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1
Inheritance
6
Pathophys.
8
Phenotypes
21
Pathograph
1
Genes
3
Medical Actions
1
References
1
Deep Research
🏷

Classifications

Harrison's Chapter
GENETICS_ENVIRONMENT_DISEASE CARDIOVASCULAR
Mechanistic Nosology
mitochondrial disease
👪

Inheritance

1
X-linked recessive HP:0001419
Barth syndrome is inherited in an X-linked recessive manner and primarily affects hemizygous males, while heterozygous females are typically asymptomatic carriers.
X-linked recessive inheritance
Show evidence (1 reference)
PMID:31239752 SUPPORT Human Clinical
"Objectives: Barth syndrome is an ultra-rare, infantile-onset, X-linked recessive mitochondrial disorder, primarily affecting males, due to variants in TAZ encoding for the cardiolipin transacylase tafazzin."
The review abstract explicitly identifies Barth syndrome as an X-linked recessive disorder affecting males.

Pathophysiology

6
Tafazzin deficiency impairs cardiolipin remodeling
Loss of tafazzin activity disrupts remodeling of mitochondrial cardiolipin, producing the signature increase in monolysocardiolipin and reduction in mature cardiolipin. Because cardiolipin is essential for inner-membrane architecture and energy transduction, this lipid-remodeling defect is the initiating lesion for downstream mitochondrial dysfunction in Barth syndrome.
cardiomyocyte CL:0000746
TAFAZZIN hgnc:11577
cardiolipin metabolic process GO:0032048 ↕ DYSREGULATED
Show evidence (1 reference)
PMID:23409742 SUPPORT Human Clinical
"It is caused by mutations in the TAZ gene encoding tafazzin, a protein involved in the metabolism of cardiolipin, a mitochondrial-specific phospholipid involved in mitochondrial energy production."
This directly links TAFAZZIN mutation to defective cardiolipin metabolism, the primary molecular lesion in Barth syndrome.
Mitochondrial respiratory chain dysfunction
Cardiolipin deficiency destabilizes the mitochondrial inner membrane, lowering membrane potential and impairing respiratory chain function. In patient-derived cells and affected tissues, this is accompanied by abnormal reactive oxygen species handling and reduced ATP-generating capacity.
oxidative phosphorylation GO:0006119 ↓ DECREASED
Show evidence (1 reference)
PMID:23361305 SUPPORT In Vitro
"An examination of the patients' fibroblast cultures revealed that extremely low mitochondrial membrane potentials (mtΔΨ about 50 % of the control value) dominated other unspecific mitochondrial changes detected (respiratory chain dysfunction, abnormal ROS production and depressed antioxidant defense)."
Patient-derived fibroblasts demonstrate markedly impaired membrane potential together with respiratory chain dysfunction, supporting a core mitochondrial bioenergetic defect.
Myocardial metabolic substrate shift
Tafazzin-deficient cardiomyocytes show reduced mitochondrial fatty-acid utilization and compensatory reliance on glucose and alternative anaplerotic fuels. This metabolic rewiring reflects impaired mitochondrial substrate handling and contributes to contractile inefficiency in the Barth heart.
cardiomyocyte CL:0000746
fatty acid beta-oxidation GO:0006635 ↓ DECREASED
Show evidence (3 references)
PMID:31861102 SUPPORT In Vitro
"We also demonstrate that TAZ517delG induces metabolic alterations in pathways related to energy production as reflected by high glucose uptake, an increase in glycolytic lactate production and a decrease in palmitate uptake."
Patient-derived and genome-edited iPSC cardiomyocytes show a shift away from fatty-acid use toward glucose-reliant metabolism.
PMID:37930434 SUPPORT Model Organism
"In mice with an inducible knockdown (KD) of TAFAZZIN,"
The abstract explicitly identifies an inducible Tafazzin-knockdown mouse model as one of the systems used to demonstrate the reported metabolic rewiring in Barth syndrome.
PMID:37930434 SUPPORT In Vitro
"in induced pluripotent stem cell-derived cardiac myocytes, mitochondrial uptake and oxidation of fatty acids was strongly decreased, while glucose uptake was increased."
iPSC-derived cardiac myocytes independently show decreased mitochondrial fatty-acid utilization with compensatory glucose uptake.
Abnormal cardiomyocyte calcium handling
In Barth syndrome cardiomyocytes, excess mitochondrial and cellular reactive oxygen species activates the CaMKII-RYR2 axis, increasing sarcoplasmic reticulum calcium leak. The result is abnormal diastolic calcium handling, reduced calcium transient amplitude, impaired contractility, and greater arrhythmia vulnerability.
cardiomyocyte CL:0000746
cardiac muscle contraction GO:0060048 ↓ DECREASED
Show evidence (2 references)
PMID:33793303 SUPPORT In Vitro
"Compared with wild-type controls, BTHS-induced pluripotent stem cell-derived cardiomyocytes had increased diastolic Ca2+ and decreased Ca2+ transient amplitude."
This directly demonstrates abnormal calcium homeostasis in Barth-syndrome iPSC-derived cardiomyocytes.
PMID:33793303 SUPPORT In Vitro
"Inhibition of this reactive oxygen species-CaMKII-RYR2 pathway through pharmacological inhibitors or genome editing normalized aberrant Ca2+ handling in BTHS-induced pluripotent stem cell-derived cardiomyocytes and improved their contractile function."
Rescue of calcium handling and contractility identifies ROS-CaMKII-RYR2 signaling as a causal mechanism rather than a bystander abnormality.
Skeletal muscle mitochondrial myopathy
Tafazzin deficiency causes skeletal-muscle mitochondrial dysfunction, reducing muscle oxygen extraction and producing the proximal myopathy and severe exercise limitation typical of Barth syndrome.
skeletal muscle cell CL:0000188
oxidative phosphorylation GO:0006119 ↓ DECREASED muscle contraction GO:0006936 ↓ DECREASED
Show evidence (2 references)
PMID:23361305 SUPPORT Human Clinical
"Our studies confirm generalised mitochondrial dysfunction in the skeletal muscle and the fibroblasts of BTHS patients, especially a severe impairment in the mitochondrial membrane potential and the inhibition of complex V activity."
Patient skeletal-muscle testing directly supports mitochondrial myopathy as a Barth syndrome mechanism.
PMID:21873497 SUPPORT Human Clinical
"In conclusion, severe exercise intolerance in BTHS is due to both cardiac and skeletal muscle impairments that are consistent with cardiac and skeletal mitochondrial myopathy."
Exercise physiology in affected patients links the skeletal mitochondrial myopathy branch to severe exercise limitation.
Impaired myeloid maturation
Barth-syndrome neutropenia reflects impaired granulocytic maturation rather than a pure peripheral destruction phenotype. Bone-marrow studies show reduced maturation of the myeloid lineage, providing a mechanistic basis for intermittent or chronic neutropenia and recurrent infection risk.
neutrophil CL:0000775
myeloid cell differentiation GO:0030099 ↓ DECREASED
Show evidence (2 references)
PMID:30451719 SUPPORT Human Clinical
"Pretreatment bone marrow evaluations predominantly showed reduced myeloid maturation which normalized on G-CSF therapy in seven of 13 examined."
Bone-marrow findings in affected patients support impaired myeloid maturation as a direct mechanism of Barth-syndrome neutropenia.
PMID:30451719 SUPPORT In Vitro
"TAZ knockdown experiments suggest accelerated apoptosis of myeloid progenitor cells due to increased dissipation of mitochondrial membrane potential, aberrant release of cytochrome c and activation of caspase-3."
Tafazzin knockdown experiments support mitochondrial progenitor-cell apoptosis as a mechanistic contributor to the myeloid maturation defect.

Pathograph

Use the checkboxes to hide or show graph categories. Hover nodes for evidence and cross-linked metadata.
Pathograph: causal mechanism network for Barth syndrome Interactive directed graph showing how pathophysiology mechanisms, phenotypes, genetic factors and variants, experimental models, environmental triggers, and treatments relate through causal and linked edges.

Phenotypes

8
Blood 1
Neutropenia Decreased total neutrophil count HP:0001875
Sequelae: Recurrent bacterial infections
Show evidence (1 reference)
PMID:30451719 SUPPORT Human Clinical
"Major features include neutropenia, dilated cardiomyopathy, motor delay and proximal myopathy, feeding problems, and constitutional growth delay."
This large Barth syndrome neutropenia review identifies neutropenia as one of the defining disease manifestations.
Cardiovascular 2
Cardiomyopathy Cardiomyopathy HP:0001638
Show evidence (1 reference)
PMID:25299040 SUPPORT Human Clinical
"Cardiomyopathy, which is almost always present before age five years, is typically dilated cardiomyopathy with or without endocardial fibroelastosis or left ventricular noncompaction; hypertrophic cardiomyopathy can also occur."
GeneReviews summarizes cardiomyopathy as the dominant early-life Barth syndrome phenotype and defines its major structural subtypes.
Arrhythmia Arrhythmia HP:0011675
Show evidence (1 reference)
PMID:25299040 SUPPORT Human Clinical
"Heart failure is a significant cause of morbidity and mortality; risk of arrhythmia and sudden death is increased."
GeneReviews identifies increased arrhythmia and sudden-death risk in Barth syndrome.
Musculoskeletal 1
Proximal muscle weakness Proximal muscle weakness HP:0003701
Show evidence (1 reference)
PMID:25299040 SUPPORT Human Clinical
"Skeletal myopathy predominantly affects the proximal muscles, and results in delays in development of early motor skills."
GeneReviews directly supports proximal-predominant skeletal muscle involvement in Barth syndrome.
Constitutional 1
Exercise intolerance Exercise intolerance HP:0003546
Show evidence (1 reference)
PMID:21873497 SUPPORT Human Clinical
"In conclusion, severe exercise intolerance in BTHS is due to both cardiac and skeletal muscle impairments that are consistent with cardiac and skeletal mitochondrial myopathy."
This exercise-physiology study directly attributes exercise intolerance to combined cardiac and skeletal-muscle dysfunction in Barth syndrome.
Growth 1
Growth delay Growth delay HP:0001510
Show evidence (1 reference)
PMID:23409742 SUPPORT Human Clinical
"BACKGROUND: Barth syndrome (BS) is an X-linked infantile-onset cardioskeletal disease characterized by cardiomyopathy, hypotonia, growth delay, neutropenia and 3-methylglutaconic aciduria."
This clinical series explicitly lists growth delay among the core Barth syndrome manifestations.
Other 2
Left ventricular noncompaction Left ventricular noncompaction cardiomyopathy HP:0011664
Show evidence (1 reference)
PMID:23361305 SUPPORT Human Clinical
"In both brothers, 2D-echocardiography revealed some features of left ventricular noncompaction (LVNC) despite marked differences in the course of the disease;"
This affected-sibling report directly documents LVNC as a Barth syndrome cardiac phenotype.
Recurrent bacterial infections Recurrent bacterial infections HP:0002718
Show evidence (1 reference)
PMID:25299040 SUPPORT Human Clinical
"Neutropenia is most often associated with bacterial infections and aphthous ulcers, pneumonia, and sepsis."
GeneReviews links Barth syndrome neutropenia to recurrent bacterial infectious complications.
🧬

Genetic Associations

1
TAFAZZIN (Loss-of-function)
Gene: TAFAZZIN hgnc:11577
Show evidence (2 references)
PMID:23409742 SUPPORT Human Clinical
"It is caused by mutations in the TAZ gene encoding tafazzin, a protein involved in the metabolism of cardiolipin, a mitochondrial-specific phospholipid involved in mitochondrial energy production."
This clinical series directly identifies TAZ/TAFAZZIN mutation as the molecular cause of Barth syndrome.
"TAFAZZIN | HGNC:11577 | Barth syndrome | MONDO:0010543 | XL | Definitive"
ClinGen classifies the TAFAZZIN-Barth syndrome gene-disease relationship as definitive with X-linked inheritance.
💊

