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Wang N, Cao Y, Wang J, Zhang Q. Case Report: Multiple types of arrhythmias in a late-confirmed Danon disease. Front Cardiovasc Med 2024; 11:1369680. [PMID: 38606381 PMCID: PMC11007043 DOI: 10.3389/fcvm.2024.1369680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/29/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction Danon disease is an X-linked disorder caused by pathogenic variants in lysosome-associated membrane protein 2 (LAMP2) gene, typically characterized by the triad of hypertrophic cardiomyopathy, myopathy, and intellectual disability. However, many patients may not present the typical presentation, especially in the early stage. Electrocardiogram (ECG) abnormalities can be found in almost all patients, with Wolff-Parkinson-White (WPW) syndrome being the most common. We reported the case of a 51-year-old woman who experienced multiple types of arrhythmias over three decades and was diagnosed with Danon disease late by genetic testing. Case summary A 51-year-old woman with a 36-year history of intermittent palpitations was admitted due to hemodynamically stable ventricular tachycardia (VT). Her past medical history revealed multiple arrhythmias and ECG abnormalities in her 30s and 40s, including WPW syndrome with paroxysmal supraventricular tachycardia, paroxysmal atrial flutter, atrial fibrillation, ventricular tachycardia, and complete left bundle branch block. She denied any family history of cardiovascular disease or sudden death. Upon arrival, her vital signs were unremarkable. Cardiovascular magnetic resonance (CMR) imaging revealed left ventricular enlargement and late gadolinium enhancement (LGE) in the anterior, inferior, and lateral walls. Subsequent, whole-exome sequencing (WES) gene testing revealed a pathogenic heterozygous variant in LAMP2 gene (c.696T>A; p.Cys232Ter), which confirmed the diagnosis of Danon disease. Conclusion Genetic testing should be considered in patients who display multiple arrhythmias with LV structural abnormalities of unknown etiology for a possible Danon disease.
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Affiliation(s)
| | | | | | - Qing Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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2
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Stavusis J, Micule I, Grinfelde I, Zdanovica A, Pudulis J, Valeina S, Sepetiene S, Lace B, Inashkina I. Altered Splicing of LAMP2 in a Multigenerational Family from Latvia Affected by Danon Disease. Medicina (Kaunas) 2024; 60:99. [PMID: 38256360 PMCID: PMC10821070 DOI: 10.3390/medicina60010099] [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] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/24/2023] [Accepted: 12/31/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Danon disease is a multisystemic disorder associated with variants in the LAMP2 gene, mainly affecting the cardiac muscle. Here, we report a multigenerational family from Latvia with two male patients, hemizygous for a novel splice-affecting variant c.928+3A>G. Affected patients exhibit a cardiac phenotype, moderate mental disability, and mild retinal changes. Materials and Methods: Both patients underwent either exome or hypertrophic cardiomyopathy gene panel next-generation sequencing. The pathogenic variant effect was determined using reverse transcription, Sanger sequencing, and high-resolution electrophoresis. Results: Evaluation of the splicing process revealed that approximately 80% of the transcripts exhibited a lack of the entire exon 7. This alteration was predicted to cause a shift of the reading frame, consequently introducing a premature stop codon downstream in the sequence. Conclusions: Based on our data, we propose that c.928+3A>G is a pathogenic variant associated with Danon disease.
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Affiliation(s)
- Janis Stavusis
- Latvian Biomedical Research and Study Centre, Ratsupites 1, LV-1067 Riga, Latvia
| | - Ieva Micule
- Latvian Biomedical Research and Study Centre, Ratsupites 1, LV-1067 Riga, Latvia
| | - Ieva Grinfelde
- Department of Medical Genetics and Prenatal Diagnostics, Children’s University Hospital, Vienibas Gatve 45, LV-1004 Riga, Latvia
| | - Anna Zdanovica
- Latvian Biomedical Research and Study Centre, Ratsupites 1, LV-1067 Riga, Latvia
| | - Janis Pudulis
- Department of Arrhythmology, Riga East University Hospital, Hipokrata 2, LV-1079 Riga, Latvia
| | - Sandra Valeina
- Ophthalmology Clinics, Children’s University Hospital, Vienibas Gatve 45, LV-1004 Riga, Latvia
| | - Svetlana Sepetiene
- Ophthalmology Clinics, Children’s University Hospital, Vienibas Gatve 45, LV-1004 Riga, Latvia
| | - Baiba Lace
- Latvian Biomedical Research and Study Centre, Ratsupites 1, LV-1067 Riga, Latvia
| | - Inna Inashkina
- Latvian Biomedical Research and Study Centre, Ratsupites 1, LV-1067 Riga, Latvia
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3
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Tang K, Wu J, Liu X, Wang S. Paediatric hypertrophic cardiomyopathy secondary to Danon disease. Cardiol Young 2024; 34:201-204. [PMID: 37990583 DOI: 10.1017/s1047951123003815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
Danon disease is a rare X-linked disorder caused by deficiency of the lysosome-associated membrane protein-2. We report a case of hypertrophic obstructive cardiomyopathy secondary to a novel mutation in the lysosome-associated membrane protein-2 gene in a 10-year-old male adolescent. We performed a modified extended Morrow procedure to minimise the risk of death and improve the patient's quality of life. The patient did not have exertional dyspnoea, and auscultation did not reveal a cardiac murmur at 1-year follow-up.
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Affiliation(s)
- Kai Tang
- Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Jiayi Wu
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiaoxi Liu
- Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Shuiyun Wang
- Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Fuwai Hospital, Beijing, China
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Zhao YT, Cao XQ, Mu XL. Hypertrophic cardiomyopathy secondary to deficiency in lysosome-associated membrane protein-2: A case report. World J Cardiol 2023; 15:609-614. [PMID: 38058400 PMCID: PMC10696204 DOI: 10.4330/wjc.v15.i11.609] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/19/2023] [Accepted: 11/03/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Danon disease (DD), in which mutations in the X-linked lysosome-associated membrane protein-2 (LAMP-2) gene result in hypertrophic cardiomyopathy, is a rare disease, reported primarily in small samples or cases. However, with the development of cardiac magnetic resonance imaging and genetic technology in recent years, the number of reports has increased. CASE SUMMARY We report a case of DD in an adolescent male patient, confirmed by genetic testing. The patient was admitted to our hospital with complaints of a three-year history of chest tightness and shortness of breath. His preliminary clinical diagnosis is hypertrophic cardiomyopathy. Our report includes the patient's clinical course from hospital admission to death, step-by-step diagnosis, treatment course, and noninvasive imaging features. We highlight how a noninvasive diagnostic approach, based solely on clinical and imaging "red flags" for DD, can be used to achieve a diagnosis of DD with a high degree of confidence. CONCLUSION DD is a very dangerous cardiomyopathy, and it is necessary to achieve early diagnosis and treatment.
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Affiliation(s)
- Ye-Tong Zhao
- Department of Radiology, Central Hospital of Dalian University of Technology, Dalian 116033, Liaoning Province, China
- Graduate School, Dalian Medical University, Dalian 116000, Liaoning Province, China
| | - Xiu-Qun Cao
- Departments of Ultrasound and Health Medicine, Central Hospital of Dalian University of Technology, Dalian 116033, Liaoning Province, China
| | - Xiao-Lin Mu
- Department of Radiology, Central Hospital of Dalian University of Technology, Dalian 116033, Liaoning Province, China.
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Hong KN, Eshraghian EA, Arad M, Argirò A, Brambatti M, Bui Q, Caspi O, de Frutos F, Greenberg B, Ho CY, Kaski JP, Olivotto I, Taylor MRG, Yesso A, Garcia-Pavia P, Adler ED. International Consensus on Differential Diagnosis and Management of Patients With Danon Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 82:1628-1647. [PMID: 37821174 DOI: 10.1016/j.jacc.2023.08.014] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/03/2023] [Indexed: 10/13/2023]
Abstract
Danon disease is a rare X-linked autophagic vacuolar cardioskeletal myopathy associated with severe heart failure that can be accompanied with extracardiac neurologic, skeletal, and ophthalmologic manifestations. It is caused by loss of function variants in the LAMP2 gene and is among the most severe and penetrant of the genetic cardiomyopathies. Most patients with Danon disease will experience symptomatic heart failure. Male individuals generally present earlier than women and die of either heart failure or arrhythmia or receive a heart transplant by the third decade of life. Herein, the authors review the differential diagnosis of Danon disease, diagnostic criteria, natural history, management recommendations, and recent advances in treatment of this increasingly recognized and extremely morbid cardiomyopathy.
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Affiliation(s)
- Kimberly N Hong
- University of California-San Diego, San Diego, California, USA
| | | | - Michael Arad
- Leviev Heart Center, Sheba Hospital and Tel Aviv University, Tel Aviv, Israel
| | - Alessia Argirò
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Quan Bui
- University of California-San Diego, San Diego, California, USA
| | - Oren Caspi
- Rambam Medical Centre and B. Rappaport Faculty of Medicine, Technion Medical School, Haifa, Israel
| | - Fernando de Frutos
- Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, Madrid, Spain
| | - Barry Greenberg
- University of California-San Diego, San Diego, California, USA
| | - Carolyn Y Ho
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Juan Pablo Kaski
- Great Ormond Street Hospital and University College London, London, United Kingdom
| | - Iacopo Olivotto
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Meyer Children's Hospital IRCCS, Florence, Italy
| | | | - Abigail Yesso
- Division of Cardiology/Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, USA
| | - Pablo Garcia-Pavia
- Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain; Universidad Francisco de Vitoria, Pozuelo de Alarcon, Spain.
| | - Eric D Adler
- University of California-San Diego, San Diego, California, USA.
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Gandaeva L, Sonicheva-Paterson N, McKenna WJ, Savostyanov K, Myasnikov R, Pushkov A, Zhanin I, Barskiy V, Zharova O, Silnova I, Kaverina V, Sdvigova N, Fisenko A, Arad M, Basargina E. Clinical features of pediatric Danon disease and the importance of early diagnosis. Int J Cardiol 2023; 389:131189. [PMID: 37454822 DOI: 10.1016/j.ijcard.2023.131189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/11/2023] [Accepted: 07/12/2023] [Indexed: 07/18/2023]
Abstract
Successful therapy in a cohort with early onset Danon disease (DD) highlights the potential importance of earlier disease recognition. We present experience from the largest National Pediatric Center in Russia for cardiomyopathy patients. This report focuses on identification of early clinical features of DD in the pediatric population by detailed pedigree analysis and review of medical records. RESULTS: Nine patients (3 females) were identified with DD at the Russian National Medical Research Center of Children's Health ("National Pediatric Center") aged birth to 16 years. At presentation/evaluation: all patients had left ventricular hypertrophy (LVH), ECG features of Wolff-Parkinson-White (WPW), and an increase in hepatic enzymes (particularly lactate dehydrogenase (LDH)); three had marked increase in NT-proBNP; two had HCM with impaired LV function; one had LVH with LV noncompaction; five had arrhythmia with paroxysmal supraventricular and/or ventricular tachycardia. Two teenagers died at ages 16-17 from refractory heart failure and two underwent heart transplantation. All patients were found to have a pathogenic/likely pathogenic variant in the LAMP2 gene, six patients had no family history and a de novo evolvement was documented in 4/6 of those available for genetic tested. Retrospective review related to family background and earlier clinical evaluations revealed a definitive or highly suspicious family history of DD in 3, early clinical presentation with cardiac abnormalities (ECG, echo) in 3, and cerebral, hepatic and/or neuromuscular symptoms in 5. Abnormalities were detected 9,5 months to 5,8 years, median 3,5 years prior to referral to the National Pediatric Center. CONCLUSION: The earliest clinical manifestations of Danon disease occur in the first 12 years of life with symptoms of skeletal muscle and cerebral disease, raised hepatic enzymes, and evidence of cardiac disease on ECG/echo.
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Affiliation(s)
- Leila Gandaeva
- National Medical Research Center for Children's Health, Moscow, Lomonosov Avenue, 2, 119991, Russia.
| | | | - William J McKenna
- University College London, London, United Kingdom; Grupo de Investigación Cardiovascular (GRINCAR), Universidad de A Coruña, Spain.
| | - Kirill Savostyanov
- National Medical Research Center for Children's Health, Moscow, Lomonosov Avenue, 2, 119991, Russia
| | - Roman Myasnikov
- National Medical Research Center for Therapy and Preventive Medicine, 101990 Moscow, Russia
| | - Alexander Pushkov
- National Medical Research Center for Children's Health, Moscow, Lomonosov Avenue, 2, 119991, Russia
| | - Ilya Zhanin
- National Medical Research Center for Children's Health, Moscow, Lomonosov Avenue, 2, 119991, Russia
| | - Vladimir Barskiy
- National Medical Research Center for Children's Health, Moscow, Lomonosov Avenue, 2, 119991, Russia
| | - Olga Zharova
- National Medical Research Center for Children's Health, Moscow, Lomonosov Avenue, 2, 119991, Russia
| | - Irina Silnova
- National Medical Research Center for Children's Health, Moscow, Lomonosov Avenue, 2, 119991, Russia
| | - Valentina Kaverina
- National Medical Research Center for Children's Health, Moscow, Lomonosov Avenue, 2, 119991, Russia
| | - Natalia Sdvigova
- National Medical Research Center for Children's Health, Moscow, Lomonosov Avenue, 2, 119991, Russia
| | - Andrey Fisenko
- National Medical Research Center for Children's Health, Moscow, Lomonosov Avenue, 2, 119991, Russia.
| | - Michael Arad
- Cardiomyopathy Clinic and Heart Failure Institute, Leviev Heart Center, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Israel.
| | - Elena Basargina
- National Medical Research Center for Children's Health, Moscow, Lomonosov Avenue, 2, 119991, Russia.
