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Singh SM, Sharkey SW, Casey SA, Harris KM, Thaler CM, Chung M, Berg A, Bennett MK, Ducanson ER, Mackey-Bojack S, Sengupta JD. Acute Myocardial Infarction-Like Events in Related Patients With a Desmoplakin-Associated Arrhythmogenic Cardiomyopathy. JACC Case Rep 2021; 3:1667-1673. [PMID: 34766015 PMCID: PMC8571794 DOI: 10.1016/j.jaccas.2021.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 11/20/2022]
Abstract
Patients with familial arrhythmogenic cardiomyopathy typically present with ventricular arrhythmias or progressive heart failure. This paper characterizes a rare presentation of an underlying genetic cardiomyopathy with clinical manifestations mimicking an acute myocardial infarction in 2 siblings, each with the same mutation in the desmoplakin (DSP) gene. (Level of Difficulty: Advanced.)
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Key Words
- ACM
- ACM, arrhythmogenic cardiomyopathy
- CMR, cardiac magnetic resonance
- CP, chest pain
- DSP, desmoplakin
- ECG, electrocardiogram
- LGE, late gadolinium enhancement
- LV, left ventricle
- PVC, premature ventricular contraction
- RV, right ventricle
- TnI, troponin I
- genetic cardiomyopathy
- heart failure
- myocardial injury
- sudden cardiac death
- troponin I
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Affiliation(s)
- Sajya M Singh
- Minneapolis Heart Institute and Foundation, Minneapolis, Minnesota, USA
| | - Scott W Sharkey
- Minneapolis Heart Institute and Foundation, Minneapolis, Minnesota, USA
| | - Susan A Casey
- Minneapolis Heart Institute and Foundation, Minneapolis, Minnesota, USA
| | - Kevin M Harris
- Minneapolis Heart Institute and Foundation, Minneapolis, Minnesota, USA
| | | | - Mina Chung
- Molecular Cardiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Allison Berg
- Genetics, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Mosi K Bennett
- Minneapolis Heart Institute and Foundation, Minneapolis, Minnesota, USA
| | - Emily R Ducanson
- Jesse E. Edwards Registry of Cardiovascular Disease, Nasseff Heart Center, United Hospital, St. Paul, Minnesota, USA
| | - Shannon Mackey-Bojack
- Jesse E. Edwards Registry of Cardiovascular Disease, Nasseff Heart Center, United Hospital, St. Paul, Minnesota, USA
| | - Jay D Sengupta
- Minneapolis Heart Institute and Foundation, Minneapolis, Minnesota, USA
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Te Riele ASJM, James CA, Calkins H, Tsatsopoulou A. Arrhythmogenic Right Ventricular Cardiomyopathy in Pediatric Patients: An Important but Underrecognized Clinical Entity. Front Pediatr 2021; 9:750916. [PMID: 34926342 PMCID: PMC8678603 DOI: 10.3389/fped.2021.750916] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/08/2021] [Indexed: 12/30/2022] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy characterized by fibrofatty infiltration of predominantly the right ventricular (RV) myocardium. Affected patients typically present as young adults with hemodynamically stable ventricular tachycardia, although pediatric cases are increasingly recognized. These young subjects often have a more severe phenotype with a high risk of sudden cardiac death (SCD) and progression toward heart failure. Diagnosis of ARVC is made by combining multiple sources of information as prescribed by the consensus-based Task Force Criteria. The description of Naxos disease, a fully penetrant autosomal recessive disorder that is associated with ARVC and a cutaneous phenotype of palmoplantar keratoderma and wooly hair facilitated the identification of the genetic cause of ARVC. At present, approximately 60% of patients are found to carry a pathogenic variant in one of five genes associated with the cardiac desmosome. The incomplete penetrance and variable expressivity of these variants however implies an important role for environmental factors, of which participation in endurance exercise is a strong risk factor. Since there currently is no definite cure for ARVC, disease management is directed toward symptom reduction, delay of disease progression, and prevention of SCD. This clinically focused review describes the spectrum of ARVC among children and adolescents, the genetic architecture underlying this disease, the cardio-cutaneous syndromes that led to its identification, and current diagnostic and therapeutic strategies in pediatric ARVC subjects.
