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Micaglio E, Tondi L, Benedetti S, Schiavo MA, Camporeale A, Disabato G, Attanasio A, Guida G, Carrafiello G, Piepoli M, Spagnolo P, Pappone C, Lombardi M. When Paying Attention Pays Back: Missense Mutation c.1006G>A p. (Val336Ile) in PRKAG2 Gene Causing Left Ventricular Hypertrophy and Conduction Abnormalities in a Caucasian Patient: Case Report and Literature Review. Int J Mol Sci 2024; 25:9171. [PMID: 39273120 PMCID: PMC11395525 DOI: 10.3390/ijms25179171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 08/20/2024] [Accepted: 08/21/2024] [Indexed: 09/15/2024] Open
Abstract
PRKAG2 cardiomyopathy is a rare genetic disorder that manifests early in life with an autosomal dominant inheritance pattern. It harbors left ventricular hypertrophy (LVH), ventricular pre-excitation and progressively worsening conduction system defects. Its estimated prevalence among patients with LVH ranges from 0.23 to about 1%, but it is likely an underdiagnosed condition. We report the association of the PRKAG2 missense variant c.1006G>A p. (Val336Ile) with LVH, conduction abnormalities (short PR interval and incomplete right bundle branch bock) and early-onset arterial hypertension (AH) in a 44-year-old Caucasian patient. While cardiac magnetic resonance (CMR) showed a mild hypertrophic phenotype with maximal wall thickness of 17 mm in absence of tissue alterations, the electric phenotype was relevant including brady-tachy syndrome and recurrent syncope. The same variant has been detected in the patient's sister and daughter, with LVH + early-onset AH and electrocardiographic (ECG) alterations + lipothymic episodes, respectively. Paying close attention to the coexistence of LVH and ECG alterations in the proband has been helpful in directing genetic tests to exclude primary cardiomyopathy. Hence, identifying the genetic basis in the patient allowed for familial screening as well as a proper follow-up and therapeutic management of the affected members. A review of the PRKAG2 cardiomyopathy literature is provided alongside the case report.
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Affiliation(s)
- Emanuele Micaglio
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
- Institute for Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
| | - Lara Tondi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy
| | - Sara Benedetti
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
- Institute for Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
| | - Maria Alessandra Schiavo
- Cardiology Unit IRCCS Azienda, Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine University of Bologna, 40138 Bologna, Italy
| | - Antonia Camporeale
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy
| | - Giandomenico Disabato
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
- Clinical Cardiology, IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
| | - Andrea Attanasio
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
- Clinical Cardiology, IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
| | - Gianluigi Guida
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
- Clinical Cardiology, IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
| | - Gianpaolo Carrafiello
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Massimo Piepoli
- Clinical Cardiology, IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Pietro Spagnolo
- Unit of Radiology, IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
| | - Carlo Pappone
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
- Department of Cardiology, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Massimo Lombardi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, Piazza E. Malan, San Donato Milanese, 20097 Milan, Italy
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Potter AS, Miyake CY, Gonzaga-Jauregui C, Aguilar-Sanchez Y, Hulsurkar MM, Lahiri SK, Moreira LM, Mehta N, Azamian MS, Lupski JR, Reilly S, Lalani SR, Wehrens XHT. Rare Variant in MRC2 Associated With Familial Supraventricular Tachycardia and Wolff-Parkinson-White Syndrome. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2024; 17:e004614. [PMID: 38953222 PMCID: PMC11335451 DOI: 10.1161/circgen.124.004614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/11/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Accessory pathways are a common cause of supraventricular tachycardia (SVT) and can lead to sudden cardiac death in otherwise healthy children and adults when associated with Wolff-Parkinson-White syndrome. The goal of this study was to identify genetic variants within a large family with structurally normal hearts affected by SVT and Wolff-Parkinson-White syndrome and determine causality of the gene deficit in a corresponding mouse model. METHODS Whole exome sequencing performed on 2 distant members of a 3-generation family in which multiple members were affected by SVT or Wolff-Parkinson-White pattern (preexcitation) on ECG identified MRC2 as a candidate gene. Serial electrocardiograms, intracardiac electrophysiology studies, echocardiography, optical mapping studies, and histology were performed on both Mrc2 mutant and WT (wild-type) mice. RESULTS A rare HET (heterozygous) missense variant c.2969A>G;p.Glu990Gly (E990G) in MRC2 was identified as the leading candidate gene variant segregating with the cardiac phenotype following an autosomal-dominant Mendelian trait segregation pattern with variable expressivity. In vivo electrophysiology studies revealed reentrant SVT in E990G mice. Optical mapping studies in E990G mice demonstrated abnormal retrograde conduction, suggesting the presence of an accessory pathway. Histological analysis of E990G mouse hearts showed a disordered ECM (extracellular matrix) in the annulus fibrosus. Finally, Mrc2 knockdown in human cardiac fibroblasts enhanced accelerated cell migration. CONCLUSIONS This study identified a rare nonsynonymous variant in the MRC2 gene in individuals with familial reentrant SVT, Wolff-Parkinson-White ECG pattern, and structurally normal hearts. Furthermore, Mrc2 knock-in mice revealed an increased incidence of reentrant SVT and bypass tract formation in the setting of preserved cardiac structure and function.
