1
|
Albertini L, Ezekian J, Care M, Silversides C, Sermer M, Gollob MH, Spears D. Assessment of Severity of Long QT Syndrome Phenotype and Risk of Fetal Death. J Am Heart Assoc 2023; 12:e029407. [PMID: 38014677 PMCID: PMC10727344 DOI: 10.1161/jaha.122.029407] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND It has been postulated that long QT syndrome (LQTS) can cause fetal loss through putative adverse effects of the channelopathy on placenta and myometrial function. The authors aimed to describe the fetal death rate in a population of pregnant women with long QT syndrome and investigate whether women with more severe phenotype had worse fetal outcomes. METHODS AND RESULTS The authors retrospectively evaluated fetal outcomes of 64 pregnancies from 23 women with long QT syndrome followed during pregnancy in a tertiary pregnancy and heart disease program. Thirteen of 64 pregnancies (20%) resulted in a fetal loss, 12 miscarriages (19%), and 1 stillbirth (1.6%). Baseline maternal characteristics, including age and use of β-blockers, did not differ between women who experienced a fetal death or not. Maternal corrected QT interval (QTc) was significantly longer in pregnancies that resulted in fetal death compared with live births (median, 518 ms [interquartile range (IQR), 482-519 ms] versus 479 ms [IQR, 454-496 ms], P<0.001). Mothers treated with β-blockers had babies born at term with lower birth weight compared with untreated women (2973±298 g versus 3470±338 g, P=0.002). In addition, the birth weight of babies born at term to treated women with QTc >500 ms was significantly lower compared with women with QTc <500 ms (2783±283 g versus 3084±256 g, P=0.029). CONCLUSIONS Women with long QT syndrome with more severe phenotypes have a higher incidence of fetal death. Maternal QTc is longer in pregnancies that result in fetal loss, and the birth weight of babies born to patients taking β-blockers with a QTc >500 ms is lower, suggesting that patients with more marked phenotype may experience worse fetal outcomes.
Collapse
Affiliation(s)
- Lisa Albertini
- Division of Cardiology, Electrophysiology, Toronto General HospitalUniversity Health Network TorontoTorontoOntarioCanada
| | - Jordan Ezekian
- Division of CardiologyThe Hospital for Sick ChildrenTorontoOntarioCanada
| | - Melanie Care
- Division of Cardiology, Electrophysiology, Toronto General HospitalUniversity Health Network TorontoTorontoOntarioCanada
| | - Candice Silversides
- Department of Medicine, Division of CardiologyUniversity of Toronto Pregnancy and Heart Disease Program and Obstetric Medicine Program, Mount Sinai and Toronto General HospitalsTorontoOntarioCanada
| | - Mathew Sermer
- Department of Obstetrics and GynaecologyMount Sinai HospitalTorontoOntarioCanada
| | - Michael H. Gollob
- Division of Cardiology, Electrophysiology, Toronto General HospitalUniversity Health Network TorontoTorontoOntarioCanada
| | - Danna Spears
- Division of Cardiology, Electrophysiology, Toronto General HospitalUniversity Health Network TorontoTorontoOntarioCanada
| |
Collapse
|
2
|
Matos J, Helle E, Care M, Moayedi Y, Gollob MH, Thavendiranathan P, Spears D, Hanneman K. Cardiac MRI and Clinical Outcomes in TMEM43 Arrhythmogenic Cardiomyopathy. Radiol Cardiothorac Imaging 2023; 5:e230155. [PMID: 38166344 DOI: 10.1148/ryct.230155] [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] [Indexed: 01/04/2024]
Abstract
Arrhythmogenic cardiomyopathy is an inherited cardiomyopathy that can involve both ventricles. Several genes have been identified as pathogenic in arrhythmogenic cardiomyopathy, including TMEM43. However, there are limited data on cardiac MRI findings in patients with TMEM43 variants to date. In this case series, cardiac MRI findings and clinical outcomes are described in 14 patients with TMEM43 variants, including eight (57%) with the pathogenic p.Ser358Leu variant (six female patients; mean age, 33 years ± 15 [SD]) and six (43%) with a TMEM43 variant of unknown significance (three female patients; mean age, 38 years ± 11). MRI findings demonstrated left ventricular systolic dysfunction in eight (57%) patients and right ventricular dysfunction in four (29%) patients. Among the nine patients with late gadolinium enhancement imaging, left ventricular late gadolinium enhancement was present in seven (78%; all subepicardial) patients. In summary, TMEM43 variants are associated with high prevalence of subepicardial late gadolinium enhancement and left ventricular dysfunction. Keywords: Arrhythmogenic Cardiomyopathy, Arrhythmogenic Right Ventricular Cardiomyopathy, TMEM43, Cardiac MRI, Genetic Variants Supplemental material is available for this article.
Collapse
Affiliation(s)
- João Matos
- From the Department of Medical Imaging (J.M., P.T., K.H.) and Division of Cardiology (E.H., M.C., Y.M., M.H.G., P.T., D.S.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada (E.H.); Stem Cells and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland (E.H.); Department of Molecular Genetics, University of Toronto, Toronto, Canada (M.C.); and Toronto General Hospital Research Institute, University Health Network (UHN), University of Toronto, Toronto, Canada (M.H.G., P.T., K.H.)
| | - Emmi Helle
- From the Department of Medical Imaging (J.M., P.T., K.H.) and Division of Cardiology (E.H., M.C., Y.M., M.H.G., P.T., D.S.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada (E.H.); Stem Cells and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland (E.H.); Department of Molecular Genetics, University of Toronto, Toronto, Canada (M.C.); and Toronto General Hospital Research Institute, University Health Network (UHN), University of Toronto, Toronto, Canada (M.H.G., P.T., K.H.)
| | - Melanie Care
- From the Department of Medical Imaging (J.M., P.T., K.H.) and Division of Cardiology (E.H., M.C., Y.M., M.H.G., P.T., D.S.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada (E.H.); Stem Cells and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland (E.H.); Department of Molecular Genetics, University of Toronto, Toronto, Canada (M.C.); and Toronto General Hospital Research Institute, University Health Network (UHN), University of Toronto, Toronto, Canada (M.H.G., P.T., K.H.)
| | - Yasbanoo Moayedi
- From the Department of Medical Imaging (J.M., P.T., K.H.) and Division of Cardiology (E.H., M.C., Y.M., M.H.G., P.T., D.S.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada (E.H.); Stem Cells and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland (E.H.); Department of Molecular Genetics, University of Toronto, Toronto, Canada (M.C.); and Toronto General Hospital Research Institute, University Health Network (UHN), University of Toronto, Toronto, Canada (M.H.G., P.T., K.H.)
| | - Michael H Gollob
- From the Department of Medical Imaging (J.M., P.T., K.H.) and Division of Cardiology (E.H., M.C., Y.M., M.H.G., P.T., D.S.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada (E.H.); Stem Cells and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland (E.H.); Department of Molecular Genetics, University of Toronto, Toronto, Canada (M.C.); and Toronto General Hospital Research Institute, University Health Network (UHN), University of Toronto, Toronto, Canada (M.H.G., P.T., K.H.)
| | - Paaladinesh Thavendiranathan
- From the Department of Medical Imaging (J.M., P.T., K.H.) and Division of Cardiology (E.H., M.C., Y.M., M.H.G., P.T., D.S.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada (E.H.); Stem Cells and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland (E.H.); Department of Molecular Genetics, University of Toronto, Toronto, Canada (M.C.); and Toronto General Hospital Research Institute, University Health Network (UHN), University of Toronto, Toronto, Canada (M.H.G., P.T., K.H.)
| | - Danna Spears
- From the Department of Medical Imaging (J.M., P.T., K.H.) and Division of Cardiology (E.H., M.C., Y.M., M.H.G., P.T., D.S.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada (E.H.); Stem Cells and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland (E.H.); Department of Molecular Genetics, University of Toronto, Toronto, Canada (M.C.); and Toronto General Hospital Research Institute, University Health Network (UHN), University of Toronto, Toronto, Canada (M.H.G., P.T., K.H.)
| | - Kate Hanneman
- From the Department of Medical Imaging (J.M., P.T., K.H.) and Division of Cardiology (E.H., M.C., Y.M., M.H.G., P.T., D.S.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network (UHN), University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada (E.H.); Stem Cells and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland (E.H.); Department of Molecular Genetics, University of Toronto, Toronto, Canada (M.C.); and Toronto General Hospital Research Institute, University Health Network (UHN), University of Toronto, Toronto, Canada (M.H.G., P.T., K.H.)
| |
Collapse
|
3
|
Novelli V, Faultless T, Cerrone M, Care M, Manzoni M, Bober SL, Adler A, De-Giorgio F, Spears D, Gollob MH. Enhancing the interpretation of genetic observations in KCNQ1 in unselected populations: relevance to secondary findings. Europace 2023; 25:euad317. [PMID: 37897496 PMCID: PMC10637310 DOI: 10.1093/europace/euad317] [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: 06/27/2023] [Accepted: 10/11/2023] [Indexed: 10/30/2023] Open
Abstract
AIMS Rare variants in the KCNQ1 gene are found in the healthy population to a much greater extent than the prevalence of Long QT Syndrome type 1 (LQTS1). This observation creates challenges in the interpretation of KCNQ1 rare variants that may be identified as secondary findings in whole exome sequencing.This study sought to identify missense variants within sub-domains of the KCNQ1-encoded Kv7.1 potassium channel that would be highly predictive of disease in the context of secondary findings. METHODS AND RESULTS We established a set of KCNQ1 variants reported in over 3700 patients with diagnosed or suspected LQTS sent for clinical genetic testing and compared the domain-specific location of identified variants to those observed in an unselected population of 140 000 individuals. We identified three regions that showed a significant enrichment of KCNQ1 variants associated with LQTS at an odds ratio (OR) >2: the pore region, and the adjacent 5th (S5) and 6th (S6) transmembrane (TM) regions. An additional segment within the carboxyl terminus of Kv7.1, conserved region 2 (CR2), also showed an increased OR of disease association. Furthermore, the TM spanning S5-Pore-S6 region correlated with a significant increase in cardiac events. CONCLUSION Rare missense variants with a clear phenotype of LQTS have a high likelihood to be present within the pore and adjacent TM segments (S5-Pore-S6) and a greater tendency to be present within CR2. This data will enhance interpretation of secondary findings within the KCNQ1 gene. Further, our data support a more severe phenotype in LQTS patients with variants within the S5-Pore-S6 region.
Collapse
Affiliation(s)
- Valeria Novelli
- Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, Milano, 20138, Italy
| | - Trent Faultless
- Toronto General Hospital Research Institute, University of Toronto, Toronto, Canada
| | - Marina Cerrone
- Inherited Arrhythmia Clinic and Heart Rhythm Center, ‘Leon Charney’ Division of Cardiology NYU Grossman School of Medicine, NewYork, NY, USA
| | - Melanie Care
- Inherited Arrhythmia and Cardiomyopathy Program, Division of Cardiology, University of Toronto, 200 Elizabeth St.Rm 3GW-360, Toronto M5G 2C4, Ontario, Canada
| | - Martina Manzoni
- Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, Milano, 20138, Italy
| | - Sara L Bober
- Toronto General Hospital Research Institute, University of Toronto, Toronto, Canada
| | - Arnon Adler
- Toronto General Hospital Research Institute, University of Toronto, Toronto, Canada
| | - Fabio De-Giorgio
- Department of Health Care Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A.Gemelli IRCCS,Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Danna Spears
- Inherited Arrhythmia and Cardiomyopathy Program, Division of Cardiology, University of Toronto, 200 Elizabeth St.Rm 3GW-360, Toronto M5G 2C4, Ontario, Canada
| | - Michael H Gollob
- Toronto General Hospital Research Institute, University of Toronto, Toronto, Canada
- Inherited Arrhythmia and Cardiomyopathy Program, Division of Cardiology, University of Toronto, 200 Elizabeth St.Rm 3GW-360, Toronto M5G 2C4, Ontario, Canada
- Department of Physiology, University of Toronto, Toronto, Canada
| |
Collapse
|
4
|
Josephs KS, Roberts AM, Theotokis P, Walsh R, Ostrowski PJ, Edwards M, Fleming A, Thaxton C, Roberts JD, Care M, Zareba W, Adler A, Sturm AC, Tadros R, Novelli V, Owens E, Bronicki L, Jarinova O, Callewaert B, Peters S, Lumbers T, Jordan E, Asatryan B, Krishnan N, Hershberger RE, Chahal CAA, Landstrom AP, James C, McNally EM, Judge DP, van Tintelen P, Wilde A, Gollob M, Ingles J, Ware JS. Beyond gene-disease validity: capturing structured data on inheritance, allelic requirement, disease-relevant variant classes, and disease mechanism for inherited cardiac conditions. Genome Med 2023; 15:86. [PMID: 37872640 PMCID: PMC10594882 DOI: 10.1186/s13073-023-01246-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND As the availability of genomic testing grows, variant interpretation will increasingly be performed by genomic generalists, rather than domain-specific experts. Demand is rising for laboratories to accurately classify variants in inherited cardiac condition (ICC) genes, including secondary findings. METHODS We analyse evidence for inheritance patterns, allelic requirement, disease mechanism and disease-relevant variant classes for 65 ClinGen-curated ICC gene-disease pairs. We present this information for the first time in a structured dataset, CardiacG2P, and assess application in genomic variant filtering. RESULTS For 36/65 gene-disease pairs, loss of function is not an established disease mechanism, and protein truncating variants are not known to be pathogenic. Using the CardiacG2P dataset as an initial variant filter allows for efficient variant prioritisation whilst maintaining a high sensitivity for retaining pathogenic variants compared with two other variant filtering approaches. CONCLUSIONS Access to evidence-based structured data representing disease mechanism and allelic requirement aids variant filtering and analysis and is a pre-requisite for scalable genomic testing.
Collapse
Affiliation(s)
- Katherine S Josephs
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London, W12 0NN, UK
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Angharad M Roberts
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London, W12 0NN, UK
- Great Ormond Street Hospital, NHS Foundation Trust, London, UK
| | - Pantazis Theotokis
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Roddy Walsh
- Amsterdam University Medical Centre, University of Amsterdam, Heart Center, Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | | | - Matthew Edwards
- Clinical Genetics & Genomics Lab, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Andrew Fleming
- Clinical Genetics & Genomics Lab, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Courtney Thaxton
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jason D Roberts
- Population Health Research Institute, McMaster University, and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Melanie Care
- Department of Molecular Genetics, University of Toronto, Toronto, Canada
- Division of Cardiology, Toronto General Hospital, Toronto, Canada
| | - Wojciech Zareba
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, NY, USA
| | - Arnon Adler
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, and Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Valeria Novelli
- Unit of Immunology and Functional Genomics, Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Emma Owens
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lucas Bronicki
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Genetics, CHEO, Ottawa, Ontario, Canada
| | - Olga Jarinova
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Genetics, CHEO, Ottawa, Ontario, Canada
| | - Bert Callewaert
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Stacey Peters
- Department of Cardiology and Genomic Medicine, Royal Melbourne Hospital, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Tom Lumbers
- Barts Health & University College London Hospitals NHS Trusts, London, UK
- Institute of Health Informatics, University College London, London, UK
| | - Elizabeth Jordan
- Divisions of Human Genetics and Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Babken Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Neesha Krishnan
- Centre for Population Genomics, Garvan Institute of Medical Research, and UNSW Sydney, Sydney, Australia
| | - Ray E Hershberger
- Divisions of Human Genetics and Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - C Anwar A Chahal
- Center for Inherited Cardiovascular Diseases, WellSpan Health, Lancaster, PA, USA
- Cardiac Electrophysiology and Inherited Cardiovascular Diseases, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Andrew P Landstrom
- Department of Pediatrics and Cell Biology, Duke University School of Medicine, Durham, NC, USA
| | - Cynthia James
- Johns Hopkins Center for Inherited Heart Diseases, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Elizabeth M McNally
- Center for Genetic Medicine, Dept of Medicine (Cardiology), Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Daniel P Judge
- Medical University of South Carolina, Charleston, SC, USA
| | - Peter van Tintelen
- Department of Genetics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Arthur Wilde
- Department of Cardiology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Michael Gollob
- Inherited Arrhythmia and Cardiomyopathy Program, Division of Cardiology, University of Toronto, Toronto, ON, Canada
| | - Jodie Ingles
- Centre for Population Genomics, Garvan Institute of Medical Research, and UNSW Sydney, Sydney, Australia
| | - James S Ware
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London, W12 0NN, UK.
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK.
- MRC London Institute of Medical Sciences, Imperial College London, London, UK.
| |
Collapse
|
5
|
Di Florio M, Care M, Beaubois R, Cota VR, Barban F, Levi T, Chiappalone M. Design of an experimental setup for delivering intracortical microstimulation in vivo via Spiking Neural Network. Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-4. [PMID: 38083051 DOI: 10.1109/embc40787.2023.10340907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Electroceutical approaches for the treatment of neurological disorders, such as stroke, can take advantage of neuromorphic engineering, to develop devices able to achieve a seamless interaction with the neural system. This paper illustrates the development and test of a hardware-based Spiking Neural Network (SNN) to deliver neural-like stimulation patterns in an open-loop fashion. Neurons in the SNN have been designed by following the Hodgkin-Huxley formalism, with parameters taken from neuroscientific literature. We then built the set-up to deliver the SNN-driven stimulation in vivo. We used deeply anesthetized healthy rats to test the potential effect of the SNN-driven stimulation. We analyzed the neuronal firing activity pre- and post-stimulation in both the primary somatosensory and the rostral forelimb area. Our results showed that the SNN-based neurostimulation was able increase the spontaneous level of neuronal firing at both monitored locations, as found in the literature only for closed-loop stimulation. This study represents the first step towards translating the use of neuromorphic-based devices into clinical applications.Clinical Relevance- Stroke represents one of the leading causes of long-term disability and death worldwide. Intracortical microstimulation is an effective approach for restoring lost sensory motor integration by promoting plasticity among the affected brain areas. Stimulation delivered via neuromorphic-based open-loop systems (i.e. neuromorphic prostheses) can pave the way to novel electroceutical strategies for brain repair.
