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Genetic Mechanisms Mediating Atherosclerosis Susceptibility at the Chromosome 9p21 Locus

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Abstract

Recent genome-wide association studies have demonstrated that common genetic variants in a region of chromosome 9p21 confer risk of coronary artery disease (CAD) and other atherosclerotic conditions. Although the absolute increase in risk is small (some 20–30% increase in risk of CAD per copy of the deleterious alleles), the common occurrence of the variants means that their effect on the population risk of disease is estimated to be substantial. Studies investigating the relationship between risk variants and both “classical” and “emerging” atherosclerotic risk factors have found no evidence of association. This suggests that the effect of the 9p21 locus on atherosclerotic risk is mediated via a hitherto unknown pathway potentially amenable to therapeutic modulation. Investigation of potential disease mechanisms at this locus is therefore a focus of intense interest. In this review, we discuss the progress that has been made in the study of mechanisms and highlight the outstanding research questions.

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References

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  1. The Wellcome Trust Case Control Consortium. Genome-wide association study of 14,000 cases of seven common diseases and 3,000 shared controls. Nature. 2007;447(7145):661–78.

    Article  Google Scholar 

  2. Helgadottir A, Thorleifsson G, Manolescu A, et al. A common variant on chromosome 9p21 affects the risk of myocardial infarction. Science. 2007;316:1491–3.

    Article  PubMed  CAS  Google Scholar 

  3. McPherson R, Pertsemlidis A, Kavaslar N, et al. A common allele on chromosome 9 associated with coronary heart disease. Science. 2007;316:1488–91.

    Article  PubMed  CAS  Google Scholar 

  4. Samani NJ, Erdmann J, Hall AS, et al. Genomewide association analysis of coronary artery disease. N Engl J Med. 2007;357(5):443–53.

    Article  PubMed  CAS  Google Scholar 

  5. Broadbent HM, Peden JF, Lorkowski S, et al. Susceptibility to coronary artery disease and diabetes is encoded by distinct, tightly linked SNPs in the ANRIL locus on chromosome 9p. Hum Mol Genet. 2008;17(6):806–14.

    Article  PubMed  CAS  Google Scholar 

  6. Emanuele E, Lista S, Ghidoni R, et al.: Chromosome 9p21.3 genotype is associated with vascular dementia and Alzheimer’s disease. Neurobiol Aging 2009, In Press.

  7. Uno S, Zembutsu H, Hirasawa A, et al. A genome-wide association study identifies genetic variants in the CDKN2BAS locus associated with endometriosis in Japanese. Nat Genet. 2010;42(8):707–10.

    Article  PubMed  CAS  Google Scholar 

  8. Helgadottir A, Thorleifsson G, Magnusson KP, et al. The same sequence variant on 9p21 associates with myocardial infarction, abdominal aortic aneurysm and intracranial aneurysm. Nat Genet. 2008;40(2):217–24.

    Article  PubMed  CAS  Google Scholar 

  9. Wrensch M, Jenkins RB, Chang JS, et al. Variants in the CDKN2B and RTEL1 regions are associated with high-grade glioma susceptibility. Nat Genet. 2009;41(8):905–8.

    Article  PubMed  CAS  Google Scholar 

  10. Cluett C, McDermott MM, Guralnik J, et al. The 9p21 myocardial infarction risk allele increases risk of peripheral artery disease in older people. Circ Cardiovasc Genet. 2009;2(4):347–53.

    Article  PubMed  Google Scholar 

  11. Gschwendtner A, Bevan S, Cole JW, et al. Sequence variants on chromosome 9p21.3 confer risk for atherosclerotic stroke. Ann Neurol. 2009;65(5):531–9.

    Article  PubMed  CAS  Google Scholar 

  12. Palomaki GE, Melillo S, Bradley LA. Association between 9p21 genomic markers and heart disease: a meta-analysis. JAMA. 2010;303(7):648–56.

    Article  PubMed  CAS  Google Scholar 

  13. Hinohara K, Nakajima T, Takahashi M, et al. Replication of the association between a chromosome 9p21 polymorphism and coronary artery disease in Japanese and Korean populations. J Hum Genet. 2008;53(4):357–9.

    Article  PubMed  Google Scholar 

  14. Ding H, Xu Y, Wang X, et al. 9p21 is a shared susceptibility locus strongly for coronary artery disease and weakly for ischemic stroke in Chinese Han population. Circ Cardiovasc Genet. 2009;2(4):338–46.

