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Wegener JW, Mitronova GY, ElShareif L, Quentin C, Belov V, Pochechueva T, Hasenfuss G, Ackermann L, Lehnart SE. A dual-targeted drug inhibits cardiac ryanodine receptor Ca 2+ leak but activates SERCA2a Ca 2+ uptake. Life Sci Alliance 2024; 7:e202302278. [PMID: 38012000 PMCID: PMC10681910 DOI: 10.26508/lsa.202302278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 11/29/2023] Open
Abstract
In the heart, genetic or acquired mishandling of diastolic [Ca2+] by ryanodine receptor type 2 (RyR2) overactivity correlates with risks of arrhythmia and sudden cardiac death. Strategies to avoid these risks include decrease of Ca2+ release by drugs modulating RyR2 activity or increase in Ca2+ uptake by drugs modulating SR Ca2+ ATPase (SERCA2a) activity. Here, we combine these strategies by developing experimental compounds that act simultaneously on both processes. Our screening efforts identified the new 1,4-benzothiazepine derivative GM1869 as a promising compound. Consequently, we comparatively studied the effects of the known RyR2 modulators Dantrolene and S36 together with GM1869 on RyR2 and SERCA2a activity in cardiomyocytes from wild type and arrhythmia-susceptible RyR2R2474S/+ mice by confocal live-cell imaging. All drugs reduced RyR2-mediated Ca2+ spark frequency but only GM1869 accelerated SERCA2a-mediated decay of Ca2+ transients in murine and human cardiomyocytes. Our data indicate that S36 and GM1869 are more suitable than dantrolene to directly modulate RyR2 activity, especially in RyR2R2474S/+ mice. Remarkably, GM1869 may represent a new dual-acting lead compound for maintenance of diastolic [Ca2+].
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Affiliation(s)
- Jörg W Wegener
- Department of Cardiology and Pulmonology, Heart Research Center Göttingen, University Medical Center of Göttingen (UMG), Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Gyuzel Y Mitronova
- Department of NanoBiophotonics, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Lina ElShareif
- Department of Cardiology and Pulmonology, Heart Research Center Göttingen, University Medical Center of Göttingen (UMG), Göttingen, Germany
| | - Christine Quentin
- Department of NanoBiophotonics, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
| | - Vladimir Belov
- Department of NanoBiophotonics, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
| | - Tatiana Pochechueva
- Department of Cardiology and Pulmonology, Heart Research Center Göttingen, University Medical Center of Göttingen (UMG), Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Gerd Hasenfuss
- Department of Cardiology and Pulmonology, Heart Research Center Göttingen, University Medical Center of Göttingen (UMG), Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Lutz Ackermann
- Georg-August University of Göttingen, Institute of Organic and Biomolecular Chemistry, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Stephan E Lehnart
- Department of Cardiology and Pulmonology, Heart Research Center Göttingen, University Medical Center of Göttingen (UMG), Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
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Chaudhry-Waterman N, Dara B, Bucholz E, Londono Obregon C, Grenier M, Snyder K, Cuneo BF. Fetal Heart Rate < 3rd Percentile for Gestational Age Can Be a Marker of Inherited Arrhythmia Syndromes. J Clin Med 2023; 12:4464. [PMID: 37445499 DOI: 10.3390/jcm12134464] [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: 04/30/2023] [Revised: 06/16/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Repeated fetal heart rates (FHR) < 3rd percentile for gestational age (GA) with 1:1 atrioventricular conduction (sinus bradycardia) can be a marker for long QT syndrome. We hypothesized that other inherited arrhythmia syndromes might present with fetal sinus bradycardia. METHODS We reviewed pregnancies referred with sinus bradycardia to the Colorado Fetal Care Center between 2013 and 2023. FHR/GA data, family history, medication exposure, normalized isovolumic contraction times (n-IVRT), postnatal genetic testing, and ECGs at 4-6 weeks after birth were reviewed. RESULTS Twenty-nine bradycardic subjects were evaluated by fetal echocardiography. Five were lost to follow-up, one refused genetic testing, and one had negative genetic testing for any inherited arrhythmia. Six had non-genetic causes of fetal bradycardia with normal prenatal n-IVRT and postnatal QTc. Thirteen carried pathogenic variants in RYR2 (n = 2), HCN4 (n = 2), KCNQ1 (6), and other LQTS genes (n = 4). The postnatal QTc was <470 ms in subjects with RYR2, HCN4, and two of those with KCNQ1 mutations, and >470 ms in subjects with CALM 2, KCNH2, SCN5A, and four of those with KCNQ1 mutations. LQTS and RYR2 mutations were associated with prolonged n-IVRT, but HCN4 was not. Two fetuses died in utero with variants of uncertain significance (CACNA1 and KCNE1). Cascade testing uncovered six affected but undiagnosed parents and confirmed familial inheritance in five. CONCLUSION In addition to heralding LQTS, repeated FHR < 3rd percentile for GA is a risk factor for other inherited arrhythmia syndromes. These findings suggest that genetic testing should be offered to infants with a history of FHR < 3rd percentile for GA even if the postnatal ECG demonstrates a normal QTc interval.
