Étude de variants du gène de la calséquestrine de type 2 (CASQ2)

La calséquestrine de type 2 (Casq2) est la protéine majeure de chélation du calcium dans le reticulum sarcoplasmique dans le muscle cardiaque. Elle est impliquée dans une sévère pathologie rythmique héréditaire : la tachycardie ventriculaire polymorphe catécholaminergique. Les mutations de CASQ2 identifiées à Grenoble au laboratoire de Biochimie et Génétique Moléculaire de 2007 à 2013 ont été recensées et l impact sur l épissage des mutations introniques et faux-sens a été évalué en utilisant des logiciels de prédiction. Deux mutations de CASQ2 ont fait l objet d une étude fonctionnelle: c.44C>G ; p.S15C localisée dans le peptide signal, et c.838+88T>G, une mutation intronique pouvant affecter l épissage. Les prédictions in silico n ont pas mis en évidence d altération de l épissage pour les variations faux-sens testées mais il apparaît que la moitié des mutations identifiées au laboratoire ont un impact sur l épissage. L utilisation d un minigène sauvage et muté en 838+88T>G a permis l étude des transcrits in vitro et n a montré aucun impact sur l épissage. La mutation p.S15C a été étudiée in vitro par expression ectopique. Cette mutation ne semble pas affecter la localisation de Casq2 dans le reticulum. En revanche, l étude de polymérisation suggérait un défaut de dimérisation de la protéine mutée, bien que ce résultat soit à confirmer. En conclusion, ces résultats n ont pas pu prouver la pathogénicité des mutations p.S15C et 838+88T>G mais ont permis de valider de nouveaux outils pour l étude fonctionnelle des variations qui seront identifiées au laboratoire.Cardiac calsequestrin (Casq2) is the major calcium storage protein in the sarcoplasmic reticulum of cardiomyocytes. It is involved in catecholaminergic polymorphic ventricular tachycardia, a severe inherited arrythmogenic disorder. CASQ2 mutations identified from 2007 to 2013 in the Molecular Genetic Laboratory of Grenoble were gathered and splicing effects of intronic and missense mutations were evaluated with prediction softwares. Functionnal analysis of two CASQ2 mutations was performed: p.S15C, a missense mutation in the signal peptide, and c.838+88T>G, a deep intronic mutation possibly involved in splicing defect. In silico predictions did not detect any splicing effect for the missense mutations but half of the mutations identified in the laboratory were shown to affect CASQ2 splicing. Wild-type and mutant c.838+88T>G minigene in vitro analysis showed no splicing defect. Wild-type and p.S15C mutant were analyzed after cell line transfections. Immunofluorescence studies, immunoblots, and glycosylation studies showed no effect of the p.S15C mutation. Polymerization studies suggested a dimerization defect for the mutant protein, although this results needs to be confirmed. In conclusion, these results could not prove the pathogenicity of the p.S15C and c.838+88T>G mutations but allowed the validation of new tools for further functional analysis in the laboratory.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

Exon skipping as a therapeutic strategy applied to an RYR1 mutation with pseudo-exon inclusion causing a severe core myopathy.

International audienceCentral core disease is a myopathy often arising from mutations in the type 1 ryanodine receptor (RYR1) gene, encoding the sarcoplasmic reticulum calcium release channel RyR1. No treatment is currently available for this disease. We studied the pathological situation of a severely affected child with two recessive mutations, which resulted in a massive reduction in the amount of RyR1. The paternal mutation induced the inclusion of a new in-frame pseudo-exon in RyR1 mRNA that resulted in the insertion of additional amino acids leading to the instability of the protein. We hypothesized that skipping this additional exon would be sufficient to restore RyR1 expression and to normalize calcium releases. We therefore developed U7-AON lentiviral vectors to force exon skipping on affected primary muscle cells. The efficiency of the exon skipping was evaluated at the mRNA level, at the protein level, and at the functional level using calcium imaging. In these affected cells, we observed a decreased inclusion of the pseudo-exon, an increased RyR1 protein expression, and a restoration of calcium releases of normal amplitude either upon direct RyR1 stimulation or in response to membrane depolarization. This study is the first demonstration of the potential of exon-skipping strategy for the therapy of central core disease, from the molecular to the functional level

