Brugada syndrome in spinal and bulbar muscular atrophy.
OBJECTIVE
The aim of this study was to clarify myocardial involvement and its clinical implications in subjects with spinal and bulbar muscular atrophy (SBMA), a neuromuscular disease affecting both neuronal and nonneuronal tissues.


METHODS
Two independent cardiologists evaluated ECGs from a total of 144 consecutive subjects with SBMA. We performed immunohistochemical, immunoblot, and quantitative real-time PCR analyses of autopsied myocardium.


RESULTS
Abnormal ECGs were detected in 70 (48.6%) of 144 subjects. The most frequent findings were ST-segment abnormalities in V1-3 (19.4%), followed by ST-segment abnormalities in V5-6 (18.1%). We detected Brugada-type ECGs in 17 of 28 subjects with ST-segment abnormalities in V1-3. Of those, one subject presented with syncope that required an implantable cardioverter defibrillator and led to eventual sudden death, and another subject also died suddenly. No subjects with Brugada-type ECGs had mutations in SCN5A, CACNA1C, or CACNB2 genes. In autopsied cases, we detected nuclear accumulation of the mutant androgen receptor protein and decreased expression levels of SCN5A in the myocardium.


CONCLUSIONS
Subjects with SBMA often show Brugada-type ECG. The accumulation of the pathogenic androgen receptor may have a role in the myocardial involvement in SBMA.
From the Department of Neurology (A.A., M.K., K.S., H.B., N.S., A.H., T. Mano, Y.H., H.N., H.W., G.S.), Nagoya University Graduate School of Medicine; Institute for Advanced Research (H.B.), Nagoya University; Department of Speech Pathology and Audiology (M.Y.), Aichi-Gakuin University School of Health Science, Nisshin; Department of Cardiovascular Medicine (T. Makiyama), Kyoto University Graduate School of Medicine; Department of Cardiovascular and Respiratory Medicine (S.O., M.F., M.H.), Shiga University of Medical Science, Ohtsu; and Division of Cardiology (S.-i.M.), Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.
Amane
A
Araki
From the Department of Neurology (A.A., M.K., K.S., H.B., N.S., A.H., T. Mano, Y.H., H.N., H.W., G.S.), Nagoya University Graduate School of Medicine; Institute for Advanced Research (H.B.), Nagoya University; Department of Speech Pathology and Audiology (M.Y.), Aichi-Gakuin University School of Health Science, Nisshin; Department of Cardiovascular Medicine (T. Makiyama), Kyoto University Graduate School of Medicine; Department of Cardiovascular and Respiratory Medicine (S.O., M.F., M.H.), Shiga University of Medical Science, Ohtsu; and Division of Cardiology (S.-i.M.), Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan. ka2no@med.nagoya-u.ac.jp sobueg@med.nagoya-u.ac.jp.
Masahisa
M
Katsuno
From the Department of Neurology (A.A., M.K., K.S., H.B., N.S., A.H., T. Mano, Y.H., H.N., H.W., G.S.), Nagoya University Graduate School of Medicine; Institute for Advanced Research (H.B.), Nagoya University; Department of Speech Pathology and Audiology (M.Y.), Aichi-Gakuin University School of Health Science, Nisshin; Department of Cardiovascular Medicine (T. Makiyama), Kyoto University Graduate School of Medicine; Department of Cardiovascular and Respiratory Medicine (S.O., M.F., M.H.), Shiga University of Medical Science, Ohtsu; and Division of Cardiology (S.-i.M.), Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.
Keisuke
K
Suzuki
From the Department of Neurology (A.A., M.K., K.S., H.B., N.S., A.H., T. Mano, Y.H., H.N., H.W., G.S.), Nagoya University Graduate School of Medicine; Institute for Advanced Research (H.B.), Nagoya University; Department of Speech Pathology and Audiology (M.Y.), Aichi-Gakuin University School of Health Science, Nisshin; Department of Cardiovascular Medicine (T. Makiyama), Kyoto University Graduate School of Medicine; Department of Cardiovascular and Respiratory Medicine (S.O., M.F., M.H.), Shiga University of Medical Science, Ohtsu; and Division of Cardiology (S.-i.M.), Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.
Haruhiko
H
Banno
From the Department of Neurology (A.A., M.K., K.S., H.B., N.S., A.H., T. Mano, Y.H., H.N., H.W., G.S.), Nagoya University Graduate School of Medicine; Institute for Advanced Research (H.B.), Nagoya University; Department of Speech Pathology and Audiology (M.Y.), Aichi-Gakuin University School of Health Science, Nisshin; Department of Cardiovascular Medicine (T. Makiyama), Kyoto University Graduate School of Medicine; Department of Cardiovascular and Respiratory Medicine (S.O., M.F., M.H.), Shiga University of Medical Science, Ohtsu; and Division of Cardiology (S.-i.M.), Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.