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Affiliation(s)
- Adam S Potter
- The Ohio State University Wexner Medical Center, Davis Heart and Lung Research Institute, Columbus, OH (A.S.P.)
- Cardiovascular Research Institute (A.S.P., C.Y.M., Y.A.-S., M.M.H., S.K.L., X.H.T.W.)
- Division of Cardiology, University of Texas Medical Branch, Galveston (A.S.P.)
| | - Christina Y Miyake
- Cardiovascular Research Institute (A.S.P., C.Y.M., Y.A.-S., M.M.H., S.K.L., X.H.T.W.)
- Department of Integrative Physiology (C.Y.M., Y.A.-S., M.M.H., S.K.L., X.H.T.W.)
- Department of Pediatrics, Section of Pediatric Cardiology, Texas Children's Hospital, Houston (C.Y.M., M.S.A., X.H.T.W.)
| | - Claudia Gonzaga-Jauregui
- Department of Molecular and Human Genetics (C.G.-J., J.R.L., S.R.L.)
- International Laboratory for Human Genome Research, Laboratorio Internacional de Investigación sobre el Genoma Humano, Universidad Nacional Autónoma de México, Juriquilla, Querétaro (C.G.-J.)
| | - Yuriana Aguilar-Sanchez
- Cardiovascular Research Institute (A.S.P., C.Y.M., Y.A.-S., M.M.H., S.K.L., X.H.T.W.)
- Department of Integrative Physiology (C.Y.M., Y.A.-S., M.M.H., S.K.L., X.H.T.W.)
| | - Mohit M Hulsurkar
- Cardiovascular Research Institute (A.S.P., C.Y.M., Y.A.-S., M.M.H., S.K.L., X.H.T.W.)
- Department of Integrative Physiology (C.Y.M., Y.A.-S., M.M.H., S.K.L., X.H.T.W.)
| | - Satadru K Lahiri
- Cardiovascular Research Institute (A.S.P., C.Y.M., Y.A.-S., M.M.H., S.K.L., X.H.T.W.)
- Department of Integrative Physiology (C.Y.M., Y.A.-S., M.M.H., S.K.L., X.H.T.W.)
| | - Lucia M Moreira
- University of Oxford, Cardiovascular Medicine, Radcliffe Department of Medicine, United Kingdom (L.M.M., N.M., S.R.)
| | - Neelam Mehta
- University of Oxford, Cardiovascular Medicine, Radcliffe Department of Medicine, United Kingdom (L.M.M., N.M., S.R.)
| | - Mahshid S Azamian
- Department of Pediatrics, Section of Pediatric Cardiology, Texas Children's Hospital, Houston (C.Y.M., M.S.A., X.H.T.W.)
| | - James R Lupski
- Department of Molecular and Human Genetics (C.G.-J., J.R.L., S.R.L.)
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX (J.R.L.)
- Texas Children's Hospital, Houston (J.R.L., S.R.L.)
| | - Svetlana Reilly
- University of Oxford, Cardiovascular Medicine, Radcliffe Department of Medicine, United Kingdom (L.M.M., N.M., S.R.)
| | - Seema R Lalani
- Department of Molecular and Human Genetics (C.G.-J., J.R.L., S.R.L.)
- Texas Children's Hospital, Houston (J.R.L., S.R.L.)
| | - Xander H T Wehrens
- Cardiovascular Research Institute (A.S.P., C.Y.M., Y.A.-S., M.M.H., S.K.L., X.H.T.W.)
- Department of Integrative Physiology (C.Y.M., Y.A.-S., M.M.H., S.K.L., X.H.T.W.)
- Department of Pediatrics, Section of Pediatric Cardiology, Texas Children's Hospital, Houston (C.Y.M., M.S.A., X.H.T.W.)
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Jadczak EA, Jnah AJ. Wolff-Parkinson-White Syndrome in the Preterm Neonate. Neonatal Netw 2024; 43:212-223. [PMID: 39164096 DOI: 10.1891/nn-2023-0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2024]
Abstract
Wolff-Parkinson-White (WPW) syndrome is a rare cardiac condition arising from abnormal embryologic development of the annulus fibrosus in combination with the cardiac conduction system. The abnormality results in the development of accessory pathways and preexcitation changes which can provoke episodes of tachyarrhythmias. The most common presentation of WPW syndrome is supraventricular tachycardia. Beyond customary abortive therapy, chronic management strategies vary based upon timing and clinical severity of the initial disease presentation. Prompt diagnosis and rate control have a dramatic impact on the outcomes of morbidity and mortality. The purpose of this article is to present a case study of a preterm infant who manifested with WPW syndrome. Additionally, the article will explore the pathophysiology of WPW syndrome and the timing and presentation of common clinical manifestations of the disease, along with current diagnostic and treatment strategies to achieve optimal patient outcomes in the neonatal population.
