Genetics and genetic testing in pulmonary arterial hypertension (RCD code: II-1A.2)
Full Text:
Abstract
Pulmonary arterial hypertension (PAH) is a rare disease with a high mortality and complex pathomechanism. Recent studies suggest an important role of genetic factors in the development of PAH. It was shown that patients with BMPR2 mutations present a disease at an earlier age and have more severe haemodynamics at diagnosis. Interestingly, in this disorder lifelong penetrance is estimated to be only about 20% and the mechanism of this phenomenon remains unknown. More recent studies focused on the mutational analysis of genes involved in TGFß signaling pathway in patients with PAH. The results of these studies are very promising but they still need to be confirmed. Moreover, data on the impact of identified mutations on the clinical course, PAH-specific treatment and prognosis in PAH is required. In Poland a multi-center study is planned to include patients from referral centers for pulmonary hypertension with diagnosed idiopathic, hereditary and drug-induced PAH or of pulmonary veno-occlusive disease (PVOD) and pulmonary capillary hemangiomatosis (PCH). The aim of the study is to perform an extended molecular analysis for better understanding the molecular basis of pathogenesis of PAH, incomplete penetrance and to create an algorithm of molecular diagnosis of PAH patients. On the basis of the nationwide registry of patients with PAH treated in referral centers in Poland the effect of the detected mutations on the clinical course, the effect of PAH-specific treatment and the prognosis in PAH will be assessed.
Keywords
References
Galiè N, Humbert M, Vachiery JL, et. al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: Eur Heart J 2016;37:67-119.
Farber HW, Miller DP, Poms AD, et al. Five‑Year outcomes of patients enrolled in the REVEAL Registry. Chest 2015;148:1043–1054.
Badesch D, Raskob G, Elliott C, et al. Pulmonary arterial hypertension: Baseline characteristics from the REVEAL registry. Chest 2010;137:376–387.
Humbert M, Sitbon O, Yaïci A, et al. Survival in incident and prevalent cohorts of patients with pulmonary arterial hypertension. Eur Respir J 2010;36:549–555
Dresdale D, Michtom RJ, Schults M. Recent studies in primary pulmonary hypertension, including pharmacodynamic observations on pulmonary vascular resistance. Bull NY Acad Med 1954;30:195–207.
Loyd JE, Primm RK, Newman JH. Familial primary pulmonary hypertension: clinical patterns. Am Rev Respir Dis 1984;129:194–197.
Lane K, Machado R, Pauciulo M, et al. Heterozygous germline mutations in BMPR2, encoding a TGFbeta receptor, cause familial primary pulmonary hypertension. Nat Genet 2000;26:81–84.
Deng Z, Morse J, Slager S, et al. Familial primary pulmonary hypertension (gene PPH1) is caused by mutations in the bone morphogenetic protein receptor‑II gene. Am J Hum Genet 2000;67:737–744.
Girerd, D. Montani, F. Coulet, et al. Clinical outcomes of pulmonary arterial hypertension in patients carrying an ACVRL1 (ALK1) Mutation. Am J Respir Crit Care Med 2010;181:851–861.
Chaouat A, Coulet F, Favre C, et al. Endoglin germline mutation in a patient with hereditary haemorrhagic telangiectasia and dexfenfluramine associated pulmonary arterial hypertension. Thorax 2004;59:446–448.
Austin ED, Ma L, LeDuc C, et al. Whole exome sequencing to identify a novel gene (caveolin‑1) associated with human pulmonary arterial hypertension. Circ Cardiovasc Genet 2012;5:336–343.
Ma L, Roman‑Campos D, Austin ED, et al. A novel channelopathy in pulmonary arterial hypertension. N Engl J Med. 2013;369:351–361
Garcia‑Rivas G, Jerjes‑Sánchez C, Rodriguez D, et al. A systematic review of genetic mutations in pulmonary arterial hypertension. MC Med Genet 2017;18:82–92.
Eyries M, Montani D, Girerd B, et al. EIF2AK4 mutations cause pulmonary veno‑occlusive disease, a recessive form of pulmonary hypertension. Nat Genet 2014;46:65–69.
Best D, Sumner K, Austin E, et al. EIF2AK4 mutations in pulmonary capillary hemangiomatosis. Chest 2014;145:231–236.
Tuder R, Archer S, Dorfmüller P, et al. Relevant issues in the pathology and pathobiology of pulmonary hypertension. J Am Coll Cardiol 2013;62(25 Suppl):D4‑D12.
Soubrier F, Chung W, Machado R, et al. Genetics and genomics of pulmonary arterial hypertension. J Am Coll Cardiol 2013;62(25 Suppl):D13‑21.
Machado R, Southgate L, Eichstaedt C, et al. Pulmonary Arterial Hypertension: A Current Perspective on Established and Emerging Molecular Genetic Defects. Hum Mutat 2015;36:1113–1127.
Koehler R, Grünig E, Pauciulo MW, et al. Low frequency of BMPR2 mutations in a German cohort of patients with sporadic idiopathic pulmonary arterial hypertension. J Med Genet 2004;41:e127
Morisaki H, Nakanishi N, Kyotani S, et al. BMPR2 mutations found in Japanese patients with familial and sporadic primary pulmonary hypertension. Hum Mutat 2004;23:632.
Larkin E, Newman J, Austin E, et al. Longitudinal analysis casts doubt on the presence of genetic anticipation in heritable pulmonary arterial hypertension. Am J Respir Crit Care Med 2012;186:892–896.
Sztrymf B, Coulet F, Girerd B, et al. Clinical outcomes of pulmonary arterial hypertension in carriers of BMPR2 mutation. Am J Respir Crit Care Med 2008;177:1377–1383
Girerd B, Montani D, Eyries M, et al. Absence of influence of gender and BMPR2 mutation type on clinical phenotypes of pulmonary arterial hypertension. Respir Res 2010;11:73.
Pfarr N, Szamalek‑Hoegel J, Fischer C, et al. Hemodynamic and clinical onset in patients with hereditary pulmonary arterial hypertension and BMPR2 mutations. Respir Res. 2011;12:99
Evans J, Girerd B, Montani D, et al. BMPR2 mutations and survival in pulmonary arterial hypertension: an individual participant data meta‑analysis. Lancet Respir Med 2016;4:129–137.
Hemnes A, Brittain E, Trammell A, et al. Evidence for right ventricular lipotoxicity in heritable pulmonary arterial hypertension. Am J Respir Crit Care Med 2014;189:325–334.
Girerd B, Montani D, Jaïs X, et al. Genetic counselling in a national referral centre for pulmonary hypertension. Eur Respir J 2016;47:541–552.
Graf S, Haimel M, Bleda M, et al. Identification of rare sequence variation underlying heritable pulmonary arterial hypertension. Nature Communications2018; 9:1416–1431.
Screening of Pulmonary Arterial Hypertension in BMPR2 Mutation Carriers (DELPHI‑2). https://clinicaltrials.gov/ct2/show/NCT01 600 898 30. Best DH, Austin ED, Chung WK, et al. Genetics of pulmonary hypertension. Curr Opin Cardiol 2014;29:520–527.
Uznańska‑Loch B, Wikło K, Kulczycka‑Wojdala D, et al. Genetic variants in a Polish
population of patients with pulmonary arterial hypertension: sequencing of BMPR2, ALK1, and ENG genes. Kardiol Pol 2018;76(5):852–859.
DOI: http://dx.doi.org/10.20418%2Fjrcd.vol3no7.322
Refbacks
- There are currently no refbacks.