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7
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Wang Y, Bai M, Zhang P, Peng Y, Chen Z, He Z, Xu J, Zhu Y, Yan D, Wang R, Zhang Z. Identification and functional analysis of a novel de novo missense mutation located in the initiation codon of LAMP2 associated with early onset female Danon disease. Mol Genet Genomic Med 2023; 11:e2216. [PMID: 37288668 PMCID: PMC10496070 DOI: 10.1002/mgg3.2216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Danon disease is characterized by the failure of lysosomal biogenesis, maturation, and function due to a deficiency of lysosomal membrane structural protein (LAMP2). METHODS The current report describes a female patient with a sudden syncope and hypertrophic cardiomyopathy phenotype. We identified the pathogenic mutations in patients by whole-exon sequencing, followed by a series of molecular biology and genetic approaches to identify and functional analysis of the mutations. RESULTS Suggestive findings by cardiac magnetic resonance (CMR), electrocardiogram (ECG), and laboratory examination suggested Danon disease which was confirmed by genetic testing. The patient carried a novel de novo mutation, LAMP2 c.2T>C located at the initiation codon. The quantitative polymerase chain reaction (qPCR) and Western blot (WB) analysis of peripheral blood leukocytes from the patients revealed evidence of LAMP2 haploinsufficiency. Labeling of the new initiation codon predicted by the software with green fluorescent protein followed by fluorescence microscopy and Western blotting showed that the first ATG downstream from the original initiation codon became the new translational initiation codon. The three-dimensional structure of the mutated protein predicted by alphafold2 revealed that it consisted of only six amino acids and failed to form a functional polypeptide or protein. Overexpression of the mutated LAMP2 c.2T>C showed a loss of function of the protein, as assessed by the dual-fluorescence autophagy indicator system. The mutation was confirmed to be null, AR experiments and sequencing results confirmed that 28% of the mutant X chromosome remained active. CONCLUSION We propose possible mechanisms of mutations associated with haploinsufficiency of LAMP2: (1) The inactivation X chromosome carrying the mutation was not significantly skewed. However, it decreased in the mRNA level and the expression ratio of the mutant transcripts; (2) The identified mutation is null, and the active mutant transcript fails to translate into the normal LAMP2 proteins. The presence of haploinsufficiency in LAMP2 and the X chromosome inactivation pattern were crucial factors contributing to the early onset of Danon disease in this female patient.
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Affiliation(s)
- Yongxiang Wang
- Heart CenterThe First Hospital of Lanzhou UniversityLanzhouGansuChina
- Gansu Key Laboratory of Cardiovascular DiseasesThe First Hospital of Lanzhou UniversityLanzhouGansuChina
- Gansu Provincial Clinical Research Center for Cardiovascular DiseasesThe First Hospital of Lanzhou UniversityLanzhouGansuChina
| | - Ming Bai
- Heart CenterThe First Hospital of Lanzhou UniversityLanzhouGansuChina
- Gansu Key Laboratory of Cardiovascular DiseasesThe First Hospital of Lanzhou UniversityLanzhouGansuChina
- Gansu Provincial Clinical Research Center for Cardiovascular DiseasesThe First Hospital of Lanzhou UniversityLanzhouGansuChina
| | - Piyi Zhang
- Heart CenterThe First Hospital of Lanzhou UniversityLanzhouGansuChina
- The First Clinical Medical School, Lanzhou UniversityLanzhouGansuChina
| | - Yu Peng
- Heart CenterThe First Hospital of Lanzhou UniversityLanzhouGansuChina
- Gansu Key Laboratory of Cardiovascular DiseasesThe First Hospital of Lanzhou UniversityLanzhouGansuChina
- Gansu Provincial Clinical Research Center for Cardiovascular DiseasesThe First Hospital of Lanzhou UniversityLanzhouGansuChina
| | - Zixian Chen
- Heart CenterThe First Hospital of Lanzhou UniversityLanzhouGansuChina
- Department of RadiologyThe First Hospital of Lanzhou UniversityLanzhouGansuChina
| | - Zhiyu He
- Heart CenterThe First Hospital of Lanzhou UniversityLanzhouGansuChina
- Gansu Key Laboratory of Cardiovascular DiseasesThe First Hospital of Lanzhou UniversityLanzhouGansuChina
- Gansu Provincial Clinical Research Center for Cardiovascular DiseasesThe First Hospital of Lanzhou UniversityLanzhouGansuChina
| | - Jin Xu
- Heart CenterThe First Hospital of Lanzhou UniversityLanzhouGansuChina
- The First Clinical Medical School, Lanzhou UniversityLanzhouGansuChina
| | - Youqi Zhu
- Heart CenterThe First Hospital of Lanzhou UniversityLanzhouGansuChina
- Gansu Key Laboratory of Cardiovascular DiseasesThe First Hospital of Lanzhou UniversityLanzhouGansuChina
- Gansu Provincial Clinical Research Center for Cardiovascular DiseasesThe First Hospital of Lanzhou UniversityLanzhouGansuChina
| | - Dongdong Yan
- Heart CenterThe First Hospital of Lanzhou UniversityLanzhouGansuChina
- Gansu Key Laboratory of Cardiovascular DiseasesThe First Hospital of Lanzhou UniversityLanzhouGansuChina
- Gansu Provincial Clinical Research Center for Cardiovascular DiseasesThe First Hospital of Lanzhou UniversityLanzhouGansuChina
| | - Runqing Wang
- Heart CenterThe First Hospital of Lanzhou UniversityLanzhouGansuChina
- The First Clinical Medical School, Lanzhou UniversityLanzhouGansuChina
| | - Zheng Zhang
- Heart CenterThe First Hospital of Lanzhou UniversityLanzhouGansuChina
- Gansu Key Laboratory of Cardiovascular DiseasesThe First Hospital of Lanzhou UniversityLanzhouGansuChina
- Gansu Provincial Clinical Research Center for Cardiovascular DiseasesThe First Hospital of Lanzhou UniversityLanzhouGansuChina
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8
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Burban A, Pucyło S, Sikora A, Opolski G, Grabowski M, Kołodzińska A. Hypertrophic Cardiomyopathy versus Storage Diseases with Myocardial Involvement. Int J Mol Sci 2023; 24:13239. [PMID: 37686045 PMCID: PMC10488064 DOI: 10.3390/ijms241713239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/20/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
One of the main causes of heart failure is cardiomyopathies. Among them, the most common is hypertrophic cardiomyopathy (HCM), characterized by thickening of the left ventricular muscle. This article focuses on HCM and other cardiomyopathies with myocardial hypertrophy, including Fabry disease, Pompe disease, and Danon disease. The genetics and pathogenesis of these diseases are described, as well as current and experimental treatment options, such as pharmacological intervention and the potential of gene therapies. Although genetic approaches are promising and have the potential to become the best treatments for these diseases, further research is needed to evaluate their efficacy and safety. This article describes current knowledge and advances in the treatment of the aforementioned cardiomyopathies.
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Affiliation(s)
- Anna Burban
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1A, 02-097 Warszawa, Poland; (A.B.); (S.P.); (A.S.); (G.O.); (M.G.)
- Doctoral School, Medical University of Warsaw, 81 Żwirki i Wigury Street, 02-091 Warsaw, Poland
| | - Szymon Pucyło
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1A, 02-097 Warszawa, Poland; (A.B.); (S.P.); (A.S.); (G.O.); (M.G.)
| | - Aleksandra Sikora
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1A, 02-097 Warszawa, Poland; (A.B.); (S.P.); (A.S.); (G.O.); (M.G.)
| | - Grzegorz Opolski
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1A, 02-097 Warszawa, Poland; (A.B.); (S.P.); (A.S.); (G.O.); (M.G.)
| | - Marcin Grabowski
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1A, 02-097 Warszawa, Poland; (A.B.); (S.P.); (A.S.); (G.O.); (M.G.)
| | - Agnieszka Kołodzińska
- First Department of Cardiology, Medical University of Warsaw, ul. Banacha 1A, 02-097 Warszawa, Poland; (A.B.); (S.P.); (A.S.); (G.O.); (M.G.)
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9
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Sun YQ, Lv Q, Chen D, Da Y, Zhao XY, Dong JZ. A Case Study and Literature Review of the Diagnosis of Danon Disease in Patients Presenting Only with Severe Cardiac Symptoms. Pharmgenomics Pers Med 2023; 16:767-775. [PMID: 37609033 PMCID: PMC10441658 DOI: 10.2147/pgpm.s392800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 08/01/2023] [Indexed: 08/24/2023] Open
Abstract
The clinical manifestations of Danon disease, which result from the primary deficiency of the lysosome-associated membrane protein 2 gene, include cardiomyopathy, skeletal myopathy, and different degrees of intellectual disability that vary greatly among patients. The present study reports on two cases of Danon disease in two patients who only presented cardiac symptoms. Cardiac symptoms usually occur in adolescence and during a patient's twenties, and most patients die from heart failure. However, the lab results from these cases suggested that other systems were involved, despite no other clinical symptoms. Significantly, the two patients had elevated serum cardiac troponin I, which often manifests in the acute cardiac phase, especially in severely affected patients with rapidly fatal outcomes. Danon disease is a multi-system involvement disease. Therefore, clinicians must be aware of its complexity when evaluating newly diagnosed patients due to its vastly different clinical course and prognosis and the importance of multidisciplinary management.
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Affiliation(s)
- Yu-Qing Sun
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung & Blood Vessel Diseases, Beijing, People’s Republic of China
| | - Qiang Lv
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung & Blood Vessel Diseases, Beijing, People’s Republic of China
| | - Dong Chen
- Department of Pathology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung & Blood Vessel Diseases, Beijing, People’s Republic of China
| | - Yuwei Da
- Department of Neurology, Beijing Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xiao-Yan Zhao
- Department of Cardiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung & Blood Vessel Diseases, Beijing, People’s Republic of China
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10
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Zhang Y, Zhao R, Yuan Y, Yu Y, Liu B, Li X. Clinical manifestations and MRI features of Danon disease: a case series. BMC Cardiovasc Disord 2023; 23:397. [PMID: 37568080 PMCID: PMC10422726 DOI: 10.1186/s12872-023-03356-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/18/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Danon disease (DD) is an exceptionally uncommon X-linked dominant lysosomal glycogen storage disorder characterized by pronounced ventricular hypertrophy and cardiac insufficiency. The timely identification of cardiac impairment in individuals with DD holds significant clinical importance. CASE PRESENTATION We present a case of Danon Disease in a three-generation pedigree from Anhui Province, China. Clinical features and laboratory data were collected and analyzed for a 16-year-old male proband (III-1) and two affected female family members (II-2 and II-3). The proband exhibited Wolf-Parkinson-White syndrome, hypertrophic cardiomyopathy, abnormal cognitive function, and muscle weakness. Gene sequencing confirmed a mutation (c.963G > A) in the LAMP-2 gene. CONCLUSION Patients with DD may present both dilated and hypertrophic cardiomyopathy. Comprehensive myocardial tissue characterization by MRI plays a key role in the diagnosis of the disease.
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Affiliation(s)
- Yang Zhang
- Department of Radiology, Fuyang People's Hospital, Fuyang, 236000, Anhui, China
| | - Ren Zhao
- Department of Cardiology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Yushan Yuan
- Department of Radiology, Fuyang People's Hospital, Fuyang, 236000, Anhui, China
| | - Yongqiang Yu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
- Research Center of Clinical Medical Imaging, Hefei, 230032, Anhui Province, China
| | - Bin Liu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China.
- Research Center of Clinical Medical Imaging, Hefei, 230032, Anhui Province, China.
- Department of Radiology, First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230022, Anhui, China.
| | - Xiaohu Li
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China.
- Research Center of Clinical Medical Imaging, Hefei, 230032, Anhui Province, China.
- Department of Radiology, First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230022, Anhui, China.
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Kleefeld F, Hentschel A, von Moers A, Hahn K, Horvath R, Goebel HH, Preusse C, Schallner J, Schuelke M, Roos A, Stenzel W. Beyond vacuolar pathology: Multiomic profiling of Danon disease reveals dysfunctional mitochondrial homeostasis. Neuropathol Appl Neurobiol 2023; 49:e12920. [PMID: 37328427 DOI: 10.1111/nan.12920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 06/06/2023] [Accepted: 06/11/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Felix Kleefeld
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Department of Neurology, Berlin, Germany
| | - Andreas Hentschel
- Leibniz-Institut für Analytische Wissenschaften-ISAS e.V., Dortmund, Germany
| | - Arpad von Moers
- Klinik für Kinder- und Jugendmedizin, DRK Kliniken Berlin Westend, Berlin, Germany
| | - Katrin Hahn
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Department of Neurology, Berlin, Germany
| | - Rita Horvath
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Hans-Hilmar Goebel
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Department of Neuropathology, Berlin, Germany
| | - Corinna Preusse
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Department of Neuropathology, Berlin, Germany
| | - Jens Schallner
- Department of Neuropaediatrics, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Markus Schuelke
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), NeuroCure Clinical Research Center, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Department of Neuropediatrics, Berlin, Germany
| | - Andreas Roos
- Pediatric Neurology, University Children's Hospital, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
- Department of Neurology, Heimer Institute for Muscle Research, University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Werner Stenzel
- Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Department of Neuropathology, Berlin, Germany
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12
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Fu D, Wang S, Luo Y, Wu S, Peng D. Identification of a novel splicing-altering LAMP2 variant in a Chinese family with Danon disease. ESC Heart Fail 2023; 10:2479-2486. [PMID: 37277924 PMCID: PMC10375081 DOI: 10.1002/ehf2.14417] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 12/27/2022] [Revised: 04/18/2023] [Accepted: 05/11/2023] [Indexed: 06/07/2023] Open
Abstract
AIMS This study aimed to identify a novel splicing-altering LAMP2 variant associated with Danon disease. METHODS AND RESULTS To identify the potential genetic mutation in a Chinese pedigree, whole-exome sequencing was conducted in the proband, and Sanger sequencing was performed on the proband's parents. To verify the impact of the splice-site variant, a minigene splicing assay was applied. The AlphaFold2 analysis was used to analyse the mutant protein structure. A splice-site variant (NM_013995.2:c.864+5G>A) located at intron 6 of the LAMP2 gene was identified as a potential pathogenic variant. The minigene splicing revealed that this variant causes exon 6 to be skipped, resulting in a truncated protein. The AlphaFold2 analysis showed that the mutation caused a protein twist direction change, leading to conformational abnormality. CONCLUSIONS A novel splice-site variant (NM_013995.2:c.864+5G>A) located at intron 6 of the LAMP2 gene was identified. This discovery may enlarge the LAMP2 variant spectrum, promote accurate genetic counselling, and contribute to the diagnosis of Danon disease.
