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Lazzarino M, Zanetti M, Chen SN, Gao S, Peña B, Lam CK, Wu JC, Taylor MRG, Mestroni L, Sbaizero O. Defective Biomechanics and Pharmacological Rescue of Human Cardiomyocytes with Filamin C Truncations. Int J Mol Sci 2024; 25:2942. [PMID: 38474188 PMCID: PMC10932268 DOI: 10.3390/ijms25052942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 03/14/2024] Open
Abstract
Actin-binding filamin C (FLNC) is expressed in cardiomyocytes, where it localizes to Z-discs, sarcolemma, and intercalated discs. Although FLNC truncation variants (FLNCtv) are an established cause of arrhythmias and heart failure, changes in biomechanical properties of cardiomyocytes are mostly unknown. Thus, we investigated the mechanical properties of human-induced pluripotent stem cells-derived cardiomyocytes (hiPSC-CMs) carrying FLNCtv. CRISPR/Cas9 genome-edited homozygous FLNCKO-/- hiPSC-CMs and heterozygous knock-out FLNCKO+/- hiPSC-CMs were analyzed and compared to wild-type FLNC (FLNCWT) hiPSC-CMs. Atomic force microscopy (AFM) was used to perform micro-indentation to evaluate passive and dynamic mechanical properties. A qualitative analysis of the beating traces showed gene dosage-dependent-manner "irregular" peak profiles in FLNCKO+/- and FLNCKO-/- hiPSC-CMs. Two Young's moduli were calculated: E1, reflecting the compression of the plasma membrane and actin cortex, and E2, including the whole cell with a cytoskeleton and nucleus. Both E1 and E2 showed decreased stiffness in mutant FLNCKO+/- and FLNCKO-/- iPSC-CMs compared to that in FLNCWT. The cell adhesion force and work of adhesion were assessed using the retraction curve of the SCFS. Mutant FLNC iPSC-CMs showed gene dosage-dependent decreases in the work of adhesion and adhesion forces from the heterozygous FLNCKO+/- to the FLNCKO-/- model compared to FLNCWT, suggesting damaged cytoskeleton and membrane structures. Finally, we investigated the effect of crenolanib on the mechanical properties of hiPSC-CMs. Crenolanib is an inhibitor of the Platelet-Derived Growth Factor Receptor α (PDGFRA) pathway which is upregulated in FLNCtv hiPSC-CMs. Crenolanib was able to partially rescue the stiffness of FLNCKO-/- hiPSC-CMs compared to control, supporting its potential therapeutic role.
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Affiliation(s)
- Marco Lazzarino
- CNR-IOM, Area Science Park, 34149 Trieste, Italy; (M.L.); (M.Z.)
- Cardiovascular Institute, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (S.N.C.); (S.G.); (B.P.); (M.R.G.T.); (L.M.)
| | - Michele Zanetti
- CNR-IOM, Area Science Park, 34149 Trieste, Italy; (M.L.); (M.Z.)
- Cardiovascular Institute, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (S.N.C.); (S.G.); (B.P.); (M.R.G.T.); (L.M.)
| | - Suet Nee Chen
- Cardiovascular Institute, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (S.N.C.); (S.G.); (B.P.); (M.R.G.T.); (L.M.)
| | - Shanshan Gao
- Cardiovascular Institute, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (S.N.C.); (S.G.); (B.P.); (M.R.G.T.); (L.M.)
| | - Brisa Peña
- Cardiovascular Institute, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (S.N.C.); (S.G.); (B.P.); (M.R.G.T.); (L.M.)
- Bioengineering Department, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Chi Keung Lam
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA 94305, USA; (C.K.L.); (J.C.W.)
| | - Joseph C. Wu
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA 94305, USA; (C.K.L.); (J.C.W.)
| | - Matthew R. G. Taylor
- Cardiovascular Institute, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (S.N.C.); (S.G.); (B.P.); (M.R.G.T.); (L.M.)
| | - Luisa Mestroni
- Cardiovascular Institute, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (S.N.C.); (S.G.); (B.P.); (M.R.G.T.); (L.M.)
| | - Orfeo Sbaizero
- Cardiovascular Institute, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; (S.N.C.); (S.G.); (B.P.); (M.R.G.T.); (L.M.)
- Engineering and Architecture Department, University of Trieste, 34127 Trieste, Italy
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Slaven S, Raymer DS, Mestroni L. The electrocardiographic signature of variant transthyretin amyloidosis. Int J Cardiol 2024; 398:131442. [PMID: 37852541 PMCID: PMC10843784 DOI: 10.1016/j.ijcard.2023.131442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023]
Affiliation(s)
- Sarah Slaven
- Department of Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - David S Raymer
- Department of Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Luisa Mestroni
- Department of Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Setti M, Merlo M, Gigli M, Munaretto L, Paldino A, Stolfo D, Pio Loco C, Medo K, Gregorio C, De Luca A, Graw S, Castrichini M, Cannatà A, Ribichini FL, Dal Ferro M, Taylor M, Sinagra G, Mestroni L. Role of arrhythmic phenotype in prognostic stratification and management of dilated cardiomyopathy. Eur J Heart Fail 2024. [PMID: 38404225 DOI: 10.1002/ejhf.3168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 12/22/2023] [Accepted: 02/05/2024] [Indexed: 02/27/2024] Open
Abstract
AIMS Dilated cardiomyopathy (DCM) with arrhythmic phenotype combines phenotypical aspects of DCM and predisposition to ventricular arrhythmias, typical of arrhythmogenic cardiomyopathy. The definition of DCM with arrhythmic phenotype is not universally accepted, leading to uncertainty in the identification of high-risk patients. This study aimed to assess the prognostic impact of arrhythmic phenotype in risk stratification and the correlation of arrhythmic markers with high-risk arrhythmogenic gene variants in DCM patients. METHODS AND RESULTS In this multicentre study, DCM patients with available genetic testing were analysed. The following arrhythmic markers, present at baseline or within 1 year of enrolment, were tested: unexplained syncope, rapid non-sustained ventricular tachycardia (NSVT), ≥1000 premature ventricular contractions/24 h or ≥50 ventricular couplets/24 h. LMNA, FLNC, RBM20, and desmosomal pathogenic or likely pathogenic gene variants were considered high-risk arrhythmogenic genes. The study endpoint was a composite of sudden cardiac death and major ventricular arrhythmias (SCD/MVA). We studied 742 DCM patients (45 ± 14 years, 34% female, 410 [55%] with left ventricular ejection fraction [LVEF] <35%). During a median follow-up of 6 years (interquartile range 1.6-12.1), unexplained syncope and NSVT were the only arrhythmic markers associated with SCD/MVA, and the combination of the two markers carried a significant additive risk of SCD/MVA, incremental to LVEF and New York Heart Association class. The probability of identifying an arrhythmogenic genotype rose from 8% to 30% if both early syncope and NSVT were present. CONCLUSION In DCM patients, the combination of early detected NSVT and unexplained syncope increases the risk of life-threatening arrhythmic outcomes and can aid the identification of carriers of malignant arrhythmogenic genotypes.
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Affiliation(s)
- Martina Setti
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Marco Merlo
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Marta Gigli
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Laura Munaretto
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Alessia Paldino
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Davide Stolfo
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Carola Pio Loco
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Kristen Medo
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Caterina Gregorio
- Biostatistics Unit, University of Trieste, Trieste, Italy
- MOX-Modeling and Scientific Computing Laboratory, Department of Mathematics, Politecnico di Milano, Milan, Italy
| | - Antonio De Luca
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Sharon Graw
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Matteo Castrichini
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Antonio Cannatà
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
- Department of Cardiovascular Sciences, King's College London, London, UK
| | | | - Matteo Dal Ferro
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Matthew Taylor
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gianfranco Sinagra
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Luisa Mestroni
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Gao S, He L, Lam CK, Taylor MRG, Mestroni L, Lombardi R, Chen SN. Filamin C Deficiency Impairs Sarcomere Stability and Activates Focal Adhesion Kinase through PDGFRA Signaling in Induced Pluripotent Stem Cell-Derived Cardiomyocytes. Cells 2024; 13:278. [PMID: 38334670 PMCID: PMC10854597 DOI: 10.3390/cells13030278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/23/2024] [Accepted: 01/31/2024] [Indexed: 02/10/2024] Open
Abstract
Truncating mutations in filamin C (FLNC) are associated with dilated cardiomyopathy and arrhythmogenic cardiomyopathy. FLNC is an actin-binding protein and is known to interact with transmembrane and structural proteins; hence, the ablation of FLNC in cardiomyocytes is expected to dysregulate cell adhesion, cytoskeletal organization, sarcomere structural integrity, and likely nuclear function. Our previous study showed that the transcriptional profiles of FLNC homozygous deletions in human pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) are highly comparable to the transcriptome profiles of hiPSC-CMs from patients with FLNC truncating mutations. Therefore, in this study, we used CRISPR-Cas-engineered hiPSC-derived FLNC knockout cardiac myocytes as a model of FLNC cardiomyopathy to determine pathogenic mechanisms and to examine structural changes caused by FLNC deficiency. RNA sequencing data indicated the significant upregulation of focal adhesion signaling and the dysregulation of thin filament genes in FLNC-knockout (FLNCKO) hiPSC-CMs compared to isogenic hiPSC-CMs. Furthermore, our findings suggest that the complete loss of FLNC in cardiomyocytes led to cytoskeletal defects and the activation of focal adhesion kinase. Pharmacological inhibition of PDGFRA signaling using crenolanib (an FDA-approved drug) reduced focal adhesion kinase activation and partially normalized the focal adhesion signaling pathway. The findings from this study suggest the opportunity in repurposing FDA-approved drug as a therapeutic strategy to treat FLNC cardiomyopathy.
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Affiliation(s)
- Shanshan Gao
- University of Colorado Cardiovascular Institute, University of Colorado-Anschutz Medical and Boulder Campuses, Aurora, CO 80045, USA; (S.G.); (L.H.); (M.R.G.T.); (L.M.); (R.L.)
| | - Lingaonan He
- University of Colorado Cardiovascular Institute, University of Colorado-Anschutz Medical and Boulder Campuses, Aurora, CO 80045, USA; (S.G.); (L.H.); (M.R.G.T.); (L.M.); (R.L.)
| | - Chi Keung Lam
- Department of Biological Sciences, University of Delaware, Newark, NE 19716, USA;
| | - Matthew R. G. Taylor
- University of Colorado Cardiovascular Institute, University of Colorado-Anschutz Medical and Boulder Campuses, Aurora, CO 80045, USA; (S.G.); (L.H.); (M.R.G.T.); (L.M.); (R.L.)
| | - Luisa Mestroni
- University of Colorado Cardiovascular Institute, University of Colorado-Anschutz Medical and Boulder Campuses, Aurora, CO 80045, USA; (S.G.); (L.H.); (M.R.G.T.); (L.M.); (R.L.)
| | - Raffaella Lombardi
- University of Colorado Cardiovascular Institute, University of Colorado-Anschutz Medical and Boulder Campuses, Aurora, CO 80045, USA; (S.G.); (L.H.); (M.R.G.T.); (L.M.); (R.L.)
- Department of Advanced Biomedical Sciences, “Federico II” University of Naples, 80138 Naples, Italy
| | - Suet Nee Chen
- University of Colorado Cardiovascular Institute, University of Colorado-Anschutz Medical and Boulder Campuses, Aurora, CO 80045, USA; (S.G.); (L.H.); (M.R.G.T.); (L.M.); (R.L.)
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Eldemire R, Mestroni L, Taylor MRG. Genetics of Dilated Cardiomyopathy. Annu Rev Med 2024; 75:417-426. [PMID: 37788487 PMCID: PMC10842880 DOI: 10.1146/annurev-med-052422-020535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Dilated cardiomyopathy (DCM) is defined as dilation and/or reduced function of one or both ventricles and remains a common disease worldwide. An estimated 40% of cases of familial DCM have an identifiable genetic cause. Accordingly, there is a fast-growing interest in the field of molecular genetics as it pertains to DCM. Many gene mutations have been identified that contribute to phenotypically significant cardiomyopathy. DCM genes can affect a variety of cardiomyocyte functions, and particular genes whose function affects the cell-cell junction and cytoskeleton are associated with increased risk of arrhythmias and sudden cardiac death. Through advancements in next-generation sequencing and cardiac imaging, identification of genetic DCM has improved over the past couple decades, and precision medicine is now at the forefront of treatment for these patients and their families. In addition to standard treatment of heart failure and prevention of arrhythmias and sudden cardiac death, patients with genetic cardiomyopathy stand to benefit from gene mechanism-specific therapies.
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Affiliation(s)
- Ramone Eldemire
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA;
| | - Luisa Mestroni
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA;
- Cardiovascular Institute, University of Colorado, Aurora, Colorado, USA
| | - Matthew R G Taylor
- Cardiovascular Institute, University of Colorado, Aurora, Colorado, USA
- Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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6
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Cannie DE, Syrris P, Protonotarios A, Bakalakos A, Pruny JF, Ditaranto R, Martinez-Veira C, Larrañaga-Moreira JM, Medo K, Bermúdez-Jiménez FJ, Ben Yaou R, Leturcq F, Mezcua AR, Marini-Bettolo C, Cabrera E, Reuter C, Limeres Freire J, Rodríguez-Palomares JF, Mestroni L, Taylor MRG, Parikh VN, Ashley EA, Barriales-Villa R, Jiménez-Jáimez J, Garcia-Pavia P, Charron P, Biagini E, García Pinilla JM, Bourke J, Savvatis K, Wahbi K, Elliott PM. Emery-Dreifuss muscular dystrophy Type 1 is associated with a high risk of malignant ventricular arrhythmias and end-stage heart failure. Eur Heart J 2023; 44:5064-5073. [PMID: 37639473 PMCID: PMC10733739 DOI: 10.1093/eurheartj/ehad561] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/06/2023] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND AND AIMS Emery-Dreifuss muscular dystrophy (EDMD) is caused by variants in EMD (EDMD1) and LMNA (EDMD2). Cardiac conduction defects and atrial arrhythmia are common to both, but LMNA variants also cause end-stage heart failure (ESHF) and malignant ventricular arrhythmia (MVA). This study aimed to better characterize the cardiac complications of EMD variants. METHODS Consecutively referred EMD variant-carriers were retrospectively recruited from 12 international cardiomyopathy units. MVA and ESHF incidences in male and female variant-carriers were determined. Male EMD variant-carriers with a cardiac phenotype at baseline (EMDCARDIAC) were compared with consecutively recruited male LMNA variant-carriers with a cardiac phenotype at baseline (LMNACARDIAC). RESULTS Longitudinal follow-up data were available for 38 male and 21 female EMD variant-carriers [mean (SD) ages 33.4 (13.3) and 43.3 (16.8) years, respectively]. Nine (23.7%) males developed MVA and five (13.2%) developed ESHF during a median (inter-quartile range) follow-up of 65.0 (24.3-109.5) months. No female EMD variant-carrier had MVA or ESHF, but nine (42.8%) developed a cardiac phenotype at a median (inter-quartile range) age of 58.6 (53.2-60.4) years. Incidence rates for MVA were similar for EMDCARDIAC and LMNACARDIAC (4.8 and 6.6 per 100 person-years, respectively; log-rank P = .49). Incidence rates for ESHF were 2.4 and 5.9 per 100 person-years for EMDCARDIAC and LMNACARDIAC, respectively (log-rank P = .09). CONCLUSIONS Male EMD variant-carriers have a risk of progressive heart failure and ventricular arrhythmias similar to that of male LMNA variant-carriers. Early implantable cardioverter defibrillator implantation and heart failure drug therapy should be considered in male EMD variant-carriers with cardiac disease.
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Affiliation(s)
- Douglas E Cannie
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Inherited Cardiovascular Diseases, Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Petros Syrris
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Inherited Cardiovascular Diseases, Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Alexandros Protonotarios
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Inherited Cardiovascular Diseases, Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Athanasios Bakalakos
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Inherited Cardiovascular Diseases, Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Jean-François Pruny
- APHP, Sorbonne Université, Centre de Référence pour les Maladies Cardiaques Héréditaires ou rares, ICAN Institute, Hôpital Pitié-Salpêtrière, Paris, France
| | - Raffaello Ditaranto
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART)
| | - Cristina Martinez-Veira
- Unidad de Cardiopatías Familiares, Complexo Hospitalario Universitario de A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC/CIBERCV), Servizo Galego de Saúde (SERGAS), Universidade da Coruña, A Coruña, Spain
| | - Jose M Larrañaga-Moreira
- Unidad de Cardiopatías Familiares, Complexo Hospitalario Universitario de A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC/CIBERCV), Servizo Galego de Saúde (SERGAS), Universidade da Coruña, A Coruña, Spain
| | - Kristen Medo
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Francisco José Bermúdez-Jiménez
- Cardiology Department, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria IBS Granada, Granada, Spain
| | - Rabah Ben Yaou
- APHP-Sorbonne Universite, Centre de Référence des Maladies Neuromusculaires, Inserm, Centre de Recherche en Myologie, Institut de Myologie, Hopital Pitie-Salpetriere, Paris, France
| | - France Leturcq
- APHP, Cochin Hospital, Department of Genomic Medicine and Systemic Diseases, University of Paris, Paris, France
| | - Ainhoa Robles Mezcua
- Heart Failure and Familial Cardiomyopathies Unit, Department of Cardiology, IBIMA, Málaga. Spain
- Ciber-Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Chiara Marini-Bettolo
- Department of Cardiology, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Eva Cabrera
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART)
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, CIBERCV, Madrid, Spain
| | - Chloe Reuter
- Stanford Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
| | - Javier Limeres Freire
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART)
- Ciber-Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
- Inherited Cardiovascular Diseases Unit, Department of Cardiology, Hospital Universitari Vall d´Hebron, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José F Rodríguez-Palomares
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART)
- Ciber-Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
- Inherited Cardiovascular Diseases Unit, Department of Cardiology, Hospital Universitari Vall d´Hebron, Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luisa Mestroni
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Matthew R G Taylor
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Victoria N Parikh
- Stanford Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
| | - Euan A Ashley
- Stanford Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
| | - Roberto Barriales-Villa
- Unidad de Cardiopatías Familiares, Complexo Hospitalario Universitario de A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC/CIBERCV), Servizo Galego de Saúde (SERGAS), Universidade da Coruña, A Coruña, Spain
| | - Juan Jiménez-Jáimez
- Cardiology Department, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria IBS Granada, Granada, Spain
| | - Pablo Garcia-Pavia
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART)
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, CIBERCV, Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Philippe Charron
- APHP, Sorbonne Université, Centre de Référence pour les Maladies Cardiaques Héréditaires ou rares, ICAN Institute, Hôpital Pitié-Salpêtrière, Paris, France
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART)
| | - Elena Biagini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART)
| | - José M García Pinilla
- Heart Failure and Familial Cardiomyopathies Unit, Department of Cardiology, IBIMA, Málaga. Spain
- Ciber-Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
- Departamento de Medicina y Dermatología, Universidad de Malaga, Malaga, Spain
| | - John Bourke
- Department of Cardiology, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
- The John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Konstantinos Savvatis
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Inherited Cardiovascular Diseases, Barts Heart Centre, St Bartholomew’s Hospital, London, UK
- William Harvey Institute, Queen Mary University London, London, United Kingdom
- National Institute for Health Research, University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Karim Wahbi
- AP-HP, Pitié-Salpêtrière Hospital, Reference Center for Muscle Diseases Paris-Est, Myology Institute, Paris, France
- AP-HP, Cochin Hospital, Cardiology Department, Paris Cedex, France
- Université de Paris, Paris, France; Paris Cardiovascular Research Center (PARCC), INSERM Unit 970, Paris, France
| | - Perry M Elliott
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Inherited Cardiovascular Diseases, Barts Heart Centre, St Bartholomew’s Hospital, London, UK
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Namasivayam M, Bertrand PB, Bernard S, Churchill TW, Khurshid S, Marcus FI, Mestroni L, Saffitz JE, Towbin JA, Zareba W, Picard MH, Sanborn DY. Utility of Left and Right Ventricular Strain in Arrhythmogenic Right Ventricular Cardiomyopathy: A Prospective Multicenter Registry. Circ Cardiovasc Imaging 2023; 16:e015671. [PMID: 38113321 PMCID: PMC10803132 DOI: 10.1161/circimaging.123.015671] [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: 05/06/2023] [Accepted: 11/13/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Imaging evaluation of arrhythmogenic right ventricular cardiomyopathy (ARVC) remains challenging. Myocardial strain assessment by echocardiography is an increasingly utilized technique for detecting subclinical left ventricular (LV) and right ventricular (RV) dysfunction. We aimed to evaluate the diagnostic and prognostic utility of LV and RV strain in ARVC. METHODS Patients with suspected ARVC (n = 109) from a multicenter registry were clinically phenotyped using the 2010 ARVC Revised Task Force Criteria and underwent baseline strain echocardiography. Diagnostic performance of LV and RV strain was evaluated using the area under the receiver operating characteristic curve analysis against the 2010 ARVC Revised Task Force Criteria, and the prognostic value was assessed using the Kaplan-Meier analysis. RESULTS Mean age was 45.3±14.7 years, and 48% of patients were female. Estimation of RV strain was feasible in 99/109 (91%), and LV strain was feasible in 85/109 (78%) patients. ARVC prevalence by 2010 ARVC Revised Task Force Criteria is 91/109 (83%) and 83/99 (84%) in those with RV strain measurements. RV global longitudinal strain and RV free wall strain had diagnostic area under the receiver operating characteristic curve of 0.76 and 0.77, respectively (both P<0.001; difference NS). Abnormal RV global longitudinal strain phenotype (RV global longitudinal strain > -17.9%) and RV free wall strain phenotype (RV free wall strain > -21.2%) were identified in 41/69 (59%) and 56/69 (81%) of subjects, respectively, who were not identified by conventional echocardiographic criteria but still met the overall 2010 ARVC Revised Task Force Criteria for ARVC. LV global longitudinal strain did not add diagnostic value but was prognostic for composite end points of death, heart transplantation, or ventricular arrhythmia (log-rank P=0.04). CONCLUSIONS In a prospective, multicenter registry of ARVC, RV strain assessment added diagnostic value to current echocardiographic criteria by identifying patients who are missed by current echocardiographic criteria yet still fulfill the diagnosis of ARVC. LV strain, by contrast, did not add incremental diagnostic value but was prognostic for identification of high-risk patients.
