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Morita S, Nomura S, Azuma K, Chida-Nagai A, Furutani Y, Inai K, Inoue T, Niimi Y, Iizuka Y, Tsutsumi Y, Ishizaki R, Yamagishi H, Kawamata T, Akagawa H. Functional characterization of variants found in Japanese patients with hereditary hemorrhagic telangiectasia. Clin Genet 2024; 105:543-548. [PMID: 38225712 DOI: 10.1111/cge.14483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/28/2023] [Accepted: 01/03/2024] [Indexed: 01/17/2024]
Abstract
Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant form of vascular dysplasia. Genetic diagnosis is made by identifying loss-of-function variants in genes, such as ENG and ACVRL1. However, the causal mechanisms of various variants of unknown significance remains unclear. In this study, we analyzed 12 Japanese patients from 11 families who were clinically diagnosed with HHT. Sequencing analysis identified 11 distinct variants in ACVRL1 and ENG. Three of the 11 were truncating variants, leading to a definitive diagnosis, whereas the remaining eight were splice-site and missense variants that required functional analyses. In silico splicing analyses demonstrated that three variants, c.526-3C > G and c.598C > G in ACVRL1, and c.690-1G > A in ENG, caused aberrant splicing, as confirmed by a minigene assay. The five remaining missense variants were p.Arg67Gln, p.Ile256Asn, p.Leu285Pro, and p.Pro424Leu in ACVRL and p.Pro165His in ENG. Nanoluciferase-based bioluminescence analyses demonstrated that these ACVRL1 variants impaired cell membrane trafficking, resulting in the loss of bone morphogenetic protein 9 (BMP9) signal transduction. In contrast, the ENG mutation impaired BMP9 signaling despite normal cell membrane expression. The updated functional analysis methods performed in this study will facilitate effective genetic testing and appropriate medical care for patients with HHT.
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Affiliation(s)
- Shuhei Morita
- Institute for Comprehensive Medical Sciences, Tokyo Women's Medical University, Tokyo, Japan
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Shunsuke Nomura
- Department of Neurosurgery, Tokyo Women's Medical University Yachiyo Medical center, Yachiyo, Japan
- Krembil Brain Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Kenko Azuma
- Institute for Comprehensive Medical Sciences, Tokyo Women's Medical University, Tokyo, Japan
| | - Ayako Chida-Nagai
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Yoshiyuki Furutani
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kei Inai
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Tatsuya Inoue
- Department of Neurosurgery, St. Luke's International Hospital, Tokyo, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, Tokyo, Japan
| | - Yuo Iizuka
- Department of Neuroradiology, Kashiwa Tanaka Hospital, Kashiwa, Japan
| | - Yoshiyuki Tsutsumi
- Department of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Reina Ishizaki
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Yamagishi
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
- Center for Preventive Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroyuki Akagawa
- Institute for Comprehensive Medical Sciences, Tokyo Women's Medical University, Tokyo, Japan
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Chida-Nagai A, Akagawa H, Sawai S, Ma YJ, Yakuwa S, Muneuchi J, Yasuda K, Yamazawa H, Yamamoto T, Takakuwa E, Tomaru U, Furutani Y, Kato T, Harada G, Inai K, Nakanishi T, Manabe A, Takeda A, Jing ZC. Identification of Prostaglandin I2 Synthase Rare Variants in Patients With Williams Syndrome and Severe Peripheral Pulmonary Stenosis. J Am Heart Assoc 2024:e032872. [PMID: 38639351 DOI: 10.1161/jaha.123.032872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/18/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Peripheral pulmonary stenosis (PPS) is a condition characterized by the narrowing of the pulmonary arteries, which impairs blood flow to the lung. The mechanisms underlying PPS pathogenesis remain unclear. Thus, the aim of this study was to investigate the genetic background of patients with severe PPS to elucidate the pathogenesis of this condition. METHODS AND RESULTS We performed genetic testing and functional analyses on a pediatric patient with PPS and Williams syndrome (WS), followed by genetic testing on 12 patients with WS and mild-to-severe PPS, 50 patients with WS but not PPS, and 21 patients with severe PPS but not WS. Whole-exome sequencing identified a rare PTGIS nonsense variant (p.E314X) in a patient with WS and severe PPS. Prostaglandin I2 synthase (PTGIS) expression was significantly downregulated and cell proliferation and migration rates were significantly increased in cells transfected with the PTGIS p.E314X variant-encoding construct when compared with that in cells transfected with the wild-type PTGIS-encoding construct. p.E314X reduced the tube formation ability in human pulmonary artery endothelial cells and caspase 3/7 activity in both human pulmonary artery endothelial cells and human pulmonary artery smooth muscle cells. Compared with healthy controls, patients with PPS exhibited downregulated pulmonary artery endothelial prostaglandin I2 synthase levels and urinary prostaglandin I metabolite levels. We identified another PTGIS rare splice-site variant (c.1358+2T>C) in another pediatric patient with WS and severe PPS. CONCLUSIONS In total, 2 rare nonsense/splice-site PTGIS variants were identified in 2 pediatric patients with WS and severe PPS. PTGIS variants may be involved in PPS pathogenesis, and PTGIS represents an effective therapeutic target.
