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Bravo-Jaimes K, Wu X, Reardon LC, Lluri G, Lin JP, Moore JP, van Arsdell G, Biniwale R, Si MS, Naini BV, Venick R, Saab S, Wray CL, Ponder R, Rosenthal C, Klomhaus A, Böstrom KI, Aboulhosn JA, Kaldas FM. Intrahepatic Transcriptomics Differentiate Advanced Fibrosis and Clinical Outcomes in Adults With Fontan Circulation. J Am Coll Cardiol 2024; 83:726-738. [PMID: 38355242 DOI: 10.1016/j.jacc.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/06/2023] [Accepted: 12/04/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND The molecular mechanisms underlying Fontan-associated liver disease (FALD) remain largely unknown. OBJECTIVES This study aimed to assess intrahepatic transcriptomic differences among patients with FALD according to the degree of liver fibrosis and clinical outcomes. METHODS This retrospective cohort study included adults with the Fontan circulation. Baseline clinical, laboratory, imaging, and hemodynamic data as well as a composite clinical outcome (CCO) were extracted from medical records. Patients were classified into early or advanced fibrosis. RNA was isolated from formalin-fixed paraffin-embedded liver biopsy samples; RNA libraries were constructed with the use of an rRNA depletion method and sequenced on an Illumina Novaseq 6000. Differential gene expression and gene ontology analyses were performed with the use of DESeq2 and Metascape. RESULTS A total of 106 patients (48% male, median age 31 years [IQR: 11.3 years]) were included. Those with advanced fibrosis had higher B-type natriuretic peptide levels and Fontan, mean pulmonary artery, and capillary wedge pressures. The CCO was present in 23 patients (22%) and was not predicted by advanced liver fibrosis, right ventricular morphology, presence of aortopulmonary collaterals, or Fontan pressures on multivariable analysis. Samples with advanced fibrosis had 228 upregulated genes compared with early fibrosis. Samples with the CCO had 894 upregulated genes compared with those without the CCO. A total of 136 upregulated genes were identified in both comparisons and were enriched in cellular response to cytokine stimulus or oxidative stress, VEGFA-VEGFR2 signaling pathway, TGF-β signaling pathway, and vasculature development. CONCLUSIONS Patients with FALD and advanced fibrosis or the CCO exhibited upregulated genes related to inflammation, congestion, and angiogenesis.
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Affiliation(s)
- Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA; Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, California, USA
| | - Xiuju Wu
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, California, USA
| | - Leigh C Reardon
- Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, California, USA; Department of Pediatric Cardiology, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California, USA
| | - Gentian Lluri
- Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, California, USA; Division of Cardiology, Department of Medicine, University of California, Los Angeles, California, USA
| | - Jeannette P Lin
- Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, California, USA; Division of Cardiology, Department of Medicine, University of California, Los Angeles, California, USA
| | - Jeremy P Moore
- Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, California, USA; Department of Pediatric Cardiology, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California, USA
| | - Glen van Arsdell
- Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, California, USA; Division of Congenital Cardiovascular Surgery, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California USA; Department of Surgery, University of California-Los Angeles, Los Angeles, California, USA
| | - Reshma Biniwale
- Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, California, USA; Division of Congenital Cardiovascular Surgery, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California USA; Department of Surgery, University of California-Los Angeles, Los Angeles, California, USA
| | - Ming-Sing Si
- Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, California, USA; Division of Congenital Cardiovascular Surgery, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California USA; Department of Surgery, University of California-Los Angeles, Los Angeles, California, USA
| | - Bita V Naini
- Department of Pathology and Lab Services, University of California, Los Angeles, California, USA
| | - Robert Venick
- Department of Gastroenterology, Hepatology, and Nutrition, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California, USA
| | - Sammy Saab
- Pfleger Liver Institute, University of California, Los Angeles, California, USA
| | - Christopher L Wray
- Department of Anesthesiology, University of California, Los Angeles, California, USA
| | - Reid Ponder
- Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, California, USA
| | - Carl Rosenthal
- Dumont-UCLA Liver Transplant Center, Department of Surgery, University of California, Los Angeles, California, USA
| | - Alexandra Klomhaus
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Kristina I Böstrom
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, California, USA
| | - Jamil A Aboulhosn
- Ahmanson/UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, California, USA; Division of Cardiology, Department of Medicine, University of California, Los Angeles, California, USA
| | - Fady M Kaldas
- Dumont-UCLA Liver Transplant Center, Department of Surgery, University of California, Los Angeles, California, USA.