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Affiliation(s)
- Nadia Chaudhry-Waterman
- The Division of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Denver, CO 80045, USA
| | - Bharat Dara
- Presbyterian Hospital, Albuquerque, NM 87106, USA
| | - Emily Bucholz
- The Division of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Denver, CO 80045, USA
- The Colorado Fetal Care Center, Children's Hospital Colorado, Aurora, CO 80045, USA
| | - Camila Londono Obregon
- The Division of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Denver, CO 80045, USA
- The Colorado Fetal Care Center, Children's Hospital Colorado, Aurora, CO 80045, USA
| | - Michelle Grenier
- The Division of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Denver, CO 80045, USA
- The Colorado Fetal Care Center, Children's Hospital Colorado, Aurora, CO 80045, USA
| | - Kristen Snyder
- The Colorado Fetal Care Center, Children's Hospital Colorado, Aurora, CO 80045, USA
| | - Bettina F Cuneo
- The Division of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Denver, CO 80045, USA
- The Colorado Fetal Care Center, Children's Hospital Colorado, Aurora, CO 80045, USA
- The Department of Obstetrics, University of Colorado School of Medicine, Denver, CO 80045, USA
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3
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Kuganeswaran NT, Smith M, Chan D. Cardiac Arrest From Undiagnosed Catecholaminergic Polymorphic Ventricular Tachycardia: A Case Report. Cureus 2023; 15:e42190. [PMID: 37602051 PMCID: PMC10439695 DOI: 10.7759/cureus.42190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare inherited heart disease in which exercise or acute emotional stress can cause potentially fatal tachyarrhythmias. We present the case of a 16-year-old female patient with a history of unexplained palpitations and syncope who suddenly collapsed in her high school cafeteria following an impassioned debate. In cardiac arrest consisting of coarse ventricular fibrillation, she was resuscitated on-scene by the school nurse via automated external defibrillation. Months later, after substantial investigation, a diagnosis of CPVT was reached. The patient made a full neurological recovery, and one year post-arrest, she was event-free on β-blocker therapy. This case demonstrates the importance of clinician awareness of CPVT, an unusual but treatable cause of cardiac arrest. Because catecholamine administration is directly contraindicated for patients with CPVT, resuscitative and post-arrest care are unique. These patients tend to be previously healthy, with normal resting electrocardiograms and no cardiac structural abnormalities, making diagnosis quite challenging.
