TY - JOUR
T1 - Truncations of titin causing dilated cardiomyopathy
AU - Herman, Daniel S.
AU - Lam, Lien
AU - Taylor, Matthew R.G.
AU - Wang, Libin
AU - Teekakirikul, Polakit
AU - Christodoulou, Danos
AU - Conner, Lauren
AU - DePalma, Steven R.
AU - McDonough, Barbara
AU - Sparks, Elizabeth
AU - Teodorescu, Debbie Lin
AU - Cirino, Allison L.
AU - Banner, Nicholas R.
AU - Pennell, Dudley J.
AU - Graw, Sharon
AU - Merlo, Marco
AU - Di Lenarda, Andrea
AU - Sinagra, Gianfranco
AU - Bos, J. Martijn
AU - Ackerman, Michael J.
AU - Mitchell, Richard N.
AU - Murry, Charles E.
AU - Lakdawala, Neal K.
AU - Ho, Carolyn Y.
AU - Barton, Paul J.R.
AU - Cook, Stuart A.
AU - Mestroni, Luisa
AU - Seidman, J. G.
AU - Seidman, Christine E.
PY - 2012/2/16
Y1 - 2012/2/16
N2 - Background: Dilated cardiomyopathy and hypertrophic cardiomyopathy arise from mutations in many genes. TTN, the gene encoding the sarcomere protein titin, has been insufficiently analyzed for cardiomyopathy mutations because of its enormous size. Methods: We analyzed TTN in 312 subjects with dilated cardiomyopathy, 231 subjects with hypertrophic cardiomyopathy, and 249 controls by using next-generation or dideoxy sequencing. We evaluated deleterious variants for cosegregation in families and assessed clinical characteristics. Results: We identified 72 unique mutations (25 nonsense, 23 frameshift, 23 splicing, and 1 large tandem insertion) that altered full-length titin. Among subjects studied by means of next-generation sequencing, the frequency of TTN mutations was significantly higher among subjects with dilated cardiomyopathy (54 of 203 [27%]) than among subjects with hypertrophic cardiomyopathy (3 of 231 [1%], P = 3×10-16) or controls (7 of 249 [3%], P = 9×10-14). TTN mutations cosegregated with dilated cardiomyopathy in families (combined lod score, 11.1) with high (>95%) observed penetrance after the age of 40 years. Mutations associated with dilated cardiomyopathy were overrepresented in the titin A-band but were absent from the Z-disk and M-band regions of titin (P≤0.01 for all comparisons). Overall, the rates of cardiac outcomes were similar in subjects with and those without TTN mutations, but adverse events occurred earlier in male mutation carriers than in female carriers (P = 4×10-5). Conclusions: TTN truncating mutations are a common cause of dilated cardiomyopathy, occurring in approximately 25% of familial cases of idiopathic dilated cardiomyopathy and in 18% of sporadic cases. Incorporation of sequencing approaches that detect TTN truncations into genetic testing for dilated cardiomyopathy should substantially increase test sensitivity, thereby allowing earlier diagnosis and therapeutic intervention for many patients with dilated cardiomyopathy. Defining the functional effects of TTN truncating mutations should improve our understanding of the pathophysiology of dilated cardiomyopathy. (Funded by the Howard Hughes Medical Institute and others.).
AB - Background: Dilated cardiomyopathy and hypertrophic cardiomyopathy arise from mutations in many genes. TTN, the gene encoding the sarcomere protein titin, has been insufficiently analyzed for cardiomyopathy mutations because of its enormous size. Methods: We analyzed TTN in 312 subjects with dilated cardiomyopathy, 231 subjects with hypertrophic cardiomyopathy, and 249 controls by using next-generation or dideoxy sequencing. We evaluated deleterious variants for cosegregation in families and assessed clinical characteristics. Results: We identified 72 unique mutations (25 nonsense, 23 frameshift, 23 splicing, and 1 large tandem insertion) that altered full-length titin. Among subjects studied by means of next-generation sequencing, the frequency of TTN mutations was significantly higher among subjects with dilated cardiomyopathy (54 of 203 [27%]) than among subjects with hypertrophic cardiomyopathy (3 of 231 [1%], P = 3×10-16) or controls (7 of 249 [3%], P = 9×10-14). TTN mutations cosegregated with dilated cardiomyopathy in families (combined lod score, 11.1) with high (>95%) observed penetrance after the age of 40 years. Mutations associated with dilated cardiomyopathy were overrepresented in the titin A-band but were absent from the Z-disk and M-band regions of titin (P≤0.01 for all comparisons). Overall, the rates of cardiac outcomes were similar in subjects with and those without TTN mutations, but adverse events occurred earlier in male mutation carriers than in female carriers (P = 4×10-5). Conclusions: TTN truncating mutations are a common cause of dilated cardiomyopathy, occurring in approximately 25% of familial cases of idiopathic dilated cardiomyopathy and in 18% of sporadic cases. Incorporation of sequencing approaches that detect TTN truncations into genetic testing for dilated cardiomyopathy should substantially increase test sensitivity, thereby allowing earlier diagnosis and therapeutic intervention for many patients with dilated cardiomyopathy. Defining the functional effects of TTN truncating mutations should improve our understanding of the pathophysiology of dilated cardiomyopathy. (Funded by the Howard Hughes Medical Institute and others.).
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U2 - 10.1056/NEJMoa1110186
DO - 10.1056/NEJMoa1110186
M3 - Article
C2 - 22335739
AN - SCOPUS:84863116641
SN - 0028-4793
VL - 366
SP - 619
EP - 628
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 7
ER -