1
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Townsend M, Khoury M, Koehl D, Kirklin JK, Cantor R, Beasley G, Chen CY, Boyle G, Parent JJ, Baez Hernandez N, Halnon N. Uncertain benefit of statins in pediatric heart transplant recipients: A PHTS analysis. J Heart Lung Transplant 2024; 43:703-713. [PMID: 38065240 DOI: 10.1016/j.healun.2023.11.021] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Cardiac allograft vasculopathy (CAV) is a leading cause of graft failure in pediatric heart transplant recipients (HTRs). Early statin use has been shown to reduce CAV incidence and all-cause mortality in adult HTRs. We sought to evaluate the contemporary prevalence and trends of statin use in pediatric HTRs and the association between statin use with CAV development and graft failure. METHODS Patients aged <17 years at the time of primary heart transplant who survived to ≥3 years without CAV were identified from the Pediatric Heart Transplant Society database (2001-2018). Statin use in the first 3 years posttransplant was defined as consecutive, intermediate, or absent. Kaplan-Meier survival, multivariable modeling, and propensity score-matched analyses evaluated associations between statin use and CAV incidence and graft survival, with subanalyses performed on subjects aged ≥10 years at transplant. RESULTS Among 3,485 (of which 1,086 aged ≥10 years) HTRs, 584 (17%) received consecutive statin therapy, 647 (19%) received intermediate use, and 2,254 (65%) received no statin therapy. Statin use varied widely between sites, with increasing use in the ≥10-year-old cohort over time. By multivariate analysis, statin use was not associated with graft loss. Consecutive statin use was also not associated with graft survival or freedom from CAV development when compared to absent statin use in unmatched or propensity-matched analyses. CONCLUSIONS While statins remain commonly utilized in pediatric HTRs, early consecutive statin therapy did not decrease CAV incidence or graft loss. The differing effects of statins on CAV development and progression in pediatric vs adult HTRs suggest differing risk and mediating factors and require further study.
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Affiliation(s)
| | - Michael Khoury
- Stollery Children's Hospital University of Alberta, Edmonton, Alberta, Canada
| | - Devin Koehl
- Kirklin Institute for Research in Surgical Outcomes, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - James K Kirklin
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ryan Cantor
- Kirklin Institute for Research in Surgical Outcomes, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gary Beasley
- University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | - Chiu-Yu Chen
- Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | | | - John J Parent
- Riley Hospital for Children University of Indiana, Indianapolis, Indiana
| | | | - Nancy Halnon
- Mattel Children's Hospital UCLA, Los Angeles, California
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2
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Biniwale R, Lahar S, Balasubramanya S, Caraccio C, Ngang B, Barone H, Stimpson E, Dela Cruz K, Alejos JC, Williams R, Halnon N, Reardon L, Si MS, Shemin R, Ardehali A, Van Arsdell G. Pediatric heart transplantation from donation after circulatory death using normothermic regional perfusion and cold storage from a distant donor: First US experience. JTCVS Tech 2023; 20:158-161. [PMID: 37555030 PMCID: PMC10405263 DOI: 10.1016/j.xjtc.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/06/2023] [Accepted: 05/01/2023] [Indexed: 08/10/2023] Open
Affiliation(s)
- Reshma Biniwale
- Division of Cardiothoracic Surgery, Department of Surgery, UCLA Health Sciences, Los Angeles, Calif
| | - Saba Lahar
- Perfusion and ECMO Services, UCLA Cardiothoracic Surgery, Los Angeles, Calif
| | | | - Carla Caraccio
- Division of Cardiothoracic Surgery, Department of Surgery, UCLA Health Sciences, Los Angeles, Calif
| | - Biliet Ngang
- Division of Cardiothoracic Surgery, Department of Surgery, UCLA Health Sciences, Los Angeles, Calif
| | - Heather Barone
- Division of Cardiothoracic Surgery, Department of Surgery, UCLA Health Sciences, Los Angeles, Calif
| | - Emily Stimpson
- Division of Cardiothoracic Surgery, Department of Surgery, UCLA Health Sciences, Los Angeles, Calif
| | - Kim Dela Cruz
- Perfusion and ECMO Services, UCLA Cardiothoracic Surgery, Los Angeles, Calif
| | - Juan Carlos Alejos
- Division of Pediatric Cardiology, Department of Pediatrics, UCLA Health Sciences, Los Angeles, Calif
| | - Ryan Williams
- Division of Pediatric Cardiology, Department of Pediatrics, UCLA Health Sciences, Los Angeles, Calif
| | - Nancy Halnon
- Division of Pediatric Cardiology, Department of Pediatrics, UCLA Health Sciences, Los Angeles, Calif
| | - Leigh Reardon
- Division of Pediatric Cardiology, Department of Pediatrics, UCLA Health Sciences, Los Angeles, Calif
| | - Ming-Sing Si
- Division of Cardiothoracic Surgery, Department of Surgery, UCLA Health Sciences, Los Angeles, Calif
| | - Richard Shemin
- Division of Cardiothoracic Surgery, Department of Surgery, UCLA Health Sciences, Los Angeles, Calif
| | - Abbas Ardehali
- Division of Cardiothoracic Surgery, Department of Surgery, UCLA Health Sciences, Los Angeles, Calif
| | - Glen Van Arsdell
- Division of Cardiothoracic Surgery, Department of Surgery, UCLA Health Sciences, Los Angeles, Calif
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3
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Sono R, Larrinaga TM, Huang A, Makhlouf F, Kang X, Su J, Lau R, Arboleda VA, Biniwale R, Fishbein GA, Khanlou N, Si MS, Satou GM, Halnon N, Van Arsdell GS, Gregorio CC, Nelson S, Touma M. Whole-Exome Sequencing Identifies Homozygote Nonsense Variants in LMOD2 Gene Causing Infantile Dilated Cardiomyopathy. Cells 2023; 12:1455. [PMID: 37296576 PMCID: PMC10252268 DOI: 10.3390/cells12111455] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 05/07/2023] [Accepted: 05/09/2023] [Indexed: 06/12/2023] Open
Abstract
As an essential component of the sarcomere, actin thin filament stems from the Z-disk extend toward the middle of the sarcomere and overlaps with myosin thick filaments. Elongation of the cardiac thin filament is essential for normal sarcomere maturation and heart function. This process is regulated by the actin-binding proteins Leiomodins (LMODs), among which LMOD2 has recently been identified as a key regulator of thin filament elongation to reach a mature length. Few reports have implicated homozygous loss of function variants of LMOD2 in neonatal dilated cardiomyopathy (DCM) associated with thin filament shortening. We present the fifth case of DCM due to biallelic variants in the LMOD2 gene and the second case with the c.1193G>A (p.W398*) nonsense variant identified by whole-exome sequencing. The proband is a 4-month male infant of Hispanic descent with advanced heart failure. Consistent with previous reports, a myocardial biopsy exhibited remarkably short thin filaments. However, compared to other cases of identical or similar biallelic variants, the patient presented here has an unusually late onset of cardiomyopathy during infancy. Herein, we present the phenotypic and histological features of this variant, confirm the pathogenic impact on protein expression and sarcomere structure, and discuss the current knowledge of LMOD2-related cardiomyopathy.
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Affiliation(s)
- Reiri Sono
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Tania M. Larrinaga
- Department of Cellular and Molecular Medicine and Sarver Molecular Cardiovascular Research Program, The University of Arizona, Tucson, AZ 85721, USA; (T.M.L.); (C.C.G.)
| | - Alden Huang
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Frank Makhlouf
- Neonatal Congenital Heart Laboratory, Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Xuedong Kang
- Neonatal Congenital Heart Laboratory, Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Jonathan Su
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Ryan Lau
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Valerie A. Arboleda
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
- Molecular Biology Institute, University of California, Los Angeles, CA 90095, USA
- Eli and Edyth Broad Stem Cell Research Center, University of California, Los Angeles, CA 90095, USA
| | - Reshma Biniwale
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Gregory A. Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Negar Khanlou
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Ming-Sing Si
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Gary M. Satou
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Nancy Halnon
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | | | - Glen S. Van Arsdell
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Carol C. Gregorio
- Department of Cellular and Molecular Medicine and Sarver Molecular Cardiovascular Research Program, The University of Arizona, Tucson, AZ 85721, USA; (T.M.L.); (C.C.G.)
- Department of Medicine and Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Stanly Nelson
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Marlin Touma
- Neonatal Congenital Heart Laboratory, Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
- Molecular Biology Institute, University of California, Los Angeles, CA 90095, USA
- Eli and Edyth Broad Stem Cell Research Center, University of California, Los Angeles, CA 90095, USA
- Children’s Discovery and Innovation Institute, University of California, Los Angeles, CA 90095, USA
- Cardiovascular Research Laboratories, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
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4
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Townsend M, Khoury M, Koehl D, Cantor R, Kirklin J, Beasley G, Chen C, Boyle G, Parent J, Hernandez NB, Halnon N. Statin Use May Not Benefit Pediatric Heart Transplant Recipients: A PHTS Analysis. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.204] [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: 04/05/2023] Open
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5
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Yang JO, Shaybekyan H, Zhao Y, Kang X, Fishbein GA, Khanlou N, Alejos JC, Halnon N, Satou G, Biniwale R, Lee H, Van Arsdell G, Nelson SF, Touma M. Case Report: Whole Exome Sequencing Identifies Compound Heterozygous Variants in TSFM Gene Causing Juvenile Hypertrophic Cardiomyopathy. Front Cardiovasc Med 2022; 8:798985. [PMID: 35071363 PMCID: PMC8770926 DOI: 10.3389/fcvm.2021.798985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/08/2021] [Indexed: 02/04/2023] Open
Abstract
We report a case of hypertrophic cardiomyopathy and lactic acidosis in a 3-year-old female. Cardiac and skeletal muscles biopsies exhibited mitochondrial hyperplasia with decreased complex IV activity. Whole exome sequencing identified compound heterozygous variants, p.Arg333Trp and p.Val119Leu, in TSFM, a nuclear gene that encodes a mitochondrial translation elongation factor, resulting in impaired oxidative phosphorylation and juvenile hypertrophic cardiomyopathy.