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Affiliation(s)
- Ayako Chida-Nagai
- Department of Pediatrics Hokkaido University Hospital Sapporo Japan
- Department of Pediatric Cardiology and Adult Congenital Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Hiroyuki Akagawa
- Institute for Comprehensive Medical Sciences Tokyo Women's Medical University Tokyo Japan
| | - Saori Sawai
- Department of Pediatrics Hokkaido University Hospital Sapporo Japan
| | - Yue-Jiao Ma
- Department of Cardiology, Peking Union Medical College Hospital Peking Union Medical College and Chinese Academy of Medical Sciences Beijing China
| | - Satoshi Yakuwa
- Department of Pediatrics Obihiro Kosei Hospital Obihiro Japan
| | - Jun Muneuchi
- Department of Pediatrics, Kyushu Hospital Japan Community Healthcare Organization Kitakyusyu Japan
| | - Kazushi Yasuda
- Department of Pediatric Cardiology Aichi Children's Health and Medical Center Obu Japan
| | | | - Toshiyuki Yamamoto
- Division of Gene Medicine, Graduate School of Medical Science Tokyo Women's Medical University Tokyo Japan
| | - Emi Takakuwa
- Department of Surgical Pathology Hokkaido University Hospital Sapporo Japan
| | - Utano Tomaru
- Department of Surgical Pathology Hokkaido University Hospital Sapporo Japan
| | - Yoshiyuki Furutani
- Department of Pediatric Cardiology and Adult Congenital Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Tatsuya Kato
- Department of Thoracic Surgery Hokkaido University Hospital Sapporo Japan
| | - Gen Harada
- Department of Pediatric Cardiology and Adult Congenital Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Kei Inai
- Department of Pediatric Cardiology and Adult Congenital Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Toshio Nakanishi
- Department of Pediatric Cardiology and Adult Congenital Cardiology Tokyo Women's Medical University Tokyo Japan
| | - Atsushi Manabe
- Department of Pediatrics Hokkaido University Hospital Sapporo Japan
| | - Atsuhito Takeda
- Department of Pediatrics Hokkaido University Hospital Sapporo Japan
| | - Zhi-Cheng Jing
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital Guangdong Academy of Medical Sciences Southern Medical University Guangzhou China
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3
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Fujita Y, Chida-Nagai A, Takeda A. Tricuspid stenosis due to pectus excavatum in a paediatric patient with trisomy 21. Eur Heart J Case Rep 2024; 8:ytae104. [PMID: 38434211 PMCID: PMC10908392 DOI: 10.1093/ehjcr/ytae104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/02/2024] [Accepted: 02/16/2024] [Indexed: 03/05/2024]
Affiliation(s)
- Yuya Fujita
- Department of Pediatrics, Hokkaido University, Kita 15, Nishi 7, Sapporo 060-8638, Hokkaido, Japan
- Department of Pediatrics, Self Defense Forces Sapporo Hospital, Hokkaido, Sapporo, Japan
| | - Ayako Chida-Nagai
- Department of Pediatrics, Hokkaido University, Kita 15, Nishi 7, Sapporo 060-8638, Hokkaido, Japan
| | - Atsuhito Takeda
- Department of Pediatrics, Hokkaido University, Kita 15, Nishi 7, Sapporo 060-8638, Hokkaido, Japan
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4
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Chida-Nagai A, Masaki N, Maeda K, Sasaki K, Sato H, Muneuchi J, Ochiai Y, Murayama H, Tahara M, Shiono A, Shinozuka A, Kono F, Machida D, Toyooka S, Sugimoto S, Nakamura K, Akagi S, Kondo M, Kasahara S, Kotani Y, Koizumi J, Oda K, Harada M, Nakajima D, Murata A, Nagata H, Yatsunami K, Kobayashi T, Matsunaga Y, Inoue T, Yamagishi H, Nakagawa N, Ohtani K, Yamamoto M, Ito Y, Hokosaki T, Kuwahara Y, Masutani S, Nomura K, Wada T, Sawada H, Abiko M, Takahashi T, Ishikawa Y, Okada S, Naitoh A, Toda T, Ando T, Masuzawa A, Hoshino S, Kawada M, Nomura Y, Ueno K, Ohashi N, Tachibana T, Cao Y, Ueda H, Yanagi S, Koide M, Mitsushita N, Higashi K, Minosaki Y, Hayashi T, Okamoto T, Kuraishi K, Ehara E, Ishida H, Horigome H, Murakami T, Takei K, Ishii T, Harada G, Hirata Y, Maeda J, Tatebe S, Ota C, Hayabuchi Y, Sakazaki H, Sasaki T, Hirono K, Suzuki S, Yasuda M, Takeda A, Sawada M, Miyaji K, Kitagawa A, Nakai Y, Kakimoto N, Agematsu K, Manabe A, Saiki Y. Corrigendum: Use of the index of pulmonary vascular disease for predicting longterm outcome of pulmonary arterial hypertension associated with congenital heart disease. Front Cardiovasc Med 2024; 11:1369831. [PMID: 38361584 PMCID: PMC10867781 DOI: 10.3389/fcvm.2024.1369831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 01/19/2024] [Indexed: 02/17/2024] Open
Abstract
[This corrects the article DOI: 10.3389/fcvm.2023.1212882.].
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Affiliation(s)
- Ayako Chida-Nagai
- Department of Pediatrics, Hokkaido University, Sapporo, Japan
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Naoki Masaki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kay Maeda
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Konosuke Sasaki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroki Sato
- Department of Cardiology and Clinical Examination, Oita University, Yufu, Japan
- Advanced Trauma, Emergency and Critical Care Center, Oita University Hospital, Yufu, Japan
| | - Jun Muneuchi
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, Kitakyushu, Japan
| | - Yoshie Ochiai
- Department of Cardiovascular Surgery, Kyushu Hospital, Japan Community Healthcare Organization, Kitakyushu, Japan
| | - Hiroomi Murayama
- Department of Cardiovascular Surgery, Aichi Children’s Health and Medical Center, Obu, Japan
| | - Masahiro Tahara
- Department of Pediatrics, Tsuchiya General Hospital, Hiroshima, Japan
| | - Atsuko Shiono
- Department of Pediatric Cardiology, Ibaraki Children’s Hospital, Mito, Japan
| | - Atsushi Shinozuka
- Department of Pediatrics, Uji-Tokushukai Medical Center, Kyoto, Japan
| | - Fumihiko Kono
- Department of Diagnostic Pathology, Uji-Tokushukai Medical Center, Kyoto, Japan
| | - Daisuke Machida
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Seiichiro Sugimoto
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Satoshi Akagi
- Department of Cardiovascular Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Maiko Kondo
- Department of Pediatrics, Okayama University Hospital, Okayama, Japan
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University, Okayama, Japan
| | - Yasuhiro Kotani
- Department of Cardiovascular Surgery, Okayama University, Okayama, Japan
| | - Junichi Koizumi
- Department of Cardiovascular Surgery, Iwate Medical University Hospital, Yahaba, Japan
| | - Katsuhiko Oda
- Department of Cardiovascular Surgery, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Masako Harada
- Division of Pediatrics, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Daisuke Nakajima
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akira Murata
- Department of Cardiovascular Surgery, Kanazawa University, Kanazawa, Japan
| | - Hazumu Nagata
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koichi Yatsunami
- Department of Pediatric Cardiology, Kumamoto City Hospital, Kumamoto, Japan
| | - Tomio Kobayashi
- Division of Cardiology, Gunma Children’s Medical Center, Shibukawa, Japan
| | - Yoshikiyo Matsunaga
- Department of Cardiovascular Surgery, Gunma Children’s Medical Center, Shibukawa, Japan
| | - Takahiro Inoue
- Department of Pediatrics, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroyuki Yamagishi
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Naomi Nakagawa
- Department of Pediatric Cardiology, Hiroshima City Hospital, Hiroshima, Japan
