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Gratton J, Humphries S, Schmidt A, Finan C, Patel R, Sofat R, Futema M, Hingorani A. Modelling a two-stage screen for autosomal dominant Familial Hypercholesterolaemia (FH) in UK Biobank. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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2
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Rocha Lopes L, Hernandez SG, Lorenzini M, Futema M, Chumakova O, Villacorta E, Garcia-Pavia P, Bilbao R, Sandin-Fuentes M, Pinilla JG, Rasmussen TB, Revilla-Marti P, Elliott D, Monserrat L, Elliott P. Alpha-protein kinase 3 (ALPK3) truncating variants cause an autosomal dominant form of hypertrophic cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
More than half of hypertrophic cardiomyopathy (HCM) remains genetically unsolved. ALPK3 truncating variants (ALPK3tv) have been described as a cause of autosomal recessive cardiomyopathy in a small number of paediatric cases, but the pathogenicity in heterozygosity as a possible cause of autosomal dominant HCM is unknown.
Aims
To determine the frequency of heterozygous ALPK3tv in patients with HCM and to confirm their pathogenicity by means of burden testing in independent cohorts, family co-segregation studies, and functional analysis of an allelic series of ALPK3tv using human embryonic stem cell-cardiomyocytes (hESC-CM). Phenotype was compared with a cohort of 1679 genotyped HCM patients.
Methods and results
In a discovery cohort of 770 index patients with HCM, 12 (1.56%) were heterozygous for ALPK3tv, odds ratio (OR) 16.01 (95% confidence interval (95% CI): 7.89 to 29.74, p<8.36e-11), compared to the Genome Aggregation Database (gnomAD) population. In a validation cohort of 2047 HCM probands, 32 (1.56%) carried heterozygous ALPK3tv, OR 16.17 (95% CI: 10.31 to 24.87; p<2.2e-16, compared to gnomAD). Combined logarithm of odds score in 7 families with ALPK3tv was 2.99. In comparison with a large cohort of genotyped HCM patients, the phenotype of 51 HCM patients with ALPK3tv (probands and relatives) was characterised by a higher prevalence of apical/concentric patterns of hypertrophy (60%) compared to both sarcomere-positives or negatives (p<0.001 overall), with the age at diagnosis (56±16ys) and maximum wall thickness (18±4mm) similar to sarcomere-negatives and LV systolic impairment at baseline (6%) and non-sustained ventricular tachycardia (31%) similar to sarcomere-positives. Short PR (10%, p=0.009 overall) and extensive fibrosis>15% of LV segments (49%) were distinctive features. During follow-up (5.3±5.7 years), 4 (9%) patients died of heart failure or had cardiac transplantation (p=0.012 vs sarcomere-negatives and p=0.425 vs sarcomere-positives). Analysis of hESC-CM showed that ALPK3 heterozygotes had phenotypic characteristics of HCM, including increased contractile force and delayed membrane repolarization.
Conclusions
Heterozygous ALPK3tv are pathogenic and segregate with a characteristic HCM phenotype.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): MRC UK, UCLH BRC
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Affiliation(s)
| | - S G Hernandez
- Institute of Biomedical Research of La Coruna (INIBIC), Health In Code, A Coruna, Spain
| | - M Lorenzini
- St Bartholomew's Hospital, London, United Kingdom
| | - M Futema
- University College London, London, United Kingdom
| | - O Chumakova
- City Clinical Hospital No. 17, Moscow, Russian Federation
| | | | - P Garcia-Pavia
- University Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | - R Bilbao
- Alvaro Cunqueiro Hospital, Vigo, Spain
| | | | - J G Pinilla
- University Hospital Virgen de la Victoria, Malaga, Spain
| | | | | | - D Elliott
- University of Melbourne, Melbourne, Australia
| | - L Monserrat
- Institute of Biomedical Research of La Coruna (INIBIC), Health In Code, A Coruna, Spain
| | - P Elliott
- St Bartholomew's Hospital, London, United Kingdom
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Mickiewicz A, Futema M, Cwiklinska A, Kuchta A, Kaszubowski M, Chmara M, Jankowski M, Wasag B, Fijalkowski M, Jaguszewski M, Humphries S, Gruchala M. Higher responsiveness to rosuvastatin in polygenic versus monogenic hypercholesterolaemia: a propensity score analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The underlying monogenic defect in familial hypercholesterolemia (FH) can be detected in ∼40% of cases. The majority of mutation-negative patients have a polygenic cause of high LDL-cholesterol (LDL-C) due to having inherited a greater than average number of common LDL-C raising single nucleotide polymorphisms (SNPs).
