В одной трети случаев причина внезапной смерти остается необъясненной после проведения стандартного судебно-медицинского исследования. При отрицательной аутопсии во многих странах рекомендовано проведение посмертного молекулярно-генетического исследования. Цель исследования – оценить диагностическую значимость молекулярной аутопсии методом экзомного секвенирования для мужчин молодого возраста, умерших внезапной сердечной смертью (ВСС). Материал и методы . Выполнено экзомное секвенирование ДНК группы молодых мужчин (37 человек), умерших ВСС в возрасте до 45 лет (средний возраст 32,4 ± 6,4 года). ДНК выделена методом фенол-хлороформной экстракции из ткани миокарда. Экзомный анализ выполнен на платформе Illumina. Для некоторых из выявленных вариантов проведено подтверждающее прямое автоматическое секвенирование по Сэнгеру. Результаты . Из 37 образцов ДНК при анализе результатов секвенирования 205 генов обнаружено более 30 вариантов в 17 образцах (46 %), вероятно имеющих отношение к фенотипу ВСС. Найденные мутации локализованы в генах, ассоциированных с фенотипами, приводящими к развитию ВСС ( дилатационная или гипертрофическая кардиомиопатия, нарушения ритма сердца). Заключение. Впервые в России проведено экзомное секвенирование образцов ДНК мужчин, умерших ВСС в возрасте до 45 лет. Молекулярная аутопсия методом экзомного секвенирования – эффективный метод поиска причинных вариантов нуклеотидной последовательности при ВСС.

Single nucleotide polymorphisms rs1008832 of the CACNA1C gene, rs4027402 of the SYNE2 gene, rs2340917 of the TMEM43 gene, rs58225473 of the CACNB2 gene were found by sequencing the clinical exome of a group of men who died of sudden cardiac death (SCD) at the age of 45 years. The aim of the study is to study the association of single nucleotide polymorphisms rs1008832 of the CACNA1C gene, rs4027402 of the SYNE2 gene, rs2340917 of the TMEM43 gene, rs58225473 of the CACNB2 gene with SCD in a case-control study using routine molecular genetic analysis. Material and methods. SCD group (n = 400, mean age 53.2 ± 8.7 years, 70.9 % men, 29.1 % women) was formed using the SCD criteria of the European Society of Cardiology from the anonymous DNA bank of the deceased sudden death (1999–2019). The control group (n = 400, mean age 53.1 ± 8.3 years, 68.3 % men, 31.7 % women) was matched by sex and age to the SCD group from DNA banks of international projects MONICA and HAPIEE of living at the time of researches participants. Genotyping was carried out using the polymerase chain reaction followed by analysis of restriction fragment length polymorphism. Results. There were no statistically significant differences in the frequencies of genotypes and alleles of single nucleotide polymorphisms rs1008832 of the CACNA1C gene, rs4027402 of the SYNE2 gene, rs2340917 of the TMEM43 gene, rs58225473 of the CACNB2 gene between the SCD group and the control group (p > 0.05). Conclusions. The association of single nucleotide rs1008832 of the CACNA1C gene, rs4027402 of the SYNE2 gene, rs2340917 of the TMEM43 gene, rs58225473 of the CACNB2 gene with SCD has not been confirmed.

В ряде зарубежных исследований проверена ассоциация метилирования промотора гена HMGCR с ишемической болезнью сердца, которая является одной из наиболее распространенных причин развития внезапной сердечной смерти (ВСС) в среднем и старшем возрасте.

The aim of the research is to verify the association with sudden cardiac death (SCD) of single nucleotide polymorphisms rs10867772 and rs4700290, identified as new molecular genetic markers of SCD in the own genome-wide pooled allelotyping.Material and methods. Case-control study. The SCD group is formed using the criteria of the European Society of Cardiology from the DNA bank of suddenly deceased residents of the Oktyabrsky district of Novosibirsk (n = 437, average age—53.1 ± 9.0 years, men — 73.5%, women — 26.5%) The control group (n = 405, average age 53.2 ± 9.2 years, men — 70.0%, women — 30.0%) is formed from the DNA bank of participants of MONICA and HAPIEE projects. DNA was isolated by phenol-­chloroform extraction from myocardial tissue in the SCD group and venous blood in the control group. Genotyping was performed by the PCR-RFLP method.Results. No statistical significance was found in allele and genotype frequencies of rs10867772 and rs4700290 between groups, even in separating in sex and age (p> 0.05). Conclusion. Single nucleotide polymorphism rs10867772 and rs4700290 are not associated with SCD.