| | - Katsuki Ohtani
- Department of Pediatric Cardiology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Masaki Yamamoto
- Department of Pediatrics, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Yushi Ito
- Division of Neonatology, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Tatsunori Hokosaki
- Department of Pediatric Cardiology, Yokohama City University Hospital, Yokohama, Japan
| | - Yuta Kuwahara
- Department of Pediatric Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
| | - Satoshi Masutani
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Koji Nomura
- Department of Pediatric Cardiovascular Surgery, Saitama Children’s Medical Center, Saitama, Japan
| | - Tsutomu Wada
- Department of Pediatrics, School of Medicine Sapporo Medical University, Sapporo, Japan
| | - Hirofumi Sawada
- Department of Pediatrics, Mie University Graduate School of Medicine, Mie,Japan
| | - Masayuki Abiko
- Department of Pediatrics, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Tatsunori Takahashi
- Department of Pediatrics, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Yuichi Ishikawa
- Department of Pediatrics, Saiseikai Shimonoseki General Hospital, Shimonoseki, Japan
| | - Seigo Okada
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Atsushi Naitoh
- Department of Neonatology, Yamanashi Prefectural Central Hospital, Kofu, Japan
| | - Takako Toda
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Tatsuya Ando
- Department of Paediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Akihiro Masuzawa
- Department of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Shinsuke Hoshino
- Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan
| | - Masaaki Kawada
- Department of Cardiac Surgery, Section of Pediatric and Congenital Cardiovascular Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Yuichi Nomura
- Department of Pediatrics, Kagoshima City Hospital, Kagoshima, Japan
| | - Kentaro Ueno
- Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Naoki Ohashi
- Department of Pediatric Cardiology, Chukyo Children Heart Centre, Community Health Care Organization Chukyo Hospital, Nagoya, Japan
| | - Tsuyoshi Tachibana
- Department of Cardiovascular Surgery, Kanagawa Children’s Medical Center, Yokohama, Japan
| | - Yuchen Cao
- Department of Cardiovascular Surgery, Kanagawa Children’s Medical Center, Yokohama, Japan
| | - Hideaki Ueda
- Department of Pediatric Cardiology, Kanagawa Children’s Medical Center, Yokohama, Japan
| | - Sadamitsu Yanagi
- Department of Pediatric Cardiology, Kanagawa Children’s Medical Center, Yokohama, Japan
| | - Masaaki Koide
- Department of Cardiovascular Surgery, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Norie Mitsushita
- Department of Cardiology, Shizuoka Children’s Hospital, Shizuoka, Japan
| | - Kouji Higashi
- Division of Cardiology, Chiba Children’s Hospital, Chiba, Japan
| | - Yoshihiro Minosaki
- Neonatal Intensive Care Unit, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Tomohiro Hayashi
- Department of Pediatrics, Kurashiki Central Hospital, Okayama, Japan
| | - Takashi Okamoto
- Department of Cardiac Surgery, Daiyukai General Hospital, Ichinomiya, Japan
| | - Kenji Kuraishi
- Department of Pediatric Cardiology and Neonatology, Ogaki Municipal Hospital, Gifu, Japan
| | - Eiji Ehara
- Department of Pediatric Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Hidekazu Ishida
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hitoshi Horigome
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takashi Murakami
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kohta Takei
- Department of Pediatric Cardiology, Nagano Children’s Hospital, Azumino, Japan
| | - Taku Ishii
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Gen Harada
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Yasutaka Hirata
- Department of Cardiac Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Jun Maeda
- Department of Cardiology, Tokyo Metropolitan Children’s Medical Center, Fuchu, Japan
| | - Shunsuke Tatebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Chiharu Ota
- Department of Pediatrics, Tohoku University Hospital, Sendai, Japan
| | - Yasunobu Hayabuchi
- Department of Pediatrics, School of Medicine, University of Tokushima, Tokushima, Japan
| | - Hisanori Sakazaki
- Department of Pediatric Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Takashi Sasaki
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Keiichi Hirono
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Sayo Suzuki
- Department of Cardiology, Fukuoka Children’s Hospital, Fukuoka, Japan
| | - Masahiro Yasuda
- Department of Pediatrics, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Atsuhito Takeda
- Department of Pediatrics, Hokkaido University, Sapporo, Japan
| | - Madoka Sawada
- Department of Pediatric Cardiology, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Kagami Miyaji
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Atsushi Kitagawa
- Department of Pediatrics, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yosuke Nakai
- Department of Cardiovascular Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Nobuyuki Kakimoto
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Kouta Agematsu
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama, Japan
| | - Atsushi Manabe
- Department of Pediatrics, Hokkaido University, Sapporo, Japan
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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5
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Chida-Nagai A, Tonoki H, Makita N, Ishiyama H, Ihara M, Maruo Y, Tsujioka T, Sasaki D, Izumi G, Yamazawa H, Kato N, Ito M, Fujimura M, Sasaki O, Takeda A. A Noonan-like pediatric patient with a de novo CBL pathogenic variant and an RNF213 polymorphism p.R4810K presenting with cardiopulmonary arrest due to left main coronary artery ostial atresia. Am J Med Genet A 2023; 191:2837-2842. [PMID: 37554039 DOI: 10.1002/ajmg.a.63370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/06/2023] [Accepted: 07/29/2023] [Indexed: 08/10/2023]
Abstract
Left main coronary artery ostial atresia (LMCAOA) is an extremely rare condition. Here, we report the case of a 14-year-old boy with Noonan syndrome-like disorder in whom LMCAOA was detected following cardiopulmonary arrest. The patient had been diagnosed with Noonan syndrome-like disorder with a pathogenic splice site variant of CBL c.1228-2 A > G. He suddenly collapsed when he was running. After administering two electric shocks using an automated external defibrillator, the patient's heartbeat resumed. Cardiac catheterization confirmed the diagnosis of LMCAOA. Left main coronary artery angioplasty was performed. The patient was discharged without neurological sequelae. Brain magnetic resonance imaging revealed asymptomatic Moyamoya disease. In addition, RNF213 c.14429 G > A p.R4810K was identified. There are no reports on congenital coronary malformations of compound variations of RNF213 and CBL. In contrast, the RNF213 p.R4810K polymorphism has been established as a risk factor for angina pectoris and myocardial infarction in adults, and several congenital coronary malformations due to genetic abnormalities within the RAS/MAPK signaling pathway have been reported. This report aims to highlight the risk of sudden death in patients with RASopathy and RNF213 p.R4810K polymorphism and emphasize the significance of actively searching for coronary artery morphological abnormalities in these patients.