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Affiliation(s)
- Mayooran Namasivayam
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Cardiology, St Vincent’s Hospital, Faculty of Medicine and Health, University of New South Wales, Victor Chang Cardiac Research Institute, Sydney, Australia
| | - Philippe B. Bertrand
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Samuel Bernard
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston
- Division of Cardiology, NYU Langone Health, New York University
| | - Timothy W. Churchill
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Shaan Khurshid
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | | | - Luisa Mestroni
- Division of Cardiology and Cardiovascular Institute, University of Colorado Anschutz Medical Campus, Aurora
| | | | - Jeffrey A. Towbin
- St. Jude Children’s Research Hospital, University of Tennessee Health Science Center, Memphis
| | | | - Michael H. Picard
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston
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8
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Nagyova E, Hoorntje ET, Te Rijdt WP, Bosman LP, Syrris P, Protonotarios A, Elliott PM, Tsatsopoulou A, Mestroni L, Taylor MRG, Sinagra G, Merlo M, Wada Y, Horie M, Mogensen J, Christensen AH, Gerull B, Song L, Yao Y, Fan S, Saguner AM, Duru F, Koskenvuo JW, Cruz Marino T, Tichnell C, Judge DP, Dooijes D, Lekanne Deprez RH, Basso C, Pilichou K, Bauce B, Wilde AAM, Charron P, Fressart V, van der Heijden JF, van den Berg MP, Asselbergs FW, James CA, Jongbloed JDH, Harakalova M, van Tintelen JP. A Systematic Analysis of the Clinical Outcome Associated with Multiple Reclassified Desmosomal Gene Variants in Arrhythmogenic Right Ventricular Cardiomyopathy Patients. J Cardiovasc Transl Res 2023; 16:1276-1286. [PMID: 37418234 PMCID: PMC10721666 DOI: 10.1007/s12265-023-10403-8] [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: 12/21/2022] [Accepted: 06/07/2023] [Indexed: 07/08/2023]
Abstract
The presence of multiple pathogenic variants in desmosomal genes (DSC2, DSG2, DSP, JUP, and PKP2) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) has been linked to a severe phenotype. However, the pathogenicity of variants is reclassified frequently, which may result in a changed clinical risk prediction. Here, we present the collection, reclassification, and clinical outcome correlation for the largest series of ARVC patients carrying multiple desmosomal pathogenic variants to date (n = 331). After reclassification, only 29% of patients remained carriers of two (likely) pathogenic variants. They reached the composite endpoint (ventricular arrhythmias, heart failure, and death) significantly earlier than patients with one or no remaining reclassified variant (hazard ratios of 1.9 and 1.8, respectively). Periodic reclassification of variants contributes to more accurate risk stratification and subsequent clinical management strategy. Graphical Abstract.
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Affiliation(s)
- Emilia Nagyova
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Department of Molecular Biology, Faculty of Natural Sciences, Comenius University in Bratislava, Bratislava, Slovakia
| | - Edgar T Hoorntje
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Wouter P Te Rijdt
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Laurens P Bosman
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Petros Syrris
- Center for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, UK
| | - Alexandros Protonotarios
- Center for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, UK
- Nikos Protonotarios Medical Center, 84300, Naxos, Greece
| | - Perry M Elliott
- Center for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, UK
| | | | - Luisa Mestroni
- Cardiovascular Institute, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Matthew R G Taylor
- Cardiovascular Institute, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria-Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Marco Merlo
- Cardiothoracovascular Department, Azienda Sanitaria-Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Yuko Wada
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Minoru Horie
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Jens Mogensen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Alex H Christensen
- Department of Cardiology, Herlev-Gentofte and Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Brenda Gerull
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Comprehensive Heart Failure Center (CHFC) and Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Lei Song
- Arrhythmia Center and Clinical EP Laboratory, State Key Laboratory of Cardiovascular Diseases, National Center for Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College-Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Yao
- Arrhythmia Center and Clinical EP Laboratory, State Key Laboratory of Cardiovascular Diseases, National Center for Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College-Chinese Academy of Medical Sciences, Beijing, China
| | - Siyang Fan
- Arrhythmia Center and Clinical EP Laboratory, State Key Laboratory of Cardiovascular Diseases, National Center for Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College-Chinese Academy of Medical Sciences, Beijing, China
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center, Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Heart Center, Zurich, Switzerland
| | | | - Tania Cruz Marino
- Department of Medical Biology, CIUSSS Saguenay Lac-St-Jean, Chicoutimi, QC, Canada
| | - Crystal Tichnell
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Daniel P Judge
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, USA
| | - Dennis Dooijes
- Department of Genetics, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Ronald H Lekanne Deprez
- Department of Human Genetics, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Cristina Basso
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Kalliopi Pilichou
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Barbara Bauce
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Arthur A M Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Philippe Charron
- APHP, Referral Center for Cardiac Hereditary Diseases, Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France
| | - Véronique Fressart
- APHP, Referral Center for Cardiac Hereditary Diseases, Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France
| | - Jeroen F van der Heijden
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Maarten P van den Berg
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Science, University College London, London, UK
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Jan D H Jongbloed
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Magdalena Harakalova
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
- Netherlands Heart Institute, Utrecht, The Netherlands.
- Regenerative Medicine Utrecht (RMU), University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands.
| | - J Peter van Tintelen
- Netherlands Heart Institute, Utrecht, The Netherlands
- Department of Human Genetics, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Department of Genetics, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
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9
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Tu C, Caudal A, Liu Y, Gorgodze N, Zhang H, Lam CK, Dai Y, Zhang A, Wnorowski A, Wu MA, Yang H, Abilez OJ, Lyu X, Narayan SM, Mestroni L, Taylor MRG, Recchia FA, Wu JC. Tachycardia-induced metabolic rewiring as a driver of contractile dysfunction. Nat Biomed Eng 2023:10.1038/s41551-023-01134-x. [PMID: 38012305 DOI: 10.1038/s41551-023-01134-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 10/15/2023] [Indexed: 11/29/2023]
Abstract
Prolonged tachycardia-a risk factor for cardiovascular morbidity and mortality-can induce cardiomyopathy in the absence of structural disease in the heart. Here, by leveraging human patient data, a canine model of tachycardia and engineered heart tissue generated from human induced pluripotent stem cells, we show that metabolic rewiring during tachycardia drives contractile dysfunction by promoting tissue hypoxia, elevated glucose utilization and the suppression of oxidative phosphorylation. Mechanistically, a metabolic shift towards anaerobic glycolysis disrupts the redox balance of nicotinamide adenine dinucleotide (NAD), resulting in increased global protein acetylation (and in particular the acetylation of sarcoplasmic/endoplasmic reticulum Ca2+-ATPase), a molecular signature of heart failure. Restoration of NAD redox by NAD+ supplementation reduced sarcoplasmic/endoplasmic reticulum Ca2+-ATPase acetylation and accelerated the functional recovery of the engineered heart tissue after tachycardia. Understanding how metabolic rewiring drives tachycardia-induced cardiomyopathy opens up opportunities for therapeutic intervention.
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Affiliation(s)
- Chengyi Tu
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Arianne Caudal
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Yu Liu
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Nikoloz Gorgodze
- Aging + Cardiovascular Discovery Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Hao Zhang
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Chi Keung Lam
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Yuqin Dai
- Sarafan ChEM-H, Stanford University, Stanford, CA, USA
| | - Angela Zhang
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Greenstone Biosciences, Palo Alto, CA, USA
| | - Alexa Wnorowski
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Matthew A Wu
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
- Greenstone Biosciences, Palo Alto, CA, USA
| | - Huaxiao Yang
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Oscar J Abilez
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Xuchao Lyu
- Department of Pathology, Stanford University, Stanford, CA, USA
| | | | - Luisa Mestroni
- Human Medical Genetics and Genomics, University of Colorado, Aurora, CO, USA
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado, Aurora, CO, USA
| | - Matthew R G Taylor
- Human Medical Genetics and Genomics, University of Colorado, Aurora, CO, USA
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado, Aurora, CO, USA
| | - Fabio A Recchia
- Aging + Cardiovascular Discovery Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
- Scuola Superiore Sant'Anna, Pisa, Italy
- Institute of Clinical Physiology of the National Research Council, Pisa, Italy
| | - Joseph C Wu
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA.
- Department of Medicine, Stanford University, Stanford, CA, USA.
- Department of Radiology, Stanford University, Stanford, CA, USA.
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10
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Vissing CR, Axelsson Raja A, Day SM, Russell MW, Zahka K, Lever HM, Pereira AC, Colan SD, Margossian R, Murphy AM, Canter C, Bach RG, Wheeler MT, Rossano JW, Owens AT, Benson L, Mestroni L, Taylor MRG, Patel AR, Wilmot I, Thrush P, Soslow JH, Becker JR, Seidman CE, Lakdawala NK, Cirino AL, McMurray JJV, MacRae CA, Solomon SD, Bundgaard H, Orav EJ, Ho CY. Cardiac Remodeling in Subclinical Hypertrophic Cardiomyopathy: The VANISH Randomized Clinical Trial. JAMA Cardiol 2023; 8:1083-1088. [PMID: 37672268 PMCID: PMC10483382 DOI: 10.1001/jamacardio.2023.2808] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/23/2023] [Indexed: 09/07/2023]
Abstract
Importance Valsartan has shown promise in attenuating cardiac remodeling in patients with early-stage sarcomeric hypertrophic cardiomyopathy (HCM). Genetic testing can identify individuals at risk of HCM in a subclinical stage who could benefit from therapies that prevent disease progression. Objective To explore the potential for valsartan to modify disease development, and to characterize short-term phenotypic progression in subclinical HCM. Design, Setting, and Participants The multicenter, double-blind, placebo-controlled Valsartan for Attenuating Disease Evolution in Early Sarcomeric Hypertrophic Cardiomyopathy (VANISH) randomized clinical trial was conducted from April 2014 to July 2019 at 17 sites in 4 countries (Brazil, Canada, Denmark, and the US), with 2 years of follow-up. The prespecified exploratory VANISH cohort studied here included sarcomere variant carriers with subclinical HCM and early phenotypic manifestations (reduced E' velocity, electrocardiographic abnormalities, or an increased left ventricular [LV] wall thickness [LVWT] to cavity diameter ratio) but no LV hypertrophy (LVH). Data were analyzed between March and December 2022. Interventions Treatment with placebo or valsartan (80 mg/d for children weighing <35 kg, 160 mg/d for children weighing ≥35 kg, or 320 mg/d for adults aged ≥18 years). Main Outcomes and Measures The primary outcome was a composite z score incorporating changes in 9 parameters of cardiac remodeling (LV cavity volume, LVWT, and LV mass; left atrial [LA] volume; E' velocity and S' velocity; and serum troponin and N-terminal prohormone of brain natriuretic peptide levels). Results This study included 34 participants, with a mean (SD) age of 16 (5) years (all were White). A total of 18 participants (8 female [44%] and 10 male [56%]) were randomized to valsartan and 16 (9 female [56%] and 7 male [44%]) were randomized to placebo. No statistically significant effects of valsartan on cardiac remodeling were detected (mean change in composite z score compared with placebo: -0.01 [95% CI, -0.29 to 0.26]; P = .92). Overall, 2-year phenotypic progression was modest, with only a mild increase in LA volume detected (increased by 3.5 mL/m2 [95% CI, 1.4-6.0 mL/m2]; P = .002). Nine participants (26%) had increased LVWT, including 6 (18%) who developed clinically overt HCM. Baseline LA volume index (LAVI; 35 vs 28 mL/m2; P = .01) and average interventricular septum thickness (8.5 vs 7.0 mm; P = .009) were higher in participants who developed HCM. Conclusions and Relevance In this exploratory cohort, valsartan was not proven to slow progression of subclinical HCM. Minimal changes in markers of cardiac remodeling were observed, although nearly one-fifth of patients developed clinically overt HCM. Transition to disease was associated with greater baseline interventricular septum thickness and LAVI. These findings highlight the importance of following sarcomere variant carriers longitudinally and the critical need to improve understanding of factors that drive disease penetrance and progression. Trial Registration ClinicalTrials.gov Identifier: NCT01912534.
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Affiliation(s)
- Christoffer Rasmus Vissing
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna Axelsson Raja
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sharlene M. Day
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | | | | | | | - Alexandre C. Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Steven D. Colan
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
| | - Renee Margossian
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
| | - Anne M. Murphy
- Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charles Canter
- Washington University School of Medicine, St Louis, Missouri
| | - Richard G. Bach
- Washington University School of Medicine, St Louis, Missouri
| | - Matthew T. Wheeler
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | | | - Anjali T. Owens
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Lee Benson
- Toronto Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - Amit R. Patel
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville
| | - Ivan Wilmot
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Philip Thrush
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | | | - Jason R. Becker
- Division of Cardiology, University of Pittsburgh School of Medicine and UPMC, Pittsburgh, Pennsylvania
| | - Christine E. Seidman
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Howard Hughes Medical Institute, Chevy Chase, Maryland
| | - Neal K. Lakdawala
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Allison L. Cirino
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - John J. V. McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Calum A. MacRae
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Scott D. Solomon
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Henning Bundgaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - E. John Orav
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carolyn Y. Ho
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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11
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Liu D, Wang M, Murthy V, McNamara DM, Nguyen TTL, Philips TJ, Vyas H, Gao H, Sahni J, Starling RC, Cooper LT, Skime MK, Batzler A, Jenkins GD, Barlera S, Pileggi S, Mestroni L, Merlo M, Sinagra G, Pinet F, Krejčí J, Chaloupka A, Miller JD, de Groote P, Tschumperlin DJ, Weinshilboum RM, Pereira NL. Myocardial Recovery in Recent Onset Dilated Cardiomyopathy: Role of CDCP1 and Cardiac Fibrosis. Circ Res 2023; 133:810-825. [PMID: 37800334 PMCID: PMC10746262 DOI: 10.1161/circresaha.123.323200] [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: 06/25/2023] [Accepted: 09/22/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Dilated cardiomyopathy (DCM) is a major cause of heart failure and carries a high mortality rate. Myocardial recovery in DCM-related heart failure patients is highly variable, with some patients having little or no response to standard drug therapy. A genome-wide association study may agnostically identify biomarkers and provide novel insight into the biology of myocardial recovery in DCM. METHODS A genome-wide association study for change in left ventricular ejection fraction was performed in 686 White subjects with recent-onset DCM who received standard pharmacotherapy. Genome-wide association study signals were subsequently functionally validated and studied in relevant cellular models to understand molecular mechanisms that may have contributed to the change in left ventricular ejection fraction. RESULTS The genome-wide association study identified a highly suggestive locus that mapped to the 5'-flanking region of the CDCP1 (CUB [complement C1r/C1s, Uegf, and Bmp1] domain containing protein 1) gene (rs6773435; P=7.12×10-7). The variant allele was associated with improved cardiac function and decreased CDCP1 transcription. CDCP1 expression was significantly upregulated in human cardiac fibroblasts (HCFs) in response to the PDGF (platelet-derived growth factor) signaling, and knockdown of CDCP1 significantly repressed HCF proliferation and decreased AKT (protein kinase B) phosphorylation. Transcriptomic profiling after CDCP1 knockdown in HCFs supported the conclusion that CDCP1 regulates HCF proliferation and mitosis. In addition, CDCP1 knockdown in HCFs resulted in significantly decreased expression of soluble ST2 (suppression of tumorigenicity-2), a prognostic biomarker for heart failure and inductor of cardiac fibrosis. CONCLUSIONS CDCP1 may play an important role in myocardial recovery in recent-onset DCM and mediates its effect primarily by attenuating cardiac fibrosis.
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Affiliation(s)
- Duan Liu
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Min Wang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Vishakantha Murthy
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Medicine. Mayo Clinic, Rochester, MN, USA
| | | | | | - Thanh Thanh L. Nguyen
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Trudy J. Philips
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Hridyanshu Vyas
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Huanyao Gao
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Jyotan Sahni
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Leslie T. Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Michelle K. Skime
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Anthony Batzler
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Simona Barlera
- Department of Cardiovascular Research, Istituto di Ricovero e Cura a Carattere Scientifico–Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Silvana Pileggi
- Department of Cardiovascular Research, Istituto di Ricovero e Cura a Carattere Scientifico–Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Luisa Mestroni
- Cardiovascular Institute, University of Colorado School of Medicine, Aurora, CO, USA
| | - Marco Merlo
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
| | - Florence Pinet
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167, Lille, France
| | - Jan Krejčí
- St. Anne’s University Hospital and Masaryk University, Brno, Czech Republic
| | - Anna Chaloupka
- St. Anne’s University Hospital and Masaryk University, Brno, Czech Republic
| | - Jordan D. Miller
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Pascal de Groote
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167, Lille, France
- CHU Lille, Service de Cardiologie, Lille, France
| | | | - Richard M. Weinshilboum
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Naveen L. Pereira
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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12
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Cannie DE, Protonotarios A, Bakalakos A, Syrris P, Lorenzini M, De Stavola B, Bjerregaard L, Dybro AM, Hey TM, Hansen FG, Navarro Peñalver M, Crespo-Leiro MG, Larrañaga-Moreira JM, de Frutos F, Johnson R, Slater TA, Monserrat L, Sengupta A, Mestroni L, Taylor MR, Sinagra G, Bilinska Z, Solla-Ruiz I, Arana Achaga X, Barriales-Villa R, Garcia-Pavia P, Gimeno JR, Dal Ferro M, Merlo M, Wahbi K, Fatkin D, Mogensen J, Rasmussen TB, Elliott PM. Risks of Ventricular Arrhythmia and Heart Failure in Carriers of RBM20 Variants. Circ Genom Precis Med 2023; 16:434-441. [PMID: 37593875 PMCID: PMC10581410 DOI: 10.1161/circgen.123.004059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/20/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Variants in RBM20 are reported in 2% to 6% of familial cases of dilated cardiomyopathy and may be associated with fatal ventricular arrhythmia and rapid heart failure progression. We sought to determine the risk of adverse events in RBM20 variant carriers and the impact of sex on outcomes. METHODS Consecutive probands and relatives carrying RBM20 variants were retrospectively recruited from 12 cardiomyopathy units. The primary end point was a composite of malignant ventricular arrhythmia (MVA) and end-stage heart failure (ESHF). MVA and ESHF end points were also analyzed separately and men and women compared. Left ventricular ejection fraction (LVEF) contemporary to MVA was examined. RBM20 variant carriers with left ventricular systolic dysfunction (RBM20LVSD) were compared with variant-elusive patients with idiopathic left ventricular systolic dysfunction. RESULTS Longitudinal follow-up data were available for 143 RBM20 variant carriers (71 men; median age, 35.5 years); 7 of 143 had an MVA event at baseline. Thirty of 136 without baseline MVA (22.0%) reached the primary end point, and 16 of 136 (11.8%) had new MVA with no significant difference between men and women (log-rank P=0.07 and P=0.98, respectively). Twenty of 143 (14.0%) developed ESHF (17 men and 3 women; log-rank P<0.001). Four of 10 variant carriers with available LVEF contemporary to MVA had an LVEF >35%. At 5 years, 15 of 67 (22.4%) RBM20LVSD versus 7 of 197 (3.6%) patients with idiopathic left ventricular systolic dysfunction had reached the primary end point (log-rank P<0.001). RBM20 variant carriage conferred a 6.0-fold increase in risk of the primary end point. CONCLUSIONS RBM20 variants are associated with a high risk of MVA and ESHF compared with idiopathic left ventricular systolic dysfunction. The risk of MVA in male and female RBM20 variant carriers is similar, but male sex is strongly associated with ESHF.
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Affiliation(s)
- Douglas E. Cannie
- Institute of Cardiovascular Science, University College London, United Kingdom (D.E.C., A.P., A.B., P.S., M.L., P.M.E.)