Absence of triadin, a protein of the calcium release complex, is responsible for cardiac arrhythmia with sudden death in human

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited arrhythmogenic disease so far related to mutations in the cardiac ryanodine receptor (RYR2) or the cardiac calsequestrin (CASQ2) genes. Because mutations in RYR2 or in CASQ2 are not retrieved in all CPVT cases, we searched for mutations in the physiological protein partners of RyR2 and CSQ2 in a large cohort of CPVT patients with no detected mutation in these two genes. Based on a candidate gene approach, we focused our investigations on triadin and junctin, two proteins that link RyR2 and CSQ2. Mutations in the triadin (TRDN) and in the junctin (ASPH) genes were searched in a cohort of 97 CPVT patients. We identified three mutations in triadin which cosegregated with the disease on a recessive mode of transmission in two families, but no mutation was found in junctin. Two TRDN mutations, a 4 bp deletion and a nonsense mutation, resulted in premature stop codons; the third mutation, a p.T59R missense mutation, was further studied. Expression of the p.T59R mutant in COS-7 cells resulted in intracellular retention and degradation of the mutant protein. This was confirmed after in vivo expression of the mutant triadin in triadin knock-out mice by viral transduction. In this work, we identified TRDN as a new gene responsible for an autosomal recessive form of CPVT. The mutations identified in the two families lead to the absence of the protein, thereby demonstrating the importance of triadin for the normal function of the cardiac calcium release complex in humans

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Etude et caractérisation des gènes impliqués dans la tachycardie ventriculaire polymorphe catécholaminergique

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare and severe inherited arrhythmogenic disorder, responsible for sudden death in young patients. It is a genetically heterogenous pathology with an autosomal dominant form associated with mutations of the RYR2 gene, and a recessive form associated with mutations of the CASQ2 gene. The ryanodine receptor RyR2 is a Ca2+ channel, and the calsequestrin Casq2 is the major calcium storage protein, located in the sarcoplasmic reticulum of the cardiomyocytes. They belong to the calcium release complex (CRC) that plays a central role in excitation-contraction coupling. In this work, we report the identification of RYR2 and CASQ2 mutations in 75 and 11 CPVT probands, respectively. We identified two cases of germline and somatic mosaicism in RYR2. Two splicing mutations of CASQ2 have been validated using a splicing minigene assay. We searched for mutations among 97 CPVT probands, negative for RYR2 and CASQ2, in three candidate genes: TRDN, ASPH and FKBP1B, encoding three proteins of the CRC. We did not identify any mutation of ASPH and FKBP1B genes. However, we found three mutations in the TRDN gene, encoding the cardiac triadin: a microdeletion, a nonsense mutation, both leading to a premature stop codon, and a missense mutation. We demonstrated that the missense mutation induces a drastic reduction of the protein in cellular and animal models. All the three mutations would thus be associated with the absence of triadin, leading to dysfunction of the CRC, and arythmias. In conclusion, our results confirm that RYR2 is the major gene implicated in CPVT, and CASQ2 rarely implicated. Moreover, we report mutations of the TRDN gene for the first time in pathology, as a third gene associated with a rare autosomal recessive form of CPVT.La Tachycardie Ventriculaire Polymorphe Catécholaminergique (TVPC) est une pathologie rythmique héréditaire rare et sévère, responsable de mort subite chez le sujet jeune. Les mutations des gènes RYR2 et CASQ2 sont associées respectivement à une transmission autosomique dominante et récessive de la maladie. Le canal calcique RyR2 et la protéine chélatrice du calcium Casq2 sont situés dans le réticulum sarcoplasmique (RS) où ils participent au complexe de relâchement calcique (CRC), essentiel à l'homéostasie calcique cardiaque. L'analyse de RYR2 et CASQ2 chez 214 probands ayant présenté une TVPC nous a permis d'identifier respectivement des mutations chez 75 et 11 probands. Deux cas de mosaïques germinales et somatiques ont été identifiés dans le gène RYR2. Deux mutations d'épissage du gène CASQ2 ont été validées à l'aide de minigènes. Chez 97 patients négatifs pour RYR2 et CASQ2, nous avons décidé de rechercher des mutations de trois protéines du CRC (la triadine, la junctine et FKBP12.6) en séquençant les gènes correspondants. Nous n'avons retrouvé aucune mutation de la junctine, ni de FKBP12.6. En revanche, nous avons identifié trois mutations de la triadine: une micro-délétion et une mutation non-sens entraînant un codon stop prématuré, ainsi qu'une variation faux-sens, dont la caractérisation à l'aide de modèle animal et cellulaire a montré qu'elle entraînait une dégradation massive de la protéine. Les mutations du gène TRDN seraient associées à une absence de triadine entraînant une dysfonction du CRC, à l'origine des arythmies observées. En conclusion, nos résultats confirment que RYR2 est le gène majeur impliqué dans la TVPC, CASQ2 étant rarement impliqué; et nous rapportons, pour la première fois, des mutations du gène TRDN en pathologie humaine, associée à une forme autosomique rare de TVPC

