Varian Kenneth, Tang W H Wilson
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, 44195, USA.
Center for Clinical Genomics, Cleveland Clinic, Cleveland, OH, USA.
Curr Heart Fail Rep. 2017 Aug;14(4):321-330. doi: 10.1007/s11897-017-0346-8.
Cardiomyopathies due to genetic mutations are a heterogeneous group of disorders that comprise diseases of contractility, myocardial relaxation, and arrhythmias. Our goal here is to discuss a limited list of genetically inherited cardiomyopathies and the specific therapeutic strategies used to treat them.
Research into the molecular pathophysiology of the development of these cardiomyopathies is leading to the development of novel treatment approaches. Therapies targeting these specific mutations with gene therapy vectors are on the horizon, while other therapies which indirectly affect the physiologic derangements of the mutations are currently being studied and used clinically. Many of these therapies are older medications being given new roles such as mexiletine for Brugada syndrome and diflunisal for transthyretin amyloid cardiomyopathy. A newer targeted therapy, the inhibitor of myosin ATPase MYK-461, has been shown to suppress the development of ventricular hypertrophy, fibrosis, and myocyte disarray and is being studied as a potential therapy in patients with hypertrophic cardiomyopathy. While this field is too large to be completely contained in a single review, we present a large cross section of recent developments in the field of therapeutics for inherited cardiomyopathies. New therapies are on the horizon, and their development will likely result in improved outcomes for patients inflicted by these conditions.
由基因突变引起的心肌病是一组异质性疾病,包括收缩性疾病、心肌舒张性疾病和心律失常性疾病。我们在此的目标是讨论一份有限的遗传性心肌病清单以及用于治疗它们的特定治疗策略。
对这些心肌病发生发展的分子病理生理学研究正在催生新的治疗方法。使用基因治疗载体针对这些特定突变的疗法即将出现,而其他间接影响突变生理紊乱的疗法目前正在研究和临床应用中。这些疗法中有许多是赋予新作用的老药物,如用于布加综合征的美西律和用于转甲状腺素蛋白淀粉样心肌病的双氟尼酸。一种较新的靶向疗法,肌球蛋白ATP酶抑制剂MYK-461,已被证明可抑制心室肥厚、纤维化和心肌细胞排列紊乱的发展,目前正在作为肥厚型心肌病患者的潜在疗法进行研究。虽然这个领域太大,无法在一篇综述中完全涵盖,但我们展示了遗传性心肌病治疗领域近期发展的一个大横截面。新疗法即将出现,它们的发展可能会改善这些疾病患者的预后。