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Affiliation(s)
- Ayako Chida-Nagai
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Hidefumi Tonoki
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
- Medical Genetics Center, Tenshi Hospital, Sapporo, Japan
| | - Naomasa Makita
- Omics Research Center, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroyuki Ishiyama
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuji Maruo
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Takao Tsujioka
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Daisuke Sasaki
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Gaku Izumi
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Hirokuni Yamazawa
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Nobuyasu Kato
- Department of Cardiovascular Surgery, Hokkaido University, Sapporo, Japan
| | - Masaki Ito
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Miki Fujimura
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Osamu Sasaki
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
- Department of Pediatrics, Tenshi Hospital, Sapporo, Japan
| | - Atsuhito Takeda
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
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6
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Chida-Nagai A, Masaki N, Maeda K, Sasaki K, Sato H, Muneuchi J, Ochiai Y, Murayama H, Tahara M, Shiono A, Shinozuka A, Kono F, Machida D, Toyooka S, Sugimoto S, Nakamura K, Akagi S, Kondo M, Kasahara S, Kotani Y, Koizumi J, Oda K, Harada M, Nakajima D, Murata A, Nagata H, Yatsunami K, Kobayashi T, Matsunaga Y, Inoue T, Yamagishi H, Nakagawa N, Ohtani K, Yamamoto M, Ito Y, Hokosaki T, Kuwahara Y, Masutani S, Nomura K, Wada T, Sawada H, Abiko M, Takahashi T, Ishikawa Y, Okada S, Naitoh A, Toda T, Ando T, Masuzawa A, Hoshino S, Kawada M, Nomura Y, Ueno K, Ohashi N, Tachibana T, Cao Y, Ueda H, Yanagi S, Koide M, Mitsushita N, Higashi K, Minosaki Y, Hayashi T, Okamoto T, Kuraishi K, Ehara E, Ishida H, Horigome H, Murakami T, Takei K, Ishii T, Harada G, Hirata Y, Maeda J, Tatebe S, Ota C, Hayabuchi Y, Sakazaki H, Sasaki T, Hirono K, Suzuki S, Yasuda M, Takeda A, Sawada M, Miyaji K, Kitagawa A, Nakai Y, Kakimoto N, Agematsu K, Manabe A, Saiki Y. Use of the index of pulmonary vascular disease for predicting long-term outcome of pulmonary arterial hypertension associated with congenital heart disease. Front Cardiovasc Med 2023; 10:1212882. [PMID: 37731527 PMCID: PMC10507182 DOI: 10.3389/fcvm.2023.1212882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
Aims Limited data exist on risk factors for the long-term outcome of pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD-PAH). We focused on the index of pulmonary vascular disease (IPVD), an assessment system for pulmonary artery pathology specimens. The IPVD classifies pulmonary vascular lesions into four categories based on severity: (1) no intimal thickening, (2) cellular thickening of the intima, (3) fibrous thickening of the intima, and (4) destruction of the tunica media, with the overall grade expressed as an additive mean of these scores. This study aimed to investigate the relationship between IPVD and the long-term outcome of CHD-PAH. Methods This retrospective study examined lung pathology images of 764 patients with CHD-PAH aged <20 years whose lung specimens were submitted to the Japanese Research Institute of Pulmonary Vasculature for pulmonary pathological review between 2001 and 2020. Clinical information was collected retrospectively by each attending physician. The primary endpoint was cardiovascular death. Results The 5-year, 10-year, 15-year, and 20-year cardiovascular death-free survival rates for all patients were 92.0%, 90.4%, 87.3%, and 86.1%, respectively. The group with an IPVD of ≥2.0 had significantly poorer survival than the group with an IPVD <2.0 (P = .037). The Cox proportional hazards model adjusted for the presence of congenital anomaly syndromes associated with pulmonary hypertension, and age at lung biopsy showed similar results (hazard ratio 4.46; 95% confidence interval: 1.45-13.73; P = .009). Conclusions The IPVD scoring system is useful for predicting the long-term outcome of CHD-PAH. For patients with an IPVD of ≥2.0, treatment strategies, including choosing palliative procedures such as pulmonary artery banding to restrict pulmonary blood flow and postponement of intracardiac repair, should be more carefully considered.
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Affiliation(s)
- Ayako Chida-Nagai
- Department of Pediatrics, Hokkaido University, Sapporo, Japan
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Naoki Masaki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kay Maeda
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Konosuke Sasaki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroki Sato
- Department of Cardiology and Clinical Examination, Oita University, Yufu, Japan
- Advanced Trauma, Emergency and Critical Care Center, Oita University Hospital, Yufu, Japan
| | - Jun Muneuchi
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, Kitakyushu, Japan
| | - Yoshie Ochiai
- Department of Cardiovascular Surgery, Kyushu Hospital, Japan Community Healthcare Organization, Kitakyushu, Japan
| | - Hiroomi Murayama
- Department of Cardiovascular Surgery, Aichi Children’s Health and Medical Center, Obu, Japan
| | - Masahiro Tahara
- Department of Pediatrics, Tsuchiya General Hospital, Hiroshima, Japan
| | - Atsuko Shiono
- Department of Pediatric Cardiology, Ibaraki Children’s Hospital, Mito, Japan
| | - Atsushi Shinozuka
- Department of Pediatrics, Uji-Tokushukai Medical Center, Kyoto, Japan
| | - Fumihiko Kono
- Department of Diagnostic Pathology, Uji-Tokushukai Medical Center, Kyoto, Japan
| | - Daisuke Machida
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Seiichiro Sugimoto
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Satoshi Akagi
- Department of Cardiovascular Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Maiko Kondo
- Department of Pediatrics, Okayama University Hospital, Okayama, Japan
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University, Okayama, Japan
| | - Yasuhiro Kotani
- Department of Cardiovascular Surgery, Okayama University, Okayama, Japan
| | - Junichi Koizumi
- Department of Cardiovascular Surgery, Iwate Medical University Hospital, Yahaba, Japan
| | - Katsuhiko Oda
- Department of Cardiovascular Surgery, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Masako Harada
- Division of Pediatrics, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Daisuke Nakajima
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akira Murata
- Department of Cardiovascular Surgery, Kanazawa University, Kanazawa, Japan
| | - Hazumu Nagata
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koichi Yatsunami
- Department of Pediatric Cardiology, Kumamoto City Hospital, Kumamoto, Japan
| | - Tomio Kobayashi
- Division of Cardiology, Gunma Children’s Medical Center, Shibukawa, Japan
| | - Yoshikiyo Matsunaga
- Department of Cardiovascular Surgery,Gunma Children’s Medical Center, Shibukawa, Japan
| | - Takahiro Inoue
- Department of Pediatrics, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroyuki Yamagishi
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Naomi Nakagawa