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Affiliation(s)
- Jamie O Yang
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Hapet Shaybekyan
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Neonatal/Congenital Heart Laboratory, Cardiovascular Research Laboratory, University of California, Los Angeles, Los Angeles, CA, United States
| | - Yan Zhao
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Neonatal/Congenital Heart Laboratory, Cardiovascular Research Laboratory, University of California, Los Angeles, Los Angeles, CA, United States
| | - Xuedong Kang
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Neonatal/Congenital Heart Laboratory, Cardiovascular Research Laboratory, University of California, Los Angeles, Los Angeles, CA, United States
| | - Gregory A Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Negar Khanlou
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Juan C Alejos
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Nancy Halnon
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Gary Satou
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Reshma Biniwale
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Hane Lee
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Glen Van Arsdell
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Stanley F Nelson
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Institute for Precision Health, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Marlin Touma
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Neonatal/Congenital Heart Laboratory, Cardiovascular Research Laboratory, University of California, Los Angeles, Los Angeles, CA, United States.,Institute for Precision Health, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Pediatrics, David Geffen School of Medicine, Children's Discovery and Innovation Institute, University of California, Los Angeles, Los Angeles, CA, United States.,The Molecular Biology Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Eli and Edythe Broad Stem Cell Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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6
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Mehta Z, Zhao Y, Xuedong K, Alejos JC, Halnon N, Nelson SF, Touma M. Abstract MP212: Integrated Genomics Analysis Identifies Recessive Ciliopathy Mutations In Primary Endocardial Fibroelastosis: A Rare Neonatal Cardiomyopathy. Circ Res 2021. [DOI: 10.1161/res.129.suppl_1.mp212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Among neonatal cardiomyopathies, primary endocardial fibroelastosis (pEFE) remains a mysterious disease of the endomyocardium, affecting 1/5000 live births and accounting for 25% of the entire pediatric dilated cardiomyopathy (DCM) population with a devastating course and grave prognosis.
Objective:
We aimed to investigate potential genetic contributions to pEFE etiology.
Methods:
We performed integrative genomic analysis in 8 infants with confirmed pathological diagnosis of pEFE using whole exome sequencing (WES), RNA-seq and functional genomics studies. Patient-derived fibroblasts, neonatal rat ventricular myocytes and neonatal rat cardiac fibroblasts were used for cellular assays. Real-time cell migration and proliferation analyses were performed using xCELLigence technology.
Results:
Whole exome sequencing detected novel and deleterious
de novo
single nucleotide variants, or inherited homozygous rare variants in 11 cilia-related genes in seven out of the eight affected probands. In particular, a novel homozygous variant [c.1938delA] in
ALMS1
was identified in a female proband, pEFE4. This variant resulted in a frameshift introducing a premature stop codon and complete absence of the ALMS1 protein in the proband fibroblasts and explanted heart. Loss of function mutations of
ALMS1
have been implicated in Alstrom syndrome [OMIM 203800], a rare recessive ciliopathy. RNA-sequencing of the proband’s dermal fibroblasts revealed significantly dysregulated cellular signaling and function, including the induction of epithelial mesenchymal transition (EMT), potentially mediated by TGFβ signaling activation. The proband fibroblasts exhibited enhanced migration activity. Herein, we present the unique pathological features of pEFE compared to DCM and utilize integrated WES with RNA-seq analysis to elucidate the molecular mechanisms by which the novel causal
ALMS1
variant contributes to the unique pathology of pEFE in a female infant with Alstrom syndrome.
Conclusions:
Our report provides insights into pEFE etiology and suggests, for the first time to our knowledge, ciliopathy as a potential underlying mechanism for this poorly understood and incurable form of neonatal cardiomyopathy.
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Affiliation(s)
- Zubin Mehta
- DAVID GEFFEN SCHOOL MEDICINE, UNIVERSITY OF CALIFORNIA, LOS ANGELES, CA
| | - Yan Zhao
- UCLA DAVID GEFFEN SCHOOL MEDICINE, Los Angeles, CA
| | - Kang Xuedong
- UCLA DAVID GEFFEN SCHOOL MEDICINE, Los Angeles, CA
| | | | - Nancy Halnon
- UCLA DAVID GEFFEN SCHOOL MEDICINE, Los Angeles, CA
| | | | - Marlin Touma
- UCLA DAVID GEFFEN SCHOOL MEDICINE, Los Angeles, CA
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7
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Zhao Y, Wang LK, Eskin A, Kang X, Fajardo VM, Mehta Z, Pineles S, Schmidt RJ, Nagiel A, Satou G, Garg M, Federman M, Reardon LC, Lee SL, Biniwale R, Grody WW, Halnon N, Khanlou N, Quintero-Rivera F, Alejos JC, Nakano A, Fishbein GA, Van Arsdell GS, Nelson SF, Touma M. Recessive ciliopathy mutations in primary endocardial fibroelastosis: a rare neonatal cardiomyopathy in a case of Alstrom syndrome. J Mol Med (Berl) 2021; 99:1623-1638. [PMID: 34387706 PMCID: PMC8541947 DOI: 10.1007/s00109-021-02112-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 06/28/2021] [Accepted: 07/05/2021] [Indexed: 11/09/2022]
Abstract
Abstract Among neonatal cardiomyopathies, primary endocardial fibroelastosis (pEFE) remains a mysterious disease of the endomyocardium that is poorly genetically characterized, affecting 1/5000 live births and accounting for 25% of the entire pediatric dilated cardiomyopathy (DCM) with a devastating course and grave prognosis. To investigate the potential genetic contribution to pEFE, we performed integrative genomic analysis, using whole exome sequencing (WES) and RNA-seq in a female infant with confirmed pathological diagnosis of pEFE. Within regions of homozygosity in the proband genome, WES analysis revealed novel parent-transmitted homozygous mutations affecting three genes with known roles in cilia assembly or function. Among them, a novel homozygous variant [c.1943delA] of uncertain significance in ALMS1 was prioritized for functional genomic and mechanistic analysis. Loss of function mutations of ALMS1 have been implicated in Alstrom syndrome (AS) [OMIM 203800], a rare recessive ciliopathy that has been associated with cardiomyopathy. The variant of interest results in a frameshift introducing a premature stop codon. RNA-seq of the proband’s dermal fibroblasts confirmed the impact of the novel ALMS1 variant on RNA-seq reads and revealed dysregulated cellular signaling and function, including the induction of epithelial mesenchymal transition (EMT) and activation of TGFβ signaling. ALMS1 loss enhanced cellular migration in patient fibroblasts as well as neonatal cardiac fibroblasts, while ALMS1-depleted cardiomyocytes exhibited enhanced proliferation activity. Herein, we present the unique pathological features of pEFE compared to DCM and utilize integrated genomic analysis to elucidate the molecular impact of a novel mutation in ALMS1 gene in an AS case. Our report provides insights into pEFE etiology and suggests, for the first time to our knowledge, ciliopathy as a potential underlying mechanism for this poorly understood and incurable form of neonatal cardiomyopathy. Key message Primary endocardial fibroelastosis (pEFE) is a rare form of neonatal cardiomyopathy that occurs in 1/5000 live births with significant consequences but unknown etiology. Integrated genomics analysis (whole exome sequencing and RNA sequencing) elucidates novel genetic contribution to pEFE etiology. In this case, the cardiac manifestation in Alstrom syndrome is pEFE. To our knowledge, this report provides the first evidence linking ciliopathy to pEFE etiology. Infants with pEFE should be examined for syndromic features of Alstrom syndrome. Our findings lead to a better understanding of the molecular mechanisms of pEFE, paving the way to potential diagnostic and therapeutic applications.
Supplementary information The online version contains supplementary material available at 10.1007/s00109-021-02112-z.
