1
|
Stroeks SLVM, Hellebrekers D, Claes GRF, Krapels IPC, Henkens MHTM, Sikking M, Vanhoutte EK, Helderman-van den Enden A, Brunner HG, van den Wijngaard A, Verdonschot JAJ. Diagnostic and prognostic relevance of using large gene panels in the genetic testing of patients with dilated cardiomyopathy. Eur J Hum Genet 2023; 31:776-783. [PMID: 37198425 PMCID: PMC10325988 DOI: 10.1038/s41431-023-01384-y] [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: 10/27/2022] [Revised: 03/24/2023] [Accepted: 05/02/2023] [Indexed: 05/19/2023] Open
Abstract
It was previously suggested that increasing the number of genes on diagnostic gene panels could increase the genetic yield in patient with dilated cardiomyopathy (DCM). We explored the diagnostic and prognostic relevance of testing DCM patients with an expanded gene panel. The current study included 225 consecutive DCM patients who had no genetic diagnosis after a 48-gene cardiomyopathy-panel. These were then evaluated using an expanded gene panel of 299 cardiac-associated genes. A likely pathogenic/pathogenic (P/LP) variant was detected in 13 patients. Five variants were reclassifications of variants found in genes which were already detected using the 48 gene panel. Only one of the other eight variants could explain the phenotype of the patient (KCNJ2). The panel detected 186 VUSs in 127 patients (of which 6 also had a P/LP variant). The presence of a VUS was significantly associated with the combined end-point of mortality, heart failure hospitalization, heart transplantation or life-threatening arrhythmias(HR, 2.04 [95% CI, 1.15 to 3.65]; p = 0.02). The association of a VUS with prognosis remained when we only included VUSs in robust DCM-associated genes (high suspicious VUSs), but disappeared when we only included VUSs in non-robust DCM-associated genes (low suspicious VUSs), highlighting the importance of weighing of VUSs. Overall, the use of large gene panels for genetic testing in DCM does not increase the diagnostic yield, although a VUS in a robust DCM-associated gene is associated with an adverse prognosis. Altogether, current diagnostic gene panels should be limited to the robust DCM-associated genes.
Collapse
Affiliation(s)
- Sophie L V M Stroeks
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
- Centre for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, (ERN GUARD-Heart), Amsterdam, The Netherlands
| | - Debby Hellebrekers
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, (ERN GUARD-Heart), Amsterdam, The Netherlands
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Godelieve R F Claes
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, (ERN GUARD-Heart), Amsterdam, The Netherlands
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ingrid P C Krapels
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, (ERN GUARD-Heart), Amsterdam, The Netherlands
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Michiel H T M Henkens
- Department of Pathology, Maastricht University Medical Center, Maastricht, The Netherlands
- Netherlands Heart Institute (NLHI), Utrecht, The Netherlands
| | - Maurits Sikking
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, (ERN GUARD-Heart), Amsterdam, The Netherlands
| | - Els K Vanhoutte
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, (ERN GUARD-Heart), Amsterdam, The Netherlands
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Apollonia Helderman-van den Enden
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, (ERN GUARD-Heart), Amsterdam, The Netherlands
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Han G Brunner
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, (ERN GUARD-Heart), Amsterdam, The Netherlands
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW Institute for Developmental Biology and Cancer, Maastricht University, Maastricht, The Netherlands
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arthur van den Wijngaard
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, (ERN GUARD-Heart), Amsterdam, The Netherlands
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Job A J Verdonschot
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, (ERN GUARD-Heart), Amsterdam, The Netherlands.
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands.
