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Recurrent germline mutations as genetic markers for aortic root dilatation in bicuspid aortic valve patients

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Abstract

Bicuspid aortic valve (BAV) is characterized by elevated risk of aortic dilatation and aneurysm. Although genetic susceptibility is suspected to influence on the development of BAV aortopathy, clinical application of genetic markers still needs validation in BAV entities with strictly defined phenotypic features. The ‘root phenotype’ represents a young, male predominant, and severely aortic regurgitant BAV population prone to aortic root dilatation. The present study launched a two-step genetic survey to evaluate the clinical significance of germline genetic markers in BAV patients. The whole-exome sequencing (WES) cohort consisted of 13 BAV patients with ‘root phenotype’ under the age of 40 years. We identified 28 different heterozygous missense mutations in 19 genes from the WES cohort, among which six variants (COL1A2 R882C, COL5A1 I1161F, ACVRL1 R218W, NOTCH1 P1227S, MYLK S243W, MYLK D717Y) were identified as pathogenic variants via unanimous agreement of in silico prediction tool analysis, and three variants (C1R I345L, TGFBR2 V216I, FBN2 G475V) were identified as recurrent variants. The panel of nine genetic markers was tested in an independent validation cohort of 154 BAV patients consecutively included from January to May 2018 in our institution. The validation cohort demonstrated 71.4% male predominance and the average age of 57 ± 13 years, among which 26.6% showed aortic root dilatation and 66.9% ascending aortic dilatation. Genetic markers were found in 32 patients, including 18 with C1R I345L, 11 with TGFBR2 V216I, 2 with FBN2 G475V, and 1 with both TGFBR2 V216I and MYLK D717Y. BAV patients carrying these genetic markers demonstrated younger age [(51 ± 12) vs. (58 ± 13) years, P = 0.014], more moderate to severe aortic regurgitation (56.2% vs. 33.6%, P = 0.019), elevated prevalence of mitral valve prolapse (9.4% vs. 0.8%, P = 0.028) and aortic root dilatation (62.5% vs. 17.2%, P < 0.001) but not ascending aortic dilatation than those without these markers. The early-onset ‘root phenotype’ entities displayed great value for BAV genetic surveys. As one of the promising complements of the current risk stratification system, recurrent germline mutations in TGFBR2, C1R, FBN2 genes could be identified and applied as genetic markers of elevated susceptibility for aortic root but not ascending aortic dilatation among BAV patients.

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Acknowledgements

The study was supported by National Natural Science Foundation of China (Grant Nos. 82071991, 81600090, 81300232, 81500194, 81570422).

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  1. Boting Wu and Jun Li have contributed equally to this manuscript.

Authors and Affiliations

  1. Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan University, 180 Fenglin Road, Shanghai, 200032, China

    Jun Li, Yongshi Wang, Chunsheng Wang & Xianhong Shu

  2. Shanghai Institute of Medical Imaging, Zhongshan Hospital Fudan University, Shanghai, China

    Yongshi Wang & Xianhong Shu

  3. Department of Cardiac Surgery, Zhongshan Hospital Fudan University, Shanghai, China

    Jun Li & Chunsheng Wang

  4. Institute of Clinical Science, Zhongshan Hospital Fudan University, Shanghai, China

    Yunfeng Cheng

  5. Department of Transfusion, Zhongshan Hospital Fudan University, Shanghai, China

    Boting Wu

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  1. Boting Wu
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Correspondence to Yongshi Wang.

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Wu, B., Li, J., Wang, Y. et al. Recurrent germline mutations as genetic markers for aortic root dilatation in bicuspid aortic valve patients. Heart Vessels 36, 530–540 (2021). https://doi.org/10.1007/s00380-020-01710-0

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