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Gehlen J, Stundl A, Debiec R, Fontana F, Krane M, Sharipova D, Nelson CP, Al-Kassou B, Giel AS, Sinning JM, Bruenger CMH, Zelck CF, Koebbe LL, Braund PS, Webb TR, Hetherington S, Ensminger S, Fujita B, Mohamed SA, Shrestha M, Krueger H, Siepe M, Kari FA, Nordbeck P, Buravezky L, Kelm M, Veulemans V, Adam M, Baldus S, Laugwitz KL, Haas Y, Karck M, Mehlhorn U, Conzelmann LO, Breitenbach I, Lebherz C, Urbanski P, Kim WK, Kandels J, Ellinghaus D, Nowak-Goettl U, Hoffmann P, Wirth F, Doppler S, Lahm H, Dreßen M, von Scheidt M, Knoll K, Kessler T, Hengstenberg C, Schunkert H, Nickenig G, Nöthen MM, Bolger AP, Abdelilah-Seyfried S, Samani NJ, Erdmann J, Trenkwalder T, Schumacher J. Elucidation of the genetic causes of bicuspid aortic valve disease. Cardiovasc Res 2023; 119:857-866. [PMID: 35727948 PMCID: PMC10153415 DOI: 10.1093/cvr/cvac099] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 05/21/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS The present study aims to characterize the genetic risk architecture of bicuspid aortic valve (BAV) disease, the most common congenital heart defect. METHODS AND RESULTS We carried out a genome-wide association study (GWAS) including 2236 BAV patients and 11 604 controls. This led to the identification of a new risk locus for BAV on chromosome 3q29. The single nucleotide polymorphism rs2550262 was genome-wide significant BAV associated (P = 3.49 × 10-08) and was replicated in an independent case-control sample. The risk locus encodes a deleterious missense variant in MUC4 (p.Ala4821Ser), a gene that is involved in epithelial-to-mesenchymal transformation. Mechanistical studies in zebrafish revealed that loss of Muc4 led to a delay in cardiac valvular development suggesting that loss of MUC4 may also play a role in aortic valve malformation. The GWAS also confirmed previously reported BAV risk loci at PALMD (P = 3.97 × 10-16), GATA4 (P = 1.61 × 10-09), and TEX41 (P = 7.68 × 10-04). In addition, the genetic BAV architecture was examined beyond the single-marker level revealing that a substantial fraction of BAV heritability is polygenic and ∼20% of the observed heritability can be explained by our GWAS data. Furthermore, we used the largest human single-cell atlas for foetal gene expression and show that the transcriptome profile in endothelial cells is a major source contributing to BAV pathology. CONCLUSION Our study provides a deeper understanding of the genetic risk architecture of BAV formation on the single marker and polygenic level.
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Affiliation(s)
- Jan Gehlen
- Institute of Human Genetics, University of Bonn and University Hospital Bonn, Bonn, Germany
- Institute of Human Genetics, Philipps University of Marburg, Marburg, Germany
| | - Anja Stundl
- Department of Medicine II, Heart Center Bonn, University of Bonn and University Hospital Bonn, Bonn, Germany
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Radoslaw Debiec
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
- East Midlands Congenital Heart Centre, Glenfield Hospital, Leicester, UK
| | - Federica Fontana
- Institute of Biochemistry and Biology, Potsdam University, Potsdam, Germany
| | - Markus Krane
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Division of Experimental Surgery, Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Dinara Sharipova
- Institute of Biochemistry and Biology, Potsdam University, Potsdam, Germany
| | - Christopher P Nelson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Baravan Al-Kassou
- Department of Medicine II, Heart Center Bonn, University of Bonn and University Hospital Bonn, Bonn, Germany
| | - Ann-Sophie Giel
- Institute of Human Genetics, Philipps University of Marburg, Marburg, Germany
| | - Jan-Malte Sinning
- Department of Medicine II, Heart Center Bonn, University of Bonn and University Hospital Bonn, Bonn, Germany
| | | | - Carolin F Zelck
- Institute of Human Genetics, Philipps University of Marburg, Marburg, Germany
| | - Laura L Koebbe
- Institute of Human Genetics, Philipps University of Marburg, Marburg, Germany
| | - Peter S Braund
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Thomas R Webb
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | | | - Stephan Ensminger
- Department of Cardiac and Thoracic Vascular Surgery, University Heart Center Lübeck, University Hospital of Schleswig-Holstein, Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Buntaro Fujita
- Department of Cardiac and Thoracic Vascular Surgery, University Heart Center Lübeck, University Hospital of Schleswig-Holstein, Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Salah A Mohamed