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Affiliation(s)
- Di Fu
- Department of Cardiovascular MedicineThe Second Xiangya Hospital, Central South University410011HunanChangshaNo. 139 Middle Renmin RoadChina
| | - Shuai Wang
- Department of Cardiovascular MedicineThe Second Xiangya Hospital, Central South University410011HunanChangshaNo. 139 Middle Renmin RoadChina
| | - Yonghong Luo
- Department of Cardiovascular MedicineThe Second Xiangya Hospital, Central South University410011HunanChangshaNo. 139 Middle Renmin RoadChina
| | - Sha Wu
- Department of Cardiovascular MedicineThe Second Xiangya Hospital, Central South University410011HunanChangshaNo. 139 Middle Renmin RoadChina
| | - Daoquan Peng
- Department of Cardiovascular MedicineThe Second Xiangya Hospital, Central South University410011HunanChangshaNo. 139 Middle Renmin RoadChina
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13
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Shalata A, Bar-Shai M, Hadid Y, Mahroum M, Mintz H, Shalata ZE, Radzishevsky E, Genizi J, Lorber A, Ben-Yosef T, Yaniv L. Danon Disease: Entire LAMP2 Gene Deletion with Unusual Clinical Presentation-Case Report and Review of the Literature. Genes (Basel) 2023; 14:1539. [PMID: 37628591 PMCID: PMC10454823 DOI: 10.3390/genes14081539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/17/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
Danon disease is a rare x-linked dominant multisystemic disorder with a clinical triad of severe cardiomyopathy, skeletal myopathy, and intellectual disability. It is caused by defects in the lysosome-associated membrane protein-2 (LAMP2) gene. Numerous different mutations in the LAMP2 protein have been described. Danon disease is typically lethal by the mid-twenties in male patients due to cardiomyopathy and heart failure. Female patients usually present with milder and variable symptoms. This report describes a 42-year-old father and his 3-year-old daughter presenting with mild manifestations of the disease. The father has normal intellectual development and normal physical activity. At the age of 13, he was diagnosed with mild ventricular pre-excitation known as Wolf-Parkinson-White syndrome (WPWs), very mild and mostly asymptomatic cardiomyopathy and left ventricular hypertrophy, and at about the age of 25 presented with visual impairment due to cone-rod dystrophy. His daughter showed normal development and very mild asymptomatic electrocardiographic WPWs abnormalities with left mild ventricular hypertrophy. Genetic testing revealed an Xq24 microdeletion encompassing the entire LAMP2 gene. Relevant literature was reviewed as a reference for the etiology, diagnosis, treatment and case management.
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Affiliation(s)
- Adel Shalata
- The Simon Winter Institute for Human Genetics, Bnai Zion Medical Center, Haifa 32000, Israel; (Y.H.); (M.M.); (H.M.)
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 32000, Israel; (E.R.); (J.G.); (A.L.); (T.B.-Y.); (L.Y.)
| | - Marina Bar-Shai
- The Institute of Medical Genetics, Carmel Medical Center, Haifa 34362, Israel;
| | - Yarin Hadid
- The Simon Winter Institute for Human Genetics, Bnai Zion Medical Center, Haifa 32000, Israel; (Y.H.); (M.M.); (H.M.)
| | - Muhammad Mahroum
- The Simon Winter Institute for Human Genetics, Bnai Zion Medical Center, Haifa 32000, Israel; (Y.H.); (M.M.); (H.M.)
| | - Hila Mintz
- The Simon Winter Institute for Human Genetics, Bnai Zion Medical Center, Haifa 32000, Israel; (Y.H.); (M.M.); (H.M.)
| | | | - Evgeny Radzishevsky
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 32000, Israel; (E.R.); (J.G.); (A.L.); (T.B.-Y.); (L.Y.)
- Cardiology Department, Bnai Zion Medical Center, Haifa 32000, Israel
| | - Jacob Genizi
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 32000, Israel; (E.R.); (J.G.); (A.L.); (T.B.-Y.); (L.Y.)
- Department of Pediatric, Bnai Zion Medical Center, Haifa 32000, Israel
| | - Avraham Lorber
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 32000, Israel; (E.R.); (J.G.); (A.L.); (T.B.-Y.); (L.Y.)
- Pediatric Cardiology Unit, Rambam Medical Centre, Haifa 31096, Israel
| | - Tamar Ben-Yosef
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 32000, Israel; (E.R.); (J.G.); (A.L.); (T.B.-Y.); (L.Y.)
| | - Liat Yaniv
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 32000, Israel; (E.R.); (J.G.); (A.L.); (T.B.-Y.); (L.Y.)
- Department of Pediatric, Bnai Zion Medical Center, Haifa 32000, Israel
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14
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Liu X, Zhai N, Wang X, Wang J, Jiang M, Sun Z, Chen Y, Xu J, Cui Y, Li L. Cardiovascular magnetic resonance findings in Danon disease: a case series of a family. Front Cardiovasc Med 2023; 10:1159576. [PMID: 37215540 PMCID: PMC10192707 DOI: 10.3389/fcvm.2023.1159576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/18/2023] [Indexed: 05/24/2023] Open
Abstract
Background Cardiac involvement constitutes the primary cause of mortality in patients with Danon disease (DD). This study aimed to explore the cardiac magnetic resonance (CMR) features and progressions of DD cardiomyopathies in a family with long-term follow-up. Methods Seven patients (five females and two males), belonging to the same family and afflicted with DD, were enrolled in this study between 2017 and 2022. The cardiac structure, function, strain, tissue characteristics on CMR and their evolutions during follow-up were analyzed. Results Three young female patients (3/7, 42.86%) exhibited normal cardiac morphology. Four patients (4/7, 57.14%) displayed left ventricle hypertrophy (LVH), and mostly with septal thickening (3/4, 75%). A single male case (1/7, 14.3%) showed decreased LV ejection fraction (LVEF). Nonetheless, the global LV strain of the four adult patients decreased in different degree. The global strain of adolescent male patients was decreased compared to the age-appropriate female patients. Five patients (5/7, 71.43%) exhibited late gadolinium enhancement (LGE), with proportion ranging from 31.6% to 59.7% (median value 42.7%). The most common LGE location was the LV free wall (5/5, 100%), followed by right ventricle insertion points (4/5, 80%) and intraventricular septum (2/5, 40%). Segmental radial strain (rs = -0.586), circumferential strain (r = 0.589), and longitudinal strain (r = 0.514) were all moderately correlated with the LGE proportions of corresponding segments (P < 0.001). T2 hyperintense and perfusion defect foci were identified, overlapping with the LGE areas. During follow-up, both the young male patients exhibited notable deterioration of their cardiac symptoms and CMR. The LVEF and strain decreased, and the extent of LGE increased year by year. One patient underwent T1 mapping examination. The native T1 value was sensitively elevated even in regions without LGE. Conclusions Left ventricular hypertrophy, LGE with sparing or relatively less involved IVS, and LV dysfunction are prominent CMR features of Danon cardiomyopathy. Strain and T1 mapping may have advantages in detecting early-stage dysfunction and myocardial abnormalities in DD patients, respectively. Multi-parametric CMR can serve as an optimal instrument for detecting DD cardiomyopathies.
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Affiliation(s)
- Xiaolong Liu
- Department of Radiology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Ning Zhai
- Department of Radiology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Xiaoqiang Wang
- Department of Radiology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Jiehuan Wang
- Department of Radiology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Mengchun Jiang
- Department of Radiology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Zhanguo Sun
- Department of Radiology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Yueqin Chen
- Department of Radiology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Jingjing Xu
- Department of Radiology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Yinghua Cui
- Department of Cardiology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Lu Li
- Department of Pathology, Affiliated Hospital of Jining Medical University, Jining, China
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15
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Pasqualucci D, Maiani S, Perra F, Cau M, Coiana A, Bianco P, Olivotto I, Corda M. Danon disease in a Sardinian family: different aspects of the same mutation-a case report. Eur Heart J Case Rep 2023; 7:ytad237. [PMID: 37223322 PMCID: PMC10202301 DOI: 10.1093/ehjcr/ytad237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/12/2022] [Accepted: 05/04/2023] [Indexed: 05/25/2023]
Abstract
Background Danon disease (DD) is a rare X-linked disorder due to mutations in the lysosome-associated membrane protein 2 gene. It is characterized by a clinical triad of hypertrophic cardiomyopathy, skeletal myopathy, and a variable degree of intellectual disability. Case summary In this case series, we describe a mother and her son affected by DD, highlighting consistent clinical severity despite the expected variability related to gender. The mother (Case 1) presented isolated cardiac involvement, with an arrhythmogenic phenotype that evolved into severe heart failure requiring heart transplantation (HT). Danon disease was diagnosed 1 year after this event. Her son (Case 2) showed an earlier age onset of symptoms with complete atrioventricular block and fast progression of cardiac disease. Diagnosis was established 2 years after clinical presentation. He is currently listed for HT. Discussion In both of our patients, diagnostic delay was extremely long and could have been avoided by emphasizing the relevant clinical red flags. Patients affected by DD may present clinical heterogeneity in terms of natural history, age of onset, and cardiac and extracardiac involvement, even in the same family. Early diagnosis that phenotypic sex differences may impact is a crucial factor in managing patients with DD. Considering the rapid progression of cardiac disease and the poor prognosis, early diagnosis is important and close surveillance should be mandatory during follow-up.
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Affiliation(s)
| | - Silvia Maiani
- Clinical Cardiology, Department of Medical Science and Public Health, University of Cagliari, Monserrato, Italy
| | - Ferdinando Perra
- Clinical Cardiology, Department of Medical Science and Public Health, University of Cagliari, Monserrato, Italy
| | - Milena Cau
- Department of Medical Science and Public Health, University of Cagliari, Laboratory of Genetics and Genomics, Pediatric Hospital Microcitemico ‘A. Cao’, Cagliari, Italy
| | - Alessandra Coiana
- Department of Medical Science and Public Health, University of Cagliari, Laboratory of Genetics and Genomics, Pediatric Hospital Microcitemico ‘A. Cao’, Cagliari, Italy
| | - Paola Bianco
- Department of Pathology, Azienda Ospedaliera Brotzu, Piazzale Alessandro Ricchi 1, Cagliari, Italy
| | - Iacopo Olivotto
- Department of Experimental and Clinical Medicine, Meyer Children Hospital, University of Florence, Florence, Italy
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16
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Olivotto I, Udelson JE, Pieroni M, Rapezzi C. Genetic causes of heart failure with preserved ejection fraction: emerging pharmacological treatments. Eur Heart J 2023; 44:656-667. [PMID: 36582184 DOI: 10.1093/eurheartj/ehac764] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 11/13/2022] [Accepted: 11/26/2022] [Indexed: 12/31/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a major driver of cardiac morbidity and mortality in developed countries, due to ageing populations and the increasing prevalence of comorbidities. While heart failure with reduced ejection fraction is dominated by left ventricular impairment, HFpEF results from a complex interplay of cardiac remodelling, peripheral circulation, and concomitant features including age, hypertension, obesity, and diabetes. In an important subset, however, HFpEF is subtended by specific diseases of the myocardium that are genetically determined, have distinct pathophysiology, and are increasingly amenable to targeted, innovative treatments. While each of these conditions is rare, they collectively represent a relevant subset within HFpEF cohorts, and their prompt recognition has major consequences for clinical practice, as access to dedicated, disease-specific treatments may radically change the quality of life and outcome. Furthermore, response to standard heart failure treatment will generally be modest for these individuals, whose inclusion in registries and trials may dilute the perceived efficacy of treatments targeting mainstream HFpEF. Finally, a better understanding of the molecular underpinnings of monogenic myocardial disease may help identify therapeutic targets and develop innovative treatments for selected HFpEF phenotypes of broader epidemiological relevance. The field of genetic cardiomyopathies is undergoing rapid transformation due to recent, groundbreaking advances in drug development, and deserves greater awareness within the heart failure community. The present review addressed existing and developing therapies for genetic causes of HFpEF, including hypertrophic cardiomyopathy, cardiac amyloidosis, and storage diseases, discussing their potential impact on management and their broader implications for our understanding of HFpEF at large.
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Affiliation(s)
- Iacopo Olivotto
- Department of Experimental and Clinical Medicine, University of Florence, Meyer University Children Hospital and Careggi University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
| | - James E Udelson
- Division of Cardiology and The CardioVascular Center, Tufts Medical Center, and the Tufts University School of Medicine, 800 Washington St, Boston, MA 02111, USA
| | - Maurizio Pieroni
- Cardiology Department, Hospital San Donato, Via Pietro Nenni, 20 - 52100 Arezzo, Italy
| | - Claudio Rapezzi
- Cardiology Centre, University of Ferrara, Via Fossato di Mortara, 64/B - 44121 Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, Via Corriera, 1, 48033 Cotignola, Emilia-Romagna, Italy
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17
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Zhai Y, Miao J, Peng Y, Wang Y, Dong J, Zhao X. Clinical features of Danon disease and insights gained from LAMP-2 deficiency models. Trends Cardiovasc Med 2023; 33:81-89. [PMID: 34737089 DOI: 10.1016/j.tcm.2021.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/06/2021] [Accepted: 10/28/2021] [Indexed: 02/07/2023]
Abstract
Danon disease (DD) is an X-linked multisystem disorder with clinical features characterized by the triad of hypertrophic cardiomyopathy, skeletal muscle weakness, and mental retardation. Cardiac involvement can be fatal in the absence of an effective treatment option such as heart transplantation. Molecular studies have proved that LAMP-2 protein deficiency, mainly LAMP-2B isoform, resulting from LAMP2 gene mutation, is the culprit for DD. Autophagy impairment due to LAMP-2 deficiency mediated the accumulation of abnormal autophagic vacuoles in cells. While it is not ideal for mimicking DD phenotypes in humans, the emergence of LAMP-2-deficient animal models and induced pluripotent stem cells from DD patients provided powerful tools for exploring DD mechanism. In both in vitro and in vivo studies, much evidence has demonstrated that mitochondria dysfunction and fragmentation can result in DD pathology. Fundamental research contributes to the therapeutic transformation. By targeting the molecular core, several potential therapies have demonstrated promising results in partial phenotypes improvement. Among them, gene therapies anticipate inaugurate a class of symptom control and prevention drugs as their in vivo effects are promising, and one clinical trial is currently underway.
