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Guo R, Du P, Pei Y, Yang J, Li S, Chang S, Sun H, He X, Dong J, Zhou J, Jing Z. Whole-Exome Sequencing Identified Genes Responsible for Thoracic Aortic Aneurysms and Dissections in three Chinese Families. Front Genet 2022; 13:910932. [PMID: 35754816 PMCID: PMC9215720 DOI: 10.3389/fgene.2022.910932] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/25/2022] [Indexed: 11/23/2022] Open
Abstract
Thoracic aortic aneurysms and dissections are precarious conditions that often cannot be diagnosed with fatal outcomes. Over the last few years, pathogenic variants in numerous genes have been identified that predispose to heritable presentations of TAAD. An evidence-based strategy for the selection of genes to test in familial TAAD helps inform family screening and intervention to prevent life-threatening events. Using whole-exome sequencing, four members of three unrelated families clinically diagnosed with TAAD were used to identify the genetic origin of the disorder. Variant evaluation was carried out to detect the pathogenic mutation. Our studies suggest that mutations of COL3A1 and ACTA2 are responsible for familial TAAD. In addition, we highlight FBLN5, FBN1, SLC2A10, FBN2, and NOTCH1 as candidate genes. Future studies of crosstalk among the pathways may provide us a step toward understanding the pathogenic mechanism. This finding indicates the necessity of obtaining family medical history and screening of extended relatives of patients with TAAD for the early identification and treatment of TAAD.
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Affiliation(s)
- Renle Guo
- Department of Vascular Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, China.,Department of Vascular Surgery, Taian Central Hospital, Taian, China
| | - Pengcheng Du
- Department of Vascular Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Yifei Pei
- Department of Vascular Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Jin Yang
- Department of Vascular Surgery, Suining Central Hostpital, Suining, China
| | - Shuangshuang Li
- Department of Vascular Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Sheng Chang
- Department of Vascular Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Huiying Sun
- Department of Vascular Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Xiaomin He
- Department of Vascular Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Jian Dong
- Department of Vascular Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, China.,Department of Vascular Surgery, Shanghai TCM-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, China
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Naval Military Medical University, Shanghai, China
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2
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Sharma P, Sonakar AK, Tyagi N, Suroliya V, Kumar M, Kutum R, Asokchandran V, Ambawat S, Shamim U, Anand A, Ahmad I, Shakya S, Uppili B, Mathur A, Parveen S, Jain S, Singh J, Seth M, Zahra S, Joshi A, Goel D, Sahni S, Kamai A, Wadhwa S, Murali A, Saifi S, Chowdhury D, Pandey S, Anand KS, Narasimhan RL, Laskar S, Kushwaha S, Kumar M, Shaji CV, Srivastava MVP, Srivastava AK, Faruq M. Genetics of Ataxias in Indian Population: A Collative Insight from a Common Genetic Screening Tool. ADVANCED GENETICS (HOBOKEN, N.J.) 2022; 3:2100078. [PMID: 36618024 PMCID: PMC9744545 DOI: 10.1002/ggn2.202100078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Indexed: 01/11/2023]
Abstract
Cerebellar ataxias (CAs) represent a group of autosomal dominant and recessive neurodegenerative disorders affecting cerebellum with or without spinal cord. Overall, CAs have preponderance for tandem nucleotide repeat expansions as an etiological factor (10 TREs explain nearly 30-40% of ataxia cohort globally). The experience of 10 years of common genetic ataxia subtypes for ≈5600 patients' referrals (Pan-India) received at a single center is shared herein. Frequencies (in %, n) of SCA types and FRDA in the sample cohort are observed as follows: SCA12 (8.6%, 490); SCA2 (8.5%, 482); SCA1 (4.8%, 272); SCA3 (2%, 113); SCA7 (0.5%, 28); SCA6 (0.1%, 05); SCA17 (0.1%, 05), and FRDA (2.2%, 127). A significant amount of variability in TRE lengths at each locus is observed, we noted presence of biallelic expansion, co-occurrence of SCA-subtypes, and the presence of premutable normal alleles. The frequency of mutated GAA-FRDA allele in healthy controls is 1/158 (0.63%), thus an expected FRDA prevalence of 1:100 000 persons. The data of this study are relevant not only for clinical decision making but also for guidance in direction of genetic investigations, transancestral comparison of genotypes, and lastly provide insight for policy decision for the consideration of SCAs under rare disease category.