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van der Steld LDP, Rocha MDS, Ladeia AMT, Livramento HL, Campos GB, Darrieux FCDC, Campuzano O, Brugada R. PRKAG2 syndrome, a rare hypertrophic cardiomyopathy: a Brazilian long-term follow-up with extracardiac disorders. EINSTEIN-SAO PAULO 2024; 22:eAO0549. [PMID: 39082507 PMCID: PMC11239200 DOI: 10.31744/einstein_journal/2024ao0549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/22/2023] [Indexed: 08/03/2024] Open
Abstract
OBJECTIVE This study aimed to provide a long-term follow-up of PRKAG2 syndrome and describe the new phenotypic aspects of the condition. PRKAG2 syndrome is a rare autosomal-dominant glycogen storage disease characterized by cardiac hypertrophy, ventricular pre-excitation, and conduction system disease. Fatal arrhythmias occur frequently. METHODS A family cohort of 66 participants was recruited. Clinical and genetic analyses were performed. RESULTS Median age of 36.97±17.28 years, with 69.9% being men. Nineteen subjects carried the deleterious variant p.K290I of the PRKAG2 gene. This group experienced many malignant events, including eight pacemaker implants, three sudden cardiac deaths, five aborted cardiac arrests, four strokes, four premature neonatal deaths, two spontaneous abortions, five forceps deliveries, and 12 cesarean procedures. Extracardiac involvement, such as in neurocognitive and psychiatric disorders, has been observed only in carriers of mutations. Palpitations, Syncope, atrial fibrillation, atrial flutter, sinus pauses, and bradycardia were strongly and significantly associated with major or severe adverse events (sudden cardiac death, aborted cardiac arrest, pacemaker use, stroke, and congestive heart failure). Early diagnosis and intervention through antiarrhythmic drugs, anticoagulation, pacemaker implantation, radiofrequency catheter ablation, and cesarean section surgery improved the symptoms and survival rates. Mutations carriers were advised to avoid pregnancy. CONCLUSION This study identified that the p.K291I_PRKAG2 mutation is associated with poor prognosis, highlighting the need for early intervention. Further research may uncover the potential connections between intellectual disability, miscarriage, and neonatal death in individuals with this syndrome.
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Affiliation(s)
- Lenises de Paula van der Steld
- Escola Bahiana de Medicina e Saúde PúblicaSalvadorBABrazilEscola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil.
| | - Mario de Seixas Rocha
- Escola Bahiana de Medicina e Saúde PúblicaSalvadorBABrazilEscola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil.
| | - Ana Marice Teixeira Ladeia
- Escola Bahiana de Medicina e Saúde PúblicaSalvadorBABrazilEscola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil.
| | - Humberto Lago Livramento
- Universidade Federal da BahiaSalvadorBABrazil Universidade Federal da Bahia, Salvador, BA, Brazil.
| | - Gervásio Batista Campos
- Universidade Federal da BahiaSalvadorBABrazil Universidade Federal da Bahia, Salvador, BA, Brazil.
| | - Francisco Carlos da Costa Darrieux
- Instituto do CoraçãoFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrazil Instituto do Coração (InCor), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Oscar Campuzano
- Medical Science DepartmentSchool of MedicineUniversity of GironaGironaSpain Medical Science Department, School of Medicine, University of Girona, Girona, Spain.
- Cardiovascular Genetics CenterUniversity of GironaGironaSpain Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain.
- Centro de Investigación Biomédica en Red-Enfermedades CardiovascularesMadridSpain Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares, Madrid, Spain.
| | - Ramon Brugada
- Medical Science DepartmentSchool of MedicineUniversity of GironaGironaSpain Medical Science Department, School of Medicine, University of Girona, Girona, Spain.
- Cardiovascular Genetics CenterUniversity of GironaGironaSpain Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain.
- Centro de Investigación Biomédica en Red-Enfermedades CardiovascularesMadridSpain Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares, Madrid, Spain.
- Hospital Josep TruetaUniversity of GironaGironaSpain Cardiology Service, Hospital Josep Trueta, University of Girona, Girona, Spain.
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Karadeniz C, Yıldız K, Öksüz S, Keçici RN, Çoğulu Ö. A case of Williams syndrome with Wolff-Parkinson-White syndrome. Birth Defects Res 2024; 116:e2385. [PMID: 39023193 DOI: 10.1002/bdr2.2385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 06/06/2024] [Accepted: 06/24/2024] [Indexed: 07/20/2024]
Abstract
INTRODUCTION Williams syndrome (WS) cases have been reported to have with 25-100 times greater increased risk of sudden cardiac death (SCD). SCD has been reported in cases without any evidence of structural cardiovascular anomalies. Wolff-Parkinson-White (WPW) syndrome is characterized by short PR interval and delta wave. Ventricular preexcitations can develop paroxysmal reentrant tachycardia through Kent bundle or less frequent atrial fibrillation and in some cases with accessory pathway effective refractory period (APERP) under 250 ms considered as risky and may lead to SCD. WS associated with WPW has not been reported before. CASE REPORT An 11-year-old male who had been followed up with WS was referred to pediatric cardiology outpatient clinic with the complaint of palpitation. Electrocardiographic examination showed short PR interval and delta wave in the ECG consistent with WPW. He underwent electrophysiological study (EPS). Basic measurements were performed, and APERP was found at 280 ms cycle atrial pacing. RF energy was delivered using a 4 mm tip nonirrigated radiofrequency (RF) ablation catheter where the best ventriculoatrial (VA) signals were received and the AP was abolished within few seconds. DISCUSSION AND CONCLUSIONS Although, WPW cases are usually asymptomatic or related to SVT, the risk of SCD should not be ignored. Thus, all patients with WPW deserve an EPS for assessing the AP conduction properties. Due to the increased risk of SCD in patients with WS compared to general population, in the presence of concomitant WPW, these patients should be evaluated with EPS even if they do not have symptoms.
