PREDICTIVE GENES, MECHANISMS, AND CLINICAL BIOMARKERS OF SUDEP

描述(由申请人提供)：不明原因的心脏和呼吸节律性崩溃是SUDEP的最终常见机制，SUDEP是癫痫患者死亡的主要和可预防的原因。最近的证据表明，在脑、自主神经、心脏和呼吸通路中共同表达的功能障碍的离子通道和受体，以及在癫痫发作周围这些通路的功能障碍的临床测量是SUDEP的可检测和潜在的可治疗的危险因素。这项建议描述了一个综合的多中心和多学科的合作项目，该项目将结合基础科学、人类神经遗传学和临床生理学方法在床边转译研究计划中对这些生物风险因素进行研究，以识别、验证和临床评估SUDEP的预测性生物标记物和预防性治疗。SUDEP中心研究管道将由该中心6名调查人员之间的一系列相互关联的工作流程组成。项目1(贝勒)将扩大来自三个中心(EMU、DraveT综合征诊所、SUDEP DNA存储库)和其他国家网络的患者的DNA样本库，这些样本将使用芯片微阵列进行分析，以确定&gt；247优先离子通道和介导心律失常、呼吸抑制和癫痫的受体基因。项目2-4(美国爱荷华州贝勒大学密歇根分校)在细胞和体内水平上分析了SUDEP小鼠模型中这些和相关基因突变的生物学、生理学和药理学，并从Dravet综合征病例中诱导出多能干细胞，以了解和验证SUDEP表型。项目5(加州大学戴维斯分校/芝加哥儿童纪念医院)将完善临床呼吸和心脏生物标记物，这些标记物是在对德拉韦综合征患者和其他有猝死高风险(发作性低氧血症、心律失常)的人进行癫痫监测时获得的。一旦得到验证，这些病例的基因就会被添加到贝勒正在开发的增量诊断芯片中，用于临床上具有其他临床生物标志物的个人的常规患者风险评估。 公共卫生相关性：癫痫猝死(SUDEP)是特发性癫痫过早死亡的主要原因。预防SUDEP有赖于确定癫痫患者的生物预测风险因素，并利用这些因素进行适当的治疗干预。该计划的目标是验证遗传/临床SUDEP风险组合情况，以筛查和治疗癫痫患者。 免责声明：请注意，以下批评是由评审员在研究小组会议之前准备的，基本上是以未经编辑的形式提供的。虽然审查员有机会根据小组的讨论更新或修订其书面评价，但不能保证在会议讨论之后更新了个别批评意见。因此，这些评论可能不能完全反映评审员在小组讨论结束时的最终意见或小组的最终多数意见。因此，讨论纪要和总结是审查员在会议上实际上认为至关重要的最后结论。

DESCRIPTION (provided by applicant): Unexplained collapse of cardiac and respiratory rhythmicity is a final common mechanism for SUDEP, a major and preventable cause of death in persons with epilepsy. Recent evidence shows that dysfunctional ion channels and receptors co-expressed in brain, autonomic, heart, and respiratory pathways, along with clinical measures of functional disturbances in these pathways at times surrounding seizures represent detectable and potentially treatable risk factors for SUDEP. This proposal describes an integrated multicenter and multidisciplinary collaborative project that will combine a basic science, human neurogenetics, and clinical physiology approaches to these biological risk factors in a bench to bedside translational research program to identify, validate, and clinically evaluate predictive biomarkers and preventative treatments for SUDEP. The SUDEP Center Research Pipeline will consist of a serially interrelated work flow among 6 investigators in the center. Project 1 (Baylor) will expand the repository of DNA samples from patient at 3 centers (EMU, Dravet Syndrome Clinic, SUDEP DNA Repository) and other national networks which will be analyzed using chip microarrays for >247 prioritized ion channel and receptor genes mediating cardiac arrhythmias, respiratory depression and epilepsy. Projects 2-4 (Baylor U. Michigan, U. Iowa) analyze the biology, physiology, and pharmacology of these and related gene mutations at the cellular and in vivo level in SUDEP mouse models and induced pluripotent stem cells from Dravet Syndrome cases in order to understand and validate the SUDEP phenotypes. Project 5 (U.C. Davis/Childrens Memorial Chicago) will refine clinical respiratory and cardiac biomarkers obtained during epilepsy monitoring of individuals with Dravet Syndrome and others at high risk of sudden death (ictal hypoxemia, cardiac arrhythmia). Once validated, genes from these cases are added to an incremental diagnostic chip in development at Baylor for routine patient risk assessment in clinics in individuals with other clinical biomarkers. PUBLIC HEALTH RELEVANCE: Sudden unexpected death in epilepsy (SUDEP) is the leading cause of premature mortality in idiopathic epilepsy. Preventing SUDEP depends upon identifying biologically predictive risk factors in individuals with epilepsy and using them to mak appropriate therapeutic interventions. The goal of this program is to validate a combined genetic/clinical SUDEP risk profile to screen and treat individuals with epilepsy. Disclaimer: Please note that the following critiques were prepared by the reviewers prior to the Study Section meeting and are provided in an essentially unedited form. While there is opportunity for the reviewers to update or revise their written evaluation, based upon the group's discussion, there is no guarantee that individual critiques have been updated subsequent to the discussion at the meeting. Therefore, the critiques may not fully reflect the final opinions of th individual reviewers at the close of group discussion or the final majority opinion of the group. Thus the Resume and Summary of Discussion is the final word on what the reviewers actually considered critical at the meeting.