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Affiliation(s)
- Pooja Sharma
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India,Academy for Scientific and Innovative ResearchGhaziabadUttar Pradesh201002India
| | | | - Nishu Tyagi
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India,Academy for Scientific and Innovative ResearchGhaziabadUttar Pradesh201002India
| | - Varun Suroliya
- Neurology DepartmentNeuroscience CentreNew Delhi110029India
| | - Manish Kumar
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India,Academy for Scientific and Innovative ResearchGhaziabadUttar Pradesh201002India
| | - Rintu Kutum
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India
| | - Vivekananda Asokchandran
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India,Academy for Scientific and Innovative ResearchGhaziabadUttar Pradesh201002India
| | - Sakshi Ambawat
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India
| | - Uzma Shamim
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India
| | - Avni Anand
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India
| | - Ishtaq Ahmad
- Neurology DepartmentNeuroscience CentreNew Delhi110029India
| | - Sunil Shakya
- Neurology DepartmentNeuroscience CentreNew Delhi110029India
| | - Bharathram Uppili
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India,Academy for Scientific and Innovative ResearchGhaziabadUttar Pradesh201002India
| | - Aradhana Mathur
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India
| | - Shaista Parveen
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India
| | - Shweta Jain
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India
| | - Jyotsna Singh
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India,Neurology DepartmentNeuroscience CentreNew Delhi110029India
| | - Malika Seth
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India
| | - Sana Zahra
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India,Academy for Scientific and Innovative ResearchGhaziabadUttar Pradesh201002India
| | - Aditi Joshi
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India
| | - Divya Goel
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India
| | - Shweta Sahni
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India
| | - Asangla Kamai
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India,Academy for Scientific and Innovative ResearchGhaziabadUttar Pradesh201002India
| | - Saruchi Wadhwa
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India,Academy for Scientific and Innovative ResearchGhaziabadUttar Pradesh201002India
| | - Aparna Murali
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India
| | - Sheeba Saifi
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India
| | | | - Sanjay Pandey
- Department of NeurologyGB Pant HospitalDelhi110002India
| | - Kuljeet Singh Anand
- Department of NeurologyPost Graduate Institute of Medical Education and ResearchDr. Ram Manohar Lohia HospitalNew Delhi110001India
| | | | | | - Suman Kushwaha
- Department of NeurologyInstitute of Human Behaviour and Allied SciencesDelhi110095India
| | | | | | | | | | - Mohammed Faruq
- Genomics and Molecular MedicineCSIR‐Institute of Genomics and Integrative Biology (CSIR‐IGIB)Mall RoadDelhi110007India,Academy for Scientific and Innovative ResearchGhaziabadUttar Pradesh201002India
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3
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Zhang K, Qi Y, Wang M, Chen Q. Long non-coding RNA HIF1A-AS2 modulates the proliferation, migration, and phenotypic switch of aortic smooth muscle cells in aortic dissection via sponging microRNA-33b. Bioengineered 2022; 13:6383-6395. [PMID: 35212609 PMCID: PMC8974049 DOI: 10.1080/21655979.2022.2041868] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aortic dissection (AD), also known as aortic dissecting aneurysm, is one of the most common and dangerous cardiovascular diseases with high morbidity and mortality. This study was aimed to investigate the functional role of long non-coding RNA Hypoxia-inducible factor 1 alpha-antisense RNA 2 (lncRNA HIF1A-AS2) in AD. An in vitro model of AD was established by platelet-derived growth factor-BB (PDGF-BB)-mediated human aortic Smooth Muscle Cells (SMCs). HIF1A-AS2 expression in human AD tissues was determined by quantitative real-time PCR (qRT-PCR) and fluorescence in situ hybridization (FISH) assays, followed by investigation of biological roles of HIF1A-AS2 in AD development by Cell Counting Kit-8 (CCK-8), immunofluorescence, and transwell assays. Additionally, the correlation between HIF1A-AS2, miR-33b, and high mobility group AT-hook2 (HMGA2) were identified by RNA immunoprecipitation (RIP), RNA pull-down and luciferase reporter assays. Results showed that HIF1A-AS2 was obviously increased, while the contractile-phenotype markers of vascular SMCs were significantly decreased in human AD tissues, when compared to normal tissues. Inhibition of HIF1A-AS2 attenuated SMCs proliferation and migration, whereas enhanced the phenotypic switch under the stimulation of PDGF-BB. Results from RIP, RNA pull-down and luciferase reporter assays demonstrated that miR-33b directly bound with HIF1A-AS2, and HIF1A-AS2 silencing suppressed the expression of HMGA2, which was induced by miR-33b inhibitor. In conclusion, knockdown of HIF1A-AS2 suppressed the proliferation and migration, while promoted the phenotypic switching of SMCs through miR-33b/HMGA2 axis, which laid a theoretical foundation for understanding the development of AD and shed light on a potential target for AD treatment.
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Affiliation(s)
- Kai Zhang
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China.,Department of Cardiac ICU, Tianjin Chest HospitalTianjin, China , Tianjin China
| | - Yujuan Qi
- Department of Cardiac ICU, Tianjin Chest Hospital, Tianjin, China
| | - Meng Wang
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Qingliang Chen
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China.,Department of Cardiac ICU, Tianjin Chest HospitalTianjin, China , Tianjin China
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4
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Li Y, Fang M, Yang J, Yu C, Kuang J, Sun T, Fan R. Analysis of the contribution of 129 candidate genes to thoracic aortic aneurysm or dissection of a mixed cohort of sporadic and familial cases in South China. Am J Transl Res 2021; 13:4281-4295. [PMID: 34150014 PMCID: PMC8205813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/14/2021] [Indexed: 06/12/2023]
Abstract
Thoracic aortic aneurysm or dissection (TAAD) is a group of life-threatening complex diseases after symptomatic onset with genetic heterogeneity accounting for approximately 20% of cases. Previously, we identified 40 rare variants in 11 TAAD-related core genes among 70 TAAD patients by next-generation sequencing. In this study, we further analyzed the variants in the disease-causing genes in 129 cases of sporadic TAAD and 22 familial cases by whole-exome sequencing. A total of 116 variants in 47 TAAD-related genes were identified, 64.7% (75/116) of which occurred in sporadic TAAD without syndromes, and among these genes, FBN1 was the most common TAAD-related gene. Of the 26.7% (31/116) that were pathogenic or likely pathogenic, almost one third were from sporadic cases without syndromes involving FBN1, SMAD3, SMAD6, MYH11, TGFBR1, MYLK, LOX and LTBP3. Interestingly, the novel VUS (variant of uncertain significance) *879Glu in MCTP2 occurred in two unrelated probands with sporadic acute aortic dissection without a bicuspid aortic valve. Furthermore, more than one variant was detected in 24 patients, and 70.8% (17/24) occurred in sporadic cases. Younger individuals were more likely to carry P/LP (pathogenic or likely pathogenic) variants and harbor more variants. P/LP carriers seem to have a larger aortic diameter, lower D-dimer levels, and a shorter ICU length of stay but longer hospitalization time. In conclusion, we expanded the candidate gene profile of TAAD, especially for sporadic cases without syndromic features. VUSs need further clarification.