Medical Actions

3
Heart failure pharmacotherapy
Action: Pharmacotherapy NCIT:C15986
Standard heart-failure medications are used to manage Barth cardiomyopathy, with careful attention to volume status because affected patients are vulnerable to overdiuresis and dehydration.
Mechanism Target:
MODULATES Mitochondrial respiratory chain dysfunction — Standard heart-failure pharmacotherapy (ACE inhibitors, beta-blockers, diuretics) reduces cardiac afterload and sympathetic drive, lowering myocardial energy demand and alleviating the hemodynamic stress imposed by mitochondrial respiratory chain dysfunction in Barth cardiomyocytes.
Target Phenotypes: Cardiomyopathy HP:0001638
Show evidence (1 reference)
PMID:25299040 SUPPORT Human Clinical
"for heart failure, careful fluid and volume management and avoidance of overdiuresis and dehydration, standard heart failure medications, and cardiac transplantation when heart failure is severe and intractable."
GeneReviews supports standard heart-failure pharmacotherapy as core management for Barth cardiomyopathy.
Granulocyte colony-stimulating factor (G-CSF)
Action: hematopoietic growth factor therapy Ontology label: Immunotherapy NCIT:C15262
G-CSF is used prophylactically in neutropenic Barth syndrome patients to reduce severe bacterial infection risk and improve marrow neutrophil maturation.
Mechanism Target:
ACTIVATES Impaired myeloid maturation — G-CSF promotes marrow myeloid differentiation and mature neutrophil output.
Show evidence (1 reference)
PMID:30451719 SUPPORT Human Clinical
"Pretreatment bone marrow evaluations predominantly showed reduced myeloid maturation which normalized on G-CSF therapy in seven of 13 examined."
Patient marrow examinations support G-CSF activation/restoration of impaired myeloid maturation.
Target Phenotypes: Neutropenia HP:0001875 Recurrent bacterial infections HP:0002718
Show evidence (1 reference)
PMID:30451719 SUPPORT Human Clinical
"Prophylaxis with G-CSF ± antibiotics prevents serious bacterial infections in the more severe neutropenic patients although infections remain a threat even in patients who are very compliant with therapy, especially in those with indwelling devices."
This review directly supports G-CSF prophylaxis as effective management for severe Barth-syndrome neutropenia.
Elamipretide
Action: Pharmacotherapy NCIT:C15986
Agent: elamipretide CHEBI:233331
Elamipretide is a cardiolipin-directed mitochondrial therapy used to improve muscle strength in Barth syndrome.
Mechanism Target:
MODULATES Tafazzin deficiency impairs cardiolipin remodeling — Elamipretide is a cardiolipin-targeting tetrapeptide that associates with cardiolipin on the inner mitochondrial membrane, stabilizing cardiolipin-protein complexes and partially compensating for the cardiolipin remodeling defect caused by tafazzin deficiency.
Target Phenotypes: Proximal muscle weakness HP:0003701
Show evidence (1 reference)
PMID:25299040 SUPPORT Human Clinical
"Targeted therapy: Elamipretide is indicated for the improvement of muscle strength in individuals with Barth syndrome."
The updated GeneReviews management section identifies elamipretide as a Barth syndrome-targeted therapy for muscle weakness.
🔬

Biochemical Markers

3
Increased monolysocardiolipin:cardiolipin ratio (INCREASED)
Pathograph Readouts
Readout Of Tafazzin deficiency impairs cardiolipin remodeling Positive Diagnostic
An increased monolysocardiolipin:cardiolipin ratio directly reports the tafazzin-dependent cardiolipin remodeling defect.
Show evidence (1 reference)
PMID:18070816 SUPPORT Human Clinical
"All BTHS patients (n = 31) had monolysocardiolipin:cardiolipin ratios >0.40 and all controls (n = 215) had monolysocardiolipin:cardiolipin ratios <0.23."
Patient bloodspot data support the MLCL:CL ratio as a diagnostic biochemical readout of the cardiolipin remodeling defect.
Show evidence (1 reference)
PMID:18070816 SUPPORT Human Clinical
"All BTHS patients (n = 31) had monolysocardiolipin:cardiolipin ratios >0.40 and all controls (n = 215) had monolysocardiolipin:cardiolipin ratios <0.23."
This bloodspot assay study establishes an increased MLCL:CL ratio as the defining Barth syndrome biomarker.
Elevated urinary 3-methylglutaconic acid (INCREASED)
Pathograph Readouts
Readout Of Tafazzin deficiency impairs cardiolipin remodeling Positive Diagnostic
Urinary 3-methylglutaconic acid elevation is a classic metabolic readout associated with the tafazzin/cardiolipin-remodeling defect, although the intermediate route is unresolved.
Show evidence (1 reference)
PMID:23409742 SUPPORT Human Clinical
"BACKGROUND: Barth syndrome (BS) is an X-linked infantile-onset cardioskeletal disease characterized by cardiomyopathy, hypotonia, growth delay, neutropenia and 3-methylglutaconic aciduria. It is caused by mutations in the TAZ gene encoding tafazzin, a protein involved in the metabolism of..."
The clinical series links Barth syndrome 3-methylglutaconic aciduria to TAZ/tafazzin and cardiolipin metabolism, supporting the diagnostic readout link while leaving intermediate mechanisms unresolved.
Show evidence (1 reference)
PMID:23409742 SUPPORT Human Clinical
"All patients exhibited 3-methylglutaconic aciduria and neutropenia, when tested and five of them also had lactic acidosis."
This case series directly documents 3-methylglutaconic aciduria as a common biochemical abnormality in Barth syndrome.
Lactic acidosis (INCREASED)
Pathograph Readouts
Readout Of Myocardial metabolic substrate shift Positive Diagnostic
Increased lactate reports the glucose-shifted, glycolytic component of Barth mitochondrial energy rewiring.
Show evidence (2 references)
PMID:31861102 SUPPORT In Vitro
"We also demonstrate that TAZ517delG induces metabolic alterations in pathways related to energy production as reflected by high glucose uptake, an increase in glycolytic lactate production and a decrease in palmitate uptake."
Barth iPSC-cardiomyocytes show increased glycolytic lactate production as part of the metabolic substrate shift, supporting lactate as a readout of that mechanism.
PMID:23409742 SUPPORT Human Clinical
"CONCLUSIONS: Lactic acidosis associated with 3-methylglutaconic aciduria is highly suggestive of BS, whilst the severity of the metabolic decompensation at disease onset should be considered for prognostic purposes."
The clinical series supports lactic acidosis in diagnostic and decompensation contexts, complementing the cellular lactate-production mechanism.
Readout Of Mitochondrial respiratory chain dysfunction Positive Diagnostic
Lactic acidosis also reports the upstream mitochondrial respiratory dysfunction branch of Barth syndrome.
Show evidence (2 references)
PMID:23361305 SUPPORT In Vitro
"An examination of the patients' fibroblast cultures revealed that extremely low mitochondrial membrane potentials (mtΔΨ about 50 % of the control value) dominated other unspecific mitochondrial changes detected (respiratory chain dysfunction, abnormal ROS production and depressed antioxidant defense)."
Patient-derived fibroblast cultures show mitochondrial membrane-potential loss with respiratory-chain dysfunction, supporting the upstream mitochondrial dysfunction target.
PMID:23361305 SUPPORT Human Clinical
"Severe lactic acidosis without 3-methylglutaconic aciduria in male neonates as well as asymptomatic left ventricular noncompaction at ECHO record may characterise a range of natural history of Barth syndrome."
The affected-sibling report documents severe neonatal lactic acidosis as part of the Barth syndrome clinical spectrum, supporting lactate as the clinical readout paired with the mitochondrial dysfunction evidence.
Show evidence (1 reference)
PMID:23409742 SUPPORT Human Clinical
"All patients exhibited 3-methylglutaconic aciduria and neutropenia, when tested and five of them also had lactic acidosis."
This cohort directly reports lactic acidosis in most evaluated patients.
{ }