| |
Collapse
|
2
|
ter Bekke RMA, de Schouwer K, Conti S, Claes GRF, Vanoevelen J, Gommers S, Helderman-van den Enden ATJM, Brunner-LaRocca HP. Juvenile-onset multifocal atrial arrhythmias, atrial standstill and compound heterozygosity of genetic variants in TAF1A: sentinel event for evolving dilated cardiomyopathy-a case report. Eur Heart J Case Rep 2023; 7:ytad255. [PMID: 37501913 PMCID: PMC10371049 DOI: 10.1093/ehjcr/ytad255] [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] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/20/2023] [Accepted: 05/19/2023] [Indexed: 07/29/2023]
Abstract
Background Juvenile onset of extensive atrial electromechanical failure, including atrial standstill, is a rare disease entity that may precede ventricular cardiomyopathy. Genetic variants associated with early-onset atrioventricular (AV) cardiomyopathy are increasingly recognized. Case summary A 16-year-old patient presented with atrial brady- and tachyarrhythmias and concomitant impaired atrial electromechanical function (atrial standstill). The atrial phenotype preceded the development of a predominantly right-sided AV dilated cardiomyopathy with pronounced myocardial fibrosis. A His-bundle pacemaker was installed for high-degree AV conduction block and sinus arrest. Using familial-based whole-exome sequencing, a missense mutation and a copy number variant deletion (compound heterozygosity) of the TAF1A gene (involved in ribosomal RNA synthesis) were identified. Discussion Juvenile onset of severe atrial electromechanical failure with atrial arrhythmias should prompt deep pheno- and genotyping and calls for vigilance for downstream cardiomyopathic deterioration.
Collapse
Affiliation(s)
| | - Koen de Schouwer
- Department of Cardiology, Cardiovascular Center Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Sergio Conti
- Department of Cardiac Electrophysiology, ARNAS Civico Hospital, Palermo, Italy
| | - Godelieve R F Claes
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jo Vanoevelen
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Suzanne Gommers
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | |
Collapse
|
3
|
Stroeks SLVM, Lunde IG, Hellebrekers DMEI, Claes GRF, Wakimoto H, Gorham J, Krapels IPC, Vanhoutte EK, van den Wijngaard A, Henkens MTHM, Raafs AG, Sikking MA, Broers JLV, Nabben M, Jones EAV, Heymans SRB, Brunner HG, Verdonschot JAJ. Prevalence and Clinical Consequences of Multiple Pathogenic Variants in Dilated Cardiomyopathy. Circ Genom Precis Med 2023; 16:e003788. [PMID: 36971006 DOI: 10.1161/circgen.122.003788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Background:
Dilated cardiomyopathy (DCM) was considered a monogenetic disease that can be caused by over 60 genes. Evidence suggests that the combination of multiple pathogenic variants leads to greater disease severity and earlier onset. So far, not much is known about the prevalence and disease course of multiple pathogenic variants in patients with DCM. To gain insight into these knowledge gaps, we (1) systematically collected clinical information from a well-characterized DCM cohort and (2) created a mouse model.
Methods:
Complete cardiac phenotyping and genotyping was performed in 685 patients with consecutive DCM. Compound heterozygous digenic (LMNA [lamin]/titin deletion A-band) with monogenic (LMNA/wild-type) and wild-type/wild-type mice were created and phenotypically followed over time.
Results:
One hundred thirty-one likely pathogenic/pathogenic (LP/P) variants in robust DCM-associated genes were found in 685 patients with DCM (19.1%) genotyped for the robust genes. Three of the 131 patients had a second LP/P variant (2.3%). These 3 patients had a comparable disease onset, disease severity, and clinical course to patients with DCM with one LP/P. The LMNA/Titin deletion A-band mice had no functional differences compared with the LMNA/wild-type mice after 40 weeks of follow-up, although RNA-sequencing suggests increased cardiac stress and sarcomere insufficiency in the LMNA/Titin deletion A-band mice.
Conclusions:
In this study population, 2.3% of patients with DCM with one LP/P also have a second LP/P in a different gene. Although the second LP/P does not seem to influence the disease course of DCM in patients and mice, the finding of a second LP/P can be of importance to their relatives.
Collapse
Affiliation(s)
- Sophie L V M Stroeks
- Cardiovascular Research Institute Maastricht (CARIM); S.L.V.M.S., T.H.M.H., A.G.R., M.A.S., E.A.V.J., S.R.B.H., J.A.J.V.), Maastricht University, Maastricht, Netherlands
- KU Leuven, Cardiovascular Sciences, Belgium (S.L.V.M.S., E.A.V.J., S.R.B.H.)
| | - Ida G Lunde
- Genetics, Harvard Medical School, Boston, MA (I.G.L., H.W., J.G.)