Noriaki
N
Suga
From the Department of Neurology (A.A., M.K., K.S., H.B., N.S., A.H., T. Mano, Y.H., H.N., H.W., G.S.), Nagoya University Graduate School of Medicine; Institute for Advanced Research (H.B.), Nagoya University; Department of Speech Pathology and Audiology (M.Y.), Aichi-Gakuin University School of Health Science, Nisshin; Department of Cardiovascular Medicine (T. Makiyama), Kyoto University Graduate School of Medicine; Department of Cardiovascular and Respiratory Medicine (S.O., M.F., M.H.), Shiga University of Medical Science, Ohtsu; and Division of Cardiology (S.-i.M.), Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.
Atsushi
A
Hashizume
From the Department of Neurology (A.A., M.K., K.S., H.B., N.S., A.H., T. Mano, Y.H., H.N., H.W., G.S.), Nagoya University Graduate School of Medicine; Institute for Advanced Research (H.B.), Nagoya University; Department of Speech Pathology and Audiology (M.Y.), Aichi-Gakuin University School of Health Science, Nisshin; Department of Cardiovascular Medicine (T. Makiyama), Kyoto University Graduate School of Medicine; Department of Cardiovascular and Respiratory Medicine (S.O., M.F., M.H.), Shiga University of Medical Science, Ohtsu; and Division of Cardiology (S.-i.M.), Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.
Tomoo
T
Mano
From the Department of Neurology (A.A., M.K., K.S., H.B., N.S., A.H., T. Mano, Y.H., H.N., H.W., G.S.), Nagoya University Graduate School of Medicine; Institute for Advanced Research (H.B.), Nagoya University; Department of Speech Pathology and Audiology (M.Y.), Aichi-Gakuin University School of Health Science, Nisshin; Department of Cardiovascular Medicine (T. Makiyama), Kyoto University Graduate School of Medicine; Department of Cardiovascular and Respiratory Medicine (S.O., M.F., M.H.), Shiga University of Medical Science, Ohtsu; and Division of Cardiology (S.-i.M.), Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.
Yasuhiro
Y
Hijikata
From the Department of Neurology (A.A., M.K., K.S., H.B., N.S., A.H., T. Mano, Y.H., H.N., H.W., G.S.), Nagoya University Graduate School of Medicine; Institute for Advanced Research (H.B.), Nagoya University; Department of Speech Pathology and Audiology (M.Y.), Aichi-Gakuin University School of Health Science, Nisshin; Department of Cardiovascular Medicine (T. Makiyama), Kyoto University Graduate School of Medicine; Department of Cardiovascular and Respiratory Medicine (S.O., M.F., M.H.), Shiga University of Medical Science, Ohtsu; and Division of Cardiology (S.-i.M.), Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.
Hideaki
H
Nakatsuji
From the Department of Neurology (A.A., M.K., K.S., H.B., N.S., A.H., T. Mano, Y.H., H.N., H.W., G.S.), Nagoya University Graduate School of Medicine; Institute for Advanced Research (H.B.), Nagoya University; Department of Speech Pathology and Audiology (M.Y.), Aichi-Gakuin University School of Health Science, Nisshin; Department of Cardiovascular Medicine (T. Makiyama), Kyoto University Graduate School of Medicine; Department of Cardiovascular and Respiratory Medicine (S.O., M.F., M.H.), Shiga University of Medical Science, Ohtsu; and Division of Cardiology (S.-i.M.), Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.
Hirohisa
H
Watanabe
From the Department of Neurology (A.A., M.K., K.S., H.B., N.S., A.H., T. Mano, Y.H., H.N., H.W., G.S.), Nagoya University Graduate School of Medicine; Institute for Advanced Research (H.B.), Nagoya University; Department of Speech Pathology and Audiology (M.Y.), Aichi-Gakuin University School of Health Science, Nisshin; Department of Cardiovascular Medicine (T. Makiyama), Kyoto University Graduate School of Medicine; Department of Cardiovascular and Respiratory Medicine (S.O., M.F., M.H.), Shiga University of Medical Science, Ohtsu; and Division of Cardiology (S.-i.M.), Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.