Source YAML

click to show
name: Barth syndrome
creation_date: '2026-04-12T00:00:00Z'
updated_date: '2026-05-21T04:58:02Z'
category: Mendelian
synonyms:
- BTHS
- TAFAZZIN-related Barth syndrome
description: >-
  Barth syndrome is an ultra-rare X-linked recessive mitochondrial disorder
  caused by hemizygous pathogenic variants in TAFAZZIN, which encodes the
  cardiolipin remodeling enzyme tafazzin. Defective tafazzin activity increases
  monolysocardiolipin, decreases mature cardiolipin, and destabilizes
  mitochondrial membrane structure, oxidative phosphorylation, and metabolic
  flexibility in high-energy tissues. The core phenotype includes
  cardiomyopathy, left ventricular noncompaction, neutropenia, skeletal
  myopathy, exercise intolerance, growth delay, recurrent bacterial infections,
  and 3-methylglutaconic aciduria, with lactic acidosis and arrhythmia risk in a
  subset of affected boys.
disease_term:
  preferred_term: Barth syndrome
  term:
    id: MONDO:0010543
    label: Barth syndrome
classifications:
  harrisons_chapter:
  - classification_value: GENETICS_ENVIRONMENT_DISEASE
  - classification_value: CARDIOVASCULAR
  mechanistic_category:
  - classification_value: mitochondrial disease
parents: []
prevalence:
- notes: >-
    Ultra-rare. Published review literature in 2019 described fewer than 200
    reported cases worldwide, while emphasizing likely underdiagnosis.
  evidence:
  - reference: PMID:31239752
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      Although Barth syndrome is still an orphan disease, with fewer than 200
      cases described so far, there is extensive ongoing research with regard to
      its pathomechanism and new therapeutic approaches.
    explanation: >-
      This review directly supports that Barth syndrome is ultra-rare and had
      fewer than 200 described cases at the time of publication.
inheritance:
- name: X-linked recessive
  inheritance_term:
    preferred_term: X-linked recessive inheritance
    term:
      id: HP:0001419
      label: X-linked recessive inheritance
  description: >-
    Barth syndrome is inherited in an X-linked recessive manner and primarily
    affects hemizygous males, while heterozygous females are typically
    asymptomatic carriers.
  evidence:
  - reference: PMID:31239752
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      Objectives: Barth syndrome is an ultra-rare, infantile-onset, X-linked
      recessive mitochondrial disorder, primarily affecting males, due to
      variants in TAZ encoding for the cardiolipin transacylase tafazzin.
    explanation: >-
      The review abstract explicitly identifies Barth syndrome as an X-linked
      recessive disorder affecting males.
genetic:
- name: TAFAZZIN
  gene_term:
    preferred_term: TAFAZZIN
    term:
      id: hgnc:11577
      label: TAFAZZIN
  association: Loss-of-function
  presence: Positive
  features: >-
    Hemizygous pathogenic variants in TAFAZZIN disrupt tafazzin-mediated
    cardiolipin remodeling. Reported disease alleles include missense, nonsense,
    frameshift, splice-site, and larger rearrangement variants, with substantial
    inter-individual phenotypic variability and no robust genotype-phenotype
    correlation.
  evidence:
  - reference: PMID:23409742
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      It is caused by mutations in the TAZ gene encoding tafazzin, a protein
      involved in the metabolism of cardiolipin, a mitochondrial-specific
      phospholipid involved in mitochondrial energy production.
    explanation: >-
      This clinical series directly identifies TAZ/TAFAZZIN mutation as the
      molecular cause of Barth syndrome.
  - reference: CGGV:assertion_1629e6ab-9749-4949-bf54-fe1addf4dcfd-2021-02-12T170000.000Z
    reference_title: "TAFAZZIN / Barth syndrome (Definitive)"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "TAFAZZIN | HGNC:11577 | Barth syndrome | MONDO:0010543 | XL | Definitive"
    explanation: ClinGen classifies the TAFAZZIN-Barth syndrome gene-disease relationship as definitive with X-linked inheritance.
pathophysiology:
- name: Tafazzin deficiency impairs cardiolipin remodeling
  description: >-
    Loss of tafazzin activity disrupts remodeling of mitochondrial cardiolipin,
    producing the signature increase in monolysocardiolipin and reduction in
    mature cardiolipin. Because cardiolipin is essential for inner-membrane
    architecture and energy transduction, this lipid-remodeling defect is the
    initiating lesion for downstream mitochondrial dysfunction in Barth syndrome.
  genes:
  - preferred_term: TAFAZZIN
    term:
      id: hgnc:11577
      label: TAFAZZIN
  cell_types:
  - preferred_term: cardiomyocyte
    term:
      id: CL:0000746
      label: cardiac muscle cell
  biological_processes:
  - preferred_term: cardiolipin metabolic process
    term:
      id: GO:0032048
      label: cardiolipin metabolic process
    modifier: DYSREGULATED
  evidence:
  - reference: PMID:23409742
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      It is caused by mutations in the TAZ gene encoding tafazzin, a protein
      involved in the metabolism of cardiolipin, a mitochondrial-specific
      phospholipid involved in mitochondrial energy production.
    explanation: >-
      This directly links TAFAZZIN mutation to defective cardiolipin metabolism,
      the primary molecular lesion in Barth syndrome.
  downstream:
  - target: Increased monolysocardiolipin:cardiolipin ratio
    description: Defective tafazzin-mediated cardiolipin remodeling produces the diagnostic increase in the MLCL:CL ratio.
    causal_link_type: DIRECT
    evidence:
    - reference: PMID:18070816
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: >-
        All BTHS patients (n = 31) had monolysocardiolipin:cardiolipin ratios
        >0.40 and all controls (n = 215) had monolysocardiolipin:cardiolipin
        ratios <0.23.
      explanation: >-
        Patient bloodspot data support increased MLCL:CL ratio as the direct
        biochemical consequence of tafazzin-dependent cardiolipin remodeling
        failure.
  - target: Elevated urinary 3-methylglutaconic acid
    description: >-
      The tafazzin defect is associated with 3-methylglutaconic aciduria,
      although the intermediate metabolic route is not fully resolved.
    causal_link_type: INDIRECT_UNKNOWN_INTERMEDIATES
    evidence:
    - reference: PMID:23409742
      supports: PARTIAL
      evidence_source: HUMAN_CLINICAL
      snippet: >-
        BACKGROUND: Barth syndrome (BS) is an X-linked infantile-onset
        cardioskeletal disease characterized by cardiomyopathy, hypotonia, growth
        delay, neutropenia and 3-methylglutaconic aciduria. It is caused by
        mutations in the TAZ gene encoding tafazzin, a protein involved in the
        metabolism of cardiolipin, a mitochondrial-specific phospholipid involved
        in mitochondrial energy production.
      explanation: >-
        The clinical series links TAZ/tafazzin mutations with
        3-methylglutaconic aciduria, while the omitted intermediate mechanism is
        left explicit as unknown.
  - target: Growth delay
    description: >-
      Tafazzin-related multisystem mitochondrial disease includes constitutional
      growth delay through incompletely resolved energetic, feeding, and systemic
      intermediates.
    causal_link_type: INDIRECT_UNKNOWN_INTERMEDIATES
    evidence:
    - reference: PMID:23409742
      supports: PARTIAL
      evidence_source: HUMAN_CLINICAL
      snippet: >-
        BACKGROUND: Barth syndrome (BS) is an X-linked infantile-onset
        cardioskeletal disease characterized by cardiomyopathy, hypotonia, growth
        delay, neutropenia and 3-methylglutaconic aciduria. It is caused by
        mutations in the TAZ gene encoding tafazzin, a protein involved in the
        metabolism of cardiolipin, a mitochondrial-specific phospholipid involved
        in mitochondrial energy production.
      explanation: >-
        The clinical series supports growth delay as part of tafazzin-related
        Barth syndrome, but does not define the full growth-delay mechanism.
  - target: Left ventricular noncompaction
    description: >-
      Tafazzin-related cardiac disease can include left ventricular
      noncompaction; the developmental intermediates between cardiolipin
      remodeling failure and noncompaction morphology remain incompletely
      resolved.
    causal_link_type: INDIRECT_UNKNOWN_INTERMEDIATES
    evidence:
    - reference: PMID:23361305
      supports: PARTIAL
      evidence_source: HUMAN_CLINICAL
      snippet: >-
        In both brothers, 2D-echocardiography revealed some features of left
        ventricular noncompaction (LVNC) despite marked differences in the course
        of the disease;
      explanation: >-
        Affected siblings with TAZ mutation showed LVNC features, supporting the
        branch while leaving the developmental mechanism unspecified.
  - target: Mitochondrial respiratory chain dysfunction
    causal_link_type: DIRECT
  - target: Myocardial metabolic substrate shift
    causal_link_type: DIRECT
  - target: Impaired myeloid maturation
    description: >-
      Tafazzin/cardiolipin defects can impair myeloid output through
      mitochondrial membrane-potential loss and apoptosis in myeloid progenitors.
    causal_link_type: INDIRECT_KNOWN_INTERMEDIATES
    intermediate_mechanisms:
    - Mitochondrial membrane-potential dissipation in myeloid progenitor cells
    - Cytochrome c release and caspase-3 activation
    evidence:
    - reference: PMID:30451719
      supports: SUPPORT
      evidence_source: IN_VITRO
      snippet: >-
        TAZ knockdown experiments suggest accelerated apoptosis of myeloid
        progenitor cells due to increased dissipation of mitochondrial membrane
        potential, aberrant release of cytochrome c and activation of caspase-3.
      explanation: >-
        Tafazzin knockdown experiments provide a mechanistic bridge from the
        primary cardiolipin-remodeling defect to impaired granulopoiesis.
- name: Mitochondrial respiratory chain dysfunction
  description: >-
    Cardiolipin deficiency destabilizes the mitochondrial inner membrane,
    lowering membrane potential and impairing respiratory chain function. In
    patient-derived cells and affected tissues, this is accompanied by abnormal
    reactive oxygen species handling and reduced ATP-generating capacity.
  biological_processes:
  - preferred_term: oxidative phosphorylation
    term:
      id: GO:0006119
      label: oxidative phosphorylation
    modifier: DECREASED
  evidence:
  - reference: PMID:23361305
    supports: SUPPORT
    evidence_source: IN_VITRO
    snippet: >-
      An examination of the patients' fibroblast cultures revealed that
      extremely low mitochondrial membrane potentials (mtΔΨ about 50 % of the
      control value) dominated other unspecific mitochondrial changes detected
      (respiratory chain dysfunction, abnormal ROS production and depressed
      antioxidant defense).
    explanation: >-
      Patient-derived fibroblasts demonstrate markedly impaired membrane
      potential together with respiratory chain dysfunction, supporting a core
      mitochondrial bioenergetic defect.
  downstream:
  - target: Myocardial metabolic substrate shift
    causal_link_type: DIRECT
  - target: Abnormal cardiomyocyte calcium handling
    causal_link_type: DIRECT
  - target: Skeletal muscle mitochondrial myopathy
    description: >-
      Respiratory-chain and membrane-potential impairment in skeletal muscle
      produces the mitochondrial myopathy branch of Barth syndrome.
    causal_link_type: DIRECT
    evidence:
    - reference: PMID:23361305
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: >-
        Our studies confirm generalised mitochondrial dysfunction in the
        skeletal muscle and the fibroblasts of BTHS patients, especially a severe
        impairment in the mitochondrial membrane potential and the inhibition of
        complex V activity.
      explanation: >-
        Patient skeletal-muscle studies directly support a mitochondrial
        myopathy branch downstream of respiratory-chain dysfunction.
- name: Myocardial metabolic substrate shift
  description: >-
    Tafazzin-deficient cardiomyocytes show reduced mitochondrial fatty-acid
    utilization and compensatory reliance on glucose and alternative anaplerotic
    fuels. This metabolic rewiring reflects impaired mitochondrial substrate
    handling and contributes to contractile inefficiency in the Barth heart.
  cell_types:
  - preferred_term: cardiomyocyte
    term:
      id: CL:0000746
      label: cardiac muscle cell
  biological_processes:
  - preferred_term: fatty acid beta-oxidation
    term:
      id: GO:0006635
      label: fatty acid beta-oxidation
    modifier: DECREASED
  evidence:
  - reference: PMID:31861102
    supports: SUPPORT
    evidence_source: IN_VITRO
    snippet: >-
      We also demonstrate that TAZ517delG induces metabolic alterations in
      pathways related to energy production as reflected by high glucose uptake,
      an increase in glycolytic lactate production and a decrease in palmitate
      uptake.
    explanation: >-
      Patient-derived and genome-edited iPSC cardiomyocytes show a shift away
      from fatty-acid use toward glucose-reliant metabolism.
  - reference: PMID:37930434
    supports: SUPPORT
    evidence_source: MODEL_ORGANISM
    snippet: >-
      In mice with an inducible knockdown (KD) of TAFAZZIN,
    explanation: >-
      The abstract explicitly identifies an inducible Tafazzin-knockdown mouse
      model as one of the systems used to demonstrate the reported metabolic
      rewiring in Barth syndrome.
  - reference: PMID:37930434
    supports: SUPPORT
    evidence_source: IN_VITRO
    snippet: >-
      in induced pluripotent stem cell-derived cardiac myocytes, mitochondrial
      uptake and oxidation of fatty acids was strongly decreased, while glucose
      uptake was increased.
    explanation: >-
      iPSC-derived cardiac myocytes independently show decreased mitochondrial
      fatty-acid utilization with compensatory glucose uptake.
  downstream:
  - target: Abnormal cardiomyocyte calcium handling
    causal_link_type: DIRECT
  - target: Lactic acidosis
    description: >-
      The glucose-shifted energy phenotype increases glycolytic lactate
      production, providing a cellular correlate for lactic acidosis in Barth
      syndrome.
    causal_link_type: INDIRECT_KNOWN_INTERMEDIATES
    evidence:
    - reference: PMID:31861102
      supports: SUPPORT
      evidence_source: IN_VITRO
      snippet: >-
        We also demonstrate that TAZ517delG induces metabolic alterations in
        pathways related to energy production as reflected by high glucose
        uptake, an increase in glycolytic lactate production and a decrease in
        palmitate uptake.
      explanation: >-
        Barth iPSC-cardiomyocytes show glycolytic lactate overproduction as part
        of the metabolic rewiring downstream of tafazzin deficiency.
- name: Abnormal cardiomyocyte calcium handling
  description: >-
    In Barth syndrome cardiomyocytes, excess mitochondrial and cellular reactive
    oxygen species activates the CaMKII-RYR2 axis, increasing sarcoplasmic
    reticulum calcium leak. The result is abnormal diastolic calcium handling,
    reduced calcium transient amplitude, impaired contractility, and greater
    arrhythmia vulnerability.
  cell_types:
  - preferred_term: cardiomyocyte
    term:
      id: CL:0000746
      label: cardiac muscle cell
  biological_processes:
  - preferred_term: cardiac muscle contraction
    term:
      id: GO:0060048
      label: cardiac muscle contraction
    modifier: DECREASED
  evidence:
  - reference: PMID:33793303
    supports: SUPPORT
    evidence_source: IN_VITRO
    snippet: >-
      Compared with wild-type controls, BTHS-induced pluripotent stem
      cell-derived cardiomyocytes had increased diastolic Ca2+ and decreased
      Ca2+ transient amplitude.
    explanation: >-
      This directly demonstrates abnormal calcium homeostasis in
      Barth-syndrome iPSC-derived cardiomyocytes.
  - reference: PMID:33793303
    supports: SUPPORT
    evidence_source: IN_VITRO
    snippet: >-
      Inhibition of this reactive oxygen species-CaMKII-RYR2 pathway through
      pharmacological inhibitors or genome editing normalized aberrant Ca2+
      handling in BTHS-induced pluripotent stem cell-derived cardiomyocytes and
      improved their contractile function.
    explanation: >-
      Rescue of calcium handling and contractility identifies ROS-CaMKII-RYR2
      signaling as a causal mechanism rather than a bystander abnormality.
  downstream:
  - target: Cardiomyopathy
    description: >-
      Abnormal calcium handling reduces cardiomyocyte contractility, linking the
      mitochondrial ROS-CaMKII-RYR2 axis to Barth cardiomyopathy.
    causal_link_type: INDIRECT_KNOWN_INTERMEDIATES
    intermediate_mechanisms:
    - Reduced calcium transient amplitude
    - Decreased cardiomyocyte contractility
    evidence:
    - reference: PMID:33793303
      supports: SUPPORT
      evidence_source: IN_VITRO
      snippet: >-
        Inhibition of this reactive oxygen species-CaMKII-RYR2 pathway through
        pharmacological inhibitors or genome editing normalized aberrant Ca2+
        handling in BTHS-induced pluripotent stem cell-derived cardiomyocytes and
        improved their contractile function.
      explanation: >-
        Rescue of calcium handling improves contractility in Barth iPSC-derived
        cardiomyocytes, supporting the calcium-handling-to-contractile-disease
        link.
  - target: Arrhythmia
    description: >-
      Calcium leak and abnormal calcium cycling increase arrhythmia
      vulnerability in tafazzin-deficient cardiac models.
    causal_link_type: INDIRECT_KNOWN_INTERMEDIATES
    intermediate_mechanisms:
    - ROS-CaMKII-RYR2 activation
    - Sarcoplasmic-reticulum calcium leak
    evidence:
    - reference: PMID:33793303
      supports: SUPPORT
      evidence_source: MODEL_ORGANISM
      snippet: >-
        A subset of mice with cardiac-specific TAZ inactivation developed
        arrhythmias, including bidirectional ventricular tachycardia, atrial
        tachycardia, and complete atrioventricular block.
      explanation: >-
        The cardiac-specific Tafazzin knockout mouse model links tafazzin
        deficiency and abnormal calcium signaling to arrhythmia vulnerability.
- name: Skeletal muscle mitochondrial myopathy
  description: >-
    Tafazzin deficiency causes skeletal-muscle mitochondrial dysfunction,
    reducing muscle oxygen extraction and producing the proximal myopathy and
    severe exercise limitation typical of Barth syndrome.
  cell_types:
  - preferred_term: skeletal muscle cell
    term:
      id: CL:0000188
      label: cell of skeletal muscle
  biological_processes:
  - preferred_term: oxidative phosphorylation
    term:
      id: GO:0006119
      label: oxidative phosphorylation
    modifier: DECREASED
  - preferred_term: muscle contraction
    term:
      id: GO:0006936
      label: muscle contraction
    modifier: DECREASED
  evidence:
  - reference: PMID:23361305
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      Our studies confirm generalised mitochondrial dysfunction in the skeletal
      muscle and the fibroblasts of BTHS patients, especially a severe
      impairment in the mitochondrial membrane potential and the inhibition of
      complex V activity.
    explanation: >-
      Patient skeletal-muscle testing directly supports mitochondrial myopathy
      as a Barth syndrome mechanism.
  - reference: PMID:21873497
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      In conclusion, severe exercise intolerance in BTHS is due to both cardiac
      and skeletal muscle impairments that are consistent with cardiac and
      skeletal mitochondrial myopathy.
    explanation: >-
      Exercise physiology in affected patients links the skeletal mitochondrial
      myopathy branch to severe exercise limitation.
  downstream:
  - target: Proximal muscle weakness
    description: Skeletal mitochondrial myopathy manifests clinically as proximal muscle weakness.
    causal_link_type: DIRECT
    evidence:
    - reference: PMID:25299040
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: >-
        Skeletal myopathy predominantly affects the proximal muscles, and
        results in delays in development of early motor skills.
      explanation: >-
        GeneReviews links Barth skeletal myopathy to proximal muscle
        involvement.
  - target: Exercise intolerance
    description: Combined skeletal-muscle and cardiac mitochondrial impairment produces severe exercise limitation.
    causal_link_type: DIRECT
    evidence:
    - reference: PMID:21873497
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: >-
