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Tarr I, Hesselson S, Iismaa SE, Rath E, Monger S, Troup M, Mishra K, Wong CM, Hsu PC, Junday K, Humphreys DT, Adlam D, Webb TR, Baranowska-Clarke AA, Hamby SE, Carss KJ, Samani NJ, Bax M, McGrath-Cadell L, Kovacic JC, Dunwoodie SL, Fatkin D, Muller DW, Graham RM, Giannoulatou E. Exploring the Genetic Architecture of Spontaneous Coronary Artery Dissection Using Whole-Genome Sequencing. Circ Genom Precis Med 2022; 15:e003527. [PMID: 35583931 PMCID: PMC9388555 DOI: 10.1161/circgen.121.003527] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Spontaneous coronary artery dissection (SCAD) is a cause of acute coronary syndrome that predominantly affects women. Its pathophysiology remains unclear but connective tissue disorders (CTD) and other vasculopathies have been observed in many SCAD patients. A genetic component for SCAD is increasingly appreciated, although few genes have been robustly implicated. We sought to clarify the genetic cause of SCAD using targeted and genome-wide methods in a cohort of sporadic cases to identify both common and rare disease-associated variants.
Methods:
A cohort of 91 unrelated sporadic SCAD cases was investigated for rare, deleterious variants in genes associated with either SCAD or CTD, while new candidate genes were sought using rare variant collapsing analysis and identification of novel loss-of-function variants in genes intolerant to such variation. Finally, 2 SCAD polygenic risk scores were applied to assess the contribution of common variants.
Results:
We identified 10 cases with at least one rare, likely disease-causing variant in CTD-associated genes, although only one had a CTD phenotype. No genes were significantly associated with SCAD from genome-wide collapsing analysis, however, enrichment for TGF (transforming growth factor)-β signaling pathway genes was found with analysis of 24 genes harboring novel loss-of-function variants. Both polygenic risk scores demonstrated that sporadic SCAD cases have a significantly elevated genetic SCAD risk compared with controls.
Conclusions:
SCAD shares some genetic overlap with CTD, even in the absence of any major CTD phenotype. Consistent with a complex genetic architecture, SCAD patients also have a higher burden of common variants than controls.
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Affiliation(s)
- Ingrid Tarr
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Stephanie Hesselson
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Siiri E. Iismaa
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- UNSW Sydney, Kensington, NSW, Australia (S.E.I., E.R., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Emma Rath
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- UNSW Sydney, Kensington, NSW, Australia (S.E.I., E.R., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Steven Monger
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Michael Troup
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Ketan Mishra
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Claire M.Y. Wong
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Pei-Chen Hsu
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Keerat Junday
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - David T. Humphreys
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - David Adlam
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, United Kingdom (D.A., T.R.W., A.A.B.-C., S.E.H., N.J.S.)
| | - Tom R. Webb
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, United Kingdom (D.A., T.R.W., A.A.B.-C., S.E.H., N.J.S.)
| | - Anna A. Baranowska-Clarke
- UNSW Sydney, Kensington, NSW, Australia (S.E.I., E.R., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Stephen E. Hamby
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, United Kingdom (D.A., T.R.W., A.A.B.-C., S.E.H., N.J.S.)
| | - Keren J. Carss
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, United Kingdom (K.J.C.)
| | - Nilesh J. Samani
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, United Kingdom (D.A., T.R.W., A.A.B.-C., S.E.H., N.J.S.)
| | - Monique Bax
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Lucy McGrath-Cadell
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- UNSW Sydney, Kensington, NSW, Australia (S.E.I., E.R., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Jason C. Kovacic
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- UNSW Sydney, Kensington, NSW, Australia (S.E.I., E.R., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.C.K.)
- Cardiology Department, St Vincent’s Hospital, Darlinghurst, NSW, Australia (J.C.K., D.F., D.W.M.M., R.M.G.)
| | - Sally L. Dunwoodie
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- UNSW Sydney, Kensington, NSW, Australia (S.E.I., E.R., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Diane Fatkin
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- UNSW Sydney, Kensington, NSW, Australia (S.E.I., E.R., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- Cardiology Department, St Vincent’s Hospital, Darlinghurst, NSW, Australia (J.C.K., D.F., D.W.M.M., R.M.G.)
| | - David W.M. Muller
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- UNSW Sydney, Kensington, NSW, Australia (S.E.I., E.R., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- Cardiology Department, St Vincent’s Hospital, Darlinghurst, NSW, Australia (J.C.K., D.F., D.W.M.M., R.M.G.)
| | - Robert M. Graham
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- UNSW Sydney, Kensington, NSW, Australia (S.E.I., E.R., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- Cardiology Department, St Vincent’s Hospital, Darlinghurst, NSW, Australia (J.C.K., D.F., D.W.M.M., R.M.G.)