Collapse
|
6
|
Tierens A, Kagotho E, Shinriki S, Seto A, Smith AC, Care M, Maze D, Sibai H, Yee KW, Schuh AC, Kim DDH, Gupta V, Minden MD, Matsui H, Capo-Chichi JM. Biallelic disruption of DDX41 activity is associated with distinct genomic and immunophenotypic hallmarks in acute leukemia. Front Oncol 2023; 13:1153082. [PMID: 37434984 PMCID: PMC10331015 DOI: 10.3389/fonc.2023.1153082] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 01/28/2023] [Accepted: 03/20/2023] [Indexed: 07/13/2023] Open
Abstract
Introduction Inherited DDX41 mutations cause familial predisposition to hematologic malignancies including acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS), with the majority of DDX41 mutated MDS/AMLs described to date harboring germline DDX41 and co-occurring somatic DDX41 variants. DDX41-AMLs were shown to share distinguishing clinical features such as a late AML onset and an indolent disease associated with a favorable outcome. However, genotype-phenotype correlation in DDX41-MDS/AMLs remain poorly understood. Methods Here, we studied the genetic profile, bone marrow morphology and immunophenotype of 51 patients with DDX41 mutations. We further assessed the functional impact of ten previously uncharacterized DDX41 variants of uncertain significance. Results Our results demonstrate that MDS/AML cases harboring two DDX41 variants share specific clinicopathologic hallmarks that are not seen in other patients with monoallelic DDX41 related hematologic malignancies. We further showed that the features seen in these individuals with two DDX41 variants were concordant with biallelic DDX41 disruption. Discussion Here, we expand on previous clinicopathologic findings on DDX41 mutated hematologic malignancies. Functional analyses conducted in this study unraveled previously uncharacterized DDX41 alleles and further illustrate the implication of biallelic disruption in the pathophysiology of this distinct AML entity.
Collapse
Affiliation(s)
- Anne Tierens
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Elizabeth Kagotho
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Nairobi, Kenya
| | - Satoru Shinriki
- Department of Molecular Laboratory Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Andrew Seto
- Division of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Adam C. Smith
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Division of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Melanie Care
- Division of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Dawn Maze
- Department of Medicine Medical Oncology and Hematology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Hassan Sibai
- Department of Medicine Medical Oncology and Hematology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Karen W. Yee
- Department of Medicine Medical Oncology and Hematology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Andre C. Schuh
- Department of Medicine Medical Oncology and Hematology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Dennis Dong Hwan Kim
- Department of Medicine Medical Oncology and Hematology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Vikas Gupta
- Department of Medicine Medical Oncology and Hematology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Mark D. Minden
- Department of Medicine Medical Oncology and Hematology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Hirotaka Matsui
- Department of Molecular Laboratory Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - José-Mario Capo-Chichi
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Division of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| |
Collapse
|
7
|
Josephs KS, Roberts AM, Theotokis P, Walsh R, Ostrowski PJ, Edwards M, Fleming A, Thaxton C, Roberts JD, Care M, Zareba W, Adler A, Sturm AC, Tadros R, Novelli V, Owens E, Bronicki L, Jarinova O, Callewaert B, Peters S, Lumbers T, Jordan E, Asatryan B, Krishnan N, Hershberger RE, Chahal CAA, Landstrom AP, James C, McNally EM, Judge DP, van Tintelen P, Wilde A, Gollob M, Ingles J, Ware JS. Beyond gene-disease validity: capturing structured data on inheritance, allelic-requirement, disease-relevant variant classes, and disease mechanism for inherited cardiac conditions. medRxiv 2023:2023.04.03.23287612. [PMID: 37066275 PMCID: PMC10104233 DOI: 10.1101/2023.04.03.23287612] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Background As availability of genomic testing grows, variant interpretation will increasingly be performed by genomic generalists, rather than domain-specific experts. Demand is rising for laboratories to accurately classify variants in inherited cardiac condition (ICC) genes, including as secondary findings. Methods We analyse evidence for inheritance patterns, allelic requirement, disease mechanism and disease-relevant variant classes for 65 ClinGen-curated ICC gene-disease pairs. We present this information for the first time in a structured dataset, CardiacG2P, and assess application in genomic variant filtering. Results For 36/65 gene-disease pairs, loss-of-function is not an established disease mechanism, and protein truncating variants are not known to be pathogenic. Using CardiacG2P as an initial variant filter allows for efficient variant prioritisation whilst maintaining a high sensitivity for retaining pathogenic variants compared with two other variant filtering approaches. Conclusions Access to evidence-based structured data representing disease mechanism and allelic requirement aids variant filtering and analysis and is pre-requisite for scalable genomic testing.
Collapse
Affiliation(s)
- Katherine S Josephs
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London UK
| | - Angharad M Roberts
- National Heart and Lung Institute, Imperial College London, London, UK
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | | | - Roddy Walsh
- Amsterdam University Medical Centre, University of Amsterdam, Heart Center, Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | | | - Matthew Edwards
- Clinical Genetics & Genomics Lab, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London UK
| | - Andrew Fleming
- Clinical Genetics & Genomics Lab, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London UK
| | - Courtney Thaxton
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jason D Roberts
- Population Health Research Institute, McMaster University, and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Melanie Care
- Department of Molecular Genetics, University of Toronto, Toronto, Canada
- Division of Cardiology, Toronto General Hospital, Toronto, Canada
| | - Wojciech Zareba
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA
| | - Arnon Adler
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network and Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Amy C Sturm
- 23andMe, Sunnyvale, California, Genomic Health
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, and Faculty of Medicine, Université de Montréal
| | - Valeria Novelli
- Unit of Immunology and Functional Genomics, Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Emma Owens
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lucas Bronicki
- CHEO Research Institute, University of Ottawa, Ontario, Canada
| | - Olga Jarinova
- CHEO Research Institute, University of Ottawa, Ontario, Canada
- Department of Genetics, CHEO, Ontario, Canada
| | - Bert Callewaert
- Center for Medical Genetics, Ghent University Hospital
- Department of Biomolecular Medicine, Ghent University
| | - Stacey Peters
- Department of Cardiology and Genomic Medicine, Royal Melbourne Hospital, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Tom Lumbers
- Barts Health & University College London Hospitals NHS Trusts, London, UK
- Institute of Health Informatics, University College London, London, UK
| | - Elizabeth Jordan
- Division of Human Genetics, The Ohio State University, Columbus, Ohio USA
| | - Babken Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Neesha Krishnan
- Centre for Population Genomics, Garvan Institute of Medical Research, and UNSW Sydney, Sydney, Australia
| | - Ray E Hershberger
- Division of Human Genetics, The Ohio State University, Columbus, Ohio USA
| | - C Anwar A Chahal
- Center for Inherited Cardiovascular Diseases, WellSpan Health, Lancaster, PA USA
- Cardiac Electrophysiology and Inherited Cardiovascular Diseases, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN USA
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Andrew P Landstrom
- Department of Pediatrics and Cell Biology, Duke University School of Medicine, Durham, North Carolina, US
| | - Cynthia James
- Johns Hopkins Center for Inherited Heart Diseases, Department of Medicine, Johns Hopkins
| | - Elizabeth M McNally
- Center for Genetic Medicine, Dept of Medicine (Cardiology), Northwestern University Feinberg School of Medicine, Chicago, IL US
| | - Daniel P Judge
- Medical University of South Carolina, Charleston, SC USA
| | - Peter van Tintelen
- Department of Genetics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Arthur Wilde
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure and arrhythmias, Amsterdam, the Netherlands
| | - Michael Gollob
- Inherited Arrhythmia and Cardiomyopathy Program, Division of Cardiology, University of Toronto, Toronto ON Canada
| | - Jodie Ingles
- Centre for Population Genomics, Garvan Institute of Medical Research, and UNSW Sydney, Sydney, Australia
| | - James S Ware
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London UK
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
| |
Collapse
|
8
|
Smith E, Care M, Burke-Martindale C, Weissler-Snir A. Secondary Findings Using Broad Pan Cardiomyopathy and Arrhythmia Panels in Patients With a Personal or Family History of Inherited Cardiomyopathy or Arrhythmia Syndrome. Am J Cardiol 2022; 178:137-141. [PMID: 35835602 DOI: 10.1016/j.amjcard.2022.05.022] [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] [Received: 03/27/2022] [Revised: 05/16/2022] [Accepted: 05/20/2022] [Indexed: 11/28/2022]
Abstract
With broad panels and whole exome or genome sequencing, there is the potential for secondary findings, which include pathogenic/likely pathogenic variants or variants of uncertain significance in genes that are unrelated to the primary clinical indication for the testing. No study examined the frequency and implications of secondary findings when using a broad panel for inherited cardiomyopathy or arrhythmia syndromes. We performed a retrospective review of the primary indications for genetic testing, tests performed, and genetic test results to identify secondary findings in patients seen in the Inherited Cardiovascular Disease Clinic for a personal or family history of (possible) inherited cardiomyopathy, inherited arrhythmia syndrome, previous cardiac arrest, or family history of sudden cardiac death. Of 325 probands and 20 family members who had genetic testing, with no-cost broad cardiomyopathy and arrhythmia panel, 4 probands (1.2%) and 4 family members (5%) had pathogenic/likely pathogenic variants in autosomal dominant genes, unrelated to the primary reason for testing. In conclusion, the prevalence of secondary findings using broad cardiomyopathy and arrhythmia panel in patients with personal or family history of inherited cardiomyopathy or arrhythmia was ∼2.2%. Our findings suggest that with appropriate genetic counseling, broad panels might be considered over disease-specific panels because of the relatively high prevalence of secondary findings that positively affect patient care and would not have been identified with more targeted testing.
Collapse
Affiliation(s)
- Emily Smith
- Hartford HealthCare, Heart and Vascular Institute, Hartford, Connecticut
| | - Melanie Care
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | | | - Adaya Weissler-Snir
- Hartford HealthCare, Heart and Vascular Institute, Hartford, Connecticut; Department of Medicine, University of Connecticut, Farmington, Connecticut.
| |
Collapse
|
9
|
Walsh R, Adler A, Amin AS, Abiusi E, Care M, Bikker H, Amenta S, Feilotter H, Nannenberg EA, Mazzarotto F, Trevisan V, Garcia J, Hershberger RE, Perez MV, Sturm AC, Ware JS, Zareba W, Novelli V, Wilde AAM, Gollob MH. Evaluation of gene validity for CPVT and short QT syndrome in sudden arrhythmic death. Eur Heart J 2022; 43:1500-1510. [PMID: 34557911 PMCID: PMC9009401 DOI: 10.1093/eurheartj/ehab687] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/11/2021] [Accepted: 09/09/2021] [Indexed: 12/02/2022] Open
Abstract
AIMS Catecholaminergic polymorphic ventricular tachycardia (CPVT) and short QT syndrome (SQTS) are inherited arrhythmogenic disorders that can cause sudden death. Numerous genes have been reported to cause these conditions, but evidence supporting these gene-disease relationships varies considerably. To ensure appropriate utilization of genetic information for CPVT and SQTS patients, we applied an evidence-based reappraisal of previously reported genes. METHODS AND RESULTS Three teams independently curated all published evidence for 11 CPVT and 9 SQTS implicated genes using the ClinGen gene curation framework. The results were reviewed by a Channelopathy Expert Panel who provided the final classifications. Seven genes had definitive to moderate evidence for disease causation in CPVT, with either autosomal dominant (RYR2, CALM1, CALM2, CALM3) or autosomal recessive (CASQ2, TRDN, TECRL) inheritance. Three of the four disputed genes for CPVT (KCNJ2, PKP2, SCN5A) were deemed by the Expert Panel to be reported for phenotypes that were not representative of CPVT, while reported variants in a fourth gene (ANK2) were too common in the population to be disease-causing. For SQTS, only one gene (KCNH2) was classified as definitive, with three others (KCNQ1, KCNJ2, SLC4A3) having strong to moderate evidence. The majority of genetic evidence for SQTS genes was derived from very few variants (five in KCNJ2, two in KCNH2, one in KCNQ1/SLC4A3). CONCLUSIONS Seven CPVT and four SQTS genes have valid evidence for disease causation and should be included in genetic testing panels. Additional genes associated with conditions that may mimic clinical features of CPVT/SQTS have potential utility for differential diagnosis.
Collapse
Affiliation(s)
- Roddy Walsh
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Arnon Adler
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Avenue, Toronto, ON M5G 2N2, Canada
| | - Ahmad S Amin
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Emanuela Abiusi
- Fondazione Policlinico Universitario A. Gemelli IRCCS and Istituto di Medicina Genomica, Università Cattolica del Sacro Cuore, L.go F. Vito 1, Rome 00168, Italy
| | - Melanie Care
- Division of Cardiology, Toronto General Hospital, The Toronto General Hospital Research Institute, University Health Network, University of Toronto, 200 Elizabeth St, Toronto, ON M5G 2C4, Canada
- Department of Molecular Genetics, University of Toronto, 1 King's College Cir, Toronto, ON M5S 1A8, Canada
| | - Hennie Bikker
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Simona Amenta
- Fondazione Policlinico Universitario A. Gemelli IRCCS and Istituto di Medicina Genomica, Università Cattolica del Sacro Cuore, L.go F. Vito 1, Rome 00168, Italy
| | - Harriet Feilotter
- Department of Pathology and Molecular Medicine, Queen's University, 88 Stuart Street, Kingston, ON K7L 3N6, Canada
| | - Eline A Nannenberg
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Francesco Mazzarotto
- Department of Experimental and Clinical Medicine, University of Florence, Viale Pieraccini 6, Florence 50139, Italy
- Faculty of Medicine, National Heart & Lung Institute, Imperial College London, Dovehouse St, London SW3 6LY, UK
- Cardiovascular Research Centre, Royal Brompton & Harefield Hospitals, Sydney St, London SW3 6NP, UK
| | - Valentina Trevisan
- Fondazione Policlinico Universitario A. Gemelli IRCCS and Istituto di Medicina Genomica, Università Cattolica del Sacro Cuore, L.go F. Vito 1, Rome 00168, Italy
| | - John Garcia
- Invitae Corp., 1400 16th St, San Francisco, CA 94103, USA
| | - Ray E Hershberger
- Division of Human Genetics, Department of Internal Medicine, The Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, 473 W 12th Ave, Columbus, OH 43210, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, 473 W 12th Ave, Columbus, OH 43210, USA
| | - Marco V Perez
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, 300 Pasteur Dr, Stanford, CA 94305, USA
| | - Amy C Sturm
- Geisinger Genomic Medicine Institute, 100 N Academy Ave, Danville, PA 17822, USA
| | - James S Ware
- Faculty of Medicine, National Heart & Lung Institute, Imperial College London, Dovehouse St, London SW3 6LY, UK
- Cardiovascular Research Centre, Royal Brompton & Harefield Hospitals, Sydney St, London SW3 6NP, UK
- Cardiovascular Genomics and Precision Medicine, MRC London Institute of Medical Sciences, Imperial College London, Du Cane Rd, London W12 0NN, UK
| | - Wojciech Zareba
- Cardiology Unit of the Department of Medicine, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, USA
| | - Valeria Novelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS and Istituto di Medicina Genomica, Università Cattolica del Sacro Cuore, L.go F. Vito 1, Rome 00168, Italy
| | - Arthur A M Wilde
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Michael H Gollob
- Division of Cardiology, Toronto General Hospital, The Toronto General Hospital Research Institute, University Health Network, University of Toronto, 200 Elizabeth St, Toronto, ON M5G 2C4, Canada
| |
Collapse
|
10
|
Lou SK, Grenier S, Care M, McCuaig J, Stockley TL, Clarke B, Ruff HM, Boerner SL. Validation of BRCA testing on cytologic samples of high-grade serous carcinoma. Cancer Cytopathol 2021; 129:907-913. [PMID: 34157791 DOI: 10.1002/cncy.22484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/22/2021] [Accepted: 05/26/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Testing for BRCA1/2 gene alterations in patients with high-grade serous carcinoma (HGSC) is a critical determinant of treatment eligibility for poly(adenosine diphosphate-ribose) polymerase inhibitors in addition to providing vital information for genetic counselling. Many patients present with effusions necessitating therapeutic drainage, and this makes cytologic specimens (CySs) the initial diagnostic material for HGSC, often before histologic sampling. Initiating somatic BRCA testing on a CyS allows the BRCA status to be determined sooner, and this affects clinical management. METHODS Retrospectively, 8 cases of formalin-fixed, paraffin-embedded (FFPE) CySs of peritoneal or pleural fluid from patients with HGSC and known BRCA1/2 alterations previously established by the testing of FFPE surgical specimens (SpSs) underwent next-generation sequencing (NGS). Prospectively, 11 cases of peritoneal or pleural fluid from patients with HGSC but an unknown BRCA1/2 status underwent NGS with fresh, alcohol-fixed, and FFPE CySs, and they were compared with subsequent NGS on 4 SpSs. RESULTS CySs yielded high-quantity and high-quality DNA for NGS analysis when sufficient tumor cellularity was present. Fresh, alcohol-fixed, and FFPE CySs were all suitable for NGS and provided identical NGS results. SpS and CyS BRCA testing was concordant in 10 of 12 cases. The 2 discordant cases showed low tumor cellularity and quality in the CyS and the SpS, respectively. CONCLUSION Effusion CySs of HGSC are excellent sources for NGS testing for BRCA1/2 genetic alterations when sufficient tumor cellularity is present. Fresh, alcohol-fixed, and FFPE CySs are equivalent for NGS of BRCA1/2. NGS testing of HGSC CySs demonstrates good concordance with SpSs for the BRCA1/2 status.