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Affiliation(s)
- Ying Li
- Department of Cardiovascular Surgery, Guangdong Provincial People’s Hospital, School of Medicine, South China University of TechnologyGuangzhou, China
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical SciencesGuangzhou, China
| | - Miaoxian Fang
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical SciencesGuangzhou, China
| | - Jue Yang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical SciencesGuangzhou, China
| | - Changjiang Yu
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical SciencesGuangzhou, China
| | - Juntao Kuang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical SciencesGuangzhou, China
- The Second School of Clinical Medicine, Southern Medical UniversityGuangzhou, China
| | - Tucheng Sun
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical SciencesGuangzhou, China
| | - Ruixin Fan
- Department of Cardiovascular Surgery, Guangdong Provincial People’s Hospital, School of Medicine, South China University of TechnologyGuangzhou, China
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical SciencesGuangzhou, China
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5
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Luan J, Mao L, Zhu Z, Fu W, Zhu T. New indicators for systematic assessment of aortic morphology: a narrative review. J Thorac Dis 2021; 13:372-383. [PMID: 33569218 PMCID: PMC7867839 DOI: 10.21037/jtd-20-2728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
In order to prevent the occurrence of aortic adverse events in ascending thoracic aortic aneurysm patients, preventive surgery is the sole option in case of large aneurysm. Identifying high-risk patients timely and accurately requires effective predictive indicators of aortic adverse events and accurate risk stratification thresholds. Absolute diameter measured after a single imaging examination, which has been used as the predictive indicator for decades, has been proved to be ineffective for risk stratification in moderately dilated aorta. Previously, new indicators combining absolute diameters with personalized parameters have been reported to show better predictive power of aortic adverse events than absolute diameters by correcting the effect of these parameters on the diameters. Meanwhile, combining three-dimensional parameters to formulate risk stratification thresholds not only may characterize the aortic risk morphology more precisely, but also predict aortic adverse events more accurately. These new indicators may provide more systematic assessment methods of patients’ risk, formulate more personalized intervention strategies for ascending thoracic aortic aneurysm patients, and also provide a basis for researchers to develop more accurate and effective risk thresholds. We also highlight that the algorithm obtained by combining multiple indicators may be a better choice compared with single indicator, but this still requires the support of more evidence. Due to the particularity of syndromic aortic disease, whether these new indicators can be used for its risk stratification is still uncertain. Therefore, the scope of this manuscript does not include this kind of disease.
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Affiliation(s)
- Jingyang Luan
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Le Mao
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ziqing Zhu
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ting Zhu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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6
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Pope MK, Ratajska A, Johnsen H, Rypdal KB, Sejersted Y, Paus B. Diagnostics of Hereditary Connective Tissue Disorders by Genetic Next-Generation Sequencing. Genet Test Mol Biomarkers 2019; 23:783-790. [DOI: 10.1089/gtmb.2019.0064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
| | | | - Hilde Johnsen
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | | | - Yngve Sejersted
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Benedicte Paus
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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7
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Pucci L, Pointet A, Good JM, Davoine E, Cina V, Zanchi F, Deglise S, Duchosal LM, Kirsch M. A New Variant in the MYH11 Gene in a Familial Case of Thoracic Aortic Aneurysm. Ann Thorac Surg 2019; 109:e279-e281. [PMID: 31473177 DOI: 10.1016/j.athoracsur.2019.07.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 07/04/2019] [Indexed: 12/01/2022]
Abstract
MYH11 (myosin heavy chain 11) gene is involved in vascular contractility and several autosomal dominant mutations have been linked to thoracic aortic aneurysms. Three male members of the same family were found to carry a heterozygous missense variant in the MYH11 gene and all 3 individuals presented a thoracic aortic aneurysm/dilation. We identified a rare missense variant in the MYH11 gene predicted to be damaging and affecting a conserved amino acid in the myosin tail of the protein. This variant appears to be responsible for our familial case of thoracic aortic aneurysms, as the clinical expression reunited all features of genetic aneurysms.
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Affiliation(s)
- Lorenzo Pucci
- Department of Heart and Vessels, Service of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland.