- Department of Inherited Cardiovascular Diseases, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (D.E.C., A.P., A.B., M.L., P.M.E.)
| | - Alexandros Protonotarios
- Institute of Cardiovascular Science, University College London, United Kingdom (D.E.C., A.P., A.B., P.S., M.L., P.M.E.)
- Department of Inherited Cardiovascular Diseases, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (D.E.C., A.P., A.B., M.L., P.M.E.)
| | - Athanasios Bakalakos
- Institute of Cardiovascular Science, University College London, United Kingdom (D.E.C., A.P., A.B., P.S., M.L., P.M.E.)
- Department of Inherited Cardiovascular Diseases, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (D.E.C., A.P., A.B., M.L., P.M.E.)
| | - Petros Syrris
- Institute of Cardiovascular Science, University College London, United Kingdom (D.E.C., A.P., A.B., P.S., M.L., P.M.E.)
| | - Massimiliano Lorenzini
- Institute of Cardiovascular Science, University College London, United Kingdom (D.E.C., A.P., A.B., P.S., M.L., P.M.E.)
- Department of Inherited Cardiovascular Diseases, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (D.E.C., A.P., A.B., M.L., P.M.E.)
| | - Bianca De Stavola
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, United Kingdom (B.D.S.)
| | - Louise Bjerregaard
- Department of Cardiology, Aarhus University Hospital, Denmark (L.B., A.M.D., T.B.R.)
| | - Anne M. Dybro
- Department of Cardiology, Aarhus University Hospital, Denmark (L.B., A.M.D., T.B.R.)
| | - Thomas M. Hey
- Department of Cardiology, Odense University Hospital, Denmark (T.M.H., F.G.H.)
| | | | - Marina Navarro Peñalver
- Inherited Cardiac Disease Unit, Hospital Universitario Virgen Arrixaca, Murcia, Spain (M.N.P., J.R.G.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) (M.N.P.,F.d.F., R.B.-V., M.G.C.-L., J.M.L.-M., P.G.-P., J.R.G.)
- Unit for Screening Studies in Inherited Cardiovascular Diseases, Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland (Z.B.)
| | - Maria G. Crespo-Leiro
- Unidad de Cardiopatías Familiares e Insuficiencia Cardíaca Avanzada, Complexo Hospitalario Universitario de A Coruña, Instituto de Investigación Biomédica de A Coruña, Servizo Galego de Saúde, Universidade da Coruña, Spain (R.B.-V., M.G.C.-L., J.M.L.-M.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) (M.N.P.,F.d.F., R.B.-V., M.G.C.-L., J.M.L.-M., P.G.-P., J.R.G.)
| | - Jose M. Larrañaga-Moreira
- Unidad de Cardiopatías Familiares e Insuficiencia Cardíaca Avanzada, Complexo Hospitalario Universitario de A Coruña, Instituto de Investigación Biomédica de A Coruña, Servizo Galego de Saúde, Universidade da Coruña, Spain (R.B.-V., M.G.C.-L., J.M.L.-M.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) (M.N.P.,F.d.F., R.B.-V., M.G.C.-L., J.M.L.-M., P.G.-P., J.R.G.)
| | - Fernando de Frutos
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, Amsterdam, the Netherlands (M.N.P.,F.d.F., P.G.-P., J.R.G., M.D.F., M.M., G.S.)
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Instituto Investigación Sanitaria Puerta de Hierro - Segovia de Arana (IDIPHISA), Madrid, Spain (F.d.F., P.G.-P.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) (M.N.P.,F.d.F., R.B.-V., M.G.C.-L., J.M.L.-M., P.G.-P., J.R.G.)
| | - Renee Johnson
- Victor Chang Cardiac Research Institute, Darlinghurst (R.J., D.F.)
- School of Clinical Medicine, University of New South Wales (UNSW) Medicine and Health, UNSW Sydney, Kensington, Australia (R.J., D.F.)
| | - Thomas A. Slater
- Yorkshire Heart Centre, Leeds General Infirmary, United Kingdom (T.A.S., A.S.)
| | - Lorenzo Monserrat
- Medical Department, Dilemma Solutions, A Coruña, Spain (L. Monserrat)
| | - Anshuman Sengupta
- Yorkshire Heart Centre, Leeds General Infirmary, United Kingdom (T.A.S., A.S.)
| | - Luisa Mestroni
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora (L. Mestroni, M.R.G.T.)
| | - Matthew R.G. Taylor
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora (L. Mestroni, M.R.G.T.)
| | - Gianfranco Sinagra
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, Amsterdam, the Netherlands (M.N.P.,F.d.F., P.G.-P., J.R.G., M.D.F., M.M., G.S.)
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina, University of Trieste, Italy (G.S., M.D.F., M.M.)
| | - Zofia Bilinska
- Unit for Screening Studies in Inherited Cardiovascular Diseases, Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland (Z.B.)
| | - Itziar Solla-Ruiz
- Department of Cardiology, Hospital Universitario Donostia, Spain (I.S.-R., X.A.A.)
| | - Xabier Arana Achaga
- Department of Cardiology, Hospital Universitario Donostia, Spain (I.S.-R., X.A.A.)
| | - Roberto Barriales-Villa
- Unidad de Cardiopatías Familiares e Insuficiencia Cardíaca Avanzada, Complexo Hospitalario Universitario de A Coruña, Instituto de Investigación Biomédica de A Coruña, Servizo Galego de Saúde, Universidade da Coruña, Spain (R.B.-V., M.G.C.-L., J.M.L.-M.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) (M.N.P.,F.d.F., R.B.-V., M.G.C.-L., J.M.L.-M., P.G.-P., J.R.G.)
| | - Pablo Garcia-Pavia
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, Amsterdam, the Netherlands (M.N.P.,F.d.F., P.G.-P., J.R.G., M.D.F., M.M., G.S.)
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Instituto Investigación Sanitaria Puerta de Hierro - Segovia de Arana (IDIPHISA), Madrid, Spain (F.d.F., P.G.-P.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) (M.N.P.,F.d.F., R.B.-V., M.G.C.-L., J.M.L.-M., P.G.-P., J.R.G.)
| | - Juan R. Gimeno
- Inherited Cardiac Disease Unit, Hospital Universitario Virgen Arrixaca, Murcia, Spain (M.N.P., J.R.G.)
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, Amsterdam, the Netherlands (M.N.P.,F.d.F., P.G.-P., J.R.G., M.D.F., M.M., G.S.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV) (M.N.P.,F.d.F., R.B.-V., M.G.C.-L., J.M.L.-M., P.G.-P., J.R.G.)
| | - Matteo Dal Ferro
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, Amsterdam, the Netherlands (M.N.P.,F.d.F., P.G.-P., J.R.G., M.D.F., M.M., G.S.)
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina, University of Trieste, Italy (G.S., M.D.F., M.M.)
| | - Marco Merlo
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, Amsterdam, the Netherlands (M.N.P.,F.d.F., P.G.-P., J.R.G., M.D.F., M.M., G.S.)
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano Isontina, University of Trieste, Italy (G.S., M.D.F., M.M.)
| | - Karim Wahbi
- Assistance Publique–Hôpitaux de Paris, Cochin Hospital, Cardiology Department, Université de Paris, Institut Imagine, France (K.W.)
| | - Diane Fatkin
- Victor Chang Cardiac Research Institute, Darlinghurst (R.J., D.F.)
- School of Clinical Medicine, University of New South Wales (UNSW) Medicine and Health, UNSW Sydney, Kensington, Australia (R.J., D.F.)
- Cardiology Department, St Vincent’s Hospital, Sydney, Australia (D.F.)
| | - Jens Mogensen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark (J.M.)
| | - Torsten B. Rasmussen
- Department of Cardiology, Aarhus University Hospital, Denmark (L.B., A.M.D., T.B.R.)
| | - Perry M. Elliott
- Institute of Cardiovascular Science, University College London, United Kingdom (D.E.C., A.P., A.B., P.S., M.L., P.M.E.)
- Department of Inherited Cardiovascular Diseases, Barts Heart Centre, St Bartholomew’s Hospital, London, United Kingdom (D.E.C., A.P., A.B., M.L., P.M.E.)
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Bueno-Beti C, Tafuni A, Chelko SP, Sheppard MN, Field E, Tollit J, Heenan IK, Barnes A, Taylor MR, Mestroni L, Kaski JP, Saffitz JE, Asimaki A. Innate immune signaling in hearts and buccal mucosa cells of patients with arrhythmogenic cardiomyopathy. Heart Rhythm O2 2023; 4:650-659. [PMID: 37936669 PMCID: PMC10626188 DOI: 10.1016/j.hroo.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
Background Nuclear factor κB (NF-κB) signaling in cardiac myocytes causes disease in a mouse model of arrhythmogenic cardiomyopathy (ACM) by mobilizing CCR2-expressing macrophages that promote myocardial injury and arrhythmias. Buccal mucosa cells exhibit pathologic features similar to those seen in cardiac myocytes in patients with ACM. Objectives We sought to determine if persistent innate immune signaling via NF-κB occurs in cardiac myocytes in patients with ACM and if this is associated with myocardial infiltration of proinflammatory cells expressing CCR2. We also determined if buccal mucosa cells from young subjects with inherited disease alleles exhibit NF-κB signaling. Methods We analyzed myocardium from ACM patients who died suddenly or required cardiac transplantation. We also analyzed buccal mucosa cells from young subjects with inherited disease alleles. The presence of immunoreactive signal for RelA/p65 in nuclei of cardiac myocytes and buccal cells was used as a reliable indicator of active NF-κB signaling. We also counted myocardial CCR2-expressing cells. Results RelA/p65 signal was seen in numerous cardiac myocyte nuclei in 34 of 36 cases of ACM but not in 19 age-matched control individuals. Cells expressing CCR2 were increased in patient hearts in numbers directly correlated with the number of cardiac myocytes showing NF-κB signaling. NF-κB signaling was observed in buccal cells in young subjects with active disease. Conclusions Patients with clinically active ACM exhibit persistent innate immune responses in cardiac myocytes and buccal mucosa cells, reflecting a local and systemic inflammatory process. Such individuals may benefit from anti-inflammatory therapy.
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Affiliation(s)
- Carlos Bueno-Beti
- Cardiovascular Academic and Clinical Academic Group and Cardiology Research Centre, Molecular and Clinical Sciences Research Group, St. George’s, University of London, United Kingdom
| | | | - Stephen P. Chelko
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, Florida
| | - Mary N. Sheppard
- Cardiovascular Academic and Clinical Academic Group and Cardiology Research Centre, Molecular and Clinical Sciences Research Group, St. George’s, University of London, United Kingdom
| | - Ella Field
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom
| | - Jennifer Tollit
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom
| | - Imogen K. Heenan
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom
| | - Annabelle Barnes
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom
| | - Matthew R. Taylor
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Luisa Mestroni
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Juan Pablo Kaski
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom
| | - Jeffrey E. Saffitz
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Angeliki Asimaki
- Cardiovascular Academic and Clinical Academic Group and Cardiology Research Centre, Molecular and Clinical Sciences Research Group, St. George’s, University of London, United Kingdom
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14
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Alegret N, Dominguez-Alfaro A, Mecerreyes D, Prato M, Mestroni L, Peña B. Neonatal rat ventricular myocytes interfacing conductive polymers and carbon nanotubes. Cell Biol Toxicol 2023; 39:1627-1639. [PMID: 36029423 PMCID: PMC10243189 DOI: 10.1007/s10565-022-09753-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/17/2022] [Indexed: 11/02/2022]
Abstract
Carbon nanotubes (CNTs) have become promising advanced materials and a new tool to specifically interact with electroresponsive cells. Likewise, conductive polymers (CP) appear promising electroactive biomaterial for proliferation of cells. Herein, we have investigated CNT blends with two different conductive polymers, polypyrrole/CNT (PPy/CNT) and PEDOT/CNT to evaluate the growth, survival, and beating behavior of neonatal rat ventricular myocytes (NRVM). The combination of CP/CNT not only shows excellent biocompatibility on NRVM, after 2 weeks of culture, but also exerts functional effects on networks of cardiomyocytes. NRVMs cultured on CNT-based substrates exhibited improved cellular function, i.e., homogeneous, non-arrhythmogenic, and more frequent spontaneous beating; particularly PEDOT/CNT substrates, which yielded to higher beating amplitudes, thus suggesting a more mature cardiac phenotype. Furthermore, cells presented enhanced structure: aligned sarcomeres, organized and abundant Connexin 43 (Cx43). Finally, no signs of induced hypertrophy were observed. In conclusion, the combination of CNT with CP produces high viability and promotes cardiac functionality, suggesting great potential to generate scaffolding supports for cardiac tissue engineering.
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Affiliation(s)
- Nuria Alegret
- School of Medicine, Division of Cardiology, Cardiovascular Institute, University of Colorado Denver Anschutz Medical Campus, 12700 E. 19th Avenue, Bldg. P15, Aurora, CO, 80045, USA.
- POLYMAT University of the Basque Country UPV/EHU, Avenida de Tolosa 72, 20018, Donostia-San Sebastián, Spain.
- Center for Cooperative Research in Biomaterials (CIC biomaGUNE), Basque Research and Technology Alliance (BRTA), Paseo de Miramón 194, 20014, Donostia-San Sebastián, Spain.
| | - Antonio Dominguez-Alfaro
- POLYMAT University of the Basque Country UPV/EHU, Avenida de Tolosa 72, 20018, Donostia-San Sebastián, Spain
- Center for Cooperative Research in Biomaterials (CIC biomaGUNE), Basque Research and Technology Alliance (BRTA), Paseo de Miramón 194, 20014, Donostia-San Sebastián, Spain
- Electrical Engineering Divison, Department of Engineering, University of Cambridge, Cambridge, CB3 0FA, UK
| | - David Mecerreyes
- POLYMAT University of the Basque Country UPV/EHU, Avenida de Tolosa 72, 20018, Donostia-San Sebastián, Spain
- Ikerbasque, Basque Foundation for Science, 48013, Bilbao, Spain
| | - Maurizio Prato
- Center for Cooperative Research in Biomaterials (CIC biomaGUNE), Basque Research and Technology Alliance (BRTA), Paseo de Miramón 194, 20014, Donostia-San Sebastián, Spain
- Ikerbasque, Basque Foundation for Science, 48013, Bilbao, Spain
- Department of Chemical and Pharmaceutical Sciences, INSTM Unit of Trieste, University of Trieste, Via L. Giorgieri 1, 34127, Trieste, Italy
| | - Luisa Mestroni
- School of Medicine, Division of Cardiology, Cardiovascular Institute, University of Colorado Denver Anschutz Medical Campus, 12700 E. 19th Avenue, Bldg. P15, Aurora, CO, 80045, USA
| | - Brisa Peña
- School of Medicine, Division of Cardiology, Cardiovascular Institute, University of Colorado Denver Anschutz Medical Campus, 12700 E. 19th Avenue, Bldg. P15, Aurora, CO, 80045, USA.
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
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15
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O'Neill MJ, Chen SN, Rumping L, Johnson R, van Slegtenhorst M, Glazer AM, Yang T, Solus JF, Laudeman J, Mitchell DW, Vanags LR, Kroncke BM, Anderson K, Gao S, Verdonschot JAJ, Brunner H, Hellebrekers D, Taylor MRG, Roden DM, Wessels MW, Lekanne Dit Deprez RH, Fatkin D, Mestroni L, Shoemaker MB. Multicenter clinical and functional evidence reclassifies a recurrent noncanonical filamin C splice-altering variant. Heart Rhythm 2023; 20:1158-1166. [PMID: 37164047 PMCID: PMC10530503 DOI: 10.1016/j.hrthm.2023.05.006] [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: 09/27/2022] [Revised: 04/25/2023] [Accepted: 05/03/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Truncating variants in filamin C (FLNC) can cause arrhythmogenic cardiomyopathy (ACM) through haploinsufficiency. Noncanonical splice-altering variants may contribute to this phenotype. OBJECTIVE The purpose of this study was to investigate the clinical and functional consequences of a recurrent FLNC intronic variant of uncertain significance (VUS), c.970-4A>G. METHODS Clinical data in 9 variant heterozygotes from 4 kindreds were obtained from 5 tertiary health care centers. We used in silico predictors and functional studies with peripheral blood and patient-specific induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs). Isolated RNA was studied by reverse transcription polymerase chain reaction. iPSC-CMs were further characterized at baseline and after nonsense-mediated decay (NMD) inhibition, using quantitative polymerase chain reaction (qPCR), RNA-sequencing, and cellular electrophysiology. American College of Medical Genetics and Genomics (ACMG) criteria were used to adjudicate variant pathogenicity. RESULTS Variant heterozygotes displayed a spectrum of disease phenotypes, spanning from mild ventricular dysfunction with palpitations to severe ventricular arrhythmias requiring device shocks or progressive cardiomyopathy requiring heart transplantation. Consistent with in silico predictors, the c.970-4A>G FLNC variant activated a cryptic splice acceptor site, introducing a 3-bp insertion containing a premature termination codon. NMD inhibition upregulated aberrantly spliced transcripts by qPCR and RNA-sequencing. Patch clamp studies revealed irregular spontaneous action potentials, increased action potential duration, and increased sodium late current in proband-derived iPSC-CMs. These findings fulfilled multiple ACMG criteria for pathogenicity. CONCLUSION Clinical, in silico, and functional evidence support the prediction that the intronic c.970-4A>G VUS disrupts splicing and drives ACM, enabling reclassification from VUS to pathogenic.
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Affiliation(s)
- Matthew J O'Neill
- Vanderbilt University School of Medicine, Medical Scientist Training Program, Vanderbilt University, Nashville, Tennessee
| | - Suet Nee Chen
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Lynne Rumping
- Department of Human Genetics, Amsterdam UMC, Amsterdam, The Netherlands
| | - Renee Johnson
- Molecular Cardiology Division, Victor Chang Cardiac Research Institute, Sydney, NSW, Australia; School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | | | - Andrew M Glazer
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tao Yang
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joseph F Solus
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Julie Laudeman
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Devyn W Mitchell
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Loren R Vanags
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brett M Kroncke
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Katherine Anderson
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shanshan Gao
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Job A J Verdonschot
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Han Brunner
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Debby Hellebrekers
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Dan M Roden
- Departments of Medicine, Pharmacology, and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marja W Wessels
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Diane Fatkin
- Molecular Cardiology Division, Victor Chang Cardiac Research Institute, Sydney, NSW, Australia; School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia; Cardiology Department, St. Vincent's Hospital, Sydney, NSW, Australia
| | - Luisa Mestroni
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - M Benjamin Shoemaker
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
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16
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Bueto-Beni C, Tafuni A, Chelko SP, Sheppard MN, Field E, Tollit J, Heenan IK, Barnes A, Taylor MR, Mestroni L, Kaski JP, Saffitz JE, Asimaki A. Innate Immune Signaling in Hearts and Buccal Mucosa Cells of Patients with Arrhythmogenic Cardiomyopathy. bioRxiv 2023:2023.07.25.550526. [PMID: 37649905 PMCID: PMC10465021 DOI: 10.1101/2023.07.25.550526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Objectives We sought to determine if persistent innate immune signaling via NFκB occurs in cardiac myocytes in patients with arrhythmogenic cardiomyopathy and if this is associated with myocardial infiltration of pro-inflammatory cells expressing CCR2. We also determined if buccal mucosa cells from young subjects with inherited disease alleles exhibit NFκB signaling. Background NFκB signaling in cardiac myocytes causes disease in a mouse model of arrhythmogenic cardiomyopathy by mobilizing CCR2-expressing macrophages which promote myocardial injury and arrhythmias. Buccal mucosa cells exhibit pathologic features similar to those seen in cardiac myocytes in patients with arrhythmogenic cardiomyopathy. Methods We analyzed myocardium from arrhythmogenic cardiomyopathy patients who died suddenly or required cardiac transplantation. We also analyzed buccal mucosa cells from young subjects with inherited disease alleles. The presence of immunoreactive signal for RelA/p65 in nuclei of cardiac myocytes and buccal cells was used as a reliable indicator of active NFκB signaling. We also counted myocardial CCR2-expressing cells. Results NFκB signaling was seen in cardiac myocytes in 34 of 36 cases of arrhythmogenic cardiomyopathy but in none of 19 age-matched controls. Cells expressing CCR2 were increased in patient hearts in numbers directly correlated with the number of cardiac myocytes showing NFκB signaling. NFκB signaling also occurred in buccal cells in young subjects with active disease. Conclusions Patients with clinically active arrhythmogenic cardiomyopathy exhibit persistent innate immune responses in cardiac myocytes and buccal mucosa cells reflecting an inflammatory process that fails to resolve. Such individuals may benefit from anti-inflammatory therapy. CONDENSED ABSTRACT NFκB signaling in cardiac myocytes causes arrhythmias and myocardial injury in a mouse model of arrhythmogenic cardiomyopathy by mobilizing pro-inflammatory CCR2-expressing macrophages to the heart. Based on these new mechanistic insights, we analyzed hearts of arrhythmogenic cardiomyopathy patients who died suddenly or required cardiac transplantation. We observed active NFκB signaling in cardiac myocytes associated with marked infiltration of CCR2-expressing cells. We also observed NFκB signaling in buccal mucosa cells obtained from young subjects with active disease. Thus, anti-inflammatory therapy may be effective in arrhythmogenic cardiomyopathy. Screening buccal cells may be a reliable way to identify patients most likely to benefit. HIGHLIGHTS Inflammation likely contributes to the pathogenesis of arrhythmogenic cardiomyopathy but the responsible mechanisms and the roles of specific classes of immune cells remain undefined.NFκB signaling in cardiac myocytes is sufficient to cause disease in a mouse model of arrhythmogenic cardiomyopathy by mobilizing injurious myeloid cells expressing CCR2 to the heart.Here, we provide evidence of persistent NFκB signaling in cardiac myocytes and increased CCR2-expressing cells in hearts of patients with arrhythmogenic cardiomyopathy. We observed a close correlation between the number of cardiac myocytes with active NFκB signaling and the number of CCR2-expressing cells in patient hearts.We also provide evidence of active NFκB signaling in buccal mucosa cells associated with initial onset of disease and/or disease progression in young subjects with arrhythmogenic cardiomyopathy alleles.