Collapse
Affiliation(s)
- Si Kei Lou
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Sylvie Grenier
- Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Melanie Care
- Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Jeanna McCuaig
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada.,Familial Cancer Clinic, Princess Margaret Hospital Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Tracy L Stockley
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Blaise Clarke
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Heather M Ruff
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Scott L Boerner
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
11
|
Care M, McCuaig J, Clarke B, Grenier S, Kim RH, Rouzbahman M, Stickle N, Bernardini M, Stockley TL. Tumor and germline next generation sequencing in high grade serous cancer: experience from a large population-based testing program. Mol Oncol 2020; 15:80-90. [PMID: 33030818 PMCID: PMC7782089 DOI: 10.1002/1878-0261.12817] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 07/23/2020] [Revised: 09/18/2020] [Accepted: 10/05/2020] [Indexed: 12/12/2022] Open
Abstract
The aim of this study was to determine the prevalence of somatic and germline pathogenic variants (PVs) in high‐grade serous cancer (HGSC) and to demonstrate the technical feasibility and effectiveness of a large‐scale, population‐based tumor testing program. It involved a retrospective review of genetic test results in 600 consecutive HGSC tumor samples and a subsequent comparison of germline and tumor results in a subset of 200 individuals. Tumor testing was successful in 95% of samples (570/600) with at least one BRCA1/2 PV identified in 16% (93/570) of cases. Among the 200 paired cases, BRCA1/2 PVs were detected in 38 tumors (19%); 58% were somatic (22/38); and 42% were germline (16/38). There was 100% concordance between germline and tumor test results. This is the largest series of BRCA1/2 testing in HGSC (tumor‐only and paired cohorts), reported to date, and our data show that an effectively designed and validated population‐based tumor testing program can be used to determine both treatment eligibility and hereditary cancer risk.
Collapse
Affiliation(s)
- Melanie Care
- Laboratory Medicine Program, Division of Clinical Laboratory Genetics, University Health Network, Toronto, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Jeanna McCuaig
- Department of Molecular Genetics, University of Toronto, Toronto, Canada.,Familial Cancer Clinic, Princess Margaret Hospital Cancer Centre, University Health Network, Toronto, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Blaise Clarke
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Sylvie Grenier
- Laboratory Medicine Program, Division of Clinical Laboratory Genetics, University Health Network, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Raymond H Kim
- Familial Cancer Clinic, Princess Margaret Hospital Cancer Centre, University Health Network, Toronto, Canada.,Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Marjan Rouzbahman
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Natalie Stickle
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Marcus Bernardini
- Department of Gynecologic Oncology, Princess Margaret Hospital Cancer Centre, Toronto, Canada
| | - Tracy L Stockley
- Laboratory Medicine Program, Division of Clinical Laboratory Genetics, University Health Network, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| |
Collapse
|
12
|
Weissler-Snir A, Dorian P, Rakowski H, Care M, Spears D. Primary prevention implantable cardioverter-defibrillators in hypertrophic cardiomyopathy-Are there predictors of appropriate therapy? Heart Rhythm 2020; 18:63-70. [PMID: 32800967 DOI: 10.1016/j.hrthm.2020.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 05/21/2020] [Revised: 08/06/2020] [Accepted: 08/09/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Identifying patients with hypertrophic cardiomyopathy (HCM) who warrant a primary prevention implantable cardioverter-defibrillator (ICD) is crucial. ICDs are effective in terminating life-threatening arrhythmias; however, ICDs carry risks of complications. OBJECTIVE The purpose of this study was to assess the incidence and predictors of appropriate ICD therapies, inappropriate shocks, and device-related complications in patients with HCM and primary prevention ICDs. METHODS All patients with HCM who underwent primary prevention ICD implantation at Toronto General Hospital between September 2000 and December 2017 were identified. Therapies (shocks or antitachycardia pacing) for ventricular tachycardia >180 beats/min or ventricular fibrillation were considered appropriate. RESULTS Three hundred two patients were followed for a mean 6.1 ± 4.3 years (1801 patient-years of follow-up). Thirty-eight patients (12.6%) received at least 1 appropriate ICD therapy (2.3%/y); the 5-year cumulative probability of receiving appropriate ICD therapy was 9.6%. None of the conventional risk factors nor the European Society of Cardiology risk score was associated with appropriate ICD therapy. In multivariable analysis, age < 40 years at implantation and atrial fibrillation were independent predictors of appropriate ICD therapy. In a subgroup of patients who had undergone cardiac magnetic resonance imaging before ICD implantation, severe late gadolinium enhancement was the strongest predictor of appropriate ICD therapies. ICD-related complications or inappropriate shocks occurred in 87 patients (28.8%), with an inappropriate shock rate of 2.1%/y; the 5-year cumulative probability was 10.7%. CONCLUSION The incidence of appropriate ICD therapies in patients with HCM and primary prevention ICDs is lower than previously reported; a high proportion of patients suffer from an ICD-related complication. Traditional risk factors have low predictive utility. Severe late gadolinium enhancement, atrial fibrillation, and young age are important predictors of ventricular tachyarrhythmias in HCM.
Collapse
Affiliation(s)
- Adaya Weissler-Snir
- Division of Cardiology, Hartford Hospital, University of Connecticut, Hartford, Connecticut.
| | - Paul Dorian
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Harry Rakowski
- Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Melanie Care
- Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Danna Spears
- Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| |
Collapse
|
13
|
McCuaig JM, Care M, Ferguson SE, Kim RH, Stockley TL, Metcalfe KA. Year 1: Experiences of a tertiary cancer centre following implementation of reflex BRCA1 and BRCA2 tumor testing for all high-grade serous ovarian cancers in a universal healthcare system. Gynecol Oncol 2020; 158:747-753. [PMID: 32674931 DOI: 10.1016/j.ygyno.2020.06.507] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 05/14/2020] [Accepted: 06/28/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study compares the rate and time to genetic referral, and patient uptake of germline genetic services, before and after implementation of reflex BRCA1/2 tumor testing for high-grade serous ovarian cancer (HGSOC) in a universal healthcare system. METHODS A retrospective chart review of HSGOC patients diagnosed in the year before (PRE) and after (POST) implementation of reflex BRCA1/2 tumor testing was conducted. Clinical information (date/age at diagnosis, personal/family history of breast/ovarian cancer, cancer stage, primary treatment, tumor results) and dates of genetics referral, counseling, and germline testing were obtained. Incident rate ratios (IRR) and 95% CI were calculated using negative binomial regression. Time to referral was evaluated using Kaplan-Meier survival analysis. Fisher Exact tests were used to evaluate uptake of genetic services. RESULTS 175 HGSOC patients were identified (81 PRE; 94 POST). Post-implementation of tumor testing, there was a higher rate of genetics referral (12.88 versus 7.10/1000 person-days; IRR = 1.60, 95% CI: 1.07-2.42) and a shorter median time from diagnosis to referral (59 days PRE, 33 days POST; p = .04). In the POST cohort, most patients were referred prior to receiving their tumor results (n = 63/77; 81.8%). Once referred, most patients attended genetic counseling (94.5% PRE, 97.6% POST; p = .418) and pursue germline testing (98.6% PRE; 100% POST; p = .455). CONCLUSIONS Following implementation of reflex BRCA1/2 tumor testing for HGSOC, significant improvements to the rate and time to genetics referral were identified. Additional studies are needed to evaluate physician referral practices and the long-term impact of reflex tumor testing.
Collapse
Affiliation(s)
- Jeanna M McCuaig
- Familial Cancer Clinic, University Health Network, 610 University Avenue, Toronto, ON M5G 2M9, Canada; Lawrence S Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON M5T 1P8, Canada.
| | - Melanie Care
- Department of Molecular Genetics, University of Toronto, 27 King's College Circle, Toronto5, ON M5S 1A8, Canada; Division of Clinical Laboratory Medicine, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
| | - Sarah E Ferguson
- Division of Gynecologic Oncology, University Health Network, 610 University Avenue, Toronto, ON M5G 2M9, Canada; Department of Obstetrics and Gynecology, University of Toronto, 27 King's College Circle, Toronto, ON M5S 1A8, Canada
| | - Raymond H Kim
- Familial Cancer Clinic, University Health Network, 610 University Avenue, Toronto, ON M5G 2M9, Canada; Division of Medical Oncology, University Health Network, 610 University Avenue, Toronto, ON M5G 2M9, Canada; Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, ON M5S 1A8, Canada
| | - Tracy L Stockley
- Division of Clinical Laboratory Medicine, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, 27 King's College Circle, Toronto, ON M5S 1A8, Canada
| | - Kelly A Metcalfe
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON M5T 1P8, Canada; Women's College Research Institute, 72 Grenville Street, Toronto, ON M5S 1B2, Canada
| |
Collapse
|
14
|
Shickh S, Gutierrez Salazar M, Zakoor KR, Lázaro C, Gu J, Goltz J, Kleinman D, Noor A, Khalouei S, Mighton C, Reble E, Kodida R, Bombard Y, DiTroia S, Baxter S, Watkins N, Care M, Adler A, Horsburgh S, Morar O, Murphy J, Nevay DL, Szybowska M, Aronson M, Panchal S, Godoy R, Holter S, Randall Armel S, Semotiuk K, Elser C, Kim RH, Chitayat D, So J, Faghfoury H, Silver J, Morel CF, Lerner-Ellis J. Exome and genome sequencing in adults with undiagnosed disease: a prospective cohort study. J Med Genet 2020; 58:275-283. [PMID: 32581083 DOI: 10.1136/jmedgenet-2020-106936] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 02/21/2020] [Revised: 04/29/2020] [Accepted: 05/02/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Exome and genome sequencing have been demonstrated to increase diagnostic yield in paediatric populations, improving treatment options and providing risk information for relatives. There are limited studies examining the clinical utility of these tests in adults, who currently have limited access to this technology. METHODS Patients from adult and cancer genetics clinics across Toronto, Ontario, Canada were recruited into a prospective cohort study evaluating the diagnostic utility of exome and genome sequencing in adults. Eligible patients were ≥18 years of age and suspected of having a hereditary disorder but had received previous uninformative genetic test results. In total, we examined the diagnostic utility of exome and genome sequencing in 47 probands and 34 of their relatives who consented to participate and underwent exome or genome sequencing. RESULTS Overall, 17% (8/47) of probands had a pathogenic or likely pathogenic variant identified in a gene associated with their primary indication for testing. The diagnostic yield for patients with a cancer history was similar to the yield for patients with a non-cancer history (4/18 (22%) vs 4/29 (14%)). An additional 24 probands (51%) had an inconclusive result. Secondary findings were identified in 10 patients (21%); three had medically actionable results. CONCLUSIONS This study lends evidence to the diagnostic utility of exome or genome sequencing in an undiagnosed adult population. The significant increase in diagnostic yield warrants the use of this technology. The identification and communication of secondary findings may provide added value when using this testing modality as a first-line test.
Collapse
Affiliation(s)
- Salma Shickh
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Mariana Gutierrez Salazar
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Kathleen-Rose Zakoor
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Conxi Lázaro
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada.,Hereditary Cancer Program, Catalan Institute of Oncology (ICO), Hospital Duran i Reynals, Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet, Barcelona, Spain.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Jessica Gu
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada.,Genetics, Medcan Clinic, Toronto, Ontario, Canada
| | - Jamie Goltz
- University of Guelph, Guelph, Ontario, Canada
| | - Dakota Kleinman
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Abdul Noor
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Sam Khalouei
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Chloe Mighton
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Emma Reble
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Rita Kodida
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Yvonne Bombard
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie DiTroia
- Center for Mendelian Genomics, Broad Institute, Cambridge, Massachusetts, USA
| | - Samantha Baxter
- Center for Mendelian Genomics, Broad Institute, Cambridge, Massachusetts, USA
| | - Nicholas Watkins
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Melanie Care
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada.,Fred A. Litwin Family Centre in Genetic Medicine, University Health Network, Toronto, Ontario, Canada
| | - Arnon Adler
- Department of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sheri Horsburgh
- Fred A. Litwin Family Centre in Genetic Medicine, University Health Network, Toronto, Ontario, Canada
| | - Oana Morar
- Fred A. Litwin Family Centre in Genetic Medicine, University Health Network, Toronto, Ontario, Canada.,Clinical Genetics, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Jillian Murphy
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada.,Fred A. Litwin Family Centre in Genetic Medicine, University Health Network, Toronto, Ontario, Canada
| | - Dayna-Lynn Nevay
- Fred A. Litwin Family Centre in Genetic Medicine, University Health Network, Toronto, Ontario, Canada
| | - Marta Szybowska
- Fred A. Litwin Family Centre in Genetic Medicine, University Health Network, Toronto, Ontario, Canada
| | - Melyssa Aronson
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Seema Panchal
- Marvelle Koffler Breast Centre, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Ruth Godoy
- Marvelle Koffler Breast Centre, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada.,Lifelabs, Toronto, Ontario, Canada
| | - Spring Holter
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Susan Randall Armel
- Familial Breast and Ovarian Cancer Clinic, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Kara Semotiuk
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Christine Elser
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Marvelle Koffler Breast Centre, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Raymond H Kim
- Fred A. Litwin Family Centre in Genetic Medicine, University Health Network, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Medical Oncology and Hematology, University Health Network, Toronto, Ontario, Canada
| | - David Chitayat
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada.,Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada.,The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Joyce So
- Fred A. Litwin Family Centre in Genetic Medicine, University Health Network, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hanna Faghfoury
- Fred A. Litwin Family Centre in Genetic Medicine, University Health Network, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Josh Silver
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada.,Fred A. Litwin Family Centre in Genetic Medicine, University Health Network, Toronto, Ontario, Canada
| | - Chantal F Morel
- Fred A. Litwin Family Centre in Genetic Medicine, University Health Network, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jordan Lerner-Ellis
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada .,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| |
Collapse
|
15
|
Hooker G, Allain DC, Buchanan AH, Care M, Conway L, Cumming A, Dixon S, Paulyson-Nuñez K, Riordan S, Williams J. An analysis of growth in the genetic counseling profession 2009 to 2019. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e13526] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13526 Background: Genetic counselors (GCs) are health care professionals who provide support to patients and physicians navigating the rapidly changing landscape of genetic testing and the genetic underpinnings of disease. Increased demand for genetic counseling services prompted an analysis of changes in the workforce over the last decade. Methods: To quantify the growth in the GC profession in the U.S and Canada in the last decade, we acquired data from the American Board of Genetic Counseling, National Society of Genetic Counselors, Canadian Association of Genetic Counselors, Accreditation Council for Genetic Counseling and Association of Genetic Counseling Program Directors. Results: Between 2009 and 2019, the workforce more than doubled, growing from 2,205 ABGC-certified GCs to 5,172. In Canada, the number of CAGC-certified GCs has grown from 211 in 2009 to 327 in 2019. Growth is striking in cancer genetic counseling; the proportion of GCs providing direct patient care in North America who report cancer as a primary specialty has increased from 25% in 2008 to 50% in 2019. Similar growth has been seen in training opportunities for GCs. The number of accredited graduate programs has increased from 33 in 2009 to 51 in 2019, with several more in development. Combined, these programs had 464 training slots in 2019, up from 223 in 2009. In 2019, 1569 applicants registered for the applicant match for training. Training opportunities and clinical genetic counselors are concentrated in large metropolitan areas, with over half of GCs working in 28 metro regions. GC services in rural areas are increasingly provided remotely via telemedicine, with 59% of GCs in direct patient care in 2018 reporting providing services by phone and 19% using web or video services to deliver care. In cancer genetics, about 50% of GCs nationwide reported in 2018 their 3rd next available appointment for new patients was within 14 days. Conclusions: The past decade has seen significant growth in the numbers of GCs and more patients have access to GCs than a decade ago. Reimbursement for services remains a significant barrier to access. Further research is warranted to understand additional political, administrative and logistical facilitators and barriers to providing care to all who need genetics services.
Collapse
|
16
|
Hoss S, Habib M, Silver J, Care M, Chan RH, Hanneman K, Morel CF, Iwanochko RM, Gollob MH, Rakowski H, Adler A. Genetic Testing for Diagnosis of Hypertrophic Cardiomyopathy Mimics. Circ: Genomic and Precision Medicine 2020; 13:e002748. [DOI: 10.1161/circgen.119.002748] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background
Genetic testing is helpful for diagnosis of hypertrophic cardiomyopathy (HCM) mimics. Little data are available regarding the yield of such testing and its clinical impact.
Methods
The HCM genetic database at our center was used for identification of patients who underwent HCM-directed genetic testing including at least 1 gene associated with an HCM mimic (
GLA
,
TTR
,
PRKAG2
,
LAMP2
,
PTPN11
,
RAF1
, and
DES
). Charts were retrospectively reviewed and genetic and clinical data extracted.
Results
There were 1731 unrelated HCM patients who underwent genetic testing for at least 1 gene related to an HCM mimic. In 1.45% of cases, a pathogenic or likely pathogenic variant in one of these genes was identified. This included a yield of 1% for Fabry disease, 0.3% for familial amyloidosis, 0.15% for
PRKAG2
-related cardiomyopathy, and 1 patient with Noonan syndrome. In the majority of patients, diagnosis of the HCM mimic based on clinical findings alone would have been challenging. Accurate diagnosis of an HCM mimic led to change in management (eg, enzyme replacement therapy) or family screening in all cases.
Conclusions
Genetic testing is helpful in the diagnosis of HCM mimics in patients with no or few extracardiac manifestations. Adding these genes to all HCM genetic panels should be considered.
Collapse
Affiliation(s)
- Sara Hoss
- Division of Cardiology, Peter Munk Cardiac Centre (S.H., M.H., R.H.C., M.H.G., H.R., A.A.), Toronto General Hospital, Canada
- University of Toronto (S.H., M.H., J.S., M.C., K.H., C.F.M., R.M.I., M.H.G., H.R., A.A.)
| | - Manhal Habib
- Division of Cardiology, Peter Munk Cardiac Centre (S.H., M.H., R.H.C., M.H.G., H.R., A.A.), Toronto General Hospital, Canada
- University of Toronto (S.H., M.H., J.S., M.C., K.H., C.F.M., R.M.I., M.H.G., H.R., A.A.)
| | - Josh Silver
- Fred A. Litwin and Family Center in Genetic Medicine, University Health Network and Mount Sinai Hospital (J.S., M.C., C.F.M.), Toronto General Hospital, Canada
- University of Toronto (S.H., M.H., J.S., M.C., K.H., C.F.M., R.M.I., M.H.G., H.R., A.A.)
| | - Melanie Care
- Fred A. Litwin and Family Center in Genetic Medicine, University Health Network and Mount Sinai Hospital (J.S., M.C., C.F.M.), Toronto General Hospital, Canada
- University of Toronto (S.H., M.H., J.S., M.C., K.H., C.F.M., R.M.I., M.H.G., H.R., A.A.)
| | - Raymond H. Chan
- Division of Cardiology, Peter Munk Cardiac Centre (S.H., M.H., R.H.C., M.H.G., H.R., A.A.), Toronto General Hospital, Canada
| | - Kate Hanneman
- Joint Department of Medical Imaging (K.H.), Toronto General Hospital, Canada
- University of Toronto (S.H., M.H., J.S., M.C., K.H., C.F.M., R.M.I., M.H.G., H.R., A.A.)
| | - Chantal F. Morel
- Fred A. Litwin and Family Center in Genetic Medicine, University Health Network and Mount Sinai Hospital (J.S., M.C., C.F.M.), Toronto General Hospital, Canada
- University of Toronto (S.H., M.H., J.S., M.C., K.H., C.F.M., R.M.I., M.H.G., H.R., A.A.)
| | - Robert M. Iwanochko
- University of Toronto (S.H., M.H., J.S., M.C., K.H., C.F.M., R.M.I., M.H.G., H.R., A.A.)
