearance via microglia.
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Affiliation(s)
- Michael Fassler
- Heart Center, Kaplan Medical Center, Rehovot, Hebrew University of Jerusalem, Jerusalem 91905, Israel
- Cognyxx Ltd., Tel Aviv, Israel
| | - Sagi Tshori
- Heart Center, Kaplan Medical Center, Rehovot, Hebrew University of Jerusalem, Jerusalem 91905, Israel
- Research Authority, Kaplan Medical Center, Rehovot, Hebrew University of Jerusalem, Jerusalem 91905, Israel
| | - Yaron Barac
- The Division of Cardiovascular and Thoracic Surgery, Rabin Medical Center, Petach Tikva 4941492, Israel
| | - Dawn E. Bowles
- Surgical Sciences Division, Department of Surgery, Duke University, Durham, NC 27710, USA
| | - Clara Benaim
- Heart Center, Kaplan Medical Center, Rehovot, Hebrew University of Jerusalem, Jerusalem 91905, Israel
- Cognyxx Ltd., Tel Aviv, Israel
| | - Jacob George
- Heart Center, Kaplan Medical Center, Rehovot, Hebrew University of Jerusalem, Jerusalem 91905, Israel
- Cognyxx Ltd., Tel Aviv, Israel
- Correspondence:
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