| | - Alexandra Pointet
- Department of Hand Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - Jean-Marc Good
- Department of Medical Genetics, Hôpital Nestlé, University Hospital of Lausanne, Lausanne, Switzerland
| | - Emeline Davoine
- Department of Medical Genetics, Hôpital Nestlé, University Hospital of Lausanne, Lausanne, Switzerland
| | - Viviane Cina
- Department of Medical Genetics, Hôpital Nestlé, University Hospital of Lausanne, Lausanne, Switzerland
| | - Fabio Zanchi
- Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Sebastien Deglise
- Department of Heart and Vessels, Service of Vascular Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Lucia Mazzolai Duchosal
- Department of Heart and Vessels, Service of Angiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Matthias Kirsch
- Department of Heart and Vessels, Service of Heart Surgery, University Hospital of Lausanne, Lausanne, Switzerland
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Clinical Validity of Genes for Heritable Thoracic Aortic Aneurysm and Dissection. J Am Coll Cardiol 2019; 72:605-615. [PMID: 30071989 DOI: 10.1016/j.jacc.2018.04.089] [Citation(s) in RCA: 154] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 04/26/2018] [Accepted: 04/30/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Thoracic aortic aneurysms progressively enlarge and predispose to acute aortic dissections. Up to 25% of individuals with thoracic aortic disease harbor an underlying Mendelian pathogenic variant. An evidence-based strategy for selection of genes to test in hereditary thoracic aortic aneurysm and dissection (HTAAD) helps inform family screening and intervention to prevent life-threatening thoracic aortic events. OBJECTIVES The purpose of this study was to accurately identify genes that predispose to HTAAD using the Clinical Genome Resource (ClinGen) framework. METHODS We applied the semiquantitative ClinGen framework to assess presumed gene-disease relationships between 53 candidate genes and HTAAD. Genes were classified as causative for HTAAD if they were associated with isolated thoracic aortic disease and were clinically actionable, triggering routine aortic surveillance, intervention, and family cascade screening. All gene-disease assertions were evaluated by a pre-defined curator-expert pair and subsequently discussed with an expert panel. RESULTS Genes were classified based on the strength of association with HTAAD into 5 categories: definitive (n = 9), strong (n = 2), moderate (n = 4), limited (n = 15), and no reported evidence (n = 23). They were further categorized by severity of associated aortic disease and risk of progression. Eleven genes in the definitive and strong groups were designated as "HTAAD genes" (category A). Eight genes were classified as unlikely to be progressive (category B) and 4 as low risk (category C). The remaining genes were recent genes with an uncertain classification or genes with no evidence of association with HTAAD. CONCLUSIONS The ClinGen framework is useful to semiquantitatively assess the strength of gene-disease relationships for HTAAD. Gene categories resulting from the curation may inform clinical laboratories in the development, interpretation, and subsequent clinical implications of genetic testing for patients with aortic disease.
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9
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Pitini E, D’Andrea E, De Vito C, Rosso A, Unim B, Marzuillo C, Federici A, Di Maria E, Villari P. A proposal of a new evaluation framework towards implementation of genetic tests. PLoS One 2019; 14:e0219755. [PMID: 31381569 PMCID: PMC6681956 DOI: 10.1371/journal.pone.0219755] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 07/02/2019] [Indexed: 11/23/2022] Open
Abstract
Background The existing frameworks for the evaluation of genetic and genomic applications clearly address the technical and clinical value of a test, but are less concerned with the way genetic services are delivered and organized. We therefore aimed to develop a comprehensive new framework that includes an assessment of service delivery. Methods A new framework was built on the evaluation dimensions identified through a systematic review of the existing frameworks and a Delphi survey of Italian experts in public health genomics. Results Our framework has four sections. The first two sections, respectively, guide the evidence collection process for the genetic test (analytic validity; clinical validity; clinical utility; personal utility) and its delivery models (organizational aspects; economic evaluation; ethical, legal and social implications; patient perspective). The third section guides the formulation of the research priorities to be addressed in future research. Finally, the fourth section suggests three criteria to summarize the collected evidence (net benefit, cost-effectiveness, feasibility). Conclusion We have successfully developed an evaluation framework for the evaluation of genetic tests that includes an assessment of service delivery. It also introduces some neglected evaluation dimensions such as personal utility and patient perspective.
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Affiliation(s)
- Erica Pitini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- * E-mail:
| | - Elvira D’Andrea
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United Sates of America
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Annalisa Rosso
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Brigid Unim
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Carolina Marzuillo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | - Emilio Di Maria
- Department of Health Sciences, University of Genova, Division of Medical Genetics, Galliera Hospital, Genova, Italy
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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10
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Schmidtke J, Wittkowski K, Glaubitz R. NGS-Based genetic testing for heritable cardiovascular diseases. Specific requirements for obtaining informed consent. Mol Cell Probes 2019; 45:70-78. [PMID: 31059777 DOI: 10.1016/j.mcp.2019.04.005] [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: 02/07/2019] [Revised: 04/26/2019] [Accepted: 04/28/2019] [Indexed: 10/26/2022]
Abstract
Clinical genetic testing in cardiovascular genetic medicine has undergone rapid changes. Next generation sequencing allows simultaneous testing of all genes associated with any cardiovascular phenotype, and molecular genetic testing for multiple genes has become the standard of practice for cardiovascular medicine. While technical and clinical advantages of multigenic approaches are evident, informed consent procedures have become more complex and challenging to the physician ordering such a test, particularly due to the increased potential for unsolicited findings. Based on the EuroGentest "Guidelines for diagnostic next-generation sequencing" we here propose a set of disease-specific requirements for obtaining informed consent for NGS-based genetic testing in a cardiogenetic clinic. We can show that it is often not feasible to obtain informed consent for every detail and suggest, in such cases, to reach general consent beforehand and discuss specific implications of unsolicited findings after the test results are available.
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Affiliation(s)
- Jörg Schmidtke
- Amedes Genetics, Georgstraße 50, Hannover, Germany; Hannover Medical School, Institute of Human Genetics, Hannover, Germany.
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11
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Genetic testing for large-caliber vessel aneurysms. THE EUROBIOTECH JOURNAL 2018. [DOI: 10.2478/ebtj-2018-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Large-caliber vessels are those with a diameter of 10 mm or more. Most aneurysms remain asymptomatic until they expand or rupture. Aortic aneurysms are of special interest for physicians and scientists because of their prevalence. Aortic aneurysms and dissections account for 1-2% of all deaths in western countries. Expansion and rupture of vascular aneurysms show a strong correlation with hyperlipidemia, hypertension, smoking, sex and age. Heritability estimates have been as high as 70%. This Utility Gene Test was developed on the basis of an analysis of the literature and existing diagnostic protocols. It is useful for confirming diagnosis, as well as for differential diagnosis, couple risk assessment and access to clinical trials.
