Published online before print February 27, 2006, doi: 10.1161/CIRCULATIONAHA.105.583674
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(Circulation. 2006;113:1171-1179.)
© 2006 American Heart Association, Inc.
Arrhythmia/Electrophysiology |
Mutations in Desmoglein-2 Gene Are Associated With Arrhythmogenic Right Ventricular Cardiomyopathy
From the Departments of Biology (K.P., G.B., A.L., A.V., G.A.D., A.R.) and Cardiothoracic-Vascular Sciences (A.N., B.B., G.F.) and the Institute of Pathology (C.B., M.V., G.T.), University of Padua Medical School, Padua, Italy; and Department of Pediatrics, Section of Cardiology, Baylor College of Medicine, Houston, Tex (J.T.).
Correspondence to Andrea Nava, MD, Department of Cardiothoracic-Vascular Sciences, University of Padua, Via Giustiniani 2, Padua, Italy. E-mail andrea.nava{at}unipd.it
Received August 19, 2005; revision received December 23, 2005; accepted December 28, 2005.
Background— Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy characterized by progressive myocardial atrophy with fibrofatty replacement. The recent identification of causative mutations in plakoglobin, desmoplakin (DSP), and plakophilin-2 (PKP2) genes led to the hypothesis that ARVC is due to desmosomal defects. Therefore, desmoglein-2 (DSG2), the only desmoglein isoform expressed in cardiac myocytes, was screened in subjects with ARVC.
Methods and Results— In a series of 80 unrelated ARVC probands, 26 carried a mutation in DSP (16%), PKP2 (14%), and transforming growth factor-ß3 (2.5%) genes; the remaining 54 were screened for DSG2 mutations by denaturing high-performance liquid chromatography and direct sequencing. Nine heterozygous DSG2 mutations (5 missense, 2 insertion-deletions, 1 nonsense, and 1 splice site mutation) were detected in 8 probands (10%). All probands fulfilled task force criteria for ARVC. An endomyocardial biopsy was obtained in 5, showing extensive loss of myocytes with fibrofatty tissue replacement. In 3 patients, electron microscopy investigation was performed, showing intercalated disc paleness, decreased desmosome number, and intercellular gap widening.
Conclusions— This is the first investigation demonstrating DSG2 gene mutations in a significant number of ARVC-unrelated probands. Cardiac phenotype is characterized clinically by typical ARVC features with frequent left ventricular involvement and morphologically by fibrofatty myocardial replacement and desmosomal remodeling. The presence of mutations in desmosomal encoding genes in 40% of cases confirms that many forms of ARVC are due to alterations in the desmosome complex.
CLINICAL PERSPECTIVE
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