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Affiliation(s)
- Anneline S J M Te Riele
- Division Heart & Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.,Netherlands Heart Institute, Utrecht, Netherlands
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Adalena Tsatsopoulou
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Center, Athens, Greece
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Chater-Diehl E, Ejaz R, Cytrynbaum C, Siu MT, Turinsky A, Choufani S, Goodman SJ, Abdul-Rahman O, Bedford M, Dorrani N, Engleman K, Flores-Daboub J, Genevieve D, Mendoza-Londono R, Meschino W, Perrin L, Safina N, Townshend S, Scherer SW, Anagnostou E, Piton A, Deardorff M, Brudno M, Chitayat D, Weksberg R. New insights into DNA methylation signatures: SMARCA2 variants in Nicolaides-Baraitser syndrome. BMC Med Genomics 2019; 12:105. [PMID: 31288860 PMCID: PMC6617651 DOI: 10.1186/s12920-019-0555-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/30/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Nicolaides-Baraitser syndrome (NCBRS) is a neurodevelopmental disorder caused by pathogenic sequence variants in SMARCA2 which encodes the catalytic component of the chromatin remodeling BAF complex. Pathogenic variants in genes that encode epigenetic regulators have been associated with genome-wide changes in DNA methylation (DNAm) in affected individuals termed DNAm signatures. METHODS Genome-wide DNAm was assessed in whole-blood samples from the individuals with pathogenic SMARCA2 variants and NCBRS diagnosis (n = 8) compared to neurotypical controls (n = 23) using the Illumina MethylationEPIC array. Differential methylated CpGs between groups (DNAm signature) were identified and used to generate a model enabling classification variants of uncertain significance (VUS; n = 9) in SMARCA2 as "pathogenic" or "benign". A validation cohort of NCBRS cases (n = 8) and controls (n = 96) demonstrated 100% model sensitivity and specificity. RESULTS We identified a DNAm signature of 429 differentially methylated CpG sites in individuals with NCBRS. The genes to which these CpG sites map are involved in cell differentiation, calcium signaling, and neuronal function consistent with NCBRS pathophysiology. DNAm model classifications of VUS were concordant with the clinical phenotype; those within the SMARCA2 ATPase/helicase domain classified as "pathogenic". A patient with a mild neurodevelopmental NCBRS phenotype and a VUS distal to the ATPase/helicase domain did not score as pathogenic, clustering away from cases and controls. She demonstrated an intermediate DNAm profile consisting of one subset of signature CpGs with methylation levels characteristic of controls and another characteristic of NCBRS cases; each mapped to genes with ontologies consistent with the patient's unique clinical presentation. CONCLUSIONS Here we find that a DNAm signature of SMARCA2 pathogenic variants in NCBRS maps to CpGs relevant to disorder pathophysiology, classifies VUS, and is sensitive to the position of the variant in SMARCA2. The patient with an intermediate model score demonstrating a unique genotype-epigenotype-phenotype correlation underscores the potential utility of this signature as a functionally relevant VUS classification system scalable beyond binary "benign" versus "pathogenic" scoring. This is a novel feature of DNAm signatures that could enable phenotypic predictions from genotype data. Our findings also demonstrate that DNAm signatures can be domain-specific, highlighting the precision with which they can reflect genotypic variation.
