CTEPH has shared and distinct genetic associations with pulmonary embolism in a genome-wide association study
Authors: Liley James , Newnham Michael , Bleda Marta , Bunclark Katherine , Auger William , Barbera Joan Albert , Bogaard Harm , Delcroix Marion , Fernandes Timothy M. , Howard Luke , Jenkins David , Lang Irene , Mayer Eckhard , Rhodes Chris , Simpson Michael , Southgate Laura , Trembath Richard , Wharton John , Wilkins Martin R , Gräf Stefan , Morrell Nicholas , Pepke Zaba Joanna , Toshner Mark 
Published: June 2023

Background

Chronic Thromboembolic Pulmonary Hypertension (CTEPH) involves formation and non-resolution of thrombus, dysregulated inflammation, angiogenesis and the development of a small vessel vasculopathy. We aimed to establish the genetic basis of CTEPH to gain insight into these pathophysiological contributors.

Methods

We conducted a genome-wide association study (GWAS) on 1945 European cases and 10491 European controls. We co-analysed our results from CTEPH with existing results from GWAS on deep vein thrombosis (DVT), pulmonary embolism (PE) and idiopathic PAH (IPAH).

Findings

Our primary GWAS revealed genetic associations at theABO,FGG,TAP2,F2, andTSPAN15loci. Through levered analysis with DVT and PE we demonstrate further CTEPH associations at theF11,EDEM2,SLC44A2andF5loci but find no statistically significant associations shared with IPAH.

Interpretation

CTEPH is a partially heritable polygenic disease, with related though distinct genetic associations to PE and to DVT. The genetic associations atTAP2suggest a potential autoimmune component in CTEPH pathology, and the differential effect size of theF5association in CTEPH compared to PE/DVT, suggests a lower risk ofF5polymorphisms in CTEPH.

Funding

This study was supported by the NIHR cardiorespiratory BRC and an unrestricted grant from Bayer Pharmaceuticals

Research in context

Evidence before this study

This study is the first genome-wide association study (GWAS) in Chronic Thromboembolic Pulmonary Hypertension (CTEPH). There is some existing evidence for genetic associations in the disease: a European study found an increased CTEPH risk in non-O blood groups and large GWAS have been conducted on CTEPH-related diseases pulmonary embolism (PE) and deep vein thrombosis (DVT). A literature review (MedLine and Google Scholar; 14 Dec 2020) using the keywords ‘Chronic Thomboembolic Pulmonary Hypertensions’ or ‘CTEPH’ and ‘genetic’ showed that no other genetic associations with CTEPH have been reported at genome-wide significance (p < 5 x 10-8).

Added value of this study

This study reports several new genetic associations with CTEPH, and identifies similarities and differences between the genetic architectures of CTEPH and DVT/PE. Shared and differential genetic associations between CTEPH and DVT/PE may lead to insights into disease pathobiology and help in developing the potential for use of genetic markers in CTEPH risk prediction

Implications of all the available evidence

CTEPH is associated with multiple genetic variants that includeABO, variants adjacent to theFGG,TAP2,TSPAN15,F2,F5/NME7,F11,SLC44A2andEDEM2genes. CTEPH has a similar but not identical genetic architecture to PE and to DVT. There is no evidence of shared genetic architecture with idiopathic pulmonary arterial hypertension.