Established and Emerging Mechanisms in the Pathogenesis of Arrhythmogenic Cardiomyopathy: A Multifaceted Disease
Open accessAbstract
Arrhythmogenic cardiomyopathy (ACM) is a heritable myocardial disease that manifests with cardiac arrhythmias, syncope, sudden cardiac death, and heart failure in the advanced stages. The pathological hallmark of ACM is a gradual replacement of the myocardium by fibroadiposis, which typically starts from the epicardium. Molecular genetic studies have identified causal mutations predominantly in genes encoding for desmosomal proteins; however, non-desmosomal causal mutations have also been described, including genes coding for nuclear proteins, cytoskeleton componentsand proteins involved in excitation-contraction coupling. Despite the poor prognosis, currently available treatments can only partially control symptoms and to date there is no effective therapy for ACM. Inhibition of the canonical Wnt/β-catenin pathway and activation of the Hippo and the TGF-β pathways have been implicated in the pathogenesis of ACM. Yet, our understanding of the molecular mechanisms involved in the development of the disease and the cell source of fibroadiposis remains incomplete. Elucidation of the pathogenesis of the disease could facilitate targeted approaches for treatment. In this manuscript we will provide a comprehensive review of the proposed molecular and cellular mechanisms of the pathogenesis of ACM, including the emerging evidence on abnormal calcium homeostasis and inflammatory/autoimmune response. Moreover, we will propose novel hypothesis about the role of epicardial cells and paracrine factors in the development of the phenotype. Finally, we will discuss potential innovative therapeutic approaches based on the growing knowledge in the field.
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Epicardial cells contribute by transdifferentiating into fibro-adipogenic progenitors.
“Epicardial cells additionally contribute by transdifferentiating into fibro-adipogenic progenitors [104,105] via pathways described in Section 4.2 and Section 4.4.”
From A Paradigm Shift: Arrhythmogenic Cardiomyopathy Is an Inflammatory Disease (2026) · cites this paper as [105]
Section 5.4 proposes that epicardial progenitor cells may differentiate directly into fibroadipocytes, and reports that a small fraction of fibroadipocytes derive from them. It does not say that epicardial cells transdifferentiate into fibro-adipogenic progenitors; it suggests the epicardium's main role in ACM is paracrine. Section 5.3 describes cardiac fibro-adipogenic progenitors as a distinct resident cell population. (LLM, conf=0.87)
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Precision Cardiogenomics in Athletes
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- Authors
- Gao, S., Puthenvedu, D., Lombardi, R., & Chen, S. N.
- Affiliations
- University of Colorado Anschutz (US)
- Corresponding author
- Lombardi, Raffaella
- Chen, Suet Nee
- Venue
- International Journal of Molecular Sciences
- Publisher
- MDPI AG
- Published
- 2020-08-31
- Volume
- 21
- Issue
- 17
- Pages
- 6320
- ISSN
- 1422-0067 (ISSN-L)
- PMC
- PMC7503882
- OpenAlex
- W3082832662
- Cited by
- 28
- References
- 143
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 1 · 2023: 8 · 2022: 5 · 2021: 6 · 2020: 1
- FWCI
- 0.85
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Journal of Molecular Sciences (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- American Heart Association (19CDA34660035)
- Boettcher Foundation (25A9520)
- Research Projects of National Interest from the Ministry of University and Research grant (20173ZWACS)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiomyopathy and Myosin Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- arrhythmogenic cardiomyopathy, pathogenesis, excitation-contraction coupling, calcium homeostasis, inflammation, autoimmunity, epicardial cells, paracrine factors, Wnt/β-catenin signaling, Hippo signaling pathway, TGF-beta signaling, sudden cardiac death, treatment options
- MeSH terms
- Animals, Arrhythmias, Cardiac, Humans, Cardiomyopathies, Signal Transduction
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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