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Affiliation(s)
- Yan Zhao
- Department of Pediatrics, 3762 MacDonald Research Laboratories, David Geffen School of Medicine, University of California Los Angeles, 675 Charles E. Young Dr S, CA, 90095, Los Angeles, USA.,Neonatal/Congenital Heart Laboratory, Cardiovascular Research Laboratory, University of California Los Angeles, Los Angeles, CA, USA.,Department of Pediatrics, Children's Discovery and Innovation Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Lee-Kai Wang
- Institute for Precision Health, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Ascia Eskin
- Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Xuedong Kang
- Department of Pediatrics, 3762 MacDonald Research Laboratories, David Geffen School of Medicine, University of California Los Angeles, 675 Charles E. Young Dr S, CA, 90095, Los Angeles, USA.,Neonatal/Congenital Heart Laboratory, Cardiovascular Research Laboratory, University of California Los Angeles, Los Angeles, CA, USA.,Department of Pediatrics, Children's Discovery and Innovation Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Viviana M Fajardo
- Department of Pediatrics, 3762 MacDonald Research Laboratories, David Geffen School of Medicine, University of California Los Angeles, 675 Charles E. Young Dr S, CA, 90095, Los Angeles, USA
| | - Zubin Mehta
- Department of Pediatrics, 3762 MacDonald Research Laboratories, David Geffen School of Medicine, University of California Los Angeles, 675 Charles E. Young Dr S, CA, 90095, Los Angeles, USA.,Neonatal/Congenital Heart Laboratory, Cardiovascular Research Laboratory, University of California Los Angeles, Los Angeles, CA, USA.,Department of Pediatrics, Children's Discovery and Innovation Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Stacy Pineles
- Department of Ophthalmology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Ryan J Schmidt
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Aaron Nagiel
- The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Department of Ophthalmology, Roski Eye Institute, University of Southern California, Los Angeles, CA, USA
| | - Gary Satou
- Department of Pediatrics, 3762 MacDonald Research Laboratories, David Geffen School of Medicine, University of California Los Angeles, 675 Charles E. Young Dr S, CA, 90095, Los Angeles, USA
| | - Meena Garg
- Department of Pediatrics, 3762 MacDonald Research Laboratories, David Geffen School of Medicine, University of California Los Angeles, 675 Charles E. Young Dr S, CA, 90095, Los Angeles, USA
| | - Myke Federman
- Department of Pediatrics, 3762 MacDonald Research Laboratories, David Geffen School of Medicine, University of California Los Angeles, 675 Charles E. Young Dr S, CA, 90095, Los Angeles, USA
| | - Leigh C Reardon
- Department of Pediatrics, 3762 MacDonald Research Laboratories, David Geffen School of Medicine, University of California Los Angeles, 675 Charles E. Young Dr S, CA, 90095, Los Angeles, USA.,Ahmanson/UCLA Adult Congenital Heart Disease Center, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Steven L Lee
- Department of Pediatrics, 3762 MacDonald Research Laboratories, David Geffen School of Medicine, University of California Los Angeles, 675 Charles E. Young Dr S, CA, 90095, Los Angeles, USA
| | - Reshma Biniwale
- Department of Pediatrics, 3762 MacDonald Research Laboratories, David Geffen School of Medicine, University of California Los Angeles, 675 Charles E. Young Dr S, CA, 90095, Los Angeles, USA.,Department of Cardiothoracic Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Wayne W Grody
- Department of Pediatrics, 3762 MacDonald Research Laboratories, David Geffen School of Medicine, University of California Los Angeles, 675 Charles E. Young Dr S, CA, 90095, Los Angeles, USA.,Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Nancy Halnon
- Department of Pediatrics, 3762 MacDonald Research Laboratories, David Geffen School of Medicine, University of California Los Angeles, 675 Charles E. Young Dr S, CA, 90095, Los Angeles, USA
| | - Negar Khanlou
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Fabiola Quintero-Rivera
- Department of Pathology and Laboratory Medicine and Department of Pediatrics, University of California Irvine, CA, Irvine, USA
| | - Juan C Alejos
- Department of Pediatrics, 3762 MacDonald Research Laboratories, David Geffen School of Medicine, University of California Los Angeles, 675 Charles E. Young Dr S, CA, 90095, Los Angeles, USA
| | - Atsushi Nakano
- Eli and Edythe Broad Stem Cell Research Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Gregory A Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Glen S Van Arsdell
- Department of Pediatrics, 3762 MacDonald Research Laboratories, David Geffen School of Medicine, University of California Los Angeles, 675 Charles E. Young Dr S, CA, 90095, Los Angeles, USA.,Department of Cardiothoracic Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Stanley F Nelson
- Department of Pediatrics, 3762 MacDonald Research Laboratories, David Geffen School of Medicine, University of California Los Angeles, 675 Charles E. Young Dr S, CA, 90095, Los Angeles, USA.,Institute for Precision Health, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Marlin Touma
- Department of Pediatrics, 3762 MacDonald Research Laboratories, David Geffen School of Medicine, University of California Los Angeles, 675 Charles E. Young Dr S, CA, 90095, Los Angeles, USA. .,Neonatal/Congenital Heart Laboratory, Cardiovascular Research Laboratory, University of California Los Angeles, Los Angeles, CA, USA. .,Department of Pediatrics, Children's Discovery and Innovation Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA. .,Eli and Edythe Broad Stem Cell Research Center, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA. .,The Molecular Biology Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
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8
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Bearl DW, Cantor R, Koehl D, Gossett JG, Bock MJ, Halnon N, Glass L, Exil V, Musselwhite C, Kirklin JK, Godown J, Ravishankar C. Fontan-associated plastic bronchitis waitlist and heart transplant outcomes: A PHTS analysis. Pediatr Transplant 2021; 25:e13951. [PMID: 33405353 DOI: 10.1111/petr.13951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/20/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
Plastic bronchitis is a rare post-Fontan complication with limited treatment options. Heart transplantation has evolved as a potential curative option, but outcomes have not been well-defined. This study aims to assess contemporary waitlist and post-transplant outcomes in patients with plastic bronchitis. All Fontan patients were identified in the PHTS database (2010 - 2018). Waitlist and post-transplant outcomes were compared between Fontan patients with and without plastic bronchitis. Competing outcomes and Kaplan-Meier analyses were used to assess the impact of plastic bronchitis on waitlist and post-transplant survival. A secondary analysis excluded those with PLE from the comparison cohort. Of 645 Fontan patients listed for heart transplant, 69 (11%) had plastic bronchitis. At listing, patients with plastic bronchitis were younger (8.9 vs 11.1 years, P = .02), but had few other differences in baseline characteristics. A fewer Fontan patients with plastic bronchitis were listed in the more recent era (46 [15.4%] in 2010-2014 vs 23 [6.6%] in 2015-2018, P < .01). Overall, there was no difference in waitlist (P = .30) or post-transplant (P = .66) survival for Fontan patients with and without plastic bronchitis. The results were similar after excluding patients with PLE. Contrary to prior reports, this relatively large series showed that plastic bronchitis did not have a negative impact on survival to or after heart transplantation in Fontan patients. Our study also found a 50% reduction in listing in the current era, which may indicate evolution in management of Fontan patients.
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Affiliation(s)
- David W Bearl
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Ryan Cantor
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Devin Koehl
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Matthew J Bock
- Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Nancy Halnon
- UCLA Mattel Children's Hospital, Los Angeles, CA, USA
| | - Lauren Glass
- Mount Sinai Kravis Children's Hospital, New York, NY, USA
| | - Vernat Exil
- University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | | | - James K Kirklin
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Justin Godown
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
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9
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Liu ZQ, Maforo NG, Renella P, Halnon N, Wu HH, Ennis DB. Reproducibility of Left Ventricular CINE DENSE Strain in Pediatric Subjects with Duchenne Muscular Dystrophy. Funct Imaging Model Heart 2021; 12738:232-241. [PMID: 36939420 PMCID: PMC10022706 DOI: 10.1007/978-3-030-78710-3_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cardiomyopathy is the leading cause of mortality in boys with Duchenne muscular dystrophy (DMD). Left ventricular (LV) peak mid-wall circumferential strain (Ecc) is a sensitive early biomarker for evaluating both the subtle and variable onset and the progression of cardiomyopathy in pediatric subjects with DMD. Cine Displacement Encoding with Stimulated Echoes (DENSE) has proven sensitive to changes in Ecc, but its reproducibility has not been reported in a pediatric cohort or a DMD cohort. The objective was to quantify the intra-observer repeatability, and intra-exam and inter-observer reproducibility of global and regional Ecc derived from cine DENSE in DMD patients (N = 10) and age-and sex-matched controls (N = 10). Global and regional Ecc measures were considered reproducible in the intra-exam, intra-observer, and inter-observer comparisons. Intra-observer repeatability was highest, followed by intra-exam reproducibility and then inter-observer reproducibility. The smallest detectable change in Ecc was 0.01 for the intra-observer comparison, which is below the previously reported yearly decrease of 0.013 ± 0.015 in Ecc in DMD patients.
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Affiliation(s)
- Zhan-Qiu Liu
- Department of Radiology, Stanford University, Palo Alto, CA, USA
| | - Nyasha G Maforo
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA
| | - Pierangelo Renella
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA
- Department of Medicine (Pediatric Cardiology), Children's Hospital, Orange, CA, USA
| | - Nancy Halnon
- Department of Pediatrics, University of California, Los Angeles, CA, USA
| | - Holden H Wu
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA
| | - Daniel B Ennis
- Department of Radiology, Stanford University, Palo Alto, CA, USA
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10