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12
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Mariscalco G, Debiec R, Elefteriades JA, Samani NJ, Murphy GJ. Systematic Review of Studies That Have Evaluated Screening Tests in Relatives of Patients Affected by Nonsyndromic Thoracic Aortic Disease. J Am Heart Assoc 2018; 7:e009302. [PMID: 30371227 PMCID: PMC6201478 DOI: 10.1161/jaha.118.009302] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/08/2018] [Indexed: 12/19/2022]
Abstract
Background Nonsyndromic thoracic aortic diseases ( NS - TADs ) are often silent entities until they present as life-threatening emergencies. Despite familial inheritance being common, screening is not the current standard of care in NS - TAD s. We sought to determine the incidence of aortic diseases, the predictive accuracy of available screening tests, and the effectiveness of screening programs in relatives of patients affected by NS - TADs . Methods and Results A systematic literature search on PubMed/ MEDLINE , Embase, and the Cochrane Library was conducted from inception to the end of December 2017. The search was supplemented with the Online Mendelian Inheritance in Man database. A total of 53 studies were included, and a total of 2696 NS - TAD relatives were screened. Screening was genetic in 49% of studies, followed by imaging techniques in 11% and a combination of the 2 in 40%. Newly affected individuals were identified in 33%, 24%, and 15% of first-, second-, and third-degree relatives, respectively. Familial NS - TAD s were primarily attributed to single-gene mutations, expressed in an autosomal dominant pattern with incomplete penetrance. Specific gene mutations were observed in 25% of the screened families. Disease subtype and genetic mutations stratified patients with respect to age of presentation, aneurysmal location, and aortic diameter before dissection. Relatives of patients with sporadic NS - TAD s were also found to be affected. No studies evaluated the predictive accuracy of imaging or genetic screening tests, or the clinical or cost-effectiveness of an NS - TAD screening program. Conclusions First- and second-degree relatives of patients affected by both familial and sporadic NS - TAD s may benefit from personalized screening programs.
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Affiliation(s)
- Giovanni Mariscalco
- Department of Cardiovascular SciencesUniversity of Leicester and National Institute for Health Research Leicester Cardiovascular Biomedical Research CentreLeicesterUnited Kingdom
| | - Radoslaw Debiec
- Department of Cardiovascular SciencesUniversity of Leicester and National Institute for Health Research Leicester Cardiovascular Biomedical Research CentreLeicesterUnited Kingdom
| | | | - Nilesh J. Samani
- Department of Cardiovascular SciencesUniversity of Leicester and National Institute for Health Research Leicester Cardiovascular Biomedical Research CentreLeicesterUnited Kingdom
| | - Gavin J. Murphy
- Department of Cardiovascular SciencesUniversity of Leicester and National Institute for Health Research Leicester Cardiovascular Biomedical Research CentreLeicesterUnited Kingdom
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13
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Favalli V, Serio A, Giuliani LP, Arbustini E. 'Precision and personalized medicine,' a dream that comes true? J Cardiovasc Med (Hagerstown) 2018; 18 Suppl 1:e1-e6. [PMID: 27661611 DOI: 10.2459/jcm.0000000000000423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Valentina Favalli
- Centre for Inherited Cardiovascular Diseases, IRCCS Foundation, Policlinico San Matteo, University Hospital, Pavia, Italy
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14
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Expert consensus recommendations on the cardiogenetic care for patients with thoracic aortic disease and their first-degree relatives. Int J Cardiol 2018; 258:243-248. [DOI: 10.1016/j.ijcard.2018.01.145] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 01/16/2018] [Accepted: 01/31/2018] [Indexed: 12/24/2022]
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15
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Arbustini E, Favalli V, Di Toro A, Giuliani L, Limongelli G. Common presentation of rare diseases: Aortic aneurysms & valves. Int J Cardiol 2018; 257:358-365. [DOI: 10.1016/j.ijcard.2018.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 12/15/2017] [Accepted: 01/02/2018] [Indexed: 12/24/2022]
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16
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Abstract
Genetic aortic syndromes (GAS) include Marfan, Loeys-Dietz, vascular Ehlers-Danlos, and Turner syndrome as well as congenital bicuspid aortic valve. The clinical management of these diseases has certain similarities and differences. We employed medical strategy analysis to test the utility of genetic diagnostics in the management of GAS. We chose the standpoint of the cardiologist for our analysis. In the first step, the medical goals in the management of GAS are specified. In the second step, the accuracy of genetic diagnostics for GAS is examined. Finally, conclusions can be drawn about the utility of genetic diagnostics in managing GAS. We found that genetic diagnostics is necessary to exclude GAS, to diagnose GAS, and to specify disease types. Second, combining phenotype with genotype information maximizes the predictability of the course of disease. Third, with genetic diagnostics it is possible to predict the birth of children with causative mutations for GAS and to initiate drug therapy to prevent the onset of aortic dilatation or to slow down its progression to aortic aneurysm. Finally, genetic diagnostics improves prognostic predictions and thereby contributes to a better timing of elective surgery and to a better choice of procedures. The findings of our medical strategy analysis indicate the high utility of genetic diagnostics for managing GAS.
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17
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Abstract
The principles of genetics apply across the entire tree of life. At the cellular level we share biological mechanisms with species from which we diverged millions, even billions of years ago. We can exploit this common ancestry to learn about health and disease, by analyzing DNA and protein sequences, but also through the observable outcomes of genetic differences, i.e. phenotypes. To solve challenging disease problems we need to unify the heterogeneous data that relates genomics to disease traits. Without a big-picture view of phenotypic data, many questions in genetics are difficult or impossible to answer. The Monarch Initiative (https://monarchinitiative.org) provides tools for genotype-phenotype analysis, genomic diagnostics, and precision medicine across broad areas of disease.