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Affiliation(s)
- Yafei Zhai
- Centre for Cardiovascular Diseases, Henan Key Laboratory of Hereditary Cardiovascular Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, P.R. China
| | - Jinxin Miao
- Academy of Medical Sciences, Zhengzhou University, Zhengzhou, P.R. China;Department of Science and Technology, Henan University of Chinese Medicine, Zhengzhou, Henan, P.R. China; Sino-British Research Center for Molecular Oncology, National Center for the International Research in Cell and Gene Therapy, School of Basic Sciences, Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, P. R. China
| | - Ying Peng
- Centre for Cardiovascular Diseases, Henan Key Laboratory of Hereditary Cardiovascular Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, P.R. China
| | - Yaohe Wang
- Sino-British Research Center for Molecular Oncology, National Center for the International Research in Cell and Gene Therapy, School of Basic Sciences, Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, P. R. China; Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Jianzeng Dong
- Centre for Cardiovascular Diseases, Henan Key Laboratory of Hereditary Cardiovascular Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, P.R. China; Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
| | - Xiaoyan Zhao
- Centre for Cardiovascular Diseases, Henan Key Laboratory of Hereditary Cardiovascular Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, P.R. China.
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18
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Sugie K. Editorial commentary: Highlighting the ray of hope in Danon disease research after 40 years. Trends Cardiovasc Med 2023; 33:90-91. [PMID: 34863946 DOI: 10.1016/j.tcm.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 11/27/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Kazuma Sugie
- Department of Neurology, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan.
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19
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Barndt RJ, Liu Q, Tang Y, Haugh MP, Cui J, Chan SY, Wu H. Metabolic Maturation Exaggerates Abnormal Calcium Handling in a Lamp2 Knockout Human Pluripotent Stem Cell-Derived Cardiomyocyte Model of Danon Disease. Biomolecules 2022; 13:biom13010069. [PMID: 36671453 PMCID: PMC9855424 DOI: 10.3390/biom13010069] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 12/27/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023] Open
Abstract
Danon disease (DD) is caused by mutations of the gene encoding lysosomal-associated membrane protein type 2 (LAMP2), which lead to impaired autophagy, glycogen accumulation, and cardiac hypertrophy. However, it is not well understood why a large portion of DD patients develop arrhythmia and sudden cardiac death. In the current study, we generated LAMP2 knockout (KO) human iPSC-derived cardiomyocytes (CM), which mimic the LAMP2 dysfunction in DD heart. Morphologic analysis demonstrated the sarcomere disarrangement in LAMP2 KO CMs. In functional studies, LAMP2 KO CMs showed near-normal calcium handling at base level. However, treatment of pro-maturation medium (MM) exaggerated the disease phenotype in the KO cells as they exhibited impaired calcium recycling and increased irregular beating events, which recapitulates the pro-arrhythmia phenotypes of DD patients. Further mechanistic study confirmed that MM treatment significantly enhanced the autophagic stress in the LAMP2 KO CMs, which was accompanied by an increase of both cellular and mitochondrial reactive oxygen species (ROS) levels. Excess ROS accumulation in LAMP2 KO CMs resulted in the over-activation of calcium/calmodulin dependent protein kinase IIδ (CaMKIIδ) and arrhythmogenesis, which was partially rescued by the treatment of ROS scavenger. In summary, our study has revealed ROS induced CaMKIIδ overactivation as a key mechanism that promotes cardiac arrhythmia in DD patients.
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Affiliation(s)
- Robert J. Barndt
- Pittsburgh Heart, Lung, and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
| | - Qing Liu
- Department of Biological Sciences, Clemson University, Clemson, SC 29634, USA
- Center for Human Genetics, Clemson University, Greenwood, SC 29646, USA
| | - Ying Tang
- Pittsburgh Heart, Lung, and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
| | - Michael P. Haugh
- Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA 15213, USA
| | - Jeffery Cui
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Stephen Y. Chan
- Pittsburgh Heart, Lung, and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
| | - Haodi Wu
- Pittsburgh Heart, Lung, and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
- Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA 15213, USA
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
- Correspondence:
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20
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Miliou A, Antonopoulos AS, Kouris N, Lazaros G, Tsioufis K, Vlachopoulos C. Danon Cardiomyopathy: Specific Imaging Signs. JACC Case Rep 2022; 4:1496-1500. [PMID: 36444189 PMCID: PMC9700059 DOI: 10.1016/j.jaccas.2022.08.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 07/06/2022] [Accepted: 08/04/2022] [Indexed: 06/01/2023]
Abstract
Danon disease (DD) is a rare, X-linked genetic disorder caused by LAMP2 deficiency. Clinical phenotype involves early cardiomyopathy development along with pre-excitation, skeletal myopathy, retinopathy, and cognitive impairment. We highlight how a noninvasive diagnostic approach based on clinical and imaging red flags for DD can be employed to raise high clinical suspicion for DD, which was confirmed by genetic testing results. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Antigoni Miliou
- Address for correspondence: Dr Miliou Antigoni, Unit of Inherited Cardiac Conditions and Sports Cardiology, First Department of Cardiology, National and Kapodistrian University of Athens, 99 Michalakopoulou Street, Athens 11527, Greece.
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21
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Chen X, Fu L, He J, Bai R, Zeng S, Liao H, Deng H, Xue Y, Wu S, Liu Y. A Frequent Observation of Wolff-Parkinson-White Syndrome and Fasciculoventricular Pathways in Patients With Danon Disease. Circ J 2021; 86:309-318. [PMID: 34937809 DOI: 10.1253/circj.cj-21-0572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Danon disease is typically associated with cardiomyopathy and ventricular pre-excitation. The study aimed to characterize the clinical profile of Danon disease, analyze electrocardiographic (ECG) and electrophysiologic features, and investigate their association with Wolff-Parkinson-White (WPW) syndrome and fasciculoventricular pathways (FVPs).Methods and Results:Clinical course, family history, ECG and electrophysiological data were collected from 16 patients with Danon disease. Over 0.4-8 years of follow up, 1 female patient died suddenly, and 5 male patients died of progressive heart failure by age 13-20 years. Family history analysis revealed that 3 mothers experienced hospitalization or death for heart failure at age 28-41 years. There was 100% penetrance for ECG abnormalities in 13 patients with original ECGs. Short PR intervals and delta waves were present in 9 and 8 patients, respectively. There were significant age-associated increases in the QRS complex width (r=0.556, P=0.048) and the number of leads with notched QRS (r=0.575, P=0.04). Four patients who underwent electrophysiological studies all had FVPs, and 2 of them still had left-side atrioventricular pathways. CONCLUSIONS Danon disease causes a malignant clinical course characterized by early death caused by heart failure in both genders and progressive ECG changes as patients age. The pre-excited ECG pattern is related to FVPs and WPW, which is suggestive of extensive cardiac involvement.
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Affiliation(s)
- Xin Chen
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Provincial People's Hospital
| | - Lijun Fu
- Department of Cardiology, Shanghai Children's Medical Center
| | - Jiqiang He
- Department of Cardiology, Beijing Anzhen Hospital
| | - Rong Bai
- Department of Cardiology, Beijing Anzhen Hospital
| | - Shaoying Zeng
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Provincial People's Hospital
| | - Hongtao Liao
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Provincial People's Hospital
| | - Hai Deng
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Provincial People's Hospital
| | - Yumei Xue
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Provincial People's Hospital
| | - Shulin Wu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Provincial People's Hospital
| | - Yang Liu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Provincial People's Hospital
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22
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Li Z, Ma F, Li R, Xiao Z, Zeng H, Wang DW. Case Report: A Novel LAMP2 Splice-Altering Mutation Causes Cardiac-Only Danon Disease. Front Cardiovasc Med 2021; 8:763240. [PMID: 34901223 PMCID: PMC8655779 DOI: 10.3389/fcvm.2021.763240] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/18/2021] [Indexed: 11/20/2022] Open
Abstract
Danon disease (DD) is a rare glycogen storage lysosomal disorder caused by mutations in the LAMP2 gene. Patients with DD are usually characterized clinically by severe multisystem syndromes. We describe a specific family with a novel pathogenic splice-altering mutation in the LAMP2 gene (c.741+2T>C) with cardiac-only symptoms (frequent ventricular tachycardia, intraventricular block, and hypertrophic cardiomyopathy). Minigene assays were used to evaluate the consequence of the splice-site mutation in the LAMP2 gene. The results showed that the c.741+2T>C mutation led to extra 6-bp preservation of intron 5 at the junction between exons 5 and 6 during transcriptional processing of the mRNA, which creates a stop codon and truncated the LAMP2 protein to 248-amino-acid residues. The mutant LAMP2 protein was predicted to have a conformational change, lacks the important transmembrane domain, and subsequent protein destabilization.
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Affiliation(s)
- Zongzhe Li
- Division of Cardiology, Department of Internal Medicine and Genetic Diagnosis Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Huazhong University of Science and Technology, Wuhan, China
| | - Fei Ma
- Division of Cardiology, Department of Internal Medicine and Genetic Diagnosis Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Li
- Division of Cardiology, Department of Internal Medicine and Genetic Diagnosis Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhichao Xiao
- Division of Cardiology, Department of Internal Medicine and Genetic Diagnosis Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hesong Zeng
- Division of Cardiology, Department of Internal Medicine and Genetic Diagnosis Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine and Genetic Diagnosis Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Huazhong University of Science and Technology, Wuhan, China
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23
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Bui QM, Hong KN, Kraushaar M, Ma GS, Brambatti M, Kahn AM, Battiha CE, Boynton K, Storm G, Mestroni L, Taylor MRG, DeMaria AN, Adler EA. Myocardial Strain and Association With Clinical Outcomes in Danon Disease: A Model for Monitoring Progression of Genetic Cardiomyopathies. J Am Heart Assoc 2021; 10:e022544. [PMID: 34845930 PMCID: PMC9075351 DOI: 10.1161/jaha.121.022544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Myocardial strain can identify subclinical left ventricular dysfunction in various cardiac diseases, but its association with clinical outcomes in genetic cardiomyopathies remains unknown. Herein, we assessed myocardial strain in patients with Danon disease (DD), a rare X‐linked autophagic disorder that causes severe cardiac manifestations. Methods and Results Echocardiographic images were reviewed and used to calculate myocardial strain from a retrospective, international registry of patients with DD. Regression analyses were performed to evaluate for an association of global longitudinal strain (GLS) and ejection fraction with the composite outcome (death, ventricular assist device, heart transplantation, and implantable cardioverter defibrillator for secondary prevention). A total of 22 patients with DD (male 14 [63.6%], median age 16.5 years) had sufficient echocardiograms for analysis. Absolute GLS was reduced with a mean of 12.2% with an apical‐sparing pattern observed. Univariable regression for GLS and composite outcome showed an odds ratio of 1.32 (95% CI, 1.02–1.71) with P=0.03. For receiver operating characteristic analysis, the areas under the curve for GLS and ejection fraction were 0.810 (P=0.02) and 0.605 (P=0.44), respectively. An absolute GLS cutoff of 10.0% yielded a true positive rate of 85.7% and false positive rate of 13.3%. Conclusions In this cohort of patients with DD, GLS may be a useful assessment of myocardial function and may predict clinical outcomes. This study highlights the potential use of myocardial strain phenotyping to monitor disease progression and potentially to predict clinical outcomes in DD and other genetic cardiomyopathies.
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Affiliation(s)
- Quan M Bui
- Division of Cardiovascular Medicine Department of Medicine University of California, San Diego San Diego CA
| | - Kimberly N Hong
- Division of Cardiovascular Medicine Department of Medicine University of California, San Diego San Diego CA
| | - Megan Kraushaar
- Division of Cardiovascular Medicine Department of Medicine University of California, San Diego San Diego CA
| | - Gary S Ma
- Division of Cardiovascular Medicine Department of Medicine University of California, San Diego San Diego CA
| | - Michela Brambatti
- Division of Cardiovascular Medicine Department of Medicine University of California, San Diego San Diego CA
| | - Andrew M Kahn
- Division of Cardiovascular Medicine Department of Medicine University of California, San Diego San Diego CA
| | - Carol Elias Battiha
- Division of Cardiovascular Medicine Department of Medicine University of California, San Diego San Diego CA
| | - Kylie Boynton
- Division of Cardiology Department of Medicine Adult Medical Genetics Program University of Colorado Anschutz Medical Campus Aurora CO
| | - Garrett Storm
- Division of Cardiology Department of Medicine Adult Medical Genetics Program University of Colorado Anschutz Medical Campus Aurora CO
| | - Luisa Mestroni
- Division of Cardiology Department of Medicine Adult Medical Genetics Program University of Colorado Anschutz Medical Campus Aurora CO
| | - Matthew R G Taylor
- Division of Cardiology Department of Medicine Adult Medical Genetics Program University of Colorado Anschutz Medical Campus Aurora CO
| | - Anthony N DeMaria
- Division of Cardiovascular Medicine Department of Medicine University of California, San Diego San Diego CA
| | - Eric A Adler
- Division of Cardiovascular Medicine Department of Medicine University of California, San Diego San Diego CA
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24
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Changsheng M, Fan J, Bingyuan Z, Jiawei Z, Li W, Lin F, Yuping L, Caiming Z. Four-dimensional echocardiography and left ventricular systolic strain measured via two-dimensional speckle-tracking for Danon disease: a case series. Eur Heart J Case Rep 2021; 5:ytab443. [PMID: 34934899 PMCID: PMC8684807 DOI: 10.1093/ehjcr/ytab443] [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: 12/23/2020] [Revised: 01/29/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Danon disease is an X-linked multisystemic disorder characterized by skeletal myopathy, cardiomyopathy, and intellectual disability. CASE SUMMARY Herein, we describe two patients affected by Danon disease from the same family, a father (Patient 1) and his daughter (Patient 2). In Patient 1, a short PR interval with pre-excitation was evident. In Patient 2, over a 24-h period 2369 atrial premature beats and rare isolated ventricular ectopics were detected. Both patients exhibited left ventricular hypertrophy with non-compaction myocardium, and the left ventricular ejection fraction was impaired in Patient 1 and normal in Patient 2. In Patient 2, the total left ventricular strain value was reduced, and layer-specific strain revealed that subepicardial strain impaired more than in other layers. Late gadolinium enhancement was detected both in left and right ventricles in Patient 2, and cardiac fibrosis was more apparent in the subepicardium of left ventricular free wall. Four-dimensional (4D) echocardiography revealed that left atrial reservoir strain and left ventricular total longitudinal strain were induced. DISCUSSION Novel 4D echocardiography and left ventricular systolic strain may play important role in diagnosis and myocardial functional evaluation in Danon disease.