- Division of Cardiology, Toronto Western Hospital, ON, Canada (R.M.I.)
| | - Michael H. Gollob
- Division of Cardiology, Peter Munk Cardiac Centre (S.H., M.H., R.H.C., M.H.G., H.R., A.A.), Toronto General Hospital, Canada
- University of Toronto (S.H., M.H., J.S., M.C., K.H., C.F.M., R.M.I., M.H.G., H.R., A.A.)
| | - Harry Rakowski
- Division of Cardiology, Peter Munk Cardiac Centre (S.H., M.H., R.H.C., M.H.G., H.R., A.A.), Toronto General Hospital, Canada
- University of Toronto (S.H., M.H., J.S., M.C., K.H., C.F.M., R.M.I., M.H.G., H.R., A.A.)
| | - Arnon Adler
- Division of Cardiology, Peter Munk Cardiac Centre (S.H., M.H., R.H.C., M.H.G., H.R., A.A.), Toronto General Hospital, Canada
- University of Toronto (S.H., M.H., J.S., M.C., K.H., C.F.M., R.M.I., M.H.G., H.R., A.A.)
| |
Collapse
|
17
|
Adler A, Novelli V, Amin AS, Abiusi E, Care M, Nannenberg EA, Feilotter H, Amenta S, Mazza D, Bikker H, Sturm AC, Garcia J, Ackerman MJ, Hershberger RE, Perez MV, Zareba W, Ware JS, Wilde AAM, Gollob MH. An International, Multicentered, Evidence-Based Reappraisal of Genes Reported to Cause Congenital Long QT Syndrome. Circulation 2020; 141:418-428. [PMID: 31983240 PMCID: PMC7017940 DOI: 10.1161/circulationaha.119.043132] [Citation(s) in RCA: 196] [Impact Index Per Article: 49.0] [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] [Indexed: 11/17/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Long QT syndrome (LQTS) is the first described and most common inherited arrhythmia. Over the last 25 years, multiple genes have been reported to cause this condition and are routinely tested in patients. Because of dramatic changes in our understanding of human genetic variation, reappraisal of reported genetic causes for LQTS is required. Methods: Utilizing an evidence-based framework, 3 gene curation teams blinded to each other’s work scored the level of evidence for 17 genes reported to cause LQTS. A Clinical Domain Channelopathy Working Group provided a final classification of these genes for causation of LQTS after assessment of the evidence scored by the independent curation teams. Results: Of 17 genes reported as being causative for LQTS, 9 (AKAP9, ANK2, CAV3, KCNE1, KCNE2, KCNJ2, KCNJ5, SCN4B, SNTA1) were classified as having limited or disputed evidence as LQTS-causative genes. Only 3 genes (KCNQ1, KCNH2, SCN5A) were curated as definitive genes for typical LQTS. Another 4 genes (CALM1, CALM2, CALM3, TRDN) were found to have strong or definitive evidence for causality in LQTS with atypical features, including neonatal atrioventricular block. The remaining gene (CACNA1C) had moderate level evidence for causing LQTS. Conclusions: More than half of the genes reported as causing LQTS have limited or disputed evidence to support their disease causation. Genetic variants in these genes should not be used for clinical decision-making, unless accompanied by new and sufficient genetic evidence. The findings of insufficient evidence to support gene-disease associations may extend to other disciplines of medicine and warrants a contemporary evidence-based evaluation for previously reported disease-causing genes to ensure their appropriate use in precision medicine.
Collapse
Affiliation(s)
- Arnon Adler
- Division of Cardiology, Toronto General Hospital and University of Toronto, Canada (A.A, M.C., M.H.G.)
| | - Valeria Novelli
- Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, and Istituto di Medicina Genomica, Università Cattolica del Sacro Cuore, Rome, Italy (V.N., E.A., S.A., D.M.)
| | - Ahmad S Amin
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences (A.S.A., A.A.M.W.), Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
| | - Emanuela Abiusi
- Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, and Istituto di Medicina Genomica, Università Cattolica del Sacro Cuore, Rome, Italy (V.N., E.A., S.A., D.M.)
| | - Melanie Care
- Division of Cardiology, Toronto General Hospital and University of Toronto, Canada (A.A, M.C., M.H.G.)
| | - Eline A Nannenberg
- Department of Clinical Genetics (E.A.N., H.B.), Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
| | - Harriet Feilotter
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Canada (H.F.)
| | - Simona Amenta
- Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, and Istituto di Medicina Genomica, Università Cattolica del Sacro Cuore, Rome, Italy (V.N., E.A., S.A., D.M.)
| | - Daniela Mazza
- Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, and Istituto di Medicina Genomica, Università Cattolica del Sacro Cuore, Rome, Italy (V.N., E.A., S.A., D.M.)
| | - Hennie Bikker
- Department of Clinical Genetics (E.A.N., H.B.), Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
| | - Amy C Sturm
- Geisinger Genomic Medicine Institute, Danville, PA (A.C.S.)
| | - John Garcia
- Invitae Corporation, San Francisco, CA (J.G.)
| | - Michael J Ackerman
- Departments of Cardiovascular Diseases, Pediatrics, and Molecular Pharmacology and Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Rochester, MN (M.J.A.)
| | - Raymond E Hershberger
- Divisions of Human Genetics and Cardiovascular Medicine in the Department of Internal Medicine, Ohio State University, Columbus (R.E.H.)
| | - Marco V Perez
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, CA (M.V.P.)
| | - Wojciech Zareba
- Cardiology Unit of the Department of Medicine, University of Rochester Medical Center, NY (W.Z.)
| | - James S Ware
- National Heart and Lung Institute and Medical Research Council London Institute of Medical Sciences, Imperial College London, UK (J.S.W.).,Royal Brompton and Harefield Hospitals National Health Service Trust, London, UK (J.S.W.)
| | - Arthur A M Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences (A.S.A., A.A.M.W.), Amsterdam University Medical Centers, University of Amsterdam, The Netherlands.,Columbia University Irving Medical Center, New York (A.A.M.W.)
| | - Michael H Gollob
- Division of Cardiology, Toronto General Hospital and University of Toronto, Canada (A.A, M.C., M.H.G.).,Department of Physiology, University of Toronto, and The Toronto General Hospital Research Institute, University Health Network, University of Toronto, Canada (M.H.G.)
| |
Collapse
|
18
|
Rippaus N, Manning J, Droop A, Al-Jabri M, Care M, Bruns AF, Jenkinson MD, Brodbelt A, Chakrabarty A, Ismail A, Short S, Stead LF. OS9.5 Evidence that adult glioblastoma adapts to standard therapy though chromatin remodeling. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.063] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Glioblastoma (GBM) tumours recur following standard treatment in almost all cases. We use ‘omics technologies to simultaneously profile pairs of primary and matched recurrent GBM to specifically identify and characterise the cells that resisted treatment, with the aim of determining how to more effectively kill them.
MATERIAL AND METHODS
We have analysed high coverage RNAseq data from pairs of GBM tumours: primary de novo tumour and matched local recurrence from patients that underwent standard therapy. Our original cohort constituted 23 pairs and our validation cohort was an additional 22 pairs. We also cultured two plates of spheroids directly from a patient’s GBM, treating one with radiation and temozolomide. We monitored growth and captured and sequenced RNA from single cells at two time-points: one week post-treatment when the deviation between untreated and treated spheroid growth curves was most pronounced; and three weeks post-treatment when the growth rate of treated spheroids had recovered. We investigated differential gene expression between primary and recurrent pairs, and single cells pre- and post-treatment, and performed a bespoke per patient gene set enrichment analysis.
RESULTS
Differential gene expression analysis in 23 tumour pairs indicated a treatment-induced shift in cell states linked to normal neurogenesis and prompted us to develop a novel gene set enrichment analysis approach to identify gene regulatory factors that may orchestrate such a shift. This revealed the significant and universal dysregulation of genes, through therapy, that are targeted by a specific chromatin remodeling machinery. This finding was validated in an independent cohort of 22 further GBM pairs. To understand the therapeutic potential of this finding we must determine whether genes are dysregulated through therapy owing to a) their fixed expression in inherently treatment resistance cells in the primary tumour which get selected during therapy to increase the signal of that profile, or b) changes in expression during the process of cells acquiring treatment resistance. To inspect this, we analysed single cell gene expression data from GBM spheroids pre- and post-treatment. We found that there was significant dysregulation of the genes associated with the chromatin remodeling complex but only at the three-week post-treatment time-point.
CONCLUSION
Our results indicate that GBM cells are being transcriptionally reprogrammed in response to treatment; the mechanism of which may represent a therapeutic opportunity.
Collapse
Affiliation(s)
- N Rippaus
- Leeds Institute of Medical Research at St James’s, Leeds, United Kingdom
| | - J Manning
- Leeds Institute of Medical Research at St James’s, Leeds, United Kingdom
| | - A Droop
- Leeds Institute of Data Analytics, Leeds, United Kingdom
| | - M Al-Jabri
- Leeds Institute of Medical Research at St James’s, Leeds, United Kingdom
| | - M Care
- Leeds Institute of Data Analytics, Leeds, United Kingdom
| | - A F Bruns
- Leeds Institute of Medical Research at St James’s, Leeds, United Kingdom
- Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, United Kingdom
| | - M D Jenkinson
- Walton Centre NHS Trust, Liverpool, United Kingdom
- Institute of Translational Medicine, Liverpool, United Kingdom
| | - A Brodbelt
- Walton Centre NHS Trust, Liverpool, United Kingdom
| | - A Chakrabarty
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - A Ismail
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - S Short
- Leeds Institute of Medical Research at St James’s, Leeds, United Kingdom
| | - L F Stead
- Leeds Institute of Medical Research at St James’s, Leeds, United Kingdom
| |
Collapse
|
19
|
Cunningham KS, Spears DA, Care M. Evaluation of cardiac hypertrophy in the setting of sudden cardiac death. Forensic Sci Res 2019; 4:223-240. [PMID: 31489388 PMCID: PMC6713129 DOI: 10.1080/20961790.2019.1633761] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 01/06/2023] Open
Abstract
Ventricular hypertrophy is a common pathological finding at autopsy that can act as a substrate for arrhythmogenesis. Pathologists grapple with the significance of ventricular hypertrophy when assessing the sudden and unexpected deaths of young people and what it could mean for surviving family members. The pathological spectrum of left ventricular hypertrophy (LVH) is reviewed herein. This article is oriented to the practicing autopsy pathologist to help make sense of various patterns of increased heart muscle, particularly those that are not clearly cardiomyopathic, yet present in the setting of sudden cardiac death. The article also reviews factors influencing arrhythmogenesis as well as genetic mutations most commonly associated with ventricular hypertrophy, especially those associated with hypertrophic cardiomyopathy (HCM).
Collapse
Affiliation(s)
- Kristopher S Cunningham
- Department of Laboratory Medicine and Pathobiology, Ontario Forensic Pathology Service, University of Toronto, Toronto, Canada
| | - Danna A Spears
- University Health Network, Division of Cardiology - Electrophysiology, University of Toronto, Toronto, Canada
| | - Melanie Care
- Fred A. Litwin Family Centre in Genetic Medicine and Inherited Arrhythmia Clinic, University Health Network & Mount Sinai Hospital, University of Toronto, Toronto, Canada
| |
Collapse
|
20
|
Hosseini SM, Kim R, Udupa S, Costain G, Jobling R, Liston E, Jamal SM, Szybowska M, Morel CF, Bowdin S, Garcia J, Care M, Sturm AC, Novelli V, Ackerman MJ, Ware JS, Hershberger RE, Wilde AA, Gollob MH. Reappraisal of Reported Genes for Sudden Arrhythmic Death: Evidence-Based Evaluation of Gene Validity for Brugada Syndrome. Circulation 2018; 138:1195-1205. [PMID: 29959160 PMCID: PMC6147087 DOI: 10.1161/circulationaha.118.035070] [Citation(s) in RCA: 218] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 06/11/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Implicit in the genetic evaluation of patients with suspected genetic diseases is the assumption that the genes evaluated are causative for the disease based on robust scientific and statistical evidence. However, in the past 20 years, considerable variability has existed in the study design and quality of evidence supporting reported gene-disease associations, raising concerns of the validity of many published disease-causing genes. Brugada syndrome (BrS) is an arrhythmia syndrome with a risk of sudden death. More than 20 genes have been reported to cause BrS and are assessed routinely on genetic testing panels in the absence of a systematic, evidence-based evaluation of the evidence supporting the causality of these genes. METHODS We evaluated the clinical validity of genes tested by diagnostic laboratories for BrS by assembling 3 gene curation teams. Using an evidence-based semiquantitative scoring system of genetic and experimental evidence for gene-disease associations, curation teams independently classified genes as demonstrating limited, moderate, strong, or definitive evidence for disease causation in BrS. The classification of curator teams was reviewed by a clinical domain expert panel that could modify the classifications based on their independent review and consensus. RESULTS Of 21 genes curated for clinical validity, biocurators classified only 1 gene ( SCN5A) as definitive evidence, whereas all other genes were classified as limited evidence. After comprehensive review by the clinical domain Expert panel, all 20 genes classified as limited evidence were reclassified as disputed with regard to any assertions of disease causality for BrS. CONCLUSIONS Our results contest the clinical validity of all but 1 gene clinically tested and reported to be associated with BrS. These findings warrant a systematic, evidence-based evaluation for reported gene-disease associations before use in patient care.
Collapse
Affiliation(s)
- S. Mohsen Hosseini
- Ted Rogers Cardiac Genome Clinic (S.M.H., R.K., R.J., E.L., S.B.), The Hospital for Sick Children, Toronto, Ontario, Canada
- * Drs Hosseini, Kim, and Udupa contributed equally
| | - Raymond Kim
- Ted Rogers Cardiac Genome Clinic (S.M.H., R.K., R.J., E.L., S.B.), The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Clinical and Metabolic Genetics (R.K., G.C., R.J., E.L., S.M.J., S.B.), The Hospital for Sick Children, Toronto, Ontario, Canada
- Fred A. Litwin Family Center in Genetic Medicine, University Health Network, Toronto, Ontario, Canada (R.K., M.S., C.F.M.)
- * Drs Hosseini, Kim, and Udupa contributed equally
| | - Sharmila Udupa
- Toronto General Hospital Research Institute, University of Toronto, Ontario, Canada (S.U., M.H.G.)
- * Drs Hosseini, Kim, and Udupa contributed equally
| | - Gregory Costain
- Division of Clinical and Metabolic Genetics (R.K., G.C., R.J., E.L., S.M.J., S.B.), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rebekah Jobling
- Ted Rogers Cardiac Genome Clinic (S.M.H., R.K., R.J., E.L., S.B.), The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Clinical and Metabolic Genetics (R.K., G.C., R.J., E.L., S.M.J., S.B.), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eriskay Liston
- Ted Rogers Cardiac Genome Clinic (S.M.H., R.K., R.J., E.L., S.B.), The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Clinical and Metabolic Genetics (R.K., G.C., R.J., E.L., S.M.J., S.B.), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Seema M. Jamal
- Division of Clinical and Metabolic Genetics (R.K., G.C., R.J., E.L., S.M.J., S.B.), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marta Szybowska
- Fred A. Litwin Family Center in Genetic Medicine, University Health Network, Toronto, Ontario, Canada (R.K., M.S., C.F.M.)
| | - Chantal F. Morel
- Fred A. Litwin Family Center in Genetic Medicine, University Health Network, Toronto, Ontario, Canada (R.K., M.S., C.F.M.)
| | - Sarah Bowdin
- Ted Rogers Cardiac Genome Clinic (S.M.H., R.K., R.J., E.L., S.B.), The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Clinical and Metabolic Genetics (R.K., G.C., R.J., E.L., S.M.J., S.B.), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - John Garcia
- Invitae Corporation, San Francisco, CA (J.G.)
| | - Melanie Care
- Peter Munk Cardiac Centre, Department of Medicine (M.C., M.H.G.), Toronto General Hospital, University of Toronto, Ontario, Canada
| | - Amy C. Sturm
- Geisinger Health System Genomic Medicine Institute, Danville, PA (A.C.S.)
| | - Valeria Novelli
- Centro Benito Stirpe per la Morte Improvvisa del Giovane Atleta, Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy (V.N.)
| | - Michael J. Ackerman
- Departments of Cardiovascular Diseases, Pediatrics, and Molecular Pharmacology and Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Rochester, MN (M.J.A.)
| | - James S. Ware
- National Heart and Lung Institute, MRC London Institute of Medical Sciences, Imperial College London, Royal Brompton & Harefield Hospitals, United Kingdom (J.S.W.)
| | - Ray E. Hershberger
- Department of Internal Medicine, Division of Human Genetics and Cardiovascular Division, Ohio State University, Columbus (R.E.H.)
| | - Arthur A.M. Wilde
- AMC Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands (A.A.M.W.)
- Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Saudi Arabia (A.A.M.W.). Columbia University Irving Medical Centre, New York (A.A.M.W.)
| | - Michael H. Gollob
- Toronto General Hospital Research Institute, University of Toronto, Ontario, Canada (S.U., M.H.G.)