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Affiliation(s)
- Cem Karadeniz
- School of Medicine, Department of Pediatric Cardiology, Division of Pediatric Arrhythmia & Electrophysiology, Katip Celebi University, Izmir, Turkey
| | - Kaan Yıldız
- Department of Pediatric Cardiology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Sedef Öksüz
- Department of Pediatric Cardiology, Tepecik Training and Research Hospital, Izmir, Turkey
| | | | - Özgür Çoğulu
- Department of Pediatric Genetics, Ege University School of Medicine, Izmir, Turkey
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Dai M, Chen Y, Qin J. Atrioventricular re-entrant tachycardia and atrioventricular node re-entrant tachycardia in a patient with cancer under chemotherapy: a case report and literature review. Front Cardiovasc Med 2024; 11:1367893. [PMID: 38911514 PMCID: PMC11190324 DOI: 10.3389/fcvm.2024.1367893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/21/2024] [Indexed: 06/25/2024] Open
Abstract
Cardio-oncology is a new field of interest in cardiology focusing on the detection and treatment of cardiovascular diseases, such as arrhythmias, myocarditis, and heart failure, as side-effects of chemotherapy and radiotherapy. The association between chemotherapeutic agents and arrhythmias has previously been established. Atrial tachyarrhythmias, particularly atrial fibrillation, are most common, but ventricular arrhythmias, including those related to treatment-induced QT prolongation, and bradyarrhythmias can also occur. However, the association between chemotherapeutic agents and atrioventricular re-entrant tachycardia (AVRT)/atrioventricular node re-entrant tachycardia (AVNRT) remains poorly understood. Here, we report a patient with new-onset AVRT/AVNRT and lung cancer who underwent chemotherapy. We considered that chemotherapy or cancer itself may have been a trigger for the initiation of paroxysmal AVRT/AVNRT, and that radiofrequency catheter ablation was effective in treating this type of tachycardia. Here, possible mechanisms and potential genes (mostly ion channels) involved in AVRT/AVNRT are summarized and the mechanisms underlying the possible regulatory patterns of cancer cells and chemotherapy on ion channels are reviewed. Finally, we considered that ion channel abnormalities may link cancer or chemotherapy to the onset of AVRT/AVNRT. The aim of the present study was to highlight the association between chemotherapeutic agents and AVRT/AVNRT and to provide new insights for future research. Understanding the intermediate mechanisms between chemotherapeutic agents and AVRT/AVNRT may be beneficial in preventing chemotherapy-evoked AVRT/AVNRT (and/or other arrhythmias) in future.
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Affiliation(s)
- Meiyan Dai
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yue Chen
- Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jin Qin
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Paludan-Müller C, Stampe NK, Vad OB, Andreasen L, Torp-Pedersen C, Køber L, Fosbøl EL, Olesen MS, Svendsen JH. Accessory Pathway Treated With Catheter Ablation Is Associated With Cardiomyopathy, Heart Failure, and Mortality. JACC Clin Electrophysiol 2024; 10:973-975. [PMID: 38520436 DOI: 10.1016/j.jacep.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/16/2024] [Accepted: 02/07/2024] [Indexed: 03/25/2024]
Affiliation(s)
| | - Niels K Stampe
- Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Oliver B Vad
- Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; University of Copenhagen, Copenhagen, Denmark
| | - Laura Andreasen
- Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- University of Copenhagen, Copenhagen, Denmark; Copenhagen University Hospital-North Zealand Hospital, Hillerød, Denmark
| | - Lars Køber
- Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; University of Copenhagen, Copenhagen, Denmark
| | - Emil L Fosbøl
- Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Morten S Olesen
- Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; University of Copenhagen, Copenhagen, Denmark
| | - Jesper H Svendsen
- Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; University of Copenhagen, Copenhagen, Denmark
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Grochowski CM, Gibbs RA, Doddapaneni H. Validation of Single-Nucleotide Mosaic Variants Through Droplet Digital PCR. Curr Protoc 2024; 4:e1041. [PMID: 38774978 PMCID: PMC11115377 DOI: 10.1002/cpz1.1041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
The detection, validation, and subsequent interpretation of potentially mosaic single-nucleotide variants (SNV) within next-generation sequencing data remains a challenge in both research and clinical laboratory settings. The ability to identify mosaic variants in high genome coverage sequencing data at levels of ≤1% underscores the necessity for developing guidelines and best practices to verify these variants orthogonally. Droplet digital PCR (ddPCR) has proven to be a powerful and precise method that allows for the determination of low-level variant fractions within a given sample. Herein we describe two precise ddPCR methods using either a fluorescent TaqMan hydrolysis probe approach or an EvaGreen fluorescent dye protocol. The TaqMan approach relies on two different fluorescent probes (FAM and HEX/VIC), each designed to amplify selectively only in the presence of a single nucleotide change denoting the variant or reference position. The fractional abundance is then calculated to determine the relative quantities of both alleles in the final sample. The EvaGreen protocol relies on two independent reactions with oligonucleotide primers designed with the single nucleotide change denoting the variant at the penultimate position of the primer. The relative amplification efficiency of both primer sets (reference and variant) can be compared to determine the mosaic level of a given variant. As the cost of high-coverage sequencing continues to decrease, the identification of potentially mosaic variants will also increase. The approaches outlined will allow clinicians and researchers a more precise determination of the true mosaic level of a given variant allowing them to better assess not only its potential pathogenicity but also its possible recurrence risk when offering genetic counseling to families. © 2024 Wiley Periodicals LLC. Basic Protocol: Droplet digital PCR (ddPCR) with TaqMan hydrolysis probes Alternate Protocol: EvaGreen oligonucleotide-specific ddPCR.
