Author, as appears in the article.: Garcia-Pavia, Pablo; Kim, Yuri; Alejandra Restrepo-Cordoba, Maria; Lunde, Ida G.; Wakimoto, Hiroko; Smith, Amanda M.; Toepfer, Christopher N.; Getz, Kelly; Gorham, Joshua; Patel, Parth; Ito, Kaoru; Willcox, Jonathan A.; Arany, Zoltan; Li, Jian; Owens, Anjali T.; Govind, Risha; Nunez, Beatriz; Mazaika, Erica; Bayes-Genis, Antoni; Walsh, Roddy; Finkelman, Brian; Lupon, Josep; Whiffin, Nicola; Serrano, Isabel; Midwinter, William; Wilk, Alicja; Bardaji, Alfredo; Ingold, Nathan; Buchan, Rachel; Tayal, Upasana; Pascual-Figal, Domingo A.; de Marvao, Antonio; Ahmad, Mian; Manuel Garcia-Pinilla, Jose; Pantazis, Antonis; Dominguez, Fernando; Baksi, A. John; O'Regan, Declan P.; Rosen, Stuart D.; Prasad, Sanjay K.; Lara-Pezzi, Enrique; Provencio, Mariano; Lyon, Alexander R.; Alonso-Pulpon, Luis; Cook, Stuart A.; DePalma, Steven R.; Barton, Paul J. R.; Aplenc, Richard; Seidman, Jonathan G.; Ky, Bonnie; Ware, James S.; Seidman, Christine E.;

Department: Medicina i Cirurgia

URV's Author/s: Bardají Ruiz, Alfredo

Keywords: Titin Polymorphisms Mutations Medical oncology Genetics Familial dilated cardiomyopathy Echocardiography Drug therapy Congestive-heart-failure Chemotherapy Cardiotoxicity Cardiomyopathies American society A-band truncation medical oncology genetics drug therapy cardiomyopathies

Abstract: Background: Cancer therapy-induced cardiomyopathy (CCM) is associated with cumulative drug exposures and preexisting cardiovascular disorders. These parameters incompletely account for substantial interindividual susceptibility to CCM. We hypothesized that rare variants in cardiomyopathy genes contribute to CCM. Methods: We studied 213 patients with CCM from 3 cohorts: retrospectively recruited adults with diverse cancers (n=99), prospectively phenotyped adults with breast cancer (n=73), and prospectively phenotyped children with acute myeloid leukemia (n=41). Cardiomyopathy genes, including 9 prespecified genes, were sequenced. The prevalence of rare variants was compared between CCM cohorts and The Cancer Genome Atlas participants (n=2053), healthy volunteers (n=445), and an ancestry-matched reference population. Clinical characteristics and outcomes were assessed and stratified by genotypes. A prevalent CCM genotype was modeled in anthracycline-treated mice. Results: CCM was diagnosed 0.4 to 9 years after chemotherapy; 90% of these patients received anthracyclines. Adult patients with CCM had cardiovascular risk factors similar to the US population. Among 9 prioritized genes, patients with CCM had more rare protein-altering variants than comparative cohorts (P <= 1.98e-04). Titin-truncating variants (TTNtvs) predominated, occurring in 7.5% of patients with CCM versus 1.1% of The Cancer Genome Atlas participants (P=7.36e-08), 0.7% of healthy volunteers (P=3.42e-06), and 0.6% of the reference population (P=5.87e-14). Adult patients who had CCM with TTNtvs experienced more heart failure and atrial fibrillation (P=0.003) and impaired myocardial recovery (P=0.03) than those without. Consistent with human data, anthracycline-treated TTNtv mice and isolated TTNtv cardiomyocytes showed sustained contractile dysfunction unlike wild-type (P=0.0004 and P<0.002, respectively). Conclusions: Unrecognized rare variants in cardiomyopathy-associated genes, particularly TTNtvs, increased the risk for CCM in children and adults, and adverse cardiac events in adults. Genotype, along with cumulative chemotherapy dosage and traditional cardiovascular risk factors, improves the identification of patients who have cancer at highest risk for CCM.

Thematic Areas: Saúde coletiva Physiology (medical) Peripheral vascular disease Nutrição Medicina iii Medicina ii Medicina i Interdisciplinar Hematology General medicine Farmacia Ensino Engenharias iv Engenharias ii Enfermagem Educação física Ciências biológicas iii Ciências biológicas ii Ciências biológicas i Ciência da computação Cardiology and cardiovascular medicine Cardiac & cardiovascular systems Biotecnología

licence for use: https://creativecommons.org/licenses/by/3.0/es/

ISSN: 00097322

Author's mail: alfredo.bardaji@urv.cat

Author identifier: 0000-0003-1900-6974

Record's date: 2023-02-22

Papper version: info:eu-repo/semantics/publishedVersion

Link to the original source: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.037934

Licence document URL: http://repositori.urv.cat/ca/proteccio-de-dades/

Papper original source: Circulation. 140 (1): 31-41

APA: Garcia-Pavia, Pablo; Kim, Yuri; Alejandra Restrepo-Cordoba, Maria; Lunde, Ida G.; Wakimoto, Hiroko; Smith, Amanda M.; Toepfer, Christopher N.; Getz, K (2019). Genetic Variants Associated With Cancer Therapy-Induced Cardiomyopathy. Circulation, 140(1), 31-41. DOI: 10.1161/CIRCULATIONAHA.118.037934

Article's DOI: 10.1161/CIRCULATIONAHA.118.037934

Entity: Universitat Rovira i Virgili

Journal publication year: 2019

Publication Type: Journal Publications