- Peter Munk Cardiac Centre, Department of Medicine (M.C., M.H.G.), Toronto General Hospital, University of Toronto, Ontario, Canada
- Department of Physiology, Peter Munk Cardiovascular Molecular Medicine Laboratory (M.H.G.), Toronto General Hospital, University of Toronto, Ontario, Canada
| |
Collapse
|
21
|
Kushnir I, Kirk L, Mallick R, Kim R, Graham GE, Breau RH, Lattouf JB, Violette P, Pautler SE, Care M, Kapoor A, Jewett MA, Wood L, Tanguay S, Heng DYC, Basappa NS, So AI, Pouliot F, Reaume MN. Application of Canadian hereditary renal cell carcinoma risk criteria to a population database. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.621] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
621 Background: Canadian criteria for identifying patients (pts) and families at risk for hereditary renal cell carcinoma (RCC) were published in 2013. They included characteristics for pts with RCC (age ≤ 45 years, bilateral or multifocal tumours, associated medical conditions and non-clear cell histologies with unusual features) and for any pts who have a family history of specific clinical or genetic diagnoses associated with renal neoplasms. The clinical impact of these criteria on genetic testing had yet to be evaluated. Methods: The Canadian hereditary RCC risk criteria were applied to pts from 16 centres in the Canadian Kidney Cancer Information System prospective database. The primary endpoint was the proportion of pts who met at least one criterion. Secondary endpoints included the number of pts with more than one criterion and the number of pts receiving genetic testing (with or without at risk criteria). Results: From January 2011 to May 2017, 8097 pts were entered in the database. 2827 (35%) met at least one criterion for genetic testing. The majority (83%) met just 1 criterion, while 16% met 2 criteria. The criterion of non-clear cell histology with unusual features contributed the largest proportion of at risk pts (59%), followed by age ≤ 45 years (29%), then first or second degree relative with renal tumour (16%). 69 pts underwent genetic testing, with 59 being classified at risk ( < 3% of at risk). Details about the genetic testing results will be presented. Conclusions: The application of the Canadian hereditary RCC risk criteria to a population database resulted in 35% of pts being identified at risk for hereditary RCC. However, the true incidence of hereditary RCC in this population is unknown as most pts did not undergo genetic testing, and thus the sensitivity or specificity of the criteria cannot be determined. The low proportion of at risk pts that underwent genetic testing was disappointing and highlights that there may be gaps in reporting, knowledge and/or barriers in access to genetic testing. The results have helped determine the proportion of at risk pts in Canada, what criteria are most common, and importantly, have established a foundation and benchmark to improve upon.
Collapse
Affiliation(s)
- Igal Kushnir
- Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Leah Kirk
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Raymond Kim
- University Health Network, Toronto, ON, Canada
| | - Gail E Graham
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | | | | | | | - Stephen E. Pautler
- St. Joseph Health Care London, University of Western Ontario, London, ON, Canada
| | | | - Anil Kapoor
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Michael A.S. Jewett
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Lori Wood
- QEII Health Sciences Centre, Halifax, NS, Canada
| | | | | | | | - Alan I. So
- Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada
| | | | | |
Collapse
|
22
|
Vrzalikova K, Ibrahim M, Vockerodt M, Perry T, Margielewska S, Lupino L, Nagy E, Soilleux E, Liebelt D, Hollows R, Last A, Reynolds G, Abdullah M, Curley H, Care M, Krappmann D, Tooze R, Allegood J, Spiegel S, Wei W, Woodman CBJ, Murray PG. S1PR1 drives a feedforward signalling loop to regulate BATF3 and the transcriptional programme of Hodgkin lymphoma cells. Leukemia 2018; 32:214-223. [PMID: 28878352 PMCID: PMC5737877 DOI: 10.1038/leu.2017.275] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 02/14/2017] [Revised: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 12/15/2022]
Abstract
The Hodgkin/Reed-Sternberg cells of classical Hodgkin lymphoma (HL) are characterised by the aberrant activation of multiple signalling pathways. Here we show that a subset of HL displays altered expression of sphingosine-1-phosphate (S1P) receptors (S1PR)s. S1P activates phosphatidylinositide 3-kinase (PI3-K) in these cells that is mediated by the increased expression of S1PR1 and the decreased expression of S1PR2. We also showed that genes regulated by the PI3-K signalling pathway in HL cell lines significantly overlap with the transcriptional programme of primary HRS cells. Genes upregulated by the PI3-K pathway included the basic leucine zipper transcription factor, ATF-like 3 (BATF3), which is normally associated with the development of dendritic cells. Immunohistochemistry confirmed that BATF3 was expressed in HRS cells of most HL cases. In contrast, in normal lymphoid tissues, BATF3 expression was confined to a small fraction of CD30-positive immunoblasts. Knockdown of BATF3 in HL cell lines revealed that BATF3 contributed to the transcriptional programme of primary HRS cells, including the upregulation of S1PR1. Our data suggest that disruption of this potentially oncogenic feedforward S1P signalling loop could provide novel therapeutic opportunities for patients with HL.
Collapse
Affiliation(s)
- K Vrzalikova
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - M Ibrahim
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - M Vockerodt
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Institute of Anatomy and Cell Biology, Georg-August University of Göttingen, Göttingen, Germany
| | - T Perry
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - S Margielewska
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - L Lupino
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - E Nagy
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - E Soilleux
- Department of Cellular Pathology, John Radcliffe Hospital, Oxford, UK
| | - D Liebelt
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - R Hollows
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - A Last
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - G Reynolds
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - M Abdullah
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Department of Pathology, Universiti Putra Malaysia, Selangor, Malaysia
| | - H Curley
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - M Care
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - D Krappmann
- Research Unit Cellular Signal Integration, Helmholtz Zentrum München, Neuherberg, Germany
| | - R Tooze
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - J Allegood
- Department of Biochemistry and Molecular Biology and Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - S Spiegel
- Department of Biochemistry and Molecular Biology and Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - W Wei
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Sheffield Institute of Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - C B J Woodman
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - P G Murray
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Department of Clinical and Molecular Pathology, Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| |
Collapse
|
23
|
Rafiq MA, Chaudhry A, Care M, Spears DA, Morel CF, Hamilton RM. Whole exome sequencing identified 1 base pair novel deletion in BCL2-associated athanogene 3 (BAG3) gene associated with severe dilated cardiomyopathy (DCM) requiring heart transplant in multiple family members. Am J Med Genet A 2017; 173:699-705. [PMID: 28211974 DOI: 10.1002/ajmg.a.38087] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 12/03/2015] [Accepted: 11/15/2016] [Indexed: 02/03/2023]
Abstract
Dilated cardiomyopathy (DCM) is characterized by dilation and impaired contraction of the left ventricle or both ventricles. Among hereditary DCM, the genetic causes are heterogeneous, and include mutations encoding cytoskeletal, nucleoskeletal, mitochondrial, and calcium-handling proteins. We report three severely affected males, in a four-generation pedigree, with DCM phenotype who underwent cardiac transplant. Cardiomegaly with marked biventricular dilation and fibrosis were noticeable histopathological findings. The affected males had tested negative on a 46-gene pancardiomyopathy panel. Whole Exome Sequencing (WES) was performed to reveal mutation in the gene responsible in generation of DCM phenotypes. The 1-bp (Chr10:121435979delC; c.913delC) novel heterozygous deletion in exon 4 of BAG3, was identified in three affected males, resulted in frame-shift and a premature termination codon (p.Met306-Stop) producing a truncated BAG3 protein lacking functionally important PXXP and BAG domains. WES data were further utilized to map 10 SNP markers around the discovered mutation to generate shared disease haplotype in all affected individuals encompassing 11 Mb on 10q25.3-26.2 harboring BAG3. Finally genotypes were inferred for the unavailable/deceased individuals in the pedigrees. Here we propose that Chr10:121435979delC in BAG3 is a causal mutation in these subjects. Our and earlier studies indicate that BAG3 mutations are associated with DCM phenotypes. BAG3 should be added to cardiomyopathy gene panels for screening of DCM patients, and patients previously considered gene elusive should undergo sequencing of the BAG3 gene. © 2017 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Muhammad Arshad Rafiq
- Physiology and Experimental Medicine, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada.,Department of Bio-Sciences, COMSATS Institute of Information Technology (CIIT), Islamabad, Pakistan
| | - Ayeshah Chaudhry
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Melanie Care
- Fred A. Litwin Family Center in Genetic Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Danna A Spears
- Division of Cardiology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Chantal F Morel
- Fred A. Litwin Family Center in Genetic Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert M Hamilton
- Physiology and Experimental Medicine, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| |
Collapse
|
24
|
Abstract
PURPOSE OF REVIEW Genetic testing has become an important element in the care of patients with inherited cardiac conditions (ICCs). The purpose of this review is to provide clinicians with insights into the utility of genetic testing as well as challenges associated with interpreting results. RECENT FINDINGS Genetic testing may be indicated for individuals who are affected with or who have family histories of various ICCs. Various testing options are available and determining the most appropriate test for any given clinical scenario is key when interpreting results. Newly published guidelines as well as various publicly accessible tools are available to clinicians to help with interpretation of genetic findings; however the subjectivity with respect to variant classification can make accurate assessment challenging. Genetic information can provide highly useful and relevant information for patients, their family members, and their healthcare providers. Given the potential ramifications of variant misclassification, expertise in both clinical phenotyping and molecular genetics is imperative in order to provide accurate diagnosis, management recommendations, and family risk assessment for this patient population.
Collapse
Affiliation(s)
- Melanie Care
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, 200 Elizabeth St., Toronto, ON, M5G 2C4, Canada.,Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Vijay Chauhan
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, 200 Elizabeth St., Toronto, ON, M5G 2C4, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Danna Spears
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, 200 Elizabeth St., Toronto, ON, M5G 2C4, Canada. .,Department of Medicine, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
25
|
Goodlad J, van Hoppe S, Ahmed S, Barrans S, Painter D, Care M, Taylor J, Evans P, Bentley M, Tooze R, Smith A, Crouch S, Roman E, Westhead D, Burton C. Molecular analysis of primary cutaneous diffuse large B-cell lymphoma, leg type. Hematol Oncol 2017. [DOI: 10.1002/hon.2439_2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - S. Ahmed
- HMDS; Leeds Cancer Centre; Leeds UK
| | | | - D. Painter
- Epidemiology and Cancer Statistics; University of York; York UK
| | - M. Care
- Institute of Molecular and Cellular Biology; University of Leeds; Leeds UK
| | | | - P. Evans
- HMDS; Leeds Cancer Centre; Leeds UK
| | - M. Bentley
- Institute of Molecular and Cellular Biology; University of Leeds; Leeds UK
| | - R.M. Tooze
- Institute of Molecular and Cellular Biology; University of Leeds; Leeds UK
| | - A. Smith
- Epidemiology and Cancer Statistics; University of York; York UK
| | - S. Crouch
- Epidemiology and Cancer Statistics; University of York; York UK
| | - E. Roman
- Epidemiology and Cancer Statistics; University of York; York UK
| | - D.R. Westhead
- Institute of Molecular and Cellular Biology; University of Leeds; Leeds UK
| | | |
Collapse
|
26
|
Burton C, Sha C, Barrans S, Jack A, Painter D, Smith A, Roman E, Crouch S, Care M, Tooze R, Westhead D. A category-free approach to prognostic modelling in aggressive non-Hodgkin B cell lymphomas based on large patient databases. Hematol Oncol 2017. [DOI: 10.1002/hon.2439_70] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- C. Burton
- Leeds Cancer Centre; Haematology Malignancy Diagnostic Service; Leeds UK
| | - C. Sha
- University of Leeds; Institute of Molecular and Cellular Biology; Leeds UK
| | - S. Barrans
- Leeds Cancer Centre; Haematology Malignancy Diagnostic Service; Leeds UK
| | - A. Jack
- Leeds Cancer Centre; Haematology Malignancy Diagnostic Service; Leeds UK
| | - D. Painter
- University of York; Epidemiology and Cancer Statistics Group; York UK
| | - A. Smith
- University of York; Epidemiology and Cancer Statistics Group; York UK
| | - E. Roman
- University of York; Epidemiology and Cancer Statistics Group; York UK
| | - S. Crouch
- University of York; Epidemiology and Cancer Statistics Group; York UK
| | - M. Care
- University of Leeds; Leeds Institute of Cancer and Pathology; Leeds UK
| | - R. Tooze
- University of Leeds; Leeds Institute of Cancer and Pathology; Leeds UK
| | - D. Westhead
- University of Leeds; Institute of Molecular and Cellular Biology; Leeds UK
| |
Collapse
|
27
|
Weissler-Snir A, Hindieh W, Gruner C, Fourey D, Appelbaum E, Rowin E, Care M, Lesser JR, Haas TS, Udelson JE, Manning WJ, Olivotto I, Tomberli B, Maron BJ, Maron MS, Crean AM, Rakowski H, Chan RH. Lack of Phenotypic Differences by Cardiovascular Magnetic Resonance Imaging in MYH7 (β-Myosin Heavy Chain)- Versus MYBPC3 (Myosin-Binding Protein C)-Related Hypertrophic Cardiomyopathy. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005311. [PMID: 28193612 DOI: 10.1161/circimaging.116.005311] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 12/19/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND The 2 most commonly affected genes in hypertrophic cardiomyopathy (HCM) are MYH7 (β-myosin heavy chain) and MYBPC3 (β-myosin-binding protein C). Phenotypic differences between patients with mutations in these 2 genes have been inconsistent. Scarce data exist on the genotype-phenotype association as assessed by tomographic imaging using cardiac magnetic resonance imaging. METHODS AND RESULTS Cardiac magnetic resonance imaging was performed on 358 consecutive genotyped hypertrophic cardiomyopathy probands at 5 tertiary hypertrophic cardiomyopathy centers. Genetic testing revealed a pathogenic mutation in 159 patients (44.4%). The most common genes identified were MYH7 (n=53) and MYBPC3 (n=75); 33.1% and 47% of genopositive patients, respectively. Phenotypic characteristics by cardiac magnetic resonance imaging of these 2 groups were similar, including left ventricular volumes, mass, maximal wall thickness, morphology, left atrial volume, and mitral valve leaflet lengths (all P=non-significant). The presence of late gadolinium enhancement (65% versus 64%; P=0.99) and the proportion of total left ventricular mass (%late gadolinium enhancement; 10.4±13.2% versus 8.5±8.5%; P=0.44) were also similar. CONCLUSIONS This multicenter multinational study shows lack of phenotypic differences between MYH7- and MYBPC3-associated hypertrophic cardiomyopathy when assessed by cardiac magnetic resonance imaging. Postmutational mechanisms appear more relevant to thick-filament disease expression and outcome than the disease-causing variant per se.
Collapse
MESH Headings
- Adult
- Canada
- Cardiac Myosins/genetics
- Cardiomyopathy, Hypertrophic, Familial/diagnostic imaging
- Cardiomyopathy, Hypertrophic, Familial/genetics
- Cardiomyopathy, Hypertrophic, Familial/physiopathology
- Carrier Proteins/genetics
- Contrast Media/administration & dosage
- Europe
- Female
- Gadolinium DTPA/administration & dosage
- Genetic Association Studies
- Genetic Predisposition to Disease
- Humans
- Image Interpretation, Computer-Assisted
- Imaging, Three-Dimensional
- Magnetic Resonance Imaging, Cine
- Male
- Middle Aged
- Mutation
- Myosin Heavy Chains/genetics
- Phenotype
- Predictive Value of Tests
- Registries
- Risk Factors
- Stroke Volume
- Tertiary Care Centers
- United States
- Ventricular Function, Left
- Ventricular Remodeling
Collapse
Affiliation(s)
- Adaya Weissler-Snir
- From the Division of Cardiology (A.W.-S., W.H., C.G., D.F., M.C., A.M.C., H.R., R.H.C.) and Joint Department of Medical Imaging (A.M.C.), University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Cardiovascular Center, University Hospital Zurich, Switzerland (C.G.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.A., W.J.M., R.H.C.); Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (E.R., J.E.U., B.J.M., M.S.M.); The Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, MN (J.R.L., T.S.H.); and Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy (I.O., B.T.)
| | - Waseem Hindieh
- From the Division of Cardiology (A.W.-S., W.H., C.G., D.F., M.C., A.M.C., H.R., R.H.C.) and Joint Department of Medical Imaging (A.M.C.), University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Cardiovascular Center, University Hospital Zurich, Switzerland (C.G.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.A., W.J.M., R.H.C.); Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (E.R., J.E.U., B.J.M., M.S.M.); The Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, MN (J.R.L., T.S.H.); and Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy (I.O., B.T.)
| | - Christiane Gruner
- From the Division of Cardiology (A.W.-S., W.H., C.G., D.F., M.C., A.M.C., H.R., R.H.C.) and Joint Department of Medical Imaging (A.M.C.), University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Cardiovascular Center, University Hospital Zurich, Switzerland (C.G.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.A., W.J.M., R.H.C.); Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (E.R., J.E.U., B.J.M., M.S.M.); The Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, MN (J.R.L., T.S.H.); and Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy (I.O., B.T.)
| | - Dana Fourey
- From the Division of Cardiology (A.W.-S., W.H., C.G., D.F., M.C., A.M.C., H.R., R.H.C.) and Joint Department of Medical Imaging (A.M.C.), University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Cardiovascular Center, University Hospital Zurich, Switzerland (C.G.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.A., W.J.M., R.H.C.); Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (E.R., J.E.U., B.J.M., M.S.M.); The Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, MN (J.R.L., T.S.H.); and Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy (I.O., B.T.)
| | - Evan Appelbaum
- From the Division of Cardiology (A.W.-S., W.H., C.G., D.F., M.C., A.M.C., H.R., R.H.C.) and Joint Department of Medical Imaging (A.M.C.), University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Cardiovascular Center, University Hospital Zurich, Switzerland (C.G.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.A., W.J.M., R.H.C.); Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (E.R., J.E.U., B.J.M., M.S.M.); The Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, MN (J.R.L., T.S.H.); and Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy (I.O., B.T.)
| | - Ethan Rowin
- From the Division of Cardiology (A.W.-S., W.H., C.G., D.F., M.C., A.M.C., H.R., R.H.C.) and Joint Department of Medical Imaging (A.M.C.), University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Cardiovascular Center, University Hospital Zurich, Switzerland (C.G.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.A., W.J.M., R.H.C.); Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (E.R., J.E.U., B.J.M., M.S.M.); The Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, MN (J.R.L., T.S.H.); and Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy (I.O., B.T.)
| | - Melanie Care
- From the Division of Cardiology (A.W.-S., W.H., C.G., D.F., M.C., A.M.C., H.R., R.H.C.) and Joint Department of Medical Imaging (A.M.C.), University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Cardiovascular Center, University Hospital Zurich, Switzerland (C.G.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.A., W.J.M., R.H.C.); Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (E.R., J.E.U., B.J.M., M.S.M.); The Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, MN (J.R.L., T.S.H.); and Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy (I.O., B.T.)