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18
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Gago-Díaz M, Ramos-Luis E, Zoppis S, Zorio E, Molina P, Braza-Boïls A, Giner J, Sobrino B, Amigo J, Blanco-Verea A, Carracedo Á, Brion M. Postmortem genetic testing should be recommended in sudden cardiac death cases due to thoracic aortic dissection. Int J Legal Med 2017; 131:1211-1219. [PMID: 28391405 DOI: 10.1007/s00414-017-1583-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 03/27/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Acute thoracic aortic dissections and ruptures, the main life-threatening complications of the corresponding aneurysms, are an important cause of sudden cardiac death. Despite the usefulness of the molecular diagnosis of these conditions in the clinical setting, the corresponding forensic field remains largely unexplored. The main goal of this study was to explore and validate a new massive parallel sequencing candidate gene assay as a diagnostic tool for acute thoracic aortic dissection autopsy cases. MATERIALS AND METHODS Massive parallel sequencing of 22 thoracic aortic disease candidate genes performed in 17 cases of thoracic aortic dissection using AmpliSeq and Ion Proton technologies. Genetic variants were filtered by location, type, and frequency at the Exome Aggregation Consortium and an internal database and further classified based on the American College of Medical Genetics and Genomics (ACMG) recommendations published in 2015. All prioritized results were confirmed by traditional sequencing. RESULTS From the total of 10 potentially pathogenic genetic variants identified in 7 out of the 17 initial samples, 2 of them were further classified as pathogenic, 2 as likely pathogenic, 1 as possibly benign, and the remaining 5 as variants of uncertain significance, reaching a molecular autopsy yield of 23%, approximately. CONCLUSIONS This massive parallel sequencing candidate gene approach proved useful for the molecular autopsy of aortic dissection sudden cardiac death cases and should therefore be progressively incorporated into the forensic field, being especially beneficial for the anticipated diagnosis and risk stratification of any other family member at risk of developing the same condition.
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Affiliation(s)
- Marina Gago-Díaz
- Xenética de Enfermidades Cardiovasculares e Oftalmolóxicas, Instituto de Investigación Sanitaria de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain.,Grupo de Medicina Xenómica, Instituto de Investigación Sanitaria de Santiago de Compostela, Universidade de Santiago de Compostela, Fundación Pública Galega de Medicina Xenómica, Santiago de Compostela, Spain
| | - Eva Ramos-Luis
- Xenética de Enfermidades Cardiovasculares e Oftalmolóxicas, Instituto de Investigación Sanitaria de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain.,Grupo de Medicina Xenómica, Instituto de Investigación Sanitaria de Santiago de Compostela, Universidade de Santiago de Compostela, Fundación Pública Galega de Medicina Xenómica, Santiago de Compostela, Spain
| | - Silvia Zoppis
- Xenética de Enfermidades Cardiovasculares e Oftalmolóxicas, Instituto de Investigación Sanitaria de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain.,Grupo de Medicina Xenómica, Instituto de Investigación Sanitaria de Santiago de Compostela, Universidade de Santiago de Compostela, Fundación Pública Galega de Medicina Xenómica, Santiago de Compostela, Spain.,Laboratorio di Genetica Forense, Sezione di Medicina Legale, Dipartimento S.A.I.M.L.A.L., Università di Roma Sapienza, Rome, Italy
| | - Esther Zorio
- Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Pilar Molina
- Servicio de Patología, Instituto de Medicina Legal de Valencia, Valencia, Spain
| | | | - Juan Giner
- Center of Excellence in Genomic Medicine Research (CEGMR), King Abdulaziz University, Jeddah, Saudi Arabia
| | - Beatriz Sobrino
- Grupo de Medicina Xenómica, Instituto de Investigación Sanitaria de Santiago de Compostela, Universidade de Santiago de Compostela, Fundación Pública Galega de Medicina Xenómica, Santiago de Compostela, Spain
| | - Jorge Amigo
- Grupo de Medicina Xenómica, Instituto de Investigación Sanitaria de Santiago de Compostela, Universidade de Santiago de Compostela, Fundación Pública Galega de Medicina Xenómica, Santiago de Compostela, Spain
| | - Alejandro Blanco-Verea
- Xenética de Enfermidades Cardiovasculares e Oftalmolóxicas, Instituto de Investigación Sanitaria de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain.,Grupo de Medicina Xenómica, Instituto de Investigación Sanitaria de Santiago de Compostela, Universidade de Santiago de Compostela, Fundación Pública Galega de Medicina Xenómica, Santiago de Compostela, Spain
| | - Ángel Carracedo
- Grupo de Medicina Xenómica, Instituto de Investigación Sanitaria de Santiago de Compostela, Universidade de Santiago de Compostela, Fundación Pública Galega de Medicina Xenómica, Santiago de Compostela, Spain.,Center of Excellence in Genomic Medicine Research (CEGMR), King Abdulaziz University, Jeddah, Saudi Arabia
| | - María Brion
- Xenética de Enfermidades Cardiovasculares e Oftalmolóxicas, Instituto de Investigación Sanitaria de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain. .,Grupo de Medicina Xenómica, Instituto de Investigación Sanitaria de Santiago de Compostela, Universidade de Santiago de Compostela, Fundación Pública Galega de Medicina Xenómica, Santiago de Compostela, Spain. .,Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Laboratorio 1, Travesía de Choupana S/N, CP: 15706, Santiago de Compostela, Spain.
