आणविक और आनुवंशिक चिकित्सा

The trans KCNMA1-M744T and cis ANXA11-I457V and DYDC2-P123R Variants are Associated with Familial Dilated Cardiomyopathy

Abstract

Purevjav E, Zhang W, Mendsai Khan U, Gong N, Martherus R, Sadek B, Munkhsai Khan U, Xu F, Lu L and Towbin JA

Objectives: Cardiomyopathies are diseases of heart muscle caused by mutations in cytoskeletal genes. Disease severity and penetrance vary greatly among patients carrying the same mutation(s) and single-gene variants often do not reliably predict cardiomyopathy phenotypes.

Background: The chromosome 10q21-q23 locus was previously associated to familial dilated cardiomyopathy (DCM), arrhythmias, heart failure, Wolff-Parkinson-White (WPW) syndrome, mitral valve prolapse (MVP) and/or mitral regurgitation (MR). However, the exact variants responsible for heterogeneous DCM and arrhythmia phenotypes remained unknown.

Methods: A large family of 62 members was re-studied using whole exome and direct sequencing. Phenotype- genotype correlation and systems genetics analysis were performed.

Results: We identified missense KCNMA1-M744T, ANXA11-I457V, and DYDC2-P123R variants at 10q21-q23. The proband and ten family members carried ANXA11-I457V and DYDC2-P123R identified in cis (digenic heterozygosity). Seven digenic carriers were affected including DCM (n = 3), heart failure (n = 1), left ventricular dysfunction (n = 3), arrhythmia (n = 2), MVP (n=2) and MR (n = 3). A single KCNMA1-M744T variant was identified in 11 individuals, including 4 affected with MVP or MR (n = 4), ventricular arrhythmia (n = 2), and WPW (n = 1). All three variants were identified in three family members and all were affected. Rare variants in cardiomyopathy-related genes such as CORIN-I52V, TTN-S21630P, TRPM7-Y537H, OTX1-H301del and FLNC- N47S were identified in affected individuals.

Conclusions: This study facilitated the family-based predictive and personalized approach in identifying disease causative basis in patients with familial DCM and their relatives “at risk”. Different variant combinations of trans- KCNMA1-M744T and cis-ANXA11-I457V and DYDC2-P123R identified at 10q21-q23 underlie the clinical heterogeneity of familial DCM. Rare variants identified beyond the 10q21-q23 were predicted to modify the function of KCNMA1, ANXA11, and DYDC2 that may serve as the genetic modifiers in intra- and inter-familial phenotypic variability.