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Identification of rare sequence variation underlying heritable pulmonary arterial hypertension.

Published version
Peer-reviewed

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Abstract

Pulmonary arterial hypertension (PAH) is a rare disorder with a poor prognosis. Deleterious variation within components of the transforming growth factor-β pathway, particularly the bone morphogenetic protein type 2 receptor (BMPR2), underlies most heritable forms of PAH. To identify the missing heritability we perform whole-genome sequencing in 1038 PAH index cases and 6385 PAH-negative control subjects. Case-control analyses reveal significant overrepresentation of rare variants in ATP13A3, AQP1 and SOX17, and provide independent validation of a critical role for GDF2 in PAH. We demonstrate familial segregation of mutations in SOX17 and AQP1 with PAH. Mutations in GDF2, encoding a BMPR2 ligand, lead to reduced secretion from transfected cells. In addition, we identify pathogenic mutations in the majority of previously reported PAH genes, and provide evidence for further putative genes. Taken together these findings contribute new insights into the molecular basis of PAH and indicate unexplored pathways for therapeutic intervention.

Description

Keywords

Adenosine Triphosphatases, Adult, Aquaporin 1, Base Sequence, Bone Morphogenetic Protein Receptors, Type II, Case-Control Studies, Familial Primary Pulmonary Hypertension, Female, Gene Expression Regulation, Genetic Predisposition to Disease, Growth Differentiation Factor 2, Growth Differentiation Factors, HEK293 Cells, Humans, Male, Membrane Transport Proteins, Models, Molecular, Mutation, Prognosis, SOXF Transcription Factors, Signal Transduction, Transforming Growth Factor beta, Whole Genome Sequencing

Journal Title

Nat Commun

Conference Name

Journal ISSN

2041-1723
2041-1723

Volume Title

9

Publisher

Springer Science and Business Media LLC
Sponsorship
Cambridge University Hospitals NHS Foundation Trust (CUH) (BRC 2012-2017)
Cambridge University Hospitals NHS Foundation Trust (CUH) (unknown)
British Heart Foundation (None)
British Heart Foundation (None)
British Heart Foundation (None)
British Heart Foundation (PG/17/58/33134)
British Heart Foundation (PG/17/1/32532)
British Heart Foundation (PG/15/39/31519)
Cambridge University Hospitals NHS Foundation Trust (CUH) (unknown)
Cambridge University Hospitals NHS Foundation Trust (CUH) (146281)
Medical Research Council (MR/K020919/1)
British Heart Foundation (None)
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