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19
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Kiotsekoglou A, Moggridge JC, Child AH, Rask P. The role of advanced echocardiography and cardiovascular magnetic resonance in the assessment of myocardial function in Marfan syndrome-An update. Echocardiography 2017; 34:760-767. [PMID: 28317279 DOI: 10.1111/echo.13517] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Cardiovascular assessment of patients with Marfan syndrome has normally focused on the aortic root and vascular manifestations of the disease due to the high risk of aortic dissection. Although primary myocardial impairment has long been suspected in these patients, the evidence has been controversial. Advanced echocardiography and cardiovascular magnetic resonance imaging have proven to be effective, accurate, and more sensitive in the detection of subtle cardiac dysfunction. The application of these techniques to Marfan syndrome over the last 10 years has made significant progress in demonstrating the presence of primary myocardial impairment in these patients, but further work is still required to obtain confirmatory molecular, pathophysiological, and prognostic clinical data. Phenotypic expression of the disease has prognostic value, also suggesting potential effective medical therapy.
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Affiliation(s)
- Anatoli Kiotsekoglou
- Department of Clinical Physiology, University Hospital of Örebro, Örebro, Sweden
| | - James C Moggridge
- Department of Medical Physics and Bioengineering, University College Hospital, London, United Kingdom
| | - Anne H Child
- Cardiovascular and Cell Sciences Research Institute, St George's, University of London, London, United Kingdom
| | - Peter Rask
- Department of Clinical Physiology, University Hospital of Örebro, Örebro, Sweden
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20
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Köhler S, Robinson PN. [Diagnostics in human genetics : Integration of phenotypic and genomic data]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:542-549. [PMID: 28293716 DOI: 10.1007/s00103-017-2538-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The development of reliable methods for annotation of clinical phenotypes and algorithms to calculate similarity values for clinical phenotype profiles will be a major challenge for genomic personalized medicine, since combined analysis of phenotypic features and genetic variants can increase diagnostic yield, especially with exome or genome sequencing. The Human Phenotype Ontology project (HPO; www.human-phenotype-ontology.org ) provides an ontology for capturing phenotypic abnormalities in human disease in a precise and comprehensive fashion. The HPO not only enables reliable integration of disease-relevant information from numerous databases, but it also allows for similarity between patients or between patients and disease descriptions to be calculated algorithmically. The HPO thereby represents a solid foundation for differential diagnostic applications as well as for translational research and prioritization of novel disease genes in exome or genome sequencing projects.
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Affiliation(s)
- Sebastian Köhler
- NeuroCure Cluster of Excellence, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - Peter N Robinson
- The Jackson Laboratory for Genomic Medicine, 10 Discovery Drive, 06032, Farmington, USA.,Institute for Systems Genomics, University of Connecticut, Farmington, USA
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21
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von Kodolitsch Y, Rybczynski M, Vogler M, Mir TS, Schüler H, Kutsche K, Rosenberger G, Detter C, Bernhardt AM, Larena-Avellaneda A, Kölbel T, Debus ES, Schroeder M, Linke SJ, Fuisting B, Napp B, Kammal AL, Püschel K, Bannas P, Hoffmann BA, Gessler N, Vahle-Hinz E, Kahl-Nieke B, Thomalla G, Weiler-Normann C, Ohm G, Neumann S, Benninghoven D, Blankenberg S, Pyeritz RE. The role of the multidisciplinary health care team in the management of patients with Marfan syndrome. J Multidiscip Healthc 2016; 9:587-614. [PMID: 27843325 PMCID: PMC5098778 DOI: 10.2147/jmdh.s93680] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Marfan syndrome (MFS) is a rare, severe, chronic, life-threatening disease with multiorgan involvement that requires optimal multidisciplinary care to normalize both prognosis and quality of life. In this article, each key team member of all the medical disciplines of a multidisciplinary health care team at the Hamburg Marfan center gives a personal account of his or her contribution in the management of patients with MFS. The authors show how, with the support of health care managers, key team members organize themselves in an organizational structure to create a common meaning, to maximize therapeutic success for patients with MFS. First, we show how the initiative and collaboration of patient representatives, scientists, and physicians resulted in the foundation of Marfan centers, initially in the US and later in Germany, and how and why such centers evolved over time. Then, we elucidate the three main structural elements; a team of coordinators, core disciplines, and auxiliary disciplines of health care. Moreover, we explain how a multidisciplinary health care team integrates into many other health care structures of a university medical center, including external quality assurance; quality management system; clinical risk management; center for rare diseases; aorta center; health care teams for pregnancy, for neonates, and for rehabilitation; and in structures for patient centeredness. We provide accounts of medical goals and standards for each core discipline, including pediatricians, pediatric cardiologists, cardiologists, human geneticists, heart surgeons, vascular surgeons, vascular interventionists, orthopedic surgeons, ophthalmologists, and nurses; and of auxiliary disciplines including forensic pathologists, radiologists, rhythmologists, pulmonologists, sleep specialists, orthodontists, dentists, neurologists, obstetric surgeons, psychiatrist/psychologist, and rehabilitation specialists. We conclude that a multidisciplinary health care team is a means to maximize therapeutic success.