Aim. To search for causal mutations in candidate genes responsible for the development of sudden cardiac death (SCD) in men who died under the age of 45.Material and methods. The SCD group (n=37) was formed using the criteria the World Health Organization and the European Society of Cardiology. Autopsy material was collected from men who died suddenly outside medical institutions and underwent forensic medical examination according to the standard protocol. Autopsy revealed no morphological changes that could explain sudden death. The mean age was 32,4±6,4 years. Genomic DNA was isolated from myocardial tissue using phenol-chloroform extraction. Clinical exome sequencing was performed. At first, we analyzed the results of sequencing of 24 genes, mutations in which lead to cardiovascular diseases associated with an increased risk of SCD: KCNQ1, KCNH2, SCN5A, AKAP9, ANK2, CACNA1C, CALM1, CALM2, CAV3, KCNE1, KNCJNE2, KCNE2, SCN4B, SNTA1, MYH2, APOB, KCNA5, TGFB3, NEB, PDX1, FLNC, PLEC, KCND3.Results. Of 37 samples, we revealed 13 probable pathogenic missense mutations in 9 samples (24,3%). Of 13 probable pathogenic variants, 5 were new.Conclusion. This pilot study provides following conclusions: it is necessary to continue molecular autopsy research in Russia; to increase the effectiveness of detecting causal mutations, it is necessary to reduce the age of patients with SCD included in the study; studying the families of deceased; cooperation of experienced specialists — forensic pathologist, laboratory geneticist, cardiologist.

Цель исследования: поиск причинных мутаций в генах-кандидатах внезапной сердечной смерти (ВСС) у мужчин, умерших в возрасте до 45 лет. Группа ВСС (30 образцов) была сформирована c использованием критериев ВСС ВОЗ и Европейского общества кардиологов. Средний возраст 31,3±5,3 года. Геномную ДНК выделяли из ткани миокарда методом фенол-хлороформной экстракции. Выполнили секвенирование клинического экзома. На первом этапе проанализировали результаты секевнирования 16 генов, мутации в которых приводят к ССЗ, ассоциированным с повышенным риском ВСС: KCNQ1, KCNH2, SCN5A, AKAP9, ANK2, CACNA1C, CALM1, CALM2, CAV3, KCNE1, KCNE2, KCNJ2, KCNJ5, SCN4B, SNTA1, SCN10A. Из 30 образцов с ВСС при анализе результатов секвенирования 16 генов было обнаружено 6 вероятно патогенных миссенс-мутаций в 7 образцах (23,3 %). В гене SCN10A обнаружено 2 мутации, в KCNH2, KCNE1, AKAP9, SNTA1 - по одной мутации. Подводя первые итоги пилотного исследования ВСС можно сделать следующие предварительные выводы: необходимо продолжение исследований в области молекулярной аутопсии в России, для повышения результативности поиска причинных мутаций, желательны снижение возраста случаев ВСС включаемых в исследование, а также работа с семьями умерших ВСС. Objective: Search for causal mutations in candidate genes for sudden cardiac death (SCD) in men who die before the age of 45. Materials and methods. The SCD group (30 samples) was formed using the criteria for sudden cardiac death of the WHO and the European Society of Cardiology. The average age is 31,3±5,3 years. Genomic DNA was isolated from myocardial tissue using phenol-chloroform extraction. Clinical exome sequencing was performed. At the first stage, the results of sequencing of 16 genes were analyzed, mutations in which result in CVD associated with an increased risk of SCD: KCNQ1, KCNH2, SCN5A, AKAP9, ANK2, CACNA1C, CALM1, CALM2, CAV3, KCNE1, KCNE2, KCNJ5, KCNJ5, SNTA1, SCN10A. Results. Of 30 samples with SCD, when analyzing the results of sequencing 16 genes, 6 probably pathogenic missense mutations were found in 7 samples (23.3%). 2 mutations were found in the SCN10A gene, one mutation in KCNH2, KCNE1, AKAP9, SNTA1. Findings. Summing up the first results of a pilot SCD study, the following preliminary conclusions can be drawn: it is necessary to continue research in the field of molecular autopsy in Russia, in order to increase the effectiveness of the search for causative mutations, it is desirable to reduce the age of SCD cases included in the study, as well as work with families of deceased SCD.