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Dual SA, Maforo NG, McElhinney DB, Prosper A, Wu HH, Maskatia S, Renella P, Halnon N, Ennis DB. Right Ventricular Function and T1-Mapping in Boys With Duchenne Muscular Dystrophy. J Magn Reson Imaging 2021; 54:1503-1513. [PMID: 34037289 DOI: 10.1002/jmri.27729] [Citation(s) in RCA: 5] [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: 02/11/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Clinical management of boys with Duchenne muscular dystrophy (DMD) relies on in-depth understanding of cardiac involvement, but right ventricular (RV) structural and functional remodeling remains understudied. PURPOSE To evaluate several analysis methods and identify the most reliable one to measure RV pre- and postcontrast T1 (RV-T1) and to characterize myocardial remodeling in the RV of boys with DMD. STUDY TYPE Prospective. POPULATION Boys with DMD (N = 27) and age-/sex-matched healthy controls (N = 17) from two sites. FIELD STRENGTH/SEQUENCE 3.0 T using balanced steady state free precession, motion-corrected phase sensitive inversion recovery and modified Look-Locker inversion recovery sequences. ASSESSMENT Biventricular mass (Mi), end-diastolic volume (EDVi) and ejection fraction (EF) assessment, tricuspid annular excursion (TAE), late gadolinium enhancement (LGE), pre- and postcontrast myocardial T1 maps. The RV-T1 reliability was assessed by three observers in four different RV regions of interest (ROI) using intraclass correlation (ICC). STATISTICAL TESTS The Wilcoxon rank sum test was used to compare RV-T1 differences between DMD boys with negative LGE(-) or positive LGE(+) and healthy controls. Additionally, correlation of precontrast RV-T1 with functional measures was performed. A P-value <0.05 was considered statistically significant. RESULTS A 1-pixel thick RV circumferential ROI proved most reliable (ICC > 0.91) for assessing RV-T1. Precontrast RV-T1 was significantly higher in boys with DMD compared to controls. Both LGE(-) and LGE(+) boys had significantly elevated precontrast RV-T1 compared to controls (1543 [1489-1597] msec and 1550 [1402-1699] msec vs. 1436 [1399-1473] msec, respectively). Compared to healthy controls, boys with DMD had preserved RVEF (51.8 [9.9]% vs. 54.2 [7.2]%, P = 0.31) and significantly reduced RVMi (29.8 [9.7] g vs. 48.0 [15.7] g), RVEDVi (69.8 [29.7] mL/m2 vs. 89.1 [21.9] mL/m2 ), and TAE (22.0 [3.2] cm vs. 26.0 [4.7] cm). Significant correlations were found between precontrast RV-T1 and RVEF (β = -0.48%/msec) and between LV-T1 and LVEF (β = -0.51%/msec). DATA CONCLUSION Precontrast RV-T1 is elevated in boys with DMD compared to healthy controls and is negatively correlated with RVEF. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Seraina A Dual
- Department of Radiology, Stanford University, Palo Alto, California, USA.,Department of Cardiothoracic Surgery, Stanford University, Palo Alto, California, USA.,Cardiovascular Institute, Stanford University, Palo Alto, California, USA
| | - Nyasha G Maforo
- Physics and Biology in Medicine Interdepartmental Program, University of California, Los Angeles, California, USA.,Department of Radiological Sciences, University of California, Los Angeles, California, USA
| | - Doff B McElhinney
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, California, USA
| | - Ashley Prosper
- Department of Radiological Sciences, University of California, Los Angeles, California, USA
| | - Holden H Wu
- Physics and Biology in Medicine Interdepartmental Program, University of California, Los Angeles, California, USA.,Department of Radiological Sciences, University of California, Los Angeles, California, USA
| | - Shiraz Maskatia
- Department of Pediatrics, Stanford University, Palo Alto, California, USA.,Maternal & Child Health Research Institute, Stanford University, Palo Alto, California, USA
| | - Pierangelo Renella
- Department of Radiological Sciences, University of California, Los Angeles, California, USA.,Children's hospital Orange County, University of California, Irvine, California, USA
| | - Nancy Halnon
- Department of Medicine (Cardiology), University of California, Los Angeles, California, USA
| | - Daniel B Ennis
- Department of Radiology, Stanford University, Palo Alto, California, USA.,Cardiovascular Institute, Stanford University, Palo Alto, California, USA.,Maternal & Child Health Research Institute, Stanford University, Palo Alto, California, USA
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11
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Maforo NG, Magrath P, Moulin K, Shao J, Kim GH, Prosper A, Renella P, Wu HH, Halnon N, Ennis DB. T 1-Mapping and extracellular volume estimates in pediatric subjects with Duchenne muscular dystrophy and healthy controls at 3T. J Cardiovasc Magn Reson 2020; 22:85. [PMID: 33302967 PMCID: PMC7731511 DOI: 10.1186/s12968-020-00687-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 10/29/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cardiovascular disease is the leading cause of death in patients with Duchenne muscular dystrophy (DMD)-a fatal X-linked genetic disorder. Late gadolinium enhancement (LGE) imaging is the current gold standard for detecting myocardial tissue remodeling, but it is often a late finding. Current research aims to investigate cardiovascular magnetic resonance (CMR) biomarkers, including native (pre-contrast) T1 and extracellular volume (ECV) to evaluate the early on-set of microstructural remodeling and to grade disease severity. To date, native T1 measurements in DMD have been reported predominantly at 1.5T. This study uses 3T CMR: (1) to characterize global and regional myocardial pre-contrast T1 differences between healthy controls and LGE + and LGE- boys with DMD; and (2) to report global and regional myocardial post-contrast T1 values and myocardial ECV estimates in boys with DMD, and (3) to identify left ventricular (LV) T1-mapping biomarkers capable of distinguishing between healthy controls and boys with DMD and detecting LGE status in DMD. METHODS Boys with DMD (N = 28, 13.2 ± 3.1 years) and healthy age-matched boys (N = 20, 13.4 ± 3.1 years) were prospectively enrolled and underwent a 3T CMR exam including standard functional imaging and T1 mapping using a modified Look-Locker inversion recovery (MOLLI) sequence. Pre-contrast T1 mapping was performed on all boys, but contrast was administered only to boys with DMD for post-contrast T1 and ECV mapping. Global and segmental myocardial regions of interest were contoured on mid LV T1 and ECV maps. ROI measurements were compared for pre-contrast myocardial T1 between boys with DMD and healthy controls, and for post-contrast myocardial T1 and ECV between LGE + and LGE- boys with DMD using a Wilcoxon rank-sum test. Results are reported as median and interquartile range (IQR). p-Values < 0.05 were considered significant. Receiver Operating Characteristic analysis was used to evaluate a binomial logistic classifier incorporating T1 mapping and LV function parameters in the tasks of distinguishing between healthy controls and boys with DMD, and detecting LGE status in DMD. The area under the curve is reported. RESULTS Boys with DMD had significantly increased global native T1 [1332 (60) ms vs. 1289 (56) ms; p = 0.004] and increased within-slice standard deviation (SD) [100 (57) ms vs. 74 (27) ms; p = 0.001] compared to healthy controls. LGE- boys with DMD also demonstrated significantly increased lateral wall native T1 [1322 (68) ms vs. 1277 (58) ms; p = 0.001] compared to healthy controls. LGE + boys with DMD had decreased global myocardial post-contrast T1 [565 (113) ms vs 635 (126) ms; p = 0.04] and increased global myocardial ECV [32 (8) % vs. 28 (4) %; p = 0.02] compared to LGE- boys. In all classification tasks, T1-mapping biomarkers outperformed a conventional biomarker, LV ejection fraction. ECV was the best performing biomarker in the task of predicting LGE status (AUC = 0.95). CONCLUSIONS Boys with DMD exhibit elevated native T1 compared to healthy, sex- and age-matched controls, even in the absence of LGE. Post-contrast T1 and ECV estimates from 3T CMR are also reported here for pediatric patients with DMD for the first time and can distinguish between LGE + from LGE- boys. In all classification tasks, T1-mapping biomarkers outperform a conventional biomarker, LVEF.
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Affiliation(s)
- Nyasha G Maforo
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA
- Physics and Biology in Medicine Interdepartmental Program, University of California, Los Angeles, CA, USA
| | - Patrick Magrath
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA
- Department of Bioengineering, University of California, Los Angeles, CA, USA
| | - Kévin Moulin
- Department of Radiology, Stanford University, 1201 Welch Road, Room P264, Stanford, CA, 94305-5488, USA
| | - Jiaxin Shao
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA
| | - Grace Hyun Kim
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA
- Department of Biostatistics, University of California, Los Angeles, CA, USA
| | - Ashley Prosper
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA
| | - Pierangelo Renella
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of Pediatric Cardiology, CHOC Children's Hospital, Orange, CA, USA
| | - Holden H Wu
- Department of Radiological Sciences, University of California, Los Angeles, CA, USA
- Physics and Biology in Medicine Interdepartmental Program, University of California, Los Angeles, CA, USA
- Department of Bioengineering, University of California, Los Angeles, CA, USA
| | - Nancy Halnon
- Department of Pediatrics (Cardiology), University of California, Los Angeles, CA, USA
| | - Daniel B Ennis
- Department of Radiology, Stanford University, 1201 Welch Road, Room P264, Stanford, CA, 94305-5488, USA.
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12
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Zhao Y, Kang X, Barsegian A, He J, Guzman A, Lau RP, Biniwale R, Wadhra M, Reemtsen B, Garg M, Halnon N, Quintero-Rivera F, Grody WW, Van Arsdell G, Nelson SF, Touma M. Gene-environment regulation of chamber-specific maturation during hypoxemic perinatal circulatory transition. J Mol Med (Berl) 2020; 98:1009-1020. [PMID: 32533200 DOI: 10.1007/s00109-020-01933-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/12/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Abstract
Chamber-specific and temporally regulated perinatal cardiac growth and maturation is critical for functional adaptation of the heart and may be altered significantly in response to perinatal stress, such as systemic hypoxia (hypoxemia), leading to significant pathology, even mortality. Understanding transcriptome regulation of neonatal heart chambers in response to hypoxemia is necessary to develop chamber-specific therapies for infants with cyanotic congenital heart defects (CHDs). We sought to determine chamber-specific transcriptome programming during hypoxemic perinatal circulatory transition. We performed transcriptome-wide analysis on right ventricle (RV) and left ventricle (LV) of postnatal day 3 (P3) mouse hearts exposed to perinatal hypoxemia. Hypoxemia decreased baseline differences between RV and LV leading to significant attenuation of ventricular patterning (AVP), which involved several molecular pathways, including Wnt signaling suppression and cell cycle induction. Notably, robust changes in RV transcriptome in hypoxemic condition contributed significantly to the AVP. Remarkably, suppression of epithelial mesenchymal transition (EMT) and dysregulation of the TP53 signaling were prominent hallmarks of the AVP genes in neonatal mouse heart. Furthermore, members of the TP53-related gene family were dysregulated in the hypoxemic RVs of neonatal mouse and cyanotic Tetralogy of Fallot hearts. Integrated analysis of chamber-specific transcriptome revealed hypoxemia-specific changes that were more robust in RVs compared with LVs, leading to previously uncharacterized AVP induced by perinatal hypoxemia. Remarkably, reprogramming of EMT process and dysregulation of the TP53 network contributed to transcriptome remodeling of neonatal heart during hypoxemic circulatory transition. These insights may enhance our understanding of hypoxemia-induced pathogenesis in newborn infants with cyanotic CHD phenotypes. KEY MESSAGES: During perinatal circulatory transition, transcriptome programming is a major driving force of cardiac chamber-specific maturation and adaptation to hemodynamic load and external environment. During hypoxemic perinatal transition, transcriptome reprogramming may affect chamber-specific growth and development, particularly in newborns with congenital heart defects (CHDs). Chamber-specific transcriptome changes during hypoxemic perinatal transition are yet to be fully elucidated. Systems-based analysis of hypoxemic neonatal hearts at postnatal day 3 reveals chamber-specific transcriptome signatures during hypoxemic perinatal transition, which involve attenuation of ventricular patterning (AVP) and repression of epithelial mesenchymal transition (EMT). Key regulatory circuits involved in hypoxemia response were identified including suppression of Wnt signaling, induction of cellular proliferation and dysregulation of TP53 network.