    Article  PubMed  CAS  Google Scholar 

  15. Cunnington MS, Mayosi BM, Hall DH, et al. Novel genetic variants linked to coronary artery disease by genome-wide association are not associated with carotid artery intima-media thickness or intermediate risk phenotypes. Atherosclerosis. 2009;203(1):41–4.

    Article  PubMed  CAS  Google Scholar 

  16. Ye S, Willeit J, Kronenberg F, et al. Association of genetic variation on chromosome 9p21 with susceptibility and progression of atherosclerosis: a population-based, prospective study. J Am Coll Cardiol. 2008;52(5):378–84.

    Article  PubMed  CAS  Google Scholar 

  17. •• Holdt LM, Beutner F, Scholz M, et al.: ANRIL expression is associated with atherosclerosis risk at chromosome 9p21. Arterioscler Thromb Vasc Biol 2010, 30(3): 620–627. This study demonstrated an association between 9p21 atherosclerosis risk variants and expression of ANRIL transcripts in peripheral blood mononuclear cells from 1098 patients with CAD, but no consistent association with expression of CDKN2A, CDKN2B, or MTAP. Results were replicated in 41 atherosclerotic plaques and ANRIL expression was also correlated with the severity of atherosclerosis. Differential effects were seen on expression of different ANRIL transcripts.

    Article  PubMed  CAS  Google Scholar 

  18. Dandona S, Stewart AFR, Chen L, et al. Gene dosage of the common variant 9p21 predicts severity of coronary artery disease. J Am Coll Cardiol. 2010;56(6):479–86.

    Article  PubMed  CAS  Google Scholar 

  19. Horne BD, Carlquist JF, Muhlestein JB, et al. Association of variation in the chromosome 9p21 locus with myocardial infarction versus chronic coronary artery disease. Circ Cardiovasc Genet. 2008;1(2):85–92.

    Article  PubMed  CAS  Google Scholar 

  20. Patel RS, Su S, Neeland IJ, et al.: The chromosome 9p21 risk locus is associated with angiographic severity and progression of coronary artery disease. Eur Heart J 2010: Epub ahead of print.

  21. Shen GQ, Li L, Rao S, et al. Four SNPs on chromosome 9p21 in a South Korean population implicate a genetic locus that confers high cross-race risk for development of coronary artery disease. Arterioscler Thromb Vasc Biol. 2008;28(2):360–5.

    Article  PubMed  CAS  Google Scholar 

  22. Anderson JL, Horne BD, Kolek MJ, et al. Genetic variation at the 9p21 locus predicts angiographic coronary artery disease prevalence but not extent and has clinical utility. Am Heart J. 2008;156(6):1155–1162.e2.

    Article  PubMed  CAS  Google Scholar 

  23. Hiura Y, Fukushima Y, Yuno M, et al. Validation of the association of genetic variants on chromosome 9p21 and 1q41 with myocardial infarction in a Japanese population. Circ J. 2008;72(8):1213–7.

    Article  PubMed  CAS  Google Scholar 

  24. Musunuru K, Post WS, Herzog W, et al. Association of single nucleotide polymorphisms on chromosome 9p21.3 with platelet reactivity. Circ Cardiovasc Genet. 2010;3(5):445–53.

    Article  PubMed  CAS  Google Scholar 

  25. Kim WY, Sharpless NE. The regulation of INK4/ARF in cancer and aging. Cell. 2006;127(2):265–75.

    Article  PubMed  CAS  Google Scholar 

  26. Gil J, Peters G. Regulation of the INK4b-ARF-INK4a tumour suppressor locus: all for one or one for all. Nat Rev Mol Cell Biol. 2006;7(9):667–77.

    Article  PubMed  CAS  Google Scholar 

  27. Holdt LM, Sass K, Gäbel G, et al.: Expression of Chr9p21 genes CDKN2B (p15INK4b), CDKN2A (p16INK4a, p14ARF) and MTAP in human atherosclerotic plaque. Atherosclerosis 2010, In Press.

  28. Dzau VJ, Braun-Dullaeus RC, Sedding DG. Vascular proliferation and atherosclerosis: New perspectives and therapeutic strategies. Nat Med. 2002;8(11):1249–56.

