Association of Methylation Signals With Incident Coronary Heart Disease in an Epigenome-Wide Assessment of Circulating Tumor Necrosis Factor α
Authors: Stella Aslibekyan, Golareh Agha, Elena Colicino, Anh N. Do, Jari Lahti, Symen Ligthart, Riccardo E. Marioni, Carola Marzi, Michael M. Mendelson, Toshiko Tanaka, Matthias Wielscher, Devin M. Absher, Luigi Ferrucci, Oscar H. Franco, Christian Gieger, Harald Grallert, Dena Hernandez, Tianxiao Huan, Stella Iurato, Roby Joehanes, Allan C. Just, Sonja Kunze, Honghuang Lin, Chunyu Liu, James B. Meigs, Joyce B. J. van Meurs, Ann Zenobia Moore, Annette Peters, Holger Prokisch, Katri Räikkönen, Wolfgang Rathmann, Michael Roden, Katharina Schramm, Joel D. Schwartz, John M. Starr, André G. Uitterlinden, Pantel Vokonas, Melanie Waldenberger, Chen Yao, Degui Zhi, Andrea A. Baccarelli, Stefania Bandinelli, Ian J. Deary, Abbas Dehghan, Johan Eriksson, Christian Herder, Marjo-Riitta Jarvelin, Daniel Levy, Donna K. Arnett
Journal: JAMA Cardiology (2018)

<h3>Importance</h3> Tumor necrosis factor α (TNF-α) is a proinflammatory cytokine with manifold consequences for mammalian pathophysiology, including cardiovascular disease. A deeper understanding of TNF-α biology may enhance treatment precision. <h3>Objective</h3> To conduct an epigenome-wide analysis of blood-derived DNA methylation and TNF-α levels and to assess the clinical relevance of findings. <h3>Design, Setting, and Participants</h3> This meta-analysis assessed epigenome-wide associations in circulating TNF-α concentrations from 5 cohort studies and 1 interventional trial, with replication in 3 additional cohort studies. Follow-up analyses investigated associations of identified methylation loci with gene expression and incident coronary heart disease; this meta-analysis included 11 461 participants who experienced 1895 coronary events. <h3>Exposures</h3> Circulating TNF-α concentration. <h3>Main Outcomes and Measures</h3> DNA methylation at approximately 450 000 loci, neighboring DNA sequence variation, gene expression, and incident coronary heart disease. <h3>Results</h3> The discovery cohort included 4794 participants, and the replication study included 816 participants (overall mean [SD] age, 60.7 [8.5] years). In the discovery stage, circulating TNF-α levels were associated with methylation of 7 cytosine-phosphate-guanine (CpG) sites, 3 of which were located in or near<i>DTX3L-PARP9 </i>at cg00959259 (β [SE] = −0.01 [0.003];<i>P</i> = 7.36 × 10<sup>−8</sup>), cg08122652 (β [SE] = −0.008 [0.002];<i>P</i> = 2.24 × 10<sup>−7</sup>), and cg22930808(β [SE] = −0.01 [0.002];<i>P</i> = 6.92 × 10<sup>−8</sup>);<i>NLRC5</i>at cg16411857 (β [SE] = −0.01 [0.002];<i>P</i> = 2.14 × 10<sup>−13</sup>) and cg07839457 (β [SE] = −0.02 [0.003];<i>P</i> = 6.31 × 10<sup>−10</sup>); or<i>ABO</i>, at cg13683939 (β [SE] = 0.04 [0.008];<i>P</i> = 1.42 × 10<sup>−7</sup>) and cg24267699 (β [SE] = −0.009 [0.002];<i>P</i> = 1.67 × 10<sup>−7</sup>), after accounting for multiple testing. Of these, negative associations between TNF-α concentration and methylation of 2 loci in<i>NLRC5</i>and 1 in<i>DTX3L-14 PARP9</i>were replicated. Replicated TNF-α–linked CpG sites were associated with 9% to 19% decreased risk of incident coronary heart disease per 10% higher methylation per CpG site (cg16411857: hazard ratio [HR], 0.86; 95% CI, 0.78-1.95;<i>P</i> = .003; cg07839457: HR, 0.89; 95% CI, 0.80-0.94;<i>P</i> = 3.1 × 10<sup>−5</sup>; cg00959259: HR, 0.91; 95% CI, 0.84-0.97;<i>P</i> = .002; cg08122652: HR, 0.81; 95% CI, 0.74-0.89;<i>P</i> = 2.0 × 10<sup>−5</sup>). <h3>Conclusions and Relevance</h3> We identified and replicated novel epigenetic correlates of circulating TNF-α concentration in blood samples and linked these loci to coronary heart disease risk, opening opportunities for validation and therapeutic applications.