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Affiliation(s)
| | - Richard A. Gibbs
- Human Genome Sequencing Center, Baylor College of Medicine,
Houston, TX 77030, USA
- Department of Molecular and Human Genetics, Baylor College
of Medicine, Houston, TX 77030, USA
| | - Harsha Doddapaneni
- Human Genome Sequencing Center, Baylor College of Medicine,
Houston, TX 77030, USA
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9
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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] [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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10
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Vătășescu RG, Paja CS, Șuș I, Cainap S, Moisa ȘM, Cinteză EE. Wolf-Parkinson-White Syndrome: Diagnosis, Risk Assessment, and Therapy-An Update. Diagnostics (Basel) 2024; 14:296. [PMID: 38337810 PMCID: PMC10855590 DOI: 10.3390/diagnostics14030296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Wolf-Parkinson-White (WPW) syndrome is a disorder characterized by the presence of at least one accessory pathway (AP) that can predispose people to atrial/ventricular tachyarrhythmias and even sudden cardiac death. It is the second most common cause of paroxysmal supraventricular tachycardia in most parts of the world, affecting about 0.1-0.3% of the general population. Most patients with WPW syndrome have normal anatomy, but it may be associated with concomitant congenital heart disease or systemic diseases. Although many individuals are asymptomatic, during supraventricular arrhythmia episodes, they may experience severe symptoms, including syncope or even sudden cardiac death (mainly due to pre-excited atrial fibrillation over rapidly conducting AP). In addition to arrhythmia-related symptoms, for some specific locations of the APs with overt anterograde conduction, there might be a reduction in exercise capacity mediated by a reduction in LV systolic performance due to anomalous LV depolarization. Although it is typically diagnosed through electrocardiography (ECG), additional tests are necessary for risk assessment. Management of WPW syndrome may be quite challenging and can vary from only acknowledging the presence of the accessory pathway to pharmacological treatment or radiofrequency ablation. Early diagnosis, risk assessment, and appropriate treatment are critical steps in the management of WPW syndrome, aiming to improve the quality of life and reduce the risk of life-threatening arrhythmias.
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Affiliation(s)
- Radu Gabriel Vătășescu
- Cardiology Department, Clinic Emergency Hospital, 014461 Bucharest, Romania;
- 4th Department—Cardio-Thoracic Pathology, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania;
| | | | - Ioana Șuș
- Emergency Institute for Cardiovascular Disease and Transplantation, 540136 Tirgu Mures, Romania;
| | - Simona Cainap
- 8th Department—“Mother and Child”, University of Medicine and Pharmacy “Iuliu Hațieganu”, 400012 Cluj-Napoca, Romania;
- 2nd Pediatric Department, Clinical Children Hospital, 400177 Cluj-Napoca, Romania
| | - Ștefana María Moisa
- Department of Pediatrics, Faculty of Medicine, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- “Sfanta Maria” Clinical Emergency Hospital for Children, 700309 Iasi, Romania
| | - Eliza Elena Cinteză
- 4th Department—Cardio-Thoracic Pathology, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania;
- Interventional Cardiology Compartment, Marie Sklodowska Curie Children Emergency Hospital, 077120 Bucharest, Romania
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11
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Marzak H, Fitouchi S, Cardi T, Kanso M, Schatz A, Jesel L. Accessory pathways in monozygotic twins with different clinical phenotypes: a case report. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2023. [DOI: 10.1186/s42444-023-00091-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Abstract
Background
The atrioventricular reentrant tachycardia (AVRT) is the most common tachycardia associated with accessory pathways (APs). Although sporadic Wolff-Parkinson-White (WPW) syndrome has been well-described, AP occurrence in identical twins with WPW syndrome remains rarely reported.