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Affiliation(s)
| | - Michael Smith
- Emergency Medicine, Carle Foundation Hospital, Urbana, USA
| | - David Chan
- Pediatric Cardiology, Carle Foundation Hospital, Urbana, USA
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4
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Leung J, Lee S, Zhou J, Jeevaratnam K, Lakhani I, Radford D, Coakley-Youngs E, Pay L, Çinier G, Altinsoy M, Behnoush AH, Mahmoudi E, Matusik PT, Bazoukis G, Garcia-Zamora S, Zeng S, Chen Z, Xia Y, Liu T, Tse G. Clinical Characteristics, Genetic Findings and Arrhythmic Outcomes of Patients with Catecholaminergic Polymorphic Ventricular Tachycardia from China: A Systematic Review. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081104. [PMID: 35892906 PMCID: PMC9330865 DOI: 10.3390/life12081104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/12/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare inherited cardiac ion channelopathy. The present study aims to examine the clinical characteristics, genetic basis, and arrhythmic outcomes of CPVT patients from China to elucidate the difference between CPVT patients in Asia and Western countries. METHODS PubMed and Embase were systematically searched for case reports or series reporting on CPVT patients from China until 19 February 2022 using the keyword: "Catecholaminergic Polymorphic Ventricular Tachycardia" or "CPVT", with the location limited to: "China" or "Hong Kong" or "Macau" in Embase, with no language or publication-type restriction. Articles that did not state a definite diagnosis of CPVT and articles with duplicate cases found in larger cohorts were excluded. All the included publications in this review were critically appraised based on the Joanna Briggs Institute Critical Appraisal Checklist. Clinical characteristics, genetic findings, and the primary outcome of spontaneous ventricular tachycardia/ventricular fibrillation (VT/VF) were analyzed. RESULTS A total of 58 unique cases from 15 studies (median presentation age: 8 (5.0-11.8) years old) were included. All patients, except one, presented at or before 19 years of age. There were 56 patients (96.6%) who were initially symptomatic. Premature ventricular complexes (PVCs) were present in 44 out of 51 patients (86.3%) and VT in 52 out of 58 patients (89.7%). Genetic tests were performed on 54 patients (93.1%) with a yield of 87%. RyR2, CASQ2, TERCL, and SCN10A mutations were found in 35 (71.4%), 12 (24.5%), 1 (0.02%) patient, and 1 patient (0.02%), respectively. There were 54 patients who were treated with beta-blockers, 8 received flecainide, 5 received amiodarone, 2 received verapamil and 2 received propafenone. Sympathectomy (n = 10), implantable cardioverter-defibrillator implantation (n = 8) and ablation (n = 1) were performed. On follow-up, 13 patients developed VT/VF. CONCLUSION This was the first systematic review of CPVT patients from China. Most patients had symptoms on initial presentation, with syncope as the presenting complaint. RyR2 mutation accounts for more than half of the CPVT cases, followed by CASQ2, TERCL and SCN10A mutations.
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Affiliation(s)
- Justin Leung
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China; (J.L.); (S.L.); (I.L.)
| | - Sharen Lee
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China; (J.L.); (S.L.); (I.L.)
| | - Jiandong Zhou
- School of Data Science, City University of Hong Kong, Hong Kong, China;
| | - Kamalan Jeevaratnam
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK;
| | - Ishan Lakhani
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China; (J.L.); (S.L.); (I.L.)
| | - Danny Radford
- Kent and Medway Medical School, Canterbury CT2 7FS, UK; (D.R.); (E.C.-Y.)
| | | | - Levent Pay
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul 34147, Turkey; (L.P.); (G.Ç.)
| | - Göksel Çinier
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul 34147, Turkey; (L.P.); (G.Ç.)
| | - Meltem Altinsoy
- Department of Cardiology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara 06145, Turkey;
| | - Amir Hossein Behnoush
- Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran 1416643931, Iran; (A.H.B.); (E.M.)
| | - Elham Mahmoudi
- Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran 1416643931, Iran; (A.H.B.); (E.M.)
| | - Paweł T. Matusik
- Department of Electrocardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Kraków, Poland;
| | - George Bazoukis
- Department of Cardiology, Larnaca General Hospital, Larnaca 6301, Cyprus;
- Medical School, University of Nicosia, Nicosia 2408, Cyprus
| | - Sebastian Garcia-Zamora
- Cardiac Intensive Care Unit, Department of Cardiology, Delta Clinic, Rosario S2000, Argentina;
| | - Shaoying Zeng
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China;
| | - Ziliang Chen
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China;
| | - Yunlong Xia
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian 116014, China;
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China;
- Correspondence: (T.L.); or or (G.T.)
| | - Gary Tse
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China; (J.L.); (S.L.); (I.L.)