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Affiliation(s)
- Yan Zhao
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles 675 Charles E. Young Dr S, 3762 MacDonald Research Laboratories, Los Angeles, CA, 90024, USA.,Neonatal/Congenital Heart Laboratory, Cardiovascular Research Laboratory, University of California Los Angeles, Los Angeles, CA, USA
| | - Xuedong Kang
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles 675 Charles E. Young Dr S, 3762 MacDonald Research Laboratories, Los Angeles, CA, 90024, USA.,Neonatal/Congenital Heart Laboratory, Cardiovascular Research Laboratory, University of California Los Angeles, Los Angeles, CA, USA
| | - Alexander Barsegian
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles 675 Charles E. Young Dr S, 3762 MacDonald Research Laboratories, Los Angeles, CA, 90024, USA.,Neonatal/Congenital Heart Laboratory, Cardiovascular Research Laboratory, University of California Los Angeles, Los Angeles, CA, USA
| | - Jian He
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles 675 Charles E. Young Dr S, 3762 MacDonald Research Laboratories, Los Angeles, CA, 90024, USA.,Neonatal/Congenital Heart Laboratory, Cardiovascular Research Laboratory, University of California Los Angeles, Los Angeles, CA, USA
| | - Alejandra Guzman
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles 675 Charles E. Young Dr S, 3762 MacDonald Research Laboratories, Los Angeles, CA, 90024, USA.,Neonatal/Congenital Heart Laboratory, Cardiovascular Research Laboratory, University of California Los Angeles, Los Angeles, CA, USA
| | - Ryan P Lau
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Reshma Biniwale
- Department of Cardiothoracic Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Madhuri Wadhra
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Brian Reemtsen
- Department of Cardiothoracic Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Meena Garg
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles 675 Charles E. Young Dr S, 3762 MacDonald Research Laboratories, Los Angeles, CA, 90024, USA
| | - Nancy Halnon
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles 675 Charles E. Young Dr S, 3762 MacDonald Research Laboratories, Los Angeles, CA, 90024, USA
| | - Fabiola Quintero-Rivera
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Wayne W Grody
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Glen Van Arsdell
- Department of Cardiothoracic Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Stanley F Nelson
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles 675 Charles E. Young Dr S, 3762 MacDonald Research Laboratories, Los Angeles, CA, 90024, USA.,Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Institute of Precision Health, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Marlin Touma
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles 675 Charles E. Young Dr S, 3762 MacDonald Research Laboratories, Los Angeles, CA, 90024, USA. .,Neonatal/Congenital Heart Laboratory, Cardiovascular Research Laboratory, University of California Los Angeles, Los Angeles, CA, USA. .,Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA. .,Children's Discovery and Innovation Institute, Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA. .,The Molecular Biology Institute, University of California Los Angeles, Los Angeles, CA, USA. .,Eli and Edythe Stem Cell Institute, University of California Los Angeles, Los Angeles, CA, USA. .,Institute of Precision Health, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
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13
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Bearl D, Cantor R, Koehl D, Gossett J, Bock M, Halnon N, Glass L, Exil V, Musselwhite C, Kirklin J, Godown J, Ravishankar C. Heart Transplant Outcomes in Children with Fontan-Associated Plastic Bronchitis: A Pediatric Heart Transplant Society Analysis. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1313] [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: 11/17/2022] Open
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14
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Zhao Y, Kang X, Gao F, Guzman A, Lau RP, Biniwale R, Wadehra M, Reemtsen B, Garg M, Halnon N, Quintero-Rivera F, Van Arsdell G, Coppola G, Nelson SF, Touma M. Gene-environment regulatory circuits of right ventricular pathology in tetralogy of fallot. J Mol Med (Berl) 2019; 97:1711-1722. [PMID: 31834445 DOI: 10.1007/s00109-019-01857-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/02/2019] [Accepted: 11/15/2019] [Indexed: 12/12/2022]
Abstract
The phenotypic spectrum of congenital heart defects (CHDs) is contributed by both genetic and environmental factors. Their interactions are profoundly heterogeneous but may operate on common pathways as in the case of hypoxia signaling during postnatal heart development in the context of CHDs. Tetralogy of Fallot (TOF) is the most common cyanotic (hypoxemic) CHD. However, how the hypoxic environment contributes to TOF pathogenesis after birth is poorly understood. We performed Genome-wide transcriptome analysis on right ventricle outflow tract (RVOT) specimens from cyanotic and noncyanotic TOF. Co-expression network analysis identified gene modules specifically associated with clinical diagnosis and hypoxemia status in the TOF hearts. In particular, hypoxia-dependent induction of myocyte proliferation is associated with E2F1-mediated cell cycle regulation and repression of the WNT11-RB1 axis. Genes enriched in epithelial mesenchymal transition (EMT), fibrosis, and sarcomere were also repressed in cyanotic TOF patients. Importantly, transcription factor analysis of the hypoxia-regulated modules suggested CREB1 as a putative regulator of hypoxia/WNT11-RB1 circuit. The study provides a high-resolution landscape of transcriptome programming associated with TOF phenotypes and unveiled hypoxia-induced regulatory circuit in cyanotic TOF. Hypoxia-induced cardiomyocyte proliferation involves negative modulation of CREB1 activity upstream of the WNT11-RB1 axis. KEY MESSAGES: Genetic and environmental factors contribute to congenital heart defects (CHDs). How hypoxia contributes to Tetralogy of Fallot (TOF) pathogenesis after birth is unclear. Systems biology-based analysis revealed distinct molecular signature in CHDs. Gene expression modules specifically associated with cyanotic TOF were uncovered. Key regulatory circuits induced by hypoxia in TOF pathogenesis after birth were unveiled.
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Affiliation(s)
- Yan Zhao
- Department of Pediatrics, David Geffen School of Medicine, University of California, 10833 Le Conte Ave, MDCC-B2-375, Los Angeles, CA, 90095, USA.,Neonatal/Congenital Heart Laboratory, Cardiovascular Research Laboratory, University of California, Los Angeles, CA, USA
| | - Xuedong Kang
- Department of Pediatrics, David Geffen School of Medicine, University of California, 10833 Le Conte Ave, MDCC-B2-375, Los Angeles, CA, 90095, USA.,Neonatal/Congenital Heart Laboratory, Cardiovascular Research Laboratory, University of California, Los Angeles, CA, USA
| | - Fuying Gao
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Alejandra Guzman
- Department of Pediatrics, David Geffen School of Medicine, University of California, 10833 Le Conte Ave, MDCC-B2-375, Los Angeles, CA, 90095, USA
| | - Ryan P Lau
- Department of Pathology and Laboratory Medicine, Clinical Genomics Center, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Reshma Biniwale
- Department of Cardiothoracic Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Madhuri Wadehra
- Department of Pathology and Laboratory Medicine, Clinical Genomics Center, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Brian Reemtsen
- Department of Cardiothoracic Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Meena Garg
- Department of Pediatrics, David Geffen School of Medicine, University of California, 10833 Le Conte Ave, MDCC-B2-375, Los Angeles, CA, 90095, USA
| | - Nancy Halnon
- Department of Pediatrics, David Geffen School of Medicine, University of California, 10833 Le Conte Ave, MDCC-B2-375, Los Angeles, CA, 90095, USA
| | - Fabiola Quintero-Rivera
- Department of Pathology and Laboratory Medicine, Clinical Genomics Center, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Glen Van Arsdell
- Department of Cardiothoracic Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Giovanni Coppola
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Stanley F Nelson
- Department of Pediatrics, David Geffen School of Medicine, University of California, 10833 Le Conte Ave, MDCC-B2-375, Los Angeles, CA, 90095, USA.,Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Department of Human Genetics, Institute of Precision Health, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Institute of Precision Health, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Marlin Touma
- Department of Pediatrics, David Geffen School of Medicine, University of California, 10833 Le Conte Ave, MDCC-B2-375, Los Angeles, CA, 90095, USA. .,Neonatal/Congenital Heart Laboratory, Cardiovascular Research Laboratory, University of California, Los Angeles, CA, USA. .,Department of Human Genetics, Institute of Precision Health, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. .,Institute of Precision Health, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. .,Department of Pediatrics, Children's Discovery and Innovation Institute, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. .,The Molecular Biology Institute, University of California, Los Angeles, CA, USA. .,Eli and Edythe Stem Cell Institute, University of California, Los Angeles, CA, USA.
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15
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Raman SV, Hor KN, Mazur W, Cardona A, He X, Halnon N, Markham L, Soslow JH, Puchalski MD, Auerbach SR, Truong U, Smart S, McCarthy B, Saeed IM, Statland JM, Kissel JT, Cripe LH. Stabilization of Early Duchenne Cardiomyopathy With Aldosterone Inhibition: Results of the Multicenter AIDMD Trial. J Am Heart Assoc 2019; 8:e013501. [PMID: 31549577 PMCID: PMC6806050 DOI: 10.1161/jaha.119.013501] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Duchenne muscular dystrophy incurs nearly universal dilated cardiomyopathy by the third decade of life, preceded by myocardial damage and impaired left ventricular strain by cardiac magnetic resonance. It has been shown that (1) mineralocorticoid receptor antagonist therapy with spironolactone attenuated damage while maintaining function when given early in a mouse model and (2) low-dose eplerenone stabilized left ventricular strain in boys with Duchenne muscular dystrophy and evident myocardial damage but preserved ejection fraction. We hypothesized that moderate-dose spironolactone versus eplerenone would provide similar cardioprotection in this first head-to-head randomized trial of available mineralocorticoid receptor antagonists, the AIDMD (Aldosterone Inhibition in Duchenne Muscular Dystrophy) trial. Methods and Results This was a multicenter, double-blind, randomized, noninferiority trial. Subjects were randomized to eplerenone, 50 mg, or spironolactone, 50 mg, orally once daily for 12 months. The primary outcome was change in left ventricular systolic strain at 12 months. Among 52 enrolled male subjects, aged 14 (interquartile range, 12-18) years, spironolactone was noninferior to eplerenone (∆strain, 0.4 [interquartile range, -0.4 to 0.6] versus 0.2 [interquartile range, -0.2 to 0.7]; P=0.542). Renal and pulmonary function remained stable in both groups, and no subjects experienced serious hyperkalemia. Infrequent adverse events included gynecomastia in one subject in the spironolactone arm and facial rash in one subject in the eplerenone arm. Conclusions In boys with Duchenne muscular dystrophy and preserved left ventricular ejection fraction, spironolactone added to background therapy is noninferior to eplerenone in preserving contractile function. These findings support early mineralocorticoid receptor antagonist therapy as effective and safe in a genetic disease with high cardiomyopathy risk. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02354352.