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Bravo-Jaimes K, Wu X, Reardon LC, Lluri G, Lin JP, Moore JP, Arsdell GV, Biniwale R, Si MS, Naini BV, Venick R, Saab S, Wray CL, Ponder R, Rosenthal C, Klomhaus A, Böstrom KI, Aboulhosn JA, Kaldas FM. Intrahepatic transcriptomics differentiate advanced fibrosis and clinical outcomes in adults with the Fontan circulation. medRxiv 2023:2023.06.05.23290997. [PMID: 37333414 PMCID: PMC10274997 DOI: 10.1101/2023.06.05.23290997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Background The molecular mechanisms underlying Fontan associated liver disease (FALD) remain largely unknown. We aimed to assess intrahepatic transcriptomic differences among patients with FALD according to the degree of liver fibrosis and clinical outcomes. Methods This retrospective cohort study included adults with the Fontan circulation at the Ahmanson/UCLA Adult Congenital Heart Disease Center. Clinical, laboratory, imaging and hemodynamic data prior to the liver biopsy were extracted from medical records. Patients were classified into early (F1-F2) or advanced fibrosis (F3-F4). RNA was isolated from formalin-fixed paraffin embedded liver biopsy samples; RNA libraries were constructed using rRNA depletion method and sequencing was performed on Illumina Novaseq 6000. Differential gene expression and gene ontology analyses were carried out using DESeq2 and Metascape. Medical records were comprehensively reviewed for a composite clinical outcome which included decompensated cirrhosis, hepatocellular carcinoma, liver transplantation, protein-losing enteropathy, chronic kidney disease stage 4 or higher, or death. Results Patients with advanced fibrosis had higher serum BNP levels and Fontan, mean pulmonary artery and capillary wedge pressures. The composite clinical outcome was present in 23 patients (22%) and was predicted by age at Fontan, right ventricular morphology and presence of aortopulmonary collaterals on multivariable analysis. Samples with advanced fibrosis had 228 up-regulated genes compared to early fibrosis. Samples with the composite clinical outcome had 894 up-regulated genes compared to those without it. A total of 136 up-regulated genes were identified in both comparisons and these genes were enriched in cellular response to cytokine stimulus, response to oxidative stress, VEGFA-VEGFR2 signaling pathway, TGF-beta signaling pathway, and vasculature development. Conclusions Patients with FALD and advanced liver fibrosis or the composite clinical outcome exhibit up-regulated genes including pathways related to inflammation, congestion, and angiogenesis. This adds further insight into FALD pathophysiology.
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Affiliation(s)
- Katia Bravo-Jaimes
- Department of Cardiovascular Diseases. Mayo Clinic Jacksonville Florida
- Ahmanson/UCLA Adult Congenital Heart Disease Center. University of California, Los Angeles
| | - Xiuju Wu
- Division of Cardiology. Department of Medicine. University of California, Los Angeles
| | - Leigh C Reardon
- Ahmanson/UCLA Adult Congenital Heart Disease Center. University of California, Los Angeles
- Department of Pediatric Cardiology. University of California, Los Angeles Mattel Children’s Hospital
| | - Gentian Lluri
- Ahmanson/UCLA Adult Congenital Heart Disease Center. University of California, Los Angeles
- Division of Cardiology. Department of Medicine. University of California, Los Angeles
| | - Jeannette P Lin
- Ahmanson/UCLA Adult Congenital Heart Disease Center. University of California, Los Angeles
- Division of Cardiology. Department of Medicine. University of California, Los Angeles
| | - Jeremy P Moore
- Ahmanson/UCLA Adult Congenital Heart Disease Center. University of California, Los Angeles
- Department of Pediatric Cardiology. University of California, Los Angeles Mattel Children’s Hospital
| | - Glen Van Arsdell
- Ahmanson/UCLA Adult Congenital Heart Disease Center. University of California, Los Angeles
- Division of Cardiology. Department of Medicine. University of California, Los Angeles
| | | | | | - Bita V Naini
- Department of Pathology and Lab Services. University of California, Los Angeles
| | - Robert Venick
- Department of Gastroenterology, Hepatology and Nutrition. University of California, Los Angeles Mattel Children’s Hospital
| | - Sammy Saab
- Department of Gastroenterology, Hepatology and Nutrition. University of California, Los Angeles Mattel Children’s Hospital
| | | | - Reid Ponder
- Ahmanson/UCLA Adult Congenital Heart Disease Center. University of California, Los Angeles
| | - Carl Rosenthal
- Dumont-UCLA Liver Transplant Center. Department of Surgery. University of California, Los Angeles
| | - Alexandra Klomhaus
- Department of Medicine Statistics Core. David Geffen School of Medicine. University of California, Los Angeles
| | - Kristina I Böstrom
- Division of Cardiology. Department of Medicine. University of California, Los Angeles
| | - Jamil A Aboulhosn
- Ahmanson/UCLA Adult Congenital Heart Disease Center. University of California, Los Angeles
- Division of Cardiology. Department of Medicine. University of California, Los Angeles
| | - Fady M Kaldas
- Dumont-UCLA Liver Transplant Center. Department of Surgery. University of California, Los Angeles
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