- Department of Cardiac and Thoracic Vascular Surgery, University Heart Center Lübeck, University Hospital of Schleswig-Holstein, Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Malakh Shrestha
- Department of Adult and Pediatric Cardiothoracic Surgery, Vascular Surgery, Heart and Lung Transplantation, Hannover Medical School, Hannover, Germany
| | - Heike Krueger
- Department of Adult and Pediatric Cardiothoracic Surgery, Vascular Surgery, Heart and Lung Transplantation, Hannover Medical School, Hannover, Germany
| | - Matthias Siepe
- Heart Center Freiburg/Bad Krozingen, University Freiburg/Bad Krozingen, Freiburg, Germany
| | - Fabian Alexander Kari
- Heart Center Freiburg/Bad Krozingen, University Freiburg/Bad Krozingen, Freiburg, Germany
| | - Peter Nordbeck
- Medizinische Klinik und Poliklinik I, University Hospital Würzburg, Würzburg, Germany
| | - Larissa Buravezky
- Medizinische Klinik und Poliklinik I, University Hospital Würzburg, Würzburg, Germany
| | - Malte Kelm
- Department of Cardiology, Pneumology and Angiology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Verena Veulemans
- Department of Cardiology, Pneumology and Angiology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Matti Adam
- Department of Medicine III, Heart Center Cologne, University Hospital Cologne, Cologne, Germany
| | - Stephan Baldus
- Department of Medicine III, Heart Center Cologne, University Hospital Cologne, Cologne, Germany
| | - Karl-Ludwig Laugwitz
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Yannick Haas
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Matthias Karck
- Department of Cardiothoracic Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Uwe Mehlhorn
- Department of Cardiothoracic Surgery, Helios Klinik Karlsruhe, Karlsruhe, Germany
| | | | - Ingo Breitenbach
- Department of Cardiothoracic Surgery and Vascular Surgery, Clinic of Braunschweig, Braunschweig, Germany
| | - Corinna Lebherz
- Department of Medicine I, Cardiology/Angiology/Intensive Care, University Hospital Aachen, Aachen, Germany
| | - Paul Urbanski
- Department of Cardiovascular Surgery, Cardiovascular Clinic, Rhön-Klinikum Campus Bad Neustadt, Neustadt, Germany
| | - Won-Keun Kim
- Department of Cardiology, Heart Center, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Joscha Kandels
- Department of Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - David Ellinghaus
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
- Novo Nordisk Foundation Center for Protein Research, Disease Systems Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ulrike Nowak-Goettl
- Department of Clinical Chemistry, Thrombosis and Hemostasis Unit, University Hospital of Kiel and Lübeck, Kiel, Germany
| | - Per Hoffmann
- Institute of Human Genetics, University of Bonn and University Hospital Bonn, Bonn, Germany
| | - Felix Wirth
- Division of Experimental Surgery, Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Stefanie Doppler
- Division of Experimental Surgery, Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Harald Lahm
- Division of Experimental Surgery, Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Martina Dreßen
- Division of Experimental Surgery, Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Moritz von Scheidt
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
| | - Katharina Knoll
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
| | - Thorsten Kessler
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Heribert Schunkert
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
| | - Georg Nickenig
- Department of Medicine II, Heart Center Bonn, University of Bonn and University Hospital Bonn, Bonn, Germany
| | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn and University Hospital Bonn, Bonn, Germany
| | - Aidan P Bolger
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
- East Midlands Congenital Heart Centre, Glenfield Hospital, Leicester, UK
- Institute of Biochemistry and Biology, Potsdam University, Potsdam, Germany
| | - Salim Abdelilah-Seyfried
- Institute of Biochemistry and Biology, Potsdam University, Potsdam, Germany
- Institute of Molecular Biology, Hannover Medical School, Hannover, Germany
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Jeanette Erdmann
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
- Institute for Cardiogenetics, University Heart Centre Lübeck, University of Lübeck, Lübeck, Germany
| | - Teresa Trenkwalder
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
| | - Johannes Schumacher
- Institute of Human Genetics, University of Bonn and University Hospital Bonn, Bonn, Germany
- Institute of Human Genetics, Philipps University of Marburg, Marburg, Germany
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