Key result
Two common deletion copy number variants within the PCDHA gene cluster were significantly associated with left ventricular outflow tract obstructions (OR 1.47; 95% CI 1.13-1.92; p=4.2×10−3).
Why the study?
BAV and related left ventricular outflow tract obstructions have a complex, heterogeneous genetic etiology, and mouse studies implicated Pcdha mutations in these phenotypes.
Do common deletion variants in the PCDHA gene cluster increase the risk of left ventricular outflow tract obstructions (LVOTO) and bicuspid aortic valve (BAV)?
Case-Control (n=3,414)
Do common deletion variants in the PCDHA gene cluster increase the risk of left ventricular outflow tract obstructions (LVOTO) and bicuspid aortic valve (BAV)?
Odds Ratio: 1.47 (95% CI 1.13–1.92)
p-value: p=4.2 × 10−3
Common deletion variants causing PCDHA deficiency are significantly associated with an increased risk of bicuspid aortic valve and other left-sided congenital heart diseases, demonstrating a complex genetic etiology.
Animal models underscore LVOTO genetic heterogeneity; leaves open causal variant discovery for human BAV and LVOTO risk.
Bicuspid aortic valve (BAV) with ∼1%–2% prevalence is the most common congenital heart defect (CHD). It frequently results in valve disease and aorta dilation and is a major cause of adult cardiac surgery. BAV is genetically linked to rare left-heart obstructions (left ventricular outflow tract obstructions [LVOTOs]), including hypoplastic left heart syndrome (HLHS) and coarctation of the aorta (CoA). Mouse and human studies indicate LVOTO is genetically heterogeneous with a complex genetic etiology. Homozygous mutation in the Pcdha protocadherin gene cluster in mice can cause BAV, and also HLHS and other LVOTO phenotypes when accompanied by a second mutation. Here we show two common deletion copy number variants (delCNVs) within the PCDHA gene cluster are associated with LVOTO. Analysis of 1,218 white individuals with LVOTO versus 463 disease-free local control individuals yielded odds ratios (ORs) at 1.47 (95% confidence interval [CI], 1.13–1.92; p = 4.2 × 10−3) for LVOTO, 1.47 (95% CI, 1.10–1.97; p = 0.01) for BAV, 6.13 (95% CI, 2.75–13.7; p = 9.7 × 10−6) for CoA, and 1.49 (95% CI, 1.07–2.08; p = 0.019) for HLHS. Increased OR was observed for all LVOTO phenotypes in homozygous or compound heterozygous PCDHA delCNV genotype comparison versus wild type. Analysis of an independent white cohort (381 affected individuals, 1,352 control individuals) replicated the PCDHA delCNV association with LVOTO. Generalizability of these findings is suggested by similar observations in Black and Chinese individuals with LVOTO. Analysis of Pcdha mutant mice showed reduced PCDHA expression at regions of cell-cell contact in aortic smooth muscle and cushion mesenchyme, suggesting potential mechanisms for BAV pathogenesis and aortopathy. Together, these findings indicate common variants causing PCDHA deficiency play a significant role in the genetic etiology of common and rare LVOTO-CHD.
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Teekakirikul et al. (2021) conducted a case-control in Left ventricular outflow tract obstructions (LVOTO) and Bicuspid aortic valve (BAV) (n=3,414). PCDHA deletion copy number variants (delCNVs) vs. Wild type was evaluated on Left ventricular outflow tract obstructions (LVOTO) (OR 1.47, 95% CI 1.13-1.92, p=4.2 × 10−3). Two common deletion copy number variants within the PCDHA gene cluster were significantly associated with left ventricular outflow tract obstructions (OR 1.47; 95% CI 1.13-1.92; p=4.2×10−3).
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