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A novel PKP2 mutation and intrafamilial phenotypic variability in ARVC/D
Nejat Mahdieh1,2, Sedigheh Saedi1,2, Mahdieh Soveizi1
1Cardiogenetic Research Laboratory, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Insights
A novel PKP2 gene mutation causes Arrhythmogenic Ventricular Cardiomyopathy (ARVC), but modifier genes may explain why only one family member developed the disease. This highlights genetic factors influencing ARVC presentation.
Area of Science:
- Cardiology
- Genetics
- Molecular Biology
Background:
- Arrhythmogenic Ventricular Cardiomyopathy (ARVC) is an inherited heart condition affecting 1 in 1000 globally.
- The average age of ARVC diagnosis is 31 years.
- This study investigates an Iranian family with ARVC linked to a new PKP2 mutation.
Purpose of the Study:
- To identify the genetic cause of ARVC in an Iranian family.
- To investigate the basis for intrafamilial phenotypic variability in ARVC.
Main Methods:
- Clinical assessments including ECG and CMR.
- Genetic testing (PCR-sequencing) to identify mutations.
- Segregation analysis and interactome analysis of PKP2.
Main Results:
- A novel PKP2 mutation (p.Tyr168Ter) was identified in the family.
- The mutation was inherited from mother to son, but only the son exhibited ARVC.
- Interactome analysis suggested modifier genes influencing PKP2 function.
Conclusions:
- A novel PKP2 mutation is implicated in ARVC in this population.
- Modifier genes likely contribute to the varying disease presentation within the family.
- Nonsense-mediated mRNA decay is a potential mechanism for phenotypic variability.
Abstract:
Background: Arrhythmogenic ventricular cardiomyopathy (AVC) is an inherited cardiac disorder affecting 1 in 1000 individuals worldwide. The mean diagnosed age of disease is 31 years. In this article, an Iranian family reported that they were affected by ARVC due to a novel PKP2 mutation. Methods: Clinical evaluations, 12-lead ECG, CMR, and signal-averaged ECG were performed. After DNA extraction, genetic testing was done, and PCR-sequencing was applied to find causal mutations. Segregation analysis was also performed for the family. Results: ARVC criteria were documented in the patients. Genetic testing revealed a novel chain termination mutation (p.Tyr168Ter) in PKP2 gene; this mutation was transmitted from the mother to her 23-year-old son, but only the son was affected with ARVC. Conclusion: Modifier genes were indicated using interactome analysis of Plakophilin 2 protein (PKP2); they might have led to phenotypic variability through cellular mechanisms, such as nonsense-mediated mRNA decay. At least, 9 proteins were identified that might have affected Plakophilin 2 protein function, and consequently, rationalizing this intrafamilial phenotypic variability. This study highlighted the role of modifier genes involved in ARVC as well as the major role of PKP2 mutation in developing the disease in our population.
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