        In conclusion, severe exercise intolerance in BTHS is due to both
        cardiac and skeletal muscle impairments that are consistent with cardiac
        and skeletal mitochondrial myopathy.
      explanation: >-
        Patient exercise testing directly attributes severe exercise
        intolerance to skeletal and cardiac mitochondrial myopathy.
- name: Impaired myeloid maturation
  description: >-
    Barth-syndrome neutropenia reflects impaired granulocytic maturation rather
    than a pure peripheral destruction phenotype. Bone-marrow studies show
    reduced maturation of the myeloid lineage, providing a mechanistic basis for
    intermittent or chronic neutropenia and recurrent infection risk.
  cell_types:
  - preferred_term: neutrophil
    term:
      id: CL:0000775
      label: neutrophil
  biological_processes:
  - preferred_term: myeloid cell differentiation
    term:
      id: GO:0030099
      label: myeloid cell differentiation
    modifier: DECREASED
  evidence:
  - reference: PMID:30451719
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      Pretreatment bone marrow evaluations predominantly showed reduced myeloid
      maturation which normalized on G-CSF therapy in seven of 13 examined.
    explanation: >-
      Bone-marrow findings in affected patients support impaired myeloid
      maturation as a direct mechanism of Barth-syndrome neutropenia.
  - reference: PMID:30451719
    supports: SUPPORT
    evidence_source: IN_VITRO
    snippet: >-
      TAZ knockdown experiments suggest accelerated apoptosis of myeloid
      progenitor cells due to increased dissipation of mitochondrial membrane
      potential, aberrant release of cytochrome c and activation of caspase-3.
    explanation: >-
      Tafazzin knockdown experiments support mitochondrial progenitor-cell
      apoptosis as a mechanistic contributor to the myeloid maturation defect.
  downstream:
  - target: Neutropenia
    description: Reduced myeloid maturation limits mature neutrophil output.
    causal_link_type: DIRECT
    evidence:
    - reference: PMID:30451719
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: >-
        Decreased myeloid maturation was reported for five of six patients prior
        to G-CSF therapy. The common abnormality was a relative paucity of mature
        neutrophils in the marrow.
      explanation: >-
        Patient bone-marrow findings link reduced myeloid maturation to paucity
        of mature neutrophils.
  - target: Recurrent bacterial infections
    description: Impaired granulopoiesis and neutropenia increase bacterial infection risk.
    causal_link_type: INDIRECT_KNOWN_INTERMEDIATES
    intermediate_mechanisms:
    - Decreased mature neutrophil output
    - Chronic or intermittent neutropenia
    evidence:
    - reference: PMID:30451719
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: >-
        Consistent clinical improvement, with reduced signs and symptoms of
        infections, was observed in response to prophylactic G-CSF
      explanation: >-
        Clinical improvement of infections after neutrophil-directed therapy
        supports the maturation/neutropenia-to-infection branch.
phenotypes:
- name: Cardiomyopathy
  description: >-
    Cardiomyopathy is the central clinical manifestation of Barth syndrome and
    may be dilated, hypertrophic, or mixed with endocardial fibroelastosis or
    noncompaction features.
  phenotype_term:
    preferred_term: Cardiomyopathy
    term:
      id: HP:0001638
      label: Cardiomyopathy
  evidence:
  - reference: PMID:25299040
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      Cardiomyopathy, which is almost always present before age five years, is
      typically dilated cardiomyopathy with or without endocardial
      fibroelastosis or left ventricular noncompaction; hypertrophic
      cardiomyopathy can also occur.
    explanation: >-
      GeneReviews summarizes cardiomyopathy as the dominant early-life Barth
      syndrome phenotype and defines its major structural subtypes.
- name: Left ventricular noncompaction
  description: >-
    Prominent ventricular trabeculation and noncompaction morphology are common
    cardiac features and may be present even when overall disease severity
    differs between affected individuals.
  phenotype_term:
    preferred_term: Left ventricular noncompaction cardiomyopathy
    term:
      id: HP:0011664
      label: Left ventricular noncompaction cardiomyopathy
  evidence:
  - reference: PMID:23361305
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      In both brothers, 2D-echocardiography revealed some features of left
      ventricular noncompaction (LVNC) despite marked differences in the course
      of the disease;
    explanation: >-
      This affected-sibling report directly documents LVNC as a Barth syndrome
      cardiac phenotype.
- name: Arrhythmia
  description: >-
    Cardiac arrhythmias, including ventricular tachyarrhythmia risk, are part of
    the Barth cardiac phenotype and contribute to sudden-death risk.
  phenotype_term:
    preferred_term: Arrhythmia
    term:
      id: HP:0011675
      label: Arrhythmia
  evidence:
  - reference: PMID:25299040
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      Heart failure is a significant cause of morbidity and mortality; risk of
      arrhythmia and sudden death is increased.
    explanation: >-
      GeneReviews identifies increased arrhythmia and sudden-death risk in Barth
      syndrome.
- name: Neutropenia
  description: >-
    Neutropenia may be chronic, intermittent, or cyclic, and contributes
    substantially to infection risk and aphthous ulceration.
  phenotype_term:
    preferred_term: Neutropenia
    term:
      id: HP:0001875
      label: Decreased total neutrophil count
  evidence:
  - reference: PMID:30451719
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      Major features include neutropenia, dilated cardiomyopathy, motor delay
      and proximal myopathy, feeding problems, and constitutional growth delay.
    explanation: >-
      This large Barth syndrome neutropenia review identifies neutropenia as one
      of the defining disease manifestations.
  sequelae:
  - target: Recurrent bacterial infections
    description: Neutropenia increases susceptibility to bacterial infections including pneumonia and sepsis.
    evidence:
    - reference: PMID:25299040
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: >-
        Neutropenia is most often associated with bacterial infections and
        aphthous ulcers, pneumonia, and sepsis.
      explanation: >-
        GeneReviews directly links Barth syndrome neutropenia to bacterial
        infection sequelae.
- name: Growth delay
  description: >-
    Constitutional growth impairment begins in childhood and is a common
    component of the multisystem phenotype.
  phenotype_term:
    preferred_term: Growth delay
    term:
      id: HP:0001510
      label: Growth delay
  evidence:
  - reference: PMID:23409742
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      BACKGROUND: Barth syndrome (BS) is an X-linked infantile-onset
      cardioskeletal disease characterized by cardiomyopathy, hypotonia, growth
      delay, neutropenia and 3-methylglutaconic aciduria.
    explanation: >-
      This clinical series explicitly lists growth delay among the core Barth
      syndrome manifestations.
- name: Proximal muscle weakness
  description: >-
    Skeletal myopathy predominantly involves proximal musculature and contributes
    to motor delay and reduced physical performance.
  phenotype_term:
    preferred_term: Proximal muscle weakness
    term:
      id: HP:0003701
      label: Proximal muscle weakness
  evidence:
  - reference: PMID:25299040
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      Skeletal myopathy predominantly affects the proximal muscles, and results
      in delays in development of early motor skills.
    explanation: >-
      GeneReviews directly supports proximal-predominant skeletal muscle
      involvement in Barth syndrome.
- name: Exercise intolerance
  description: >-
    Profound exercise limitation reflects the combined effect of impaired cardiac
    reserve and reduced skeletal-muscle oxygen extraction/utilization.
  phenotype_term:
    preferred_term: Exercise intolerance
    term:
      id: HP:0003546
      label: Exercise intolerance
  evidence:
  - reference: PMID:21873497
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      In conclusion, severe exercise intolerance in BTHS is due to both cardiac
      and skeletal muscle impairments that are consistent with cardiac and
      skeletal mitochondrial myopathy.
    explanation: >-
      This exercise-physiology study directly attributes exercise intolerance to
      combined cardiac and skeletal-muscle dysfunction in Barth syndrome.
- name: Recurrent bacterial infections
  description: >-
    Recurrent bacterial infection is a major downstream consequence of Barth
    syndrome neutropenia and includes pneumonia, sepsis, cellulitis, and oral
    ulcer-associated infection.
  phenotype_term:
    preferred_term: Recurrent bacterial infections
    term:
      id: HP:0002718
      label: Recurrent bacterial infections
  evidence:
  - reference: PMID:25299040
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      Neutropenia is most often associated with bacterial infections and
      aphthous ulcers, pneumonia, and sepsis.
    explanation: >-
      GeneReviews links Barth syndrome neutropenia to recurrent bacterial
      infectious complications.
biochemical:
- name: Increased monolysocardiolipin:cardiolipin ratio
  presence: INCREASED
  notes: >-
    The MLCL:CL ratio is the key biochemical signature of Barth syndrome and is
    sufficiently robust for dried-blood-spot screening.
  evidence:
  - reference: PMID:18070816
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      All BTHS patients (n = 31) had monolysocardiolipin:cardiolipin ratios
      >0.40 and all controls (n = 215) had monolysocardiolipin:cardiolipin
      ratios <0.23.
    explanation: >-
      This bloodspot assay study establishes an increased MLCL:CL ratio as the
      defining Barth syndrome biomarker.
  readouts:
  - target: Tafazzin deficiency impairs cardiolipin remodeling
    relationship: READOUT_OF
    direction: POSITIVE
    endpoint_context: DIAGNOSTIC
    interpretation: An increased monolysocardiolipin:cardiolipin ratio directly reports the tafazzin-dependent cardiolipin remodeling defect.
    evidence:
    - reference: PMID:18070816
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: >-
        All BTHS patients (n = 31) had monolysocardiolipin:cardiolipin ratios
        >0.40 and all controls (n = 215) had monolysocardiolipin:cardiolipin
        ratios <0.23.
      explanation: >-
        Patient bloodspot data support the MLCL:CL ratio as a diagnostic
        biochemical readout of the cardiolipin remodeling defect.
- name: Elevated urinary 3-methylglutaconic acid
  presence: INCREASED
  biomarker_term:
    preferred_term: 3-methylglutaconic acid
    term:
      id: CHEBI:144330
      label: 3-methylglutaconic acid
  notes: >-
    Increased urinary 3-methylglutaconic acid is a classic metabolic marker,
    although it may be absent in some neonatal presentations.
  evidence:
  - reference: PMID:23409742
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      All patients exhibited 3-methylglutaconic aciduria and neutropenia, when
      tested and five of them also had lactic acidosis.
    explanation: >-
      This case series directly documents 3-methylglutaconic aciduria as a
      common biochemical abnormality in Barth syndrome.
  readouts:
  - target: Tafazzin deficiency impairs cardiolipin remodeling
    relationship: READOUT_OF
    direction: POSITIVE
    endpoint_context: DIAGNOSTIC
    interpretation: Urinary 3-methylglutaconic acid elevation is a classic metabolic readout associated with the tafazzin/cardiolipin-remodeling defect, although the intermediate route is unresolved.
    evidence:
    - reference: PMID:23409742
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: >-
        BACKGROUND: Barth syndrome (BS) is an X-linked infantile-onset
        cardioskeletal disease characterized by cardiomyopathy, hypotonia, growth
        delay, neutropenia and 3-methylglutaconic aciduria. It is caused by
        mutations in the TAZ gene encoding tafazzin, a protein involved in the
        metabolism of cardiolipin, a mitochondrial-specific phospholipid involved
        in mitochondrial energy production.
      explanation: >-
        The clinical series links Barth syndrome 3-methylglutaconic aciduria to
        TAZ/tafazzin and cardiolipin metabolism, supporting the diagnostic
        readout link while leaving intermediate mechanisms unresolved.
- name: Lactic acidosis
  presence: INCREASED
  biomarker_term:
    preferred_term: lactate
    term:
      id: CHEBI:24996
      label: lactate
  notes: >-
    Lactic acidosis accompanies the mitochondrial energy defect in a substantial
    subset of affected patients and may be particularly prominent in severe
    infantile presentations.
  evidence:
  - reference: PMID:23409742
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      All patients exhibited 3-methylglutaconic aciduria and neutropenia, when
      tested and five of them also had lactic acidosis.
    explanation: >-
      This cohort directly reports lactic acidosis in most evaluated patients.
  readouts:
  - target: Myocardial metabolic substrate shift
    relationship: READOUT_OF
    direction: POSITIVE
    endpoint_context: DIAGNOSTIC
    interpretation: Increased lactate reports the glucose-shifted, glycolytic component of Barth mitochondrial energy rewiring.
    evidence:
    - reference: PMID:31861102
      supports: SUPPORT
      evidence_source: IN_VITRO
      snippet: >-
        We also demonstrate that TAZ517delG induces metabolic alterations in
        pathways related to energy production as reflected by high glucose
        uptake, an increase in glycolytic lactate production and a decrease in
        palmitate uptake.
      explanation: >-
        Barth iPSC-cardiomyocytes show increased glycolytic lactate production
        as part of the metabolic substrate shift, supporting lactate as a
        readout of that mechanism.
    - reference: PMID:23409742
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: >-
        CONCLUSIONS: Lactic acidosis associated with 3-methylglutaconic aciduria
        is highly suggestive of BS, whilst the severity of the metabolic
        decompensation at disease onset should be considered for prognostic
        purposes.
      explanation: >-
        The clinical series supports lactic acidosis in diagnostic and
        decompensation contexts, complementing the cellular lactate-production
        mechanism.
  - target: Mitochondrial respiratory chain dysfunction
    relationship: READOUT_OF
    direction: POSITIVE
    endpoint_context: DIAGNOSTIC
    interpretation: Lactic acidosis also reports the upstream mitochondrial respiratory dysfunction branch of Barth syndrome.
    evidence:
    - reference: PMID:23361305
      supports: SUPPORT
      evidence_source: IN_VITRO
      snippet: >-
        An examination of the patients' fibroblast cultures revealed that
        extremely low mitochondrial membrane potentials (mtΔΨ about 50 % of the
        control value) dominated other unspecific mitochondrial changes detected
        (respiratory chain dysfunction, abnormal ROS production and depressed
        antioxidant defense).
      explanation: >-
        Patient-derived fibroblast cultures show mitochondrial membrane-potential
        loss with respiratory-chain dysfunction, supporting the upstream
        mitochondrial dysfunction target.
    - reference: PMID:23361305
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: >-
        Severe lactic acidosis without 3-methylglutaconic aciduria in male
        neonates as well as asymptomatic left ventricular noncompaction at ECHO
        record may characterise a range of natural history of Barth syndrome.
      explanation: >-
        The affected-sibling report documents severe neonatal lactic acidosis as
        part of the Barth syndrome clinical spectrum, supporting lactate as the
        clinical readout paired with the mitochondrial dysfunction evidence.
treatments:
- name: Heart failure pharmacotherapy
  description: >-
    Standard heart-failure medications are used to manage Barth cardiomyopathy,
    with careful attention to volume status because affected patients are
    vulnerable to overdiuresis and dehydration.
  treatment_term:
    preferred_term: Pharmacotherapy
    term:
      id: NCIT:C15986
      label: Pharmacotherapy
  evidence:
  - reference: PMID:25299040
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      for heart failure, careful fluid and volume management and avoidance of
      overdiuresis and dehydration, standard heart failure medications, and
      cardiac transplantation when heart failure is severe and intractable.
    explanation: >-
      GeneReviews supports standard heart-failure pharmacotherapy as core
      management for Barth cardiomyopathy.
  target_phenotypes:
  - preferred_term: Cardiomyopathy
    term:
      id: HP:0001638
      label: Cardiomyopathy
  target_mechanisms:
  - target: Mitochondrial respiratory chain dysfunction
    treatment_effect: MODULATES
    description: >-
      Standard heart-failure pharmacotherapy (ACE inhibitors, beta-blockers,
      diuretics) reduces cardiac afterload and sympathetic drive, lowering
      myocardial energy demand and alleviating the hemodynamic stress imposed
      by mitochondrial respiratory chain dysfunction in Barth cardiomyocytes.
- name: Granulocyte colony-stimulating factor (G-CSF)
  description: >-
    G-CSF is used prophylactically in neutropenic Barth syndrome patients to
    reduce severe bacterial infection risk and improve marrow neutrophil
    maturation.
  treatment_term:
    preferred_term: hematopoietic growth factor therapy
    term:
      id: NCIT:C15262
      label: Immunotherapy
  evidence:
  - reference: PMID:30451719
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      Prophylaxis with G-CSF ± antibiotics prevents serious bacterial infections
      in the more severe neutropenic patients although infections remain a
      threat even in patients who are very compliant with therapy, especially in
      those with indwelling devices.
    explanation: >-
      This review directly supports G-CSF prophylaxis as effective management
      for severe Barth-syndrome neutropenia.
  target_phenotypes:
  - preferred_term: Neutropenia
    term:
      id: HP:0001875
      label: Decreased total neutrophil count
  - preferred_term: Recurrent bacterial infections
    term:
      id: HP:0002718
      label: Recurrent bacterial infections
  target_mechanisms:
  - target: Impaired myeloid maturation
    treatment_effect: ACTIVATES
    description: G-CSF promotes marrow myeloid differentiation and mature neutrophil output.
    evidence:
    - reference: PMID:30451719
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: >-
        Pretreatment bone marrow evaluations predominantly showed reduced
        myeloid maturation which normalized on G-CSF therapy in seven of 13
        examined.
      explanation: >-
        Patient marrow examinations support G-CSF activation/restoration of
        impaired myeloid maturation.
- name: Elamipretide
  description: >-
    Elamipretide is a cardiolipin-directed mitochondrial therapy used to improve
    muscle strength in Barth syndrome.
  treatment_term:
    preferred_term: Pharmacotherapy
    term:
      id: NCIT:C15986
      label: Pharmacotherapy
    therapeutic_agent:
    - preferred_term: elamipretide
      term:
        id: CHEBI:233331
        label: elamipretide
  evidence:
  - reference: PMID:25299040
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: >-
      Targeted therapy: Elamipretide is indicated for the improvement of muscle
      strength in individuals with Barth syndrome.
    explanation: >-
      The updated GeneReviews management section identifies elamipretide as a
      Barth syndrome-targeted therapy for muscle weakness.
  target_phenotypes:
  - preferred_term: Proximal muscle weakness
    term:
      id: HP:0003701
      label: Proximal muscle weakness
  target_mechanisms:
  - target: Tafazzin deficiency impairs cardiolipin remodeling
    treatment_effect: MODULATES
    description: >-
      Elamipretide is a cardiolipin-targeting tetrapeptide that associates
      with cardiolipin on the inner mitochondrial membrane, stabilizing
      cardiolipin-protein complexes and partially compensating for the
      cardiolipin remodeling defect caused by tafazzin deficiency.
datasets: []
references:
- reference: PMID:25299040
  title: "Barth Syndrome."
  tags:
  - GeneReviews
  findings: []
📚