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK;
- Kent and Medway Medical School, Canterbury CT2 7FS, UK; (D.R.); (E.C.-Y.)
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China;
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian 116014, China;
- Correspondence: (T.L.); or or (G.T.)
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5
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Prakash O, Held M, McCormick LF, Gupta N, Lian LY, Antonyuk S, Haynes LP, Thomas NL, Helassa N. CPVT-associated calmodulin variants N53I and A102V dysregulate Ca2+ signalling via different mechanisms. J Cell Sci 2022; 135:274029. [PMID: 34888671 PMCID: PMC8917356 DOI: 10.1242/jcs.258796] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 11/29/2021] [Indexed: 12/26/2022] Open
Abstract
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited condition that can cause fatal cardiac arrhythmia. Human mutations in the Ca2+ sensor calmodulin (CaM) have been associated with CPVT susceptibility, suggesting that CaM dysfunction is a key driver of the disease. However, the detailed molecular mechanism remains unclear. Focusing on the interaction with the cardiac ryanodine receptor (RyR2), we determined the effect of CPVT-associated variants N53I and A102V on the structural characteristics of CaM and on Ca2+ fluxes in live cells. We provide novel data showing that interaction of both Ca2+/CaM-N53I and Ca2+/CaM-A102V with the RyR2 binding domain is decreased. Ca2+/CaM-RyR23583-3603 high-resolution crystal structures highlight subtle conformational changes for the N53I variant, with A102V being similar to wild type (WT). We show that co-expression of CaM-N53I or CaM-A102V with RyR2 in HEK293 cells significantly increased the duration of Ca2+ events; CaM-A102V exhibited a lower frequency of Ca2+ oscillations. In addition, we show that CaMKIIδ (also known as CAMK2D) phosphorylation activity is increased for A102V, compared to CaM-WT. This paper provides novel insight into the molecular mechanisms of CPVT-associated CaM variants and will facilitate the development of strategies for future therapies.
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Affiliation(s)
- Ohm Prakash
- Liverpool Centre for Cardiovascular Science, Department of Cardiovascular Science and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Marie Held
- Liverpool Centre for Cardiovascular Science, Department of Cardiovascular Science and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Liam F. McCormick
- Liverpool Centre for Cardiovascular Science, Department of Cardiovascular Science and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Nitika Gupta
- Department of Molecular Physiology and Cell Signalling, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Lu-Yun Lian
- Nuclear Magnetic Resonance Centre for Structural Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 7ZB, UK
| | - Svetlana Antonyuk
- Molecular Biophysics Group, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 7ZB, UK
| | - Lee P. Haynes
- Department of Molecular Physiology and Cell Signalling, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - N. Lowri Thomas
- School of Pharmacy & Pharmaceutical Sciences, Cardiff University, Cardiff, Redwood Building, CF10 3NB, UK
| | - Nordine Helassa
- Liverpool Centre for Cardiovascular Science, Department of Cardiovascular Science and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 3BX, UK,Author for correspondence ()
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6
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Erickson CC, Salerno JC, Berger S, Campbell R, Cannon B, Christiansen J, Moffatt K, Pflaumer A, Snyder CS, Srinivasan C, Valdes SO, Vetter VL, Zimmerman F. Sudden Death in the Young: Information for the Primary Care Provider. Pediatrics 2021; 148:peds.2021-052044. [PMID: 34155130 DOI: 10.1542/peds.2021-052044] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
There are multiple conditions that can make children prone to having a sudden cardiac arrest (SCA) or sudden cardiac death (SCD). Efforts have been made by multiple organizations to screen children for cardiac conditions, but the emphasis has been on screening before athletic competition. This article is an update of the previous American Academy of Pediatrics policy statement of 2012 that addresses prevention of SCA and SCD. This update includes a comprehensive review of conditions that should prompt more attention and cardiology evaluation. The role of the primary care provider is of paramount importance in the evaluation of children, particularly as they enter middle school or junior high. There is discussion about whether screening should find any cardiac condition or just those that are associated with SCA and SCD. This update reviews the 4 main screening questions that are recommended, not just for athletes, but for all children. There is also discussion about how to handle post-SCA and SCD situations as well as discussion about genetic testing. It is the goal of this policy statement update to provide the primary care provider more assistance in how to screen for life-threatening conditions, regardless of athletic status.