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Affiliation(s)
| | | | | | - Thomas S Mir
- Clinic for Pediatric Cardiology, University Heart Centre
| | | | | | | | | | | | | | - Tilo Kölbel
- Clinic of Vascular Medicine, University Heart Centre
| | | | - Malte Schroeder
- Department of Trauma, Hand, and Reconstructive Surgery
- Department of Orthopedics
| | - Stephan J Linke
- Clinic of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Smilow Center for Translational Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Bettina Fuisting
- Clinic of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | - Peter Bannas
- Diagnostic and Interventional Radiology Department and Clinic
| | | | - Nele Gessler
- Clinic of Electrophysiology, University Heart Centre
| | - Eva Vahle-Hinz
- Department of Orthodontics, Center for Dental and Oral Medicine
| | | | | | | | | | - Stefan Neumann
- Business Unit Quality Management, University Medical Center Hamburg-Eppendorf
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22
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Pinard A, Salgado D, Desvignes JP, Rai G, Hanna N, Arnaud P, Guien C, Martinez M, Faivre L, Jondeau G, Boileau C, Zaffran S, Béroud C, Collod-Béroud G. WES/WGS Reporting of Mutations from Cardiovascular "Actionable" Genes in Clinical Practice: A Key Role for UMD Knowledgebases in the Era of Big Databases. Hum Mutat 2016; 37:1308-1317. [PMID: 27647783 DOI: 10.1002/humu.23119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/22/2016] [Accepted: 09/12/2016] [Indexed: 12/27/2022]
Abstract
High-throughput next-generation sequencing such as whole-exome and whole-genome sequencing are being rapidly integrated into clinical practice. The use of these techniques leads to the identification of secondary variants for which decisions about the reporting or not to the patient need to be made. The American College of Medical Genetics and Genomics recently published recommendations for the reporting of these variants in clinical practice for 56 "actionable" genes. Among these, seven are involved in Marfan Syndrome And Related Disorders (MSARD) resulting from mutations of the FBN1, TGFBR1 and 2, ACTA2, SMAD3, MYH11 and MYLK genes. Here, we show that mutations collected in UMD databases for MSARD genes (UMD-MSARD) are rarely reported, including the most frequent ones, in global scale initiatives for variant annotation such as the NHLBI GO Exome Sequencing Project (ESP), the Exome Aggregation Consortium (ExAC), and ClinVar. The predicted pathogenic mutations reported in global scale initiatives but absent in locus-specific databases (LSDBs) mainly correspond to rare events. UMD-MSARD databases are therefore the only resources providing access to the full spectrum of known pathogenic mutations. They are the most comprehensive resources for clinicians and geneticists to interpret MSARD-related variations not only primary variants but also secondary variants.
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Affiliation(s)
| | | | | | - Ghadi Rai
- Aix Marseille Univ, INSERM, GMGF, Marseille, France
| | - Nadine Hanna
- Département de Génétique, Hôpital Bichat AP-HP, Paris, France.,Inserm U1148 LVTS, Equipe 2 Maladies Structurelles Cardiovasculaires, Hôpital Bichat, Université Paris Diderot, Sorbonne Paris Cité.,Centre National de Référence Maladies Rares, Syndrome de Marfan et pathologies apparentées, Hôpital Bichat, AP-HP, Paris, France
| | - Pauline Arnaud
- Département de Génétique, Hôpital Bichat AP-HP, Paris, France.,Inserm U1148 LVTS, Equipe 2 Maladies Structurelles Cardiovasculaires, Hôpital Bichat, Université Paris Diderot, Sorbonne Paris Cité.,Centre National de Référence Maladies Rares, Syndrome de Marfan et pathologies apparentées, Hôpital Bichat, AP-HP, Paris, France
| | - Céline Guien
- Aix Marseille Univ, INSERM, GMGF, Marseille, France
| | - Maria Martinez
- IRSD, INSERM, INRA, ENVT, UPS, Université de Toulouse, Toulouse, France
| | - Laurence Faivre
- Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement (TRANSLAD), Centre Hospitalier Universitaire Dijon, Dijon, France.,Centre de Génétique et Centre de Référence, Anomalies du Développement et Syndromes Malformatifs de l'Inter-région Est, Centre Hospitalier Universitaire Dijon, Dijon, France.,EA 4271 GAD, Université de Bourgogne Franche-Comté, Dijon, France
| | - Guillaume Jondeau
- Centre National de Référence Maladies Rares, Syndrome de Marfan et pathologies apparentées, Hôpital Bichat, AP-HP, Paris, France.,Service de Cardiologie, AP-HP, Hôpital Bichat, Paris, France.,AP-HP, Centre de référence pour les syndromes de Marfan et apparentés, Service de Cardiologie, Hôpital Bichat, Paris, France
| | - Catherine Boileau
- Inserm U1148 LVTS, Equipe 2 Maladies Structurelles Cardiovasculaires, Hôpital Bichat, Université Paris Diderot, Sorbonne Paris Cité.,Centre National de Référence Maladies Rares, Syndrome de Marfan et pathologies apparentées, Hôpital Bichat, AP-HP, Paris, France.,AP-HP, Centre de référence pour les syndromes de Marfan et apparentés, Service de Cardiologie, Hôpital Bichat, Paris, France
| | | | - Christophe Béroud
- Aix Marseille Univ, INSERM, GMGF, Marseille, France.,AP-HM, Département de Génétique Médicale, Hôpital Timone Enfants, Marseille, France
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23
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Matthijs G, Dierking A, Schmidtke J. New EuroGentest/ESHG guidelines and a new clinical utility gene card format for NGS-based testing. Eur J Hum Genet 2015; 24:1. [PMID: 26508569 DOI: 10.1038/ejhg.2015.229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Gert Matthijs
- Department of Human Genetics, Centre for Human Genetics, KU Leuven, Leuven, Belgium
| | - Anna Dierking
- Institute of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Jörg Schmidtke
- Institute of Human Genetics, Hannover Medical School, Hannover, Germany
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