References & Deep Research

References

1
Barth Syndrome.
No top-level findings curated for this source.

Deep Research

1
Asta
Asta Literature Retrieval: Pathophysiology and clinical mechanisms of Barth syndrome. Core disease mechanisms, molecular and cellular pathways,...
Asta Scientific Corpus Retrieval 20 citations 2026-04-12T15:06:56.454789

Asta Literature Retrieval: Pathophysiology and clinical mechanisms of Barth syndrome. Core disease mechanisms, molecular and cellular pathways,...

This report is retrieval-only and is generated directly from Asta results.

  • Papers retrieved: 20
  • Snippets retrieved: 20

Relevant Papers

[1] Emerging Role of Organ‐on‐a‐Chip Technologies in Quantitative Clinical Pharmacology Evaluation

  • Authors: N. Isoherranen, R. Madabushi, Shiew-Mei Huang
  • Year: 2019
  • Venue: Clinical and Translational Science
  • URL: https://www.semanticscholar.org/paper/6050d8e5592be35f6dc371e5ad8ba57f852c360c
  • DOI: 10.1111/cts.12627
  • PMID: 30740886
  • PMCID: 6440571
  • Citations: 42
  • Influential citations: 2
  • Summary: This paper describes the US Food and Drug Administration (FDA) Office of Clinical Pharmacology's continuing efforts in developing quantitative clinical pharmacology models (disease, drug, and clinical trial models) to advance MIDD and how emerging novel tools can provide new insights into physiology and disease mechanisms.
  • Evidence snippets:
  • Snippet 1 (score: 0.497) > 2 Potential role of microphysiological systems to inform quantitative clinical pharmacology models. Better understanding of physiology, pathology, and pharmacology is critical for developing systems biology and systems pharmacology models. Microphysiological systems can be viewed as an innovative technology that has the potential to enhance the understanding of physiology, pathology, and pharmacology. Specific applications of the microphysiological systems in the areas of biomarker development; demonstrating proof-of-concept, elucidating the mechanism of drug toxicity, and characterizing the complex physiologic changes that occur in disease states can provide the necessary information to advance the role of quantitative clinical pharmacology models in drug development. > work done to elucidate the pathophysiology underlying the cardiomyopathy of Barth syndrome. Using Barth syndrome iPSC-derived cardiomyocytes, the metabolic, structural, and functional abnormalities associated with mutations in the gene encoding tafazzin were defined. The authors further demonstrated with Cas9-mediated genome editing that mutation in the gene encoding tafazzin was sufficient to cause the disease phenotype. 35 The use of patient-derived cells opens the potential for personalized disease modeling as well as the ability to model the longitudinal progression of the disease both at an individual as well as at the population level.

[2] Metabolic cardiomyopathies: untangling clinical heterogeneity with human stem-cell derived models

  • Authors: Adriana S. Passadouro, B. Balfoort, M. Langeveld, C. V. van Karnebeek, J. van der Velden et al.
  • Year: 2025
  • Venue: EMBO Molecular Medicine
  • URL: https://www.semanticscholar.org/paper/b325b119830caf533cae0e65712444415c0bab13
  • DOI: 10.1038/s44321-025-00313-4
  • PMID: 40983718
  • PMCID: 12603204
  • Citations: 1
  • Summary: This review summarises literature on metabolic cardiomyopathies, focusing on long-chain fatty acid oxidation disorders and Barth syndrome, and highlights the potential of patient-specific hiPSC-derived cardiomyocytes as clinically relevant platforms to study disease mechanisms and therapeutic responses.
  • Evidence snippets:
  • Snippet 1 (score: 0.430) > Inherited metabolic diseases are rare monogenic conditions that disrupt biochemical pathways, affecting energy production and homeostasis, often leading to damaging metabolite accumulation. These disorders are clinically heterogeneous and can impact all organs, including the heart. Metabolic cardiomyopathies present with varying severity and unpredictable prognosis, complicating patient care. Pre-clinical research aims to model these cardiomyopathies to understand their pathophysiological mechanisms and develop personalised treatments. Animal models have provided insights into cardiac pathology and treatment, but species differences limit data translation. Human induced pluripotent stem cells (hiPSC) offer a valuable tool for establishing disease models using reprogrammed somatic cells from patients and healthy donors, differentiated into disease-relevant cell types. Cardiomyocytes generated in significant numbers are crucial for investigating cardiac mechanisms and assessing patient-specific drug responses. This review summarises literature on metabolic cardiomyopathies, focusing on long-chain fatty acid oxidation disorders and Barth syndrome. We highlight cardiac readouts from various models and discuss the potential of hiPSC technologies as clinically relevant disease models. In this review, S. Mosegaard, R.H. Houtkooper and colleagues discuss metabolic cardiomyopathies, highlighting the potential of patient-specific hiPSC-derived cardiomyocytes as clinically relevant platforms to study disease mechanisms and therapeutic responses.

[3] Age-related changes in cardiomyopathic phenotype in patients with barth syndrome

  • Authors: Hani N. Sabbah
  • Year: 2023
  • Venue: Open Access Government
  • URL: https://www.semanticscholar.org/paper/6d33a25cbc34bf580ca605a961b4a35f22563801
  • DOI: 10.56367/oag-040-11042
  • Summary: The BTHS cardiomyopathic phenotypes appear to evolve with advancing age, which may be useful in treatment selection, and the potential of more targeted treatment approaches is explored.
  • Evidence snippets:
  • Snippet 1 (score: 0.426) > With current treatment options for BTHS cardiomyopathic phenotype focused predominantly on alleviating symptoms, Dr Hani N. Sabbah, Director of Cardiovascular Research at Henry Ford Health, explores the potential of more targeted treatment approaches. Barth syndrome (BTHS) is a rare, X-linked disease caused by defects in the TAFAZZIN gene encoding an acyltransferase responsible for the remodeling/maturation of cardiolipin (critical to mitochondrial structure/function).(1) The most common clinical manifestation of BTHS is cardiomyopathy (~90% of BTHS patients) with a wide range of phenotypical presentations.(2,3) Mechanisms contributing to BTHS cardiomyopathy pathophysiology include abnormal mitochondrial structure/function,(4) defective mitochondrial calcium uptake,(5) a mismatch between ATP supply and demand,(6) and altered lipid/glucose metabolism.(7) The BTHS cardiomyopathic phenotypes appear to evolve with advancing age, which may be useful in treatment selection.