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Kim Y, Mastali M, Van Eyk JE, Orav EJ, Vissing CR, Day SM, Raja AA, Russell MW, Zahka K, Lever HM, Pereira AC, Murphy AM, Canter C, Bach RG, Wheeler MT, Rossano JW, Owens AT, Bundgaard H, Benson L, Mestroni L, Taylor MRG, Patel AR, Wilmot I, Thrush P, Soslow JH, Becker JR, Seidman CE, Ho CY. Transforming Growth Factor-β Analysis of the VANISH Trial Cohort. Circ Heart Fail 2023; 16:e010314. [PMID: 36999957 PMCID: PMC10121916 DOI: 10.1161/circheartfailure.122.010314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Affiliation(s)
- Yuri Kim
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston MA, USA
| | - Mitra Mastali
- Advanced Clinical Biosystems Research Institute, The Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jennifer E. Van Eyk
- Advanced Clinical Biosystems Research Institute, The Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - E. John Orav
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Christoffer R. Vissing
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston MA, USA
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Sharlene M. Day
- Division of Cardiovascular Medicine Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Anna Axelsson Raja
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Mark W. Russell
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Kenneth Zahka
- Department of Pediatric Cardiology, Cleveland Clinic Children’s, Pediatric Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Harry M. Lever
- Department of Pediatric Cardiology, Cleveland Clinic Children’s, Pediatric Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Alexandre C. Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Anne M. Murphy
- Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles Canter
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Richard G. Bach
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew T. Wheeler
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Joseph W. Rossano
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Anjali T. Owens
- Division of Cardiovascular Medicine Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lee Benson
- The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Luisa Mestroni
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Matthew R. G. Taylor
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Amit R. Patel
- Division of Cardiology, University of Virginia, Charlottesville, VA, USA
| | - Ivan Wilmot
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Philip Thrush
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Jonathan H. Soslow
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jason R. Becker
- Division of Cardiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Christine E. Seidman
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston MA, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | | | - Carolyn Y. Ho
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston MA, USA
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Castrichini M, De Luca A, Paldino A, Quaife RA, Eldemire R, Graw SL, De Angelis G, Barbati G, Medo K, Taylor MR, Groves DW, Dal Ferro M, Gigli M, Merlo M, Mestroni L, Sinagra G. CARDIAC MAGNETIC RESONANCE PHENOTYPE AND GENOTYPE IN LEFT-SIDED CARDIOMYOPATHIES: CHARACTERIZATION AND CLINICAL OUTCOMES. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00906-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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19
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Altman NL, Berning AA, Saxon CE, Adamek KE, Wagner JA, Slavov D, Quaife RA, Gill EA, Minobe WA, Jonas ER, Carroll IA, Huebler SP, Raines J, Messenger JC, Ambardekar AV, Mestroni L, Rosenberg RM, Rove J, Campbell TB, Bristow MR. Myocardial Injury and Altered Gene Expression Associated With SARS-CoV-2 Infection or mRNA Vaccination. JACC Basic Transl Sci 2023; 8:124-137. [PMID: 36281440 PMCID: PMC9581498 DOI: 10.1016/j.jacbts.2022.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/17/2022] [Accepted: 08/17/2022] [Indexed: 11/07/2022]
Abstract
SARS CoV-2 enters host cells via its Spike protein moiety binding to the essential cardiac enzyme angiotensin-converting enzyme (ACE) 2, followed by internalization. COVID-19 mRNA vaccines are RNA sequences that are translated into Spike protein, which follows the same ACE2-binding route as the intact virion. In model systems, isolated Spike protein can produce cell damage and altered gene expression, and myocardial injury or myocarditis can occur during COVID-19 or after mRNA vaccination. We investigated 7 COVID-19 and 6 post-mRNA vaccination patients with myocardial injury and found nearly identical alterations in gene expression that would predispose to inflammation, coagulopathy, and myocardial dysfunction.
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Key Words
- ACE, angiotensin I–converting enzyme gene
- ACE2, angiotensin-converting enzyme 2 gene
- AGT, angiotensinogen gene
- AGTR1, angiotensin II receptor type 1 gene
- ANG II, angiotensin II
- BNP, B-type natriuretic peptide
- CMR, cardiac magnetic resonance
- COVID-19
- EM, electron microscopy
- F3, coagulation factor III (tissue factor) gene
- ITGA5, integrin subunit alpha 5 gene
- IVS, interventricular septum
- LGE, late gadolinium enhancement
- LM, light microscopy
- LV, left ventricular
- LVEF, left ventricular ejection fraction
- NDC, nonischemic dilated cardiomyopathy
- NPPB, natriuretic peptide B gene
- RV, right ventricular
- S, SARS-CoV-2 Spike
- TnI, troponin I
- gene expression
- mRNA vaccines
- myocardial injury
- myocarditis
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Affiliation(s)
- Natasha L. Altman
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Amber A. Berning
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cara E. Saxon
- Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kylie E. Adamek
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jessica A. Wagner
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Dobromir Slavov
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Robert A. Quaife
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Edward A. Gill
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Wayne A. Minobe
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Eric R. Jonas
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | | | - Joshua Raines
- Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - John C. Messenger
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Amrut V. Ambardekar
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Luisa Mestroni
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rachel M. Rosenberg
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jessica Rove
- Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Thomas B. Campbell
- Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michael R. Bristow
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- ARCA Biopharma, Westminster, Colorado, USA
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20
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MacRae CA, Taylor MR, Mestroni L, Moses J, Ashley EA, Wheeler MT, Lakdawala NK, Hershberger RE, Sandor V, Saunders ME, Oliver C, Lee PA, Judge DP. Plain Language Summary of Publication of the safety and efficacy of ARRY-371797 in people with dilated cardiomyopathy and a faulty LMNA gene. Future Cardiol 2023; 19:55-63. [PMID: 36718638 DOI: 10.2217/fca-2022-0099] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
WHAT IS THIS PLAIN LANGUAGE SUMMARY ABOUT? This plain language summary describes the results of a study looking at the effects of a medicine called ARRY-371797 (also known as PF-07265803) in people with dilated cardiomyopathy (DCM for short) caused by a faulty LMNA gene. This condition is called LMNA-related DCM. DCM happens when the heart becomes bigger and weaker than normal, impacting functional capacity and leading to symptoms of heart failure. This means the heart is not able to pump blood around the body as easily, and people are unable to do as much in their daily lives (like getting dressed and going shopping). People may inherit a faulty LMNA gene from one of their parents, or a faulty LMNA gene may develop when mistakes happen during cell growth and replication. ARRY-371797 targets a specific mechanism in the body that can lead to heart problems in people with a faulty LMNA gene. As ARRY-371797 is not currently approved for use outside of clinical trials, it doesn't currently have an easily recognizable trade name. WHAT WERE THE RESULTS? 12 American people (average age 50 years) with LMNA-related DCM took part in the study and received 400 mg or 100 mg of ARRY-371797 twice daily for 48 weeks. People knew which dose of ARRY-371797 they were taking. People were checked after 4, 12, 24, 36 and 48 weeks of taking ARRY-371797 to see how far they could walk in the 6-minute walk test (6MWT for short). The level of NT-proBNP in their blood was also measured. NT-proBNP is a biomarker used to measure the severity of heart failure. A biomarker is something found in the body that can be measured to indicate the extent of a disease. -After taking ARRY-371797 for 12 weeks, people were able to walk further in the 6MWT and had lower levels of NT-proBNP in their blood. This suggests improvement in functional capacity (exercise tolerance) and heart function. Researchers also asked people about their quality of life using the Kansas City Cardiomyopathy Questionnaire (KCCQ for short), and looked for any side effects. -Researchers saw some improvement in KCCQ scores. -Researchers saw no major side effects that they considered to be related to ARRY-371797 treatment. A side effect is something that people feel was caused by a medicine or treatment. Overall, this study showed that people with LMNA-related DCM who took ARRY-371797 had improved functional capacity (exercise tolerance), improved heart function, and improved quality of life. Phase 2 study (NCT02057341) Phase 2 long-term extension study (NCT02351856) Phase 3 REALM-DCM study (NCT03439514).
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Affiliation(s)
- Calum A MacRae
- Brigham & Women's Hospital, Cardiovascular Medicine, Boston, MA, USA
| | - Matthew Rg Taylor
- University of Colorado, Department of Medicine, Adult Medical Genetics Program, Aurora, CO, USA
| | - Luisa Mestroni
- UnityPoint Health, Heart & Vascular Institute, Madison, WI, USA
| | - John Moses
- UnityPoint Health, Heart & Vascular Institute, Madison, WI, USA
| | - Euan A Ashley
- Stanford University, Center for Inherited Cardiovascular Disease, Stanford, CA, USA
| | - Matthew T Wheeler
- Stanford University, Center for Inherited Cardiovascular Disease, Stanford, CA, USA
| | - Neal K Lakdawala
- Brigham & Women's Hospital, Cardiovascular Medicine, Boston, MA, USA
| | - Ray E Hershberger
- The Ohio State University, Human Genetics & Cardiovascular Medicine, Columbus, OH, USA
| | | | | | | | | | - Daniel P Judge
- Medical University of South Carolina, Cardiovascular Genetics, Charleston, SC, USA
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Castrichini M, De Luca A, Paldino A, Cittar M, Dal Ferro M, Angelis GD, Barbati G, Medo K, Groves D, Quaife R, Eldemire R, Gigli M, Stolfo D, Graw S, Addison J, Taylor MR, Mestroni L, Merlo M, Sinagra G. 398 CARDIAC MAGNETIC RESONANCE PHENOTYPE AND GENOTYPE IN LEFT-SIDED CARDIOMYOPATHIES: CHARACTERIZATION AND CLINICAL OUTCOMES. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
The combined prognostic role of cardiac magnetic resonance (CMR) and genotype in cardiomyopathies has not been fully investigated. The aim of this study was to identify specific genotype-CMR phenotype correlations in a well-characterized cohort of patients with a spectrum of left-sided cardiomyopathies spanning from arrhythmogenic (ACM) to dilated cardiomyopathy (DCM), and analyze patients’ outcome.
Methods and Results
One-hundred and seventy-four patients with DCM (127) and left sided ACM (47), who underwent a comprehensive evaluation including genetic testing and CMR imaging, were enrolled in this study. The phenotype was classified as DCM or ACM according to current consensus criteria. The primary outcome was a composite of sudden cardiac death/life-threatening ventricular arrhythmias (SCD/MVA). DCM patients showed more frequently pathogenic or likely pathogenic (P/LP) variants of non-arrhythmic genes (34% vs. 7%, p < 0.001), whereas ACM patients reported more frequently P/LP variants of arrhythmic genes (47% vs. 8%, p < 0.001) and non-ischemic free-wall LGE (30% vs. 10%, p = 0.002). After a median follow-up of 92 months (interquartile range 46 - 168), 39 patients (22%) reached the combined endpoint. Carrying a P/LP variant of arrhythmic genes (hazard ratio (HR) 2.2, 95% confidence interval (CI) 1.1 - 4.4, p = 0.024) along with presence of LGE (HR 4.5, 95% CI 1.99 - 11.5, p < 0.001) were independently associated with the study endpoint.
Conclusion
In cohort of well-characterized left sided cardiomyopathies patients spanning from ACM to DCM, a P/LP variant of arrhythmic genes along with presence of LGE were independent predictors of SCD/MVA.
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Affiliation(s)
- Matteo Castrichini
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Italy
- Division Of Cardiology, University Of Colorado Anshutz Medical Campus , Aurora, Co , Usa
| | - Antonio De Luca
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Italy
| | - Alessia Paldino
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Italy
| | - Marco Cittar
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Italy
| | - Matteo Dal Ferro
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Italy
| | - Giulia De Angelis
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Italy
| | - Giulia Barbati
- Biostatistics Unit, Department Of Medical Sciences, University Of Trieste , Italy
| | - Kristen Medo
- Division Of Cardiology, University Of Colorado Anshutz Medical Campus , Aurora, Co , Usa
| | - Daniel Groves
- Division Of Cardiology, University Of Colorado Anshutz Medical Campus , Aurora, Co , Usa
| | - Robert Quaife
- Division Of Cardiology, University Of Colorado Anshutz Medical Campus , Aurora, Co , Usa
| | - Ramone Eldemire
- Division Of Cardiology, University Of Colorado Anshutz Medical Campus , Aurora, Co , Usa
| | - Marta Gigli
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Italy
| | - Davide Stolfo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Italy
| | - Sharon Graw
- Division Of Cardiology, University Of Colorado Anshutz Medical Campus , Aurora, Co , Usa
| | - Jeffrey Addison
- Division Of Cardiology, University Of Colorado Anshutz Medical Campus , Aurora, Co , Usa
| | - Matthew Rg Taylor
- Division Of Cardiology, University Of Colorado Anshutz Medical Campus , Aurora, Co , Usa
| | - Luisa Mestroni
- Division Of Cardiology, University Of Colorado Anshutz Medical Campus , Aurora, Co , Usa
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (Asugi), University Of Trieste , Italy
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22
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Setti M, Merlo M, Gigli M, Munaretto L, Paldino A, Stolfo D, Loco CP, Medo K, Barbati G, Graw S, Ribichini FL, Ferro MD, Taylor M, Sinagra G, Mestroni L. 207 RE-DEFINING ARRHYTHMOGENIC CARDIOMYOPATHY: CHARACTERIZATION AND LONG-TERM PROGNOSTIC IMPLICATIONS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Arrhythmogenic dilated cardiomyopathy (AR-DCM) combines phenotypical aspects of dilated cardiomyopathy (DCM) and risk of sudden cardiac death (SCD), typical of the arrhythmogenic form (ACM). However, AR-DCM is often ambiguously defined leaving clinicians uncertain on how to identify these high-risk patients.
The aims of the study were to re-define AR-DCM based on outcome related arrhythmic markers and to test the usefulness of the novel AR-DCM definition in identifying arrhythmogenic genotypes (i.e., LMNA, FLNC, RBM20, and desmosomal genes).
Materials and methods
Consecutive DCM patients with genetic evaluation and Holter ECG monitoring or telemetry in two referral institution were analyzed. The arrhythmic markers tested to define AR-DCM were: SCD or major ventricular arrhythmias (MVA), unexplained syncope, rapid nonsustained ventricular tachycardia (nsTV), ≥1000 premature ventricular contractions/24 hours, or ≥50 ventricular couplets/24 hours. Patients were labeled as Early AR-DCM if criteria were met within 12 months from enrolment. The primary endpoint was a composite of SCD/MVA; the secondary endpoint was a composite of all-cause mortality/heart transplant/LVAD implantation (D/HTx/LVAD).
Results
Among the 743 DCM patients included, 290 had disease-related variants (39%), 94 (30%) of these carried arrhythmogenic genotype. Early AR-DCM was identified in 429 (58%) patients. During a median follow-up of 7.0 [2.2-13.8] years, among arrhythmic markers the occurrence of syncope and/or nsVT within 12 months from enrolment were the only arrhythmic markers independently associated with SCD/MVA (Figure), while the occurrence of early MVA and/or nsTV emerged as the strongest long-term predictors of D/ HTx/LVAD. Family history of MVA was also independently associated with primary and secondary endpoints, and together with MVA, nsTV or unexplained syncope increased the agreement between AR-DCM and arrhythmogenic genotypes in 1 out 2 patients.
Conclusions
A combination of early (i.e., within 1 year from diagnosis) MVA or nsVT or unexplained syncope might be proposed as a clinically useful new definition of AR-DCM, especially if associated to family history of MVA. This definition in fact allows clinicians to anticipates worse long-term arrhythmic and global outcomes, and to accurately identify malignant arrhythmogenic genotypes.
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Affiliation(s)
- Martina Setti
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University Of Trieste , Italy
- Division Of Cardiology, Department Of Medicine, University Of Verona , Italy
| | - Marco Merlo
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University Of Trieste , Italy
| | - Marta Gigli
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University Of Trieste , Italy
| | - Laura Munaretto
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University Of Trieste , Italy
| | - Alessia Paldino
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University Of Trieste , Italy
| | - Davide Stolfo
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University Of Trieste , Italy
| | - Carola Pio Loco
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University Of Trieste , Italy
| | - Kristen Medo
- Cardiovascular Institute And Adult Medical Genetics Program, University Of Colorado Anschutz Medical Campus , Aurora, Co , Usa
| | | | - Sharon Graw
- Cardiovascular Institute And Adult Medical Genetics Program, University Of Colorado Anschutz Medical Campus , Aurora, Co , Usa
| | | | - Matteo Dal Ferro
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University Of Trieste , Italy
| | - Matthew Taylor
- Cardiovascular Institute And Adult Medical Genetics Program, University Of Colorado Anschutz Medical Campus , Aurora, Co , Usa
| | - Gianfranco Sinagra
- Center For Diagnosis And Treatment Of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina, University Of Trieste , Italy
| | - Luisa Mestroni
- Cardiovascular Institute And Adult Medical Genetics Program, University Of Colorado Anschutz Medical Campus , Aurora, Co , Usa
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23
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MacRae CA, Taylor MR, Mestroni L, Moses J, Ashley EA, Wheeler MT, Lakdawala NK, Hershberger RE, Sandor V, Saunders ME, Oliver C, Lee PA, Judge DP. Efficacy and Safety of ARRY-371797 in LMNA-Related Dilated Cardiomyopathy: A Phase 2 Study. Circ Genom Precis Med 2022; 16:e003730. [PMID: 36515663 PMCID: PMC9946172 DOI: 10.1161/circgen.122.003730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Lamin A/C gene (LMNA)-related dilated cardiomyopathy is a serious and life-threatening condition with a high unmet medical need. This phase 2 study assessed the effects of the oral selective p38 mitogen-activated protein kinase inhibitor ARRY-371797 on functional capacity and cardiac function in patients with LMNA-related dilated cardiomyopathy. METHODS Patients with LMNA-related dilated cardiomyopathy in New York Heart Association class II-IIIA, on background heart failure treatment, received ARRY-371797 100 or 400 mg twice daily for 48 weeks. The primary end point was change from baseline in the 6-minute walk test distance at 12 weeks. Secondary end points included changes over time in 6-minute walk test distance, NT-proBNP (N-terminal pro-B-type natriuretic peptide) concentration, left ventricular ejection fraction, and quality-of-life scores on the Kansas City Cardiomyopathy Questionnaire. Data from the 2 dose groups were combined. RESULTS Twelve patients were enrolled; median (minimum, maximum) 6-minute walk test distance at baseline was 314 (246, 412) m. At week 12, the mean (80% CI) increase from baseline in 6-minute walk test distance was 69 (39, 100) m (median, 47 m). Median NT-proBNP concentration declined from 1409 pg/mL at baseline to 848 pg/mL at week 12. Mean left ventricular ejection fraction was stable at week 12. There was a trend toward improvement in Kansas City Cardiomyopathy Questionnaire Overall and Clinical Summary scores at week 12. No clinically significant drug-related safety concerns were identified. CONCLUSIONS ARRY-371797 was well tolerated and resulted in potential increases in functional capacity and lower concentrations of cardiac biomarker NT-proBNP in patients with LMNA-related dilated cardiomyopathy. REGISTRATION URL: https://clinicaltrials.gov; Unique identifier: NCT02057341.
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Affiliation(s)
- Calum A. MacRae
- Brigham and Women’s Hospital, Cardiovascular Medicine, Boston, MA (C.A.M., N.K.L.)
| | - Matthew R.G. Taylor
- Department of Medicine, Adult Medical Genetics Program, University of Colorado, Aurora (M.R.G.T., L.M.)
| | - Luisa Mestroni
- Department of Medicine, Adult Medical Genetics Program, University of Colorado, Aurora (M.R.G.T., L.M.)
| | - John Moses
- UnityPoint Health, Heart and Vascular Institute, Madison, WI (J.M.)
| | - Euan A. Ashley
- Center for Inherited Cardiovascular Disease, Stanford University, CA (E.A.A., M.T.W.)
| | - Matthew T. Wheeler
- Center for Inherited Cardiovascular Disease, Stanford University, CA (E.A.A., M.T.W.)
| | - Neal K. Lakdawala
- Brigham and Women’s Hospital, Cardiovascular Medicine, Boston, MA (C.A.M., N.K.L.)
| | - Ray E. Hershberger
- Human Genetics and Cardiovascular Medicine, The Ohio State University, Columbus (R.E.H.)
| | - Victor Sandor
- Pfizer Inc, Boulder, CO (V.S., M.E.S., C.O., P.A.L.)
| | | | | | | | - Daniel P. Judge
- Cardiovascular Genetics, Medical University of South Carolina, Charleston (D.P.J.)