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Affiliation(s)
- Subha V Raman
- Ohio State University Wexner Medical Center Columbus OH
| | - Kan N Hor
- Nationwide Children's Hospital Columbus OH
| | - Wojciech Mazur
- The Christ Hospital Heart and Vascular Center Cincinnati OH
| | | | - Xin He
- Department of Epidemiology and Biostatistics University of Maryland College Park MD
| | - Nancy Halnon
- University of California, Los Angeles Los Angeles CA
| | | | | | | | | | | | - Suzanne Smart
- Ohio State University Wexner Medical Center Columbus OH
| | - Beth McCarthy
- Ohio State University Wexner Medical Center Columbus OH
| | | | | | - John T Kissel
- Department of Neurology Ohio State University Columbus OH
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16
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Singh S, Roy B, Pike N, Daniel E, Ehlert L, Lewis AB, Halnon N, Woo MA, Kumar R. Altered brain diffusion tensor imaging indices in adolescents with the Fontan palliation. Neuroradiology 2019; 61:811-824. [PMID: 31041457 DOI: 10.1007/s00234-019-02208-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 04/02/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE Single ventricle heart disease (SVHD) patients show injury in brain sites that regulate autonomic, mood, and cognitive functions. However, the nature (acute or chronic changes) and extent of brain injury in SVHD are unclear. Our aim was to examine regional brain tissue damage in SVHD over controls using DTI-based mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD), and fractional anisotropy (FA) procedures. METHODS We collected two DTI series (3.0-T MRI), mood and cognitive data, from 27 SVHD and 35 control adolescents. Whole-brain MD, AD, RD, and FA maps were calculated from each series, realigned and averaged, normalized to a common space, smoothed, and compared between groups using ANCOVA (covariates, age and sex; false discovery rate, p < 0.05). Region-of-interest analyses were performed to calculate MD, AD, RD, and FA values for magnitude assessment between groups. RESULTS SVHD patients showed impaired mood and cognitive functions over healthy adolescents. Multiple brain sites in SVHD showed increased MD values, including the insula, caudate, cingulate, hypothalamus, thalamus, medial prefrontal and frontal cortices, parahippocampal gyrus, hippocampus, precentral gyrus, amygdala, cerebellum, corpus callosum, basal forebrain, mammillary bodies, internal capsule, midbrain, fornix, and occipital, parietal, and temporal cortices, indicating chronic tissue changes. Similar areas showed either increased AD or RD values, with RD changes more enhanced over AD in SVHD compared to controls. Few brain regions emerged with increased or decreased FA values in SVHD patients over controls. CONCLUSION SVHD adolescents, more than a decade from their last surgical procedure, show widespread brain abnormalities in autonomic, mood, and cognitive regulatory areas. These findings indicate that brain injury is in a chronic stage in SVHD with predominantly myelin changes that may result from previous hypoxia/ischemia- or developmental-induced processes.
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Affiliation(s)
- Sadhana Singh
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, 56-141 CHS, 10833 Le Conte Aves, Los Angeles, CA, 90095-1763, USA
| | - Bhaswati Roy
- UCLA School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
| | - Nancy Pike
- UCLA School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
| | - Ebenezer Daniel
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, 56-141 CHS, 10833 Le Conte Aves, Los Angeles, CA, 90095-1763, USA
| | - Luke Ehlert
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, 56-141 CHS, 10833 Le Conte Aves, Los Angeles, CA, 90095-1763, USA
| | - Alan B Lewis
- Division of Cardiology, Children's Hospital, Los Angeles, CA, USA
| | - Nancy Halnon
- Division of Pediatric Cardiology, University of California Los Angeles, Los Angeles, CA, USA
| | - Mary A Woo
- UCLA School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
| | - Rajesh Kumar
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, 56-141 CHS, 10833 Le Conte Aves, Los Angeles, CA, 90095-1763, USA. .,Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA.
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17
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Abstract
Duchenne muscular dystrophy (DMD) is a fatal inherited genetic disorder that results in progressive muscle weakness and ultimately loss of ambulation, respiratory failure and heart failure. Cardiac MRI (MRI) plays an increasingly important role in the diagnosis and clinical care of boys with DMD and associated cardiomyopathies. Conventional cardiac MRI biomarkers permit measurements of global cardiac function and presence of fibrosis, but changes in these measures are late manifestations. Emerging MRI biomarkers of myocardial function and structure include the estimation of rotational mechanics and regional strain using MRI tagging; T1-mapping; and T2-mapping, a marker of inflammation, edema and fat. These emerging biomarkers provide earlier insights into cardiac involvement in DMD, improving patient care and aiding the evaluation of emerging therapies.
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Affiliation(s)
- Patrick Magrath
- Department of Radiological Sciences, University of California, Los Angeles, CA 90024, USA.,Department of Bioengineering, University of California, Los Angeles, CA 90095, USA
| | - Nyasha Maforo
- Department of Radiological Sciences, University of California, Los Angeles, CA 90024, USA.,Physics & Biology in Medicine IDP, University of California, Los Angeles, CA 90095, USA
| | - Pierangelo Renella
- Department of Radiological Sciences, University of California, Los Angeles, CA 90024, USA.,Department of Medicine, Division of Pediatric Cardiology, CHOC Children's Hospital, Orange, CA 92868, USA
| | - Stanley F Nelson
- Center for Duchenne Muscular Dystrophy, Department of Human Genetics, University of California, Los Angeles, CA 90095, USA
| | - Nancy Halnon
- Department of Radiological Sciences, University of California, Los Angeles, CA 90024, USA.,Department of Medicine, Division of Pediatric Cardiology, University of California, Los Angeles, CA 90024, USA
| | - Daniel B Ennis
- Department of Radiological Sciences, University of California, Los Angeles, CA 90024, USA.,Department of Bioengineering, University of California, Los Angeles, CA 90095, USA.,Physics & Biology in Medicine IDP, University of California, Los Angeles, CA 90095, USA
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18
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Singh S, Kumar R, Roy B, Woo MA, Lewis A, Halnon N, Pike N. Regional brain gray matter changes in adolescents with single ventricle heart disease. Neurosci Lett 2017; 665:156-162. [PMID: 29222023 DOI: 10.1016/j.neulet.2017.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/20/2017] [Accepted: 12/04/2017] [Indexed: 11/25/2022]
Abstract
Adolescents with single ventricle heart disease (SVHD) show autonomic, mood, and cognitive deficits, indicating aberrations in brain areas that regulate these functions. However, the gray matter integrity in autonomic, mood, and cognitive control sites is unclear. We examined regional brain gray matter changes, using high-resolution T1-weighted images (3.0-T magnetic resonance scanner) with voxel based morphometry procedures, as well as mood and cognitive functions in SVHD (n=18; age, 15.7±1.1years; male, 10) and controls (n=31; age, 16.0±1.1years; male, 17). High-resolution T1-weighted images were realigned, gray matter tissue type partitioned, normalized to a common space, smoothed, and compared between groups (analysis of covariance; covariates, age and gender). The mood and cognitive scores were compared between groups using independent samples t-tests. SVHD subjects showed significantly altered mood and cognitive functions over controls. Significantly reduced gray matter emerged in multiple brain areas, including the thalamus, caudate nuclei, putamen, insula, prefrontal, post-central and precentral gyrus, occipital gyrus, para-hippocampal gyrus, temporal gyrus, and cerebellar sites in SVHD over controls. SVHD subjects show compromised gray matter integrity in autonomic, mood and cognitive control sites. The findings indicate that frequent deficits found in SVHD subjects have a brain structural basis in the condition.
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Affiliation(s)
- Sadhana Singh
- Department of Anesthesiology, University of California, Los Angeles, CA, USA
| | - Rajesh Kumar
- Department of Anesthesiology, University of California, Los Angeles, CA, USA; Department of Radiological Sciences, University of California, Los Angeles, CA, USA; Department of Bioengineering, University of California, Los Angeles, CA, USA; Brain Research Institute, University of California, Los Angeles, CA, USA.
| | - Bhaswati Roy
- UCLA School of Nursing, University of California, Los Angeles, CA, USA
| | - Mary A Woo
- UCLA School of Nursing, University of California, Los Angeles, CA, USA
| | - Alan Lewis
- Division of Pediatric Cardiology, Children's Hospital, Los Angeles, CA, USA
| | - Nancy Halnon
- Division of Pediatric Cardiology, University of California, Los Angeles, CA, USA
| | - Nancy Pike
- UCLA School of Nursing, University of California, Los Angeles, CA, USA.
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19
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Shaddy R, Canter C, Halnon N, Kochilas L, Rossano J, Bonnet D, Bush C, Zhao Z, Kantor P, Burch M, Chen F. Design for the sacubitril/valsartan (LCZ696) compared with enalapril study of pediatric patients with heart failure due to systemic left ventricle systolic dysfunction (PANORAMA-HF study). Am Heart J 2017; 193:23-34. [PMID: 29129252 DOI: 10.1016/j.ahj.2017.07.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 07/12/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Sacubitril/valsartan (LCZ696) is an angiotensin receptor neprilysin inhibitor approved for the treatment of adult heart failure (HF); however, the benefit of sacubitril/valsartan in pediatric HF patients is unknown. STUDY DESIGN This global multi-center study will use an adaptive, seamless two-part design. Part 1 will assess the pharmacokinetics/pharmacodynamics of single ascending doses of sacubitril/valsartan in pediatric (1 month to <18 years) HF patients with systemic left ventricle and reduced left ventricular systolic function stratified into 3 age groups (Group 1: 6 to <18 years; Group 2: 1 to <6 years; Group 3: 1 month to <1 year). Part 2 is a 52-week, efficacy and safety study where 360 eligible patients will be randomized to sacubitril/valsartan or enalapril. A novel global rank primary endpoint derived by ranking patients (worst-to-best outcome) based on clinical events such as death, initiation of mechanical life support, listing for urgent heart transplant, worsening HF, measures of functional capacity (NYHA/Ross scores), and patient-reported HF symptoms will be used to assess efficacy. CONCLUSION The PANORAMA-HF study, which will be the largest prospective pediatric HF trial conducted to date and the first to use a global rank primary endpoint, will determine whether sacubitril/valsartan is superior to enalapril for treatment of pediatric HF patients with reduced systemic left ventricular systolic function.