Research and characterization of genes implicated in the catecholaminergic ventricular tachycardia

La Tachycardie Ventriculaire Polymorphe Catécholaminergique (TVPC) est une pathologie rythmique héréditaire rare et sévère, responsable de mort subite chez le sujet jeune. Les mutations des gènes RYR2 et CASQ2 sont associées respectivement à une transmission autosomique dominante et récessive de la maladie. Le canal calcique RyR2 et la protéine chélatrice du calcium Casq2 sont situés dans le réticulum sarcoplasmique (RS) où ils participent au complexe de relâchement calcique (CRC), essentiel à l'homéostasie calcique cardiaque. L'analyse de RYR2 et CASQ2 chez 214 probands ayant présenté une TVPC nous a permis d'identifier respectivement des mutations chez 75 et 11 probands. Deux cas de mosaïques germinales et somatiques ont été identifiés dans le gène RYR2. Deux mutations d'épissage du gène CASQ2 ont été validées à l'aide de minigènes. Chez 97 patients négatifs pour RYR2 et CASQ2, nous avons décidé de rechercher des mutations de trois protéines du CRC (la triadine, la junctine et FKBP12.6) en séquençant les gènes correspondants. Nous n'avons retrouvé aucune mutation de la junctine, ni de FKBP12.6. En revanche, nous avons identifié trois mutations de la triadine: une micro-délétion et une mutation non-sens entraînant un codon stop prématuré, ainsi qu'une variation faux-sens, dont la caractérisation à l'aide de modèle animal et cellulaire a montré qu'elle entraînait une dégradation massive de la protéine. Les mutations du gène TRDN seraient associées à une absence de triadine entraînant une dysfonction du CRC, à l'origine des arythmies observées. En conclusion, nos résultats confirment que RYR2 est le gène majeur impliqué dans la TVPC, CASQ2 étant rarement impliqué; et nous rapportons, pour la première fois, des mutations du gène TRDN en pathologie humaine, associée à une forme autosomique rare de TVPC.Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare and severe inherited arrhythmogenic disorder, responsible for sudden death in young patients. It is a genetically heterogenous pathology with an autosomal dominant form associated with mutations of the RYR2 gene, and a recessive form associated with mutations of the CASQ2 gene. The ryanodine receptor RyR2 is a Ca2+ channel, and the calsequestrin Casq2 is the major calcium storage protein, located in the sarcoplasmic reticulum of the cardiomyocytes. They belong to the calcium release complex (CRC) that plays a central role in excitation-contraction coupling. In this work, we report the identification of RYR2 and CASQ2 mutations in 75 and 11 CPVT probands, respectively. We identified two cases of germline and somatic mosaicism in RYR2. Two splicing mutations of CASQ2 have been validated using a splicing minigene assay. We searched for mutations among 97 CPVT probands, negative for RYR2 and CASQ2, in three candidate genes: TRDN, ASPH and FKBP1B, encoding three proteins of the CRC. We did not identify any mutation of ASPH and FKBP1B genes. However, we found three mutations in the TRDN gene, encoding the cardiac triadin: a microdeletion, a nonsense mutation, both leading to a premature stop codon, and a missense mutation. We demonstrated that the missense mutation induces a drastic reduction of the protein in cellular and animal models. All the three mutations would thus be associated with the absence of triadin, leading to dysfunction of the CRC, and arythmias. In conclusion, our results confirm that RYR2 is the major gene implicated in CPVT, and CASQ2 rarely implicated. Moreover, we report mutations of the TRDN gene for the first time in pathology, as a third gene associated with a rare autosomal recessive form of CPVT