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Affiliation(s)
- Ma Changsheng
- The first Affiliated Hospital of Soochow University, Street Shizi 188, SuZhou, JiangSu Province, China
| | - Jiali Fan
- The first Affiliated Hospital of Soochow University, Street Shizi 188, SuZhou, JiangSu Province, China
| | - Zhou Bingyuan
- The first Affiliated Hospital of Soochow University, Street Shizi 188, SuZhou, JiangSu Province, China
| | - Zhou Jiawei
- The first Affiliated Hospital of Soochow University, Street Shizi 188, SuZhou, JiangSu Province, China
| | - Wang Li
- The first Affiliated Hospital of Soochow University, Street Shizi 188, SuZhou, JiangSu Province, China
| | - Fan Lin
- The first Affiliated Hospital of Soochow University, Street Shizi 188, SuZhou, JiangSu Province, China
| | - Liao Yuping
- The first Affiliated Hospital of Soochow University, Street Shizi 188, SuZhou, JiangSu Province, China
| | - Zhao Caiming
- The first Affiliated Hospital of Soochow University, Street Shizi 188, SuZhou, JiangSu Province, China
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25
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Alcalai R, Arad M, Wakimoto H, Yadin D, Gorham J, Wang L, Burns E, Maron BJ, Roberts WC, Konno T, Conner DA, Perez-Atayde AR, Seidman JG, Seidman CE. LAMP2 Cardiomyopathy: Consequences of Impaired Autophagy in the Heart. J Am Heart Assoc 2021; 10:e018829. [PMID: 34459252 PMCID: PMC8649277 DOI: 10.1161/jaha.120.018829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Human mutations in the X‐linked lysosome‐associated membrane protein‐2 (LAMP2) gene can cause a multisystem Danon disease or a primary cardiomyopathy characterized by massive hypertrophy, conduction system abnormalities, and malignant ventricular arrhythmias. We introduced an in‐frame LAMP2 gene exon 6 deletion mutation (denoted L2Δ6) causing human cardiomyopathy, into mouse LAMP2 gene, to elucidate its consequences on cardiomyocyte biology. This mutation results in in‐frame deletion of 41 amino acids, compatible with presence of some defective LAMP2 protein. Methods and Results Left ventricular tissues from L2Δ6 and wild‐type mice had equivalent amounts of LAMP2 RNA, but a significantly lower level of LAMP2 protein. By 20 weeks of age male mutant mice developed left ventricular hypertrophy which was followed by left ventricular dilatation and reduced systolic function. Cardiac electrophysiology and isolated cardiomyocyte studies demonstrated ventricular arrhythmia, conduction disturbances, abnormal calcium transients and increased sensitivity to catecholamines. Myocardial fibrosis was strikingly increased in 40‐week‐old L2Δ6 mice, recapitulating findings of human LAMP2 cardiomyopathy. Immunofluorescence and transmission electron microscopy identified mislocalization of lysosomes and accumulation of autophagosomes between sarcomeres, causing profound morphological changes disrupting the cellular ultrastructure. Transcription profile and protein expression analyses of L2Δ6 hearts showed significantly increased expression of genes encoding activators and protein components of autophagy, hypertrophy, and apoptosis. Conclusions We suggest that impaired autophagy results in cardiac hypertrophy and profound transcriptional reactions that impacted metabolism, calcium homeostasis, and cell survival. These responses define the molecular pathways that underlie the pathology and aberrant electrophysiology in cardiomyopathy of Danon disease.
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Affiliation(s)
- Ronny Alcalai
- Heart InstituteHadassah Hebrew University Medical Center Jerusalem Israel.,Department of Genetics Harvard Medical School Boston MA
| | - Michael Arad
- Division of Cardiology Sheba Medical Centre and Tel Aviv University Ramat Gan Israel
| | | | - Dor Yadin
- Division of Cardiology Sheba Medical Centre and Tel Aviv University Ramat Gan Israel
| | - Joshua Gorham
- Department of Genetics Harvard Medical School Boston MA
| | - Libin Wang
- Department of Genetics Harvard Medical School Boston MA
| | - Elia Burns
- Heart InstituteHadassah Hebrew University Medical Center Jerusalem Israel
| | - Barry J Maron
- Minneapolis Heart Institute Foundation Minneapolis MN
| | - William C Roberts
- Baylor Heart & Vascular InstituteBaylor University Medical Center Dallas TX
| | - Tetsuo Konno
- Department of Genetics Harvard Medical School Boston MA
| | | | | | - Jon G Seidman
- Department of Genetics Harvard Medical School Boston MA
| | - Christine E Seidman
- Department of Genetics Harvard Medical School Boston MA.,Howard Hughes Medical Institute and Cardiovascular DivisionBrigham and Women's Hospital Boston MA
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26
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Shimozono T, Ueno K, Shiokawa N, Ohno S, Kawano Y. Early diagnosis of infantile Danon disease complicated by tetralogy of Fallot. Pediatr Int 2021; 63:988-990. [PMID: 34086384 DOI: 10.1111/ped.14542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/21/2020] [Accepted: 11/11/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | - Kentaro Ueno
- Department of Pediatrics, Kagoshima University, Kagoshima, Japan
| | - Naohiro Shiokawa
- Department of Pediatrics, Kagoshima University, Kagoshima, Japan
| | - Seiko Ohno
- Department of Bioscience and Genetics, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshifumi Kawano
- Department of Pediatrics, Kagoshima University, Kagoshima, Japan
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27
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Antukh D, Shchekochikhin D, Rosina T, Mershina E, Larina O, Pasha S, Zaklyazminskaya E, Sinitsyn V, Moiseev S. Scintigraphy false-positive results for cardiac amyloidosis in a patient with Danon disease. Clin Case Rep 2021; 9:e04652. [PMID: 34430015 PMCID: PMC8365861 DOI: 10.1002/ccr3.4652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 11/17/2020] [Accepted: 12/08/2020] [Indexed: 12/04/2022] Open
Abstract
Common diagnostic approach in patients with suspected cardiac amyloidosis includes cardiac magnetic resonance imaging and scintigraphy. We report the first clinical case of false-positive results of scintigraphy in a patient with Danon disease.
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Affiliation(s)
- Dmitry Antukh
- Pirogov Russian National Research Medical UniversityMoscowRussia
| | - Dmitry Shchekochikhin
- Pirogov Russian National Research Medical UniversityMoscowRussia
- Sechenov UniversityMoscowRussia
| | - Teona Rosina
- Sechenov UniversityMoscowRussia
- Lomonosov Moscow State UniversityMoscowRussia
| | | | - Olga Larina
- Lomonosov Moscow State UniversityMoscowRussia
| | | | | | | | - Sergey Moiseev
- Sechenov UniversityMoscowRussia
- Lomonosov Moscow State UniversityMoscowRussia
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28
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Ranganath PG, Tower-Rader A. Utility of Cardiac Magnetic Resonance Imaging in the Diagnosis, Prognosis, and Treatment of Infiltrative Cardiomyopathies. Curr Cardiol Rep 2021; 23:87. [PMID: 34081227 DOI: 10.1007/s11886-021-01518-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE OF REVIEW Diagnosis of infiltrative cardiomyopathies can be challenging despite differences in clinical manifestations due to overlapping cardiac manifestations. We review the salient findings by cardiac magnetic resonance imaging that aids in diagnosis, as well the potential implications for prognosis and treatment. RECENT FINDINGS Cardiac magnetic resonance imaging has added substantially to our understanding of various infiltrative cardiomyopathies, and the addition of late gadolinium enhancement imaging and parametric mapping has yielded additional insights regarding potential diagnoses, prognosis, and therapy. Cardiac magnetic resonance imaging should be employed in the setting of suspected hypertrophic or infiltrative cardiomyopathies to aid in diagnosis. In the setting of cardiac amyloidosis and Fabry disease, there is data to suggest that cardiac magnetic resonance imaging is useful for risk stratification as well as for monitoring response to therapy.
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Affiliation(s)
| | - Albree Tower-Rader
- Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Yawkey 5B, Boston, MA, 02114, USA.
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29
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Suzuki H, Morita Y, Saito R, Tatebe S, Niihori T, Saiki Y, Yasuda S, Shimokawa H. Detection of intracellular histological abnormalities using cardiac magnetic resonance T1 mapping in patients with Danon disease: a case series. Eur Heart J Case Rep 2021; 5:ytab145. [PMID: 34268477 PMCID: PMC8276603 DOI: 10.1093/ehjcr/ytab145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/26/2020] [Accepted: 04/09/2021] [Indexed: 11/13/2022]
Abstract
Background Danon disease is an X-linked dominant disorder with defects in the lysosome-associated
membrane protein 2 (LAMP2) gene and is characterized histologically by intracellular
autophagic vacuoles in skeletal and cardiac muscles. Cardiac magnetic resonance (CMR) T1
mapping potentially allows to differentiate intracellular and extracellular cardiac
abnormalities with a combination of native T1 value and extracellular volume (ECV)
fraction. Case summary We assessed CMR T1 mapping in two Danon disease patients (a 22-year-old man and his
48-year-old mother), who had a LAMP2 c.864G>A p. Val288Val mutation, and two blood
relatives without Danon disease (his 47-year-old maternal aunt and 49-year-old father).
The male patient underwent a left ventricular (LV) assist device implantation at
15 months after the image acquisition because he was inotrope dependent (INTERMACS
profile 3) and had no noticeable psychological or musculoskeletal symptoms. His mother
was in New York Heart Association Class II with mildly reduced LV ejection fraction
(46%). The Danon group showed late gadolinium enhancement (LGE) in the anterior and
posterolateral LV walls. In the interventricular wall, where evident LGE was not noted,
the Danon group had high native T1 value, compared with the T1 value in the non-Danon
group, and normal ECV fraction. Cardiac biopsy from the interventricular wall showed
intracytoplasmic autophagic vacuoles, which are characteristics of Danon disease. Discussion This characteristic pattern of high native T1 and normal ECV fraction in the areas
without LGE, which may reflect the existence of intracytoplasmic autophagic vacuoles,
may support the differential diagnosis of Danon disease from other cardiomyopathies.
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Affiliation(s)
- Hideaki Suzuki
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.,Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8573, Japan.,Division of Brain Sciences, Department of Medicine, Hammersmith Campus, Imperial College London, Du Cane Raod, London W12 0NN, UK
| | - Yoshiaki Morita
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.,National Cerebral and Cardiovascular Center, Suita, Japan
| | - Ryoko Saito
- Department of Anatomic Pathology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Shunsuke Tatebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Tetsuya Niihori
- Department of Medical Genetics, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.,National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.,Graduate School of Medicine, International University of Health and Welfare, Kozunomori 4-3, Narita 286-8686, Japan
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30
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Xu J, Li Z, Liu Y, Zhang X, Niu F, Zheng H, Wang L, Kang L, Wang K, Xu B. Danon disease: a case report and literature review. Diagn Pathol 2021; 16:39. [PMID: 33933120 PMCID: PMC8088694 DOI: 10.1186/s13000-021-01100-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Danon disease (DD) is a rare x-linked dominant multisystemic disorder with a clinical triad of severe cardiomyopathy, skeletal myopathy, and mental retardation. It is caused by a defect in the lysosomal-associated membrane protein-2 (LAMP2) gene, which leads to the formation of autophagic vacuoles containing glycogen granule deposits in skeletal and cardiac muscle fibers. So far, more than 50 different mutations in LAMP2 have been identified. CASE PRESENTATION Here, we report an 18-year-old male patient who was hospitalized for heart failure. Biopsy of the left lateral femoral muscle revealed scattered autophagic vacuoles in the muscle fibers with increased glycogen. Next generation sequencing (NGS) was used to detect gene mutations of the proband sample and a novel frameshift mutation (c.1052delG) has been identified in exon 8 of LAMP2, which leads to truncation of the protein. CONCLUSION We found a novel frameshift mutation, a hemizygous mutation (c.1052delG) in exon 8 of LAMP2, identified as presenting the hypertrophic cardiomyopathy (HCM) phenotype. Genetic analysis is the gold standard for the diagnosis of DD and is essential to determine appropriate treatment strategies and to confirm the genetic risk of family members.
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Affiliation(s)
- Jiamin Xu
- Department of Cardiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, P.R. China
| | - Zhu Li
- Department of Cardiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, P.R. China
| | - Yihai Liu
- Department of Cardiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, P.R. China
| | - Xinlin Zhang
- Department of Cardiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, P.R. China
| | - Fengnan Niu
- Department of Pathology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, P.R. China
| | - Hongyan Zheng
- Department of Cardiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, P.R. China
| | - Lian Wang
- Department of Cardiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, P.R. China
| | - Lina Kang
- Department of Cardiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, P.R. China.
| | - Kun Wang
- Department of Cardiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, P.R. China.
| | - Biao Xu
- Department of Cardiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, P.R. China.