[4] Barth syndrome: mechanisms and management

  • Authors: J. Finsterer
  • Year: 2019
  • Venue: The Application of Clinical Genetics
  • URL: https://www.semanticscholar.org/paper/fb97e79fcdebf4e739bdfd19c2f54a99ecfca9b1
  • DOI: 10.2147/TACG.S171481
  • PMID: 31239752
  • PMCID: 6558240
  • Citations: 31
  • Summary: Although Barth syndrome is still an orphan disease, there is extensive ongoing research with regard to its pathomechanism and new therapeutic approaches, and most of these approaches are still experimental, it can be expected that causative strategies will be developed in the near future.
  • Evidence snippets:
  • Snippet 1 (score: 0.419) > Barth syndrome: mechanisms and management

[5] Application of Human Induced Pluripotent Stem Cells for Tissue Engineered Cardiomyocyte Modelling

  • Authors: P. Katili, Amira P. Karima, Winda Azwani, R. Antarianto, M. Djer
  • Year: 2023
  • Venue: Regenerative Engineering and Translational Medicine
  • URL: https://www.semanticscholar.org/paper/230ce81f53920be5341915add9ac3de36432f6f2
  • DOI: 10.1007/s40883-023-00294-1
  • Citations: 5
  • Summary: The cardiac patch is currently the most effective delivery system, proving safety and improvements in animal models, which are suggested to be the role of the paracrine mechanism.
  • Evidence snippets:
  • Snippet 1 (score: 0.394) > Disease models of cardiac diseases had been reported for long QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardia (CPVT), Friedreich's ataxia and Barth syndrome, and syndromic diagnosis associated with cardiomyopathy (LEOPARD syndrome, Pompe disease, laminopathies) [52][53][54][55]. These diagnoses comprise largely of genetic mutations; however, direct causality between genetic and environmental factors that affect disease phenotypes is still largely unknown, and until recently, there has been no reliable, human-sourced model to reenact disease progression outside the human body. hiPSCs allow the collection of diseased cell types to be investigated as cardiomyocytes develop in vitro, enabling the investigation of molecular and cellular mechanisms that contribute to pathological changes in an individual context. > Current studies focus on identifying new genetic mutations and reproducing their phenotypes in vitro using cell lines from diagnosed patients and their families. Disease models of hypertrophic cardiomyopathy (HCM) showed hypertrophy of cardiomyocytes, irregular sarcomere, and interstitial fibrosis in a hiPSC-CMs model. In the study by Lan et al., genetic analysis was carried out on ten patients in 2nd-and 3rd-generation families where one family member had been diagnosed with HCM. A missense mutation confirmed genetic aetiology in the myosin heavy chain (MYH7 gene) in 5 family members, but only one family member showed clinical manifestation [56]. Arrhythmias and irregular calcium handling were also found in the cellular level analysis. Genetic mutations without clinical phenotypes are an exciting area of research, and mechanisms regarding environmental influence on the genetic background are yet to be discovered. To confirm this hypothesis, Tanaka et al. analysed the influence of multiple hypertrophy-promoting factors in the hiPSC-CMs disease model from 3 known HCM patients, in which two of them were negative for known sarcomeric mutations. hiPSC-CMs HCM model treated with endothelin-1 (ET-1) showed disorganised cell hypertrophy and myofibrils compared to negative controls.

[6] Modeling psychiatric disorders: from genomic findings to cellular phenotypes

  • Authors: Anna Falk, Vivi M. Heine, A. Harwood, Patrick F. Sullivan, M. Peitz et al.
  • Year: 2016
  • Venue: Molecular Psychiatry
  • URL: https://www.semanticscholar.org/paper/235b41240d78140de7ab06a3ad8a7d0b1bdff1a5
  • DOI: 10.1038/mp.2016.89
  • PMID: 27240529
  • PMCID: 4995546
  • Citations: 77
  • Influential citations: 2
  • Summary: The challenges for modeling of psychiatric disorders, potential solutions and how iPSC technology can be used to develop an analytical framework for the evaluation and therapeutic manipulation of fundamental disease processes are critically reviewed.
  • Evidence snippets:
  • Snippet 1 (score: 0.388) > The key challenge for iPSC-based disease modeling is to identify one or more relevant cellular phenotypes that accurately represent the disease pathophysiology. Increasing numbers of reports have demonstrated that for many diseases specific pathophysiology can be captured in human iPSC-based disease models. These range from cardiovascular disease, 44,45 cancer, 46,47 ocular disease, 48,49 diabetes mellitus 50,51 and neurological disorders of the brain. 52,53 Can the same approach be applied to complex psychiatric disorders? > The problem is that almost all psychiatric disorders are characterized by clinical signs and symptoms, but lack independent verification from objective biomarkers. Thus, how might these clinical phenotypes manifest themselves in terms of cell behavior? The identity of robust cellular 'readouts', which typify any psychiatric disorder, is a crucial unsolved problem and an area of intense study 54 (Table 2). When satisfactorily answered, this will herald a new degree of biological objectivity and quantification for the study of psychiatric disorders. > The aim is to find a single or small number of cell phenotypes or parameters that strongly associate with psychiatric disorders, and establish a cellular profile characteristic of cells derived from the general patient population. Although a consensus set of cellular phenotypes for psychiatric disorder is yet to be established, we can define some of their desired characteristics. First, cellular phenotypes have to relate to the biological pathways identified by genetics. Second, although there are many risk genes in disparate biological pathways, at some level, phenotypes should converge onto a much smaller grouping. Third, phenotypes need to be quantifiable. Finally, to be useful for drug development cellular phenotypes should be reversed by pharmacological treatment, although not necessarily by drugs in current use. > Although human iPSC-based approaches underrepresent the complexity of the human central nervous system, cellular phenotypes are likely to lie more proximal to molecular disease mechanisms than phenotypes seen at the level of a tissue or organism, 55 and thus may bypass compensatory homeostatic (2) Gene expression profiles of SCZ human iPSC neurons identified altered expression of many components of the cyclic AMP and WNT signaling pathways. > (3

[7] 18O-assisted dynamic metabolomics for individualized diagnostics and treatment of human diseases

  • Authors: E. Nemutlu, Song Zhang, N. Juranic, A. Terzic, S. Macura et al.
  • Year: 2012
  • Venue: Croatian Medical Journal
  • URL: https://www.semanticscholar.org/paper/880f053c7f060db4b990e447d0a22c4b69372ddb
  • DOI: 10.3325/cmj.2012.53.529
  • PMID: 23275318
  • PMCID: 3541579
  • Citations: 28
  • Summary: The potential use of dynamic phosphometabolomic platform for disease diagnostics currently under development at Mayo Clinic is described and discussed briefly.
  • Evidence snippets:
  • Snippet 1 (score: 0.387) > Living cells represent an integrated and interacting network of genes, transcripts, proteins, small signaling molecules, and metabolites that define cellular phenotype and function. Traditionally the focus of biomedical research was on individual genes, single protein targets, single metabolites, and metabolic or signaling pathways. This "molecular reductionist" paradigm was based on the assumption that identifying genetic variations and molecular components would lead to discovery of cures for human diseases. However, most of diseases are complex and multi-factorial and the disease phenotype is determined by the alterations of multiple genes, pathways, proteins and metabolites (at cellular, tissue, and organismal levels). Therefore, an integrated "omics" approach is more viable direction for uncovering alterations in metabolic networks, disease mechanisms, and mechanisms of drug effects. > Recent advent of large-scale metabolomics and fluxomic (metabolite dynamics and metabolic flux analysis) completed the "omics revolution" (Figure 1), where genomics, transcriptomics, proteomics, metabolomics, and fluxomics all together complement phenotype determination of living organism. Such integrated "omics" cascades provide a framework for advances in system and network biology, integrative physiology, and system medicine as well as system pharmacology and regenerative medicine. Noteworthy is the "reverse omic" approach or "metabolomicsinformed pharmacogenomics, " where discovery of specific metabolite changes have led to discovery of genetic alterations (2). Therefore, bringing new "omics" technologies to clinical practice will improve disease diagnostics and treatment by targeting drugs and procedures for each unique transcriptomic and metabolomic profiles.

[8] Changes in Serum Proteomic Profiles at Different Stages of Pregnancy Toxemia in Goats

  • Authors: M. Uzti̇mür, C. N. Ünal, Gurler Akpinar
  • Year: 2025
  • Venue: Journal of Veterinary Internal Medicine
  • URL: https://www.semanticscholar.org/paper/4b9c488b5dbd65d7b26fd2ad9aed70e8c4b59942
  • DOI: 10.1111/jvim.70139
  • PMID: 40492724
  • PMCID: 12150350
  • Summary: Understanding the serum proteome profiles of goats with pregnancy toxemia might help identify the proteomes and pathways responsible for the development of this disease and improve diagnosis and treatment.
  • Evidence snippets:
  • Snippet 1 (score: 0.386) > The pathophysiology and progression of this disease are not fully understood. > Traditional biomedical research has focused on the analysis of single genes, proteins, metabolites, or metabolic pathways in diseases. This molecular reductionist approach is based on the assumption that identifying genetic variations and molecular components will lead to new treatments for diseases [13][14][15][16]. However, many diseases are complex and multifactorial, and in order to determine the phenotype of such diseases, it is necessary to understand the changes that occur in more than one gene, pathway, protein, or metabolite at the cellular, tissue, and organismal levels [17][18][19]. Therefore, in recent years, proteomics, as one field of multi-omics technologies, has helped in evaluating the complex pathogenetic mechanisms of different diseases from a broad perspective and has made substantial contributions [20,21]. In veterinary medicine, proteomic analysis of metabolic diseases such as ketosis [16], hypocalcemia [22], and fatty liver [23] in dairy cows has contributed valuable insights for the definition of new pathophysiological pathways and new diagnosis and treatment protocols for these diseases. The proteomic approach can contribute importantly to a broad and detailed understanding of the changes that occur at the organismal level associated with the increase in BHBA concentration in goats with pregnancy toxemia. Our aim was to evaluate the serum protein profiles of goats with SPT or CPT using proteomic techniques to determine the proteomic profiles of these animals and to identify the relevant pathophysiological mechanisms.

[9] New therapeutic targets in rare genetic skeletal diseases

  • Authors: M. Briggs, Peter A. Bell, M. Wright, K. A. Pirog
  • Year: 2015
  • Venue: Expert Opinion on Orphan Drugs
  • URL: https://www.semanticscholar.org/paper/1363107f71ae6d2d60abca471cddf3da5d13644b
  • DOI: 10.1517/21678707.2015.1083853
  • PMID: 26635999
  • PMCID: 4643203
  • Citations: 37
  • Influential citations: 1
  • Summary: An overview of disease mechanisms that are shared amongst groups of different GSDs and potential therapeutic approaches that are under investigation are described to generate critical mass for the identification and validation of novel therapeutic targets and biomarkers.
  • Evidence snippets:
  • Snippet 1 (score: 0.379) > proteins of the cartilage ECM such as type II collagen [50]. However, emerging knowledge suggests that the primary genetic defect may be less important than the cells' response to the expression of the mutant gene product [107]. Moreover, the largely overlooked response of a cell (i.e. chondrocyte) to the abnormal extracellular environment is also important for disease progression as illustrated by several GSDs discussed in this review. > It is important that 'omics'-based approaches and technologies are systematically applied to the study of rare GSDs so that definitive reference profiles and disease signatures are generated for each phenotype. These can then be used in a Systems Biology approach to identify both common and dissimilar pathological signatures and disease mechanisms. This approach is entirely dependent upon relevant in vitro and in vivo models (and also novel 'disease-mechanism phenocopies' [107]) for testing new diagnostic and prognostic tools and for determining the molecular mechanisms that underpin the pathophysiology so that effective therapeutic treatments can be developed and validated. This approach will eventually lead to personalized treatments and care strategies centred on shared disease mechanisms with the use of relevant biomarkers to monitor the efficacy of treatment and disease progression. > It is vital that all relevant stakeholders are involved from the outset in defining the appropriate outcomes of any potential therapeutic regime. The perceptions of a successful therapy can differ widely between the clinical academic community and the relevant patient-support groups and it is vital that there is engagement on all these issues. > In summary, the identification of causative genes and mutations for GSDs over the last 20 years, coupled with the generation and in-depth analysis of a plethora of relevant cell and mouse models, has derived new knowledge on disease mechanisms and suggested potential therapeutic targets. The fast-evolving hypothesis that clinically disparate diseases can share common disease mechanisms is a powerful concept that will generate critical mass for the identification and validation of novel therapeutic targets and biomarkers.

