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Martínez-Barrios E, Grassi S, Brión M, Toro R, Cesar S, Cruzalegui J, Coll M, Alcalde M, Brugada R, Greco A, Ortega-Sánchez ML, Barberia E, Oliva A, Sarquella-Brugada G, Campuzano O. Molecular autopsy: Twenty years of post-mortem diagnosis in sudden cardiac death. Front Med (Lausanne) 2023; 10:1118585. [PMID: 36844202 PMCID: PMC9950119 DOI: 10.3389/fmed.2023.1118585] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/30/2023] [Indexed: 02/12/2023] Open
Abstract
In the forensic medicine field, molecular autopsy is the post-mortem genetic analysis performed to attempt to unravel the cause of decease in cases remaining unexplained after a comprehensive forensic autopsy. This negative autopsy, classified as negative or non-conclusive, usually occurs in young population. In these cases, in which the cause of death is unascertained after a thorough autopsy, an underlying inherited arrhythmogenic syndrome is the main suspected cause of death. Next-generation sequencing allows a rapid and cost-effectives genetic analysis, identifying a rare variant classified as potentially pathogenic in up to 25% of sudden death cases in young population. The first symptom of an inherited arrhythmogenic disease may be a malignant arrhythmia, and even sudden death. Early identification of a pathogenic genetic alteration associated with an inherited arrhythmogenic syndrome may help to adopt preventive personalized measures to reduce risk of malignant arrhythmias and sudden death in the victim's relatives, at risk despite being asymptomatic. The current main challenge is a proper genetic interpretation of variants identified and useful clinical translation. The implications of this personalized translational medicine are multifaceted, requiring the dedication of a specialized team, including forensic scientists, pathologists, cardiologists, pediatric cardiologists, and geneticists.
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Affiliation(s)
- Estefanía Martínez-Barrios
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, Barcelona, Spain,European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam, Netherlands,Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Simone Grassi
- Forensic Medical Sciences, Department of Health Science, University of Florence, Florence, Italy
| | - María Brión
- Family Heart Disease Unit, Cardiology Service, Santiago de Compostela University Hospital, Santiago de Compostela, Spain,Cardiovascular Genetics, Santiago de Compostela Health Research Institute, Santiago de Compostela, Spain,Genomic Medicine Group, Universidade de Santiago de Compostela, Santiago de Compostela, Spain,Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain
| | - Rocío Toro
- Medicine Department, School of Medicine, University of Cádiz, Cádiz, Spain
| | - Sergi Cesar
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, Barcelona, Spain,European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam, Netherlands,Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - José Cruzalegui
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, Barcelona, Spain,European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam, Netherlands,Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Mònica Coll
- Medical Science Department, School of Medicine, University of Girona, Girona, Spain,Cardiovascular Genetics Center, Institut d’Investigacions Biomèdiques de Girona (IDIBGI), University of Girona, Girona, Spain
| | - Mireia Alcalde
- Medical Science Department, School of Medicine, University of Girona, Girona, Spain,Cardiovascular Genetics Center, Institut d’Investigacions Biomèdiques de Girona (IDIBGI), University of Girona, Girona, Spain
| | - Ramon Brugada
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain,Medical Science Department, School of Medicine, University of Girona, Girona, Spain,Cardiovascular Genetics Center, Institut d’Investigacions Biomèdiques de Girona (IDIBGI), University of Girona, Girona, Spain,Cardiology Department, Hospital Josep Trueta, Girona, Spain
| | - Andrea Greco
- Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain,Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - María Luisa Ortega-Sánchez
- Forensic Pathology Department, Institut de Medicina Legal i Ciències Forenses de Catalunya (IMLCFC), Barcelona, Spain,School of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallés, Spain
| | - Eneko Barberia
- Forensic Pathology Department, Institut de Medicina Legal i Ciències Forenses de Catalunya (IMLCFC), Barcelona, Spain,School of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Spain
| | - Antonio Oliva
- Section of Legal Medicine, Department of Health Surveillance and Bioethics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Georgia Sarquella-Brugada
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, Barcelona, Spain,European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam, Netherlands,Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain,Medical Science Department, School of Medicine, University of Girona, Girona, Spain,*Correspondence: Georgia Sarquella-Brugada,
| | - Oscar Campuzano