- Department of Pediatric Cardiology, Hiroshima City Hospital, Hiroshima, Japan
| | - Katsuki Ohtani
- Department of Pediatric Cardiology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Masaki Yamamoto
- Department of Pediatrics, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Yushi Ito
- Division of Neonatology, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Tatsunori Hokosaki
- Department of Pediatric Cardiology, Yokohama City University Hospital, Yokohama, Japan
| | - Yuta Kuwahara
- Department of Pediatric Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
| | - Satoshi Masutani
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Koji Nomura
- Department of Pediatric Cardiovascular Surgery, Saitama Children’s Medical Center, Saitama, Japan
| | - Tsutomu Wada
- Department of Pediatrics, School of Medicine Sapporo Medical University, Sapporo, Japan
| | - Hirofumi Sawada
- Department of Pediatrics, Mie University Graduate School of Medicine, Mie, Japan
| | - Masayuki Abiko
- Department of Pediatrics, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Tatsunori Takahashi
- Department of Pediatrics, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Yuichi Ishikawa
- Department of Pediatrics, Saiseikai Shimonoseki General Hospital, Shimonoseki, Japan
| | - Seigo Okada
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Atsushi Naitoh
- Department of Neonatology, Yamanashi Prefectural Central Hospital, Kofu, Japan
| | - Takako Toda
- Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Tatsuya Ando
- Department of Paediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Akihiro Masuzawa
- Department of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Shinsuke Hoshino
- Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan
| | - Masaaki Kawada
- Department of Cardiac Surgery, Section of Pediatric and Congenital Cardiovascular Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Yuichi Nomura
- Department of Pediatrics, Kagoshima City Hospital, Kagoshima, Japan
| | - Kentaro Ueno
- Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Naoki Ohashi
- Department of Pediatric Cardiology, Chukyo Children Heart Centre, Community Health Care Organization Chukyo Hospital, Nagoya, Japan
| | - Tsuyoshi Tachibana
- Department of Cardiovascular Surgery, Kanagawa Children’s Medical Center, Yokohama, Japan
| | - Yuchen Cao
- Department of Cardiovascular Surgery, Kanagawa Children’s Medical Center, Yokohama, Japan
| | - Hideaki Ueda
- Department of Pediatric Cardiology, Kanagawa Children’s Medical Center, Yokohama, Japan
| | - Sadamitsu Yanagi
- Department of Pediatric Cardiology, Kanagawa Children’s Medical Center, Yokohama, Japan
| | - Masaaki Koide
- Department of Cardiovascular Surgery, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Norie Mitsushita
- Department of Cardiology, Shizuoka Children’s Hospital, Shizuoka, Japan
| | - Kouji Higashi
- Division of Cardiology, Chiba Children's Hospital, Chiba, Japan
| | - Yoshihiro Minosaki
- Neonatal Intensive Care Unit, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Tomohiro Hayashi
- Department of Pediatrics, Kurashiki Central Hospital, Okayama, Japan
| | - Takashi Okamoto
- Department of Cardiac Surgery, Daiyukai General Hospital, Ichinomiya, Japan
| | - Kenji Kuraishi
- Department of Pediatric Cardiology and Neonatology, Ogaki Municipal Hospital, Gifu, Japan
| | - Eiji Ehara
- Department of Pediatric Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Hidekazu Ishida
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hitoshi Horigome
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takashi Murakami
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kohta Takei
- Department of Pediatric Cardiology, Nagano Children’s Hospital, Azumino, Japan
| | - Taku Ishii
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Gen Harada
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Yasutaka Hirata
- Department of Cardiac Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Jun Maeda
- Department of Cardiology, Tokyo Metropolitan Children’s Medical Center, Fuchu, Japan
| | - Shunsuke Tatebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Chiharu Ota
- Department of Pediatrics, Tohoku University Hospital, Sendai, Japan
| | - Yasunobu Hayabuchi
- Department of Pediatrics, School of Medicine, University of Tokushima, Tokushima, Japan
| | - Hisanori Sakazaki
- Department of Pediatric Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Takashi Sasaki
- Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan
| | - Keiichi Hirono
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Sayo Suzuki
- Department of Cardiology, Fukuoka Children’s Hospital, Fukuoka, Japan
| | - Masahiro Yasuda
- Department of Pediatrics, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Atsuhito Takeda
- Department of Pediatrics, Hokkaido University, Sapporo, Japan
| | - Madoka Sawada
- Department of Pediatric Cardiology, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Kagami Miyaji
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Atsushi Kitagawa
- Department of Pediatrics, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yosuke Nakai
- Department of Cardiovascular Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Nobuyuki Kakimoto
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Kouta Agematsu
- Departmentof Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama, Japan
| | - Atsushi Manabe
- Department of Pediatrics, Hokkaido University, Sapporo, Japan
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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7
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Takeda A, Ueki M, Abe J, Maeta K, Horiguchi T, Yamazawa H, Izumi G, Chida-Nagai A, Sasaki D, Tsujioka T, Sato I, Shiraishi M, Matsuo M. A case of infantile Barth syndrome with severe heart failure: Importance of splicing variants in the TAZ gene. Mol Genet Genomic Med 2023:e2190. [PMID: 37186429 DOI: 10.1002/mgg3.2190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 03/30/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
Barth syndrome (BTHS) is an X-linked disorder characterized by cardiomyopathy, skeletal myopathy, and 3-methylglutaconic aciduria. The causative pathogenic variants for BTHS are in TAZ, which encodes a putative acyltransferase named tafazzin and is involved in the remodeling of cardiolipin in the inner mitochondrial membranes. Pathogenic variants in TAZ result in mitochondrial structural and functional abnormalities. We report a case of infantile BTHS with severe heart failure, left ventricular noncompaction, and lactic acidosis, having a missense c.640C>T (p.His214Tyr) variant in TAZ, which is considered a pathogenic variant based on the previously reported amino acid substitution at the same site (c.641A>G, p.His214Arg). However, in this previously reported case, heart function was compensated and not entirely similar to the present case. Silico prediction analysis suggested that c.640C>T could alter the TAZ messenger RNA (mRNA) splicing process. TAZ mRNAs in isolated peripheral mononuclear cells from the patient and in vitro splicing analysis using minigenes of TAZ found an 8 bp deletion at the 3' end of exon 8, which resulted in the formation of a termination codon in the coding region of exon 9 (H214Nfs*3). These findings suggest that splicing abnormalities should always be considered in BTHS.