    Article  PubMed  CAS  Google Scholar 

  29. Fuster JJ, Fernandez P, Gonzalez-Navarro H, et al. Control of cell proliferation in atherosclerosis: insights from animal models and human studies. Cardiovasc Res. 2010;86(2):254–64.

    Article  PubMed  CAS  Google Scholar 

  30. Andreassi M. DNA damage, vascular senescence and atherosclerosis. J Mol Med. 2008;86(9):1033–43.

    Article  PubMed  CAS  Google Scholar 

  31. Minamino T, Komuro I. Vascular cell senescence: contribution to atherosclerosis. Circ Res. 2007;100(1):15–26.

    Article  PubMed  CAS  Google Scholar 

  32. Hannon GJ, Beach D. pl5INK4B is a potentia| effector of TGF-beta-induced cell cycle arrest. Nature. 1994;371(6494):257–61.

    Article  PubMed  CAS  Google Scholar 

  33. Kalinina N, Agrotis A, Antropova Y, et al. Smad expression in human atherosclerotic lesions: evidence for impaired TGF-beta/Smad signaling in smooth muscle cells of fibrofatty lesions. Arterioscler Thromb Vasc Biol. 2004;24(8):1391–6.

    Article  PubMed  CAS  Google Scholar 

  34. Christopher SA, Diegelman P, Porter CW, Kruger WD. Methylthioadenosine phosphorylase, a gene frequently codeleted with p16cdkN2a/ARF, acts as a tumor suppressor in a breast cancer cell line. Cancer Res. 2002;62(22):6639–44.

    PubMed  CAS  Google Scholar 

  35. Talmud PJ, Cooper JA, Palmen J, et al. Chromosome 9p21.3 coronary heart disease locus genotype and prospective risk of chd in healthy middle-aged men. Clin Chem. 2008;54(3):467–74.

    Article  PubMed  CAS  Google Scholar 

  36. Liu Y, Sanoff HK, Cho H, et al.: INK4/ARF Transcript expression is associated with chromosome 9p21 variants linked to atherosclerosis. PLoS One 2009, 4(4): e5027. This study found a significant association between genotype at a CAD risk SNP and reduced expression of CDKN2A, ARF, and CDKN2B in peripheral blood T cells from 170 healthy volunteers. No association with expression of these genes was detected for another CAD risk SNPs in the same population.

    Article  PubMed  Google Scholar 

  37. •• Cunnington MS, Santibanez Koref MF, Mayosi BM, et al.: Chromosome 9p21 SNPs associated with multiple disease phenotypes correlate with ANRIL expression. PLoS Genet 2010, 6(4): e1000899. This study showed that CAD risk alleles were all highly associated with reduced expression of ANRIL in peripheral blood from 487 healthy volunteers, yet only a small proportion were significantly associated with CDKN2A and CDKN2B expression. Most of the variation in total expression levels of these genes was due to trans effects (80%–95%), and although total expression levels of the genes are positively correlated SNPs had inverse effects on ANRIL and CDKN2B expression, supporting a role of antisense transcription in CDKN2B regulation. Multiple SNPs independently influenced ANRIL expression in cis.

    Article  PubMed  Google Scholar 

  38. Jarinova O, Stewart AFR, Roberts R, et al.: Functional analysis of the chromosome 9p21.3 coronary artery disease risk locus. Arterioscler Thromb Vasc Biol 2009, 29(10): 1671–1677. This study compared whole blood expression of ANRIL, CDKN2A and CDKN2B in 63 healthy individuals homozygous for the 9p21 risk allele and 61 healthy individuals homozygous for the non-risk allele. The risk allele was associated with reduced expression of the long ANRIL transcript and increased expression of short ANRIL transcripts, but there was no significant association with CDKN2A or CDKN2B expression.

    Article  PubMed  CAS  Google Scholar 

  39. Folkersen L, Kyriakou T, Goel A, et al.: Relationship between CAD risk genotype in the chromosome 9p21 locus and gene expression. identification of eight new ANRIL splice variants. PLoS One 2009, 4(11): e7677. This study documented multiple novel ANRIL transcripts in cells derived from different tissues, highlighting the transcript complexity of this locus. No association was found between genotype at an atherosclerosis risk variant and regional or genome-wide expression data in lymphoblastoid cell lines and atherosclerotic tissues.