| | - John R Lesser
- From the Division of Cardiology (A.W.-S., W.H., C.G., D.F., M.C., A.M.C., H.R., R.H.C.) and Joint Department of Medical Imaging (A.M.C.), University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Cardiovascular Center, University Hospital Zurich, Switzerland (C.G.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.A., W.J.M., R.H.C.); Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (E.R., J.E.U., B.J.M., M.S.M.); The Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, MN (J.R.L., T.S.H.); and Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy (I.O., B.T.)
| | - Tammy S Haas
- From the Division of Cardiology (A.W.-S., W.H., C.G., D.F., M.C., A.M.C., H.R., R.H.C.) and Joint Department of Medical Imaging (A.M.C.), University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Cardiovascular Center, University Hospital Zurich, Switzerland (C.G.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.A., W.J.M., R.H.C.); Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (E.R., J.E.U., B.J.M., M.S.M.); The Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, MN (J.R.L., T.S.H.); and Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy (I.O., B.T.)
| | - James E Udelson
- From the Division of Cardiology (A.W.-S., W.H., C.G., D.F., M.C., A.M.C., H.R., R.H.C.) and Joint Department of Medical Imaging (A.M.C.), University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Cardiovascular Center, University Hospital Zurich, Switzerland (C.G.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.A., W.J.M., R.H.C.); Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (E.R., J.E.U., B.J.M., M.S.M.); The Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, MN (J.R.L., T.S.H.); and Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy (I.O., B.T.)
| | - Warren J Manning
- From the Division of Cardiology (A.W.-S., W.H., C.G., D.F., M.C., A.M.C., H.R., R.H.C.) and Joint Department of Medical Imaging (A.M.C.), University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Cardiovascular Center, University Hospital Zurich, Switzerland (C.G.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.A., W.J.M., R.H.C.); Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (E.R., J.E.U., B.J.M., M.S.M.); The Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, MN (J.R.L., T.S.H.); and Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy (I.O., B.T.)
| | - Iacopo Olivotto
- From the Division of Cardiology (A.W.-S., W.H., C.G., D.F., M.C., A.M.C., H.R., R.H.C.) and Joint Department of Medical Imaging (A.M.C.), University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Cardiovascular Center, University Hospital Zurich, Switzerland (C.G.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.A., W.J.M., R.H.C.); Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (E.R., J.E.U., B.J.M., M.S.M.); The Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, MN (J.R.L., T.S.H.); and Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy (I.O., B.T.)
| | - Benedetta Tomberli
- From the Division of Cardiology (A.W.-S., W.H., C.G., D.F., M.C., A.M.C., H.R., R.H.C.) and Joint Department of Medical Imaging (A.M.C.), University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Cardiovascular Center, University Hospital Zurich, Switzerland (C.G.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.A., W.J.M., R.H.C.); Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (E.R., J.E.U., B.J.M., M.S.M.); The Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, MN (J.R.L., T.S.H.); and Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy (I.O., B.T.)
| | - Barry J Maron
- From the Division of Cardiology (A.W.-S., W.H., C.G., D.F., M.C., A.M.C., H.R., R.H.C.) and Joint Department of Medical Imaging (A.M.C.), University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Cardiovascular Center, University Hospital Zurich, Switzerland (C.G.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.A., W.J.M., R.H.C.); Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (E.R., J.E.U., B.J.M., M.S.M.); The Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, MN (J.R.L., T.S.H.); and Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy (I.O., B.T.)
| | - Martin S Maron
- From the Division of Cardiology (A.W.-S., W.H., C.G., D.F., M.C., A.M.C., H.R., R.H.C.) and Joint Department of Medical Imaging (A.M.C.), University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Cardiovascular Center, University Hospital Zurich, Switzerland (C.G.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.A., W.J.M., R.H.C.); Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (E.R., J.E.U., B.J.M., M.S.M.); The Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, MN (J.R.L., T.S.H.); and Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy (I.O., B.T.)
| | - Andrew M Crean
- From the Division of Cardiology (A.W.-S., W.H., C.G., D.F., M.C., A.M.C., H.R., R.H.C.) and Joint Department of Medical Imaging (A.M.C.), University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Cardiovascular Center, University Hospital Zurich, Switzerland (C.G.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.A., W.J.M., R.H.C.); Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (E.R., J.E.U., B.J.M., M.S.M.); The Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, MN (J.R.L., T.S.H.); and Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy (I.O., B.T.)
| | - Harry Rakowski
- From the Division of Cardiology (A.W.-S., W.H., C.G., D.F., M.C., A.M.C., H.R., R.H.C.) and Joint Department of Medical Imaging (A.M.C.), University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Cardiovascular Center, University Hospital Zurich, Switzerland (C.G.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.A., W.J.M., R.H.C.); Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (E.R., J.E.U., B.J.M., M.S.M.); The Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, MN (J.R.L., T.S.H.); and Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy (I.O., B.T.)
| | - Raymond H Chan
- From the Division of Cardiology (A.W.-S., W.H., C.G., D.F., M.C., A.M.C., H.R., R.H.C.) and Joint Department of Medical Imaging (A.M.C.), University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Cardiovascular Center, University Hospital Zurich, Switzerland (C.G.); Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.A., W.J.M., R.H.C.); Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA (E.R., J.E.U., B.J.M., M.S.M.); The Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, MN (J.R.L., T.S.H.); and Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy (I.O., B.T.).
| |
Collapse
|
28
|
Fourey D, Care M, Siminovitch KA, Weissler-Snir A, Hindieh W, Chan RH, Gollob MH, Rakowski H, Adler A. Prevalence and Clinical Implication of Double Mutations in Hypertrophic Cardiomyopathy. ACTA ACUST UNITED AC 2017; 10:CIRCGENETICS.116.001685. [DOI: 10.1161/circgenetics.116.001685] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 02/07/2017] [Indexed: 11/16/2022]
Abstract
Background—
Available data suggests that double mutations in patients with hypertrophic cardiomyopathy are not rare and are associated with a more severe phenotype. Most of this data, however, is based on noncontemporary variant classification.
Methods and Results—
Clinical data of all hypertrophic cardiomyopathy patients with 2 rare genetic variants were retrospectively reviewed and compared with a group of patients with a single disease-causing variant. Furthermore, a literature search was performed for all studies with information on prevalence and outcome of patients with double mutations. Classification of genetic variants was reanalyzed according to current guidelines. In our cohort (n=1411), 9% of gene-positive patients had 2 rare variants in sarcomeric genes but only in 1 case (0.4%) were both variants classified as pathogenic. Patients with 2 rare variants had a trend toward younger age at presentation when compared with patients with a single mutation. All other clinical variables were similar. In data pooled from cohort studies in the literature, 8% of gene-positive patients were published to have double mutations. However, after reanalysis of reported variants, this prevalence diminished to 0.4%. All patients with 2 radical mutations in
MYBPC3
in the literature had severe disease with death or heart transplant during the first year of life. Data on other specific genotype–phenotype correlations were scarce.
Conclusions—
Double mutations in patients with hypertrophic cardiomyopathy are much less common than previously estimated. With the exception of double radical
MYBPC3
mutations, there is little data to guide clinical decision making in cases with double mutations.
Collapse
Affiliation(s)
- Dana Fourey
- From the Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada (D.F., A.W.-S., W.H., R.H.C., M.H.G., H.R., A.A.); Fred A. Litwin & Family Center in Genetic Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada (M.C., K.A.S.)
| | - Melanie Care
- From the Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada (D.F., A.W.-S., W.H., R.H.C., M.H.G., H.R., A.A.); Fred A. Litwin & Family Center in Genetic Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada (M.C., K.A.S.)
| | - Katherine A. Siminovitch
- From the Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada (D.F., A.W.-S., W.H., R.H.C., M.H.G., H.R., A.A.); Fred A. Litwin & Family Center in Genetic Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada (M.C., K.A.S.)
| | - Adaya Weissler-Snir
- From the Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada (D.F., A.W.-S., W.H., R.H.C., M.H.G., H.R., A.A.); Fred A. Litwin & Family Center in Genetic Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada (M.C., K.A.S.)
| | - Waseem Hindieh
- From the Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada (D.F., A.W.-S., W.H., R.H.C., M.H.G., H.R., A.A.); Fred A. Litwin & Family Center in Genetic Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada (M.C., K.A.S.)
| | - Raymond H. Chan
- From the Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada (D.F., A.W.-S., W.H., R.H.C., M.H.G., H.R., A.A.); Fred A. Litwin & Family Center in Genetic Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada (M.C., K.A.S.)
| | - Michael H. Gollob
- From the Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada (D.F., A.W.-S., W.H., R.H.C., M.H.G., H.R., A.A.); Fred A. Litwin & Family Center in Genetic Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada (M.C., K.A.S.)
| | - Harry Rakowski
- From the Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada (D.F., A.W.-S., W.H., R.H.C., M.H.G., H.R., A.A.); Fred A. Litwin & Family Center in Genetic Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada (M.C., K.A.S.)
| | - Arnon Adler
- From the Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada (D.F., A.W.-S., W.H., R.H.C., M.H.G., H.R., A.A.); Fred A. Litwin & Family Center in Genetic Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada (M.C., K.A.S.)
| |
Collapse
|
29
|
Weissler-Snir A, Gollob MH, Chauhan V, Care M, Spears DA. Evaluation of Prolonged QT Interval: Structural Heart Disease Mimicking Long QT Syndrome. Pacing Clin Electrophysiol 2017; 40:417-424. [PMID: 28155223 DOI: 10.1111/pace.13040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 12/20/2016] [Accepted: 01/08/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND In about 20-25% of patients with congenital long QT syndrome (LQTS) a causative pathogenic mutation is not found. The aim of this study was to explore the prevalence of alternative cardiac diagnoses among patients exhibiting prolongation of QT interval with negative genetic testing for LQTS genes. METHODS We conducted a retrospective analysis of 239 consecutive patients who were evaluated in the inherited arrhythmia clinic at the Toronto General Hospital between July 2013 and December 2015 for possible LQTS. A detailed review of the patients' charts, electrocardiograms, and imaging was carried out. RESULTS The analysis included 56 gene-negative patients and 61 gene-positive patients. Of the gene-negative group, 25% had structural heart disease compared to only 1.6% of gene-positive patients (P < 0.001). Structural heart disease was more likely if only one abnormal QTc parameter was found in the course of the evaluation (35.2% vs 9.1%, P = 0.01). The most common structural cardiac pathology was bileaflet mitral valve prolapse (8.9%). No gene-positive patient had episodes of nonsustained ventricular tachycardia, compared to seven of the gene-negative patients (0% vs 12.5%, P = 0.005). CONCLUSIONS Structural pathology was detected in a quarter of gene-negative patients evaluated for possible LQTS. Hence, cardiac imaging and Holter monitoring should be strongly encouraged to rule out structural heart disease in this population.
Collapse
Affiliation(s)
- Adaya Weissler-Snir
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Michael H Gollob
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Vijay Chauhan
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Melanie Care
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Danna A Spears
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
30
|
Porta-Sánchez A, Spillane DR, Harris L, Xue J, Dorsey P, Care M, Chauhan V, Gollob MH, Spears DA. T-Wave Morphology Analysis in Congenital Long QT Syndrome Discriminates Patients From Healthy Individuals. JACC Clin Electrophysiol 2016; 3:374-381. [PMID: 29759450 DOI: 10.1016/j.jacep.2016.10.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 07/05/2016] [Revised: 10/18/2016] [Accepted: 10/20/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study aims to assess the capability of T-wave analysis to: 1) identify genotype-positive long QT syndrome (LQTS) patients; 2) identify LQTS patients with borderline or normal QTc interval (≤460 ms); and 3) classify LQTS subtype. BACKGROUND LQTS often presents with a nondiagnostic electrocardiogram (ECG). T-wave abnormalities may be the only marker of this potentially lethal arrhythmia syndrome. METHODS ECGs taken at rest in 108 patients (43 with LQTS1, 20 with LQTS2, and 45 control subjects) were evaluated for T-wave flatness, asymmetry, and notching, which produces a morphology combination score (MCS) of the 3 features (MCS = 1.6 × flatness + asymmetry + notch) using QT Guard Plus Software (GE Healthcare, Milwaukee, Wisconsin). To assess for heterogeneity of repolarization, the principal component analysis ratio 2 (PCA-2) was calculated. RESULTS Mean QTc intervals were 486 ± 50 ms (LQTS1), 479 ± 36 ms (LQTS2), and 418 ± 24 ms (control subjects) (p < 0.05). MCS and PCA-2 differed between LQTS patients and control subjects (MCS: 117.8 ± 57.4 vs. 71.9 ± 16.2; p < 0.001; PCA-2: 20.2 ± 10.4% vs. 14.6 ± 5.5%; p < 0.001), LQTS1 and LQTS2 patients (MCS: 96.3 ± 28.7 vs. 164 ± 75.2; p < 0.001; PCA-2: 17.8 ± 8.3% vs. 25 ± 12.6%; p < 0.001), and between LQTS patients with borderline or normal QTc intervals (n = 17) and control subjects (MCS: 105.7 ± 49.9 vs. 71.9 ± 16.2; p < 0.001; PCA-2: 18.1 ± 7.2% vs. 14.6 ± 5.5%; p < 0.001). T-wave metrics were consistent across multiple ECGs from individual patients based on the average intraclass correlation coefficient (MCS: 0.96; PCA-2: 0.86). CONCLUSIONS Automated T-wave morphology analysis accurately discriminates patients with pathogenic LQTS mutations from control subjects and between the 2 most common LQTS subtypes. Mutation carriers without baseline QTc prolongation were also identified. This may be a useful tool for screening families of LQTS patients, particularly when the QTc interval is subthreshold and genetic testing is unavailable.
Collapse
Affiliation(s)
- Andreu Porta-Sánchez
- Division of Cardiology, Peter Munk Cardiac Center, University Health Network, Toronto, Ontario, Canada
| | - David R Spillane
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Louise Harris
- Division of Cardiology, Peter Munk Cardiac Center, University Health Network, Toronto, Ontario, Canada
| | - Joel Xue
- GE Healthcare, Wauwatosa, Wisconsin
| | | | | | - Vijay Chauhan
- Division of Cardiology, Peter Munk Cardiac Center, University Health Network, Toronto, Ontario, Canada
| | - Michael H Gollob
- Division of Cardiology, Peter Munk Cardiac Center, University Health Network, Toronto, Ontario, Canada
| | - Danna A Spears
- Division of Cardiology, Peter Munk Cardiac Center, University Health Network, Toronto, Ontario, Canada.
| |
Collapse
|
31
|
Weissler-Snir A, Chan RH, Adler A, Care M, Chauhan V, Gollob MH, Ziv-Baran T, Fourey D, Hindieh W, Rakowski H, Spears DA. Usefulness of 14-Day Holter for Detection of Nonsustained Ventricular Tachycardia in Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 2016; 118:1258-1263. [PMID: 27567133 DOI: 10.1016/j.amjcard.2016.07.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/21/2016] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
Abstract
Nonsustained ventricular tachycardia (NSVT), defined as ≥3 consecutive ventricular beats at ≥120 beats/min lasting <30 seconds, is an independent predictor of sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HC). Current guidelines recommend 24- to 48-hour Holter monitoring as part of SCD risk stratification. We sought to assess the difference in diagnostic yield of 14-day Holter monitoring compared to 24-48 hours for the detection of NSVT and to assess the prevalence and characteristics of NSVT in patients with HC with prolonged monitoring. We retrospectively analyzed the 14-day Holter monitors of 77 patients with HC from May 2014 to March 2016. Number of episodes and maximal length and rate on each day were recorded. NSVT was detected in 75.3% of patients during 14-day Holter monitoring. The median number of runs was 2 (range 0 to 26 runs). The median number of beats of the longest run was 10.5 (range 3 to 68 beats) with a mean maximum rate of 159.5 ± 20.8.4 beats/min (range 102 to 203 beats/min). First episodes of NSVT were detected throughout the 14 days, with only 22.5% and 44.8% of the episodes captured within the first 24 and 48 hours of monitoring, respectively. In conclusion, prolonged Holter monitoring revealed ≥1 episode of NSVT in 75% of patients with HC of which <50% were detected within the first 48 hours. Hence, prolonged Holter monitoring may be superior for SCD risk stratification in HC. However, the high prevalence of NSVT in this population may limit its utility in evaluating the risk for SCD of the individual patient.
Collapse
|
32
|
Lattouf JB, Pautler SE, Reaume MN, Kim RH, Care M, Green J, So A, Violette PD, Saliba I, Major P, Silver S, Leicht R, Basiuk J, Tanguay S, Jewett MAS, Drachenberg D. Structured assessment and followup for patients with hereditary kidney tumour syndromes. Can Urol Assoc J 2016; 10:E214-E222. [PMID: 28255411 DOI: 10.5489/cuaj.3798] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Optimal clinical assessment and subsequent followup of patients with or suspected of having a hereditary renal cell carcinoma syndrome (hRCC) is not standardized and practice varies widely. We propose protocols to optimize these processes in patients with hRCC to encourage a more uniform approach to management that can then be evaluated. METHODS A review of the literature, including existing guidelines, was carried out for the years 1985-2015. Expert consensus was used to define recommendations for initial assessment and followup. RESULTS Recommendations for newly diagnosed patients' assessment and optimal ages to initiate followup protocols for von Hippel Lindau disease (VHL), hereditary papillary renal cancer (HPRC), hereditary leiomyomatosis with renal cell carcinoma (HLRCC), Birt-Hogg-Dubé syndrome (BHD), familial paraganglioma-pheochromocytoma syndromes (PGL-PCC), and tuberous sclerosis (TSC) are proposed. CONCLUSIONS Our proposed consensus for structured assessment and followup is intended as a roadmap for the care of patients with hRCC to guide healthcare providers. Although the list of syndromes included is not exhaustive, the document serves as a starting point for future updates.
