Identification of rare sequence variation underlying heritable pulmonary arterial hypertension

• Published in: Nature communications Vol. 9; no. 1; pp. 1416 - 16
• Main Authors: Gräf, Stefan, Haimel, Matthias, Bleda, Marta, Hadinnapola, Charaka, Southgate, Laura, Li, Wei, Hodgson, Joshua, Liu, Bin, Salmon, Richard M., Southwood, Mark, Machado, Rajiv D., Martin, Jennifer M., Treacy, Carmen M., Yates, Katherine, Daugherty, Louise C., Shamardina, Olga, Whitehorn, Deborah, Holden, Simon, Aldred, Micheala, Bogaard, Harm J., Church, Colin, Coghlan, Gerry, Condliffe, Robin, Corris, Paul A., Danesino, Cesare, Eyries, Mélanie, Gall, Henning, Ghio, Stefano, Ghofrani, Hossein-Ardeschir, Gibbs, J. Simon R., Girerd, Barbara, Houweling, Arjan C., Howard, Luke, Humbert, Marc, Kiely, David G., Kovacs, Gabor, MacKenzie Ross, Robert V., Moledina, Shahin, Montani, David, Newnham, Michael, Olschewski, Andrea, Olschewski, Horst, Peacock, Andrew J., Pepke-Zaba, Joanna, Prokopenko, Inga, Rhodes, Christopher J., Scelsi, Laura, Seeger, Werner, Soubrier, Florent, Stein, Dan F., Suntharalingam, Jay, Swietlik, Emilia M., Toshner, Mark R., van Heel, David A., Vonk Noordegraaf, Anton, Waisfisz, Quinten, Wharton, John, Wort, Stephen J., Ouwehand, Willem H., Soranzo, Nicole, Lawrie, Allan, Upton, Paul D., Wilkins, Martin R., Trembath, Richard C., Morrell, Nicholas W.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 12.04.2018; Nature Publishing Group; Nature Portfolio
• Subjects: 631/114/2785; 631/208/726/649/2219; 692/308/2056; 692/699/75/593/2724; Adenosine Triphosphatases - chemistry; Adenosine Triphosphatases - genetics; Adenosine Triphosphatases - metabolism; Adult; Aquaporin 1; Aquaporin 1 - chemistry; Aquaporin 1 - genetics; Aquaporin 1 - metabolism; Base Sequence; Bone morphogenetic protein receptor type II; Bone Morphogenetic Protein Receptors, Type II - genetics; Bone Morphogenetic Protein Receptors, Type II - metabolism; Case-Control Studies; Familial Primary Pulmonary Hypertension - diagnosis; Familial Primary Pulmonary Hypertension - genetics; Familial Primary Pulmonary Hypertension - metabolism; Familial Primary Pulmonary Hypertension - pathology; Female; Gene Expression Regulation; Gene sequencing; Genes; Genetic Predisposition to Disease; Genomes; Growth Differentiation Factor 2; Growth Differentiation Factors - chemistry; Growth Differentiation Factors - genetics; Growth Differentiation Factors - metabolism; HEK293 Cells; Heritability; Humanities and Social Sciences; Humans; Hypertension; Life Sciences; Male; Membrane Transport Proteins - chemistry; Membrane Transport Proteins - genetics; Membrane Transport Proteins - metabolism; Models, Molecular; multidisciplinary; Mutation; Prognosis; Pulmonary hypertension; Science; Science (multidisciplinary); Secretion; Signal Transduction; SOXF Transcription Factors - chemistry; SOXF Transcription Factors - genetics; SOXF Transcription Factors - metabolism; Transforming growth factor; Transforming Growth Factor beta - genetics; Transforming Growth Factor beta - metabolism; Transforming growth factor-b; Whole Genome Sequencing
• ISSN: 2041-1723; 2041-1723
• DOI: 10.1038/s41467-018-03672-4

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. Pulmonary arterial hypertension (PAH) is a rare lung disorder characterised by narrowing and obliteration of small pulmonary arteries ultimately leading to right heart failure. Here, the authors sequence whole genomes of over 1000 PAH patients and identify likely causal variants in GDF2 , ATP13A3 , AQP1 and SOX17 .