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Affiliation(s)
- Atsuhito Takeda
- Department of Pediatrics, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Masahiro Ueki
- Department of Pediatrics, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Jiro Abe
- MRC Mitochondrial Biology Unit, University of Cambridge, Cambridge, UK
| | - Kazuhiro Maeta
- KNC Department of Nucleic Acid Drug Discovery, Faculty of Rehabilitation, Kobe Gakuin University, Kobe, Japan
- Research Center for Locomotion Biology, Kobe Gakuin University, Kobe, Japan
| | - Tomoko Horiguchi
- KNC Department of Nucleic Acid Drug Discovery, Faculty of Rehabilitation, Kobe Gakuin University, Kobe, Japan
- Research Center for Locomotion Biology, Kobe Gakuin University, Kobe, Japan
| | - Hirokuni Yamazawa
- Department of Pediatrics, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Gaku Izumi
- Department of Pediatrics, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Ayako Chida-Nagai
- Department of Pediatrics, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Daisuke Sasaki
- Department of Pediatrics, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Takao Tsujioka
- Department of Pediatrics, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Itsumi Sato
- Department of Pediatrics, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Masahiro Shiraishi
- Department of Pediatrics, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Masafumi Matsuo
- KNC Department of Nucleic Acid Drug Discovery, Faculty of Rehabilitation, Kobe Gakuin University, Kobe, Japan
- Research Center for Locomotion Biology, Kobe Gakuin University, Kobe, Japan
- Faculty of Health Sciences, Kobe Tokiwa University, Kobe, Japan
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8
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Chida-Nagai A, Tsujino I, Yakuwa S, Akagawa H, Tsujioka T, Taniguchi K, Sasaki O, Izumi G, Yamazawa H, Takeda A. A Cardiac Arrest Case due to Left Coronary Artery Compression in Congenital Heart Disease-Associated Pulmonary Arterial Hypertension. CJC Pediatr Congenit Heart Dis 2022; 1:229-231. [PMID: 37969429 PMCID: PMC10642145 DOI: 10.1016/j.cjcpc.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/13/2022] [Indexed: 11/17/2023]
Abstract
We report the case of an adult who had a cardiac arrest in the setting of pulmonary hypertension and a previously repaired intermediate atrioventricular septal defect, with left main coronary trunk stenosis due to dilatation of the main pulmonary artery. In patients with pulmonary hypertension exhibiting anginal symptoms, it is advisable to perform chest contrast computed tomography to confirm the pulmonary artery diameter and the presence of coronary artery compression. In addition, our case highlights the importance of early collaboration among specialists during the transition from adolescence to adulthood.
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Affiliation(s)
- Ayako Chida-Nagai
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Ichizo Tsujino
- Department of Respiratory, Hokkaido University Hospital, Sapporo, Japan
| | - Satoshi Yakuwa
- Department of Pediatrics, Obihiro Kosei Hospital, Obihiro, Japan
| | - Hiroyuki Akagawa
- Tokyo Women’s Medical University Institute of Integrated Medical Sciences, Tokyo, Japan
| | - Takao Tsujioka
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Kota Taniguchi
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Osamu Sasaki
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Gaku Izumi
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Hirokuni Yamazawa
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Atsuhito Takeda
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
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9
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Chida-Nagai A, Sato H, Sato I, Shiraishi M, Sasaki D, Izumi G, Yamazawa H, Cho K, Manabe A, Takeda A. Risk factors for hospitalisation due to respiratory syncytial virus infection in children receiving prophylactic palivizumab. Eur J Pediatr 2022; 181:539-547. [PMID: 34417646 DOI: 10.1007/s00431-021-04216-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/18/2021] [Accepted: 07/20/2021] [Indexed: 12/01/2022]
Abstract
Respiratory syncytial virus (RSV) is a common pathogen that causes extremely severe respiratory symptoms in the first few weeks and months of life. In infants with cardiopulmonary diseases, RSV infections have a significant clinical impact. Palivizumab, a humanised monoclonal antibody for RSV, has been shown to significantly reduce the rate of hospitalisation of high-risk infants diagnosed with RSV. However, we have experienced a significant number of RSV infections in our institution that required hospitalisation or intensive care, despite the administration of palivizumab. This study aimed to analyse the risk factors associated with severe RSV despite the use of palivizumab. We retrospectively reviewed the medical records of 688 patients who visited or were admitted to our hospital and received palivizumab. Thirty-seven (5.4%) patients required hospitalisation for RSV, despite receiving palivizumab. In addition, 31 of these patients (83.8%) required hospitalisation out of season for palivizumab injection. Preterm birth (≤ 28-week gestation), bronchopulmonary dysplasia (BPD), and trisomy 21 were risk factors for RSV-related hospitalisation in infected patients, despite receiving palivizumab. Furthermore, subgroup analysis of 69 patients with RSV revealed that hemodynamically significant congenital heart disease (CHD) was also a risk factor for RSV-related hospitalisation.Conclusion: Preterm birth (≤ 28 weeks of gestation), BPD, trisomy 21, hemodynamically significant CHD, and CHD requiring surgery or cardiac catheterisation/intervention during infancy could be considered when determining whether year-round administration of palivizumab is appropriate. What is Known: • Respiratory syncytial virus causes severe respiratory symptoms in infants, particularly those with cardiopulmonary diseases. • The use of palivizumab has reduced the rate of hospitalisation of infants diagnosed with RSV. Despite this, the rate of hospitalisation is still high. What is New: • We identified that preterm birth (≤ 28-week gestation), bronchopulmonary dysplasia, trisomy 21, and hemodynamically significant congenital heart disease were risk factors for RSV-related hospitalisation, even after receiving palivizumab treatment. • High-risk infants should be closely monitored and the prolonged use of palivizumab should be considered.
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Affiliation(s)
- Ayako Chida-Nagai
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Hiroki Sato
- Department of Cardiology and Clinical Examination, Oita University, Oita, Japan.,Department of Preventive Medicine and Public Health, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Itsumi Sato
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Masahiro Shiraishi
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Daisuke Sasaki
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Gaku Izumi
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Hirokuni Yamazawa
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Kazutoshi Cho
- Maternity and Perinatal Care Center, Hokkaido University Hospital, Sapporo, Japan
| | - Atsushi Manabe
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Atsuhito Takeda
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan.
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10
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Chida-Nagai A, Tsujioka T, Sasaki D, Izumi G, Yamazawa H, Takeda A. An Adolescent Patient With Idiopathic Pulmonary Arterial Hypertension Weaned Off Intravenous Epoprostenol Following Treatment With Selexipag: A Case Report. Front Pediatr 2022; 10:909595. [PMID: 35783314 PMCID: PMC9247454 DOI: 10.3389/fped.2022.909595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/25/2022] [Indexed: 11/21/2022] Open
Abstract
Idiopathic pulmonary arterial hypertension (PAH) is a rare, progressive disease affecting the pulmonary arteries. Epoprostenol, a synthetic prostaglandin analog, is the most potent pharmacological treatment modality used in patients with PAH. However, it requires continuous intravenous infusion, which negatively impacts the patient's quality of life and frequently results in complications, such as catheter-related bloodstream infection. We weaned an adolescent female patient off epoprostenol by gradually introducing oral selexipag over a sustained period, following many years of continuous intravenous epoprostenol use alone. Oral selexipag might have an efficacy comparable to epoprostenol in young patients with PAH.
