Jennifer Karmouch1, Qiong Q Zhou1, Christina Y Miyake1, Raffaella Lombardi1, Kai Kretzschmar1, Marie Bannier-Hélaouët1, Hans Clevers1, Xander H T Wehrens1, James T Willerson1, Ali J Marian2. 1. From the Center for Cardiovascular Genetics, Institute of Molecular Medicine, The University of Texas Health Sciences Center, Houston (J.K., Q.Q.Z., R.L., J.T.W., A.J.M.); Texas Heart Institute, Houston (J.T.W., A.J.M.); Cardiovascular Research Institute, Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX (C.Y.M., X.H.T.W.); Department of Pediatrics, Texas Children Hospital, Houston (C.Y.M.); Hubrecht Institute, University Medical Center, Utrecht, The Netherlands (K.K., M.B.-H., H.C.); Royal Netherlands Academy of Arts and Sciences and Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands (H.C.); and École Normale Supérieure de Lyon, France (M.B.-H.). 2. From the Center for Cardiovascular Genetics, Institute of Molecular Medicine, The University of Texas Health Sciences Center, Houston (J.K., Q.Q.Z., R.L., J.T.W., A.J.M.); Texas Heart Institute, Houston (J.T.W., A.J.M.); Cardiovascular Research Institute, Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX (C.Y.M., X.H.T.W.); Department of Pediatrics, Texas Children Hospital, Houston (C.Y.M.); Hubrecht Institute, University Medical Center, Utrecht, The Netherlands (K.K., M.B.-H., H.C.); Royal Netherlands Academy of Arts and Sciences and Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands (H.C.); and École Normale Supérieure de Lyon, France (M.B.-H.). ali.j.marian@uth.tmc.edu.
Abstract
RATIONALE: Arrhythmogenic cardiomyopathy is caused primarily by mutations in genes encoding desmosome proteins. Ventricular arrhythmias are the cardinal and typically early manifestations, whereas myocardial fibroadiposis is the pathological hallmark. Homozygous DSP (desmoplakin) and JUP (junction protein plakoglobin) mutations are responsible for a subset of patients with arrhythmogenic cardiomyopathy who exhibit cardiac arrhythmias and dysfunction, palmoplanter keratosis, and hair abnormalities (cardiocutaneous syndromes). OBJECTIVE: To determine phenotypic consequences of deletion of Dsp in a subset of cells common to the heart and skin. METHODS AND RESULTS: Expression of CSPG4 (chondroitin sulfate proteoglycan 4) was detected in epidermal keratinocytes and the cardiac conduction system. CSPG4pos cells constituted ≈5.6±3.3% of the nonmyocyte cells in the mouse heart. Inducible postnatal deletion of Dsp under the transcriptional control of the Cspg4 locus led to ventricular arrhythmias, atrial fibrillation, atrioventricular conduction defects, and death by 4 months of age. Cardiac arrhythmias occurred early and in the absence of cardiac dysfunction and excess cardiac fibroadipocytes, as in human arrhythmogenic cardiomyopathy. The mice exhibited palmoplantar keratosis and progressive alopecia, leading to alopecia totalis, associated with accelerated proliferation and impaired terminal differentiation of keratinocytes. The phenotype is similar to human cardiocutaneous syndromes caused by homozygous mutations in DSP. CONCLUSIONS: Deletion of Dsp under the transcriptional regulation of the CSPG4 locus led to lethal cardiac arrhythmias in the absence of cardiac dysfunction or fibroadiposis, palmoplantar keratosis, and alopecia, resembling the human cardiocutaneous syndromes. The findings offer a cellular basis for early cardiac arrhythmias in patients with arrhythmogenic cardiomyopathy and cardiocutaneous syndromes.
RATIONALE: Arrhythmogenic cardiomyopathy is caused primarily by mutations in genes encoding desmosome proteins. Ventricular arrhythmias are the cardinal and typically early manifestations, whereas myocardial fibroadiposis is the pathological hallmark. Homozygous DSP (desmoplakin) and JUP (junction protein plakoglobin) mutations are responsible for a subset of patients with arrhythmogenic cardiomyopathy who exhibit cardiac arrhythmias and dysfunction, palmoplanter keratosis, and hair abnormalities (cardiocutaneous syndromes). OBJECTIVE: To determine phenotypic consequences of deletion of Dsp in a subset of cells common to the heart and skin. METHODS AND RESULTS: Expression of CSPG4 (chondroitin sulfate proteoglycan 4) was detected in epidermal keratinocytes and the cardiac conduction system. CSPG4pos cells constituted ≈5.6±3.3% of the nonmyocyte cells in the mouse heart. Inducible postnatal deletion of Dsp under the transcriptional control of the Cspg4 locus led to ventricular arrhythmias, atrial fibrillation, atrioventricular conduction defects, and death by 4 months of age. Cardiac arrhythmias occurred early and in the absence of cardiac dysfunction and excess cardiac fibroadipocytes, as in humanarrhythmogenic cardiomyopathy. The mice exhibited palmoplantar keratosis and progressive alopecia, leading to alopecia totalis, associated with accelerated proliferation and impaired terminal differentiation of keratinocytes. The phenotype is similar to humancardiocutaneous syndromes caused by homozygous mutations in DSP. CONCLUSIONS: Deletion of Dsp under the transcriptional regulation of the CSPG4 locus led to lethal cardiac arrhythmias in the absence of cardiac dysfunction or fibroadiposis, palmoplantar keratosis, and alopecia, resembling the humancardiocutaneous syndromes. The findings offer a cellular basis for early cardiac arrhythmias in patients with arrhythmogenic cardiomyopathy and cardiocutaneous syndromes.
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