- Diagnostics and Technology, Akershus University Hospital, Oslo, Norway (I.G.L.)
| | - Debby M E I Hellebrekers
- Clinical Genetics, Maastricht University Medical Center, the Netherlands (D.M.E.I.H., G.R.F.C., I.P.C.K., E.P.K., A.v.d.W., H.G.B., J.A.J.V.)
| | - Godelieve R F Claes
- Clinical Genetics, Maastricht University Medical Center, the Netherlands (D.M.E.I.H., G.R.F.C., I.P.C.K., E.P.K., A.v.d.W., H.G.B., J.A.J.V.)
| | - Hiroko Wakimoto
- Genetics, Harvard Medical School, Boston, MA (I.G.L., H.W., J.G.)
| | - Joshua Gorham
- Genetics, Harvard Medical School, Boston, MA (I.G.L., H.W., J.G.)
| | - Ingrid P C Krapels
- Clinical Genetics, Maastricht University Medical Center, the Netherlands (D.M.E.I.H., G.R.F.C., I.P.C.K., E.P.K., A.v.d.W., H.G.B., J.A.J.V.)
| | | | - Arthur van den Wijngaard
- Clinical Genetics, Maastricht University Medical Center, the Netherlands (D.M.E.I.H., G.R.F.C., I.P.C.K., E.P.K., A.v.d.W., H.G.B., J.A.J.V.)
| | | | - Anne G Raafs
- Cardiovascular Research Institute Maastricht (CARIM); S.L.V.M.S., T.H.M.H., A.G.R., M.A.S., E.A.V.J., S.R.B.H., J.A.J.V.), Maastricht University, Maastricht, Netherlands
| | - Maurits A Sikking
- Cardiovascular Research Institute Maastricht (CARIM); S.L.V.M.S., T.H.M.H., A.G.R., M.A.S., E.A.V.J., S.R.B.H., J.A.J.V.), Maastricht University, Maastricht, Netherlands
| | - Jos L V Broers
- Genetics and Cell Biology (J.L.V.B., M.N.), Maastricht University, Maastricht, Netherlands
| | - Miranda Nabben
- Genetics and Cell Biology (J.L.V.B., M.N.), Maastricht University, Maastricht, Netherlands
| | - Elizabeth A V Jones
- Cardiovascular Research Institute Maastricht (CARIM); S.L.V.M.S., T.H.M.H., A.G.R., M.A.S., E.A.V.J., S.R.B.H., J.A.J.V.), Maastricht University, Maastricht, Netherlands
- KU Leuven, Cardiovascular Sciences, Belgium (S.L.V.M.S., E.A.V.J., S.R.B.H.)
| | | | - Han G Brunner
- Clinical Genetics, Maastricht University Medical Center, the Netherlands (D.M.E.I.H., G.R.F.C., I.P.C.K., E.P.K., A.v.d.W., H.G.B., J.A.J.V.)
- Radboud University Medical Center, Human Genetics, Nijmegen, the Netherlands (H.G.B.)
| | - Job A J Verdonschot
- Cardiovascular Research Institute Maastricht (CARIM); S.L.V.M.S., T.H.M.H., A.G.R., M.A.S., E.A.V.J., S.R.B.H., J.A.J.V.), Maastricht University, Maastricht, Netherlands
- Clinical Genetics, Maastricht University Medical Center, the Netherlands (D.M.E.I.H., G.R.F.C., I.P.C.K., E.P.K., A.v.d.W., H.G.B., J.A.J.V.)