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Affiliation(s)
- Ayako Chida-Nagai
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Takao Tsujioka
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Daisuke Sasaki
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Gaku Izumi
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Hirokuni Yamazawa
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Atsuhito Takeda
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
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11
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Chida-Nagai A, Sawai S, Yakuwa S, Akagawa H, Furutani Y, Takakuwa E, Takeda A. A rare nonsense variant of the X-gene in a paediatric patient with severe peripheral pulmonary stenosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Most cases of peripheral pulmonary stenosis (PPS) associated with William's syndrome are usually very mild or resolve spontaneously. However, we encountered a paediatric case of William's syndrome (WS) with severe PPS. In this case, we investigate whether the patient's genetic background was responsible for the severity of the PPS.
Case presentation
Shortly after birth, the male patient was suspected as WS because of his peculiar facial appearance and PPS. Fluorescence in situ hybridization identified microdeletion in the 7q11.23 region, and he had a confirmed diagnosis of WS. PPS became worsened subsequently, and a cardiac catheterization was performed at the age of 7 years. Due to severe multiple PPS, the right ventricular pressure exceeded the left ventricular pressure. At the age of 12, he had haemoptysis, which required ventilatory management. A pseudoaneurysm of the right pulmonary artery was identified and a right middle lobectomy was performed.
Methods and results
First, we performed multiplex ligation-dependent probe amplification and whole exome sequencing, considering the possibility of homozygous mutations in the region responsible for WS (7q11.23) or a larger deletion of this region in the patient. The deletion was confirmed to be a heterozygous deletion with a typical range for WS. Therefore, we hypothesized that the causative gene of severe PPS may exist separately from the region responsible for WS. After reviewing the result of the whole exome sequencing, we identified a rare nonsense variant of the “X”-gene as the disease-causing gene. The X-gene is involved in the suppression of vascular smooth muscle cell proliferation and the generation of pulmonary arteriolar dilator “Y”. The X-gene has been reported as a disease-causing gene in patients with pulmonary arterial hypertension. Based on these previous reports, we assumed that the X gene variant could be a cause of PPS; therefore, we performed functional analysis. We first introduced a mutant X-gene construct into human pulmonary arterial endothelial cells (hPAECs) and human pulmonary arterial smooth muscle cells and found that the mutant significantly reduced the production of Y compared to the wild-type X-gene. When transfected into hPAECs, the mutant X gene significantly increased cell proliferation compared to the wild-type X-gene. The hPAECs also showed reduced caspase 3/7 activity and reduced apoptosis compared to wild-type X-gene transfected cells. In the patient's own lung pathology specimens, irregular fibrous thickening of the intima of the intrapulmonary arteries was observed, which supported the results of the functional analysis.
Conclusion
Our study showed that an X-gene variant could lead to reduced Y production in the pulmonary arteries, abnormal proliferation of hPAECs, and the development of severe PPS. As Y-replenishing drugs are already in clinical use, the results may lead to the development of medical treatments for severe PPS.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - S Sawai
- Hokkaido University, Sapporo, Japan
| | - S Yakuwa
- Obihiro Kosei Hospital, Obihiro, Japan
| | - H Akagawa
- Tokyo Women's Medical University, Tokyo, Japan
| | - Y Furutani
- Tokyo Women's Medical University, Tokyo, Japan
| | | | - A Takeda
- Hokkaido University, Sapporo, Japan
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12
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Ueno M, Takeda A, Yamazawa H, Takei K, Furukawa T, Suzuki Y, Chida-Nagai A, Kimura A. A case report: Twin sisters with restrictive cardiomyopathy associated with rare mutations in the cardiac troponin I gene. J Cardiol Cases 2021; 23:154-157. [PMID: 33841591 DOI: 10.1016/j.jccase.2020.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 10/07/2020] [Accepted: 10/22/2020] [Indexed: 11/18/2022] Open
Abstract
Restrictive cardiomyopathy (RCM) is a rare cardiomyopathy in children, and its prognosis until now, has been poor. Recently some sarcomeric mutations have been reported as disease-causing genes of RCM. However, the genotype-phenotype correlation is not fully understood. Additionally, prognostic factors including sudden death in patients with RCM have not been elucidated. We report our experience in treating twin sisters with RCM or hypertrophic cardiomyopathy with RCM phenotype, both carriers of the same mutation in TNNI3, which encodes one of the major sarcomeric proteins in myofibrils. They were both diagnosed with RCM by cardiac catheterization at the age of 11 years. Despite appropriate follow-up and medical treatment, one died suddenly at the age of 11 years and the other also died at the age of 15 years due to heart failure while awaiting heart transplantation. In addition to our cases, other reports of younger fatal cases with RCM carrying TNNI3 mutations may suggest it as one of the prognostic factors. Genetic diagnosis is important in the clinical diagnosis, management, and treatment of cardiomyopathy. <Learning objective: Our cases involved twin sisters diagnosed with restrictive cardiomyopathy (RCM) with rare mutations in the cardiac troponin I. Based on their clinical course, this mutation appears to have a poor prognosis. It was reported that RCM was caused by sarcomere gene mutations, however, the relationship between genotype and phenotype is not clearly defined. To elucidate the prognosis of this rare disease not only the genetic mutations but the accumulation of various clinical outcomes is important.>.
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Affiliation(s)
- Michihiko Ueno
- Department of Pediatrics and Developmental Medicine, Hokkaido University, Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Atsuhito Takeda
- Department of Pediatrics and Developmental Medicine, Hokkaido University, Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Hirokuni Yamazawa
- Department of Pediatrics and Developmental Medicine, Hokkaido University, Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Kohta Takei
- Department of Pediatrics and Developmental Medicine, Hokkaido University, Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Takuo Furukawa
- Department of Pediatrics and Developmental Medicine, Hokkaido University, Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Yasuto Suzuki
- Department of Pediatrics, Kushiro Red Cross Hospital, Kushiro, Hokkaido, Japan
| | - Ayako Chida-Nagai
- Department of Pediatrics and Developmental Medicine, Hokkaido University, Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Akinori Kimura
- Department of Molecular Pathogenesis, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
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13
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Shiraishi H, Chida-Nagai A, Taniguchi K, Abe J, Izumi G, Yamazawa H, Ueda Y, Sasaki O, Miyakoshi K, Takeda A. Diagnostic dilemma in a case of obstructive sleep apnoea syndrome with reversible pulmonary hypertension and right heart failure: A case report. Int J Pediatr Otorhinolaryngol 2020; 138:110378. [PMID: 33152969 DOI: 10.1016/j.ijporl.2020.110378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/08/2020] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
Abstract
Childhood obstructive sleep apnoea syndrome (OSAS) secondary to adenoid hyperplasia is known to give rise to pulmonary hypertension. However, we present a case of a toddler with pulmonary hypertension (PH) and right heart failure due to OSAS, the cause of which is difficult to identify. After the patient underwent an adenotonsillectomy, OSAS disappeared and the PH eventually resolved. Both paediatricians and otolaryngologists should know that paediatric OSAS can occur even in the setting of mild, clinically insignificant palatine tonsil hypertrophy and adenoid hyperplasia. Surgical intervention should be considered without losing the opportunity if it could be the cause of PH.
