Description

Vivek Nanda1,2, Ting Wang2,3, Milos Pjanic2,3, Boxiang Liu2,3, Thomas Quertermous2,3, Nicholas J Leeper1,2 and Clint L Miller2,3

1Departments of Surgery, 2Stanford Cardiovascular Institute and 3Medicine, Stanford Medicine, California

Atherosclerotic coronary artery disease (CAD) continues to be the leading cause of mortality and morbidity worldwide, with an estimated 40% of one’s lifetime risk attributed to genetic factors. Meta-analysis of genome-wide association studies implemented to identify this risk in human populations, has now identified rs2820315 (P=7.7E-10; OR=1.05), in the smooth muscle cell-restricted gene, Leiomodin 1 (LMOD1), as the leading genetic polymorphism associated with CAD. However, the causal mechanism by which this polymorphism is responsible for predisposition to CAD remains to be identified. Expression quantitative trait loci (eQTL) mapping in GTEx and STARNET databases revealed that carriers of the risk allele at rs2820315 display significantly attenuated LMOD1 expression

in vascular tissues than carriers of the ancestral allele. Epigenomic profiling and fine-mapping analyses identified rs34091558 as a top candidate causal variant in high linkage disequilibrium (r2=0.94) with the lead variant. To determine the mechanism responsible for reduced LMOD1 expression, we performed position weight matrix (PWM) motif analyses and found that rs34091558 disrupts the binding site of a transcription factor called forkhead box O3 (FOXO3). Subsequent chromatin immunoprecipitation and reporter assays demonstrated reduced FOXO3 binding and transcriptional activity by the risk allele in cultured HCASMCs. Platelet-derived growth factor BB (PDGF-BB) stimulation also significantly reduced LMOD1 expression coincident with FOXO3 knockdown. Finally, both gain and loss-of-function for FOXO3 and LMOD1 in HCASMC delineated a regulatory circuit by which LMOD1 regulates SMC proliferation, migration and contraction, characteristic features of atherosclerotic lesion progression. Taken together, these results provide compelling functional evidence that: 1) rs3091558 is associated with reduced LMOD1 expression, 2) this reduction appears to be mediated through the inhibition of FOXO3 binding and 3) changes in vessel wall processes through LMOD1 dysregulation may partially explain the heritable risk for CAD.