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31
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Darden D, Hsu JC, Tzou WS, von Alvensleben JC, Brooks M, Hoffmayer KS, Brambatti M, Sauer WH, Feld GK, Adler E. Fasciculoventricular and atrioventricular accessory pathways in patients with Danon disease and preexcitation: A multicenter experience. Heart Rhythm 2021; 18:1194-1202. [PMID: 33737230 DOI: 10.1016/j.hrthm.2021.03.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 02/23/2021] [Accepted: 03/11/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Studies have suggested that a fasciculoventricular pathway (FVP) may be the cause of preexcitation in patients with Danon disease, a rare X-linked dominant genetic disorder of hypertrophic cardiomyopathy. OBJECTIVE The purpose of this study was to describe the prevalence of ventricular preexcitation on resting 12-lead electrocardiogram (ECG) in patients with Danon disease and the electrophysiological study (EPS) results of those with preexcitation. METHODS Patients with confirmed Danon disease diagnosed with preexcitation (PR ≤120 ms, delta wave, QRS >110 ms) on ECG were included from a multicenter registry. The incidence of arrhythmias, implantable cardioverter-defibrillator (ICD) procedures, ICD shocks, and EPS results were collected. RESULTS Thirteen of 40 patients (32.5%) with Danon disease were found to have preexcitation (mean age 17.3 years; 38% women). EPS performed in 9 of 13 patients (69%) demonstrated FVP only in 2 (22.2%), extranodal pathway without exclusion of FVP in 2 (22.2%), and both FVP and extranodal pathway in 5 (55.6%). Two patients had malignant accessory pathway (AP) properties. Over median follow-up of 842 days (interquartile range 138-1678), 11 patients (85%) had ICD placement, and 6 (46.1%) underwent heart transplantation. No patients required therapy for ventricular tachycardia, and 2 patients (15%) had paroxysmal atrial fibrillation. CONCLUSION In a large multicenter cohort of patients with Danon disease, there was a high prevalence of FVP and extranodal pathways diagnosed on EPS in those with preexcitation. These findings suggest patients with preexcitation and Danon disease should undergo EPS to assess for FVP and potentially malignant extranodal AP.
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Affiliation(s)
- Douglas Darden
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, California.
| | - Jonathan C Hsu
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Wendy S Tzou
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Johannes C von Alvensleben
- Division of Cardiology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Mary Brooks
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Kurt S Hoffmayer
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Michela Brambatti
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, California
| | - William H Sauer
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Gregory K Feld
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, California
| | - Eric Adler
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, California
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Wang S, Wang Q, Zhai N, Wang X, Li Z, Gan L, Cui Y. Progression of Danon disease with medical imaging: two case reports. J Int Med Res 2021; 49:300060520986676. [PMID: 33530800 PMCID: PMC7871080 DOI: 10.1177/0300060520986676] [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] [Indexed: 11/16/2022] Open
Abstract
Danon disease is a rare X-linked dominant genetic disorder caused by loss-of-function mutations in the lysosome-associated membrane protein 2 gene. Progression of Danon disease is unknown because of its rare incidence in a diverse ethnic population. We report longitudinal data from two patients who were diagnosed with Danon disease by a genetic test. The evaluation protocol included electrocardiographic monitoring, echocardiography, and magnetic resonance imaging. Progression of hypertrophic cardiomyopathy to dilated cardiomyopathy was observed in the first patient. He died from sudden cardiac arrest. The second patient is currently suffering from hypertrophic cardiomyopathy. Development of the hypertrophic phase progressing into the dilated phase in Danon disease may provide useful information for early identification and clinical decisions in patients with this disease.
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Affiliation(s)
- Shuai Wang
- Department of Cardiology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
| | - Qinglei Wang
- Department of Cardiology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
| | - Ning Zhai
- Department of Medical Imaging, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
| | - Xin Wang
- Department of Cardiology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
| | - Zhihua Li
- Department of Cardiology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
| | - Lijun Gan
- Department of Cardiology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
| | - Yinghua Cui
- Department of Cardiology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
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Kousal B, Majer F, Vlaskova H, Dvorakova L, Piherova L, Meliska M, Langrova H, Palecek T, Kubanek M, Krebsova A, Gurka J, Stara V, Michaelides M, Kalina T, Sikora J, Liskova P. Pigmentary retinopathy can indicate the presence of pathogenic LAMP2 variants even in somatic mosaic carriers with no additional signs of Danon disease. Acta Ophthalmol 2021; 99:61-68. [PMID: 32533651 DOI: 10.1111/aos.14478] [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: 12/22/2019] [Accepted: 04/29/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Danon disease (DD) is a rare X-linked disorder caused by pathogenic variants in LAMP2. DD primarily manifests as a severe cardiomyopathy. An early diagnosis is crucial for patient survival. The aim of the study was to determine the usefulness of ocular examination for identification of DD. METHODS Detailed ocular examination in 10 patients with DD (3 males, 7 females) and a 45-year-old asymptomatic female somatic mosaic carrier of a LAMP2 disease-causing variant. RESULTS All patients with manifest cardiomyopathy had pigmentary retinopathy with altered autofluorescence and diffuse visual field loss. Best corrected visual acuity (BCVA) was decreased (<0.63) in 8 (40%) out of 20 eyes. The severity of retinal pathology increased with age, resulting in marked cone-rod involvement overtime. Spectral-domain optical coherence tomography in younger patients revealed focal loss of photoreceptors, disruption and deposition at the retinal pigment epithelium/Bruch's membrane layer (corresponding to areas of marked increased autofluorescence), and hyperreflective foci in the outer nuclear layer. Cystoid macular oedema was seen in one eye. In the asymptomatic female with somatic mosaicism, the BCVA was 1.0 bilaterally. An abnormal autofluorescence pattern in the left eye was present; while full-field electroretinography was normal. CONCLUSIONS Detailed ocular examination may represent a sensitive and quick screening tool for the identification of carriers of LAMP2 pathogenic variants, even in somatic mosaicism. Hence, further investigation should be undertaken in all patients with pigmentary retinal dystrophy as it may be a sign of a life-threatening disease.
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Affiliation(s)
- Bohdan Kousal
- Department of Ophthalmology First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
- Research Unit for Rare Diseases Department of Pediatrics and Adolescent Medicine First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | - Filip Majer
- Research Unit for Rare Diseases Department of Pediatrics and Adolescent Medicine First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | - Hana Vlaskova
- Research Unit for Rare Diseases Department of Pediatrics and Adolescent Medicine First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | - Lenka Dvorakova
- Research Unit for Rare Diseases Department of Pediatrics and Adolescent Medicine First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | - Lenka Piherova
- Research Unit for Rare Diseases Department of Pediatrics and Adolescent Medicine First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | - Martin Meliska
- Department of Ophthalmology First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | - Hana Langrova
- Department of Ophthalmology Faculty of Medicine in Hradec Kralove Charles University and University Hospital Hradec Kralove Hradec Kralove Czech Republic
| | - Tomas Palecek
- 2nd Department of Medicine ‐ Department of Cardiovascular Medicine First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | - Milos Kubanek
- Department of Cardiology Institute for Clinical and Experimental Medicine Prague Czech Republic
| | - Alice Krebsova
- Department of Cardiology Institute for Clinical and Experimental Medicine Prague Czech Republic
| | - Jiri Gurka
- Department of Cardiology Institute for Clinical and Experimental Medicine Prague Czech Republic
| | - Veronika Stara
- Department of Paediatrics Second Faculty of Medicine Charles University and Motol University Hospital Prague Czech Republic
| | - Michel Michaelides
- Moorfields Eye Hospital NHS Foundation Trust London UK
- UCL Institute of Ophthalmology University College London London UK
| | - Tomas Kalina
- Department of Paediatric Haematology and Oncology Childhood Leukaemia Investigation Prague Second Faculty of Medicine Charles University and Motol University Hospital Prague Czech Republic
| | - Jakub Sikora
- Research Unit for Rare Diseases Department of Pediatrics and Adolescent Medicine First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
- Institute of Pathology First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | - Petra Liskova
- Department of Ophthalmology First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
- Research Unit for Rare Diseases Department of Pediatrics and Adolescent Medicine First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
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Zhang L, Yang F, Chen M, Zhou M, Qian T, Mujtaba MO, Mohammed AH, Yin J, Cheng X, Chen J, Qin Y, Yang S. Case Report: Identification of Mutations in LAMP2 in Two Chinese Infants With Danon Disease. Front Genet 2021; 11:589838. [PMID: 33505424 PMCID: PMC7831386 DOI: 10.3389/fgene.2020.589838] [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: 07/31/2020] [Accepted: 12/10/2020] [Indexed: 11/16/2022] Open
Abstract
Danon disease (DD) is a monogenic lysosomal storage disorder characterized by cardiomyopathy, skeletal myopathy, and variable degrees of intellectual disability. It is caused by a deficiency of lysosomal-associated membrane protein 2 (LAMP2). Two unrelated boys who presented with severe hypertrophic cardiomyopathy and elevated levels of liver enzymes, and were diagnosed with Danon disease at a very young age, were investigated. One boy was diagnosed at 4 months old and died soon after; his mother also died of hypertrophic cardiomyopathy shortly after his birth. Another developed hypertrophic cardiomyopathy at 3 months old but reported no significant cardiovascular symptoms during more than 5 years follow-up. Genetic screening found compound variants of LAMP2 and MYH7 in both of them. This report highlights the clinical heterogeneity in DD. The timely identification of LAMP2 mutation plays a critical role in their treatment and family counseling.
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Affiliation(s)
- Luyan Zhang
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Fan Yang
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Mei Chen
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Ming Zhou
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Tianwei Qian
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Mohammed Omer Mujtaba
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Abdul Haseeb Mohammed
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Yin
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xueying Cheng
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jinlong Chen
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yuming Qin
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Shiwei Yang
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
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Semeraro M, Sacchetti E, Deodato F, Coşkun T, Lay I, Catesini G, Olivieri G, Rizzo C, Boenzi S, Dionisi-Vici C. A new UHPLC-MS/MS method for the screening of urinary oligosaccharides expands the detection of storage disorders. Orphanet J Rare Dis 2021; 16:24. [PMID: 33422100 PMCID: PMC7796585 DOI: 10.1186/s13023-020-01662-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 12/22/2020] [Indexed: 12/17/2022] Open
Abstract
Background Oligosaccharidoses are storage disorders due to enzymatic defects involved in the breakdown of the oligosaccharidic component of glycosylated proteins. The defect cause the accumulation of oligosaccharides (OS) and, depending on the lacking enzyme, results in characteristic profiles which are helpful for the diagnosis. We developed a new tandem mass spectrometry method for the screening of urinary OS which was applied to identify a large panel of storage disorders. Methods The method was set-up in urine and dried urine spots (DUS). Samples were analysed, without derivatization and using maltoheptaose as internal standard, by UHPLC-MS/MS with MRM acquisition of target OS transitions, including Glc4, the biomarker of Pompe disease. The chromatographic run was < 30 min. Samples from patients with known storage disorders were used for clinical validation. Results The method allowed to confirm the diagnosis of oligosaccharidoses (sialidosis, α-/β-mannosidosis, fucosidosis, aspartylglucosaminuria) and of GM1 and GM2 (Sandhoff type) gangliosidosis, by detecting specific OS profiles. In other storage disorders (mucolipidosis II and III, mucopolysaccharidosis type IVB) the analyisis revealed abnormal OS excretion with non-specific profiles. Besides Pompe disease, the tetrasaccharide Glc4 was increased also in disorders of autophagy (Vici syndrome, Yunis-Varon syndrome, and Danon disease) presenting cardiomuscular involvement with glycogen storage. Overall, results showed a clear separation between patients and controls, both in urine and in DUS. Conclusion This new UHPLC/MS-MS method, which is suitable for rapid and easy screening of OS in urine and DUS, expands the detection of storage disorders from oligosaccharidoses to other diseases, including the novel category of inherited disorders of autophagy.
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Affiliation(s)
- Michela Semeraro
- Division of Metabolism and Metabolic Diseases Research Unit, Bambino Gesù Children's Hospital, IRCCS, Viale San Paolo 15, 00146, Rome, Italy.
| | - Elisa Sacchetti
- Division of Metabolism and Metabolic Diseases Research Unit, Bambino Gesù Children's Hospital, IRCCS, Viale San Paolo 15, 00146, Rome, Italy
| | - Federica Deodato
- Division of Metabolism and Metabolic Diseases Research Unit, Bambino Gesù Children's Hospital, IRCCS, Viale San Paolo 15, 00146, Rome, Italy
| | - Turgay Coşkun
- Metabolism Unit, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Incilay Lay
- Department of Medical Biochemistry and Hacettepe University Hospitals Clinical Pathology Laboratory, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Giulio Catesini
- Division of Metabolism and Metabolic Diseases Research Unit, Bambino Gesù Children's Hospital, IRCCS, Viale San Paolo 15, 00146, Rome, Italy
| | - Giorgia Olivieri
- Division of Metabolism and Metabolic Diseases Research Unit, Bambino Gesù Children's Hospital, IRCCS, Viale San Paolo 15, 00146, Rome, Italy
| | - Cristiano Rizzo
- Division of Metabolism and Metabolic Diseases Research Unit, Bambino Gesù Children's Hospital, IRCCS, Viale San Paolo 15, 00146, Rome, Italy
| | - Sara Boenzi
- Division of Metabolism and Metabolic Diseases Research Unit, Bambino Gesù Children's Hospital, IRCCS, Viale San Paolo 15, 00146, Rome, Italy
| | - Carlo Dionisi-Vici
- Division of Metabolism and Metabolic Diseases Research Unit, Bambino Gesù Children's Hospital, IRCCS, Viale San Paolo 15, 00146, Rome, Italy
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Myerowitz R, Puertollano R, Raben N. Impaired autophagy: The collateral damage of lysosomal storage disorders. EBioMedicine 2021; 63:103166. [PMID: 33341443 PMCID: PMC7753127 DOI: 10.1016/j.ebiom.2020.103166] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 12/12/2022] Open
Abstract
Lysosomal storage disorders (LSDs), which number over fifty, are monogenically inherited and caused by mutations in genes encoding proteins that are involved in lysosomal function. Lack of the functional protein results in storage of a distinctive material within the lysosomes, which for years was thought to determine the pathophysiology of the disorder. However, our current view posits that the primary storage material disrupts the normal role of the lysosome in the autophagic pathway resulting in the secondary storage of autophagic debris. It is this "collateral damage" which is common to the LSDs but nonetheless intricately nuanced in each. We have selected five LSDs resulting from defective proteins that govern widely different lysosomal functions including glycogen degradation (Pompe), lysosomal transport (Cystinosis), lysosomal trafficking (Danon), glycolipid degradation (Gaucher) and an unidentified function (Batten) and argue that despite the disparate functions, these proteins, when mutant, all impair the autophagic process uniquely.