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Affiliation(s)
- Christopher C Erickson
- Children's Specialty Physicians, University of Nebraska Medical Center, University of Nebraska, Omaha, Nebraska .,Creighton University Medical Center, Creighton University, Omaha, Nebraska
| | - Jack C Salerno
- Seattle Children's Hospital and the University of Washington School of Medicine, Seattle, Washington
| | - Stuart Berger
- Lurie Children's Hospital and Northwestern University, Chicago, Illinois
| | - Robert Campbell
- Children's Healthcare of Atlanta Sibley Heart Center and School of Medicine, Emory University, Atlanta, Georgia
| | | | - James Christiansen
- Seattle Children's Hospital and the University of Washington School of Medicine, Seattle, Washington
| | - Kody Moffatt
- Children's Specialty Physicians, University of Nebraska Medical Center, University of Nebraska, Omaha, Nebraska
| | - Andreas Pflaumer
- The Royal Children's Hospital and University of Melbourne, Melbourne, Australia
| | - Christopher S Snyder
- Rainbow Babies and Children's Hospital and Case Western Reserve University, Cleveland, Ohio
| | - Chandra Srinivasan
- McGovern Medical School, The University of Texas and The University of Texas Health Science Center, Houston, Texas
| | - Santiago O Valdes
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Victoria L Vetter
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
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7
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Vemireddy LP, Aqeel A, Ying GW, Majlesi D, Woo V. A Rare Case of RYR2 Mutation Causing Sudden Cardiac Arrest Due to Catecholaminergic Polymorphic Ventricular Tachycardia. Cureus 2021; 13:e13417. [PMID: 33763313 PMCID: PMC7980721 DOI: 10.7759/cureus.13417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 11/07/2022] Open
Abstract
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a complex disorder that can induce lethal ventricular arrhythmias, secondary to activation of the sympathetic nervous system. This disease is often diagnosed in childhood but can also manifest in adulthood (the early 40s). Gene mutations such as CALM1, RYR2 (ryanodine receptor-2), CASQ2, and TRDN have been identified as common causes of CPVT. Those affected can present with episodes of syncope, sudden cardiac arrest, or sudden cardiac death due to either fast polymorphic ventricular tachycardia (VT) or bidirectional VT. Diagnosing and managing CPVT can often be challenging as patients are often asymptomatic and may present after a sudden cardiac arrest. Exercise stress testing and genetic testing play a pivotal role in the workup of CPVT. Avoidance of strenuous activities and pharmacological therapy with beta-blockers are the mainstays of treatment. Here, we report a case of CPVT in a patient with RYR2 gene mutation, causing sudden cardiac arrest.
