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Published on: April 4, 2018
Compound Heterozygous Missense Variants in RPL3L Genes Associated with Severe Forms of Dilated Cardiomyopathy: A Case
Bibhuti B Das1, Viswanath Gajula2, Sandeep Arya2
1Department of Pediatrics, Division of Cardiology, Children's of Mississippi, University of Mississippi Medical Center, Jackson, MS 39216, USA.
Insights
Whole exome sequencing identified a novel genetic cause of severe early-onset dilated cardiomyopathy (DCM) in an infant. This finding highlights the RPL3L gene
Area of Science:
- Genetics
- Cardiology
- Molecular Biology
Background:
- Dilated cardiomyopathy (DCM) is a severe heart condition often with a genetic basis.
- Early-onset DCM in infants presents a significant clinical challenge.
- Identifying causative genes is crucial for diagnosis and management.
Observation:
- Whole exome sequencing identified pathogenic variants in the ribosomal protein large 3-like (RPL3L) gene in an infant with fulminant DCM.
- The infant experienced severe acute heart failure, requiring mechanical support (Berlin-Excor) as a bridge to heart transplantation.
- Other genetic and secondary causes of DCM were excluded.
Findings:
- Bi-allelic RPL3L variants are associated with a severe, early-onset form of DCM.
- This is only the eighth reported case of RPL3L-related DCM globally.
- The condition has a poor prognosis, often necessitating heart transplantation.
Implications:
- RPL3L should be considered in the genetic workup of infants with severe early-onset DCM.
- Further research into RPL3L function is needed to understand DCM pathogenesis.
- This discovery expands the known genetic landscape of cardiomyopathies.
Abstract:
Whole exome sequencing has identified an infant girl with fulminant dilated cardiomyopathy (DCM), leading to severe acute heart failure associated with ribosomal protein large 3-like (RPL3L) gene pathologic variants. Other genetic tests for mitochondrial disorders by sequence analysis and deletion testing of the mitochondrial genome were negative. Secondary causes for DCM due to metabolic and infectious etiologies were ruled out. She required a Berlin-Excor left ventricular assist device due to worsening of her heart failure as a bridge to orthotopic heart transplantation. At three months follow-up after heart transplantation, she has been doing well. We reviewed the literature on published RPL3L-related DCM cases and their outcomes. Bi-allelic variants in RPL3L have been reported in only seven patients from four unrelated families in the literature. RPL3L is a newer and likely pathogenic gene associated with a severe form of early-onset dilated cardiomyopathy with poor prognosis necessitating heart transplantation.
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