| |
Collapse
|
4
|
Verdonschot JAJ, Hazebroek MR, Krapels IPC, Henkens MTHM, Raafs A, Wang P, Merken JJ, Claes GRF, Vanhoutte EK, van den Wijngaard A, Heymans SRB, Brunner HG. Implications of Genetic Testing in Dilated Cardiomyopathy. Circ Genom Precis Med 2020; 13:476-487. [PMID: 32880476 DOI: 10.1161/circgen.120.003031] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Genetic analysis is a first-tier test in dilated cardiomyopathy (DCM). Electrical phenotypes are common in genetic DCM, but their exact contribution to the clinical course and outcome is unknown. We determined the prevalence of pathogenic gene variants in a large unselected DCM population and determined the role of electrical phenotypes in association with outcome. METHODS This study included 689 patients with DCM from the Maastricht Cardiomyopathy Registry, undergoing genetic evaluation using a 48 cardiomyopathy-associated gene-panel, echocardiography, endomyocardial biopsies, and Holter monitoring. Upon detection of a pathogenic variant in a patient with DCM, familial segregation was performed. Outcome was defined as cardiovascular death, heart transplantation, heart failure hospitalization, and/or occurrence of life-threatening arrhythmias. RESULTS A (likely) pathogenic gene variant was found in 19% of patients, varying from 36% in familial to 13% in nonfamilial DCM. Family segregation analysis showed familial disease in 46% of patients with DCM who were initially deemed nonfamilial by history. Overall, 18% of patients with a nongenetic risk factor had a pathogenic gene variant. Almost all pathogenic gene variants occurred in just 12 genes previously shown to have robust disease association with DCM. Genetic DCM was independently associated with electrical phenotypes such as atrial fibrillation, nonsustained ventricular tachycardia, and atrioventricular block and inversely correlated with the presence of a left bundle branch block (P<0.01). After a median follow-up of 4 years, event-free survival was reduced in genetic versus patients with nongenetic DCM (P=0.01). This effect on outcome was mediated by the associated electrical phenotypes of genetic DCM (P<0.001). CONCLUSIONS One in 5 patients with an established nongenetic risk factor or a nonfamilial disease still carries a pathogenic gene variant. Genetic DCM is characterized by a profile of electrical phenotypes (atrial fibrillation, nonsustained ventricular tachycardia, and atrioventricular block), which carries increased risk for adverse outcomes. Based on these findings, we envisage a broader role for genetic testing in DCM.
Collapse
Affiliation(s)
- Job A J Verdonschot
- Department of Cardiology (J.A.J.V., M.R.H., M.T.H.M.H., A.R., J.J.M., S.R.B.H.)
- Department of Clinical Genetics (J.A.J.V., I.P.C.K., P.W., G.R.F.C., E.K.V., A.v.d.W., H.G.B.)
| | - Mark R Hazebroek
- Department of Cardiology (J.A.J.V., M.R.H., M.T.H.M.H., A.R., J.J.M., S.R.B.H.)
| | - Ingrid P C Krapels
- Department of Clinical Genetics (J.A.J.V., I.P.C.K., P.W., G.R.F.C., E.K.V., A.v.d.W., H.G.B.)
| | | | - Anne Raafs
- Department of Cardiology (J.A.J.V., M.R.H., M.T.H.M.H., A.R., J.J.M., S.R.B.H.)
| | - Ping Wang
- Department of Clinical Genetics (J.A.J.V., I.P.C.K., P.W., G.R.F.C., E.K.V., A.v.d.W., H.G.B.)
| | - Jort J Merken
- Department of Cardiology (J.A.J.V., M.R.H., M.T.H.M.H., A.R., J.J.M., S.R.B.H.)
| | - Godelieve R F Claes
- Department of Clinical Genetics (J.A.J.V., I.P.C.K., P.W., G.R.F.C., E.K.V., A.v.d.W., H.G.B.)
| | - Els K Vanhoutte
- Department of Clinical Genetics (J.A.J.V., I.P.C.K., P.W., G.R.F.C., E.K.V., A.v.d.W., H.G.B.)
| | | | - Stephane R B Heymans
- Department of Cardiology (J.A.J.V., M.R.H., M.T.H.M.H., A.R., J.J.M., S.R.B.H.)
- Department of Cardiovascular Research, University of Leuven, Belgium (S.R.B.H.)
- Netherlands Heart Institute (ICIN), Utrecht (S.R.B.H.)
| | - Han G Brunner
- Department of Clinical Genetics (J.A.J.V., I.P.C.K., P.W., G.R.F.C., E.K.V., A.v.d.W., H.G.B.)
- GROW Institute for Developmental Biology and Cancer, Maastricht University Medical Center (H.G.B.)