Masahiko
M
Yamamoto
From the Department of Neurology (A.A., M.K., K.S., H.B., N.S., A.H., T. Mano, Y.H., H.N., H.W., G.S.), Nagoya University Graduate School of Medicine; Institute for Advanced Research (H.B.), Nagoya University; Department of Speech Pathology and Audiology (M.Y.), Aichi-Gakuin University School of Health Science, Nisshin; Department of Cardiovascular Medicine (T. Makiyama), Kyoto University Graduate School of Medicine; Department of Cardiovascular and Respiratory Medicine (S.O., M.F., M.H.), Shiga University of Medical Science, Ohtsu; and Division of Cardiology (S.-i.M.), Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.
Takeru
T
Makiyama
From the Department of Neurology (A.A., M.K., K.S., H.B., N.S., A.H., T. Mano, Y.H., H.N., H.W., G.S.), Nagoya University Graduate School of Medicine; Institute for Advanced Research (H.B.), Nagoya University; Department of Speech Pathology and Audiology (M.Y.), Aichi-Gakuin University School of Health Science, Nisshin; Department of Cardiovascular Medicine (T. Makiyama), Kyoto University Graduate School of Medicine; Department of Cardiovascular and Respiratory Medicine (S.O., M.F., M.H.), Shiga University of Medical Science, Ohtsu; and Division of Cardiology (S.-i.M.), Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.
Seiko
S
Ohno
From the Department of Neurology (A.A., M.K., K.S., H.B., N.S., A.H., T. Mano, Y.H., H.N., H.W., G.S.), Nagoya University Graduate School of Medicine; Institute for Advanced Research (H.B.), Nagoya University; Department of Speech Pathology and Audiology (M.Y.), Aichi-Gakuin University School of Health Science, Nisshin; Department of Cardiovascular Medicine (T. Makiyama), Kyoto University Graduate School of Medicine; Department of Cardiovascular and Respiratory Medicine (S.O., M.F., M.H.), Shiga University of Medical Science, Ohtsu; and Division of Cardiology (S.-i.M.), Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.
Megumi
M
Fukuyama
From the Department of Neurology (A.A., M.K., K.S., H.B., N.S., A.H., T. Mano, Y.H., H.N., H.W., G.S.), Nagoya University Graduate School of Medicine; Institute for Advanced Research (H.B.), Nagoya University; Department of Speech Pathology and Audiology (M.Y.), Aichi-Gakuin University School of Health Science, Nisshin; Department of Cardiovascular Medicine (T. Makiyama), Kyoto University Graduate School of Medicine; Department of Cardiovascular and Respiratory Medicine (S.O., M.F., M.H.), Shiga University of Medical Science, Ohtsu; and Division of Cardiology (S.-i.M.), Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.
Shin-Ichiro
S
Morimoto
From the Department of Neurology (A.A., M.K., K.S., H.B., N.S., A.H., T. Mano, Y.H., H.N., H.W., G.S.), Nagoya University Graduate School of Medicine; Institute for Advanced Research (H.B.), Nagoya University; Department of Speech Pathology and Audiology (M.Y.), Aichi-Gakuin University School of Health Science, Nisshin; Department of Cardiovascular Medicine (T. Makiyama), Kyoto University Graduate School of Medicine; Department of Cardiovascular and Respiratory Medicine (S.O., M.F., M.H.), Shiga University of Medical Science, Ohtsu; and Division of Cardiology (S.-i.M.), Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.
Minoru
M
Horie
From the Department of Neurology (A.A., M.K., K.S., H.B., N.S., A.H., T. Mano, Y.H., H.N., H.W., G.S.), Nagoya University Graduate School of Medicine; Institute for Advanced Research (H.B.), Nagoya University; Department of Speech Pathology and Audiology (M.Y.), Aichi-Gakuin University School of Health Science, Nisshin; Department of Cardiovascular Medicine (T. Makiyama), Kyoto University Graduate School of Medicine; Department of Cardiovascular and Respiratory Medicine (S.O., M.F., M.H.), Shiga University of Medical Science, Ohtsu; and Division of Cardiology (S.-i.M.), Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan. ka2no@med.nagoya-u.ac.jp sobueg@med.nagoya-u.ac.jp.
Gen
G
Sobue
D000328:Adult; D000368:Aged; D053840:Brugada Syndrome / Q000150:complications* / Q000235:genetics / Q000473:pathology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020966:Muscular Disorders, Atrophic / Q000150:complications* / Q000235:genetics / Q000473:pathology; D009154:Mutation; D009206:Myocardium / Q000378:metabolism / Q000473:pathology; D011944:Receptors, Androgen / Q000235:genetics
D011944:Receptors, Androgen