Case presentation
We report a case of 14-year-old monozygotic twin brothers referred for an electrophysiology (EP) study. Twin A presented with recurrent symptomatic narrow complex tachycardia after exercise, noted for 3 years. His 12-lead surface electrocardiogram (ECG) did not show ventricular pre-excitation. However, an orthodromic AVRT utilizing a concealed right posteroseptal AP was found and successfully ablated. AVRT did not recur 12 months after the procedure. Twin B was asymptomatic. During his medical examination for firefighter volunteerism, his 12-lead ECG showed a spontaneous ventricular pre-excitation. EP study revealed a short anterograde right midseptal AP, which was then successfully eliminated by catheter ablation. His 12-lead ECG showed no ventricular pre-excitation recurrence 12 months after the procedure.
Conclusions
These identical twin brothers had a right-side AP in almost the same place but showed completely different phenotypes. This case clearly illustrates the difficulty in understanding genetic contribution in the origin of atrioventricular APs. Environmental exposure could play a role in their clinical presentations and AP electrophysiological properties.
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12
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York NS, Sanchez-Arias JC, McAdam ACH, Rivera JE, Arbour LT, Swayne LA. Mechanisms underlying the role of ankyrin-B in cardiac and neurological health and disease. Front Cardiovasc Med 2022; 9:964675. [PMID: 35990955 PMCID: PMC9386378 DOI: 10.3389/fcvm.2022.964675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
The ANK2 gene encodes for ankyrin-B (ANKB), one of 3 members of the ankyrin family of proteins, whose name is derived from the Greek word for anchor. ANKB was originally identified in the brain (B denotes “brain”) but has become most widely known for its role in cardiomyocytes as a scaffolding protein for ion channels and transporters, as well as an interacting protein for structural and signaling proteins. Certain loss-of-function ANK2 variants are associated with a primarily cardiac-presenting autosomal-dominant condition with incomplete penetrance and variable expressivity characterized by a predisposition to supraventricular and ventricular arrhythmias, arrhythmogenic cardiomyopathy, congenital and adult-onset structural heart disease, and sudden death. Another independent group of ANK2 variants are associated with increased risk for distinct neurological phenotypes, including epilepsy and autism spectrum disorders. The mechanisms underlying ANKB's roles in cells in health and disease are not fully understood; however, several clues from a range of molecular and cell biological studies have emerged. Notably, ANKB exhibits several isoforms that have different cell-type–, tissue–, and developmental stage– expression profiles. Given the conservation within ankyrins across evolution, model organism studies have enabled the discovery of several ankyrin roles that could shed important light on ANKB protein-protein interactions in heart and brain cells related to the regulation of cellular polarity, organization, calcium homeostasis, and glucose and fat metabolism. Along with this accumulation of evidence suggesting a diversity of important ANKB cellular functions, there is an on-going debate on the role of ANKB in disease. We currently have limited understanding of how these cellular functions link to disease risk. To this end, this review will examine evidence for the cellular roles of ANKB and the potential contribution of ANKB functional variants to disease risk and presentation. This contribution will highlight the impact of ANKB dysfunction on cardiac and neuronal cells and the significance of understanding the role of ANKB variants in disease.
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Affiliation(s)
- Nicole S. York
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | | | - Alexa C. H. McAdam
- Department of Medical Genetics, University of British Columbia, Victoria, BC, Canada
| | - Joel E. Rivera
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Laura T. Arbour
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
- Department of Medical Genetics, University of British Columbia, Victoria, BC, Canada
- *Correspondence: Laura T. Arbour
| | - Leigh Anne Swayne
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
- Department of Cellular and Physiological Sciences and Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Leigh Anne Swayne
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Gong X, Yu P, Wu T, He Y, Zhou K, Hua Y, Lin S, Wang T, Huang H, Li Y. Controversial molecular functions of CBS versus non-CBS domain variants of PRKAG2 in arrhythmia and cardiomyopathy: A case report and literature review. Mol Genet Genomic Med 2022; 10:e1962. [PMID: 35588295 PMCID: PMC9266596 DOI: 10.1002/mgg3.1962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/01/2022] [Accepted: 04/18/2022] [Indexed: 02/05/2023] Open
Abstract
Background PRKAG2 cardiac syndrome is a rare autosomal dominant genetic disorder caused by a PRKAG2 gene variant. There are several major adverse cardiac presentations, including hypertrophic cardiomyopathy (HCM) and life‐threatening arrhythmia. Two cases with pathogenic variants in the PRKAG2 gene are reported here who presents different cardiac phenotypes. Methods Exome sequencing and variant analysis of PRKAG2 were performed to obtain genetic data, and clinical characteristics were determined. Results The first proband was a 9‐month‐old female infant (Case 1), and was identified with severe DCM and resistant heart failure. The second proband was a 10‐year‐old female infant (Case 2), and presented with HCM and ventricular preexcitation. Exome sequencing identified a de novo c.425C > T (p.T142I) heterozygous variant in the PRKAG2 gene for Case 1, and a c.869A > T (p.K290I) for Case 2. The mutated sites in the protein were labeled and identified as p.K290 in the CBS domain and p.T142 in the non‐CBS domain. Differences in the molecular functions of CBS and non‐CBS domains have not been resolved, and variants might lead to the different cardiomyopathy phenotypes. Single‐cell RNA analysis demonstrated similar expression levels of PRKAG2 in cardiomyocytes and conductive tissues. These results suggest that the arrhythmia induced by the PRKAG2 variant was the primary change, and not secondary to cardiomyopathy. Conclusion In summary, this is the first case report to describe a DCM phenotype with early onset in patients possessing a PRKAG2 c.425C > T (p.T142I) pathogenic variant. Our results aid in understanding the molecular function of non‐CBS variants in terms of the disordered sequence of transcripts. Moreover, we used scRNA‐seq to show that electrically conductive cells express a higher level of PRKAG2 than do cardiomyocytes. Therefore, variants in PRKAG2 are expected to also alter the biological function of the conduction system.