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24
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Peña B, Gao S, Borin D, Del Favero G, Abdel-Hafiz M, Farahzad N, Lorenzon P, Sinagra G, Taylor MRG, Mestroni L, Sbaizero O. Cellular Biomechanic Impairment in Cardiomyocytes Carrying the Progeria Mutation: An Atomic Force Microscopy Investigation. Langmuir 2022; 38:14928-14940. [PMID: 36420863 PMCID: PMC9730902 DOI: 10.1021/acs.langmuir.2c02623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/03/2022] [Indexed: 06/16/2023]
Abstract
Given the clinical effect of progeria syndrome, understanding the cell mechanical behavior of this pathology could benefit the patient's treatment. Progeria patients show a point mutation in the lamin A/C gene (LMNA), which could change the cell's biomechanical properties. This paper reports a mechano-dynamic analysis of a progeria mutation (c.1824 C > T, p.Gly608Gly) in neonatal rat ventricular myocytes (NRVMs) using cell indentation by atomic force microscopy to measure alterations in beating force, frequency, and contractile amplitude of selected cells within cell clusters. Furthermore, we examined the beating rate variability using a time-domain method that produces a Poincaré plot because beat-to-beat changes can shed light on the causes of arrhythmias. Our data have been further related to our cell phenotype findings, using immunofluorescence and calcium transient analysis, showing that mutant NRVMs display changes in both beating force and frequency. These changes were associated with a decreased gap junction localization (Connexin 43) in the mutant NRVMs even in the presence of a stable cytoskeletal structure (microtubules and actin filaments) when compared with controls (wild type and non-treated cells). These data emphasize the kindred between nucleoskeleton (LMNA), cytoskeleton, and the sarcolemmal structures in NRVM with the progeria Gly608Gly mutation, prompting future mechanistic and therapeutic investigations.
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Affiliation(s)
- Brisa Peña
- Cardiovascular
Institute & Adult Medical Genetics, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado80045, United States
- Bioengineering
Department, University of Colorado Denver
Anschutz Medical Campus, 12705 E. Montview Avenue, Suite 100, Aurora, Colorado80045, United States
| | - Shanshan Gao
- Cardiovascular
Institute & Adult Medical Genetics, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado80045, United States
| | - Daniele Borin
- Department
of Engineering and Architecture, University
of Trieste, Trieste34127, Italy
| | - Giorgia Del Favero
- Department
of Food Chemistry and Toxicology, Faculty of Chemistry, University of Vienna, Währinger Straße 38-42, 1090Vienna, Austria
- Core
Facility Multimodal Imaging, Faculty of Chemistry, University of Vienna, Wien, Währinger Straße 38-42, 1090Vienna, Austria
| | - Mostafa Abdel-Hafiz
- Bioengineering
Department, University of Colorado Denver
Anschutz Medical Campus, 12705 E. Montview Avenue, Suite 100, Aurora, Colorado80045, United States
| | - Nasim Farahzad
- Bioengineering
Department, University of Colorado Denver
Anschutz Medical Campus, 12705 E. Montview Avenue, Suite 100, Aurora, Colorado80045, United States
| | - Paola Lorenzon
- Department
F of Life Sciences, University of Trieste, Trieste34127, Italy
| | - Gianfranco Sinagra
- Polo
Cardiologico, Azienda Sanitaria Universitaria
Integrata di Trieste, Strada di Fiume 447, Trieste34127, Italy
| | - Matthew R. G. Taylor
- Cardiovascular
Institute & Adult Medical Genetics, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado80045, United States
| | - Luisa Mestroni
- Cardiovascular
Institute & Adult Medical Genetics, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado80045, United States
| | - Orfeo Sbaizero
- Cardiovascular
Institute & Adult Medical Genetics, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado80045, United States
- Department
of Engineering and Architecture, University
of Trieste, Trieste34127, Italy
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25
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Paldino A, Dal Ferro M, Stolfo D, Gandin I, Medo K, Graw S, Gigli M, Gagno G, Zaffalon D, Castrichini M, Masè M, Cannatà A, Brun F, Storm G, Severini GM, Lenarduzzi S, Girotto G, Gasparini P, Bortolotti F, Giacca M, Zacchigna S, Merlo M, Taylor MRG, Mestroni L, Sinagra G. Prognostic Prediction of Genotype vs Phenotype in Genetic Cardiomyopathies. J Am Coll Cardiol 2022; 80:1981-1994. [PMID: 36396199 PMCID: PMC10754019 DOI: 10.1016/j.jacc.2022.08.804] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 06/21/2022] [Revised: 08/09/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Diverse genetic backgrounds often lead to phenotypic heterogeneity in cardiomyopathies (CMPs). Previous genotype-phenotype studies have primarily focused on the analysis of a single phenotype, and the diagnostic and prognostic features of the CMP genotype across different phenotypic expressions remain poorly understood. OBJECTIVES We sought to define differences in outcome prediction when stratifying patients based on phenotype at presentation compared with genotype in a large cohort of patients with CMPs and positive genetic testing. METHODS Dilated cardiomyopathy (DCM), arrhythmogenic right ventricular cardiomyopathy, left-dominant arrhythmogenic cardiomyopathy, and biventricular arrhythmogenic cardiomyopathy were examined in this study. A total of 281 patients (80% DCM) with pathogenic or likely pathogenic variants were included. The primary and secondary outcomes were: 1) all-cause mortality (D)/heart transplant (HT); 2) sudden cardiac death/major ventricular arrhythmias (SCD/MVA); and 3) heart failure-related death (DHF)/HT/left ventricular assist device implantation (LVAD). RESULTS Survival analysis revealed that SCD/MVA events occurred more frequently in patients without a DCM phenotype and in carriers of DSP, PKP2, LMNA, and FLNC variants. However, after adjustment for age and sex, genotype-based classification, but not phenotype-based classification, was predictive of SCD/MVA. LMNA showed the worst trends in terms of D/HT and DHF/HT/LVAD. CONCLUSIONS Genotypes were associated with significant phenotypic heterogeneity in genetic cardiomyopathies. Nevertheless, in our study, genotypic-based classification showed higher precision in predicting the outcome of patients with CMP than phenotype-based classification. These findings add to our current understanding of inherited CMPs and contribute to the risk stratification of patients with positive genetic testing.
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Affiliation(s)
- Alessia Paldino
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste (a member of the European Reference Network for rare, low-prevalence, or complex diseases of the Heart [ERN GUARD-Heart]), Trieste, Italy
| | - Matteo Dal Ferro
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste (a member of the European Reference Network for rare, low-prevalence, or complex diseases of the Heart [ERN GUARD-Heart]), Trieste, Italy.
| | - Davide Stolfo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste (a member of the European Reference Network for rare, low-prevalence, or complex diseases of the Heart [ERN GUARD-Heart]), Trieste, Italy
| | - Ilaria Gandin
- Biostatistics Unit, University of Trieste, Trieste, Italy
| | - Kristen Medo
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sharon Graw
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Marta Gigli
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste (a member of the European Reference Network for rare, low-prevalence, or complex diseases of the Heart [ERN GUARD-Heart]), Trieste, Italy
| | - Giulia Gagno
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste (a member of the European Reference Network for rare, low-prevalence, or complex diseases of the Heart [ERN GUARD-Heart]), Trieste, Italy
| | - Denise Zaffalon
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste (a member of the European Reference Network for rare, low-prevalence, or complex diseases of the Heart [ERN GUARD-Heart]), Trieste, Italy
| | - Matteo Castrichini
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste (a member of the European Reference Network for rare, low-prevalence, or complex diseases of the Heart [ERN GUARD-Heart]), Trieste, Italy; Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Marco Masè
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste (a member of the European Reference Network for rare, low-prevalence, or complex diseases of the Heart [ERN GUARD-Heart]), Trieste, Italy
| | - Antonio Cannatà
- King's College London, British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine and Sciences, London, United Kingdom
| | - Francesca Brun
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste (a member of the European Reference Network for rare, low-prevalence, or complex diseases of the Heart [ERN GUARD-Heart]), Trieste, Italy
| | - Garrett Storm
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Stefania Lenarduzzi
- Institute for Maternal and Child Health-IRCCS, Burlo Garofolo, Trieste, Italy
| | - Giorgia Girotto
- Institute for Maternal and Child Health-IRCCS, Burlo Garofolo, Trieste, Italy; Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Paolo Gasparini
- Institute for Maternal and Child Health-IRCCS, Burlo Garofolo, Trieste, Italy; Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Francesca Bortolotti
- International Center for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
| | - Mauro Giacca
- King's College London, British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine and Sciences, London, United Kingdom; International Center for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
| | - Serena Zacchigna
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; International Center for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste (a member of the European Reference Network for rare, low-prevalence, or complex diseases of the Heart [ERN GUARD-Heart]), Trieste, Italy
| | - Matthew R G Taylor
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Luisa Mestroni
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste (a member of the European Reference Network for rare, low-prevalence, or complex diseases of the Heart [ERN GUARD-Heart]), Trieste, Italy; Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
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26
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Paldino A, Dal Ferro M, Stolfo D, Gandin I, Graw S, Gigli M, Medo K, Gagno G, Zaffalon D, Castrichini M, Mase' M, Merlo M, Taylor M, Mestroni L, Sinagra G. Prognostic prediction of genotype versus phenotype in genetic cardiomyopathies. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In cardiomyopathies (CMPs), the diverse genetic background often leads to phenotypic heterogeneity. Currently, genotype-phenotype studies are founded on clinical phenotype-based classification of CMPs, contributing possible biases due to the exclusion of specific and unascertained phenotypic expressions of CMP genes.
Purpose
We sought to define differences in outcome when stratifying patients based on phenotype at presentation compared with genotype in a large cohort of CMP patients with positive genetic testing.
Methods
In this study, we included the whole spectrum of non-hypertrophic CMP phenotypes, genetically determined: dilated cardiomyopathy (DCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), left ventricular arrhythmogenic cardiomyopathy (ALVC) and biventricular ARVC (BiV). The primary and secondary outcomes were: 1) all-cause mortality/heart transplant (D/HT); 2) heart failure-related death/heart transplant/left ventricular assist device implantation (DHF/HT/VAD); and 3) sudden cardiac death/life-threatening ventricular arrhythmias (SCD/MVA).
Results
Two hundred and eighty-one patients (80% DCM) carrying pathogenic or likely pathogenic variants were included in this study. The phenotype was classified as DCM, ARVC, ALVC and BiV according to current consensus criteria. The median follow-up was 188 months. Variants in titin (TTN; 34%) and sarcomeric genes (SARC; 22%) were the most frequent genotypes and almost invariably associated with a DCM phenotype. DSP, LMNA and FLNC displayed more heterogeneous phenotypic presentations, including DCM, ARVC, ALVC, BiV. At survival analysis, the arrhythmic outcome occurred more frequently in patients without a DCM phenotype and in carriers of DSP, PKP2, LMNA and FLNC variants. However, after adjustment for age and sex, the genotype-based classification but not the phenotype-based classification was predictive of the arrhythmic outcome. LMNA showed the worst trend in term of D/HT and DHF/HT/LVAD.
Conclusions
In genetic cardiomyopathies, genotype is associated with significant phenotypic heterogeneity. Nevertheless, in our study, the genotypic-based classification showed higher precision in predicting CMP patients' outcome in respect to the phenotype-based classification. These findings add to the current understanding of inherited CMPs and may implement the risk stratification of patients with positive genetic testing.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Paldino
- University Hospital Riuniti, Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy , Trieste , Italy
| | - M Dal Ferro
- University Hospital Riuniti, Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy , Trieste , Italy
| | - D Stolfo
- University Hospital Riuniti, Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy , Trieste , Italy
| | - I Gandin
- University of Trieste, Biostatistics Unit , Trieste , Italy
| | - S Graw
- University of Colorado, Cardiovascular Institute and Adult Medical Genetics Program , Denver , United States of America
| | - M Gigli
- University Hospital Riuniti, Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy , Trieste , Italy
| | - K Medo
- University of Colorado, Cardiovascular Institute and Adult Medical Genetics Program , Denver , United States of America
| | - G Gagno
- University Hospital Riuniti, Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy , Trieste , Italy
| | - D Zaffalon
- University Hospital Riuniti, Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy , Trieste , Italy
| | - M Castrichini
- University Hospital Riuniti, Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy , Trieste , Italy
| | - M Mase'
- University Hospital Riuniti, Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy , Trieste , Italy
| | - M Merlo
- University Hospital Riuniti, Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy , Trieste , Italy
| | - M Taylor
- University of Colorado, Cardiovascular Institute and Adult Medical Genetics Program , Denver , United States of America
| | - L Mestroni
- University of Colorado, Cardiovascular Institute and Adult Medical Genetics Program , Denver , United States of America
| | - G Sinagra
- University Hospital Riuniti, Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy , Trieste , Italy
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27
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Pena B, Knight W, Cavasin M, Ferrari I, Abdel-Hafiz M, Vagnozzi R, Bosi S, Park D, Shandas R, Song K, McKinsey T, Sbaizero O, Taylor M, Prato M, Mestroni L. Injectable carbon nanotube-functionalized hydrogel as a tool for cardiac tissue engineering. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.3016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background/Introduction
Heart failure (HF) is an expensive major public health problem in the United States and around the world (1). The current treatments for HF are aimed at reducing symptoms, slowing disease progression, and reducing mortality and not aimed at repairing heart muscle or restoring function. Furthermore, even with these treatments, approximately half of patients with HF will die within 5 years of diagnosis (2). Cardiac transplantation remains the only definitive treatment for those affected with end-stage HF, but availability of donor hearts remains a major limitation (3).
Purpose
The ability of the adult heart to regenerate cardiomyocytes (CMs) lost after injury is limited, generating interest in developing tissue engineering therapies to avoid progression towards HF. Rigid carbon nanotubes (CNTs) scaffolds have been used to improve CMs viability, proliferation, and maturation (4), but require undesirable invasive surgeries for implantation. To overcome this limitation, we engineered an injectable reverse thermal gel (RTG) functionalized with CNTs (RTG-CNT) that transitions from a liquid-solution to a gel-based matrix shortly after reaching body temperature allowing for a liquid-based delivery rapidly followed by a stable-gel localization (5).
Methods and results
Here we show experimental evidences the RTG-CNT hydrogel, used as a three-dimensional (3D) niche to culture human induced pluripotent stem cells (hiPSC)-CMs, promotes hiPSC-CMs alignment and elongation with increased Cx43 localization and improved contraction function when compared with traditional two-dimensional (2D) fibronectin controls and plain 3D RTG system without CNTs. Moreover, the short-term (4-week) biocompatibility of the RTG-CNT hydrogel was also assessed in a mouse model (intracardial injection). The results confirmed that the RTG-CNT hydrogel is well tolerated by the cardiac tissue.
Conclusion
Our results indicated that the injectable RTG-CNT hydrogel has the potential to be used as a minimally invasive tool for cardiac tissue engineering efforts.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): NATIONAL HEART, LUNG, AND BLOOD (NHLBI) INSTITUTE
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Affiliation(s)
- B Pena
- University of Colorado , Aurora , United States of America
| | - W Knight
- University of Colorado , Aurora , United States of America
| | - M Cavasin
- University of Colorado , Aurora , United States of America
| | - I Ferrari
- University of Colorado , Aurora , United States of America
| | - M Abdel-Hafiz
- University of Colorado , Aurora , United States of America
| | - R Vagnozzi
- University of Colorado , Aurora , United States of America
| | - S Bosi
- University of Trieste, Chemical and Pharmaceutical Sciences , Trieste , Italy
| | - D Park
- University of Colorado , Aurora , United States of America
| | - R Shandas
- University of Colorado , Aurora , United States of America
| | - K Song
- University of Colorado , Aurora , United States of America
| | - T McKinsey
- University of Colorado , Aurora , United States of America
| | - O Sbaizero
- University of Trieste, Engineering and Architecture , Trieste , Italy
| | - M Taylor
- University of Colorado , Aurora , United States of America
| | - M Prato
- University of Trieste, Chemical and Pharmaceutical Sciences , Trieste , Italy
| | - L Mestroni
- University of Colorado , Aurora , United States of America
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28
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Wang M, Liu D, Nguyen T, McNamara D, Barlera S, Pileggi S, Mestroni L, Merlo M, Sinagra G, Pinet F, Krejci J, Kilianova A, De Groote P, Weishilboum R, Pereira N. NAV3 is a genetic determinant of myocardial recovery in dilated cardiomyopathy and attenuates cardiac fibrosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
A genome-wide association study (GWAS) assessing change in left ventricular ejection fraction (LVEF) in dilated cardiomyopathy (DCM), a surrogate marker of morbidity and mortality in heart failure (HF), had not been performed previously and could provide insight into novel biological pathways that could lead to the development of new drugs that might target myocardial recovery. The presence and extent of cardiac fibrosis in DCM is independently associated with myocardial recovery and cardiovascular mortality.
Purpose
To identify the biological relevance of genetic targets that are associated with change in LVEF in patients with DCM.
Methods
A GWAS was performed using DNA from 686 patients with recent onset DCM who were on standard HF therapy using change in LVEF at a median of 6 months after initial diagnosis. Cultured human cardiac fibroblasts (HCFs) were used as an in vitro model to study the functional and biological relevance of the gene target identified in the GWAS. Specifically, HCFs were transfected with siRNA by using the Lipofectamine™ RNAiMAX Transfection Reagent for gene knockdown (KD). RNA-seq was performed using the Illumina TruSeq protocol with expression analysis conducted with the EdgeR package. Ingenuity Pathway Analysis was used.
Results
A single-nucleotide polymorphism, rs11105445(G>A), mapping to the neuron navigator 3 (NAV3) gene (rs11105445, p=2.37E-07; beta 2.74±0.53) was associated with improvement in LVEF. We performed a phenome-wide association study using data from the UK Biobank and demonstrated that genetic variation in NAV3 was significantly associated with HF mortality (p=3.2E-28), highlighting the potential importance of this gene in HF. Using GTEx data we demonstrated that in LV tissue the minor allele A was associated with ↓NAV3 expression (p=0.03) suggesting that ↓NAV3 expression might be associated with improvement in LVEF. We demonstrated that NAV3 KD significantly ↓TGF-β1 mediated HCF transdifferentiation into myofibroblasts, ↓α-smooth muscle actin (ACTA2) and ↓collagen I (COL1A1), therefore NAV3 KD was anti-fibrotic (see Figure 1), 1a. HCFs treated by vehicle/TGF-β1 after KD of NAV3/ctrl, and ACTA2 and COL1A1 were analyzed by qPCR; 1b. Representative immunofluorescence staining for α-SMA (in green), RNA-seq after NAV3 KD followed by pathway analysis suggested that NAV3 exerted its effect by regulating cell cycle related proteins (Figure 2), 2a. Volcano plot shows significant differentially expressed genes identified by RNA-seq analysis (down-regulated in blue, up-regulated in red); 2b. NAV3 KD significantly increased expression of cell cycle related proteins, which was validated by Western blot.
Conclusions
Decreased expression of NAV3 is associated with myocardial recovery in DCM, most likely due to its anti-fibrotic effect via direct regulation of cell cycle proteins. The role of NAV3 as a novel therapeutic target in DCM needs to be explored.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Mayo Clinic Center for Individualized MedicineMayo Clinic Department of Cardiovascular Medicine
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Affiliation(s)
- M Wang
- Mayo Clinic , Rochester , United States of America
| | - D Liu
- Mayo Clinic , Rochester , United States of America
| | - T Nguyen
- Mayo Clinic , Rochester , United States of America
| | - D McNamara
- University of Pittsburgh Medical Centre , Pittsburgh , United States of America
| | - S Barlera
- The Mario Negri Institute for Pharmacological Research , Milan , Italy
| | - S Pileggi
- The Mario Negri Institute for Pharmacological Research , Milan , Italy
| | - L Mestroni
- University of Colorado , Denver , United States of America
| | - M Merlo
- Milan Polytechnic , Milan , Italy
| | - G Sinagra
- University of Trieste , Trieste , Italy
| | - F Pinet
- Institut Pasteur , Paris , France
| | - J Krejci
- Institut Pasteur , Paris , France
| | | | | | | | - N Pereira
- Mayo Clinic , Rochester , United States of America
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29
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Gao S, Taylor MRG, Mestroni L. Hidden Risk: Arrhythmogenic Genes in the General Population. Circ Genom Precis Med 2022; 15:e003869. [PMID: 35980659 PMCID: PMC10874281 DOI: 10.1161/circgen.122.003869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The past 2 decades have seen the development of large-scale DNA biobanks associated with phenotypic information of the general population. Examples of these efforts are the UK Biobank, BioVU at Vanderbilt and MyCode. These repositories were designed to generate information to enable a precision medicine approach to diagnose, prevent, and treat human disease.