[10] Investigating the role of NPR1 in dilated cardiomyopathy and its potential as a therapeutic target for glucocorticoid therapy

  • Authors: Yaomeng Huang, Tongxin Li, Shichao Gao, Shuyu Li, Xiaoran Zhu et al.
  • Year: 2023
  • Venue: Frontiers in Pharmacology
  • URL: https://www.semanticscholar.org/paper/be229f6f2059faab4c97ec0a04bd055adab9dfe1
  • DOI: 10.3389/fphar.2023.1290253
  • PMID: 38026943
  • PMCID: 10662320
  • Citations: 3
  • Summary: Natriuretic peptide receptor 1 (NPR1) was identified as a core gene associated with DCM through bioinformatics analysis and led to substantial improvements in cardiac and renal function, accompanied by an upregulation of NPR1 expression.
  • Evidence snippets:
  • Snippet 1 (score: 0.375) > Multiple pathways and molecules are involved in this process; however, the detailed underlying mechanisms remain unclear. In recent years, with the development of high-throughput sequencing and gene chip technologies, the use of bioinformatics technology to explore the occurrence, development, and prognosis of diseases has become a hot topic for scholars worldwide (Hwang et al., 2018;Nayor et al., 2019;Rinschen et al., 2019;Sturm et al., 2019;Montaner et al., 2020). > The present study aimed to use bioinformatics technology to screen for DCM-related genes and investigate their mechanisms, with the purpose of revealing the pathogenesis of DCM and seeking treatment methods. The GSE3586 dataset, containing expression profiles related to DCM, was selected from the Gene Expression Omnibus (GEO) database. This study aimed to predict the core genes that may play crucial roles in disease progression at the molecular level through the enrichment of relevant molecular pathways associated with DCM. Furthermore, the phenotype of the core genes was validated to further support the results of the bioinformatics analysis through basic and clinical experiments. Additionally, the role of glucocorticoids in DCM treatment is discussed in this article with the purpose of providing a theoretical and experimental basis for exploring the pathogenesis of DCM and elucidating therapeutic methods. This study also provides a theoretical reference for the interpretation, early diagnosis, and treatment of DCM.

[11] Exploring the molecular mechanisms of subarachnoid hemorrhage and potential therapeutic targets: insights from bioinformatics and drug prediction

  • Authors: Yi Liu, Yang Zhang, Huan Wei, Li Wang, Lishang Liao
  • Year: 2025
  • Venue: Scientific Reports
  • URL: https://www.semanticscholar.org/paper/19a91d9c8cabec6a5a186729d545077e252ecb67
  • DOI: 10.1038/s41598-025-97642-8
  • PMID: 40229542
  • PMCID: 11997208
  • Summary: The findings not only elucidate the molecular mechanisms underlying SAH but also provide robust bioinformatics and experimental evidence supporting IRN as a promising therapeutic candidate, offering novel insights for future intervention strategies in SAH.
  • Evidence snippets:
  • Snippet 1 (score: 0.369) > involved in SAH pathology. As a result, our understanding of the cellular composition and microenvironment in SAH remains incomplete 8 . > Advances in bioinformatics provide powerful tools to analyze large-scale gene expression data and understand complex biological processes. By integrating transcriptomic data with immune cell infiltration analysis, we can gain a deeper understanding of the molecular mechanisms underlying SAH and identify potential key genes as therapeutic targets 9,10 . Previous studies have indicated that inflammation, oxidative stress, and cell death play crucial roles in the development of SAH, processes that are often closely associated with changes in specific cell types and immune responses 11 . > The goal of this study is to explore the molecular mechanisms of SAH, with a focus on immune cell infiltration and its role in disease progression. We aim to identify key genes and signaling pathways associated with SAH and investigate potential therapeutic strategies. Specifically, we will examine Isorhynchophylline (IRN) as a potential treatment for SAH and analyze its effects on relevant targets and signaling pathways. Through a comprehensive understanding of the pathological features of SAH, this study aims to provide valuable insights into future clinical interventions and treatment strategies.

[12] Transcriptional profiling of Hutchinson-Gilford progeria patients identifies primary target pathways of progerin

  • Authors: Sandra Vidak, Sohyoung Kim, Tom Misteli
  • Year: 2026
  • Venue: Nucleus
  • URL: https://www.semanticscholar.org/paper/4bd99b0875508364d8672b6da5a50d024d485a53
  • DOI: 10.1080/19491034.2025.2611484
  • PMID: 41489464
  • PMCID: 12773485
  • Summary: To probe the clinical relevance of previously implicated cellular pathways and to address the extent of gene expression heterogeneity between patients, transcriptomic analysis of a comprehensive set of HGPS patients finds misexpression of several cellular pathways, including multiple signaling pathways, the UPR and mesodermal cell fate specification.
  • Evidence snippets:
  • Snippet 1 (score: 0.368) > Oxidative stress represents another key pathogenic mechanism in HGPS, as impaired NRF2 activity or increased reactive oxygen species (ROS) levels are sufficient to recapitulate HGPSassociated phenotypes [17,32,60]. Collectively, these findings underscore the multifactorial nature of HGPS pathogenesis, implicating interconnected signaling cascades involved in inflammation, oxidative stress, proteostasis, and vascular remodeling. Reassuringly, our findings indicate that many of the major pathways that have been described to contribute to HGPS phenotypes in mouse and cellular disease models are also misregulated in progeria patients, and targeting these pathways may provide therapeutic avenues to mitigate disease severity and improve outcomes in HGPS. > Although individuals with HGPS typically exhibit a characteristic set of clinical features, such as craniofacial abnormalities, growth retardation, and cardiovascular complications, there is notable variability in the age of onset, severity, and progression of symptoms between patients [7,9]. At the cellular level, HGPS is associated with several hallmark abnormalities, including nuclear envelope defects, decreased expression of several nuclear proteins and epigenetic marks, mitochondrial dysfunction, and increased cellular senescence [1,11,30,31,61]. These cellular phenotypes also exhibit considerable variation between patients, possibly contributing to differences in clinical outcomes. Our results indicate that even though some degree of transcriptional heterogeneity between the individual patients exists, the majority of patients exhibit misregulation of a set of shared pathways, suggesting that these pathways are universal driver mechanisms in HGPS. Further work is needed to understand the molecular and genetic factors that underlie inter-individual variability in disease expression and progression. > A limitation of pathway analysis of HGPS patient samples is to distinguish the pathways which are directly targeted by the disease-causing progerin protein and the emergence of adaptive secondary response pathways during progression of the disease in patients during their lifetime. The same caveat applies to the use of cell-based models used in the study of HGPS disease mechanisms.

[13] The ties that bind: functional clusters in limb-girdle muscular dystrophy

  • Authors: E. Barton, C. A. Pacak, Whitney L. Stoppel, P. Kang
  • Year: 2020
  • Venue: Skeletal Muscle
  • URL: https://www.semanticscholar.org/paper/653422e1a9dc9cc7f16758b10f3f203155bc68c9
  • DOI: 10.1186/s13395-020-00240-7
  • PMID: 32727611
  • PMCID: 7389686
  • Citations: 24
  • Summary: A deeper understanding of these disease pathways could yield a new generation of precision therapies that would each be expected to treat a broader range of LGMD patients than a single subtype, thus expanding the scope of the molecular medicines that may be developed for this complex array of muscular dystrophies.
  • Evidence snippets:
  • Snippet 1 (score: 0.366) > Pyridine nucleotide-disulfide reductase [55] Many of the protein functions listed require further confirmation or are disputed these methodologies. Those patients with moderate disease phenotypes regardless of the underlying causative gene mutation would likely fall into a category where there may be interest in testing a pharmacological treatment (that could be halted) but reduced interest in a more permanent experimental strategy. For all of the above-mentioned reasons, the identification of unifying therapeutic targets applicable to multiple subtypes of > LGMDs is highly desirable. > To identify such targets, we should first consider the question: What binds all of these LGMDs together? The two core phenotypic features are progressive proximal muscle weakness, along with characteristic signs of muscle fiber destruction on biopsy, referred to as "dystrophic" features. Nuances in clinical presentation have helped to distinguish some of the LGMDs, such as the frequent occurrence of difficulty walking on tiptoes in LGMD R2 (LGMD2B), caused by dysferlin deficiency. However, heterogeneity associated with variable ages of onset and ranges of severity makes it generally difficult to distinguish and diagnose LGMD subtypes based on clinical presentation alone. A change in perspective is in order to aid in understanding disease pathways responsible for clinical features even when the genetic mutation is unknown. Further, given the large number of genespecific LGMD subtypes, it could very well be that several major disease mechanisms may be shared across the family of diseases. Yet despite careful studies that have collectively determined the cellular localization of most proteins associated with LGMD (Fig. 1), there is limited knowledge of potentially unifying molecular disease mechanisms. We assert that the identification of functional clusters of these proteins, grouped by such common mechanisms, will streamline our understanding of the disease processes and identify therapeutic targets relevant to individuals in multiple disease subgroups, including individuals whose pathogenic mutations have not been found. By extension, this approach may serve as a tool to not only find common mechanisms, but may also help to distinguish LGMD subtypes that do not share similar functional patterns, and afford further refinement of potential treatments.

[14] The ties that bind: functional clusters in limb-girdle muscular dystrophy

  • Authors: E. Barton, C. A. Pacak, Whitney L. Stoppel, Peter B. Kang
  • Year: 2020
  • Venue: Skeletal Muscle
  • URL: https://www.semanticscholar.org/paper/3493c658bb8716d789a05ddf292162832e064e47
  • DOI: 10.1186/s13395-020-00240-7
  • Summary: A deeper understanding of these disease pathways could yield a new generation of precision therapies that would each be expected to treat a broader range of LGMD patients than a single subtype, thus expanding the scope of the molecular medicines that may be developed for this complex array of muscular dystrophies.
  • Evidence snippets:
  • Snippet 1 (score: 0.366) > Pyridine nucleotide-disulfide reductase [55] Many of the protein functions listed require further confirmation or are disputed these methodologies. Those patients with moderate disease phenotypes regardless of the underlying causative gene mutation would likely fall into a category where there may be interest in testing a pharmacological treatment (that could be halted) but reduced interest in a more permanent experimental strategy. For all of the above-mentioned reasons, the identification of unifying therapeutic targets applicable to multiple subtypes of > LGMDs is highly desirable. > To identify such targets, we should first consider the question: What binds all of these LGMDs together? The two core phenotypic features are progressive proximal muscle weakness, along with characteristic signs of muscle fiber destruction on biopsy, referred to as "dystrophic" features. Nuances in clinical presentation have helped to distinguish some of the LGMDs, such as the frequent occurrence of difficulty walking on tiptoes in LGMD R2 (LGMD2B), caused by dysferlin deficiency. However, heterogeneity associated with variable ages of onset and ranges of severity makes it generally difficult to distinguish and diagnose LGMD subtypes based on clinical presentation alone. A change in perspective is in order to aid in understanding disease pathways responsible for clinical features even when the genetic mutation is unknown. Further, given the large number of genespecific LGMD subtypes, it could very well be that several major disease mechanisms may be shared across the family of diseases. Yet despite careful studies that have collectively determined the cellular localization of most proteins associated with LGMD (Fig. 1), there is limited knowledge of potentially unifying molecular disease mechanisms. We assert that the identification of functional clusters of these proteins, grouped by such common mechanisms, will streamline our understanding of the disease processes and identify therapeutic targets relevant to individuals in multiple disease subgroups, including individuals whose pathogenic mutations have not been found. By extension, this approach may serve as a tool to not only find common mechanisms, but may also help to distinguish LGMD subtypes that do not share similar functional patterns, and afford further refinement of potential treatments.

[15] Towards Mutation-Specific Precision Medicine in Atypical Clinical Phenotypes of Inherited Arrhythmia Syndromes

  • Authors: T. Nakajima, S. Tamura, M. Kurabayashi, Y. Kaneko
  • Year: 2021
  • Venue: International Journal of Molecular Sciences
  • URL: https://www.semanticscholar.org/paper/3d299f57f344d42eff9d3565d1581dae7fb87a54
  • DOI: 10.3390/ijms22083930
  • PMID: 33920294
  • PMCID: 8069124
  • Citations: 6
  • Influential citations: 1
  • Summary: Since the epileptic phenotype appears to manifest prior to cardiac events in this mutation carrier, identifying KCND3 mutations in patients with epilepsy and providing optimal therapy will help prevent sudden unexpected death in epilepsy.
  • Evidence snippets:
  • Snippet 1 (score: 0.365) > Recent advances in molecular genetics have identified many causal genes for inherited arrhythmia syndromes (IASs) such as long QT syndrome (LQTS) [1], short QT syndrome (SQTS) [2], Brugada syndrome (BrS) [3,4] and early repolarization (ER) syndrome (ERS) [3,5]. Most causal genes for IASs encode cardiac ion channels or their related proteins. Genotype-phenotype studies and functional analyses of mutant genes, using heterologous expression systems and experimental animal models, have revealed the pathophysiology of IASs and enabled the establishment of causal gene-specific precision medicine [6][7][8]. Furthermore, analyses of patient-specific and/or genome-edited induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) have provided further insights into the pathophysiology of IASs and novel promising therapeutic strategies for IASs, although there are still some limitations of using iPSC-CMs, such as immature structure and function and mixed population of atrial, ventricular, and nodal cells, as a standard technology [9]. > The altered function of causal genes that encode cardiac ion channels is caused by multiple mechanisms, including trafficking defects, producing non-functional channels, altered channel gating properties, and a combination thereof. These altered functions of mutant channels underly the clinical phenotypes of IASs [10][11][12]. Particularly, unique electrophysiological properties of mutant channels have been shown to be associated with the atypical clinical phenotypes of IASs [10,13]. Furthermore, the elucidation of the mechanisms underlying the atypical clinical phenotypes of IASs has raised the possibility of mutation-specific precision medicine. > We herein review the current knowledge of genotype-phenotype relationships, underlying molecular and cellular mechanisms, and established pharmacological therapies of IASs, including LQTS, SQTS, and J wave syndrome (BrS and ERS).