| | - Eleni Giannoulatou
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- UNSW Sydney, Kensington, NSW, Australia (S.E.I., E.R., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
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Zekavat SM, Chou EL, Zekavat M, Pampana A, Paruchuri K, Lino Cardenas CL, Koyama S, Ghazzawi Y, Kii E, Uddin MM, Pirruccello J, Zhao H, Wood M, Natarajan P, Lindsay ME. Fibrillar Collagen Variants in Spontaneous Coronary Artery Dissection. JAMA Cardiol 2022; 7:396-406. [PMID: 35234813 PMCID: PMC8892371 DOI: 10.1001/jamacardio.2022.0001] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Spontaneous coronary artery dissection (SCAD) is an increasingly recognized nonatherosclerotic cause of acute myocardial infarction enriched among individuals with early-onset myocardial infarction but is of unclear etiology. OBJECTIVE To assess which genes contribute to the development of SCAD. DESIGN, SETTING, AND PARTICIPANTS To prioritize genes influencing risk for SCAD, whole-exome sequencing was performed among individuals with SCAD in the discovery and replication cohorts from a tertiary care hospital outpatient specialty clinic, and gene set enrichment analyses were also performed for disruptive coding variants. All patients were sequentially enrolled beginning July 2013. Aggregate prevalence of rare disruptive variants for prioritized gene sets was compared between individuals with SCAD with population-based controls comprising 46 468 UK Biobank participants with whole-exome sequencing. Complementary mice models were used for in vivo validation. Analysis took place between June 2020 and January 2021. MAIN OUTCOMES AND MEASURES The frequency and identity of rare genetic variants in individuals with SCAD. RESULTS Of 130 patients, 109 (83.8%) were female (26 of 32 [81.2%] in the discovery cohort and 83 of 98 [84.7%] in the replication cohort) with mean (SD) age at first SCAD event of 48.41 (8.76) years in the discovery cohort and 47.74 (10.09) years in the replication cohort. Across all patients with SCAD, rare disruptive variants were found within 10 collagen genes (COL3A1, COL5A1, COL4A1, COL6A1, COL5A2, COL12A1, COL4A5, COL1A1, COL1A2, and COL27A1) were 17-fold (P = 1.5 × 10-9) enriched among individuals with SCAD compared with a background of 2506 constrained genes expressed in coronary artery. Furthermore, compared with individuals from the UK Biobank, individuals with SCAD were 1.75-fold (P = .04) more likely to carry disruptive rare variants within fibrillar collagen genes. Complementary mice models haploinsufficient for Col3a1 or Col5a1, the 2 most common collagen gene variants identified in SCAD cases, demonstrated increased risk of arterial dissection and increased size of arterial diameters especially in female mice, with resulting changes in collagen fibril organization and diameter. CONCLUSIONS AND RELEVANCE Unbiased gene discovery in patients with SCAD with independent human and murine validation highlights the role of the extracellular matrix dysfunction in SCAD.
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Affiliation(s)
- Seyedeh Maryam Zekavat
- Cardiovascular Research Center, Massachusetts General Hospital, Boston.,Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts
| | - Elizabeth L Chou
- Cardiovascular Research Center, Massachusetts General Hospital, Boston.,Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Melica Zekavat
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
| | - Akhil Pampana
- Cardiovascular Research Center, Massachusetts General Hospital, Boston.,Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts
| | - Kaavya Paruchuri
- Cardiovascular Research Center, Massachusetts General Hospital, Boston.,Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts.,Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Christian Lacks Lino Cardenas
- Cardiovascular Research Center, Massachusetts General Hospital, Boston.,Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Satoshi Koyama
- Cardiovascular Research Center, Massachusetts General Hospital, Boston.,Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts
| | - Yousef Ghazzawi
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston.,Corrigan Women's Heart Health Program, Massachusetts General Hospital, Boston
| | - Erina Kii
- Cardiovascular Research Center, Massachusetts General Hospital, Boston.,Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts
| | - Md Mesbah Uddin
- Cardiovascular Research Center, Massachusetts General Hospital, Boston.,Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts
| | - James Pirruccello
- Cardiovascular Research Center, Massachusetts General Hospital, Boston.,Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts.,Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Hongyu Zhao
- Computational Biology and Bioinformatics Program, Yale University, New Haven, Connecticut
| | - Malissa Wood
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston.,Corrigan Women's Heart Health Program, Massachusetts General Hospital, Boston
| | - Pradeep Natarajan
- Cardiovascular Research Center, Massachusetts General Hospital, Boston.,Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts.,Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston.,Cardiovascular Genetics Program, Massachusetts General Hospital, Boston
| | - Mark E Lindsay
- Cardiovascular Research Center, Massachusetts General Hospital, Boston.,Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts.,Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston.,Cardiovascular Genetics Program, Massachusetts General Hospital, Boston
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