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Affiliation(s)
- Eric Chater-Diehl
- Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario M5G 1X8 Canada
| | - Resham Ejaz
- Division of Genetics, Department of Pediatrics, McMaster University, Hamilton, Ontario L8S 4L8 Canada
| | - Cheryl Cytrynbaum
- Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario M5G 1X8 Canada
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario M5G 1X8 Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario M5S 1A1 Canada
| | - Michelle T. Siu
- Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario M5G 1X8 Canada
| | - Andrei Turinsky
- Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario M5G 1X8 Canada
- Centre for Computational Medicine, The Hospital for Sick Children, Toronto, Ontario M5G 1X8 Canada
| | - Sanaa Choufani
- Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario M5G 1X8 Canada
| | - Sarah J. Goodman
- Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario M5G 1X8 Canada
| | - Omar Abdul-Rahman
- Department of Genetic Medicine, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE USA
| | - Melanie Bedford
- Genetics Program, North York General Hospital, Toronto, Ontario M2K 1E1 Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario M5S 3H7 Canada
| | | | - Kendra Engleman
- Division of Clinical Genetics, Children’s Mercy Hospital, Kansas City, MO 66111 USA
| | - Josue Flores-Daboub
- Division of Pediatric Clinical Genetics, University of Utah School of Medicine, Salt Lake City, UT 84132 USA
| | - David Genevieve
- Service de génétique clinique, Département de génétique médicale, maladies rares, médecine personnalisée, Unité INSERM U1183, Université Montpellier, CHU Montpellier, 34000 Montpellier, France
| | - Roberto Mendoza-Londono
- Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario M5G 1X8 Canada
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario M5G 1X8 Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario M5S 1A1 Canada
| | - Wendy Meschino
- Genetics Program, North York General Hospital, Toronto, Ontario M2K 1E1 Canada
| | - Laurence Perrin
- AP-HP, Department of Genetics, Hôpital Robert Debré, 75019 Paris, France
| | - Nicole Safina
- University of Missouri Kansas City, School of Medicine, Kansas City, MO 64108 USA
- Division of Clinical Genetics, Children’s Mercy Hospital, Kansas City, MO 64108 USA
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, MO 64108 USA
| | - Sharron Townshend
- Department of Health, Government of Western Australia, Genetic Services of Western Australia, Perth, WA Australia
| | - Stephen W. Scherer
- Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario M5G 1X8 Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario M5S 1A1 Canada
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario M5G 1X8 Canada
- McLaughlin Centre, University of Toronto, Toronto, Ontario M5S 1A1 Canada
| | - Evdokia Anagnostou
- Holland Bloorview Kids Rehabilitation Hospital Toronto, Toronto, Ontario M4G 1R8 Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario M5S 1A1 Canada
| | - Amelie Piton
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, 67400 Illkirch, France
- Laboratoire de Diagnostic Génétique, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Matthew Deardorff
- Division of Genetics, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104 USA
- The Department of Pediatrics, The Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Michael Brudno
- Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario M5G 1X8 Canada
- Centre for Computational Medicine, The Hospital for Sick Children, Toronto, Ontario M5G 1X8 Canada
- Department of Computer Science, University of Toronto, Toronto, Ontario M5S 1A1 Canada
| | - David Chitayat
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario M5G 1X8 Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario M5S 1A1 Canada
- Prenatal Diagnosis and Medical Genetics Program, Mount Sinai Hospital, Toronto, Ontario M5G 1X5 Canada
| | - Rosanna Weksberg
- Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario M5G 1X8 Canada
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario M5G 1X8 Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario M5S 1A1 Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario M5S 1A8 Canada
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Li GL, Saguner AM, Fontaine GH. Naxos disease: from the origin to today. Orphanet J Rare Dis 2018; 13:74. [PMID: 29747658 PMCID: PMC5946438 DOI: 10.1186/s13023-018-0814-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/18/2018] [Indexed: 11/21/2022] Open
Abstract
Naxos disease, first described by Dr. Nikos Protonotarios and colleagues on the island of Naxos, Greece, is a special form of arrhythmogenic right ventricular dysplasia (ARVD). It is an inherited condition with a recessive form of transmission and a familial penetrance of 90%. It is associated with thickening of the skin of the hands and sole, and a propensity to woolly hair. The cardiac anomalies characterized by ventricular arrhythmias with ventricular extrasystoles and tachycardia and histologic features of the myocardium are consistent with ARVD, but in a more severe form of dysplasia with major dilatation of the right ventricle. The identification of the responsible first gene on chromosome 17, and its product plakoglobin as the responsible protein for Naxos disease proved to be a milestone in the study of ARVD, which opened a new field of research. Thanks to those with the determination to discover Naxos disease, there is and will be more clarity in understanding the mechanisms of juvenile sudden death in the young who have an apparently otherwise normal heart.
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Affiliation(s)
- Guo-Liang Li
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, Shaanxi, 710061, People's Republic of China. .,Institut de Cardiologie, Unité de Rythmologie, Hôpital Universitaire La Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75651, Paris, France.
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Guy H Fontaine
- Institut de Cardiologie, Unité de Rythmologie, Hôpital Universitaire La Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75651, Paris, France
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