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Affiliation(s)
- Lalitha Padmanabha Vemireddy
- Internal Medicine, Chicago Medical School Internal Medicine Residency Program at Northwestern McHenry Hospital, McHenry, USA
| | - Ammar Aqeel
- Internal Medicine, Chicago Medical School Internal Medicine Residency Program at Northwestern McHenry Hospital, McHenry, USA
| | - Grace W Ying
- Internal Medicine, Chicago Medical School Internal Medicine Residency Program at Northwestern McHenry Hospital, McHenry, USA
| | - Delaram Majlesi
- Internal Medicine, Chicago Medical School Internal Medicine Residency Program at Northwestern McHenry Hospital, McHenry, USA
| | - Vincent Woo
- Cardiology, Northwestern Medicine McHenry Hospital, McHenry, USA
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8
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Wleklinski MJ, Kannankeril PJ, Knollmann BC. Molecular and tissue mechanisms of catecholaminergic polymorphic ventricular tachycardia. J Physiol 2020; 598:2817-2834. [PMID: 32115705 DOI: 10.1113/jp276757] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/03/2020] [Indexed: 12/21/2022] Open
Abstract
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a stress-induced cardiac channelopathy that has a high mortality in untreated patients. Our understanding has grown tremendously since CPVT was first described as a clinical syndrome in 1995. It is now established that the deadly arrhythmias are caused by unregulated 'pathological' calcium release from the sarcoplasmic reticulum (SR), the major calcium storage organelle in striated muscle. Important questions remain regarding the molecular mechanisms that are responsible for the pathological calcium release, regarding the tissue origin of the arrhythmic beats that initiate ventricular tachycardia, and regarding optimal therapeutic approaches. At present, mutations in six genes involved in SR calcium release have been identified as the genetic cause of CPVT: RYR2 (encoding ryanodine receptor calcium release channel), CASQ2 (encoding cardiac calsequestrin), TRDN (encoding triadin), CALM1, CALM2 and CALM3 (encoding identical calmodulin protein). Here, we review each CPVT subtype and how CPVT mutations alter protein function, RyR2 calcium release channel regulation, and cellular calcium handling. We then discuss research and hypotheses surrounding the tissue mechanisms underlying CPVT, such as the pathophysiological role of sinus node dysfunction in CPVT, and whether the arrhythmogenic beats originate from the conduction system or the ventricular working myocardium. Finally, we review the treatments that are available for patients with CPVT, their efficacy, and how therapy could be improved in the future.
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Affiliation(s)
- Matthew J Wleklinski
- Vanderbilt Center for Arrhythmia Research and Therapeutics, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Prince J Kannankeril
- Vanderbilt Center for Arrhythmia Research and Therapeutics, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bjӧrn C Knollmann
- Vanderbilt Center for Arrhythmia Research and Therapeutics, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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9
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Cortez AG, Ortiz NA, Argüellez EA, Molina TV, Serra AT, Torres PI, Márquez MF. Catecholaminergic polymorphic ventricular tachycardia due to de novo RyR2 mutation: recreational cycling as a trigger of lethal arrhythmias. Arch Med Sci 2020; 16:466-470. [PMID: 32190159 PMCID: PMC7069429 DOI: 10.5114/aoms.2019.89691] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/31/2018] [Indexed: 12/04/2022] Open
Affiliation(s)
- Antonio Gallegos Cortez
- Hospital Regional de Alta Especialidad del Bajío, San Carlos la Roncha, León Guanajuato, Mexico
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10
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Hou C, Jiang X, Zhang Y, Xu M, Sun X, Jia J, Li Y, Zhao Y, Xie L, Xiao T. A de novo heterozygous cardiac ryanodine receptor gene (RYR2) mutation in a catecholaminergic polymorphic ventricular tachycardia patient. GENE REPORTS 2019. [DOI: 10.1016/j.genrep.2019.100439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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11
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Nouira S, Chabrak S, Ouragini H. Clinical and genetic investigation of catecholaminergic polymorphic ventricular tachycardia in a consanguineous Tunisian family. Acta Cardiol 2019; 75:677-680. [PMID: 31453761 DOI: 10.1080/00015385.2019.1658374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare disease presenting with syncopal events and sudden cardiac death at a young age in the absence of structural heart disease. Two major genes have been shown to be responsible for CPVT: RYR2 and CASQ2 genes involved in calcium homeostasis. Methods: We report here clinical and molecular investigation of a consanguineous Tunisian family including three affected members. Involvement of RYR2 and CASQ2 genes was investigated. Results: Mutation screening for RYR2 gene showed that no mutation were detected in the coding sequence. A novel variation c.572C/T was identified in CASQ2 gene leading to a p.Pro191Leu. Conclusion: To our knowledge, this is the first clinical and genetic investigation of CPVT in North Africa.
