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To test this hypothesis, we examined LV specimens obtained from pediatric and adult donor controls and DCM patients. Consistent with the established pathophysiology of adult heart failure, adults with DCM displayed marked cardiomyocyte hypertrophy and myocardial fibrosis compared with donor controls. In contrast, pediatric DCM specimens demonstrated minimal cardiomyocyte hypertrophy and myocardial fibrosis compared with both age-matched controls and adults with DCM. Strikingly, RNA sequencing uncovered divergent gene expression profiles in pediatric and adult patients, including enrichment of transcripts associated with adverse remodeling and innate immune activation in adult DCM specimens. Collectively, these findings reveal that pediatric and adult DCM represent distinct pathological entities, provide a mechanistic basis to explain why children fail to respond to adult heart failure therapies, and suggest the need to develop new approaches for pediatric DCM.<\/jats:p>","DOI":"10.1172\/jci.insight.94382","type":"journal-article","created":{"date-parts":[[2017,7,19]],"date-time":"2017-07-19T11:22:28Z","timestamp":1500463348000},"source":"Crossref","is-referenced-by-count":68,"title":["Pediatric and adult dilated cardiomyopathy represent distinct pathological entities"],"prefix":"10.1172","volume":"2","author":[{"given":"Meghna D.","family":"Patel","sequence":"first","affiliation":[{"name":"Department of Pediatrics,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayaram","family":"Mohan","sequence":"additional","affiliation":[{"name":"Center for Cardiovascular Research, Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caralin","family":"Schneider","sequence":"additional","affiliation":[{"name":"Center for Cardiovascular Research, Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geetika","family":"Bajpai","sequence":"additional","affiliation":[{"name":"Center for Cardiovascular Research, Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6188-7176","authenticated-orcid":true,"given":"Enkhsaikhan","family":"Purevjav","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Cardiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles E.","family":"Canter","sequence":"additional","affiliation":[{"name":"Department of Pediatrics,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Towbin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Cardiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2970-5998","authenticated-orcid":true,"given":"Andrea","family":"Bredemeyer","sequence":"additional","affiliation":[{"name":"Center for Cardiovascular Research, Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kory J.","family":"Lavine","sequence":"additional","affiliation":[{"name":"Center for Cardiovascular Research, Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA."},{"name":"Department of Developmental Biology, and"},{"name":"Department of Immunology and Pathology, Washington University School of Medicine, St. Louis, Missouri, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"232","published-online":{"date-parts":[[2017,7,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.296.15.1867"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2009.08.014"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e31828124ad"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.ppedcard.2010.11.008"},{"issue":"11","key":"B5","doi-asserted-by":"crossref","DOI":"10.7326\/0003-4819-152-11-201006010-01006","article-title":"In the clinic. 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