Purpose
We sought to investigate, whether the monogenic or polygenic defect in FH is associated with the response to rosuvastatin.
Methods
Individuals with a clinical diagnosis of FH were tested for mutations in LDLR and APOB genes. A previously established LDL-C-specific polygenic risk score (PRS) was used to examine the possibility of polygenic hypercholesterolemia in mutation negative patients. The propensity score analysis was performed to evaluate the variables associated with the response to rosuvastatin. The type of hypercholesterolemia (polygenic or monogenic) and following variables: age, gender, LDL-baseline, statin intolerance, ezetimibe use, rosuvastatin dose, diabetes and cardiovascular disease (CVD), were examined to minimize the bias of this observational study.
Results
LDLR/APOB mutation was found in 47 (42%) patients, whereas polygenic hypercholesterolemia was diagnosed in 65 (58%) of patients. Mean age was comparable in both groups (54±13 vs 51±13, p=0.134). CVD was diagnosed in ≈26% of individuals in both cohorts (p=0.343). There was no difference in the distribution of CV risk factors, such as arterial hypertension, smoking, diabetes, body mass index and in rate of statin intolerance. Monogenic subjects had higher baseline LDL-C compared to polygenic (Table 1). Adjusted model showed a lower percentage of change in LDL-C after rosuvastatin treatment in monogenic vs. polygenic subjects (46% vs 55%, p<0.001) (Figure 1). The probability of achieving LDL-C targets in monogenic FH was lower than in polygenic subjects (0.075 vs. 0.245, p=0.004). Polygenic patients were more likely to achieve LDL-C goals, compared to mutation-positive patients (OR 3.28; 95% CI:1.23–8.72).
Conclusion
Our findings indicate an essentially higher responsiveness to rosuvastatin in patients with a polygenic cause, as compared to those carrying monogenic mutations.
Figure 1
Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): 1. Polish Ministry of Science and Higher Education European Regional Development Fund under the Programme Innovative Economy 2007–2013 (POIG.01.01.02-22-079/09). 2. British Heart Foundation (PG 08/008). 3. The National Institute for Health Research, University College London Hospitals, Biomedical Research Centre. 4. The Foundation Leducq Transatlantic Networks of Excellence Program grant (no. 14 CVD03)
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Affiliation(s)
- A Mickiewicz
- Medical University of Gdansk, 1st Department of Cardiology, Gdansk, Poland
| | - M Futema
- University College London, Centre for Heart Muscle Disease, Institute of Cardiovascular Science, London, United Kingdom
| | - A Cwiklinska
- Medical University of Gdansk, Department of Clinical Chemistry, Gdansk, Poland
| | - A Kuchta
- Medical University of Gdansk, Department of Clinical Chemistry, Gdansk, Poland
| | - M Kaszubowski
- Gdansk University of Technology, Institute of Statistics, Department of Economic Sciences, Faculty of Management and Economics, Gdansk, Poland
| | - M Chmara
- Medical University of Gdansk, Department of Biology & Genetics, Gdansk, Poland
| | - M Jankowski
- Medical University of Gdansk, Department of Clinical Chemistry, Gdansk, Poland
| | - B Wasag
- Medical University of Gdansk, Department of Biology & Genetics, Gdansk, Poland
| | - M Fijalkowski
- Medical University of Gdansk, 1st Department of Cardiology, Gdansk, Poland
| | - M Jaguszewski
- Medical University of Gdansk, 1st Department of Cardiology, Gdansk, Poland
| | - S.E Humphries
- University College London, Centre for Cardiovascular Genetics,Institute of Cardiovascular Science, London, United Kingdom
| | - M Gruchala
- Medical University of Gdansk, 1st Department of Cardiology, Gdansk, Poland
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Protonotarios A, Quinn E, Dalageorgou C, Futema M, Akhtar MM, Asimaki A, Ashworth M, Savvatis K, Syrris P, Elliott PM, Lopes LR. P3686A novel desmin gene variant as an important cause of biventricular arrhythmogenic cardiomyopathy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Arrhythmogenic Cardiomyopathy (AC) is typically caused by mutations in the desmosomal genes, however non-desmosomal genes have been increasingly implicated. Desmin gene (DES) mutations have been previously reported in AC, but in many cases there are insufficient data to support their pathogenicity.
Purpose
We assessed our AC cohort for DES gene mutations and describe the clinical phenotype associated with a recurring variant present in 3 unrelated families.