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Affiliation(s)
- Shanshan Gao
- Division of Cardiology, Cardiovascular Institute (S.G., M.R.G.T., L.M.), University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Matthew R G Taylor
- Division of Cardiology, Cardiovascular Institute (S.G., M.R.G.T., L.M.), University of Colorado Anschutz Medical Campus, Aurora, CO
- Adult Medical Genetics Program (M.R.G.T.), University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Luisa Mestroni
- Division of Cardiology, Cardiovascular Institute (S.G., M.R.G.T., L.M.), University of Colorado Anschutz Medical Campus, Aurora, CO
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30
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Escobar-Lopez L, Ochoa JP, Royuela A, Verdonschot JAJ, Dal Ferro M, Espinosa MA, Sabater-Molina M, Gallego-Delgado M, Larrañaga-Moreira JM, Garcia-Pinilla JM, Basurte-Elorz MT, Rodríguez-Palomares JF, Climent V, Bermudez-Jimenez FJ, Mogollón-Jiménez MV, Lopez J, Peña-Peña ML, Garcia-Alvarez A, López-Abel B, Ripoll-Vera T, Palomino-Doza J, Bayes-Genis A, Brugada R, Idiazabal U, Mirelis JG, Dominguez F, Henkens MTHM, Krapels IPC, Brunner HG, Paldino A, Zaffalon D, Mestroni L, Sinagra G, Heymans SRB, Merlo M, Garcia-Pavia P. Clinical Risk Score to Predict Pathogenic Genotypes in Patients With Dilated Cardiomyopathy. J Am Coll Cardiol 2022; 80:1115-1126. [PMID: 36109106 PMCID: PMC10804447 DOI: 10.1016/j.jacc.2022.06.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 04/28/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although genotyping allows family screening and influences risk-stratification in patients with nonischemic dilated cardiomyopathy (DCM) or isolated left ventricular systolic dysfunction (LVSD), its result is negative in a significant number of patients, limiting its widespread adoption. OBJECTIVES This study sought to develop and externally validate a score that predicts the probability for a positive genetic test result (G+) in DCM/LVSD. METHODS Clinical, electrocardiogram, and echocardiographic variables were collected in 1,015 genotyped patients from Spain with DCM/LVSD. Multivariable logistic regression analysis was used to identify variables independently predicting G+, which were summed to create the Madrid Genotype Score. The external validation sample comprised 1,097 genotyped patients from the Maastricht and Trieste registries. RESULTS A G+ result was found in 377 (37%) and 289 (26%) patients from the derivation and validation cohorts, respectively. Independent predictors of a G+ result in the derivation cohort were: family history of DCM (OR: 2.29; 95% CI: 1.73-3.04; P < 0.001), low electrocardiogram voltage in peripheral leads (OR: 3.61; 95% CI: 2.38-5.49; P < 0.001), skeletal myopathy (OR: 3.42; 95% CI: 1.60-7.31; P = 0.001), absence of hypertension (OR: 2.28; 95% CI: 1.67-3.13; P < 0.001), and absence of left bundle branch block (OR: 3.58; 95% CI: 2.57-5.01; P < 0.001). A score containing these factors predicted a G+ result, ranging from 3% when all predictors were absent to 79% when ≥4 predictors were present. Internal validation provided a C-statistic of 0.74 (95% CI: 0.71-0.77) and a calibration slope of 0.94 (95% CI: 0.80-1.10). The C-statistic in the external validation cohort was 0.74 (95% CI: 0.71-0.78). CONCLUSIONS The Madrid Genotype Score is an accurate tool to predict a G+ result in DCM/LVSD.
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Affiliation(s)
- Luis Escobar-Lopez
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, Madrid, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART), Madrid, Spain
| | - Juan Pablo Ochoa
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, Madrid, Spain; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART), Madrid, Spain
| | - Ana Royuela
- Biostatistics Unit, Puerta de Hierro Biomedical Research Institute (IDIPHISA), CIBERESP, Madrid, Spain
| | - Job A J Verdonschot
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Matteo Dal Ferro
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART), Madrid, Spain; Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Maria Angeles Espinosa
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Maria Sabater-Molina
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART), Madrid, Spain; Inherited Cardiac Disease Unit, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Maria Gallego-Delgado
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Inherited Cardiac Diseases Unit, Department of Cardiology, Instituto de Investigación Biomédica de Salamanca (IBSAL), Complejo Asistencial Universitario de Salamanca, Gerencia Regional de Salud de Castilla y León (SACYL), Salamanca, Spain
| | - Jose M Larrañaga-Moreira
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Inherited Cardiac Diseases Unit, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde (SERGAS), Universidade da Coruña, A Coruña, Spain
| | - Jose M Garcia-Pinilla
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Heart Failure and Familial Heart Diseases Unit, Cardiology Department, Hospital Universitario Virgen de la Victoria, IBIMA, Malaga, Spain
| | | | - José F Rodríguez-Palomares
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Inherited Cardiovascular Diseases Unit, Department of Cardiology, Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Vicente Climent
- Inherited Cardiovascular Diseases Unit, Department of Cardiology, Hospital General Universitario de Alicante, Institute of Health and Biomedical Research, Alicante, Spain
| | | | | | - Javier Lopez
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Instituto de Ciencias Del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Maria Luisa Peña-Peña
- Inherited Cardiac Diseases Unit, Hospital Universitario Virgen Del Rocío, Seville, Spain
| | - Ana Garcia-Alvarez
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; IDIBAPS, Hospital Clínic, Department of Cardiology, Universitat de Barcelona, Barcelona, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Bernardo López-Abel
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Inherited Cardiac Diseases Unit, Department of Cardiology, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Tomas Ripoll-Vera
- Inherited Cardiac Diseases Unit, Cardiology Department, Hospital Universitario Son Llatzer and IdISBa, Palma de Mallorca, Spain
| | - Julian Palomino-Doza
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Inherited Cardiac Diseases Unit, Cardiology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación i+12. Madrid, Spain
| | - Antoni Bayes-Genis
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Ramon Brugada
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitari Dr Josep Trueta, Girona, Spain
| | - Uxua Idiazabal
- Department of Cardiology, Clinica San Miguel, Pamplona, Spain
| | - Jesus G Mirelis
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, Madrid, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART), Madrid, Spain
| | - Fernando Dominguez
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, Madrid, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART), Madrid, Spain
| | - Michiel T H M Henkens
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Ingrid P C Krapels
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Han G Brunner
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, the Netherlands; GROW Institute for Developmental Biology and Cancer, Maastricht University, Maastricht, the Netherlands; Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Alessia Paldino
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART), Madrid, Spain; Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Denise Zaffalon
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART), Madrid, Spain; Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Luisa Mestroni
- CU Cardiovascular Institute, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Gianfranco Sinagra
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART), Madrid, Spain; Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Stephane R B Heymans
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands; Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Belgium
| | - Marco Merlo
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART), Madrid, Spain; Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Pablo Garcia-Pavia
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, IDIPHISA, Madrid, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART), Madrid, Spain; Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcón, Spain.
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Judge DP, Lakdawala NK, Taylor MRG, Mestroni L, Li H, Oliver C, Angeli FS, Lee PA, MacRae CA. Long-Term Efficacy and Safety of ARRY-371797 (PF-07265803) in Patients With Lamin A/C-Related Dilated Cardiomyopathy. Am J Cardiol 2022; 183:93-98. [PMID: 36114020 DOI: 10.1016/j.amjcard.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/28/2022] [Accepted: 08/06/2022] [Indexed: 11/01/2022]
Abstract
Dilated cardiomyopathy associated with lamin A/C (LMNA) gene variants (LMNA-related dilated cardiomyopathy [DCM]) is a life-threatening condition with a high unmet need, accounting for approximately 6% of idiopathic DCM cases. Currently, no disease-specific treatments target the underlying disease mechanism. ARRY-371797 (PF-07265803), a potent, selective, oral, small-molecule inhibitor of the p38α mitogen-activated protein kinase pathway, improved 6-minute walk test (6MWT) distance in 12 patients with symptomatic LMNA-related DCM in a 48-week, open-label, phase 2 study. This long-term extension study examined the safety and efficacy of ARRY-371797 in patients from the phase 2 study. 6MWT, N-terminal pro-B-type natriuretic peptide concentration, and 12-item Kansas City Cardiomyopathy Questionnaire score were assessed at weeks 48, 72, 96, 120, and 144 from phase 2 study baseline. Eight patients enrolled (mean [SD] age, 51 [10] years, 4 male). Mean 6MWT increased by >30 m (>10%) from phase 2 study baseline up to week 120. The decrease in N-terminal pro-B-type natriuretic peptide observed in the phase 2 study was maintained throughout the present study. Twelve-item Kansas City Cardiomyopathy Questionnaire Physical Limitation increased from baseline at all visits except week 96 (range: -0.8 [week 96] to 13.8 [week 120]); results for other domains were variable. Treatment was generally well tolerated; 2 patients discontinued because of causes not considered treatment-related. There were no deaths. ARRY-371797 was generally well tolerated over median (range) 155.7 (61 to 327)-week exposure; evidence suggested preserved exercise capacity over the study period. The ongoing, pivotal, phase 3, randomized, placebo-controlled study REALM-DCM investigates the efficacy and safety of ARRY-371797 (PF-07265803) in LMNA-related DCM. (ClinicalTrials.gov Identifier: NCT02351856).
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Affiliation(s)
- Daniel Philip Judge
- Cardiovascular Genetics, Medical University of South Carolina, Charleston, South Carolina.
| | - Neal Kush Lakdawala
- Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Luisa Mestroni
- Department of Medicine, Adult Medical Genetics Program, University of Colorado, Aurora, Colorado
| | - Huihua Li
- Pfizer Inc., Collegeville, Pennsylvania
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Castrichini M, Porcari A, Baggio C, Gagno G, Maione D, Barbati G, Medo K, Mestroni L, Merlo M, Sinagra G. Sex differences in natural history of cardiovascular magnetic resonance- and biopsy-proven lymphocytic myocarditis. ESC Heart Fail 2022; 9:4010-4019. [PMID: 36000547 PMCID: PMC9773744 DOI: 10.1002/ehf2.14102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/04/2022] [Accepted: 07/28/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS The role of sex in determining the profile and the outcomes of patients with myocarditis is largely unexplored. We evaluated the impact of sex as a modifier factor in the clinical characterization and natural history of patients with definite diagnosis of myocarditis. METHODS AND RESULTS We retrospectively analysed a single-centre cohort of consecutive patients with definite diagnosis of myocarditis (i.e. endomyocardial biopsy or cardiac magnetic resonance proven). Specific sub-analyses were performed in cohorts of patients with chest pain, ventricular arrhythmias, and heart failure as different main symptoms at presentation. The primary outcome measure was a composite of all-cause mortality or heart transplantation (HTx). We included 312 patients, of which 211, 68% of the whole population, were males. Despite no clinically relevant differences found at baseline presentation, males had a higher indexed left ventricular end-diastolic volume (62 ± 23 mL/m2 vs. 52 ± 20 mL/m2, P = 0.011 in males vs. females, respectively) at follow-up evaluation. At a median follow-up of 72 months, 36 (17%) males vs. 8 (8%) females experienced death or HTx (P = 0.033). Male sex emerged as predictors of all-cause mortality or HTx in every combination of covariates (HR 2.600; 1.163-5.809; P = 0.020). Results were agreeable regardless of the main symptom of presentation. CONCLUSIONS In a large cohort of patients with definite diagnosis of myocarditis, females experienced a more favourable long-term prognosis than males, despite a similar clinical profile at presentation.
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Affiliation(s)
- Matteo Castrichini
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI), University of Trieste, European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart‐ERN GUARD‐HeartTriesteItaly,Division of CardiologyUniversity of Colorado Anschutz Medical CampusAuroraCOUSA
| | - Aldostefano Porcari
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI), University of Trieste, European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart‐ERN GUARD‐HeartTriesteItaly
| | - Chiara Baggio
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI), University of Trieste, European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart‐ERN GUARD‐HeartTriesteItaly
| | - Giulia Gagno
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI), University of Trieste, European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart‐ERN GUARD‐HeartTriesteItaly
| | - Davide Maione
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI), University of Trieste, European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart‐ERN GUARD‐HeartTriesteItaly
| | - Giulia Barbati
- Biostatistics Unit, Department of Medical SciencesUniversity of TriesteTriesteItaly
| | - Kristen Medo
- Division of CardiologyUniversity of Colorado Anschutz Medical CampusAuroraCOUSA
| | - Luisa Mestroni
- Division of CardiologyUniversity of Colorado Anschutz Medical CampusAuroraCOUSA
| | - Marco Merlo
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI), University of Trieste, European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart‐ERN GUARD‐HeartTriesteItaly
| | - Gianfranco Sinagra
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular DepartmentAzienda Sanitaria Universitaria Giuliano‐Isontina (ASUGI), University of Trieste, European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart‐ERN GUARD‐HeartTriesteItaly
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Kuwabara JT, Hara A, Heckl JR, Peña B, Bhutada S, DeMaris R, Ivey MJ, DeAngelo LP, Liu X, Park J, Jahansooz JR, Mestroni L, McKinsey TA, Apte SS, Tallquist MD. Regulation of extracellular matrix composition by fibroblasts during perinatal cardiac maturation. J Mol Cell Cardiol 2022; 169:84-95. [PMID: 35569524 PMCID: PMC10149041 DOI: 10.1016/j.yjmcc.2022.05.003] [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: 09/25/2020] [Revised: 05/05/2022] [Accepted: 05/08/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Cardiac fibroblasts are the main non-myocyte population responsible for extracellular matrix (ECM) production. During perinatal development, fibroblast expansion coincides with the transition from hyperplastic to hypertrophic myocardial growth. Therefore, we investigated the consequences of fibroblast loss at the time of cardiomyocyte maturation by depleting fibroblasts in the perinatal mouse. METHODS AND RESULTS We evaluated the microenvironment of the perinatal heart in the absence of fibroblasts and the potential functional impact of fibroblast loss in regulation of cardiomyocyte cell cycle arrest and binucleation. Cre-mediated expression of diphtheria toxin A in PDGFRα expressing cells immediately after birth eliminated 70-80% of the cardiac fibroblasts. At postnatal day 5, hearts lacking fibroblasts appeared similar to controls with normal morphology and comparable numbers of endothelial and smooth muscle cells, despite a pronounced reduction in fibrillar collagen. Immunoblotting and proteomic analysis of control and fibroblast-deficient hearts identified differential abundance of several ECM proteins. In addition, fibroblast loss decreased tissue stiffness and resulted in increased cardiomyocyte mitotic index, DNA synthesis, and cytokinesis. Moreover, decellularized matrix from fibroblast-deficient hearts promoted cardiomyocyte DNA replication. While cardiac architecture was not overtly affected by fibroblast reduction, few pups survived past postnatal day 11, suggesting an overall requirement for PDGFRα expressing fibroblasts. CONCLUSIONS These studies demonstrate the key role of fibroblasts in matrix production and cardiomyocyte cross-talk during mouse perinatal heart maturation and revealed that fibroblast-derived ECM may modulate cardiomyocyte maturation in vivo. Neonatal depletion of fibroblasts demonstrated that although hearts can tolerate reduced ECM composition, fibroblast loss eventually leads to perinatal death as the approach simultaneously reduced fibroblast populations in other organs.
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Affiliation(s)
- Jill T Kuwabara
- Center for Cardiovascular Research, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, United States of America; Department of Cell and Molecular Biology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, United States of America
| | - Akitoshi Hara
- Center for Cardiovascular Research, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, United States of America
| | - Jack R Heckl
- Center for Cardiovascular Research, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, United States of America; Department of Cell and Molecular Biology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, United States of America
| | - Brisa Peña
- Department of Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States of America; Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States of America; Consortium for Fibrosis Research & Translation, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States of America
| | - Sumit Bhutada
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, OH 44195, United States of America
| | - Regan DeMaris
- Center for Cardiovascular Research, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, United States of America
| | - Malina J Ivey
- Center for Cardiovascular Research, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, United States of America; Department of Cell and Molecular Biology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, United States of America; Department of Pathology and Laboratory Medicine, University of Cincinnati, Cincinnati, OH 45267, United States of America
| | - Lydia P DeAngelo
- Center for Cardiovascular Research, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, United States of America
| | - Xiaoting Liu
- Center for Cardiovascular Research, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, United States of America
| | - Juwon Park
- Center for Cardiovascular Research, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, United States of America
| | - Julia R Jahansooz
- Center for Cardiovascular Research, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, United States of America
| | - Luisa Mestroni
- Department of Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States of America
| | - Timothy A McKinsey
- Department of Medicine, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States of America; Consortium for Fibrosis Research & Translation, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States of America
| | - Suneel S Apte
- Department of Biomedical Engineering, Cleveland Clinic Lerner Research Institute, Cleveland, OH 44195, United States of America
| | - Michelle D Tallquist
- Center for Cardiovascular Research, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, United States of America.
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Zanetti M, Andolfi L, Taylor MR, Mestroni L, Lazzarino M. AFM macro-probes to investigate whole 3D cardiac spheroids. Micro and Nano Engineering 2022. [DOI: 10.1016/j.mne.2022.100134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bui Q, Hong K, Kraushaar M, Ma G, Brambatti M, Kahn A, Battiha C, Boynton K, Storm G, Mestroni L, Taylor M, Demaria A, Adler E. Association Of Myocardial Strain With Clinical Outcomes In Danon Disease. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cannatà A, Merlo M, Dal Ferro M, Barbati G, Manca P, Paldino A, Graw S, Gigli M, Stolfo D, Johnson R, Roy D, Tharratt K, Bromage DI, Jirikowic J, Abbate A, Goodwin A, Rao K, Marawan A, Carr-White G, Robert L, Parikh V, Ashley E, McDonagh T, Lakdawala NK, Fatkin D, Taylor MRG, Mestroni L, Sinagra G. Association of Titin Variations With Late-Onset Dilated Cardiomyopathy. JAMA Cardiol 2022; 7:371-377. [PMID: 35138330 PMCID: PMC8829739 DOI: 10.1001/jamacardio.2021.5890] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/09/2021] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Dilated cardiomyopathy (DCM) is frequently caused by genetic factors. Studies identifying deleterious rare variants have predominantly focused on early-onset cases, and little is known about the genetic underpinnings of the growing numbers of patients with DCM who are diagnosed when they are older than 60 years (ie, late-onset DCM). OBJECTIVE To investigate the prevalence, type, and prognostic impact of disease-associated rare variants in patients with late-onset DCM. DESIGN, SETTING, AND PARTICIPANTS A population of patients with late-onset DCM who had undergone genetic testing in 7 international tertiary referral centers worldwide were enrolled from March 1990 to August 2020. A positive genotype was defined as the presence of pathogenic or likely pathogenic (P/LP) variants. MAIN OUTCOMES AND MEASURES The study outcome was all-cause mortality. RESULTS A total of 184 patients older than 60 years (103 female [56%]; mean [SD] age, 67 [6] years; mean [SD] left ventricular ejection fraction, 32% [10%]) were studied. Sixty-six patients (36%) were carriers of a P/LP variant. Titin-truncating variants were the most prevalent (present in 46 [25%] of the total population and accounting for 46 [69%] of all genotype-positive patients). During a median (interquartile range) follow-up of 42 (10-115) months, 23 patients (13%) died; 17 (25%) of these were carriers of P/LP variants, while 6 patients (5.1%) were genotype-negative. CONCLUSIONS AND RELEVANCE Late-onset DCM might represent a distinct subgroup characterized by and a high genetic variation burden, largely due to titin-truncating variants. Patients with a positive genetic test had higher mortality than genotype-negative patients. These findings support the extended use of genetic testing also in older patients.
