However, recent studies provide evidence that trypsin can leak from the small intestine into the bloodstream and digest myocardial tissue during heart failure.31 Trypsin-mediated degradation of heart tissue was also observed in cases of dilated cardiomyopathy following influenza A infection.32 CNTN4, in turn, encodes a cell adhesion molecule implicated in the development of autism spectrum disorders.33 Recent studies have shown that mutations in CNTN4 were associated with an elevated production of a prothrombotic agent called thromboxane A2 and an increased risk of cardiovascular events.34 This evidence concerns the gene CNTN4 and dilated cardiomyopathy.