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Affiliation(s)
- Sonia Nouira
- Laboratory of Molecular and Cellular Haematology, Pasteur Institute of Tunis, Université Tunis ElManar, Tunis, Tunisia
- Molecular Biology Cell and Biotechnology Department, Higher Institute of Biotechnology of Monastir, Université de Monastir, Monastir, Tunisia
| | - Sonia Chabrak
- Cardiology Department, La Rabta Hospital, Tunis, Tunisia
| | - Houyem Ouragini
- Laboratory of Molecular and Cellular Haematology, Pasteur Institute of Tunis, Université Tunis ElManar, Tunis, Tunisia
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Wong CS, Kogon AJ, Warady BA, Furth SL, Lantos JD, Wilfond BS. Ethical and Policy Considerations for Genomic Testing in Pediatric Research: The Path Toward Disclosing Individual Research Results. Am J Kidney Dis 2019; 73:837-845. [PMID: 30879919 DOI: 10.1053/j.ajkd.2019.01.020] [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: 08/05/2018] [Accepted: 01/29/2019] [Indexed: 11/11/2022]
Abstract
DNA is now commonly collected in clinical research either for immediate genomic analyses or stored for future studies. Many genomic studies were previously designed without awareness of the ethical issues that might arise regarding the disclosure of genomic test results. At the start of the Chronic Kidney Disease in Children (CKiD) Cohort Study in 2004, we did not foresee the advent of genomic technology or the associated ethical issues pertaining to genetic research in children. Recent genomic studies and ancillary proposals using genomic technology stimulated the CKiD investigators to reassess the current ethical and policy environment pertaining to genomic testing and results disclosure. We consider the issues pertaining to next generation sequencing and individual results disclosure that may guide current and future research practices.
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Affiliation(s)
- Craig S Wong
- Division of Nephrology, Department of Pediatrics, University of New Mexico Health Systems, Albuquerque, NM.
| | - Amy J Kogon
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Bradley A Warady
- Division of Nephrology, Department of Pediatrics, Children's Mercy Kansas City
| | - Susan L Furth
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - John D Lantos
- Department of Pediatrics, Children's Mercy Hospital and Medical Center, Kansas City, MO
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
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Trivedi A, Arora R. Gene Therapy for the Treatment of Cardiac Arrhythmias: Current and Emerging Applications. J Innov Card Rhythm Manag 2018; 9:3440-3445. [PMID: 32477792 PMCID: PMC7252777 DOI: 10.19102/icrm.2018.091204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/25/2018] [Indexed: 01/16/2023] Open
Abstract
In this review, we examine the current state of gene therapy for the treatment of cardiac arrhythmias. We describe advances and challenges in successfully creating and incorporating gene vectors into the myocardium. After summarizing the current scientific research in gene transfer technology, we then focus on the most promising areas of gene therapy at this time, which is the treatment of atrial fibrillation and ventricular tachyarrhythmias. We also review the scientific literature to determine how gene therapy could potentially be used to treat patients with cardiac arrhythmias.
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Affiliation(s)
- Amar Trivedi
- Department of Cardiology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Rishi Arora
- Department of Cardiology, Northwestern Memorial Hospital, Chicago, IL, USA
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Abstract
Sudden cardiac death (SCD) is a rare but devastating event in children and adolescents. Etiologies include congenital heart disease, cardiomyopathies, primary arrhythmia syndromes, and miscellaneous conditions. Challenges in the diagnosis and prevention of SCD in the young are reviewed.
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Affiliation(s)
- Elizabeth D Sherwin
- Division of Cardiology, Children's National Health System, 111 Michigan Avenue Northwest, Washington, DC 20010, USA; Department of Pediatrics, George Washington University School of Medicine, 2300 Eye Street NW, Washington, DC 20037, USA.
