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Published on: August 8, 2022
Myosin binding protein C mutations and compound heterozygosity in hypertrophic cardiomyopathy
Sara L Van Driest1, Vlad C Vasile, Steve R Ommen
1Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Insights
Myosin binding protein C (MYBPC3) mutations are found in 18% of hypertrophic cardiomyopathy (HCM) patients. Multiple MYBPC3 mutations indicate a more severe HCM presentation.
Area of Science:
- Cardiovascular Genetics
- Molecular Cardiology
Background:
- Mutations in MYBPC3 are a leading genetic cause of hypertrophic cardiomyopathy (HCM).
- Previous studies have not fully characterized MYBPC3 mutation frequency and clinical presentation in large, diverse patient cohorts.
Purpose of the Study:
- To determine the prevalence and clinical characteristics of MYBPC3 gene mutations in a large cohort of hypertrophic cardiomyopathy patients.
- To investigate the association between MYBPC3 mutations and disease severity.
Main Methods:
- Genomic DNA from 389 unrelated HCM patients was analyzed for MYBPC3 mutations using PCR, DHPLC, and DNA sequencing.
- Clinical data, including age at diagnosis and hypertrophy, were collected and analyzed, blinded to genotype.
Main Results:
- MYBPC3 mutations were identified in 71 (18%) of the 389 HCM patients, with 33 novel mutations found.
- Patients with MYBPC3 mutations showed similar clinical presentations to those with other HCM genetic causes, except for those with multiple mutations.
- Patients harboring multiple MYBPC3 mutations (2.6%) exhibited the most severe disease phenotype.
Conclusions:
- This study provides the largest dataset on MYBPC3 mutation frequency and phenotype in HCM patients.
- MYBPC3 mutations in HCM patients largely mimic the phenotype of beta-myosin heavy chain mutations.
- The presence of multiple MYBPC3 mutations is associated with a significantly more severe hypertrophic cardiomyopathy presentation.
Objectives:
We sought to determine the frequency and phenotype of mutations in myosin binding protein C (MYBPC3) in a large outpatient cohort of patients with hypertrophic cardiomyopathy (HCM) seen at our tertiary referral center.
Background:
Mutations in MYBPC3 are one of the most frequent genetic causes of HCM and have been associated with variable onset of disease and prognosis. However, the frequency of mutations and associated clinical presentation have not been established in a large, unrelated cohort of patients.
Methods:
Using deoxyribonucleic acid from 389 unrelated patients with HCM, each protein coding exon of MYBPC3 was analyzed for mutations by polymerase chain reaction, denaturing high-performance liquid chromatography, and direct deoxyribonucleic acid sequencing. Clinical data were extracted from patient records blinded to patient genotype.
Results:
Of 389 patients with HCM, 71 (18%) had mutations in MYBPC3. In all, 46 mutations were identified, 33 of which were novel (72%). Patients with MYBPC3 mutations did not differ significantly from patients with thick filament-HCM, thin filament-HCM, or genotype-negative HCM with respect to age at diagnosis, degree of hypertrophy, incidence of myectomy, or family history of HCM or sudden death. Patients with multiple mutations (n = 10, 2.6%) had the most severe disease presentation.
Conclusions:
This study defines the frequency and associated phenotype for MYBPC3 and/or multiple mutations in HCM in the largest cohort to date. In this cohort, unrelated patients with MYBPC3-HCM virtually mimicked the phenotype of those with mutations in the beta-myosin heavy chain. Patients with multiple mutations had the most severe phenotype.
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