Methods
Genetic testing was performed using next-generation sequencing for 41 genes in a total of 138 AC probands with a definite diagnosis of AC based on the revised 2010 Task Force diagnostic criteria. All candidate variants were confirmed using Sanger sequencing. Clinical and genetic cascade screening were expanded to the first-degree relatives of the probands. Retained tissue from deceased individuals was used for genetic testing. All living mutation carriers underwent clinical assessment including physical examination, 12-lead ECG, signal-averaged ECG, echocardiography, cardiac magnetic resonance imaging (MRI) and 24h Holter-monitoring.
Results
Two DES gene variants, p.Ser298Leu (n=1) and p.Leu115Ile (n=3), were identified in 4 out of the 138 probands (3%). The former coexisted with a pathogenic DSP gene mutation and has not been further evaluated. The latter is a novel variant, absent in control databases (gnomAD) and was the only variant present in 3 unrelated families (see figure). One carrier required heart transplant (A-II-1), two died suddenly (A-III-1, B-II-1) and one died of non-cardiac causes (B-I-2). Detailed clinical information was present in 8 mutation carriers (2 male, age 45±19 years). Seven (88%) had a definite diagnosis and one had a borderline diagnosis of AC. All cases (100%) had right ventricular (RV) wall motion abnormalities, 6 (75%) had a dilated RV, 6 (75%) a dilated LV and 6 (75%) had LV dysfunction (mild in 5 and severe in 1). LV late gadolinium enhancement (LGE) was present in all 6 carriers that had a cardiac MRI with a circumferential sub-epicardial distribution (see figure, case A-III-2). Non-sustained ventricular tachycardia (VT) was present in 7 (88%) and sustained VT in 2 cases (25%). The ventricular ectopic burden per 24h ranged from 426 to 10583 with a median value of 820.
Figure 1
Conclusion
Variants of the DES gene are rare causes of AC. The novel p.Leu115Ile variant seems to be prevalent in a large UK-based cohort and it causes a biventricular form of AC, with a characteristic scar pattern on MRI and severe outcomes.
Acknowledgement/Funding
Alexandros Protonotarios is supported by a BHF Clinical Research Training Fellowship no. FS/18/82/34024
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Affiliation(s)
- A Protonotarios
- University College London, Institute of Cardiovascular Science, London, United Kingdom
| | - E Quinn
- St Bartholomew's Hospital, Inherited Cardiovascular Disease Unit, London, United Kingdom
| | - C Dalageorgou
- University College London, Institute of Cardiovascular Science, London, United Kingdom
| | - M Futema
- University College London, Institute of Cardiovascular Science, London, United Kingdom
| | - M M Akhtar
- St Bartholomew's Hospital, Inherited Cardiovascular Disease Unit, London, United Kingdom
| | - A Asimaki
- St George's University of London, Molecular and Clinical Sciences Research Institute, Cardiology Clinical Academic Group, London, United Kingdom
| | - M Ashworth
- Great Ormond Street Hospital for Children, Department of Pathology, London, United Kingdom
| | - K Savvatis
- St Bartholomew's Hospital, Inherited Cardiovascular Disease Unit, London, United Kingdom
| | - P Syrris
- University College London, Institute of Cardiovascular Science, London, United Kingdom
| | - P M Elliott
- University College London, Institute of Cardiovascular Science, London, United Kingdom
| | - L R Lopes
- St Bartholomew's Hospital, Inherited Cardiovascular Disease Unit, London, United Kingdom
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Mariano C, Alves A, Medeiros A, Chora J, Futema M, Humphries S, Bourbon M. Fh Phenotype: Monogenic, Polygenic Or Other Causes? Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Fairoozy RH, Futema M, Vakili R, Abbaszadegan MR, Hosseini S, Aminzadeh M, Zaeri H, Mobini M, Humphries SE, Sahebkar A. The Genetic Spectrum of Familial Hypercholesterolemia (FH) in the Iranian Population. Sci Rep 2017; 7:17087. [PMID: 29213121 PMCID: PMC5719081 DOI: 10.1038/s41598-017-17181-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/15/2017] [Indexed: 12/16/2022] Open
Abstract
Familial hypercholesterolemia (FH) is an autosomal dominant disorder associated with premature cardiovascular disease (CVD). Mutations in the LDLR, APOB, and PCSK9 genes are known to cause FH. In this study, we analysed the genetic spectrum of the disease in subjects from the Iranian population with a clinical diagnosis of FH. Samples were collected from 16 children and family members from five different cities of Iran. Probands were screened for mutations in the LDLR, APOB, and PCSK9 genes using next generation sequencing, with results confirmed by Sanger sequencing. The likely pathology of identified variants was examined using in silico tools. Of the probands, 14 had a clinical diagnosis of homozygous FH and two of heterozygous FH. No mutations were found in either APOB or PCSK9, but nine probands were homozygous for seven different LDLR mutations, with p.(Trp577Arg) occurring in three and p.Val806Glyfs*11 occurring in two patients. Two mutations were novel: p.(Leu479Gln) and p.(Glu668*). Seven probands with a clinical diagnosis of FH were mutation negative. This pilot study, integrating clinical and molecular-based techniques, begins to elucidate the FH heterogeneity and the mutation spectrum in the Iranian population. Such information is important for future disease management and cost savings.