Целью исследования является подтверждение ассоциации с внезапной сердечной смертью однонуклеотидных полиморфизмов rs77270326, rs34643859, выявленных в ходе собственного полноэкзомного секвенирования как возможных молекулярно-генетических маркеров внезапной сердечной смерти. В группе внезапной сердечной смерти (n=400, средний возраст умерших 53,2±8,7 года, доля мужчин - 70,9%, женщин - 29,1%) и контрольной группе (n=400, средний возраст 53,1±8,3 года, мужчины - 68,3 %, женщины - 31,7%) проведено генотипирование по выбранным полиморфизмам методом ПЦР-ПДРФ по авторским протоколам. По частотам генотипов и аллелей полиморфизма rs77270326 не найдено статистически значимых различий между группами (p>0,05). В группе женщин в возрасте до 50 лет выявлено статистически значимое уменьшение доли носительниц генотипа ТТ в группе внезапной сердечной смерти (32,3%) по сравнению с контрольной группой (60,0%) (ОШ=0,32, 95%ДИ 0,11-0,91, р=0,04). Таким образом, однонуклеотидный полиморфизм rs77270326 не ассоциирован с внезапной сердечной смертью. Для женщин младше 50 лет генотип ТТ полиморфизма rs34643859 ассоциирован с протективным эффектом в отношении внезапной сердечной смерти. The aim of the study is to confirm the association with sudden cardiac death of single-nucleotide polymorphisms rs77270326, rs34643859, identified during own whole-exome sequencing as possible molecular genetic markers of sudden cardiac death. In the group of sudden cardiac death (n = 400, the average age of the dead - 53.2 ± 8.7 years, the proportion of men - 70.9%, women - 29.1%) and the control group (n = 400, average age - 53 , 1 ± 8.3 years, men - 68.3%, women - 31.7%) genotyping of the selected polymorphisms was conducted by PCR-RFLP method according to the authors’ protocols. According to the frequencies of genotypes and alleles of rs77270326 polymorphism, no statistically significant differences were found between the groups (p>0.05). A group of women under the age of 50 revealed a statistically significant decrease in the proportion of carriers of the TT genotype in the group of sudden cardiac death (32.3%) compared with the control group (60.0%) (OR = 0.32, 95% CI 0, 11-0.91, p = 0.04). Thus, the rs77270326 is not associated with sudden cardiac death. For women under the age of 50, the TT genotype of rs34643859 polymorphism is associated with a protective effect against sudden cardiac death.

The aim of the research is to verify the association with sudden cardiac death (SCD) of single nucleotide polymorphisms rs7172856 and rs61999948, identified as new molecular genetic markers of SCD in the own genome-wide pooled allelotyping. Material and methods. Case-control study. The SCD group is formed using the criteria of the European Society of Cardiology from the DNA bank of suddenly deceased residents of the Oktyabrsky district of Novosibirsk ( n = 437, average age – 53.1±9.0 years, men – 73.5 %, women – 26.5 %) The control group ( n = 405, average age 53.2±9.2 years, men 70.0 %, women 30.0 %) is formed from the DNA bank of participants of MONICA and HAPIEE projects. DNA was isolated by phenol-chloroform extraction from myocardial tissue in the SCD group and venous blood in the control group. Genotyping was performed by the PCR-RFLP method. Results. No statistical significance was found in allele and genotype frequencies of rs7172856 between groups, even in separating in sex and age ( p > 0.05). The proportion of male carriers of the TT genotype rs61999948 in the SCD group (6.3 %) is statistically significantly less than the proportion of male carriers of the TT genotype rs61999948 in the control group (12.6 %) (OR = 0.47, 95 % CI 0.26-0.85, p = 0.011). The identified significance is reserved in the group under 50 years old ( p = 0.007) and in the group of men under 50 years old ( p = 0.002). The proportion of carriers of the CC genotype rs61999948 is statistically significantly higher in the SCD group (59.0 %) compared with the control group (42.5 %) (OR = 1.94, 95 % CI 1.21–3.12, p = 0.006) for people under 50 years old. The identified association of the CC genotype with the SCD is reserved in the group of men under 50 years old ( p = 0.001). Conclusions. Single nucleotide polymorphism rs7172856 is not associated with SCD. The TT genotype of the single nucleotide polymorphism rs61999948 is associated with a protective effect against SCD and the CC genotype of rs61999948 is associated with an increased risk of SCD for men under 50 years old.