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Affiliation(s)
- Antonio Cannatà
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
- Department of Cardiovascular Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- Department of Cardiology, King’s College Hospital, London, United Kingdom
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Matteo Dal Ferro
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Giulia Barbati
- Biostatistics Unit, University of Trieste, Trieste, Italy
| | - Paolo Manca
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Alessia Paldino
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Sharon Graw
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora
| | - Marta Gigli
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Davide Stolfo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Renee Johnson
- Molecular Cardiology Division, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia
- Faculty of Medicine, UNSW Sydney, Kensington, New South Wales, Australia
- Cardiology Department, St Vincent’s Hospital, Darlinghurst, New South Wales, Australia
| | - Darius Roy
- Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kevin Tharratt
- Center for Inherited Heart Disease, Stanford University, Stanford, California
| | - Daniel I. Bromage
- Department of Cardiovascular Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- Department of Cardiology, King’s College Hospital, London, United Kingdom
| | - Jean Jirikowic
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora
| | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond
| | - Allison Goodwin
- VCU Medical Center, Clinical Genetics Services, Richmond, Virginia
| | - Krishnasree Rao
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond
| | - Amr Marawan
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond
| | - Gerry Carr-White
- Department of Cardiology, Guys and St Thomas’ NHS Trust, London, United Kingdom
| | - Leema Robert
- Department of Clinical Genetics, Guys and St Thomas' NHS Trust, London, United Kingdom
| | - Victoria Parikh
- Center for Inherited Heart Disease, Stanford University, Stanford, California
| | - Euan Ashley
- Center for Inherited Heart Disease, Stanford University, Stanford, California
| | - Theresa McDonagh
- Department of Cardiovascular Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- Department of Cardiology, King’s College Hospital, London, United Kingdom
| | - Neal K. Lakdawala
- Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Diane Fatkin
- Molecular Cardiology Division, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia
- Faculty of Medicine, UNSW Sydney, Kensington, New South Wales, Australia
- Cardiology Department, St Vincent’s Hospital, Darlinghurst, New South Wales, Australia
| | - Matthew R. G. Taylor
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora
| | - Luisa Mestroni
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy
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Paldino A, Ferro MD, Stolfo D, Gigli M, Medo K, Graw SL, Taylor MR, Gandin I, Sinagra G, Mestroni L. CLINICAL MANIFESTATION AND PROGNOSIS OF DIFFERENT CARDIOMYOPATHIES ON THE BASE OF GENETIC BACKGROUND (GEN-PHEN). J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01259-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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38
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Zanetti M, Chen SN, Conti M, Taylor MRG, Sbaizero O, Mestroni L, Lazzarino M. Microfabricated cantilevers for parallelized cell-cell adhesion measurements. Eur Biophys J 2022; 51:147-156. [PMID: 34304293 DOI: 10.1007/s00249-021-01563-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/09/2021] [Accepted: 06/12/2021] [Indexed: 11/25/2022]
Abstract
Single-cell adhesion measured with atomic force microscopy (AFM) offers outstanding time and force resolution and allows the investigation of many important phenomena with unmatched precision. However, this technique suffers from serious practical limitations that hinder its effective application to a broader set of situations. Here we propose a different strategy based on the fabrication of large cantilevers and on the culture of the cells directly on them. Cantilevers are fabricated by standard micromachining, with an active area of 300 × 300 µm. A wedged structure is created so that the cantilever surface lies parallel to the substrate when mounted on an AFM system, so that the adhesion measurement probes the whole surface area at the same time. Thanks to the large area, cells can be seeded and grown on the cantilevers the day before the experiment, and let recover to optimal condition for the experiment. We used Human Embryonic Kidney cells, HEK 293A, to demonstrate the measurement of adhesion forces of up to 100 cells in parallel, and obtain a straightforward measurement of the average single cell adhesion energy. Our approach can improve significantly the cell-cell and cell-substrate adhesion statistics, reduce the experiment time and allow the investigation of the adhesion properties of cells that do not grow well in solution or on low adherent substrates, or that develop their characteristic features only after several hours or days of culture on a solid and adherent substrate.
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Affiliation(s)
- Michele Zanetti
- CNR-IOM, Istituto Officina dei Materiali - Consiglio Nazionale delle Ricerche, 34149, Trieste, Italy
- University of Trieste, 34127, Trieste, Italy
| | - Suet Nee Chen
- Molecular Genetics, Cardiovascular Institute, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, 80045-2507, USA
| | - Martina Conti
- CNR-IOM, Istituto Officina dei Materiali - Consiglio Nazionale delle Ricerche, 34149, Trieste, Italy
- University of Trieste, 34127, Trieste, Italy
| | - Matthew R G Taylor
- Molecular Genetics, Cardiovascular Institute, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, 80045-2507, USA
| | | | - Luisa Mestroni
- Molecular Genetics, Cardiovascular Institute, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, 80045-2507, USA
| | - Marco Lazzarino
- CNR-IOM, Istituto Officina dei Materiali - Consiglio Nazionale delle Ricerche, 34149, Trieste, Italy.
- Molecular Genetics, Cardiovascular Institute, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, 80045-2507, USA.
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39
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Sidhu K, Castrini AI, Parikh V, Reza N, Owens A, Tremblay-Gravel M, Wheeler MT, Mestroni L, Taylor M, Graw S, Gigli M, Merlo M, Paldino A, Sinagra G, Judge DP, Ramos H, Mesubi O, Brown E, Turnbull S, Kumar S, Roy D, Tedrow UB, Ngo L, Haugaa K, Lakdawala NK. The Response to Cardiac Resynchronization Therapy in LMNA cardiomyopathy. Eur J Heart Fail 2022; 24:685-693. [PMID: 35229420 PMCID: PMC9106891 DOI: 10.1002/ejhf.2463] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS Cardiac implantable electronic device (CIED) therapy is fundamental to the management of LMNA-cardiomyopathy due to the high frequency of atrioventricular block and ventricular tachyarrhythmias. We aim to define the role of cardiac resynchronization therapy (CRT) in impacting heart failure in LMNA-cardiomyopathy. METHODS AND RESULTS From 9 referral centers, LMNA-cardiomyopathy patients who underwent CRT with available pre- and post- echocardiograms were identified retrospectively. Factors associated with CRT response were identified [defined as improvement in left ventricular ejection fraction (LVEF) ≥5% 6-months post-implant] and the associated impact on the primary outcome of death, implantation of a left ventricular assist device or cardiac transplantation was assessed. We identified 105 patients (51±10 years) undergoing CRT, including 70 (67%) who underwent CRT as a CIED upgrade. The mean change in LVEF ~6 months post CRT was +4±9%. A CRT response occurred in 40 (38%) patients and was associated with lower baseline LVEF or a high percentage of right ventricular pacing prior to CRT in patients with pre-existing CIED. In patients with an ESC Class I guideline indication for CRT, response rates were 61%. A CRT response was evident at thresholds of LVEF ≤45% or percent pacing ≥50%. There was a 1.3 year estimated median difference in event-free survival in those who responded to CRT (p=0.04). CONCLUSION Systolic function improves in patients with LMNA-cardiomyopathy who undergo CRT, especially with strong guideline indications for implantation. Post CRT improvements in LVEF are associated with survival benefits in this population with otherwise limited options.
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Affiliation(s)
- Kiran Sidhu
- Section of Cardiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | | | | | - Nosheen Reza
- University of Pennsylvania Health System, Philadelphia, USA
| | - Anjali Owens
- University of Pennsylvania Health System, Philadelphia, USA
| | | | | | - Luisa Mestroni
- University of Colorado Anschutz Medical Campus, Denver, USA
| | - Matthew Taylor
- University of Colorado Anschutz Medical Campus, Denver, USA
| | - Sharon Graw
- University of Colorado Anschutz Medical Campus, Denver, USA
| | - Marta Gigli
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Alessia Paldino
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | | | - Hannia Ramos
- Medical University of South Carolina, Charleston, USA
| | | | - Emily Brown
- Johns Hopkins University School of Medicine, Baltimore, USA
| | - Samual Turnbull
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | - Darius Roy
- Brigham and Women's Hospital, Boston, USA
| | | | - Long Ngo
- Harvard T.H Chan School of Public Health, Boston, USA
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40
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Borrelli F, Storm G, Losi MA, Canciello G, Manganelli F, Tozza S, Esposito G, Taylor MR, Mestroni L, Lombardi R. HYPERTROPHIC CARDIOMYOPATHY: BEYOND THE SARCOMERE. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)03231-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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41
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Chen SN, Lam CK, Wan YW, Gao S, Malak OA, Zhao SR, Lombardi R, Ambardekar AV, Bristow MR, Cleveland J, Gigli M, Sinagra G, Graw S, Taylor MR, Wu JC, Mestroni L. Activation of PDGFRA signaling contributes to filamin C-related arrhythmogenic cardiomyopathy. Sci Adv 2022; 8:eabk0052. [PMID: 35196083 PMCID: PMC8865769 DOI: 10.1126/sciadv.abk0052] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/25/2021] [Indexed: 05/07/2023]
Abstract
FLNC truncating mutations (FLNCtv) are prevalent causes of inherited dilated cardiomyopathy (DCM), with a high risk of developing arrhythmogenic cardiomyopathy. We investigated the molecular mechanisms of mutant FLNC in the pathogenesis of arrhythmogenic DCM (a-DCM) using patient-specific induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs). We demonstrated that iPSC-CMs from two patients with different FLNCtv mutations displayed arrhythmias and impaired contraction. FLNC ablation induced a similar phenotype, suggesting that FLNCtv are loss-of-function mutations. Coimmunoprecipitation and proteomic analysis identified β-catenin (CTNNB1) as a downstream target. FLNC deficiency induced nuclear translocation of CTNNB1 and subsequently activated the platelet-derived growth factor receptor alpha (PDGFRA) pathway, which were also observed in human hearts with a-DCM and FLNCtv. Treatment with the PDGFRA inhibitor, crenolanib, improved contractile function of patient iPSC-CMs. Collectively, our findings suggest that PDGFRA signaling is implicated in the pathogenesis, and inhibition of this pathway is a potential therapeutic strategy in FLNC-related cardiomyopathies.
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Affiliation(s)
- Suet Nee Chen
- University of Colorado Cardiovascular Institute, University of Colorado Anschutz Medical Aurora, CO, USA
| | - Chi Keung Lam
- Stanford Cardiovascular Institute, Stanford, CA, USA
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Biological Sciences, University of Delaware, Newark, DE, USA
| | - Ying-Wooi Wan
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Shanshan Gao
- University of Colorado Cardiovascular Institute, University of Colorado Anschutz Medical Aurora, CO, USA
| | - Olfat A. Malak
- Stanford Cardiovascular Institute, Stanford, CA, USA
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Shane Rui Zhao
- Stanford Cardiovascular Institute, Stanford, CA, USA
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Raffaella Lombardi
- University of Colorado Cardiovascular Institute, University of Colorado Anschutz Medical Aurora, CO, USA
- Department of Advanced Biomedical Sciences University of Naples “Federico II”, Naples, Italy
| | - Amrut V. Ambardekar
- University of Colorado Cardiovascular Institute, University of Colorado Anschutz Medical Aurora, CO, USA
| | - Michael R. Bristow
- University of Colorado Cardiovascular Institute, University of Colorado Anschutz Medical Aurora, CO, USA
| | - Joseph Cleveland
- University of Colorado Cardiovascular Institute, University of Colorado Anschutz Medical Aurora, CO, USA
| | - Marta Gigli
- Cardiovascular Department, Azienda Sanitaria-Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria-Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Sharon Graw
- University of Colorado Cardiovascular Institute, University of Colorado Anschutz Medical Aurora, CO, USA
| | - Matthew R.G. Taylor
- University of Colorado Cardiovascular Institute, University of Colorado Anschutz Medical Aurora, CO, USA
| | - Joseph C. Wu
- Stanford Cardiovascular Institute, Stanford, CA, USA
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Luisa Mestroni
- University of Colorado Cardiovascular Institute, University of Colorado Anschutz Medical Aurora, CO, USA
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42
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Gao S, Mumme-Monheit A, Chen SN, Spector EB, Slavov D, Baralle FE, Bristow MR, Mestroni L, Taylor MR. An LMNA synonymous variant associated with severe dilated cardiomyopathy: Case report. Am J Med Genet A 2022; 188:600-605. [PMID: 34652067 PMCID: PMC8758524 DOI: 10.1002/ajmg.a.62530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/18/2021] [Accepted: 09/25/2021] [Indexed: 02/03/2023]
Abstract
Dilated cardiomyopathy (DCM) is one of the most common cardiac phenotypes caused by mutations of lamin A/C (LMNA) gene in humans. In our study, a cohort of 57 patients who underwent heart transplant for dilated cardiomyopathy was screened for variants in LMNA. We identified a synonymous variant c.936G>A in the last nucleotide of exon 5 of LMNA in a DCM family. Clinically, the LMNA variant carriers presented with severe familial DCM, conduction disease, and high creatine-kinase level. The LMNA c.936G>A variant is novel and has not been reported in current genetic variant databases. Sanger sequencing results showed the presence of LMNA c.936G>A variant in the genomic DNA but not in the cDNA derived from one family member's heart tissue. Real-time quantitative polymerase chain reaction showed significantly lower LMNA mRNA levels in the patient's heart compared to the controls, suggesting that the c.936G>A LMNA variant resulted in reduced mRNA and possibly lower protein expression of LMNA. These findings expand the understanding on the association between synonymous variant of LMNA and the molecular pathogenesis in DCM patients.
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Affiliation(s)
- Shanshan Gao
- Divison of Cardiology, Cardiovascular Institute, University of Colorado at Denver and Health Sciences Center, Aurora, Colorado, U.S.A
| | - Abigail Mumme-Monheit
- Divison of Cardiology, Cardiovascular Institute, University of Colorado at Denver and Health Sciences Center, Aurora, Colorado, U.S.A
| | - Suet Nee Chen
- Divison of Cardiology, Cardiovascular Institute, University of Colorado at Denver and Health Sciences Center, Aurora, Colorado, U.S.A
| | - Elaine B. Spector
- DNA Laboratory, University of Colorado at Denver and Health Sciences Center, Aurora, Colorado, U.S.A
| | - Dobromir Slavov
- Divison of Cardiology, Cardiovascular Institute, University of Colorado at Denver and Health Sciences Center, Aurora, Colorado, U.S.A
| | | | - Michael R. Bristow
- Divison of Cardiology, Cardiovascular Institute, University of Colorado at Denver and Health Sciences Center, Aurora, Colorado, U.S.A.,Adult Medical Genetics Program, University of Colorado at Denver and Health Sciences Center, Aurora, Colorado, U.S.A
| | - Luisa Mestroni
- Divison of Cardiology, Cardiovascular Institute, University of Colorado at Denver and Health Sciences Center, Aurora, Colorado, U.S.A.,Adult Medical Genetics Program, University of Colorado at Denver and Health Sciences Center, Aurora, Colorado, U.S.A
| | - Matthew R.G. Taylor
- Divison of Cardiology, Cardiovascular Institute, University of Colorado at Denver and Health Sciences Center, Aurora, Colorado, U.S.A
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43
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Castrichini M, Eldemire R, Groves DW, Taylor MR, Miyamoto S, Mestroni L. Clinical and genetic features of arrhythmogenic cardiomyopathy: diagnosis, management and the heart failure perspective. Prog Pediatr Cardiol 2022; 63. [PMID: 34970070 DOI: 10.1016/j.ppedcard.2021.101459] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Arrhythmogenic cardiomyopathy (ACM) is an emerging new concept of a life-threatening heart muscle disorder due not only to desmosome gene mutations, but also to non-desmosome genes, such as filamin C, lamin A/C, phospholamban, transmembrane protein 43, titin, SCN5A and RNA binding motif protein 20.Multi-modality imaging along with genetic testing are important tools for risk stratification to tailor treatment to a single patient. Cardiac magnetic resonance imaging (CMR) with late gadolinium enhancement (LGE) is the gold standard for evaluating left and right ventricular structure and function, edema, and fibrosis. The identification of regional fibrosis with LGE has prognostic value. The management of ACM involves several aspects: treatment of arrhythmias and heart failure, risk stratification, implantable cardioverter-defibrillator (ICD) placement, exercise restrictions, and life-style changes. The decision for ICD placement in ACM patients is not well established and should be made weighing risks and benefits. However, the presence of specific genotypes can allow a precision medicine approach. In ACM patients with only mild left ventricular dysfunction but phospholamban, filamin C or lamin A/C mutations, an ICD is now considered a reasonable approach. Aim of Review We sought to provide an overview of clinical and genetic feature of arrhythmogenic cardiomyopathy providing epidemiology, imaging, diagnostic and treatment information, using a systematic genetic approach.
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Affiliation(s)
- Matteo Castrichini
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Cardiology, Cardiothoracovascular Department, Azienda Ospedaliera Universitaria Integrata Giuliano Isontina (ASUGI), Trieste, Italy
| | - Ramone Eldemire
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Daniel W Groves
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Cardiothoracic Imaging, University of Colorado Anschutz Medical Campus Aurora, CO
| | - Matthew Rg Taylor
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
- Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Shelley Miyamoto
- Division of Cardiology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Luisa Mestroni
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
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Merlo M, Grilli G, Cappelletto C, Masé M, Porcari A, Ferro MD, Gigli M, Stolfo D, Zecchin M, De Luca A, Mestroni L, Sinagra G. The Arrhythmic Phenotype in Cardiomyopathy. Heart Fail Clin 2022; 18:101-113. [PMID: 34776072 DOI: 10.1016/j.hfc.2021.07.011] [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] [Indexed: 11/23/2022]
Abstract
In the wide phenotypic spectrum of cardiomyopathies, sudden cardiac death (SCD) has always been the most visible and devastating disease complication. The introduction of implantable cardioverter-defibrillators for SCD prevention by the late 1980s has moved the question from how to whom we should protect from SCD, leaving clinicians with a measure of uncertainty regarding the most reliable option to guide identification of the highest-risk patients. In this review, we will go through all the available evidence in the field of arrhythmic expression and arrhythmic risk stratification in the different phenotypes of cardiomyopathies to provide practical suggestions in daily clinical management.
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Affiliation(s)
- Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Italy.
| | - Giulia Grilli
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
| | - Chiara Cappelletto
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
| | - Marco Masé
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
| | - Aldostefano Porcari
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
| | - Matteo Dal Ferro
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
| | - Marta Gigli
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
| | - Davide Stolfo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
| | - Massimo Zecchin
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
| | - Antonio De Luca
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
| | - Luisa Mestroni
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
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45
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Cannata A, Merlo M, Dal Ferro M, Manca P, Paldino A, Barbati G, Graw S, Bromage D, Johnson R, Roy D, Gigli M, Stolfo D, Abbate A, Parkih V, Ashley E, Lakdawala N, Carr-White G, Fatkin D, Mcdonagh T, Taylor M, Mestroni L, Sinagra G. 418 Titin mutations and female sex characterize dilated cardiomyopathy in the elderly. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab142.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Dilated cardiomyopathy (DCM) is frequently caused by genetic factors. Studies identifying deleterious rare variants have predominantly focused on early-onset cases, and little is known about the genetic underpinnings of the growing numbers of patients with DCM who are diagnosed after 60 years of age (i.e. late-onset DCM). The aim is to investigate the prevalence, type, and prognostic impact of disease-associated rare variants in late-onset DCM patients.
Methods and results
We analysed a population of late-onset DCM patients who had undergone genetic testing in seven international tertiary referral centres worldwide. A positive genotype was defined as the presence of ‘pathogenic’ or ‘likely pathogenic’ (P/LP) variants. The study outcome was all-cause mortality. 184 patients over age 60 years (56% females, mean age 67 ± 6 years, mean left ventricular ejection fraction 32 ± 10%) were studied. Sixty-six patients (36%) were carriers of a P/LP variant. Titin truncating variants (TTNtv) were the most prevalent (present in 25% of the total population and accounting for 69% of all genotype-positive patients). During a median follow-up of 42 months (interquartile range: 10–115), 23 patients (13%) died; 17 of these (25%) were carriers of P/LP variants while six patients (5.1%) were genotype-negative (P < 0.001).
Conclusions
In the largest series worldwide, to date, of patients with late-onset DCM, we found a high prevalence of female sex and a high genetic mutation burden, largely due to TTNtv. Patients with a positive genetic test had higher mortality than genotype-negative patients. These findings support the extended use of genetic testing also in the elderly.
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Affiliation(s)
- Antonio Cannata
- Azienda Sanitaria Universitaria Giuliano Isontina, Italy
- King’s College London, UK
| | - Marco Merlo
- Azienda Sanitaria Universitaria Giuliano Isontina, Italy
| | | | - Paolo Manca
- Azienda Sanitaria Universitaria Giuliano Isontina, Italy
| | | | - Giulia Barbati
- Azienda Sanitaria Universitaria Giuliano Isontina, Italy
| | | | | | | | | | - Marta Gigli
- Azienda Sanitaria Universitaria Giuliano Isontina, Italy
| | - Davide Stolfo
- Azienda Sanitaria Universitaria Giuliano Isontina, Italy
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46
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Paldino A, Stolfo D, Dal Ferro M, Gigli M, Medo K, Graw S, Gagno G, Zaffalon D, Gandin I, Taylor M, Masè M, Merlo M, Mestroni L, Sinagra G. 382 Clinical manifestation and prognosis of different cardiomyopathies on the base of genetic background (GEN-PHEN). Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab142.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Cardiomyopathies (CMP) are a heterogeneous group of heart disease characterized by structural and electrical abnormalities with no other secondary causative etiology and frequently related to mutations in disease related genes. Clinical evaluation and phenotype definition are the key factors for clinical classification of CMPs. Recent studies in this field have showed important phenotype overlaps between Dilated Cardiomyopathy (DCM) and Arrhythmogenic Cardiomyopathy (ACM), making the diagnosis a challenging task. The aim of this study is to assess whether a classification of CMP patients (not hypertrophic) based on genetic characterization outperforms in diagnostic and prognostic accuracy the classical, phenotype-driven, diagnostic approach.