Collapse
Affiliation(s)
- Jean-Baptiste Lattouf
- Division of Urology, Department of Surgery, University of Montreal Hospital Centre, Montreal, QC, Canada
| | - Stephen E Pautler
- Divisions of Urology and Surgical Oncology, Departments of Surgery and Oncology, Western University, London, ON, Canada
| | - M Neil Reaume
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | - Raymond H Kim
- Division of Medical Oncology, Department of Medicine, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Melanie Care
- Fred A. Litwin Family Centre in Genetic Medicine, University Health Network & Mount Sinai Hospital, Toronto, ON, Canada
| | - Jane Green
- Disciplines of Genetics and Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Alan So
- Department of Urologic Sciences, Faculty of Medicine, Vancouver General Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Philippe D Violette
- Division of Urology, Department of Surgery, Woodstock General Hospital, Woodstock, ON, Canada
| | - Issam Saliba
- Division of ENT, Department of Surgery, University of Montreal Hospital Centre, Montreal, QC, Canada
| | - Philippe Major
- CHU Sainte-Justine, Department of Neurosciences, University of Montreal, Montreal, QC, Canada
| | - Shane Silver
- Faculty of Medicine and the Division of Dermatology, University of Manitoba, Winnipeg, MB, Canada
| | - Richard Leicht
- Department of Ophthalmology, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Joan Basiuk
- Kidney Cancer Research Network of Canada, Toronto, ON, Canada
| | - Simon Tanguay
- Division of Urology, McGill University, Montreal, QC, Canada
| | - Michael A S Jewett
- Division of Urology, Departments of Surgical Oncology and Surgery, Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON, Canada
| | - Darrel Drachenberg
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | | |
Collapse
|
33
|
Violette PD, Kamel-Reid S, Graham GE, Reaume MN, Jewett MA, Care M, Basiuk J, Pautler SE. Knowledge of genetic testing for hereditary kidney cancer in Canada is lacking: The results of the Canadian national hereditary kidney cancer needs assessment survey. Can Urol Assoc J 2014; 8:E832-40. [PMID: 25485012 DOI: 10.5489/cuaj.2415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTON Treatment of hereditary renal cell carcinoma (HRCC) requires a multidisciplinary approach that may involve medical oncologists, geneticists, genetic counsellors, and urologists. The objective of our survey was to obtain current and representative information about the use and perceived importance of genetic testing for HRCC in Canada. METHODS A self-administered web-based survey was provided to Canadian medical oncologists, geneticists, genetic counsellors, and urologists in collaboration with their respective associations. The survey was created through an iterative process in consultation with the Kidney Cancer Research Network of Canada and contained both quantitative and qualitative components. The survey was designed to be exploratory and results were compared across regions. RESULTS The overall response was low (6.6%). Of the respondents, 42%, 33%, 19%, 5% were genetic counsellors, urologists, medical oncologists and medical geneticists, respectively. Of the respondents, 62.7% described their practice as academic, and 37.3% described it as non-academic. Non-academic respondents tended to refer for genetic counselling less frequently than academic (48.6% vs. 67.2%). Most respondents believed that genetic testing for HRCC was available (82.8%), although 47.7% did not know which tests were available. This observation was consistent across provinces. Testing for Von Hippel-Lindau syndrome was given the highest priority among respondents. Limited provider knowledge, clinical guidelines, institutional funding, access, and poor coordination between disciplines were cited as barriers to testing. INTERPRETATION There is a need to increase provider knowledge of genetic testing for HRCC. These findings support the development of practice guidelines and national strategies to improve coordination of specialists and access to genetics services. Limitations of the present study include low survey response which did not allow for inferential analysis by geographic region or respondent specialty.
Collapse
Affiliation(s)
- Philippe D Violette
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON
| | - Suzanne Kamel-Reid
- Molecular Diagnostics, Department of Pathology, University Health Network, Toronto, ON
| | - Gail E Graham
- Eastern Ontario Regional Genetics Program, Children's Hospital of Eastern Ontario and the University of Ottawa, Ottawa, ON
| | - M Neil Reaume
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre and the University of Ottawa, Ottawa, ON
| | - Michael A Jewett
- Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, ON
| | - Melanie Care
- Department of Molecular Genetics, University Health Network, Toronto, ON
| | - Joan Basiuk
- Kidney Cancer Research Network of Canada, Toronto, ON
| | - Stephen E Pautler
- Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON; ; Division of Surgical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON
| |
Collapse
|
34
|
Li Q, Gruner C, Chan RH, Care M, Siminovitch K, Williams L, Woo A, Rakowski H. Genotype-Positive Status in Patients With Hypertrophic Cardiomyopathy Is Associated With Higher Rates of Heart Failure Events. ACTA ACUST UNITED AC 2014; 7:416-22. [DOI: 10.1161/circgenetics.113.000331] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background—
The aim of the study was to clarify the relationship between genotype status and major cardiovascular outcomes in a large cohort of patients with hypertrophic cardiomyopathy.
Methods and Results—
Genetic testing was performed in 558 consecutive proband patients with hypertrophic cardiomyopathy. Baseline and follow-up (mean follow-up 6.3 years) clinical and echocardiographic data were obtained. Pathogenic mutations were identified in 198 (35.4%) patients. Genotype-positive patients were more likely to be women (44% versus 30%;
P
=0.001), younger (39 versus 48 years;
P
<0.001), and have a family history of hypertrophic cardiomyopathy (53% versus 20%;
P
<0.001), as well as family history of sudden cardiac death (17% versus 7%;
P
=0.002). There were no significant differences in the rates of atrial fibrillation, stroke, or septal reduction procedures. Multivariable analysis demonstrated that genotype-positive status was an independent risk factor for the development of combined heart failure end points (decline in left ventricular ejection fraction to <50%, New York Heart Association III or IV in the absence of obstruction, heart failure–related hospital admission, transplantation, and heart failure–related death; hazards ratio, 4.51; confidence interval, 2.09–9.31;
P
<0.001). No difference was seen in heart failure events between the myosin heavy chain and myosin-binding protein C genotype-positive patients.
Conclusions—
The presence of a pathogenic sarcomere mutation in patients with hypertrophic cardiomyopathy was associated with an increase in heart failure events, with no differences in event rates seen between myosin heavy chain and myosin-binding protein C genotype-positive patients. The presence of a disease-causing mutation seems more clinically relevant than the specific mutation itself.
Collapse
Affiliation(s)
- Qin Li
- From the Division of Cardiology, Peter Munk Cardiac Center, Toronto General Hospital, Toronto, Ontario, Canada (Q.L., L.W., A.W., H.R.); Division of Cardiology, University Hospital of Zurich, Zurich, Switzerland (C.G.); Department of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C.); Fred A. Litwin and Family Center in Genetic Medicine, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada (M.C., K
| | - Christiane Gruner
- From the Division of Cardiology, Peter Munk Cardiac Center, Toronto General Hospital, Toronto, Ontario, Canada (Q.L., L.W., A.W., H.R.); Division of Cardiology, University Hospital of Zurich, Zurich, Switzerland (C.G.); Department of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C.); Fred A. Litwin and Family Center in Genetic Medicine, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada (M.C., K
| | - Raymond H. Chan
- From the Division of Cardiology, Peter Munk Cardiac Center, Toronto General Hospital, Toronto, Ontario, Canada (Q.L., L.W., A.W., H.R.); Division of Cardiology, University Hospital of Zurich, Zurich, Switzerland (C.G.); Department of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C.); Fred A. Litwin and Family Center in Genetic Medicine, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada (M.C., K
| | - Melanie Care
- From the Division of Cardiology, Peter Munk Cardiac Center, Toronto General Hospital, Toronto, Ontario, Canada (Q.L., L.W., A.W., H.R.); Division of Cardiology, University Hospital of Zurich, Zurich, Switzerland (C.G.); Department of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C.); Fred A. Litwin and Family Center in Genetic Medicine, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada (M.C., K
| | - Katherine Siminovitch
- From the Division of Cardiology, Peter Munk Cardiac Center, Toronto General Hospital, Toronto, Ontario, Canada (Q.L., L.W., A.W., H.R.); Division of Cardiology, University Hospital of Zurich, Zurich, Switzerland (C.G.); Department of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C.); Fred A. Litwin and Family Center in Genetic Medicine, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada (M.C., K
| | - Lynne Williams
- From the Division of Cardiology, Peter Munk Cardiac Center, Toronto General Hospital, Toronto, Ontario, Canada (Q.L., L.W., A.W., H.R.); Division of Cardiology, University Hospital of Zurich, Zurich, Switzerland (C.G.); Department of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C.); Fred A. Litwin and Family Center in Genetic Medicine, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada (M.C., K
| | - Anna Woo
- From the Division of Cardiology, Peter Munk Cardiac Center, Toronto General Hospital, Toronto, Ontario, Canada (Q.L., L.W., A.W., H.R.); Division of Cardiology, University Hospital of Zurich, Zurich, Switzerland (C.G.); Department of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C.); Fred A. Litwin and Family Center in Genetic Medicine, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada (M.C., K
| | - Harry Rakowski
- From the Division of Cardiology, Peter Munk Cardiac Center, Toronto General Hospital, Toronto, Ontario, Canada (Q.L., L.W., A.W., H.R.); Division of Cardiology, University Hospital of Zurich, Zurich, Switzerland (C.G.); Department of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (R.H.C.); Fred A. Litwin and Family Center in Genetic Medicine, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada (M.C., K
| |
Collapse
|
35
|
Gruner C, Chan RH, Crean A, Rakowski H, Rowin EJ, Care M, Deva D, Williams L, Appelbaum E, Gibson CM, Lesser JR, Haas TS, Udelson JE, Manning WJ, Siminovitch K, Ralph-Edwards AC, Rastegar H, Maron BJ, Maron MS. Significance of left ventricular apical-basal muscle bundle identified by cardiovascular magnetic resonance imaging in patients with hypertrophic cardiomyopathy. Eur Heart J 2014; 35:2706-13. [PMID: 24810389 DOI: 10.1093/eurheartj/ehu154] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
AIMS Cardiovascular magnetic resonance (CMR) has improved diagnostic and management strategies in hypertrophic cardiomyopathy (HCM) by expanding our appreciation for the diverse phenotypic expression. We sought to characterize the prevalence and clinical significance of a recently identified accessory left ventricular (LV) muscle bundle extending from the apex to the basal septum or anterior wall (i.e. apical-basal). METHODS AND RESULTS CMR was performed in 230 genotyped HCM patients (48 ± 15 years, 69% male), 30 genotype-positive/phenotype-negative (G+/P-) family members (32 ± 15 years, 30% male), and 126 controls. Left ventricular apical-basal muscle bundle was identified in 145 of 230 (63%) HCM patients, 18 of 30 (60%) G+/P- family members, and 12 of 126 (10%) controls (G+/P- vs. controls; P < 0.01). In HCM patients, the prevalence of an apical-basal muscle bundle was similar among those with disease-causing sarcomere mutations compared with patients without mutation (64 vs. 62%; P = 0.88). The presence of an LV apical-basal muscle bundle was not associated with LV outflow tract obstruction (P = 0.61). In follow-up, 33 patients underwent surgical myectomy of whom 22 (67%) were identified to have an accessory LV apical-basal muscle bundle, which was resected in all patients. CONCLUSION Apical-basal muscle bundles are a unique myocardial structure commonly present in HCM patients as well as in G+/P- family members and may represent an additional morphologic marker for HCM diagnosis in genotype-positive status.
Collapse
Affiliation(s)
- Christiane Gruner
- Division of Cardiology and Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada Division of Cardiology, Cardiovascular Center, University Hospital, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Raymond H Chan
- PERFUSE Core Laboratory and Data Coordinating Center, Harvard Medical School, Boston, MA, USA Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Andrew Crean
- Division of Cardiology and Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Harry Rakowski
- Division of Cardiology and Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Ethan J Rowin
- Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA, USA
| | - Melanie Care
- Fred A. Litwin and Family Centre in Genetic Medicine, Mount Sinai Hospital & University Health Network, Toronto, ON, Canada Department of Medicine, University of Toronto and Samuel Lunenfeld and Toronto General Research Institutes, Toronto, ON, Canada
| | - Djeven Deva
- Division of Cardiology and Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Lynne Williams
- Division of Cardiology and Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Evan Appelbaum
- PERFUSE Core Laboratory and Data Coordinating Center, Harvard Medical School, Boston, MA, USA Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - C Michael Gibson
- PERFUSE Core Laboratory and Data Coordinating Center, Harvard Medical School, Boston, MA, USA Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - John R Lesser
- Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Tammy S Haas
- Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - James E Udelson
- Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA, USA
| | - Warren J Manning
- PERFUSE Core Laboratory and Data Coordinating Center, Harvard Medical School, Boston, MA, USA Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Katherine Siminovitch
- Fred A. Litwin and Family Centre in Genetic Medicine, Mount Sinai Hospital & University Health Network, Toronto, ON, Canada Department of Medicine, University of Toronto and Samuel Lunenfeld and Toronto General Research Institutes, Toronto, ON, Canada
| | - Anthony C Ralph-Edwards
- Division of Cardiology and Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Hassan Rastegar
- Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA, USA
| | - Barry J Maron
- Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Martin S Maron
- Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, MA, USA
| |
Collapse
|
36
|
Reaume MN, Graham GE, Tomiak E, Kamel-Reid S, Jewett MA, Bjarnason GA, Blais N, Care M, Drachenberg D, Gedye C, Grant R, Heng DY, Kapoor A, Kollmannsberger C, Lattouf JB, Maher ER, Pause A, Ruether D, Soulieres D, Tanguay S, Turcotte S, Violette PD, Wood L, Basiuk J, Pautler SE. Canadian guideline on genetic screening for hereditary renal cell cancers. Can Urol Assoc J 2013; 7:319-23. [PMID: 24319509 PMCID: PMC3854468 DOI: 10.5489/cuaj.1496] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hereditary renal cell cancer (RCC) is an ideal model for germline genetic testing. We propose a guideline of hereditary RCC specific criteria to suggest referral for genetic assessment. METHODS A review of the literature and stakeholder resources for existing guidelines or consensus statements was performed. Referral criteria were developed by expert consensus. RESULTS The criteria included characteristics for patients with RCC (age ≤45 years, bilateral or multifocal tumours, associated medical conditions and non-clear cell histologies with unusual features) and for patients with or without RCC, but a family history of specific clinical or genetic diagnoses. CONCLUSIONS This guideline represents a practical RCC-specific reference to allow healthcare providers to identify patients who may have a hereditary RCC syndrome, without extensive knowledge of each syndrome. RCC survivors and their families can also use the document to guide their discussions with healthcare providers about their need for referral. The criteria refer to the most common hereditary renal tumour syndromes and do not represent a comprehensive or exclusive list. Prospective validation of the criteria is warranted.
Collapse
Affiliation(s)
- M. Neil Reaume
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre and the University of Ottawa, Ottawa, ON
| | - Gail E. Graham
- Eastern Ontario Regional Genetics Program, Children’s Hospital of Eastern Ontario and the University of Ottawa, Ottawa, ON
| | - Eva Tomiak
- Eastern Ontario Regional Genetics Program, Children’s Hospital of Eastern Ontario and the University of Ottawa, Ottawa, ON
| | - Suzanne Kamel-Reid
- Molecular Diagnostics, Department of Pathology, The University Health Network, University of Toronto, Toronto, ON
| | - Michael A.S. Jewett
- Division of Urology, Departments of Surgical Oncology and Surgery, Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON
| | - Georg A. Bjarnason
- Division of Medical Oncology/Hematology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON
| | - Normand Blais
- Division of Hematology/Oncology, Centre Hospitalier de l’Université de Montréal, Montreal, QC
| | - Melanie Care
- Fred A. Litwin Family Centre in Genetic Medicine, University Health Network & Mount Sinai Hospital, Toronto, ON
| | - Darryl Drachenberg
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB
| | - Craig Gedye
- Ontario Cancer Institute, Princess Margaret Cancer Centre and the University Health Network, Toronto, ON
| | - Ronald Grant
- Division of Haematology/Oncology, Department of Pediatrics, University of Toronto, Toronto, ON
| | - Daniel Y.C. Heng
- Department of Medical Oncology, Tom Baker Cancer Center, and the University of Calgary, Calgary, AB
| | - Anil Kapoor
- McMaster Institute of Urology, Division of Urology, Department of Surgery, McMaster University, Hamilton, ON
| | - Christian Kollmannsberger
- Division of Medical Oncology, British Columbia Cancer Agency-Vancouver Cancer Centre, and the Univeristy of British Columbia, Vancouver, BC
| | | | - Eamonn R. Maher
- Department of Medical Genetics, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Arnim Pause
- Department of Biochemistry, McGill University, Montreal, QC
| | - Dean Ruether
- Department of Medical Oncology, Tom Baker Cancer Center, and the University of Calgary, Calgary, AB
| | - Denis Soulieres
- Division of Hematology/Oncology, Centre Hospitalier de l’Université de Montréal, Montreal, QC
| | - Simon Tanguay
- Division of Urology, McGill University, Montreal, QC
| | - Sandra Turcotte
- Department of Chemistry and Biochemistry, Universite de Moncton, Moncton, NB
| | | | - Lori Wood
- Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - Joan Basiuk
- Kidney Cancer Research Network of Canada, Toronto, ON
| | - Stephen E. Pautler
- Division of Urology, Department of Surgery and Division of Surgical Oncology, Department of Oncology, Western University, London, ON
| | | |
Collapse
|
37
|
Deva DP, Williams LK, Care M, Siminovitch KA, Moshonov H, Wintersperger BJ, Rakowski H, Crean AM. Deep basal inferoseptal crypts occur more commonly in patients with hypertrophic cardiomyopathy due to disease-causing myofilament mutations. Radiology 2013; 269:68-76. [PMID: 23771913 DOI: 10.1148/radiol.13122344] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine the relationship between deep basal inferoseptal crypts and disease-causing gene mutations in hypertrophic cardiomyopathy (HCM). MATERIALS AND METHODS Institutional research and ethics board approval was obtained for this retrospective study, and the requirement to obtain informed consent was waived. Two readers, who were blinded to genetic status, independently assessed cardiac magnetic resonance (MR) images obtained in 300 consecutive unrelated genetically tested patients with HCM. Readers documented the morphologic phenotype, the presence of deep basal inferoseptal crypts, and the imaging plane in which crypts were first convincingly visualized. The Student t test, the Fisher exact test, and multivariate logistic regression were used for comparisons and to evaluate the relationship between these crypts and the detection of disease-causing mutations. RESULTS The frequency of deep basal inferoseptal crypts was significantly higher in patients with disease-causing mutations than in those without disease-causing mutations (36% and 4%, respectively; P < .001). The presence of crypts was a stronger predictor of disease-causing mutations than was reverse septal curvature (P = .025). Patients with these crypts had a higher likelihood of having disease-causing mutations than non-disease-causing mutations (P < .001). Thirty-one of the 34 patients with both deep basal inferoseptal crypts and reverse septal curvature (91%) had disease-causing mutations (sensitivity, 26%; specificity, 98%). The presence of deep basal inferoseptal crypts (odds ratio: 6.64; 95% confidence interval: 2.631, 16.755; P < .001) and reverse septal curvature (odds ratio: 4.8; 95% confidence interval: 2.552, 9.083; P < .001) were predictive of disease-causing mutations. Both observers required additional imaging planes to identify approximately half of all crypts. CONCLUSION Deep basal inferoseptal crypts occur more commonly in patients with HCM with disease-causing mutations than in those with genotype-negative HCM.