    Article  PubMed  Google Scholar 

  40. Pasmant E, Laurendeau I, Heron D, et al. Characterization of a germ-line deletion, including the entire INK4/ARF locus, in a melanoma-neural system tumor family: identification of ANRIL, an antisense noncoding rna whose expression coclusters with ARF. Cancer Res. 2007;67(8):3963–9.

    Article  PubMed  CAS  Google Scholar 

  41. Mattick JS, Makunin IV. Non-coding RNA. Hum Mol Genet. 2006;15(suppl_1):R17–29.

    Article  PubMed  CAS  Google Scholar 

  42. Mercer TR, Dinger ME, Mattick JS. Long non-coding RNAs: insights into functions. Nat Rev Genet. 2009;10(3):155–9.

    Article  PubMed  CAS  Google Scholar 

  43. Bracken AP, Kleine-Kohlbrecher D, Dietrich N, et al. The Polycomb group proteins bind throughout the INK4A-ARF locus and are disassociated in senescent cells. Genes Dev. 2007;21(5):525–30.

    Article  PubMed  CAS  Google Scholar 

  44. Zindy F, Quelle DE, Roussel MF, Sherr CJ. Expression of the p16(INK4a) tumor suppressor versus other INK4 family members during mouse development and aging. Oncogene. 1997;15(2):203–11.

    Article  PubMed  CAS  Google Scholar 

  45. Visel A, Zhu Y, May D, et al.: Targeted deletion of the 9p21 non-coding coronary artery disease risk interval in mice. Nature 2010, 464(7287): 409–12. This study showed that deletion of a 70-kb non-coding region on mouse chromosome 4, which is orthologous to the 9p21 atherosclerosis risk region in humans, was associated with marked reduction of cardiac Cdkn2a and Cdkn2b expression, indicating that distant-acting gene regulatory functions are located in the deleted region. Aortic sooth muscle cells from knockout mice showed excessive proliferation which may contribute to atherosclerosis development.

    Article  PubMed  CAS  Google Scholar 

  46. González-Navarro H, Abu Nabah YN, Vinué Á, et al.: p19ARF deficiency reduces macrophage and vascular smooth muscle cell apoptosis and aggravates atherosclerosis. J Am Coll Cardiol 2010, 55(20): 2258–2268. This study showed that ARF knockout in atherosclerosis-prone apoE-null mice accelerated aortic atheroma development, possibly through attenuated apoptosis of macrophages and vascular smooth muscle cells within atherosclerotic lesions. This supports a direct link between ARF, plaque apoptosis, and atherosclerosis.

    Article  PubMed  Google Scholar 

  47. Yu W, Gius D, Onyango P, et al.: Epigenetic silencing of tumour suppressor gene p15 by its antisense RNA. Nature 2008, 451(7175): 202–206. This study showed that CDKN2B antisense transcription, mapping to the first intron of ANRIL, is associated with down-regulation of CDKN2B expression in leukemia cells and mouse embryonic stem cells, mediated in cis and trans through heterochromatin formation. This suggests that ANRIL may be involved in regulation of CDKN2B expression.

    Article  PubMed  CAS  Google Scholar 

  48. •• Yap KL, Li S, Muñoz-Cabello AM, et al.: Molecular interplay of the noncoding RNA ANRIL and methylated histone H3 lysine 27 by Polycomb CBX7 in transcriptional silencing of INK4a. Mol Cell 2010, 38(5): 662–674. This study showed that ANRIL specifically interacts with CBX7, a protein within the polycomb repressive complex 1 that represses transcription of CDKN2A and CDKN2B. This suggests a direct role of ANRIL in regulating the expression of these genes.

    Article  PubMed  CAS  Google Scholar 

  49. Debniak T, Gorski B, Huzarski T, et al. A common variant of CDKN2A (p16) predisposes to breast cancer. J Med Genet. 2005;42(10):763–5.

    Article  PubMed  CAS  Google Scholar 

  50. The International HapMap Project. [cited 2010 1st November]; Available from: http://www.hapmap.org.

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Cunnington, M.S., Keavney, B. Genetic Mechanisms Mediating Atherosclerosis Susceptibility at the Chromosome 9p21 Locus. Curr Atheroscler Rep 13, 193–201 (2011). https://doi.org/10.1007/s11883-011-0178-z

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