Key result
A novel HRAS mutation independently contributed to left ventricular hypertrophy in a family with a known MYH7 mutation, demonstrating the coexistence of a mild RASopathy and sarcomeric hypertrophic cardiomyopathy.
Case Report (n=5)
No
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Comprehensive genetic testing is crucial for accurate differential diagnosis of left ventricular hypertrophy, as demonstrated by a novel HRAS mutation causing a RASopathy in a family with a known sarcomeric mutation.
Several genetic conditions can lead to left ventricular hypertrophy (LVH). Among them, hypertrophic cardiomyopathy (HCM), caused by mutations in sarcomere genes, is the most common inherited cardiac disease. Instead, RASopathies, a rare class of disorders characterized by neuro-cardio-facial-cutaneous abnormalities and sometimes presenting with LVH, are caused by mutations in the RAS-MAPK pathway. We report on a 62-years-old male who presented isolated severe obstructive LVH but did not carry the sarcomere mutation previously identified in his affected relatives. By exome sequencing, we detected a novel mutation in HRAS gene (NM_005343.2:p.Arg68Trp), present also in the proband's daughter, who showed mild LVH and severe intellectual disability. The cardiac phenotype was indistinguishable between family members carrying either mutation. In silico studies suggested that the mutated HRAS protein is constitutionally activated. Consistently, functional characterization in vitro confirmed elevated HRAS-GTP accumulation and downstream RAS-MAPK pathway activation that are known to drive cell proliferation in LVH. Our study emphasizes the role of RAS signaling in cardiac hypertrophy and highlights the complexity in differential diagnosis of RASopathies. In fact, the mild features of RASopathy and the recurrence of sarcomeric HCM in this family delayed the correct diagnosis until comprehensive genetic testing was performed.
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Sana et al. (2016) conducted a case report in Left ventricular hypertrophy (n=5). HRAS mutation (p.Arg68Trp) was evaluated on Genetic and functional characterization of LVH etiology. A novel HRAS mutation independently contributed to left ventricular hypertrophy in a family with a known MYH7 mutation, demonstrating the coexistence of a mild RASopathy and sarcomeric hypertrophic cardiomyopathy.
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