Arrhythmogenic Right Ventricular Cardiomyopathy Type 5 Is a Fully Penetrant, Lethal Arrhythmic Disorder Caused by a Missense Mutation in the TMEM43 Gene

• Published in: American journal of human genetics Vol. 82; no. 4; pp. 809 - 821
• Main Authors: Merner, Nancy D., Hodgkinson, Kathy A., Haywood, Annika F.M., Connors, Sean, French, Vanessa M., Drenckhahn, Jörg-Detlef, Kupprion, Christine, Ramadanova, Kalina, Thierfelder, Ludwig, McKenna, William, Gallagher, Barry, Morris-Larkin, Lynn, Bassett, Anne S., Parfrey, Patrick S., Young, Terry-Lynn
• Format: Journal Article
• Language: English
• Published: Chicago, IL Elsevier Inc 01.04.2008; University of Chicago Press; Cell Press; American Society of Human Genetics
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Amino Acid Sequence; Arrhythmogenic Right Ventricular Dysplasia - complications; Arrhythmogenic Right Ventricular Dysplasia - genetics; Arrhythmogenic Right Ventricular Dysplasia - pathology; Biological and medical sciences; Cardiac dysrhythmias; Cardiology; Cardiology. Vascular system; Cardiovascular disease; Child; Chromosomes, Human, Pair 3 - genetics; DNA Mutational Analysis; Female; Fundamental and applied biological sciences. Psychology; General aspects. Genetic counseling; Genes; Genetic Testing; Genetics; Genetics of eukaryotes. Biological and molecular evolution; Heart; Heart Failure - etiology; Heart Failure - genetics; Heart Failure - pathology; Humans; Life Expectancy; Male; Medical genetics; Medical sciences; Membrane Proteins - chemistry; Membrane Proteins - genetics; Membrane Proteins - metabolism; Middle Aged; Molecular and cellular biology; Molecular Sequence Data; Mutation; Mutation, Missense; Myocardium - pathology; Pedigree; Penetrance; Physical Chromosome Mapping; Protein Conformation; Sex Factors; Human; Missense mutation; Arrhythmia; Gene; Arrhythmogenic right ventricular dysplasia; Heart disease; Genetics; Cardiovascular disease; Genetic disease
• ISSN: 0002-9297; 1537-6605; 1537-6605
• DOI: 10.1016/j.ajhg.2008.01.010

Autosomal-dominant arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) causes sudden cardiac death and is characterized by clinical and genetic heterogeneity. Fifteen unrelated ARVC families with a disease-associated haplotype on chromosome 3p (ARVD5) were ascertained from a genetically isolated population. Identification of key recombination events reduced the disease region to a 2.36 Mb interval containing 20 annotated genes. Bidirectional resequencing showed one rare variant in transmembrane protein 43 (TMEM43 1073C→T, S358L), was carried on all recombinant ARVD5 ancestral haplotypes from affected subjects and not found in population controls. The mutation occurs in a highly conserved transmembrane domain of TMEM43 and is predicted to be deleterious. Clinical outcomes in 257 affected and 151 unaffected subjects were compared, and penetrance was determined. We concluded that ARVC at locus ARVD5 is a lethal, fully penetrant, sex-influenced morbid disorder. Median life expectancy was 41 years in affected males compared to 71 years in affected females (relative risk 6.8, 95% CI 1.3–10.9). Heart failure was a late manifestation in survivors. Although little is known about the function of the TMEM43 gene, it contains a response element for PPARγ (an adipogenic transcription factor), which may explain the fibrofatty replacement of the myocardium, a characteristic pathological finding in ARVC.