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Affiliation(s)
| | | | - Nancy Halnon
- University of California Los Angeles, Los Angeles, CA
| | | | - Joseph Rossano
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | - Ziqiang Zhao
- Novartis Pharmaceuticals Corporation, Shanghai, China
| | | | - Michael Burch
- Great Ormond Street Hospital for Children, London, UK
| | - Fabian Chen
- Novartis Pharmaceuticals Corporation, Shanghai, China.
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20
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Weng PL, Alejos JC, Halnon N, Zhang Q, Reed EF, Tsai-Chambers E. Long-term outcomes of simultaneous heart and kidney transplantation in pediatric recipients. Pediatr Transplant 2017; 21:10.1111/petr.13023. [PMID: 28727227 PMCID: PMC5638697 DOI: 10.1111/petr.13023] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2017] [Indexed: 11/30/2022]
Abstract
Pediatric sHKTx has become an effective therapy for patients with combined cardiac and renal failure. Often, these patients develop human leukocyte antigen antibodies from their previous allografts and are therefore more difficult to re-transplant. We describe the largest case series of a predominantly sensitized pediatric sHKTx with emphasis on medical management and patient outcomes. Demographics, clinical characteristics, antibody, and biopsy data were retrospectively collected from University of California, Los Angeles database and correlated with short- and long-term patient and allograft outcomes of all sHKTx performed between 2002 and 2015. We identified seven pediatric patients who underwent sHKTx at our center. Mean age at time of sHKTx was 13.7 years and 85.7% were re-graft patients. 57.1% were sensitized with cPRA >50% and another 57.1% had preformed donor-specific antibody. Five-year renal allograft survival and patient survival was 85.7% for both end-points. The remaining six patients are all alive (mean follow-up 78.5 months) with good kidney and heart function. sHKTx in a population with increased immunological risk can be associated with good long-term outcomes and offers potential guidance to the pediatric transplant community where data are limited.
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Affiliation(s)
- Patricia L. Weng
- Division of Pediatric Nephrology, Mattel Children's Hospital UCLA, Los Angeles, CA, USA
| | - Juan Carlos Alejos
- Division of Pediatric Cardiology, Mattel Children's Hospital UCLA, Los Angeles, CA, USA
| | - Nancy Halnon
- Division of Pediatric Cardiology, Mattel Children's Hospital UCLA, Los Angeles, CA, USA
| | - Qiuheng Zhang
- UCLA Immunogenetics Center, Department of Pathology and Laboratory Medicine, University of California, Los Angeles, CA, USA
| | - Elaine F. Reed
- UCLA Immunogenetics Center, Department of Pathology and Laboratory Medicine, University of California, Los Angeles, CA, USA
| | - Eileen Tsai-Chambers
- Division of Pediatric Nephrology, Duke University Medical Center, Durham, NC, USA
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21
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Touma M, Reemtsen B, Halnon N, Alejos J, Finn JP, Nelson SF, Wang Y. A Path to Implement Precision Child Health Cardiovascular Medicine. Front Cardiovasc Med 2017; 4:36. [PMID: 28620608 PMCID: PMC5451507 DOI: 10.3389/fcvm.2017.00036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 03/01/2017] [Accepted: 05/04/2017] [Indexed: 12/17/2022] Open
Abstract
Congenital heart defects (CHDs) affect approximately 1% of live births and are a major source of childhood morbidity and mortality even in countries with advanced healthcare systems. Along with phenotypic heterogeneity, the underlying etiology of CHDs is multifactorial, involving genetic, epigenetic, and/or environmental contributors. Clear dissection of the underlying mechanism is a powerful step to establish individualized therapies. However, the majority of CHDs are yet to be clearly diagnosed for the underlying genetic and environmental factors, and even less with effective therapies. Although the survival rate for CHDs is steadily improving, there is still a significant unmet need for refining diagnostic precision and establishing targeted therapies to optimize life quality and to minimize future complications. In particular, proper identification of disease associated genetic variants in humans has been challenging, and this greatly impedes our ability to delineate gene–environment interactions that contribute to the pathogenesis of CHDs. Implementing a systematic multileveled approach can establish a continuum from phenotypic characterization in the clinic to molecular dissection using combined next-generation sequencing platforms and validation studies in suitable models at the bench. Key elements necessary to advance the field are: first, proper delineation of the phenotypic spectrum of CHDs; second, defining the molecular genotype/phenotype by combining whole-exome sequencing and transcriptome analysis; third, integration of phenotypic, genotypic, and molecular datasets to identify molecular network contributing to CHDs; fourth, generation of relevant disease models and multileveled experimental investigations. In order to achieve all these goals, access to high-quality biological specimens from well-defined patient cohorts is a crucial step. Therefore, establishing a CHD BioCore is an essential infrastructure and a critical step on the path toward precision child health cardiovascular medicine.
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Affiliation(s)
- Marlin Touma
- Department of Pediatrics, Children's Discovery and Innovation Institute, University of California at Los Angeles, Los Angeles, CA, United States.,Cardiovascular Research Laboratory, University of California at Los Angeles, Los Angeles, CA, United States
| | - Brian Reemtsen
- Department of Cardiothoracic Surgery, University of California at Los Angeles, Los Angeles, CA, United States
| | - Nancy Halnon
- Department of Pediatrics, University of California at Los Angeles, Los Angeles, CA, United States
| | - Juan Alejos
- Department of Pediatrics, University of California at Los Angeles, Los Angeles, CA, United States
| | - J Paul Finn
- Department of Radiology, Cardiovascular Imaging, University of California at Los Angeles, Los Angeles, CA, United States
| | - Stanley F Nelson
- Department of Human Genetics, University of California at Los Angeles, Los Angeles, CA, United States
| | - Yibin Wang
- Cardiovascular Research Laboratory, University of California at Los Angeles, Los Angeles, CA, United States.,Department of Anesthesiology, Physiology and Medicine, University of California at Los Angeles, Los Angeles, CA, United States
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22
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Chowdhury D, Gurvitz M, Marelli A, Anderson J, Baker-Smith C, Diab KA, Edwards TC, Hougen T, Jedeikin R, Johnson JN, Karpawich P, Lai W, Lu JC, Mitchell S, Newburger JW, Penny DJ, Portman MA, Satou G, Teitel D, Villafane J, Williams R, Jenkins K, Williams R, Jenkins K, Gurvitz M, Marelli A, Campbell R, Chowdhury D, Jedeikin R, Behera S, Hokanson J, Lu J, Kakavand B, Boris J, Cardis B, Bansal M, Anderson J, Schultz A, O'Connor M, Vinocur JM, Halnon N, Johnson J, Barrett C, Graham E, Krawczeski C, Franklin W, McGovern J, Hattendorf B, Teitel D, Cotts T, Davidson A, Harahsheh A, Johnson W, Jone PN, Sutton N, Tani L, Dahdah N, Portman M, Mensch D, Newburger J, Hougen T, Cross R, Diab K, Karpawich P, Lai W, Peuster M, Schiff R, Saarel E, Satou G, Serwer G, Villafane J, Edwards T, Penny D, Carlson K, Jayakumar KA, Park M, Tede N, Uzark K, Baker Smith C, Fleishman C, Connuck D, Ettedgui J, Likes M, Tsuda T. Development of Quality Metrics in Ambulatory Pediatric Cardiology. J Am Coll Cardiol 2017; 69:541-555. [DOI: 10.1016/j.jacc.2016.11.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/25/2016] [Accepted: 11/18/2016] [Indexed: 11/24/2022]
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23
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Reyhan M, Wang Z, Kim HJ, Halnon N, Finn PJ, Ennis DB. The effect of free-breathing on left ventricular rotational mechanics in normal subjects and patients with duchenne muscular dystrophy. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328323 DOI: 10.1186/1532-429x-17-s1-q22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
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24
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Subramanian S, Hor KN, Mazur W, Smart S, Tran T, Halnon N, Taylor MD, Cripe L, Raman SV. Effect of pulmonary function on right heart function in Duchenne muscular dystrophy patients. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328159 DOI: 10.1186/1532-429x-17-s1-p279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
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25
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Wang Z, Reyhan M, Halnon N, Khan SN, Finn PJ, Renella P, Ennis DB. Quantitative left ventricular rotational mechanics in Duchenne and Becker muscular dystrophy patients. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328834 DOI: 10.1186/1532-429x-17-s1-q34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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26
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Srinivasan S, Kroeker RM, Gabriel S, Plotnik A, Godinez SR, Hu P, Halnon N, Finn JP, Ennis DB. Free-breathing variable flip angle balanced SSFP cardiac cine imaging with reduced SAR at 3T. Magn Reson Med 2015; 76:1210-6. [PMID: 26509846 DOI: 10.1002/mrm.26011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 09/15/2015] [Accepted: 09/15/2015] [Indexed: 11/08/2022]
Abstract
PURPOSE To develop a free-breathing variable flip angle (VFA) balanced steady-state free precession (bSSFP) cardiac cine imaging technique with reduced specific absorption rate (SAR) at 3 Tesla. METHODS Free-breathing VFA (FB-VFA) images in the short-axis and four-chamber views were acquired using an optimal VFA scheme, then compared with conventional breath-hold constant flip angle (BH-CFA) acquisitions. Two cardiac MRI experts used a 5-point scale to score images from healthy subjects (N = 10). The left ventricular ejection fraction, end diastolic volume (LVEDV), end systolic volume, stroke volume (LVSV), and end diastolic myocardial mass (LVEDM) were determined by manual contour analysis for BH-CFA and FB-VFA. A pilot evaluation of FB-VFA was performed in one patient with Duchenne muscular dystrophy. RESULTS FB-VFA SAR was 25% lower than BH-CFA with similar blood-myocardium contrast. The qualitative FB-VFA score was lower than the BH-CFA for the short-axis (3.1 ± 0.5 versus 4.3 ± 0.8; P < 0.05) and the four-chamber view (3.4 ± 0.4 versus 4.6 ± 0.6; P < 0.05). The LVEDV and the LVSV were 5% and 12% larger (P < 0.05) for FB-VFA compared with BH-CFA. There was no difference in LVEDM. CONCLUSION FB-VFA bSSFP cardiac cine imaging decreased the SAR at 3T with image quality sufficient to perform cardiac functional analysis. Magn Reson Med 76:1210-1216, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Subashini Srinivasan
- Department of Radiological Sciences, University of California, Los Angeles, California, USA.,Department of Bioengineering, University of California, Los Angeles, California, USA
| | | | - Simon Gabriel
- Department of Radiological Sciences, University of California, Los Angeles, California, USA
| | - Adam Plotnik
- Department of Radiological Sciences, University of California, Los Angeles, California, USA
| | - Sergio R Godinez
- Department of Radiological Sciences, University of California, Los Angeles, California, USA
| | - Peng Hu
- Department of Radiological Sciences, University of California, Los Angeles, California, USA.,Biomedical Physics Interdepartmental Program, University of California, Los Angeles, California, USA
| | - Nancy Halnon
- Department of Pediatrics, University of California, Los Angeles, California, USA
| | - J Paul Finn
- Department of Radiological Sciences, University of California, Los Angeles, California, USA.,Biomedical Physics Interdepartmental Program, University of California, Los Angeles, California, USA
| | - Daniel B Ennis
- Department of Radiological Sciences, University of California, Los Angeles, California, USA. .,Department of Bioengineering, University of California, Los Angeles, California, USA. .,Biomedical Physics Interdepartmental Program, University of California, Los Angeles, California, USA.