Aim. To search for causal mutations in candidate genes responsible for the development of sudden cardiac death (SCD) in men who died under the age of 45. Material and methods. The SCD group (n=37) was formed using the criteria the World Health Organization and the European Society of Cardiology. Autopsy material was collected from men who died suddenly outside medical institutions and underwent forensic medical examination according to the standard protocol. Autopsy revealed no morphological changes that could explain sudden death. The mean age was 32,4±6,4 years. Genomic DNA was isolated from myocardial tissue using phenol-chloroform extraction. Clinical exome sequencing was performed. At first, we analyzed the results of sequencing of 24 genes, mutations in which lead to cardiovascular diseases associated with an increased risk of SCD: KCNQ1, KCNH2, SCN5A, AKAP9, ANK2, CACNA1C, CALM1, CALM2, CAV3, KCNE1, KNCJNE2, KCNE2, SCN4B, SNTA1, MYH2, APOB, KCNA5, TGFB3, NEB , PDX1, FLNC, PLEC, KCND3. Results. Of 37 samples, we revealed 13 probable pathogenic missense mutations in 9 samples (24,3%). Of 13 probable pathogenic variants, 5 were new. Conclusion. This pilot study provides following conclusions: it is necessary to continue molecular autopsy research in Russia; to increase the effectiveness of detecting causal mutations, it is necessary to reduce the age of patients with SCD included in the study; studying the families of deceased; cooperation of experienced specialists — forensic pathologist, laboratory geneticist, cardiologist.

The aim of the work is to compare the number of copies of mtDNA in myocardial tissue in persons who died of sudden cardiac and non-cardiac death. Material and methods. Group of sudden cardiac death (SCD, 150 samples): the autopsy material was collected from those who suddenly died outside the medical and preventive treatment facilities of persons who underwent a forensic medical examination according to a standard protocol. As a control group (n = 150), a sample of individuals (selected by gender and age) was used, which, according to the conclusion of the forensic medical examination, died suddenly from other causes (SD). The study of the number of copies of mtDNA was performed in DNA samples isolated from myocardial tissue by the method of phenol-chloroform extraction, using real-time quantitative PCR (qPCR). Results. In both studied groups, there are no significant correlations of the number of copies of mtDNA with age in both men and women. In the general regression analysis, with the introduction of age into the model, the difference between the SCD and SD groups was obtained in the number of copies of mtDNA (p = 0.01). When divided by sex in the group of women, there are no differences between SCD and SD in the number of copies of mtDNA (p = 0.089). In men, differences in the number of copies of mtDNA persist between SCD and SD (p = 0.023). High variability in the number of copies of mtDNA in the myocardium was noted even within the same group in individuals of the same sex and of comparable age compared to the variability in the number of copies of mtDNA in peripheral blood leukocytes (according to the literature). This is probably due to the heterogeneity of the groups on the etiology and pathogenesis of sudden death. In men, the decrease in the number of copies of mtDNA in the group with SCD, compared with those who died suddenly from other causes, is more pronounced at the age of 50 years and older. Conclusion. The number of copies of mtDNA in myocardial tissue in men who have died of SCD is lower, compared with men who died suddenly from other causes (especially over the age of 50 years).

The aim of the work is to compare the number of copies of mtDNA in myocardial tissue in persons who died of sudden cardiac and non-cardiac death. Material and methods. Group of sudden cardiac death (SCD, 150 samples): the autopsy material was collected from those who suddenly died outside the medical and preventive treatment facilities of persons who underwent a forensic medical examination according to a standard protocol. As a control group (n = 150), a sample of individuals (selected by gender and age) was used, which, according to the conclusion of the forensic medical examination, died suddenly from other causes (SD). The study of the number of copies of mtDNA was performed in DNA samples isolated from myocardial tissue by the method of phenol-chloroform extraction, using real-time quantitative PCR (qPCR). Results. In both studied groups, there are no significant correlations of the number of copies of mtDNA with age in both men and women. In the general regression analysis, with the introduction of age into the model, the difference between the SCD and SD groups was obtained in the number of copies of mtDNA (p = 0.01). When divided by sex in the group of women, there are no differences between SCD and SD in the number of copies of mtDNA (p = 0.089). In men, differences in the number of copies of mtDNA persist between SCD and SD (p = 0.023). High variability in the number of copies of mtDNA in the myocardium was noted even within the same group in individuals of the same sex and of comparable age compared to the variability in the number of copies of mtDNA in peripheral blood leukocytes (according to the literature). This is probably due to the heterogeneity of the groups on the etiology and pathogenesis of sudden death. In men, the decrease in the number of copies of mtDNA in the group with SCD, compared with those who died suddenly from other causes, is more pronounced at the age of 50 years and older. Conclusion. The number of copies of mtDNA in myocardial tissue in men who have died of SCD is lower, compared with men who died suddenly from other causes (especially over the age of 50 years).