- Department of Human Genetics and Donders Center for Neuroscience, Radboudumc Nijmegen, the Netherlands (H.G.B.)
| |
Collapse
|
5
|
Verdonschot JAJ, Vanhoutte EK, Claes GRF, Helderman-van den Enden ATJM, Hoeijmakers JGJ, Hellebrekers DMEI, de Haan A, Christiaans I, Lekanne Deprez RH, Boen HM, van Craenenbroeck EM, Loeys BL, Hoedemaekers YM, Marcelis C, Kempers M, Brusse E, van Waning JI, Baas AF, Dooijes D, Asselbergs FW, Barge-Schaapveld DQCM, Koopman P, van den Wijngaard A, Heymans SRB, Krapels IPC, Brunner HG. A mutation update for the FLNC gene in myopathies and cardiomyopathies. Hum Mutat 2020; 41:1091-1111. [PMID: 32112656 PMCID: PMC7318287 DOI: 10.1002/humu.24004] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/12/2020] [Accepted: 02/25/2020] [Indexed: 12/11/2022]
Abstract
Filamin C (FLNC) variants are associated with cardiac and muscular phenotypes. Originally, FLNC variants were described in myofibrillar myopathy (MFM) patients. Later, high‐throughput screening in cardiomyopathy cohorts determined a prominent role for FLNC in isolated hypertrophic and dilated cardiomyopathies (HCM and DCM). FLNC variants are now among the more prevalent causes of genetic DCM. FLNC‐associated DCM is associated with a malignant clinical course and a high risk of sudden cardiac death. The clinical spectrum of FLNC suggests different pathomechanisms related to variant types and their location in the gene. The appropriate functioning of FLNC is crucial for structural integrity and cell signaling of the sarcomere. The secondary protein structure of FLNC is critical to ensure this function. Truncating variants with subsequent haploinsufficiency are associated with DCM and cardiac arrhythmias. Interference with the dimerization and folding of the protein leads to aggregate formation detrimental for muscle function, as found in HCM and MFM. Variants associated with HCM are predominantly missense variants, which cluster in the ROD2 domain. This domain is important for binding to the sarcomere and to ensure appropriate cell signaling. We here review FLNC genotype–phenotype correlations based on available evidence.
Collapse
Affiliation(s)
- Job A J Verdonschot
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Cardiovascular Research Institute (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Els K Vanhoutte
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Godelieve R F Claes
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | - Debby M E I Hellebrekers
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Amber de Haan
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Imke Christiaans
- Department of Clinical Genetics, Amsterdam University Medical Center, Amsterdam, The Netherlands.,Department of Clinical Genetics, University Medical Centre Groningen, Groningen, The Netherlands
| | - Ronald H Lekanne Deprez
- Department of Clinical Genetics, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Hanne M Boen
- Department of Cardiology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | | | - Bart L Loeys
- Department of Medical Genetics, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Yvonne M Hoedemaekers
- Department of Clinical Genetics, University Medical Centre Groningen, Groningen, The Netherlands.,Department of Clinical Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Carlo Marcelis
- Department of Clinical Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Marlies Kempers
- Department of Clinical Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Esther Brusse
- Department of Neurology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Jaap I van Waning
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Annette F Baas
- Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dennis Dooijes
- Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Arthur van den Wijngaard
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Stephane R B Heymans
- Department of Cardiology, Cardiovascular Research Institute (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium.,The Netherlands Heart Institute, Utrecht, The Netherlands
| | - Ingrid P C Krapels
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Han G Brunner
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Clinical Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Genetics and Cell Biology, GROW Institute for Developmental Biology and Cancer, Maastricht University Medical Centre, Maastricht, The Netherlands
| |
Collapse
|
6
|
Verdonschot JAJ, Robinson EL, James KN, Mohamed MW, Claes GRF, Casas K, Vanhoutte EK, Hazebroek MR, Kringlen G, Pasierb MM, van den Wijngaard A, Glatz JFC, Heymans SRB, Krapels IPC, Nahas S, Brunner HG, Szklarczyk R. Mutations in PDLIM5 are rare in dilated cardiomyopathy but are emerging as potential disease modifiers. Mol Genet Genomic Med 2019; 8:e1049. [PMID: 31880413 PMCID: PMC7005607 DOI: 10.1002/mgg3.1049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/23/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND A causal genetic mutation is found in 40% of families with dilated cardiomyopathy (DCM), leaving a large percentage of families genetically unsolved. This prevents adequate counseling and clear recommendations in these families. We aim to identify novel genes or modifiers associated with DCM. METHODS We performed computational ranking of human genes based on coexpression with a