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain,Medical Science Department, School of Medicine, University of Girona, Girona, Spain,Cardiovascular Genetics Center, Institut d’Investigacions Biomèdiques de Girona (IDIBGI), University of Girona, Girona, Spain,Oscar Campuzano,
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Popa IP, Șerban DN, Mărănducă MA, Șerban IL, Tamba BI, Tudorancea I. Brugada Syndrome: From Molecular Mechanisms and Genetics to Risk Stratification. Int J Mol Sci 2023; 24:ijms24043328. [PMID: 36834739 PMCID: PMC9967917 DOI: 10.3390/ijms24043328] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/13/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
Brugada syndrome (BrS) is a rare hereditary arrhythmia disorder, with a distinctive ECG pattern, correlated with an increased risk of ventricular arrhythmias and sudden cardiac death (SCD) in young adults. BrS is a complex entity in terms of mechanisms, genetics, diagnosis, arrhythmia risk stratification, and management. The main electrophysiological mechanism of BrS requires further research, with prevailing theories centered on aberrant repolarization, depolarization, and current-load match. Computational modelling, pre-clinical, and clinical research show that BrS molecular anomalies result in excitation wavelength (k) modifications, which eventually increase the risk of arrhythmia. Although a mutation in the SCN5A (Sodium Voltage-Gated Channel Alpha Subunit 5) gene was first reported almost two decades ago, BrS is still currently regarded as a Mendelian condition inherited in an autosomal dominant manner with incomplete penetrance, despite the recent developments in the field of genetics and the latest hypothesis of additional inheritance pathways proposing a more complex mode of inheritance. In spite of the extensive use of the next-generation sequencing (NGS) technique with high coverage, genetics remains unexplained in a number of clinically confirmed cases. Except for the SCN5A which encodes the cardiac sodium channel NaV1.5, susceptibility genes remain mostly unidentified. The predominance of cardiac transcription factor loci suggests that transcriptional regulation is essential to the Brugada syndrome's pathogenesis. It appears that BrS is a multifactorial disease, which is influenced by several loci, each of which is affected by the environment. The primary challenge in individuals with a BrS type 1 ECG is to identify those who are at risk for sudden death, researchers propose the use of a multiparametric clinical and instrumental strategy for risk stratification. The aim of this review is to summarize the latest findings addressing the genetic architecture of BrS and to provide novel perspectives into its molecular underpinnings and novel models of risk stratification.
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Affiliation(s)
- Irene Paula Popa
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
| | - Dragomir N. Șerban
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Minela Aida Mărănducă
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Ionela Lăcrămioara Șerban
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Bogdan Ionel Tamba
- Department of Pharmacology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Correspondence:
| | - Ionuț Tudorancea
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
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5
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Martínez-Campelo L, Cruz R, Blanco-Verea A, Moscoso I, Ramos-Luis E, Lage R, Álvarez-Barredo M, Sabater-Molina M, Peñafiel-Verdú P, Jiménez-Jáimez J, Rodríguez-Mañero M, Brion M. Searching for genetic modulators of the phenotypic heterogeneity in Brugada syndrome. PLoS One 2022; 17:e0263469. [PMID: 35231055 PMCID: PMC8887717 DOI: 10.1371/journal.pone.0263469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/20/2022] [Indexed: 11/19/2022] Open
Abstract
In Brugada syndrome, even within the same family where all affected individuals share the same mutation, phenotypic variation is prominent, with variable penetrance and expressivity, presenting different degrees of involvement. It is difficult to establish a direct correlation between genotype and phenotype to predict prognosis in complications and risk of sudden death. The factors that modulate this inter- and intra-familial phenotypic variability remain to be determined. With the intention of testing whether other genetic factors, in addition to the causal mutation in SCN5A, may have a modulating effect on the Brugada phenotype and the risk of sudden death, we have studied 8 families with a causal variant in SCN5A with at least two affected individuals, one of whom has suffered cardiac arrest or sudden death. Whole exome sequencing was performed looking for additional variants that modify the phenotype and allow us to predict a better or worse prognosis for the evolution of the disease. The results did not show any clear genetic modifier; nevertheless, highlight the possible implication of the cholesterol and fibrosis pathways, as well as the circadian rhythm, as possible modulators of Brugada syndrome phenotype.
