Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, 35121 Padua, Italy.
Int J Mol Sci. 2024 Jun 6;25(11):6267. doi: 10.3390/ijms25116267.
Arrhythmogenic cardiomyopathy (ACM) is an inherited myocardial disease at risk of sudden death. Genetic testing impacts greatly in ACM diagnosis, but gene-disease associations have yet to be determined for the increasing number of genes included in clinical panels. Genetic variants evaluation was undertaken for the most relevant non-desmosomal disease genes. We retrospectively studied 320 unrelated Italian ACM patients, including 243 cases with predominant right-ventricular (ARVC) and 77 cases with predominant left-ventricular (ALVC) involvement, who did not carry pathogenic/likely pathogenic (P/LP) variants in desmosome-coding genes. The aim was to assess rare genetic variants in transmembrane protein 43 (), desmin (), phospholamban (), filamin c (), cadherin 2 (), and tight junction protein 1 (), based on current adjudication guidelines and reappraisal on reported literature data. Thirty-five rare genetic variants, including 23 (64%) P/LP, were identified in 39 patients (16/243 ARVC; 23/77 ALVC): 22 , 9 , 2 , and 2 . No P/LP variants were found in and genes. Gene-based burden analysis, including P/LP variants reported in literature, showed significant enrichment for (3.79-fold), (10.31-fold), (117.8-fold) and (107-fold). A non-desmosomal rare genetic variant is found in a minority of ARVC patients but in about one third of ALVC patients; as such, clinical decision-making should be driven by genes with robust evidence. More than two thirds of non-desmosomal P/LP variants occur in FLNC.
致心律失常性右室心肌病(ARVC)是一种遗传性心肌疾病,存在猝死风险。基因检测对 ARVC 的诊断有重要影响,但对于不断增加的纳入临床检测面板的基因,其与疾病的关联尚未确定。我们对最相关的非桥粒病基因进行了遗传变异评估。我们回顾性研究了 320 名意大利无关联 ARVC 患者,包括 243 例以右心室(ARVC)为主和 77 例以左心室(ALVC)为主受累的患者,这些患者在桥粒编码基因中未携带致病变异/可能致病变异(P/LP)。其目的是根据当前的裁决标准和重新评估已发表的文献数据,评估跨膜蛋白 43 ()、结蛋白 ()、磷酸化酶结合蛋白 ()、细丝蛋白 C ()、钙粘蛋白 2 () 和紧密连接蛋白 1 () 中的罕见遗传变异。在 39 名患者(243 例 ARVC 中有 16 例;77 例 ALVC 中有 23 例)中发现了 35 种罕见的遗传变异,包括 23 种(64%)P/LP:22 种、9 种、2 种和 2 种。在和 基因中未发现 P/LP 变异。包括文献中报道的 P/LP 变异在内的基于基因的负担分析显示,在 (3.79 倍)、 (10.31 倍)、 (117.8 倍)和 (107 倍)中显著富集。非桥粒的罕见遗传变异在少数 ARVC 患者中发现,但在大约三分之一的 ALVC 患者中发现;因此,临床决策应根据具有可靠证据的基因来驱动。非桥粒的 P/LP 变异中超过三分之二发生在 FLNC 中。