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Affiliation(s)
- Rachel Myerowitz
- Department of Biology St. Mary's College of Maryland, St. Mary's City Maryland, 20686, USA
| | - Rosa Puertollano
- Cell and Developmental Biology Center, National Heart, Lung, and Blood Institute, NIH, 50 South Dr./Room 3533, Bethesda, MD 20892, USA
| | - Nina Raben
- Cell and Developmental Biology Center, National Heart, Lung, and Blood Institute, NIH, 50 South Dr./Room 3533, Bethesda, MD 20892, USA.
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Li Q, Chen D, Shang JF, Lu JY, Kang JR, Lyu J. [Pathological diagnosis of Danon disease by endomyocardial biopsy]. Zhonghua Bing Li Xue Za Zhi 2020; 49:1276-81. [PMID: 33287513 DOI: 10.3760/cma.j.cn112151-20200318-00224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective To investigate the clinicopathological features and differential diagnosis of Danon disease. Methods: Two cases of Danon disease were selected from Beijing Anzhen Hospital Affiliated to Capital Medical University from January 2019 to December 2019. The clinical history, histological, immunohistochemical, ultrastructural and gene mutation analysis were collected. Results: Both of the patients were male, aged 21 and 19 years old, respectively. They were diagnosed with hypertrophic cardiomyopathy by clinicians. The histologic features of endocardial biopsies were hypertrophy and vacuolar degeneration of cardiomyocytes. Part of cardiomyocytes appeared as intracellular clear areas lacking myofibers. The nuclei were large, irregular and hyperchromatic. And lipofuscin was occasionally observed in the nuclei of cardiomyocytes. Ultrastructural feature of electron microscopic was glycogen accumulation. Genetic analysis identified two lysosome-associated membrane protein-2 (LAMP2) gene mutations. A 1-bp deletion in exon 8 (c.973delC) was found in patient 1, leading to a frame-shift mutation. A 3-bp duplication in exon 5 (c.719_721dupAGC) was found in patient 2, leading to an insertion mutation. Conclusions: Danon disease is a rare disease characterized by hypertrophic cardiomyopathy. It is caused by mutations in the LAMP2 gene. Vacuolar degeneration of cardiomyocytes, glycogen accumulation under electron microscope and the mutation of LAMP2 gene are the critical features of Danon disease. Familiar with its clinicopathological characteristics would be helpful to avoid the misdiagnosis of Danon disease.
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Yang JM, Lee BH, Nam GB, Kim JG, Lee JY. Long-Term Follow-Up of Peripheral Pigmentary Retinopathy in Asian Patients with Danon Disease. Genes (Basel) 2020; 11:E1356. [PMID: 33207664 DOI: 10.3390/genes11111356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/05/2020] [Accepted: 11/12/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Peripheral pigmentary changes are common amongst women with Danon disease; however, there is currently a lack of longitudinal observational studies of the retinal changes in this condition, and the long-term visual prognosis is not well understood. Methods and Results: In this report, we present long-term follow-up data (12 years of follow-up) regarding peripheral retinopathy in an Asian woman and her mother who were both diagnosed with Danon disease. Both patients showed a novel nonsense mutation of the LAMP2 gene (c.123 of exon 2). During the follow-up period, no evident extension of peripheral pigmented lesions or visual field progression was observed. Conclusions: We report, for the first time, the long-term longitudinal follow-up of Danon disease-related retinopathy in an Asian patient featuring an indolent macular-sparing peripheral lesion.
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Montañés ME, Granados MA, Valverde M, Palomino J, Fontenla A, Escribano L. Wolff Parkinson white pattern in Danon disease: When preexcitation is not what it seems. J Electrocardiol 2020; 62:161-164. [PMID: 32919126 DOI: 10.1016/j.jelectrocard.2020.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/14/2020] [Accepted: 08/27/2020] [Indexed: 11/27/2022]
Abstract
Danondisease is a rare genetic disorder with an X-linked dominant inheritance affecting both skeletal and cardiac muscle. Its characteristic cardiac phenotype consists on a severe, non-obstructive and concentric hypertrophic cardiomyopathy (HCM) usually associated with a Wolff-Parkinson-White (WPW) type preexcitation pattern. Whether this corresponds to the presence of an AV or another type of accessory pathways, such as fasciculoventricular pathways (FVP) remains controversial in the literature. However, we describe the case of a teenager with Danon disease and preexcitation who develops a first degree AV block without any change in his QRS morphology, fact that favors the hypothesis of the presence of a FVP. This finding has important clinical implications in the management and prognosis of these complex patients. The absence of an AV accessory pathway decreases their risk of potential SCD in the context of a fast atrial arrhythmia and their chances of having a reentrant AV tachycardia.
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Affiliation(s)
- M Elena Montañés
- Division of pediatric cardiology, Hospital 12 Octubre, Madrid, Spain.
| | - Miguel A Granados
- Division of pediatric cardiology, Hospital 12 Octubre, Madrid, Spain
| | - María Valverde
- Division of cardiology, Hospital 12 Octubre, Madrid, Spain
| | | | | | - Lucía Escribano
- Division of pediatric cardiology, Hospital General de Albacete, Albacete, Spain
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Del Favero G, Bonifacio A, Rowland TJ, Gao S, Song K, Sergo V, Adler ED, Mestroni L, Sbaizero O, Taylor MRG. Danon Disease-Associated LAMP-2 Deficiency Drives Metabolic Signature Indicative of Mitochondrial Aging and Fibrosis in Cardiac Tissue and hiPSC-Derived Cardiomyocytes. J Clin Med 2020; 9:E2457. [PMID: 32751926 DOI: 10.3390/jcm9082457] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/15/2020] [Accepted: 07/21/2020] [Indexed: 12/15/2022] Open
Abstract
Danon disease is a severe X-linked disorder caused by deficiency of the lysosome-associated membrane protein-2 (LAMP-2). Clinical manifestations are phenotypically diverse and consist of hypertrophic and dilated cardiomyopathies, skeletal myopathy, retinopathy, and intellectual dysfunction. Here, we investigated the metabolic landscape of Danon disease by applying a multi-omics approach and combined structural and functional readouts provided by Raman and atomic force microscopy. Using these tools, Danon patient-derived cardiac tissue, primary fibroblasts, and human induced pluripotent stem cells differentiated into cardiomyocytes (hiPSC-CMs) were analyzed. Metabolic profiling indicated LAMP-2 deficiency promoted a switch toward glycolysis accompanied by rerouting of tryptophan metabolism. Cardiomyocytes' energetic balance and NAD+/NADH ratio appeared to be maintained despite mitochondrial aging. In turn, metabolic adaption was accompanied by a senescence-associated signature. Similarly, Danon fibroblasts appeared more stress prone and less biomechanically compliant. Overall, shaping of both morphology and metabolism contributed to the loss of cardiac biomechanical competence that characterizes the clinical progression of Danon disease.
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Gurka J, Piherova L, Majer F, Chaloupka A, Zakova D, Pelak O, Krebsova A, Peichl P, Krejci J, Freiberger T, Melenovsky V, Kautzner J, Kalina T, Sikora J, Kubanek M. Danon disease is an underdiagnosed cause of advanced heart failure in young female patients: a LAMP2 flow cytometric study. ESC Heart Fail 2020; 7:2534-2543. [PMID: 32657043 PMCID: PMC7524080 DOI: 10.1002/ehf2.12823] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/04/2020] [Accepted: 05/20/2020] [Indexed: 01/14/2023] Open
Abstract
Aims Danon disease (DD) is a rare X‐linked disorder caused by mutations in the lysosomal‐associated membrane protein type 2 gene (LAMP2). DD is difficult to distinguish from other causes of dilated or hypertrophic cardiomyopathy (HCM) in female patients. As DD female patients regularly progress into advanced heart failure (AHF) aged 20–40 years, their early identification is critical to improve patient survival and facilitate genetic counselling. In this study, we evaluated the prevalence of DD among female patients with non‐ischemic cardiomyopathy, who reached AHF and were younger than 40 years. Methods and results The study cohort comprised 60 female patients: 47 (78%) heart transplant recipients, 2 (3%) patients treated with ventricular assist device, and 11 (18%) patients undergoing pre‐transplant assessment. Aetiology of the cardiomyopathy was known in 15 patients (including two DD patients). LAMP2 expression in peripheral white blood cells (WBC) was tested by flow cytometry (FC) in the remaining 45 female patients. Whole exome sequencing was used as an alternative independent testing method to FC. Five additional female DD patients (two with different novel LAMP2 mutations) were identified by FC. The total prevalence of DD in this cohort was 12%. HCM phenotype (57% vs. 9%, *P = 0.022) and delta waves identified by electrocardiography (43% vs. 0%, **P = 0.002) were significantly more frequent in DD female patients. Conclusions Danon disease is an underdiagnosed cause of AHF in young female patients. LAMP2 expression testing in peripheral WBCs by FC can be used as an effective screening/diagnostic tool to identify DD in this patient population.
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Affiliation(s)
- Jiri Gurka
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Lenka Piherova
- Research Unit for Rare Diseases, Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Filip Majer
- Research Unit for Rare Diseases, Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Anna Chaloupka
- 1st Internal Cardioangiologic Clinic, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czech Republic
| | - Daniela Zakova
- Centre of Cardiovascular and Transplant Surgery, St. Annes University Hospital, Brno, Czech Republic
| | - Ondrej Pelak
- Department of Paediatric Haematology and Oncology, Childhood Leukaemia Investigation Prague, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Alice Krebsova
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petr Peichl
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jan Krejci
- 1st Internal Cardioangiologic Clinic, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno, Czech Republic
| | - Tomas Freiberger
- Centre of Cardiovascular and Transplant Surgery, St. Annes University Hospital, Brno, Czech Republic
| | - Vojtech Melenovsky
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Tomas Kalina
- Department of Paediatric Haematology and Oncology, Childhood Leukaemia Investigation Prague, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Jakub Sikora
- Research Unit for Rare Diseases, Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.,Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Milos Kubanek
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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Ntelios D, Parcharidou D, Zegkos T, Paraskevaidis S, Manolakos E, Papoulidis I, Vassilikos V, Karvounis H, Efthimiadis G. The multiple faces of Danon disease. Hellenic J Cardiol 2020; 62:178-179. [PMID: 32553999 DOI: 10.1016/j.hjc.2020.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/28/2020] [Accepted: 06/05/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Dimitrios Ntelios
- 1(st) Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece.
| | - Despoina Parcharidou
- 1(st) Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - Thomas Zegkos
- 1(st) Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - Stylianos Paraskevaidis
- 1(st) Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | | | | | - Vassilios Vassilikos
- 3(rd) Cardiology Department, Hippokration Hospital, Aristotle University Medical School, Thessaloniki, Greece
| | - Haralampos Karvounis
- 1(st) Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - Georgios Efthimiadis
- 1(st) Cardiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
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Popa MA, Klingel K, Hadamitzky M, Deisenhofer I, Hessling G. An unusual case of severe myocarditis in a genetic cardiomyopathy: a case report. Eur Heart J Case Rep 2020; 4:1-7. [PMID: 32974466 PMCID: PMC7501922 DOI: 10.1093/ehjcr/ytaa124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/10/2019] [Accepted: 04/23/2020] [Indexed: 11/13/2022]
Abstract
Background Myocarditis is an inflammatory disease of the myocardium caused by infectious pathogens, immune-mediated conditions, or toxic agents. This report explores a rare case of severe myocarditis occurring in an inherited cardiomyopathy. Case summary A 24-year-old female patient presented with progressing dyspnoea and chest discomfort. Echocardiography and cardiac magnetic resonance imaging revealed dilated cardiomyopathy (DCM) with severe biventricular dysfunction [left ventricle ejection fraction (LV-EF) 10%]. Myocardial inflammation was suspected due to extensive subendocardial to transmural late gadolinium enhancement. Endomyocardial biopsy (EMB) showed severe chronic lymphocytic myocarditis. As inflammatory DCM was assumed, immunosuppressive therapy with prednisolone was initiated in addition to standard heart failure therapy. Endomyocardial biopsy after 3 months showed resolving inflammation. However, a marked architectural disarray observed in all biopsies raised the suspicion of an inherited cardiomyopathy. Genetic testing revealed a de novo mutation with effect on splicing of lysosome-associated membrane protein 2, as found in Danon disease. Periodic acid–Schiff (PAS) staining confirmed a glycogen storage disorder. Immunosuppressive therapy was intensified due to reactivation of myocardial inflammation and led to improvement of LV-EF and to significant symptom relief over a 16-month follow-up period. Discussion This is the first report of Danon disease initially presenting as a severe myocarditis. It illustrates the clinical value of EMB for diagnosis and immunosuppressive therapy monitoring in chronic myocarditis. Increasing evidence suggests that myocardial inflammation may modify disease progression and prognosis in inherited cardiomyopathies. The causal role of cardiac protein mutations in the pathophysiology of myocarditis remains to be determined.