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Affiliation(s)
- Xue Gong
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Peiyu Yu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.,Department of Pediatrics, Chengdu Shangjin Nanfu Hospital, Chengdu, China
| | - Ting Wu
- Department of Ultrasonic Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yunru He
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Kaiyu Zhou
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yimin Hua
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Sha Lin
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Tao Wang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - He Huang
- Department of Echocardiography, West China Hospital, Sichuan University, Chengdu, China
| | - Yifei Li
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
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14
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Franciosi S, Abrams DJ, Ingles J, Sanatani S. Sudden Cardiac Arrest in the Paediatric Population. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2022; 1:45-59. [PMID: 37969243 PMCID: PMC10642157 DOI: 10.1016/j.cjcpc.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/03/2022] [Indexed: 11/17/2023]
Abstract
Sudden cardiac arrest in the young is a rare event with a range of potential causes including cardiomyopathies, ion channelopathies, and autonomic nervous system dysfunction. Investigations into the cause involve a multidisciplinary team, including cardiologists, geneticists, and psychologists. In addition to a detailed medical history, family history and circumstances surrounding the event are important in determining the cause. Clinical investigations including an electrocardiogram are fundamental in diagnosis and should be interpreted cautiously because some children may have atypical presentations and an evolving phenotype. The potential for misdiagnosis exists that could lead to incorrect long-term management strategies. If an inherited condition is suspected, genetic testing of the patient and cascade screening of family members is recommended with genetic counselling and psychological support. Medical management is left to the treating physician acknowledging that a clear diagnosis cannot be made in approximately half of cases. Secondary prevention implantable defibrillators are widely deployed but can be associated with complications in young patients. A plan for safe return to activity is recommended along with a proper transition of care into adulthood. Broad screening of the general population for arrhythmia syndromes is not recommended; preventative measures include screening paediatric patients for risk factors by their primary care physician. Several milestone events or activities that take place in youth could be used as opportunities to promote safety. Further work into risk stratification of this paediatric population through patient registries and greater awareness of cardiopulmonary resuscitation and automated external defibrillator use in saving lives is warranted.
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Affiliation(s)
- Sonia Franciosi
- BC Children’s Hospital Heart Centre, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dominic J. Abrams
- Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jodie Ingles
- Centre for Population Genomics, Garvan Institute of Medical Research, and UNSW Sydney, Sydney, New South Wales, Australia
- Centre for Population Genomics, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Shubhayan Sanatani
- BC Children’s Hospital Heart Centre, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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15
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Vilca Velazco MF, Lavado García L, Torres Ramos G, López Ramos RP. Pulp chamber opening alternative in pulpectomies in a child with Wolff-Parkinson-White syndrome. A case report. SPECIAL CARE IN DENTISTRY 2021; 42:294-298. [PMID: 34644402 DOI: 10.1111/scd.12666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/25/2021] [Accepted: 09/29/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Wolff-Parkinson-White syndrome is a congenital abnormality of the heart. Patients with this syndrome and multiple dental caries with pulp exposure may require comprehensive dental treatment under general anesthesia. Pulpectomy is performed in primary teeth with pulp expose. This treatment in anterior teeth requires palatal access and the majority there is no good visibility, requiring more time to perform. Therefore, this case aimed to demonstrate a pulp chamber opening alternative in pulpectomies in a child with Wolff-Parkinson-White syndrome. CASE PRESENTATION A 3-year-old female patient with Wolff-Parkinson-White syndrome and multiple dental caries with reversible pulpitis in anterior upper teeth. The dental treatment was performed under general anesthesia. Due to abundant hemorrhage in anterior upper teeth, pulpectomies were performed, which pulp chamber openings were modified by labial and the treatment itself was completed. After, these teeth were rehabilitated with direct restorative veneers using light-curing composite resin. The follow-up at 12 months showed an absence of evidence clinic and radiographic. CONCLUSION This case demonstrated the pulp chamber opening performed by labial in pulpectomy is an effective and viable alternative to reduce operative time and improve visibility in pulpotomies in a child with Wolff-Parkinson-White syndrome.
