Aortic Stenosis Clinical Trial
Official title:
Prevalence and Significance of Mutations in Genes Encoding NaPi-co-transporters in the Development of CAVD
Mutations in the SLC34A2 gene, that encodes the sodium phosphate co-transporter (NaPi-IIb),
cause defect cell-uptake of phosphate, which leads to formation of calcium-phosphate
concretions in the lungs as seen in Pulmonary Alveolar Microlithiasis (PAM). Extra pulmonary
calcifications, including heart valve calcification, have previously been reported in
patients with PAM.
Calcific Aortic Valve Disease (CAVD) is a common disease in the elderly and is characterised
by thickening and calcification of the aortic valve leaflets in the absence of rheumatic
heart disease. CAVD is present in more than 25% of patients older than age 65 years and is
associated with an increased risk of cardiovascular events. Currently, there is no effective
therapy for the disease other than surgical aortic valve replacement. Both calcium and
phosphate are the major components of calcific deposits in PAM and CAVD. Based on these
preliminary findings, the investigators hypothesize that mutations in sodium phosphate
co-transporters may play a role in both pulmonary and extra pulmonary calcifications.
Two studies will be performed: 1. A retrospective cross-sectional study including patients
with an age ≤ 65 years with CAVD from Denmark and Örebro, will be carried out. Genetic
association analysis will be performed to investigate the incidence of common variants in
five genes representing sodium phosphate co-transporters (SLC34A1, SLC34A2, SLC34A3,
SLC20A1, SLC20A2) compared to healthy controls. Associated genes will subsequently be
sequenced to identify possible causal mutations. 2. In a prospective study, aortic valve
tissue will be collected from patients with AS undergoing surgical valve replacement.
Molecular characterisation of the transporters will be conducted by determining the level of
specific mRNA and protein by RT-PCR/qPCR, and Western Blotting, respectively. The
localisation and visualisation will be investigated by immunostaining and confocal laser
microscopy. Fibroblasts and endothelial cells will be isolated and grown in cultures with
subsequent functional studies of the phosphate uptake.
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