predefined set of genes known to be associated with DCM, which allowed us to prioritize gene candidates for their likelihood of being involved in DCM. Top candidates will be checked for variants in the available whole-exome sequencing data of 142 DCM patients. RNA was isolated from cardiac biopsies to investigate gene expression. RESULTS PDLIM5 was classified as the top candidate. An interesting heterozygous variant (189_190delinsGG) was found in a DCM patient with a known pathogenic truncating TTN-variant. The PDLIM5 loss-of-function (LoF) variant affected all cardiac-specific isoforms of PDLIM5 and no LoF variants were detected in the same region in a control cohort of 26,000 individuals. RNA expression of PDLIM5 and its direct interactors (MYOT, LDB3, and MYOZ2) was increased in cardiac tissue of this patient, indicating a possible compensatory mechanism. The PDLIM5 variant cosegregated with the TTN-variant and the phenotype, leading to a high disease penetrance in this family. A second patient was an infant with a homozygous 10 kb-deletion of exon 2 in PDLIM5 resulting in early-onset cardiac disease, showing the importance of PDLIM5 in cardiac function. CONCLUSIONS Heterozygous PDLIM5 variants are rare and therefore will not have a major contribution in DCM. Although they likely play a role in disease development as this gene plays a major role in contracting cardiomyocytes and homozygous variants lead to early-onset cardiac disease. Other environmental and/or genetic factors are probably necessary to unveil the cardiac phenotype in PDLIM5 mutation carriers.
Collapse
Affiliation(s)
- Job A J Verdonschot
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Emma L Robinson
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Kiely N James
- Rady Children's Institute for Genomic Medicine, San Diego, CA, USA
| | - Mohamed W Mohamed
- Sanford Children's Hospital, Fargo, ND, USA.,North Dakota University, Fargo, ND, USA
| | - Godelieve R F Claes
- Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Kari Casas
- Sanford Children's Hospital, Fargo, ND, USA.,North Dakota University, Fargo, ND, USA
| | - Els K Vanhoutte
- Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Mark R Hazebroek
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | | | - Arthur van den Wijngaard
- Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jan F C Glatz
- Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Stephane R B Heymans
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Cardiovascular Research, University of Leuven, Leuven, Belgium.,Netherlands Heart Institute (ICIN), Utrecht, The Netherlands
| | - Ingrid P C Krapels
- Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Shareef Nahas
- Rady Children's Institute for Genomic Medicine, San Diego, CA, USA
| | - Han G Brunner
- Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Human Genetics, Donders Center for Neuroscience, Radboudumc, Nijmegen, The Netherlands.,GROW Institute for Developmental Biology and Cancer, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Radek Szklarczyk
- Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
| |
Collapse
|
7
|
Claes GRF, van Tienen FHJ, Lindsey P, Krapels IPC, Helderman-van den Enden ATJM, Hoos MB, Barrois YEG, Janssen JWH, Paulussen ADC, Sels JWEM, Kuijpers SHH, van Tintelen JP, van den Berg MP, Heesen WF, Garcia-Pavia P, Perrot A, Christiaans I, Salemink S, Marcelis CLM, Smeets HJM, Brunner HG, Volders PGA, van den Wijngaard A. Hypertrophic remodelling in cardiac regulatory myosin light chain (MYL2) founder mutation carriers. Eur Heart J 2015; 37:1815-22. [PMID: 26497160 DOI: 10.1093/eurheartj/ehv522] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [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: 04/01/2015] [Accepted: 09/16/2015] [Indexed: 01/25/2023] Open
Abstract
AIMS Phenotypic heterogeneity and incomplete penetrance are common in patients with hypertrophic cardiomyopathy (HCM). We aim to improve the understanding in genotype-phenotype correlations in HCM, particularly the contribution of an MYL2 founder mutation and risk factors to left ventricular hypertrophic remodelling. METHODS AND RESULTS We analysed 14 HCM families of whom 38 family members share the MYL2 c.64G > A [p.(Glu22Lys)] mutation and a common founder haplotype. In this unique cohort, we investigated factors influencing phenotypic outcome in addition to the primary mutation. The mutation alone showed benign disease manifestation with low penetrance. The co-presence of additional risk factors for hypertrophy such as hypertension, obesity, or other sarcomeric gene mutation increased disease penetrance substantially and caused HCM in 89% of MYL2 mutation carriers (P = 0.0005). The most prominent risk factor was hypertension, observed in 71% of mutation carriers with HCM and an additional risk factor. CONCLUSION The MYL2 mutation c.64G > A on its own is incapable of triggering clinical HCM in most carriers. However, the presence of an additional risk factor for hypertrophy, particularly hypertension, adds to the development of HCM. Early diagnosis of risk factors is important for early treatment of MYL2 mutation carriers and close monitoring should be guaranteed in this case. Our findings also suggest that the presence of hypertension or another risk factor for hypertrophy should not be an exclusion criterion for genetic studies.