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Affiliation(s)
- Haruki Shiraishi
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan; Department of Pediatrics, Japanese Red Cross Kitami Hospital, Kitami, Japan
| | - Ayako Chida-Nagai
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan.
| | - Kota Taniguchi
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Jiro Abe
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Gaku Izumi
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Hirokuni Yamazawa
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Yuki Ueda
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Osamu Sasaki
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan; Department of Pediatrics, Tenshi Hospital, Sapporo, Japan
| | - Kosei Miyakoshi
- Department of Otolaryngology, Tenshi Hospital, Sapporo, Japan
| | - Atsuhito Takeda
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
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14
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Chida-Nagai A, Sagawa K, Tsujioka T, Fujimoto T, Taniguchi K, Sasaki O, Izumi G, Yamazawa H, Masaki N, Manabe A, Takeda A. Pulmonary vasodilators can lead to various complications in pulmonary "arterial" hypertension associated with congenital heart disease. Heart Vessels 2020; 35:1307-1315. [PMID: 32285188 PMCID: PMC7152743 DOI: 10.1007/s00380-020-01604-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/03/2020] [Indexed: 11/25/2022]
Abstract
Congenital heart disease-associated pulmonary arterial hypertension (CHD-PAH) is one of the major complications in patients with CHD. A timely closure of the left-to-right shunt will generally result in the normalization of the pulmonary hemodynamics, but a few patients have severe prognosis in their early childhood. We hypothesized that wide-ranging pathological mechanism in PAH could elucidate the clinical state of severe CHD-PAH. Using electronic medical records, we retrospectively analyzed six infants with severe CHD-PAH who had treatment-resistant PH. All patients were born with congenital malformation syndrome. After starting on a pulmonary vasodilator, five of the six patients developed complications including pulmonary edema and interstitial lung disease (ILD), and four patients had alveolar hemorrhage. After steroid therapy, the clinical condition improved in four patients, but two patients died. The autopsy findings in one of the deceased patients indicated the presence of recurrent alveolar hemorrhage, pulmonary venous hypertension, ILD, and PAH. Based on the clinical course of these CHD-PAH in patients and the literature, CHD-PAH can occur with pulmonary vascular obstructive disease (PVOD)/pulmonary capillary hemangiomatosis (PCH), ILD, and/or alveolar hemorrhage. The severity of CHD-PAH may depend on a genetic disorder, respiratory infection, and upper airway stenosis. Additionally, pulmonary vasodilators may be involved in the development of PVOD/PCH and ILD. When patients with CHD-PAH show unexpected deterioration, clinicians should consider complications associated with PVOD/PCH and/or pulmonary disease. In addition, the choice of upfront combination therapy for pediatric patients with CHD-PAH should be selected carefully.
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Affiliation(s)
- Ayako Chida-Nagai
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Koichi Sagawa
- Department of Pediatric Cardiology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Takao Tsujioka
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Takanori Fujimoto
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Kota Taniguchi
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Osamu Sasaki
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Gaku Izumi
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Hirokuni Yamazawa
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Naoki Masaki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Atsushi Manabe
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Atsuhito Takeda
- Department of Pediatrics, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan.
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15
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Chida-Nagai A, Shintani M, Sato H, Nakayama T, Nii M, Akagawa H, Furukawa T, Rana A, Furutani Y, Inai K, Nonoyama S, Nakanishi T. Role of BRCA1-associated protein (BRAP) variant in childhood pulmonary arterial hypertension. PLoS One 2019; 14:e0211450. [PMID: 30703135 PMCID: PMC6355015 DOI: 10.1371/journal.pone.0211450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 01/15/2019] [Indexed: 11/18/2022] Open
Abstract
Although mutations in several genes have been reported in pulmonary arterial hypertension (PAH), most of PAH cases do not carry these mutations. This study aimed to identify a novel cause of PAH. To determine the disease-causing variants, direct sequencing and multiplex ligation-dependent probe amplification were performed to analyze 18 families with multiple affected family members with PAH. In one of the 18 families with PAH, no disease-causing variants were found in any of BMPR2, ACVRL1, ENG, SMAD1/4/8, BMPR1B, NOTCH3, CAV1, or KCNK3. In this family, a female proband and her paternal aunt developed PAH in their childhood. Whole-exome next-generation sequencing was performed in the 2 PAH patients and the proband’s healthy mother, and a BRCA1-associated protein (BRAP) gene variant, p.Arg554Leu, was identified in the 2 family members with PAH, but not in the proband’s mother without PAH. Functional analyses were performed using human pulmonary arterial smooth muscle cells (hPASMCs). Knockdown of BRAP via small interfering RNA in hPASMCs induced p53 signaling pathway activation and decreased cell proliferation. Overexpression of either wild-type BRAP or p.Arg554Leu-BRAP cDNA constructs caused cell death confounding these studies, however we observed higher levels of p53 signaling inactivation and hPASMC proliferation in cells expressing p.Arg554Leu-BRAP compared to wild-type BRAP. In addition, p.Arg554Leu-BRAP induced decreased apoptosis of hPASMCs compared with wild-type BRAP. In conclusion, we have identified a novel variant of BRAP in a Japanese family with PAH and our results suggest it could have a gain-of-function. This study sheds light on new mechanism of PAH pathogenesis.
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Affiliation(s)
- Ayako Chida-Nagai
- Department of Pediatrics, National Defense Medical College, Tokorozawa, Saitama, Japan
- Department of Pediatric Cardiology, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan
| | - Masaki Shintani
- Department of Pediatric Cardiology, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan
| | - Hiroki Sato
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Tomotaka Nakayama
- Department of Pediatrics, Toho University Omori Medical Center, Ota, Tokyo, Japan
| | - Masaki Nii
- Department of Cardiology, Shizuoka Children’s Hospital, Shizuoka, Shizuoka, Japan
| | - Hiroyuki Akagawa
- Institute for Integrated Medical Sciences, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan
| | - Toru Furukawa
- Institute for Integrated Medical Sciences, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan
- Department of Histopathology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Amer Rana
- Division of Respiratory Medicine, Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Yoshiyuki Furutani
- Department of Pediatric Cardiology, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan
| | - Kei Inai
- Department of Pediatric Cardiology, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan
| | - Shigeaki Nonoyama
- Department of Pediatrics, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Toshio Nakanishi
- Department of Pediatric Cardiology, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan
- * E-mail:
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