Rouhi Leila
Center for Cardiovascular Genetics, Institute of Molecular Medicine and Department of Medicine, University of Texas Health Sciences Center at Houston, Houston, Texas, USA.
Curr Opin Cardiol. 2025 May 1;40(3):131-138. doi: 10.1097/HCO.0000000000001209. Epub 2025 Feb 17.
This review highlights the diverse cardiac manifestations of LMNA mutations, focusing on their underlying molecular mechanisms and clinical implications. As LMNA mutations are implicated in cardiomyopathies, such as dilated cardiomyopathy (DCM), arrhythmogenic cardiomyopathy (ARVC), and conduction system diseases, understanding these phenotypes is critical for advancing diagnosis and management strategies.
Recent studies reveal that LMNA mutations disrupt nuclear envelope stability, activating the DNA damage response (DDR) and compromising chromatin organization and mechanotransduction. Mouse models have elucidated pathways linking LMNA dysfunction to fibrosis, arrhythmias, and myocardial remodeling. Emerging evidence demonstrates that fibroblasts play a crucial role in cardiac phenotypes. Advances in genetic screening have also underscored the importance of early identification and risk stratification, particularly for arrhythmias and sudden cardiac death.
The diverse spectrum of LMNA-related cardiac phenotypes, from isolated conduction defects to severe DCM and ARVC, underscores the necessity of personalized care strategies. Bridging insights from molecular studies and clinical research paves the way for targeted therapies to slow disease progression and improve patient outcomes. Future efforts should prioritize translational research on molecular mechanisms with potential in mouse models, alongside a deeper exploration of genotype-phenotype correlations, to refine and implement effective therapeutic interventions.
本综述重点介绍了LMNA突变的多种心脏表现,着重阐述其潜在的分子机制和临床意义。由于LMNA突变与心肌病有关,如扩张型心肌病(DCM)、致心律失常性心肌病(ARVC)和传导系统疾病,了解这些表型对于推进诊断和管理策略至关重要。
最近的研究表明,LMNA突变会破坏核膜稳定性,激活DNA损伤反应(DDR),并损害染色质组织和机械转导。小鼠模型已经阐明了将LMNA功能障碍与纤维化、心律失常和心肌重塑联系起来的途径。新出现的证据表明,成纤维细胞在心脏表型中起关键作用。基因筛查的进展也强调了早期识别和风险分层的重要性,特别是对于心律失常和心源性猝死。
从孤立的传导缺陷到严重的DCM和ARVC,LMNA相关心脏表型的多样性凸显了个性化护理策略的必要性。将分子研究和临床研究的见解相结合,为减缓疾病进展和改善患者预后的靶向治疗铺平了道路。未来的工作应优先开展对小鼠模型中具有潜力的分子机制的转化研究,同时更深入地探索基因型与表型的相关性,以完善和实施有效的治疗干预措施。