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Affiliation(s)
- Laura Martínez-Campelo
- Cardiovascular Genetics, Santiago de Compostela Health Research Institute, Santiago de Compostela, Spain
- Genomic Medicine Group, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Raquel Cruz
- Genomic Medicine Group, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- CIBER of Rare Diseases, Carlos III Health Institute, Madrid, Spain
| | - Alejandro Blanco-Verea
- Cardiovascular Genetics, Santiago de Compostela Health Research Institute, Santiago de Compostela, Spain
- Genomic Medicine Group, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Isabel Moscoso
- Cardiovascular CIBER, Carlos III Health Institute, Madrid, Spain
- Cardiology Group, Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Eva Ramos-Luis
- Cardiovascular Genetics, Santiago de Compostela Health Research Institute, Santiago de Compostela, Spain
- Genomic Medicine Group, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ricardo Lage
- Cardiovascular CIBER, Carlos III Health Institute, Madrid, Spain
- Cardiology Group, Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - María Álvarez-Barredo
- Cardiovascular Genetics, Santiago de Compostela Health Research Institute, Santiago de Compostela, Spain
- Cardiovascular CIBER, Carlos III Health Institute, Madrid, Spain
| | - María Sabater-Molina
- Cardiovascular CIBER, Carlos III Health Institute, Madrid, Spain
- Cardiogenetics Laboratory, Murcian Institute for Biosanitary Research, Cardiology Service, Virgen de la Arrixaca University Clinical Hospital, Murcia, Spain
| | - Pablo Peñafiel-Verdú
- Cardiovascular CIBER, Carlos III Health Institute, Madrid, Spain
- Cardiogenetics Laboratory, Murcian Institute for Biosanitary Research, Cardiology Service, Virgen de la Arrixaca University Clinical Hospital, Murcia, Spain
| | - Juan Jiménez-Jáimez
- Cardiovascular CIBER, Carlos III Health Institute, Madrid, Spain
- Arrhythmia Unit, Virgen de las Nieves University Hospital, Granada, Spain
| | - Moisés Rodríguez-Mañero
- Cardiovascular CIBER, Carlos III Health Institute, Madrid, Spain
- Cardiology Service, Santiago de Compostela University Hospital, Santiago de Compostela, Spain
| | - María Brion
- Cardiovascular Genetics, Santiago de Compostela Health Research Institute, Santiago de Compostela, Spain
- Genomic Medicine Group, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Cardiovascular CIBER, Carlos III Health Institute, Madrid, Spain
- Family Heart Disease Unit, Cardiology Service, Santiago de Compostela University Hospital, Santiago de Compostela, Spain
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6
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Huang Y, Chen XM, Barajas-Martinez H, Jiang H, Antzelevitch C, Hu D. Common variants in SCN10A gene associated with Brugada syndrome. Hum Mol Genet 2021; 31:157-165. [PMID: 34312669 DOI: 10.1093/hmg/ddab217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Genome-wide association studies indicate that SCN10A plays an important role in cardiac electrophysiology. Common and rare SCN10A variants are suggested to contribute to Brugada Syndrome (BrS), an inherited channelopathy resulting from genetic-determined loss-of-function in cardiac sodium channel. This study sought to characterize the role of SCN10A common variants in BrS. METHODS AND RESULTS Clinical and genetic analyses were performed in 197 patients diagnosed with BrS. Baseline ECG parameters were evaluated in patients carrying each of four common variants associated with BrS. Cellular electrophysiological study was performed in SCN5A-SCN10A co-transfected TSA201 cells to investigate the possible electrophysiological characteristics of the allele of rs6795970, which displayed the most significant association with BrS. Four SCN10A common variants (rs7630989, rs57326399, rs6795970, rs12632942) displayed significant association with BrS susceptibility. There were no evident associations between baseline ECG parameters in BrS patients and the different genotypes of the four variants. Rs6795970 (V1073) was strongly associated with a risk for BrS, which suggests the different electrophysiological characters between these two alleles. Functional study showed a positive shift in steady-state activation (V1/2: -62.2 ± 2.6 vs. -53.5 ± 1.6 for A1073 and V1073 group, respectively; P < 0.05) and slower recovery from inactivation in mutant SCN5A-SCN10A co-transfected cells with, which contribute to the slow conduction in BrS patients with rs6795970. CONCLUSIONS SCN10A common variants are associated with increased susceptibility to BrS. An allele rs6795970 (V1073) increases the risk for BrS. The electrophysiological changes in a positive shift in steady-state activation and slower recovery from inactivation by SCN10A-V1073 contribute to this variant associated BrS.
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Affiliation(s)
- Yan Huang
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China.,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, 430060, China
| | - Xiao-Meng Chen
- Department of Cardiology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, 266071, China
| | - Hector Barajas-Martinez
- Lankenau Institute for Medical Research, and Lankenau Heart Institute, Wynnwood, Pennsylvania and Jefferson Medical College, Philadelphia, Pennsylvania, USA
| | - Hong Jiang
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China.,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, 430060, China
| | - Charles Antzelevitch
- Lankenau Institute for Medical Research, and Lankenau Heart Institute, Wynnwood, Pennsylvania and Jefferson Medical College, Philadelphia, Pennsylvania, USA
| | - Dan Hu
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, China.,Hubei Key Laboratory of Cardiology, Wuhan, Hubei, 430060, China
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