Collapse
Affiliation(s)
- Djeven Parameshvara Deva
- Department of Medical Imaging and Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, 585 University Ave, 1c-544 NCSB, Toronto, ON, Canada M5G 2N2
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Nam Hong S, Gruner C, Chan R, Care M, Williams L, Li Q, Laczay B, Siminovitch K, Woo A, Manning W, Rakowski H. FEMALE SEX IS ASSOCIATED WITH ADVERSE CLINICAL AND ECHOCARDIOGRAPHIC MEASURES IN A GENETICALLY TESTED HYPERTROPHIC CARDIOMYOPATHY COHORT. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61274-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
39
|
Gruner C, Chan R, Appelbaum E, Rowin E, Care M, Williams L, Gibson M, Lesser J, Haas T, Udelson J, Manning W, Tomberli B, Olivotto I, Maron B, Crean A, Maron M, Rakowski H. LACK OF PHENOTYPIC DIFFERENCES BY CMRI IN THE TWO MOST COMMON SARCOMERE PROTEIN GENE MUTATIONS IN HYPERTROPHIC CARDIOMYOPATHY. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61222-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
40
|
Deva DP, Williams LK, Care M, Siminovitch KA, Moshonov H, Wintersperger BJ, Rakowski H, Crean AM. Incremental predictive value of deep crypts in the basal inferoseptum in the setting of hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 2013. [PMCID: PMC3559512 DOI: 10.1186/1532-429x-15-s1-o33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
41
|
Gruner C, Ivanov J, Care M, Williams L, Moravsky G, Yang H, Laczay B, Siminovitch K, Woo A, Rakowski H. Toronto hypertrophic cardiomyopathy genotype score for prediction of a positive genotype in hypertrophic cardiomyopathy. ACTA ACUST UNITED AC 2012; 6:19-26. [PMID: 23239831 DOI: 10.1161/circgenetics.112.963363] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Genotyping in hypertrophic cardiomyopathy has gained increasing attention in the past decade. Its major role is for family screening and rarely influences decision-making processes in any individual patient. It is associated with substantial costs, and cost-effectiveness can only be achieved in the presence of high-detection rates for disease-causing sarcomere protein gene mutations. Therefore, our aim was to develop a score based on clinical and echocardiographic variables that allows prediction of the probability of a positive genotype. METHODS AND RESULTS Clinical and echocardiographic variables were collected in 471 consecutive patients undergoing genetic testing at a tertiary referral center between July 2005 and November 2010. Logistic regression for a positive genotype was used to construct integer risk weights for each independent predictor variable. These were summed for each patient to create the Toronto hypertrophic cardiomyopathy genotype score. A positive genotype was found in 163 of 471 patients (35%). Independent predictors with associated-risk weights in parentheses were as follows: age at diagnosis 20 to 29 (-1), 30 to 39 (-2), 40 to 49 (-3), 50 to 59 (-4), 60 to 69 (-5), 70 to 79 (-6), ≥80 (-7); female sex (4); arterial hypertension (-4); positive family history for hypertrophic cardiomyopathy (6); morphology category (5); ratio of maximal wall thickness:posterior wall thickness <1.46 (0), 1.47 to 1.70 (1), 1.71 to 1.92 (2), 1.93 to 2.26 (3), ≥2.27 (4). The model had a receiver operator curve of 0.80 and Hosmer-Lemeshow goodness-of-fit P=0.22. CONCLUSIONS The Toronto genotype score is an accurate tool to predict a positive genotype in a hypertrophic cardiomyopathy cohort at a tertiary referral center.
Collapse
Affiliation(s)
- Christiane Gruner
- Division of Cardiology, Toronto General Hospital, Peter Munk Cardiac Center, 4N-504, 200 Elizabeth St, Toronto, ON M5G 2C4, Canada.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Jewett M, Finelli A, Kollmannsberger C, Wood L, Legere L, Basiuk J, Canil C, Heng D, Reaume N, Tanguay S, Atkins M, Bjarnason G, Dancey J, Evans M, Fleshner N, Haider M, Kapoor A, Uzzo R, Maskens D, Soulieres D, Yousef G, Basappa N, Bendali N, Black P, Blais N, Cagiannos I, Care M, Chow R, Chung H, Czaykowski P, Derosa D, Durrant K, Ellard S, Farquharson G, Filion-Brulotte C, Gingerich J, Godbout L, Grant R, Hamilton W, Kassouf W, Kurban G, Lane K, Lattouf J, Lau D, Leveridge M, McCarthy J, Moore R, North S, O'brien P, Pituskin E, Racine P, Rendon R, So A, Sridhar S, Stubbs K, Su Z, Taylor L, Udall T, Venner P, Vogel W, Yap S, Yau P, Cooper M, Giroux N, Miron D, Mosher D, Ross K, Willacy J. Management of kidney cancer: canadian kidney cancer forum consensus update 2011. Can Urol Assoc J 2012; 6:16-22. [PMID: 22396361 DOI: 10.5489/cuaj.11273] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
43
|
Nair K, Pekhletski R, Harris L, Care M, Morel C, Farid T, Backx PH, Szabo E, Nanthakumar K. Escape capture bigeminy: phenotypic marker of cardiac sodium channel voltage sensor mutation R222Q. Heart Rhythm 2012; 9:1681-1688.e1. [PMID: 22710484 DOI: 10.1016/j.hrthm.2012.06.029] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Indexed: 01/02/2023]
Abstract
BACKGROUND Electrocardiographic signature of escape capture bigeminy that spans generations and clusters in a family has not been linked to a sodium channel voltage sensor mutation. OBJECTIVE To characterize the clinical and biophysical consequences of the R222Q mutation in the voltage sensor of cardiac sodium channels. METHODS Comprehensive clinical assessment, invasive electrophysiologic study, genetic analysis, and patch-clamp studies were undertaken. RESULTS Uniquely, 5 members had the same electrocardiographic pattern of a junctional escape ventricular capture bigeminy. Genetic analysis of 3 family members revealed the same mutation (R222Q) in the cardiac sodium channel gene, SCN5A (nucleotide change was 665 G→A that led to missense amino acid substitution Arg 222 Gln, located in the S4 voltage sensor in domain I). Catheterization and mapping revealed that there was no consistent evidence of bundle branch reentry or fascicular potentials preceding ectopic beats. The bigeminy was suppressed by the intravenous administration of the sodium channel blocker, lidocaine. Patch-clamp studies revealed unique differential leftward voltage-dependent shifts in activation and inactivation properties of human voltage-gated Na(+) channels with the R222Q mutation, consistent with increasing channel excitability at precisely the voltages corresponding to the resting membrane potential of cardiomyocytes. CONCLUSIONS The R222Q mutation enhances cardiac sodium channel excitability, resulting in an unusual, highly penetrant phenotype of escape capture bigeminy and cardiomyopathy. These findings support the conclusion that a mutation in the voltage sensor of cardiac sodium channels can cause bigeminal arrhythmia associated with cardiomyopathy.
Collapse
Affiliation(s)
- Krishnakumar Nair
- Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Gruner C, Verocai F, Carasso S, Vannan MA, Jamorski M, Clarke JTR, Care M, Iwanochko RM, Rakowski H. Systolic myocardial mechanics in patients with Anderson-Fabry disease with and without left ventricular hypertrophy and in comparison to nonobstructive hypertrophic cardiomyopathy. Echocardiography 2012; 29:810-7. [PMID: 22497597 DOI: 10.1111/j.1540-8175.2012.01704.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Anderson-Fabry disease (AFD) is a lysosomal storage disease, which can involve the heart, mimicking hypertrophic cardiomyopathy (HCM). The underlying mechanism of disease in AFD is an infiltrative, diffuse process, whereas HCM is a primary heart muscle condition with patchy distribution, which may prompt differences in myocardial mechanics. The aim of this study was to assess myocardial mechanics in AFD according to the presence of left ventricular hypertrophy (LVH) compared to nonobstructive HCM (NHCM) and healthy controls. METHODS AND RESULTS We carried out a single-center, retrospective study in a small, genetically confirmed AFD cohort, which was divided into a subgroup with LVH (LVH+, n = 19), and without LVH (LVH-, n = 21). Comparison groups were healthy controls (n = 40) and NHCM patients (n = 19). Vector Velocity Imaging was applied to two-dimensional echocardiography studies for assessment of longitudinal strain (LS), circumferential strain (CS), and base-to-apex CS gradients. AFD LVH+ patients had lower global LS than AFD LVH- patients (-14 ± 4% vs -17 ± 3%, P < 0.05), but similarly lowered global CS (-24 ± 5% vs -22 ± 5%, P = ns). AFD LVH+ and NHCM had similarly lowered global LS compared to normals, but significantly lower global CS was observed in AFD LVH+ (-24 ± 5% vs -28 ± 4%, P < 0.05), whereas it was significantly increased in NHCM (-31 ± 2% vs -28 ± 4%, P < 0.05). Unlike NHCM, in both AFD subgroups, patients lost their normal base-to-apex CS gradient. CONCLUSIONS AFD patients without LVH already show abnormal systolic myocardial mechanics. Relevant differences in myocardial mechanics between AFD patients with LVH compared to NHCM reflect the different underlying mechanisms of disease.
Collapse
Affiliation(s)
- Christiane Gruner
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Ptasinska A, Assi SA, Mannari D, James SR, Williamson D, Dunne J, Hoogenkamp M, Wu M, Care M, McNeill H, Cauchy P, Cullen M, Tooze RM, Tenen DG, Young BD, Cockerill PN, Westhead DR, Heidenreich O, Bonifer C. Depletion of RUNX1/ETO in t(8;21) AML cells leads to genome-wide changes in chromatin structure and transcription factor binding. Leukemia 2012; 26:1829-41. [PMID: 22343733 PMCID: PMC3419980 DOI: 10.1038/leu.2012.49] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The t(8;21) translocation fuses the DNA-binding domain of the hematopoietic master regulator RUNX1 to the ETO protein. The resultant RUNX1/ETO fusion protein is a leukemia-initiating transcription factor that interferes with RUNX1 function. The result of this interference is a block in differentiation and, finally, the development of acute myeloid leukemia (AML). To obtain insights into RUNX1/ETO-dependant alterations of the epigenetic landscape, we measured genome-wide RUNX1- and RUNX1/ETO-bound regions in t(8;21) cells and assessed to what extent the effects of RUNX1/ETO on the epigenome depend on its continued expression in established leukemic cells. To this end, we determined dynamic alterations of histone acetylation, RNA Polymerase II binding and RUNX1 occupancy in the presence or absence of RUNX1/ETO using a knockdown approach. Combined global assessments of chromatin accessibility and kinetic gene expression data show that RUNX1/ETO controls the expression of important regulators of hematopoietic differentiation and self-renewal. We show that selective removal of RUNX1/ETO leads to a widespread reversal of epigenetic reprogramming and a genome-wide redistribution of RUNX1 binding, resulting in the inhibition of leukemic proliferation and self-renewal, and the induction of differentiation. This demonstrates that RUNX1/ETO represents a pivotal therapeutic target in AML.
Collapse
Affiliation(s)
- A Ptasinska
- Section of Experimental Haematology, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Deva D, Gruner C, Care M, Wintersperger BJ, Rakowski H, Crean AM. Subtle structural abnormalities in genotype positive phenotype ‘negative’ patients with pre-clinical hypertrophic cardiomyopathy (HCM): a blinded, controlled cardiovascular magnetic resonance (CMR) study. J Cardiovasc Magn Reson 2012. [PMCID: PMC3304940 DOI: 10.1186/1532-429x-14-s1-o96] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
47
|
Gruner C, Care M, Siminovitch K, Moravsky G, Wigle ED, Woo A, Rakowski H. Sarcomere protein gene mutations in patients with apical hypertrophic cardiomyopathy. ACTA ACUST UNITED AC 2011; 4:288-95. [PMID: 21511876 DOI: 10.1161/circgenetics.110.958835] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Apical hypertrophic cardiomyopathy (HCM) is a unique form of HCM with left ventricular hypertrophy confined to the cardiac apex. The purpose of our study was to report genetic findings in a large series of unrelated patients with apical HCM and compare them with a nonapical HCM cohort. METHODS AND RESULTS Overall, 429 patients with HCM underwent genetic testing. The panel included 8 sarcomere protein genes and 3 other genes (GLA, PRKAG2, and LAMP2). Sixty-one patients were diagnosed with apical HCM. A positive genotype was found in 8 patients with apical HCM. The genotype-positive and genotype-negative patients had similar maximal wall thicknesses (17.5 ± 3.5 mm versus 17.6 ± 3.3 mm, P = 0.71) and similar frequency of HCM-related events (2/8; 25% versus 13/53; 25%; P = 0.98). Thirteen percent with apical HCM and 40% with nonapical HCM had a positive genotype (P<0.001) most often involving the MYBPC3 and MYH7 genes. CONCLUSIONS In apical HCM, a positive genotype was found less frequently than in nonapical HCM, and it was most often involving MYBPC3 and MYH7 genes. Only 13% of patients with apical HCM were found to be genotype positive, indicating that genome-wide association studies and gene expression profiling are needed for better understanding of the genetic background of the disease. There was no significant genotype-phenotype correlation in our cohort with apical HCM.
Collapse
Affiliation(s)
- Christiane Gruner
- Division of Cardiology, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
| | | | | | | | | | | | | |
Collapse
|
48
|
Saltzman AJ, Mancini-DiNardo D, Li C, Chung WK, Ho CY, Hurst S, Wynn J, Care M, Hamilton RM, Seidman GW, Gorham J, McDonough B, Sparks E, Seidman JG, Seidman CE, Rehm HL. Short communication: the cardiac myosin binding protein C Arg502Trp mutation: a common cause of hypertrophic cardiomyopathy. Circ Res 2010; 106:1549-52. [PMID: 20378854 DOI: 10.1161/circresaha.109.216291] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
RATIONALE The myosin-binding protein C isoform 3 (MYBPC3) variant Arg502Trp has been identified in multiple hypertrophic cardiomyopathy (HCM) cases, but compelling evidence to support or refute the pathogenicity of this variant is lacking. OBJECTIVE To determine the prevalence, origin and clinical significance of the MYBPC3 Arg502Trp variant. METHODS AND RESULTS The prevalence of MYBPC3 Arg502Trp was ascertained in 1414 sequential HCM patients of primarily European descent. MYBPC3 Arg502Trp was identified in 34 of these 1414 unrelated HCM patients. Segregation of MYBPC3 Arg502Trp with clinical status was assessed in family members. Disease haplotypes were examined in 17 families using two loci flanking MYBPC3. Family studies identified an additional 43 variant carriers, many with manifest disease, yielding a calculated odds ratio of 11 000:1 for segregation of MYBPC3 Arg502Trp with HCM. Analyses in 17 families showed at least 4 independent haplotypes flanked MYBPC3 Arg502Trp. Eight individuals (4 probands and 4 family members) also had another sarcomere protein gene mutation. Major adverse clinical events occurred in approximately 30% of MYBPC3 Arg502Trp carriers by age 50; these were significantly more likely (P<0.0001) when another sarcomere mutation was present. CONCLUSIONS MYBPC3 Arg502Trp is the most common and recurrent pathogenic mutation in a diverse primarily European descent HCM cohort, occurring in 2.4% of patients. MYBPC3 Arg502Trp conveys a 340-fold increased risk for HCM by 45 years of age, when more than 50% of carriers have overt disease. HCM prognosis worsens when MYBPC3 Arg502Trp occurs in the setting of another sarcomere protein gene mutation.
Collapse
Affiliation(s)
- Adam J Saltzman
- Department of Medicine, Columbia University, New York, NY, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Holland S, Karunanayaka P, Altaye M, Rajagopal A, Care M, Egelhoff J, Mecoli M, Smith K, Choo D. Evidence for Speech Processing in Deaf Infants Under Sedation Using fMRI. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)70787-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
50
|
Abstract
Fanconi anemia (FA) is an autosomal recessive disorder, characterised by multiple congenital malformations, bone marrow failure and a predisposition to developing malignancies, especially leukemia. FA cells show increased levels of spontaneous chromosomal aberrations and a hypersensitivity to DNA cross-linking agents such as mitomycin C (MMC) and diepoxybutane (DEB). There are at least eight complementation groups involved in FA, and the genes for two of these groups, FA(A) and FA(C), have been isolated and cloned. Mouse models for FA(C) have been developed by replacing exon 8 or exon 9 of Fac with the neo gene. Mice homozygous for Fac mutations show reduced fertility and hypersensitivity to induction of chromosomal aberrations by MMC and DEB. To facilitate the study of cellular defects in vitro, transformed mouse fibroblast cell lines were established. Cell-killing experiments and cytogenetic analyses were performed on these cells following treatment with MMC and DEB. Fac-/- showed significant hypersensitivity to MMC and DEB as compared with Fac+/+ and +/- for both cellular phenotypes. This is consistent with results obtained from similar studies on human fibroblasts and lymphoblastoid cell lines. Therefore, these isogenic transformed mouse fibroblasts provide as in vitro model for further investigation of the hypersensitivity of Fanconi anemia cells to DNA cross-linking agents.
Collapse
Affiliation(s)
- D J Tomkins
- Department of Pathology, McMaster University, Hamilton, Ontario, Canada.
| | | | | | | |
Collapse
|