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Affiliation(s)
- Miruna-Andreea Popa
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Lazarettstraße 36, 80636 Munich, Germany
| | - Karin Klingel
- Department of Cardiopathology, Institute of Pathology and Neuropathology, University Hospital Tübingen, Liebermeisterstraße 8, 72076 Tübingen, Germany
| | - Martin Hadamitzky
- Department of Radiology, German Heart Center Munich, Technical University of Munich, Lazarettstraße 36, 80636 Munich, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Lazarettstraße 36, 80636 Munich, Germany
| | - Gabriele Hessling
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Lazarettstraße 36, 80636 Munich, Germany
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Hummel K, Glotzbach K, Menon S, Griffiths E, Lal AK. Thrombotic microangiopathy following heart transplant in pediatric Danon disease. Pediatr Transplant 2020; 24:e13669. [PMID: 32067323 DOI: 10.1111/petr.13669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/16/2020] [Indexed: 11/28/2022]
Abstract
This case describes an uncommon acute complication of diffuse thrombotic angiopathy and associated aHUS/TTP in an 11-year-old girl with Danon disease who underwent orthotopic heart transplant. Shortly after transplant, despite an uncomplicated operative course, the patient developed severe kidney injury and progressive altered mental status, culminating in cerebral edema, brain herniation, and death. She had received a single dose of tacrolimus (FK506) and a single dose of antithymocyte globulin. Sources of progressive somnolence, including oversedation from impaired renal clearance of opiates, and severe myopathy as has been previously described in Danon disease, were ruled out, and the patient continued to decline. Initial brain CT scan early after transplant showed no signs of cerebral edema, but repeat CT indicated severe cerebral edema. Based on autopsy, diffuse thrombotic angiopathy, with signs of hemolytic anemia with schistocytes, was likely responsible for her deterioration in the broader condition of aHUS/TTP.
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Affiliation(s)
- Kevin Hummel
- Division of Pediatric Critical Care Medicine, University of Utah, Salt Lake City, Utah.,Intermountain Healthcare Primary Children's Hospital, Salt Lake City, Utah
| | - Kristi Glotzbach
- Division of Pediatric Critical Care Medicine, University of Utah, Salt Lake City, Utah.,Intermountain Healthcare Primary Children's Hospital, Salt Lake City, Utah
| | - Shaji Menon
- Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah.,Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Eric Griffiths
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Ashwin K Lal
- Intermountain Healthcare Primary Children's Hospital, Salt Lake City, Utah.,Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah
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Staikou C, Stamelos M, Stavroulakis E. Perioperative management of patients with genetic multisystem diseases associated with pre‑excitation. Anaesthesiol Intensive Ther 2019; 51:133-46. [PMID: 31268275 DOI: 10.5114/ait.2019.86278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pre-excitation is associated with life-threatening arrhythmias. Apart from the well-known Wolff-Parkinson-White syndrome, a number of rare diseases are associated with pre-excitation due to the existence of accessory pathways. The present review aims to focus on anaesthesia and perioperative care of patients with rare genetic diseases associated with pre-excitation due to the existence of a bundle of Kent or other accessory pathways. The Danon disease, Fabry disease and Pompe disease, tuberous sclerosis, Leber hereditary optic neuropathy (LHON), and mitochondrial encephalopathy, lactic acidosis and stroke-like episodes (MELAS) syndrome are genetic multisystem disorders which may involve pre-excitation, usually combined with cardiomyopathy. The anaesthetic management of the above syndromes may become quite challenging. We conducted a PubMed and manual literature search for all types of relevant publications; we identified 58 articles suitable to be included in the present review. According to the literature, a high index of suspicion for the possibility of pre-excitation is required, and anaesthetic drugs and adjuvants should be chosen carefully, in order to prevent or at least not facilitate arrhythmias associated with accessory pathways. The perioperative management should be further tailored to the specific abnormalities of each condition. Multidisciplinary consultation and care, according to the affected organs, are mandatory for a safe outcome. The anaesthetic plan should be focused on preoperative clinical optimization and on case-specific management, tailored to the various systems involved.
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Novelli V, Bisignani A, Pelargonio G, Primiano G, Narducci ML, Palmieri V, Tiziano FD, Zeppilli P, Servidei S, Crea F, Genuardi M. Clinical utility of genetic testing in the early diagnosis of Danon disease mimicking hypertrophic cardiomyopathy: a case report. BMC Cardiovasc Disord 2020; 20:156. [PMID: 32248794 PMCID: PMC7132987 DOI: 10.1186/s12872-020-01421-4] [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: 08/27/2019] [Accepted: 03/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Danon disease (OMIM 300257) is an X-linked lysosomal storage disorder, characterized by hypertrophic cardiomyopathy (HCM), skeletal myopathy, variable intellectual disability, and other minor clinical features. This condition accounts for ~ 4% of HCM patients, with a more severe and early onset phenotype in males, causing sudden cardiac death (SCD) in the first three decades of life. Genetic alterations in the LAMP2 gene are the main cause of this inherited fatal condition. Up to date, more than 100 different pathogenic variants have been reported in the literature. However, the majority of cases are misdiagnosed as HCM or have a delay in the diagnosis. CASE PRESENTATION Here, we describe a young boy with an early diagnosis of HCM. After 2 episodes of ventricular fibrillation within 2 years, genetic testing identified a novel LAMP2 pathogenic variant. Subsequently, further clinical evaluations showing muscle weakness and mild intellectual disability confirmed the diagnosis of Danon disease. CONCLUSIONS This report highlights the role of genetic testing in the rapid diagnosis of Danon disease, underscoring the need to routinely consider the inclusion of LAMP2 gene in the genetic screening for HCM, since an early diagnosis of Danon disease in patients with a phenotype mimicking HCM is essential to plan appropriate treatment, ie cardiac transplantation.
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Affiliation(s)
- Valeria Novelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Genetica Medica, Rome, Italy.,Istituto di Medicina Genomica, Università del Sacro Cuore, L.go F. Vito 1, 00168, Rome, Italy
| | - Antonio Bisignani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze Cardiovascolari e Toraciche, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gemma Pelargonio
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze Cardiovascolari e Toraciche, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Guido Primiano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Neurofisiopatologia, Rome, Italy.,Istituto di Neurologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Lucia Narducci
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze Cardiovascolari e Toraciche, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Palmieri
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Unità di Medicina dello Sport, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Danilo Tiziano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Genetica Medica, Rome, Italy.,Istituto di Medicina Genomica, Università del Sacro Cuore, L.go F. Vito 1, 00168, Rome, Italy
| | - Paolo Zeppilli
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Unità di Medicina dello Sport, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Serenella Servidei
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Neurofisiopatologia, Rome, Italy.,Istituto di Neurologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Scienze Cardiovascolari e Toraciche, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maurizio Genuardi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Genetica Medica, Rome, Italy. .,Istituto di Medicina Genomica, Università del Sacro Cuore, L.go F. Vito 1, 00168, Rome, Italy.
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Chi C, Riching AS, Song K. Lysosomal Abnormalities in Cardiovascular Disease. Int J Mol Sci 2020; 21:E811. [PMID: 32012649 DOI: 10.3390/ijms21030811] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/20/2020] [Accepted: 01/25/2020] [Indexed: 12/12/2022] Open
Abstract
The lysosome, a key organelle for cellular clearance, is associated with a wide variety of pathological conditions in humans. Lysosome function and its related pathways are particularly important for maintaining the health of the cardiovascular system. In this review, we highlighted studies that have improved our understanding of the connection between lysosome function and cardiovascular diseases with an emphasis on a recent breakthrough that characterized a unique autophagosome-lysosome fusion mechanism employed by cardiomyocytes through a lysosomal membrane protein LAMP-2B. This finding may impact the development of future therapeutic applications.
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Kuroda K, Seguchi O, Matama H, Kimura Y, Iwasaki K, Toda K, Kikuchi N, Kumai Y, Nakajima S, Matsumoto Y, Watanabe T, Yanase M, Fukushima S, Tomoyuki F, Kobayashi J, Fukushima N. Left ventricular assist device implantation in an adult male with Danon disease. J Cardiol Cases 2019; 20:106-109. [PMID: 31497177 PMCID: PMC6718825 DOI: 10.1016/j.jccase.2019.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/05/2019] [Accepted: 06/10/2019] [Indexed: 11/26/2022] Open
Abstract
Danon disease is an extremely rare inherited disorder characterized by cardiac involvement, myopathy, and intellectual disability. As patients with Danon disease die at an early age, mainly as a result of cardiac involvement, implantation of a left ventricular assist device (LVAD) and/or heart transplantation are essential options. However, various comorbidities associated with Danon disease should be assessed when these patients are being considered as potential heart transplant candidates. We report the case of an adult male patient with dilated-phase hypertrophic cardiomyopathy secondary to Danon disease, who received an LVAD as a bridge to transplantation. <Learning objective: Some patients with Danon disease who underwent heart transplantation have been reported in Japan, but all were female. Male patients with Danon disease have more severe systemic comorbidities than females and heart failure progression is usually too rapid for them to be listed as heart transplant candidates. We present a rare case of an adult male with Danon disease who successfully underwent implantation of a left-ventricular assist device as a bridge to transplantation.>
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Affiliation(s)
- Kensuke Kuroda
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Osamu Seguchi
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Hideo Matama
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Yuki Kimura
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Keiichiro Iwasaki
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Koichi Toda
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Noriko Kikuchi
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Yuto Kumai
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Seiko Nakajima
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Yorihiko Matsumoto
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Japan
| | - Takuya Watanabe
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Masanobu Yanase
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Japan
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Japan
| | - Fujita Tomoyuki
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Japan
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Japan
| | - Norihide Fukushima
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, Japan
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Guo S, Zhou L, Wang R, Lv Z, Xu H, Han B, Korantzopoulos P, Hu F, Liu T. Danon disease: Two patients with atrial fibrillation in a single family and review of the literature. Exp Ther Med 2019; 18:1527-1532. [PMID: 31410105 PMCID: PMC6676149 DOI: 10.3892/etm.2019.7777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 05/31/2019] [Indexed: 11/05/2022] Open
Abstract
The present study reports on a family with two members affected by Danon disease but having different phenotypes. The clinical manifestations of Danon disease include cardiomyopathy, skeletal myopathy and different degrees of intellectual disability that varies greatly among patients. The present case study reports on two siblings, an older sister and a younger brother, with Danon disease from an affected pedigree, presenting with distinctly different phenotypes. The sister was diagnosed with dilated cardiomyopathy at the age of 26 years with an unfavorable outcome, while her younger brother presented with hypertrophic cardiomyopathy in a relatively stable state. The two probands shared the same mutation, c.974delTinsAA in exon 8, in the lysosomal-associated membrane protein-2 gene. Of note, the two patients had a pre-excitation pattern in the electrocardiogram on initial presentation and later developed atrial fibrillation (AF), which markedly aggravated heart failure. To the best of our knowledge, AF has not been widely reported in patients with Danon disease. The development of AF may have a prognostic value under these circumstances.
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Affiliation(s)
- Shaohua Guo
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, P.R. China
| | - Linghuan Zhou
- Department of Cardiology, Shijiazhuang Great Wall Hospital of Integrated Traditional Chinese and Western Medicine, Shijiazhuang, Hebei 050035, P.R. China
| | - Renping Wang
- Department of Cardiology, Shijiazhuang Great Wall Hospital of Integrated Traditional Chinese and Western Medicine, Shijiazhuang, Hebei 050035, P.R. China
| | - Zhixin Lv
- Department of Cardiology, Shijiazhuang Great Wall Hospital of Integrated Traditional Chinese and Western Medicine, Shijiazhuang, Hebei 050035, P.R. China
| | - Hongzun Xu
- Department of Cardiology, Shijiazhuang Great Wall Hospital of Integrated Traditional Chinese and Western Medicine, Shijiazhuang, Hebei 050035, P.R. China
| | - Baoli Han
- Department of Cardiology, Shijiazhuang Great Wall Hospital of Integrated Traditional Chinese and Western Medicine, Shijiazhuang, Hebei 050035, P.R. China
| | | | - Fuli Hu
- Department of Cardiology, Shijiazhuang Great Wall Hospital of Integrated Traditional Chinese and Western Medicine, Shijiazhuang, Hebei 050035, P.R. China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, P.R. China
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Xu J, Wang L, Liu X, Dai Q. A novel LAMP2 p.G93R mutation associated with mild Danon disease presenting with familial hypertrophic cardiomyopathy. Mol Genet Genomic Med 2019; 7:e00941. [PMID: 31464081 PMCID: PMC6785429 DOI: 10.1002/mgg3.941] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 08/07/2019] [Accepted: 08/07/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Danon disease (DD) is an X-linked dominant multisystem disorder that is associated with cardiomyopathy, skeletal myopathy, and varying degrees of intellectual disability. It results from mutations in the lysosome-associated membrane protein 2 (LAMP2) gene. METHODS Herein, a proband with a mild DD case presenting with a familial hypertrophic cardiomyopathy (HCM) phenotype and additional family members were evaluated. Exome sequencing and Sanger sequencing were performed to explore the genetic basis of DD in the proband. Segregation, in silico, and functional analyses were carried out to explore potential pathogenicity in the candidate mutation. RESULTS Exome sequencing and Sanger sequencing identified one novel missense mutation (p.G93R) in the LAMP2 gene in the proband, and this mutation was also identified in three other family members. In silico analysis of LAMP2 predicted that the mutation causes a conformational change and subsequent protein destabilization. Furthermore, functional examination showed that mutation carriers have a significant reduction in LAMP2 expression, which supports that the mutation is pathogenic. Moreover, skewed X chromosome inactivation (XCI) was identified in one female mutation carrier, thus suggesting that skewed XCI may be the reason why this individual escaped the pathogenic influence of the mutation. CONCLUSION These findings will aid in diagnosing DD patients carrying this LAMP2 mutation that presents with a HCM phenotype. Furthermore, this study illustrates the importance of utilizing a molecular diagnostic approach in HCM patients and is the first study to report a LAMP2 p.G93R mutation associated with mild DD and identify that XCI serves a protective role in DD etiology.
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Affiliation(s)
- Jing Xu
- Department of Clinical Laboratory, ZhongDa Hospital, Southeast University, Nanjing, P. R. China.,Institute of Life Science, Southeast University, Nanjing, P. R. China
| | - Lu Wang
- Institute of Life Science, Southeast University, Nanjing, P. R. China
| | - Xiangdong Liu
- Institute of Life Science, Southeast University, Nanjing, P. R. China
| | - Qiming Dai
- Department of Cardiology, ZhongDa Hospital, Southeast University, Nanjing, P. R. China
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