Methods and results
We analysed a population of patients affected by genetically determined DCM and ACM, carriers of ‘pathogenic’ or ‘likely pathogenic’ (P/LP) variants, registered into the Heart Disease Centers of Trieste and Denver hospitals. First, we described the phenotype distribution in our population with a clinical and echocardiographic evaluation based on the different disease-related mutated genes. Then, we examined the prognostic impact of the single gene/genetic cluster in assessing these composite outcomes: (1) all-cause mortality and heart transplant; (2) heart failure-related death, heart transplant or destination left ventricular assist device implantation (DHF/HTx/VAD); and (3) sudden cardiac death, sustained ventricular tachycardia/ventricular fibrillation or appropriate defibrillator shock (SCD/VT/VF/shock). 281 patients carrying P/LP variants (82% DCM) were included in the study. Titin (TTN) and sarcomeric genes (SARC) variants were the most prevalent (TTN: 95 patients, 34% of total population; SARC: 63 patients, 22% of total population) and almost completely related to DCM phenotype (TTN: 100% DCM, SARC: 95% DCM), such as lamin (LMNA) patients (29 patients, 10% of total population, 96% DCM). A more heterogeneous phenotypic distribution between DCM and ACM were detected for desmoplakin (DSP), plakoglobin (PKP2), and filamin (FLNC) variants. Patients with not isolated DCM phenotype and patients’ carriers of DSP, PKP2, FLNC and LMNA variants (arrhythmic genes) experienced more frequent SCD/VT/VF/shock events (P-value = 0.002 and P = 0.023), compared respectively to patients with DCM phenotype and to patients’ carriers of TTNtv and SARC variants, during follow-up (median time 132 months). The multivariable analysis shown that only P/LP variants of arrhythmic genes, younger age of disease onset and male gender, were associated with an increased risk of SCD/VT/VF/shock events during follow-up. No difference in terms of HF events was significantly related to genotype.
Conclusions
Our study demonstrated that the classification based on the presence of a specific genotype outperforms phenotypic classification in terms of arrhythmic risk in a large DCM and ACM population with a positive genetic test for P/LP variants. These findings support the need of extensive genetic testing to support CMP diagnosis and prognosis.
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Affiliation(s)
- Alessia Paldino
- Cardiovascular Department, Azienda Sanitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
| | - Davide Stolfo
- Cardiovascular Department, Azienda Sanitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
| | - Matteo Dal Ferro
- Cardiovascular Department, Azienda Sanitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
| | - Marta Gigli
- Cardiovascular Department, Azienda Sanitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
| | - Kristen Medo
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado, Aurora, CO, USA
| | - Sharon Graw
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado, Aurora, CO, USA
| | - Giulia Gagno
- Cardiovascular Department, Azienda Sanitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
| | - Denise Zaffalon
- Cardiovascular Department, Azienda Sanitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
| | | | - Matthew Taylor
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado, Aurora, CO, USA
| | - Marco Masè
- Cardiovascular Department, Azienda Sanitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
| | - Luisa Mestroni
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado, Aurora, CO, USA
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Giuliano Isontina (ASUGI), University of Trieste, Italy
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Castrichini M, Merlo M, Baggio C, Gagno G, Maione D, Porcari A, Barbati G, Adamo L, Mestroni L, Sinagra G. 125 Sex differences in myocarditis natural history. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab142.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aims
The role of sex in determining the profile and the outcomes of patients with myocarditis is widely unexplored. Our study seeks to evaluate the impact of sex as a modifier factor in the clinical characterization and natural history of patients with definite diagnosis of myocarditis.
Methods and results
We retrospectively analysed a single-centre cohort of consecutive patients with definite diagnosis (i.e., endomyocardial biopsy or cardiac magnetic resonance proven) of myocarditis. A sub-analysis was performed after division of population according to the main symptom of presentation (i.e., chest pain, ventricular arrhythmias, and heart failure). Clinical and echocardiographic data were evaluated at diagnosis and at last available evaluation (i.e., median of 30 months). The study outcome measure was a composite of all-cause mortality or heart transplantation. We enrolled 312 patients (187; 60% presenting with chest pain; 19; 6% with ventricular arrhythmias; 106; 34% with heart failure). Most of patients (211, 68% of the whole population) were males, consistently in the three modes of presentation. Despite no clinically relevant differences were found at baseline presentation, males presented a larger indexed left ventricular end-diastolic volume (LVEDVi) (62 ± 23 vs. 52 ± 20, P = 0.011 in males vs. females respectively) at follow-up evaluation. At a median follow-up of 62 months, 36 (17%) males vs. females experienced death or heart transplantation (Log-rank P = 0.037). At multivariable Cox analysis, male sex emerged as a predictor of mortality (HR: 2.358; 1.044–5.322; P = 0.039 and left ventricular ejection fraction (LVEF) < 50% (HR: 8.169; 1.226–54.425; P = 0.030)]. Results were consistent in patients presenting with heart failure and chest pain, while arrhythmic group was too small to be reliably interpreted.
Conclusions
In a large cohort of patients with definite diagnosis of myocarditis, females experienced a more favorable long-term prognosis than male, despite a similar clinical profile at baseline.
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Affiliation(s)
- Matteo Castrichini
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano-Isontina (ASUGI), Trieste, Italy
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Marco Merlo
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano-Isontina (ASUGI), Trieste, Italy
| | - Chiara Baggio
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano-Isontina (ASUGI), Trieste, Italy
| | - Giulia Gagno
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano-Isontina (ASUGI), Trieste, Italy
| | - Davide Maione
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano-Isontina (ASUGI), Trieste, Italy
| | - Aldostefano Porcari
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano-Isontina (ASUGI), Trieste, Italy
| | - Giulia Barbati
- Biostatistic Unit, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Luigi Adamo
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Luisa Mestroni
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gianfranco Sinagra
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Integrata Giuliano-Isontina (ASUGI), Trieste, Italy
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Bui QM, Hong KN, Kraushaar M, Ma GS, Brambatti M, Kahn AM, Battiha CE, Boynton K, Storm G, Mestroni L, Taylor MRG, DeMaria AN, Adler EA. Myocardial Strain and Association With Clinical Outcomes in Danon Disease: A Model for Monitoring Progression of Genetic Cardiomyopathies. J Am Heart Assoc 2021; 10:e022544. [PMID: 34845930 PMCID: PMC9075351 DOI: 10.1161/jaha.121.022544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Myocardial strain can identify subclinical left ventricular dysfunction in various cardiac diseases, but its association with clinical outcomes in genetic cardiomyopathies remains unknown. Herein, we assessed myocardial strain in patients with Danon disease (DD), a rare X‐linked autophagic disorder that causes severe cardiac manifestations. Methods and Results Echocardiographic images were reviewed and used to calculate myocardial strain from a retrospective, international registry of patients with DD. Regression analyses were performed to evaluate for an association of global longitudinal strain (GLS) and ejection fraction with the composite outcome (death, ventricular assist device, heart transplantation, and implantable cardioverter defibrillator for secondary prevention). A total of 22 patients with DD (male 14 [63.6%], median age 16.5 years) had sufficient echocardiograms for analysis. Absolute GLS was reduced with a mean of 12.2% with an apical‐sparing pattern observed. Univariable regression for GLS and composite outcome showed an odds ratio of 1.32 (95% CI, 1.02–1.71) with P=0.03. For receiver operating characteristic analysis, the areas under the curve for GLS and ejection fraction were 0.810 (P=0.02) and 0.605 (P=0.44), respectively. An absolute GLS cutoff of 10.0% yielded a true positive rate of 85.7% and false positive rate of 13.3%. Conclusions In this cohort of patients with DD, GLS may be a useful assessment of myocardial function and may predict clinical outcomes. This study highlights the potential use of myocardial strain phenotyping to monitor disease progression and potentially to predict clinical outcomes in DD and other genetic cardiomyopathies.
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Affiliation(s)
- Quan M Bui
- Division of Cardiovascular Medicine Department of Medicine University of California, San Diego San Diego CA
| | - Kimberly N Hong
- Division of Cardiovascular Medicine Department of Medicine University of California, San Diego San Diego CA
| | - Megan Kraushaar
- Division of Cardiovascular Medicine Department of Medicine University of California, San Diego San Diego CA
| | - Gary S Ma
- Division of Cardiovascular Medicine Department of Medicine University of California, San Diego San Diego CA
| | - Michela Brambatti
- Division of Cardiovascular Medicine Department of Medicine University of California, San Diego San Diego CA
| | - Andrew M Kahn
- Division of Cardiovascular Medicine Department of Medicine University of California, San Diego San Diego CA
| | - Carol Elias Battiha
- Division of Cardiovascular Medicine Department of Medicine University of California, San Diego San Diego CA
| | - Kylie Boynton
- Division of Cardiology Department of Medicine Adult Medical Genetics Program University of Colorado Anschutz Medical Campus Aurora CO
| | - Garrett Storm
- Division of Cardiology Department of Medicine Adult Medical Genetics Program University of Colorado Anschutz Medical Campus Aurora CO
| | - Luisa Mestroni
- Division of Cardiology Department of Medicine Adult Medical Genetics Program University of Colorado Anschutz Medical Campus Aurora CO
| | - Matthew R G Taylor
- Division of Cardiology Department of Medicine Adult Medical Genetics Program University of Colorado Anschutz Medical Campus Aurora CO
| | - Anthony N DeMaria
- Division of Cardiovascular Medicine Department of Medicine University of California, San Diego San Diego CA
| | - Eric A Adler
- Division of Cardiovascular Medicine Department of Medicine University of California, San Diego San Diego CA
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Gigli M, Stolfo D, Graw SL, Merlo M, Gregorio C, Nee Chen S, Dal Ferro M, PaldinoMD A, De Angelis G, Brun F, Jirikowic J, Salcedo EE, Turja S, Fatkin D, Johnson R, van Tintelen JP, Te Riele ASJM, Wilde AAM, Lakdawala NK, Picard K, Miani D, Muser D, Maria Severini G, Calkins H, James CA, Murray B, Tichnell C, Parikh VN, Ashley EA, Reuter C, Song J, Judge DP, McKenna WJ, Taylor MRG, Sinagra G, Mestroni L. Phenotypic Expression, Natural History, and Risk Stratification of Cardiomyopathy Caused by Filamin C Truncating Variants. Circulation 2021; 144:1600-1611. [PMID: 34587765 DOI: 10.1161/circulationaha.121.053521] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Filamin C truncating variants (FLNCtv) cause a form of arrhythmogenic cardiomyopathy: the mode of presentation, natural history, and risk stratification of FLNCtv remain incompletely explored. We aimed to develop a risk profile for refractory heart failure and life-threatening arrhythmias in a multicenter cohort of FLNCtv carriers. METHODS FLNCtv carriers were identified from 10 tertiary care centers for genetic cardiomyopathies. Clinical and outcome data were compiled. Composite outcomes were all-cause mortality/heart transplantation/left ventricle assist device (D/HT/LVAD), nonarrhythmic death/HT/LVAD, and sudden cardiac death/major ventricular arrhythmias. Previously established cohorts of 46 patients with LMNA and 60 with DSP-related arrhythmogenic cardiomyopathies were used for prognostic comparison. RESULTS Eighty-five patients carrying FLNCtv were included (42±15 years, 53% men, 45% probands). Phenotypes were heterogeneous at presentation: 49% dilated cardiomyopathy, 25% arrhythmogenic left dominant cardiomyopathy, 3% arrhythmogenic right ventricular cardiomyopathy. Left ventricular ejection fraction was <50% in 64% of carriers and 34% had right ventricular fractional area changes (RVFAC=(right ventricular end-diastolic area - right ventricular end-systolic area)/right ventricular end-diastolic area) <35%. During follow-up (median time 61 months), 19 (22%) carriers experienced D/HT/LVAD, 13 (15%) experienced nonarrhythmic death/HT/LVAD, and 23 (27%) experienced sudden cardiac death/major ventricular arrhythmias. The sudden cardiac death/major ventricular arrhythmias incidence of FLNCtv carriers did not significantly differ from LMNA carriers and DSP carriers. In FLNCtv carriers, left ventricular ejection fraction was associated with the risk of D/HT/LVAD and nonarrhythmic death/HT/LVAD. CONCLUSIONS Among patients referred to tertiary referral centers, FLNCtv arrhythmogenic cardiomyopathy is phenotypically heterogeneous and characterized by a high risk of life-threatening arrhythmias, which does not seem to be associated with the severity of left ventricular dysfunction.
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Affiliation(s)
- Marta Gigli
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy (M.G., D.S., M.M., M.D.F., A.P., G.D.A., F.B., G.S.)
| | - Davide Stolfo
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy (M.G., D.S., M.M., M.D.F., A.P., G.D.A., F.B., G.S.).,Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden (D.S.)
| | - Sharon L Graw
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora (S.G., S.N.C., J.J., E.E.S., S.T., M.R.G.T., L.M.)
| | - Marco Merlo
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy (M.G., D.S., M.M., M.D.F., A.P., G.D.A., F.B., G.S.)
| | - Caterina Gregorio
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, Italy (C.G.).,MOX-Modeling and Scientific Computing Laboratory, Department of Mathematics, Politecnico di Milano, Milan, Italy (C.G.)
| | - Suet Nee Chen
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora (S.G., S.N.C., J.J., E.E.S., S.T., M.R.G.T., L.M.)
| | - Matteo Dal Ferro
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy (M.G., D.S., M.M., M.D.F., A.P., G.D.A., F.B., G.S.)
| | - Alessia PaldinoMD
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy (M.G., D.S., M.M., M.D.F., A.P., G.D.A., F.B., G.S.)
| | - Giulia De Angelis
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy (M.G., D.S., M.M., M.D.F., A.P., G.D.A., F.B., G.S.)
| | - Francesca Brun
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy (M.G., D.S., M.M., M.D.F., A.P., G.D.A., F.B., G.S.)
| | - Jean Jirikowic
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora (S.G., S.N.C., J.J., E.E.S., S.T., M.R.G.T., L.M.)
| | - Ernesto E Salcedo
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora (S.G., S.N.C., J.J., E.E.S., S.T., M.R.G.T., L.M.)
| | - Sylvia Turja
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora (S.G., S.N.C., J.J., E.E.S., S.T., M.R.G.T., L.M.)
| | - Diane Fatkin
- Molecular Cardiology Division, Victor Chang Cardiac Research Institute, and St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Australia (D.F., R.J.).,Cardiology Department, St Vincent's Hospital, Sydney, Australia (D.F.)
| | - Renee Johnson
- Molecular Cardiology Division, Victor Chang Cardiac Research Institute, and St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Australia (D.F., R.J.)
| | - J Peter van Tintelen
- Division of Medicine, Department of Genetics and Cardiology, University Medical Center, Utrecht, the Netherlands (J.P.v.T., A.S.J.M.T.R.).,Netherlands Heart Institute, Utrecht (J.P.v.T., A.S.J.M.T.R.)
| | - Anneline S J M Te Riele
- Division of Medicine, Department of Genetics and Cardiology, University Medical Center, Utrecht, the Netherlands (J.P.v.T., A.S.J.M.T.R.).,Netherlands Heart Institute, Utrecht (J.P.v.T., A.S.J.M.T.R.)
| | - Arthur A M Wilde
- Heart Centre, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, the Netherlands (A.W.)
| | - Neal K Lakdawala
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.K.L., K.P.)
| | - Kermshlise Picard
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.K.L., K.P.)
| | - Daniela Miani
- University Hospital of Udine, Italy (D. Miani, D. Muser)
| | - Daniele Muser
- University Hospital of Udine, Italy (D. Miani, D. Muser)
| | | | - Hugh Calkins
- Division of Cardiology, Department of Medicine, The Johns Hopkins University, Baltimore, MD (H.C., C.A.J., B.M., C.T.)
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, The Johns Hopkins University, Baltimore, MD (H.C., C.A.J., B.M., C.T.)
| | - Brittney Murray
- Division of Cardiology, Department of Medicine, The Johns Hopkins University, Baltimore, MD (H.C., C.A.J., B.M., C.T.)
| | - Crystal Tichnell
- Division of Cardiology, Department of Medicine, The Johns Hopkins University, Baltimore, MD (H.C., C.A.J., B.M., C.T.)
| | - Victoria N Parikh
- Stanford Center for Inherited Cardiovascular Disease, CA (V.N.P., E.A.A., C.R.)
| | - Euan A Ashley
- Stanford Center for Inherited Cardiovascular Disease, CA (V.N.P., E.A.A., C.R.)
| | - Chloe Reuter
- Stanford Center for Inherited Cardiovascular Disease, CA (V.N.P., E.A.A., C.R.)
| | - Jiangping Song
- National Center for Cardiovascular Diseases in Beijing, China (J.S.)
| | | | - William J McKenna
- Institute of Cardiovascular Science, University College of London, United Kingdom (W.J.M.)
| | - Matthew R G Taylor
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora (S.G., S.N.C., J.J., E.E.S., S.T., M.R.G.T., L.M.)
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), University of Trieste, Trieste, Italy (M.G., D.S., M.M., M.D.F., A.P., G.D.A., F.B., G.S.)
| | - Luisa Mestroni
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora (S.G., S.N.C., J.J., E.E.S., S.T., M.R.G.T., L.M.)
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50
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Chadalawada S, Rassi A, Samara O, Monzon A, Gudapati D, Vargas Barahona L, Hyson P, Sillau S, Mestroni L, Taylor M, da Consolação Vieira Moreira M, DeSanto K, Agudelo Higuita NI, Franco-Paredes C, Henao-Martínez AF. Mortality risk in chronic Chagas cardiomyopathy: a systematic review and meta-analysis. ESC Heart Fail 2021; 8:5466-5481. [PMID: 34716744 PMCID: PMC8712892 DOI: 10.1002/ehf2.13648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/13/2021] [Accepted: 09/23/2021] [Indexed: 11/09/2022] Open
Abstract
Aims This study aimed to estimate the annual mortality risk and its determinants in chronic Chagas cardiomyopathy. Methods and results We conducted a systematic search in MEDLINE, Web of Science Core Collection, Embase, Cochrane Library, and LILACS. Longitudinal studies published between 1 January 1946 and 24 October 2018 were included. A random‐effects meta‐analysis using the death rate over the mean follow‐up period in years was used to obtain pooled estimated annual mortality rates. Main outcomes were defined as all‐cause mortality, including cardiovascular, non‐cardiovascular, heart failure, stroke, and sudden cardiac deaths. A total of 5005 studies were screened for eligibility. A total of 52 longitudinal studies for chronic Chagas cardiomyopathy including 9569 patients and 2250 deaths were selected. The meta‐analysis revealed an annual all‐cause mortality rate of 7.9% [95% confidence interval (CI): 6.3–10.1; I2 = 97.74%; T2 = 0.70] among patients with chronic Chagas cardiomyopathy. The pooled estimated annual cardiovascular death rate was 6.3% (95% CI: 4.9–8.0; I2 = 96.32%; T2 = 0.52). The annual mortality rates for heart failure, sudden death, and stroke were 3.5%, 2.6%, and 0.4%, respectively. Meta‐regression showed that low left ventricular ejection fraction (coefficient = −0.04; 95% CI: −0.07, −0.02; P = 0.001) was associated with an increased mortality risk. Subgroup analysis based on American Heart Association (AHA) classification revealed pooled estimate rates of 4.8%, 8.7%, 13.9%, and 22.4% (P < 0.001) for B1/B2, B2/C, C, and C/D stages of cardiomyopathy, respectively. Conclusions The annual mortality risk in chronic Chagas cardiomyopathy is substantial and primarily attributable to cardiovascular causes. This risk significantly increases in patients with low left ventricular ejection fraction and those classified as AHA stages C and C/D.
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Affiliation(s)
- Sindhu Chadalawada
- Department of Medicine, Alameda Health System-Highland Hospital, Oakland, CA, USA
| | - Anis Rassi
- Division of Cardiology, Anis Rassi Hospital, Goiânia, GO, Brazil
| | - Omar Samara
- School of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Anthony Monzon
- School of Medicine, University of Colorado Denver, Aurora, CO, USA
| | | | | | - Peter Hyson
- Hospital Infantil de México, Federico Gómez, México City, Mexico
| | - Stefan Sillau
- Department of Neurology, University of Colorado Denver School of Medicine, Aurora, CO, USA
| | - Luisa Mestroni
- Adult Medical Genetics Program, Cardiovascular Institute, University of Colorado Denver School of Medicine, Aurora, CO, USA
| | - Matthew Taylor
- Adult Medical Genetics Program, Cardiovascular Institute, University of Colorado Denver School of Medicine, Aurora, CO, USA
| | - Maria da Consolação Vieira Moreira
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Kristen DeSanto
- Health Sciences Library, University of Colorado Denver, Aurora, CO, USA
| | | | - Carlos Franco-Paredes
- Hospital Infantil de México, Federico Gómez, México City, Mexico.,Department of Medicine, Division of Infectious Diseases, University of Colorado Denver School of Medicine, 12700 E. 19th Avenue, Mail Stop B168, Aurora, CO, 80045, USA
| | - Andrés F Henao-Martínez
- Department of Medicine, Division of Infectious Diseases, University of Colorado Denver School of Medicine, 12700 E. 19th Avenue, Mail Stop B168, Aurora, CO, 80045, USA
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