Collapse
Affiliation(s)
- Godelieve R F Claes
- Department of Clinical Genetics, Unit Clinical Genomics, Maastricht University Medical Centre, P.O. Box 5800, 6229 GR Maastricht, The Netherlands School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Florence H J van Tienen
- Department of Clinical Genetics, Unit Clinical Genomics, Maastricht University Medical Centre, P.O. Box 5800, 6229 GR Maastricht, The Netherlands School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Patrick Lindsey
- Department of Clinical Genetics, Unit Clinical Genomics, Maastricht University Medical Centre, P.O. Box 5800, 6229 GR Maastricht, The Netherlands School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ingrid P C Krapels
- Department of Clinical Genetics, Unit Clinical Genomics, Maastricht University Medical Centre, P.O. Box 5800, 6229 GR Maastricht, The Netherlands School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Apollonia T J M Helderman-van den Enden
- Department of Clinical Genetics, Unit Clinical Genomics, Maastricht University Medical Centre, P.O. Box 5800, 6229 GR Maastricht, The Netherlands School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marije B Hoos
- Department of Clinical Genetics, Unit Clinical Genomics, Maastricht University Medical Centre, P.O. Box 5800, 6229 GR Maastricht, The Netherlands School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Yvette E G Barrois
- Department of Clinical Genetics, Unit Clinical Genomics, Maastricht University Medical Centre, P.O. Box 5800, 6229 GR Maastricht, The Netherlands School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Johanna W H Janssen
- Department of Clinical Genetics, Unit Clinical Genomics, Maastricht University Medical Centre, P.O. Box 5800, 6229 GR Maastricht, The Netherlands
| | - Aimée D C Paulussen
- Department of Clinical Genetics, Unit Clinical Genomics, Maastricht University Medical Centre, P.O. Box 5800, 6229 GR Maastricht, The Netherlands School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jan-Willem E M Sels
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands Department of Intensive Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - J Peter van Tintelen
- Department of Clinical Genetics, Academic Medical Centre, Amsterdam, The Netherlands
| | - Maarten P van den Berg
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Wilfred F Heesen
- Department of Cardiology, VieCuri Medical Centre, Venlo, The Netherlands
| | - Pablo Garcia-Pavia
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Andreas Perrot
- Charité-Universitätsmedizin Berlin, Experimental & Clinical Research Centre, A Joint Cooperation Between the Charité Medical Faculty and the Max-Delbrück Centre for Molecular Medicine, Berlin, Germany
| | - Imke Christiaans
- Department of Clinical Genetics, Academic Medical Centre, Amsterdam, The Netherlands
| | - Simone Salemink
- Department of Human Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Carlo L M Marcelis
- Department of Human Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Hubert J M Smeets
- Department of Clinical Genetics, Unit Clinical Genomics, Maastricht University Medical Centre, P.O. Box 5800, 6229 GR Maastricht, The Netherlands
| | - Han G Brunner
- Department of Clinical Genetics, Unit Clinical Genomics, Maastricht University Medical Centre, P.O. Box 5800, 6229 GR Maastricht, The Netherlands Department of Human Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Paul G A Volders
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Arthur van den Wijngaard
- Department of Clinical Genetics, Unit Clinical Genomics, Maastricht University Medical Centre, P.O. Box 5800, 6229 GR Maastricht, The Netherlands School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands
| |
Collapse
|