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27
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Wang RT, Silverstein Fadlon CA, Ulm JW, Jankovic I, Eskin A, Lu A, Rangel Miller V, Cantor RM, Li N, Elashoff R, Martin AS, Peay HL, Halnon N, Nelson SF. Online self-report data for duchenne muscular dystrophy confirms natural history and can be used to assess for therapeutic benefits. PLoS Curr 2014; 6. [PMID: 25635234 PMCID: PMC4207635 DOI: 10.1371/currents.md.e1e8f2be7c949f9ffe81ec6fca1cce6a] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
To assess the utility of online patient self-report outcomes in a rare disease, we attempted to observe the effects of corticosteroids in delaying age at fulltime wheelchair use in Duchenne muscular dystrophy (DMD) using data from 1,057 males from DuchenneConnect, an online registry. Data collected were compared to prior natural history data in regard to age at diagnosis, mutation spectrum, and age at loss of ambulation. Because registrants reported differences in steroid and other medication usage, as well as age and ambulation status, we could explore these data for correlations with age at loss of ambulation. Using multivariate analysis, current steroid usage was the most significant and largest independent predictor of improved wheelchair-free survival. Thus, these online self-report data were sufficient to retrospectively observe that current steroid use by patients with DMD is associated with a delay in loss of ambulation. Comparing commonly used steroid drugs, deflazacort prolonged ambulation longer than prednisone (median 14 years and 13 years, respectively). Further, use of Vitamin D and Coenzyme Q10, insurance status, and age at diagnosis after 4 years were also significant, but smaller, independent predictors of longer wheelchair-free survival. Nine other common supplements were also individually tested but had lower study power. This study demonstrates the utility of DuchenneConnect data to observe therapeutic differences, and highlights needs for improvement in quality and quantity of patient-report data, which may allow exploration of drug/therapeutic practice combinations impractical to study in clinical trial settings. Further, with the low barrier to participation, we anticipate substantial growth in the dataset in the coming years.
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Affiliation(s)
- Richard T Wang
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Cheri A Silverstein Fadlon
- Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - J Wes Ulm
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Ivana Jankovic
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Ascia Eskin
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Ake Lu
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | | | - Rita M Cantor
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Ning Li
- Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Robert Elashoff
- Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Anne S Martin
- Parent Project Muscular Dystrophy, Hackensack, New Jersey, USA
| | - Holly L Peay
- Parent Project Muscular Dystrophy, Hackensack, New Jersey, USA
| | - Nancy Halnon
- Pediatric Cardiology, University of California, Los Angeles, California, USA
| | - Stanley F Nelson
- Department of Human Genetics and Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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Evan EE, Patel PA, Amegatcher A, Halnon N. Post-Traumatic Stress Symptoms in Pediatric Heart Transplant Recipients. Health Psychol Res 2014; 2:1549. [PMID: 26973937 PMCID: PMC4768549 DOI: 10.4081/hpr.2014.1549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 04/12/2013] [Indexed: 12/24/2022] Open
Abstract
Traumatic experiences are not unusual in pediatric heart transplant (HT) recipients before and after transplantation. Post-traumatic stress symptoms (PTSS) present at the time of transplant evaluation and developing afterward occur with an unknown frequency. We sought to determine the burden of these symptoms in heart transplant patients. We reviewed 51 consecutive HTs between 2003-2007, including 40 primary transplants and 11 re-transplants. Symptoms were present in 17 of the 51 patients (34%) at the time of orthotopic heart transplantation evaluation. None met the criteria for full post traumatic stress disorder. Transplant complications were examined. Nineteen subjects of the total sample had rejection in the first year following transplant. Rejection rates in the first year was 41% for those with PTSS (7 of 17 patients) and 36% for those without (12 of 33 patients) (P=n.s). Of those patients presenting for a second heart transplant, 55% had PTSS at the time of transplant evaluation and/or the peritransplant period; whereas, (28%) undergoing a primary transplant had PTSS. In addition to symptoms resulting from the disease process leading to HT and other prior experiences, the HT itself seems to present a large psychiatric burden on patients. All patients need to be followed before and after HT for signs and symptoms related to PTSS. Future studies should be undertaken to determine if preventative detection and treatment of patients with these PTSS symptoms early can lead to better outcomes.
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Affiliation(s)
- Elana E Evan
- Department of Pediatric Cardiology, University of California , Los Angeles, CA, USA
| | - Payal A Patel
- Department of Pediatric Cardiology, University of California , Los Angeles, CA, USA
| | - Alison Amegatcher
- Department of Pediatric Cardiology, University of California , Los Angeles, CA, USA
| | - Nancy Halnon
- Department of Pediatric Cardiology, University of California , Los Angeles, CA, USA
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Zhang Q, McNamara J, Cadeiras M, Khuu T, Baas A, Depasquale E, Halnon N, Perens G, Carlos J, Nsair A, Shemin R, Murray K, Ardehali A, Deng M, Reed E. Incidence and Importance of Donor-Specific HLA Antibody in Heart Transplant Recipients. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.095] [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: 11/30/2022] Open
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30
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DePasquale EC, Cheng R, Nsair A, Reardon L, Baas A, Cadeiras M, Cruz D, Halnon N, Alejos J, Deng M, Laks H, Ardehali A. CARDIAC RETRANSPLANTATION: HOW FAR HAVE WE COME? J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60807-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: 10/25/2022]
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31
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Purdy IB, Halnon N, Singh N, Milisavljevic V. Vein of Galen arteriovenous malformation with PAPVR and use of serial B-type natriuretic peptide levels in the management: a case report and review of the literature. Cases J 2010; 3:43. [PMID: 20205818 PMCID: PMC2824638 DOI: 10.1186/1757-1626-3-43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2009] [Accepted: 02/02/2010] [Indexed: 12/30/2022]
Abstract
BACKGROUND Arteriovenous malformation of the vein of Galen with partial anomalous pulmonary venous return can lead to a critically challenging condition associated with a high morbidity and mortality. CASE REPORT We report a case of a full term infant born with a vein of Gallen arteriovenous malformation complicated by partial anomalous pulmonary venous return and congestive heart failure where B-type natriuretic peptide was used as a vital tool in clinical assessment and treatment management. CONCLUSIONS Rapid diagnosis and treatment in infants with complex conditions such as this are imperative to expedite appropriate treatments, preventing long term negative outcome.
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Affiliation(s)
- Isabell B Purdy
- Department of Pediatrics, Division of Neonatology & Developmental Biology, David Geffen School of Medicine at University of California at Los Angeles, 10833 Le Conte Avenue, Room B2-375 MDCC, Los Angeles, CA 90095, USA.
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32
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Shindo T, Alejos J, Halnon N. 519: Predictors of Complications after Heart Transplantation in Pediatric Patients with Restrictive Cardiomyopathy. J Heart Lung Transplant 2010. [DOI: 10.1016/j.healun.2009.11.536] [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: 10/19/2022] Open
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Abstract
As the pediatric OHT population expands, there is increasing demand for convenient, yet sensitive screening techniques to identify children with acute rejection when they present to acute care facilities. In children, symptoms of acute rejection or other causes of graft dysfunction are often non-specific and can mimic other childhood illnesses. The aim of this study was to assess the utility of BNP as a biomarker to assist providers in clinical decision-making when evaluating symptomatic pediatric heart transplant patients. One hundred twenty-two urgent care and emergency room visits from 53 symptomatic pediatric OHT patients were retrospectively reviewed to evaluate the relationship between BNP levels, symptoms, and clinical diagnosis at these visits. An ROC curve was generated to determine the accuracy of BNP as a screening tool for acute rejection in this patient population. In this group of patients, a BNP value of >700 pg/mL was 100% sensitive and 92% specific for detecting allograft acute rejection (NPV of 100%). We concluded that BNP is a highly sensitive screening test for acute rejection in symptomatic pediatric heart transplant patients.
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Affiliation(s)
- Miwa Geiger
- Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, CA 90027, USA.
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Wu J, Laks H, Banerji A, Halnon N, Drant S, Odim J. 394 CARDIAC REPAIR UNDER CARDIOPULMONARY BYPASS IN CHILDREN WITH END-STAGE LIVER DISEASE. J Investig Med 2005. [DOI: 10.2310/6650.2005.00005.393] [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: 11/18/2022]
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