[16] Mechanistic Models of Signaling Pathways Reveal the Drug Action Mechanisms behind Gender-Specific Gene Expression for Cancer Treatments

  • Authors: C. Çubuk, F. Can, M. Peña-Chilet, J. Dopazo
  • Year: 2020
  • Venue: Cells
  • URL: https://www.semanticscholar.org/paper/e40f7a3b8f72ba01374ba00fbf308a47a3fa5dd4
  • DOI: 10.3390/cells9071579
  • PMID: 32610626
  • PMCID: 7408716
  • Citations: 9
  • Summary: Despite the existence of differences in gene expression across numerous genes between males and females having been known for a long time, these have been mostly ignored in many studies, including drug development and its therapeutic use. In fact, the consequences of such differences over the disease mechanisms or the drug action mechanisms are completely unknown. Here we applied mechanistic mathematical models of signaling activity to reveal the ultimate functional consequences that gender-s...
  • Evidence snippets:
  • Snippet 1 (score: 0.363) > Therefore, a proper interpretation of the effect that differences in gene expression have over phenotypes, such as drug response or disease progression, involves understanding the mechanisms of the disease or the mode of action of drugs, which can be interpreted through mechanistic models of cell signaling [12] or cell metabolism [13]. Mechanistic models have helped to understand the disease mechanisms behind different cancers [14,15], including neuroblastoma [16,17], breast cancer [18], rare diseases [19], complex diseases [20], the mechanisms of action of drugs [21,22], and other biologically interesting scenarios such as the molecular mechanisms that explain how stress-induced activation of brown adipose tissue prevents obesity [23] or the molecular mechanisms of death and the post-mortem ischemia of a tissue [24]. Among the few available proposals of mechanistic modeling algorithms that model different aspects of signaling pathway activity, Hipathia has demonstrated having superior sensitivity and specificity [12]. > Here, we propose the use of mechanistic models [13,14] of signaling activity related with cancer hallmarks [25], other cancer-related signaling pathways, and some extra relevant cellular functions to understand the functional consequences of the gender bias in gene expression. Such mechanistic models use gene expression data to produce an estimation of profiles of signaling or metabolic circuit activity within pathways [13,14]. An interesting property of mechanistic models is that they can be used not only to understand molecular mechanisms of disease or of drug action but also to predict the potential consequences of gene perturbations over the circuit activity in a given condition [26]. Actually, in a recent work, our group has successfully predicted therapeutic targets in cancer cell lines with a precision over 60% [15]. Therefore, we will use this mechanistic framework to understand what is the molecular basis of the different effects of cancer drugs by directly simulating their effect in the patients. This approach has recently been used by us to understand the generation of resistances in cancer at the single cell level in glioblastoma [27].

[17] Cellular reprogramming and inherited peripheral neuropathies: perspectives and challenges

  • Authors: M. Saporta
  • Year: 2015
  • Venue: Neural Regeneration Research
  • URL: https://www.semanticscholar.org/paper/8c3dabb1b4abf93506e2026564b8a329c0ec37c6
  • DOI: 10.4103/1673-5374.158345
  • PMID: 26199602
  • PMCID: 4498347
  • Citations: 4
  • Summary: iPSC-based models of neuromuscular disorders, including amyotrophic lateral sclerosis (ALS), spinal muscular atrophy (SMA) and inherited peripheral neuropathies, have successfully reproduced pathophysiological findings from previous animal and cellular models and have also identified new disease mechanisms with potential therapeutical implications.
  • Evidence snippets:
  • Snippet 1 (score: 0.362) > Inherited peripheral neuropathies (or Charcot-Marie-Tooth disease, CMT) are a phenotypically and genetically heterogeneous group of disorders, which are currently untreatable. They are the most common inherited neuromuscular disorder, affecting around 1 in every 2,500 people (over 120,000 people in the US). Based on clinical neurophysiological and histopathological features, inherited neuropathies can be divided into two major forms: demyelinating (type 1) and axonal (type 2) CMT (Saporta, 2014). From a biological standpoint, these two major forms of CMT are associated with mutations in different sets of genes, affecting Schwann cell development and myelination (type 1) or peripheral axon physiology (type 2), although some overlap does exist (Figure 1). To date, over 70 genes have been associated with a CMT phenotype, making CMT an attractive natural model to study peripheral nervous system biology. Despite significant advances made in our knowledge of disease mechanisms in CMT, findings from animal models have so far translated poorly in clinical trials, underscoring the need for innovative methods to investigate the pathophysiology of these human disorders. Induced pluripotent stem cells (iPSCs) offer an unlimited source of patient specific, disease-relevant cell lines that can be used as a platform for identification of disease mechanisms, discovery of molecular targets and development of phenotypic screens for drug discovery (Saporta et al., 2011). iPSC-based models of neuromuscular disorders, including amyotrophic lateral sclerosis (ALS), spinal muscular atrophy (SMA) and inherited peripheral neuropathies, have successfully reproduced pathophysiological findings from previous animal and cellular models and have also identified new disease mechanisms with potential therapeutical implications.

[18] Molecular insights into the premature aging disease progeria

  • Authors: Sandra Vidak, R. Foisner
  • Year: 2016
  • Venue: Histochemistry and Cell Biology
  • URL: https://www.semanticscholar.org/paper/60fb3b46bb7e42d5d08cc3b7cbc783b118300c31
  • DOI: 10.1007/s00418-016-1411-1
  • PMID: 26847180
  • PMCID: 4796323
  • Citations: 105
  • Influential citations: 3
  • Summary: Changes in mechanosignaling, altered chromatin organization and impaired genome stability, and changes in signaling pathways, leading to impaired regulation of adult stem cells, defective extracellular matrix production and premature cell senescence are discussed.
  • Evidence snippets:
  • Snippet 1 (score: 0.361) > The number of molecular biological studies aiming at the identification of lamin-mediated molecular disease mechanisms involved in HGPS increased tremendously following the surprising discovery that LMNA is causally linked to the premature aging disease HGPS in 2003. Despite numerous cellular pathways that were identified to be affected by the expression of the mutant lamin A protein (Fig. 2), the mechanistic details behind these effects are still unclear in most cases. Knowledge based on what was already known on lamin biology before the protein was linked to HGPS and findings on novel roles of lamins in diverse pathways in recent years allowed the launch of translational studies and the efficient search for drug targets and therapeutic approaches within a short time period. The results of the first clinical trials taught us that some improvements of the disease phenotypes can be achieved by FTI treatment, but they also made clear that we need a much better understanding of the underlying disease mechanisms to be able to tackle specific aspects of the disease in a more focused approach. It will also be important to elucidate which of the numerous pathways found to be impaired in HGPS are most relevant for and causally involved in the pathologies, and which ones are just bystanders.

[19] Pharmacogenomic characterization of gemcitabine response – a framework for data integration to enable personalized medicine

  • Authors: Michael Harris, K. Bhuvaneshwar, Thanemozhi Natarajan, L. Sheahan, Difei Wang et al.
  • Year: 2013
  • Venue: Pharmacogenetics and Genomics
  • URL: https://www.semanticscholar.org/paper/1382ddf84b87736a73c2f2f81164ca876c29f4c4
  • DOI: 10.1097/FPC.0000000000000015
  • PMID: 24401833
  • PMCID: 3888473
  • Citations: 16
  • Summary: This in-silico study identified gene variants significantly associated with gemcitabine response that may help to personalize treatment in the clinic and gain insights into drug response mechanisms and to facilitate clinical trial design and regulatory reviews.
  • Evidence snippets:
  • Snippet 1 (score: 0.358) > Understanding the genetic and molecular mechanisms underlying complex diseases such as cancer is extremely challenging. Genome-wide association studies (GWAS) have been extensively used in the past decade to discover important genetic variants. However, the identified SNPs explain only a small proportion of the phenotypic variation, and the predictive power of these SNPs remains low for many complex diseases [10]. To fully elucidate genetic underpinnings of disease a systems biology approach is necessary to characterize variants, mRNA, copy number, proteins, and metabolites, as well as their cellular interactions [11]. Gene set and pathway association analyses are playing an increasingly important role in explaining disease mechanisms through the identification of functional genetic interactions [12]. Many gene-disease association analyses are based on SNP genotype profiling or gene expression studies. However, SNPs can influence many downstream processes including the expression levels of multiple genes and/or protein levels, and variations in expression levels can directly or indirectly impact disease progression and even drug response [13]. An integrative approach combining multiple data types can more accurately capture pathway associations [12] for discovery of clinically actionable variants. > Statistical approaches commonly used to associate variants with disease and/or drug response Fisher's exact test (FET) is commonly used in the association of germline polymorphisms with drug response [14]. The use of probabilistic networks in conjunction with traditional statistical models for mining relationships and associations from genotype-phenotype data is well established [15]. Probabilistic network methods for pharmacogenomics and newer methods such as the Markov Blanket concept may be helpful to better analyze these complex genotype-phenotype associations [16]. Considering the complexity of both cancer prognosis and individual drug response to chemotherapeutics, application of these association methods in conjunction with novel informatics and data integration approaches is necessary to identify clinically relevant variants for validation studies and ultimately testing in the clinic for pharmacogenomics applications.

[20] Clinical Phenotypes of Cardiovascular and Heart Failure Diseases Can Be Reversed? The Holistic Principle of Systems Biology in Multifaceted Heart Diseases

  • Authors: K. Lourida, G. Louridas
  • Year: 2022
  • Venue: Cardiogenetics
  • URL: https://www.semanticscholar.org/paper/3960806730c4c1115f527e22d6d0a76536570ec5
  • DOI: 10.3390/cardiogenetics12020015
  • Citations: 4
  • Influential citations: 1
  • Summary: Only by understanding the complexity of chronic heart diseases and explaining the interrelationship between different interconnected biological networks can the probability for clinical phenotypes reversal be increased.
  • Evidence snippets:
  • Snippet 1 (score: 0.357) > Treatment with ACEIs, ARBs, and β-blockers impedes deterioration of myocardial function as well as clinical deterioration caused by the deleterious impact of the compensatory systems [58,59]. Therefore, the therapy with ACEIs, ARBs, and β-blockers is the appropriate therapy to block LV remodeling and HF progression and reduce symptoms and/or mortality [55]. > In general, the HF syndrome demonstrates a modular construction with predictable behavior of functional clinical phenotypes having a strong impact on biological networks from epigenetic, cellular to regulatory systems [18]. The importance of individual genes for the pathogenesis and clinical progression of the HF syndrome is restricted to the hypertrophic and dilated cardiomyopathies. It seems that some HF patients have a complex multigenic inheritance, but the importance of individual genes is limited. In contrast, the significant role of epigenetics, proteomics, and metabolomics is increased; but, the complete genetic network system and the interactions between multiomics systems are still uncertain [60]. Multimodal systems that include genetic networks, multiomics, metabolic pathways, environmental factors, and sophisticated disease-related clinical networks are required to be integrated and provide a new holistic and realistic picture. > Significant breakthroughs have been made to understand many of the pathophysiological mechanisms of HFrEF but the natural pathophysiological history and clinical progression of HFpEF still remains inadequately defined [39]. The subclinical progression of pre-clinical diastolic dysfunction (PDD) of LV "to clinical phenotype of HFpEF and the further clinical progression to some more complex clinical models with multi-organ involvement . . . continue to be poorly understood" [40]. Prospective studies are expected to clarify the natural history and clinical progression of HFpEF and define the LV remodeling mechanisms involved. The pathophysiology of LV systolic dysfunction is different to the diastolic dysfunction, as systolic dysfunction is considered a disease of calcium handling and diastolic dysfunction is regarded as a disease of increased myofilament sensitivity to calcium [61][62][63].

Notes

  • This provider combines search_papers_by_relevance with snippet_search.
  • No synthesis or second-stage model call is performed.