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Levin MG, Huffman JE, Verma A, Sullivan KA, Rodriguez AA, Kainer D, Garvin MR, Lane M, Cashman M, Miller JI, Won H, Li B, Luo Y, Jarvik GP, Hakonarson H, Jasper EA, Bick AG, Tsao PS, Ritchie MD, Jacobson DA, Madduri RK, Damrauer SM. Genetics of varicose veins reveals polygenic architecture and genetic overlap with arterial and venous disease. NATURE CARDIOVASCULAR RESEARCH 2023; 2:44-57. [PMID: 39196206 DOI: 10.1038/s44161-022-00196-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 11/23/2022] [Indexed: 08/29/2024]
Abstract
Varicose veins represent a common cause of cardiovascular morbidity, with limited available medical therapies. Although varicose veins are heritable and epidemiologic studies have identified several candidate varicose vein risk factors, the molecular and genetic basis remains uncertain. Here we analyzed the contribution of common genetic variants to varicose veins using data from the Veterans Affairs Million Veteran Program and four other large biobanks. Among 49,765 individuals with varicose veins and 1,334,301 disease-free controls, we identified 139 risk loci. We identified genetic overlap between varicose veins, other vascular diseases and dozens of anthropometric factors. Using Mendelian randomization, we prioritized therapeutic targets via integration of proteomic and transcriptomic data. Finally, topological enrichment analyses confirmed the biologic roles of endothelial shear flow disruption, inflammation, vascular remodeling and angiogenesis. These findings may facilitate future efforts to develop nonsurgical therapies for varicose veins.
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Affiliation(s)
- Michael G Levin
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Jennifer E Huffman
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
| | - Anurag Verma
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Kyle A Sullivan
- Computational and Predictive Biology, Oak Ridge National Laboratory, Oak Ridge, TN, USA
| | - Alexis A Rodriguez
- Data Science and Learning Division, Argonne National Laboratory, Lemont, IL, USA
| | - David Kainer
- Computational and Predictive Biology, Oak Ridge National Laboratory, Oak Ridge, TN, USA
| | - Michael R Garvin
- Computational and Predictive Biology, Oak Ridge National Laboratory, Oak Ridge, TN, USA
| | - Matthew Lane
- Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville, TN, USA
| | - Mikaela Cashman
- Computational and Predictive Biology, Oak Ridge National Laboratory, Oak Ridge, TN, USA
| | - J Izaak Miller
- Computational and Predictive Biology, Oak Ridge National Laboratory, Oak Ridge, TN, USA
| | - Hyejung Won
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - Binglan Li
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Yuan Luo
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Gail P Jarvik
- Departments of Medicine (Division of Medical Genetics) and Genome Sciences, University of Washington Medical Center, Seattle, WA, USA
| | - Hakon Hakonarson
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elizabeth A Jasper
- Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alexander G Bick
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Philip S Tsao
- VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Marylyn D Ritchie
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Institute for Biomedical Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Daniel A Jacobson
- Computational and Predictive Biology, Oak Ridge National Laboratory, Oak Ridge, TN, USA
| | - Ravi K Madduri
- Data Science and Learning Division, Argonne National Laboratory, Lemont, IL, USA
| | - Scott M Damrauer
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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Emrich FC, Okamura H, Dalal AR, Penov K, Merk DR, Raaz U, Hennigs JK, Chin JT, Miller MO, Pedroza AJ, Craig JK, Koyano TK, Blankenberg FG, Connolly AJ, Mohr FW, Alvira CM, Rabinovitch M, Fischbein MP. Enhanced Caspase Activity Contributes to Aortic Wall Remodeling and Early Aneurysm Development in a Murine Model of Marfan Syndrome. Arterioscler Thromb Vasc Biol 2015; 35:146-54. [DOI: 10.1161/atvbaha.114.304364] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective—
Rupture and dissection of aortic root aneurysms remain the leading causes of death in patients with the Marfan syndrome, a hereditary connective tissue disorder that affects 1 in 5000 individuals worldwide. In the present study, we use a Marfan mouse model (
Fbn1
C1039G/+
) to investigate the biological importance of apoptosis during aneurysm development in Marfan syndrome.
Approach and Results—
Using in vivo single-photon emission computed tomographic-imaging and ex vivo autoradiography for Tc99m-annexin, we discovered increased apoptosis in the
Fbn1
C1039G/+
ascending aorta during early aneurysm development peaking at 4 weeks. Immunofluorescence colocalization studies identified smooth muscle cells (SMCs) as the apoptotic cell population. As biological proof of concept that early aortic wall apoptosis plays a role in aneurysm development in Marfan syndrome,
Fbn1
C1039G/+
mice were treated daily from 2 to 6 weeks with either (1) a pan-caspase inhibitor, Q-V
D
-OPh (20 mg/kg), or (2) vehicle control intraperitoneally. Q-V
D
-OPh treatment led to a significant reduction in aneurysm size and decreased extracellular matrix degradation in the aortic wall compared with control mice. In vitro studies using
Fbn1
C1039G/+
ascending SMCs showed that apoptotic SMCs have increased elastolytic potential compared with viable cells, mostly because of caspase activity. Moreover, in vitro (1) cell membrane isolation, (2) immunofluorescence staining, and (3) scanning electron microscopy studies illustrate that caspases are expressed on the exterior cell surface of apoptotic SMCs.
Conclusions—
Caspase inhibition attenuates aneurysm development in an
Fbn1
C1039G/+
Marfan mouse model. Mechanistically, during apoptosis, caspases are expressed on the cell surface of SMCs and likely contribute to elastin degradation and aneurysm development in Marfan syndrome.
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Affiliation(s)
- Fabian C. Emrich
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Homare Okamura
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Alex R. Dalal
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Kiril Penov
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Denis R. Merk
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Uwe Raaz
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Jan K. Hennigs
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Jocelyn T. Chin
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Miquell O. Miller
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Albert J. Pedroza
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Juliana K. Craig
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Tiffany K. Koyano
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Francis G. Blankenberg
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Andrew J. Connolly
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Friedrich W. Mohr
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Cristina M. Alvira
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Marlene Rabinovitch
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
| | - Michael P. Fischbein
- From the Department of Cardiothoracic Surgery (F.C.E., H.O., A.R.D., K.P., D.R.M., J.T.C., M.O.M., A.J.P., J.K.C., T.K.K, M.P.F.), Department of Cardiovascular Medicine (U.R.), Department of Pediatrics (J.K.H., C.M.A, M.R.), Department of Radiology (F.G.B.), and Department of Pathology (A.J.C.), Stanford University, CA; Department of Cardiothoracic Surgery, Heart Center, Leipzig University, Leipzig, Germany (F.C.E., K.P., D.R.M., F.W.M.); and Department of Cardiovascular Surgery, Saitama Medical
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