Gene expression profiling for etiological exploration of cardiac hypertrophic phenotype after 50 years

Transcription

1 Gene expression profiling for etiological exploration of cardiac hypertrophic phenotype after 50 years Diane Bodez CHU Henri Mondor, Créteil Thibaud Damy CHU Henri Mondor Unité Insuffisance cardiaque - Amylose GRC Amyloid Research Institute Hakim Hocini - Yves Lévy CHU Henri Mondor Vaccine Research Institute UPEC IMRB Philippe Charron CHU La Pitié-Salpêtrière Départements de génétique et cardiologie Ligue contre la cardiomyopathie

2 Disclosure Statement of Financial Interest I currently have, or have had over the last two years, an affiliation or financial interests or interests of any order with a company or I receive compensation or fees or research grants with a commercial company : NONE

3 LV hypertrophy in the general population Assessment of left ventricular hypertrophy (LVH) in the general population: Echocardiography Lang RM et al. Eur Heart J Cardiovsc Imaging 2015 Mar;16(3): LVH is frequent in the general population and rises with aging: 47,5% after 65 years The cause of LVH is often not identified Frequency of cofounding factors : arterial hypertension... Exploration tool not always doable/available : cardiac MRI... Laszlo et al. for ActiFE study group, Aging Clin Exp Res 2016 Nov Identify causes of increase wall thickness is a common diagnosis challenge

4 Hypertrophic cardiomyopathy or cardiac hypertrophy? Cardiomyopathies HCM DCM ARVC RCM Unclassified Familial/Genetic Non-familial/Non-genetic Elliott et al., Eur Heart J 2008 Jan;29(2):270-6 Increase left ventricular wall thickness Cardiomyocyte hypertrophy Myocardial infiltration Loading conditions Sarcomeric cardiomyopathy The Task Force for the Diagnosis and Management of HCM of the ESC, Eur Heart J 2014 Oct 14;35(39):

5 Phenotype first: increase LV wall thickness Loading conditions Arterial hypertension Aortic stenosis... Sarcomeric HCM Known mutation Unidentified gene defect Infiltrative cardiomyopathy Cardiac amyloidosis Seward & Casaclang, JACC 2010 Sarcomeric Cardiomyocyte hypertrophy Myofibrillar disarray Fibrosis Elliott & McKenna, The Lancet 2004 Loading conditions Cardiomyocyte hypertrophy Fibrosis Infiltrative Extracellular deposits LV hypertrophy: different diseases gathered on a common phenotype

6 Infiltrative cardiomyopathy in middle-aged to elderly patients: senile amyloidosis? WT-TTR amyloidosis 13% HFpEF WT-TTR amyloidosis?? LVH 48% after 65 years Diagnostic and pathophysiological challenge Crucial interest of biomarkers

7 RNA as biomarkers for hypertrophic cardiomyopathies Derda et al., Int J Cardiol 2015 Oct;196:

8 Aim: compare circulating gene expression profiles of distinct cardiac hypertrophies HENRI MONDOR PITIE-SALPETRIERE Patients referred in HM for an amyloidosis diagnostic work-up Patients followed in LPS for a sarcomeric HCM TTE, cardiac MRI, bone scintigraphy, cardiac biomarkers, +/- endomyocardial biopsy Age > 50 years, IVST 12mm, NT-proBNP > 400 pg/ml Sarcomeric HCM Identified gene mutation Hypertensive cardiomyopathy No other diagnostic Arterial hypertension WT-TTR amyloidosis Cardiac scintigraphic uptake No TTR gene mutation

9 Aim: compare circulating gene expression profiles of distinct ILVWT Age > 50 years, IVST 12mm, NT-proBNP > 400 pg/ml Sarcomeric HCM n=8 Hypertensive cardiomyopathy Age- and sex-match Senile Amyloidosis N=7 Total blood Total RNA AAAA-3 AAAA-3 TTTT-5 Single then double strand cdna UUUU-5 UUUU-5 * UUUU-5 * Labelled crna Illumina Human HT12-V4 Transcriptomic analysis in whole blood genes/ probes Without any a priori notion

10 Hypertensive or sarcomeric HCM? Age > 50 years, IVST 12mm, NT-proBNP > 400 pg/ml Sarcomeric HCM n=8 Hypertensive cardiomyopathy Age- and sex-match Senile Amyloidosis N=7 Sarcomeric HCM N=8 Hypertensive LVH N=8 Age, years 63 (58;72) 67 (55;75) 0.74 Male sex, n (%) 4 (50) 4 (50) 1 NT-proBNP, pg/ml 2253 (1053;3966) 2123 (749;6053) 0.74 IVST, mm 18 (15;24) 15 (14;16) 0.21 NYHA class III-IV 1 (20) 4 (50) 0.57 LVEF, % 65 (53;75) 51 (46;69) 0.10 P No significant difference on main cardiac baseline characteristics

11 RNY4 SNORD3D RNY5 SNORD3A RNY1 SNORD3C ZNF223 ZNF93 IL8 Fold-change (shcm / hypertensive LVH) Hypertensive or sarcomeric HCM? 169 genes (235 probes) differentially expressed in whole blood fold-change 1.5; p-value 0.01 Linear discriminant analysis Hypertensive LVH s-hcm Translation initiation Ribosome subunits Zinc finger proteins DNA/RNA binding Inflammasome Distinct gene expression profiles between shcm and hypertensive LVH Essential role of small non-coding RNAs in sarcomeric HCM

12 Hypertension or WT amyloidosis? Age > 50 years, IVST 12mm, NT-proBNP > 400 pg/ml Sarcomeric HCM n=8 Hypertensive cardiomyopathy Age- and sex-match Senile Amyloidosis N=7 WT-TTR amyloidosis N=7 Hypertensive LVH N=7 Age, years 79 (76;85) 80 (76;86) 0.69 Male sex, n (%) 6 (88) 6 (88) 1 NT-proBNP, pg/ml 3716 (2341;4976) 2278 (1570;5636) 0.81 IVST, mm 21 (16;24) 15 (13;18) 0.23 NYHA class III-IV 4 (57) 6 (88) 0.56 LVEF, % 42 (33;48) 45 (45;47) 0.84 P No significant difference on main cardiac baseline characteristics

13 MYOM2 MYL4 GYPE GYPB Elafin IL8 ALAS2 UROS Fold-change (WT-TTR / hypertensive LVH) Hypertension or WT amyloidosis? 64 genes (72 probes) differentially expressed in whole blood fold-change 1.5; p-value 0.01 Linear discriminant analysis Sarcomere Glycophorin Inflammasome Tetrapyrrole / heme biosynthesis Hypertensive LVH WT-TTR Distinct gene expression profiles between WT-TTR and hypertensive LVH Involvement of sarcomeric protein and oxygen transport

14 Conclusions Small RNAs Secondary LVH Sarcomere lesions Gene expression profiles Sarcomeric LVH Infiltrative LVH Specific blood-based biomarkers Pathophysiological processes and new therapeutic targets Applicable to other causes of left ventricular hypertrophy?

15 Acknowledgments Philippe Charron Jean-François Pruny Yves Lévy Hakim Hocini Pascaline Tisserand Cécile Lefèbvre Thibaud Damy Soulef Guendouz Arnault Galat Mounira Kharoubi Karima Ayad Aziz Guellich Nicole Benhaiem Emmanuel Itti Jean-François Deux Valérie Frenkel Benoit Funalot Nicolas Tchitchek