Apport de l'analyse chromosomique des spermatozoïdes lors du conseil génétique ou de l'aide médicale à la procréation chez un patient porteur d'une translocation équilibrée

GRENOBLE1-BU Médecine pharm. (385162101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Germline and somatic mosaicism for a mutation of the ryanodine receptor type 2 gene: implication for genetic counselling and patient caring.

International audienceWe identified a heterozygous p.Arg2401His mutation of RYR2 by sequencing the DNA of a 7-year-old girl who was referred for catecholaminergic polymorphic ventricular tachycardia (CPVT). Using high-resolution melting assay, we have demonstrated a mosaicism for this mutation in her asymptomatic mother which illustrates the benefit of extensive genetic analysis in CPVT, in particular regarding genetic counselling

Evidence for genetic heterogeneity in Carvajal syndrome.

International audienceCarvajal syndrome is a rare syndrome with woolly hair, palmoplantar keratosis and dilated cardiomyopathy. The inheritance of the mutation is autosomal recessive. As a causal gene, the desmoplakin gene (DSP) has so far been identified; it encodes an essential component of desmosomes, a cell-cell structure aimed at keeping cells attached to each other in tissues in which cells are often exposed to strong shear forces. Recently, familial cases of an autosomal dominant Carvajal syndrome were documented with a new feature: hypo/oligodontia. A mutation in the DSP gene was also evidenced in these latter cases. A patient was seen for cardiogenetic consultation at the University Hospital of Lyon with cardiac failure involving first degree atrioventricular block, complete left bundle branch block, non-compaction of the apex of the left ventricle and a dilated cardiomyopathy. A coronarography disclosed a complete thrombosis of the right coronary artery. At examination, he had also woolly hair, mild palmoplantar keratosis and missing teeth (essentially molars and premolars). His family history was uninformative. His DNA was screened for mutations in the DSP and plakoglobin genes but no mutation could be found. This case suggests that Carvajal syndrome with hypo/oligodontia is a heterogeneous condition in which genes other than DSP might be involved, although we cannot rule out a mutation in this gene consisting in a deletion of a single exon or a gene rearrangement

Challenging indication of cardioverter defibrillator implantation after sudden cardiac arrest in the very young: a case series of catecholaminergic polymorphic ventricular tachycardia secondary to de novo calmodulin p.Asn98Ser

International audienceBackgroundCalmodulinopathy is an emerging group of primary electrical disease with various, severe, and early onset phenotype. Sudden cardiac arrest (SCA)/death can be the first symptom and current medical management seems insufficient to prevent recurrences. Implantable cardioverter-defibrillator (ICD) in the young is challenging and can be harmful.Case summaryWe report the management of two very young boys (aged 3.5 and 5.5 years old) who survived an SCA due to calmodulin mutation responsible of a catecholaminergic polymorphic ventricular tachycardia phenotype. In both case, SCA had an adrenergic trigger. Despite SCA, ICD implantation was denied by the parents. After thorough discussion with the family, the patients were managed with solely betablocker treatment and loop recorder implantation. At last follow-up of 30 and 23 months, respectively, there were no recurrence of any cardiac event.DiscussionThe benefits of ICD implantation at a very young age must be weighed against the risk complication. In the youngest, whom recreative activities are under constant supervision, the decision, jointly made with the parents, could be to postpone ICD