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Affiliation(s)
| | - Lenny Lavado García
- Faculty of Dentistry, Universidad Nacional Mayor de San Marcos, Lima, Peru and Dentistry Department, Instituto Nacional de Salud del Niño, Lima, Peru
| | - Gilmer Torres Ramos
- Director of Postgraduate Unit of Dentistry, Faculty of Dentistry, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Roxana Patricia López Ramos
- PhD(c) Epidemiology Research, Faculty of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
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Abu Nahia K, Migdał M, Quinn TA, Poon KL, Łapiński M, Sulej A, Liu J, Mondal SS, Pawlak M, Bugajski Ł, Piwocka K, Brand T, Kohl P, Korzh V, Winata C. Genomic and physiological analyses of the zebrafish atrioventricular canal reveal molecular building blocks of the secondary pacemaker region. Cell Mol Life Sci 2021; 78:6669-6687. [PMID: 34557935 PMCID: PMC8558220 DOI: 10.1007/s00018-021-03939-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/06/2021] [Accepted: 09/10/2021] [Indexed: 01/06/2023]
Abstract
The atrioventricular canal (AVC) is the site where key structures responsible for functional division between heart regions are established, most importantly, the atrioventricular (AV) conduction system and cardiac valves. To elucidate the mechanism underlying AVC development and function, we utilized transgenic zebrafish line sqet31Et expressing EGFP in the AVC to isolate this cell population and profile its transcriptome at 48 and 72 hpf. The zebrafish AVC transcriptome exhibits hallmarks of mammalian AV node, including the expression of genes implicated in its development and those encoding connexins forming low conductance gap junctions. Transcriptome analysis uncovered protein-coding and noncoding transcripts enriched in AVC, which have not been previously associated with this structure, as well as dynamic expression of epithelial-to-mesenchymal transition markers and components of TGF-β, Notch, and Wnt signaling pathways likely reflecting ongoing AVC and valve development. Using transgenic line Tg(myl7:mermaid) encoding voltage-sensitive fluorescent protein, we show that abolishing the pacemaker-containing sinoatrial ring (SAR) through Isl1 loss of function resulted in spontaneous activation in the AVC region, suggesting that it possesses inherent automaticity although insufficient to replace the SAR. The SAR and AVC transcriptomes express partially overlapping species of ion channels and gap junction proteins, reflecting their distinct roles. Besides identifying conserved aspects between zebrafish and mammalian conduction systems, our results established molecular hallmarks of the developing AVC which underlies its role in structural and electrophysiological separation between heart chambers. This data constitutes a valuable resource for studying AVC development and function, and identification of novel candidate genes implicated in these processes.
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Affiliation(s)
- Karim Abu Nahia
- International Institute of Molecular and Cell Biology in Warsaw, Warsaw, Poland
| | - Maciej Migdał
- International Institute of Molecular and Cell Biology in Warsaw, Warsaw, Poland
| | - T Alexander Quinn
- Department of Physiology and Biophysics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kar-Lai Poon
- Institute of Molecular and Cell Biology, 61 Biopolis Dr, Singapore , Singapore.,Developmental Dynamics, National Heart and Lung Institute, Imperial College London, London, UK
| | - Maciej Łapiński
- International Institute of Molecular and Cell Biology in Warsaw, Warsaw, Poland
| | - Agata Sulej
- International Institute of Molecular and Cell Biology in Warsaw, Warsaw, Poland
| | - Jiandong Liu
- McAllister Heart Institute, University of North Carolina, Chapel Hill, USA
| | - Shamba S Mondal
- International Institute of Molecular and Cell Biology in Warsaw, Warsaw, Poland
| | - Michał Pawlak
- International Institute of Molecular and Cell Biology in Warsaw, Warsaw, Poland
| | | | | | - Thomas Brand
- Developmental Dynamics, National Heart and Lung Institute, Imperial College London, London, UK
| | - Peter Kohl
- Institute for Experimental Cardiovascular Medicine, University Heart Centre, Faculty of Medicine, and Faculty of Engineering, University of Freiburg, Freiburg im Breisgau, Germany
| | - Vladimir Korzh
- International Institute of Molecular and Cell Biology in Warsaw, Warsaw, Poland.
| | - Cecilia Winata
- International Institute of Molecular and Cell Biology in Warsaw, Warsaw, Poland.
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Regulation of Cardiac Conduction and Arrhythmias by Ankyrin/Spectrin-Based Macromolecular Complexes. J Cardiovasc Dev Dis 2021; 8:jcdd8050048. [PMID: 33946725 PMCID: PMC8146975 DOI: 10.3390/jcdd8050048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 12/19/2022] Open
Abstract
The cardiac conduction system is an extended network of excitable tissue tasked with generation and propagation of electrical impulses to signal coordinated contraction of the heart. The fidelity of this system depends on the proper spatio-temporal regulation of ion channels in myocytes throughout the conduction system. Importantly, inherited or acquired defects in a wide class of ion channels has been linked to dysfunction at various stages of the conduction system resulting in life-threatening cardiac arrhythmia. There is growing appreciation of the role that adapter and cytoskeletal proteins play in organizing ion channel macromolecular complexes critical for proper function of the cardiac conduction system. In particular, members of the ankyrin and spectrin families have emerged as important nodes for normal expression and regulation of ion channels in myocytes throughout the conduction system. Human variants impacting ankyrin/spectrin function give rise to a broad constellation of cardiac arrhythmias. Furthermore, chronic neurohumoral and biomechanical stress promotes ankyrin/spectrin loss of function that likely contributes to conduction disturbances in the setting of acquired cardiac disease. Collectively, this review seeks to bring attention to the significance of these cytoskeletal players and emphasize the potential therapeutic role they represent in a myriad of cardiac disease states.
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