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Affiliation(s)
- R H Fairoozy
- Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, London, United Kingdom.,Molecular Diagnostic Unit, Clinical Laboratory Department, King Abdullah Medical city in Makkah, Makkah, Saudi Arabia
| | - M Futema
- Centre for Cardiology in the Young, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - R Vakili
- Department of Pediatric Endocrinology and Metabolism, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Medical Genetics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - M R Abbaszadegan
- Medical Genetics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - S Hosseini
- Medical Genetics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - M Aminzadeh
- Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - H Zaeri
- Neonatal and Children Health Research Centre, Golestan University of Medical Sciences, Gorgan, Iran
| | - M Mobini
- School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - S E Humphries
- Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, London, United Kingdom.
| | - A Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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ArulJothi K, Whitthall R, Futema M, Humphries S, George M, Elangovan S, Nair DR, Devi A. Molecular analysis of the LDLR gene in coronary artery disease patients from the Indian population. Clin Biochem 2016; 49:669-674. [DOI: 10.1016/j.clinbiochem.2016.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 02/07/2023]
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Sharifi M, Gallivan A, Harvey D, Li KW, Futema M, Cooper J, Humphries S, Nair D. Atherosclerosis in monogenic Familial Hypercholesterolaemia versus polygenic hypercholesterolaemia. Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2015.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Futema M, Whittall R, Wood G, Curtis M, McEwan J, Humphries S. Identification of patients with familial hypercholesterolaemia (FH) through the application of genetic testing in young mi patients from the MINAP register. Atherosclerosis 2011. [DOI: 10.1016/j.atherosclerosis.2011.07.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Nihtyanova S, Ong V, Black C, Denton C, Lutalo P, Shattles W, Jones H, Nouri R, Hepburn A, Chard M, Horwood N, Lynn M, Duke O, Kiely P, Zouita L, Davies U, Hughes R, Lloyd M, Nikitorowicz Buniak J, Shiwen X, Abraham D, Denton C, Black C, Stratton R, Hugle T, Schuetz P, Daikeler T, Tyndall A, Matucci-Cerinic M, Walker UA, van Laar JM, Pauling JD, Flower V, McHugh N, Liu S, Leask A, Nikitorowicz Buniak J, Aden N, Denton C, Abraham D, Stratton R, Khan K, Hoyles R, Shiwen X, Ong V, Abraham D, Denton C, Bhagat S, Drummond T, Goh C, Busch R, Hall F, Meyer P, Moinzadeh P, Krieg T, Hellmich M, Brinckmann J, Neumann E, Mueller-Ladner U, Kreuter A, Dumitresco D, Rosenkranz S, Hunzelmann N, Binai N, Huegle T, van Laar J, Shiwen X, Sonnylal S, Tam A, Jones H, Stratton R, Leask A, Norman J, Denton C, de Crombrugghe B, Abraham D, Chighizola CB, Luigi Meroni P, Coghlan G, Denton C, Ong V, Newton F, Shiwen X, Denton C, Abraham D, Stratton R, Derrett-Smith EC, Dooley A, Baliga R, Hobbs A, MacAllister R, Abraham D, Denton C, Futema M, Pantelidis P, Renzoni E, Schreiber BE, Ong V, Coghlan GJ, Denton C, Wells AU, Welsh K, Abraham D, Fonseca C, Futema M, Ponticos M, Pantelidis P, Wells A, Denton C, Abraham D, Fonseca C, Denton C, Guillevin L, Krieg T, Schwierin B, Rosenberg D, Silkey M, Matucci-Cerinic M, Parapuram S, Shi-wen X, Denton C, Abraham D, Leask A, Nihtyanova S, Ahmed Abdi B, Khan K, Abraham D, Denton C, Khan K, Denton C, Xu S, Ong V. Scleroderma and related disorders: 223. Long Term Outcome in a Contemporary Systemic Sclerosis Cohort. Rheumatology (Oxford) 2011. [DOI: 10.1093/rheumatology/ker033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kihara T, Futema M, Watanabe M, Takahara K. [Case of contrast media regurgitated into the pancreatic duct and acini]. Rinsho Hoshasen 1966; 11:120-5. [PMID: 4959949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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