| | - Charles I Berul
- Division of Cardiology, Children's National Health System, 111 Michigan Avenue Northwest, Washington, DC 20010, USA; Department of Pediatrics, George Washington University School of Medicine, 2300 Eye Street NW, Washington, DC 20037, USA
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Josephs K, Patel K, Janson CM, Montagna C, McDonald TV. Compound heterozygous CASQ2 mutations and long-term course of catecholaminergic polymorphic ventricular tachycardia. Mol Genet Genomic Med 2017; 5:788-794. [PMID: 29178653 PMCID: PMC5702571 DOI: 10.1002/mgg3.323] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/07/2017] [Accepted: 07/10/2017] [Indexed: 01/05/2023] Open
Abstract
Background Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a potentially lethal inherited cardiac disorder characterized by episodic ventricular tachycardia during adrenergic stimulation. It is associated with significant morbidity and mortality. Knowledge of the underlying genetic cause, pathogenesis, and the natural history of the disease remains incomplete. Approximately 50% of CPVT cases are caused by dominant mutations in the cardiac ryanodine receptor (RYR2) gene, <5% of cases are accounted for by recessive mutations in cardiac calsequestrin (CASQ2) or Triadin (TRDN). Methods We report a family with two CASQ2 gene mutations. A research‐based next‐generation sequencing (NGS) initiative was used in a patient with a severe CPVT phenotype and her clinically unaffected son. Reverse transcription polymerase chain reaction (RT‐PCR) from platelet RNA was used to assess the consequences of predicted splice variants. Results NGS revealed that the proband carried a novel c.199C>T (p.Gln67*) mutation and a previously reported splice site mutation c.532+1G>A in CASQ2. Her son is a heterozygous carrier of the c.199C>T (p.Gln67*) mutation alone and the proband was compound heterozygous at CASQ2. RNA analysis demonstrated that the splice site mutation results in the retention of intron 3 with no full‐length CASQ2 mRNA. Conclusion This study describes a novel CPVT genotype and further characterizes the effect of a previously reported CASQ2 splice site mutation. The long‐term follow‐up of 23 years since first symptom provides additional insight into the natural history of CASQ2‐associated CPVT.
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Affiliation(s)
- Katherine Josephs
- Department of Genetics, Albert Einstein College of Medicine, Bronx, New York
| | - Kunjan Patel
- Department of Genetics, Albert Einstein College of Medicine, Bronx, New York
| | - Christopher M Janson
- Department of Pediatrics (Cardiology), Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, New York
| | - Cristina Montagna
- Department of Genetics, Albert Einstein College of Medicine, Bronx, New York
| | - Thomas V McDonald
- Department of Medicine (Cardiology), Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, New York.,Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, New York
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Finlay M, Harmer SC, Tinker A. The control of cardiac ventricular excitability by autonomic pathways. Pharmacol Ther 2017; 174:97-111. [PMID: 28223225 DOI: 10.1016/j.pharmthera.2017.02.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Central to the genesis of ventricular cardiac arrhythmia are variations in determinants of excitability. These involve individual ionic channels and transporters in cardiac myocytes but also tissue factors such as variable conduction of the excitation wave, fibrosis and source-sink mismatch. It is also known that in certain diseases and particularly the channelopathies critical events occur with specific stressors. For example, in hereditary long QT syndrome due to mutations in KCNQ1 arrhythmic episodes are provoked by exercise and in particular swimming. Thus not only is the static substrate important but also how this is modified by dynamic signalling events associated with common physiological responses. In this review, we examine the regulation of ventricular excitability by signalling pathways from a cellular and tissue perspective in an effort to identify key processes, effectors and potential therapeutic approaches. We specifically focus on the autonomic nervous system and related signalling pathways.
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Affiliation(s)
- Malcolm Finlay
- The Heart Centre, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Charterhouse Square, London EC1M6BQ, UK
| | - Stephen C Harmer
- The Heart Centre, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Charterhouse Square, London EC1M6BQ, UK
| | - Andrew Tinker
- The Heart Centre, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Charterhouse Square, London EC1M6BQ, UK.
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Yamazoe M, Furukawa T. Long-Term Prognosis of Catecholaminergic Polymorphic Ventricular Tachycardia Patients With Ryanodine Receptor (RYR2) Mutations. Circ J 2016; 80:1892-4. [DOI: 10.1253/circj.cj-16-0745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Masahiro Yamazoe
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
- Department of Bio-informational Pharmacology, Medical Research Institute, Tokyo Medical and Dental University
| | - Tetsushi Furukawa
- Department of Bio-informational Pharmacology, Medical Research Institute, Tokyo Medical and Dental University
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