E nvironmental hypoxia is an important cause of pulmonary hypertension worldwide. Reducing alveolar Po 2 causes pulmonary vasoconstriction.1 Chronic exposure to hypoxia leads to pulmonary vascular remodeling, including increased muscularization of distal arterioles, with extension of muscle into previously unmuscularized vessels, and an increase in the collagen and elastin content of the vessel wall. 2 The increased pressure-load on the right ventricle reduces exercise capacity and can lead to right heart failure.
Clinical Perspective on p 929Variation in susceptibility to hypoxia-induced pulmonary hypertension is well recognized, both between and within species, and has a genetic basis. The Tibetans are notably well-adapted to high-altitude life, having lived >3000 m for thousands of years, 3 and are less susceptible than recent migrants to high-altitude pulmonary hypertension. 4 The Kyrgyz have inhabited the high plains of the Tien-Shen and Background-Human variation in susceptibility to hypoxia-induced pulmonary hypertension is well recognized. Highaltitude residents who do not develop pulmonary hypertension may host protective gene mutations. Methods and Results-Exome sequencing was conducted on 24 unrelated Kyrgyz highlanders living 2400 to 3800 m above sea level, 12 (10 men; mean age, 54 years) with an elevated mean pulmonary artery pressure (mean±SD, 38.7±2.7 mm Hg) and 12 (11 men; mean age, 52 years) with a normal mean pulmonary artery pressure (19.2±0.6 mm Hg) to identify candidate genes that may influence the pulmonary vascular response to hypoxia. A total of 140 789 exomic variants were identified and 26 116 (18.5%) were classified as novel or rare. Thirty-three novel or rare potential pathogenic variants (frameshift, essential splice-site, and nonsynonymous) were found exclusively in either ≥3 subjects with high-altitude pulmonary hypertension or ≥3 highlanders with a normal mean pulmonary artery pressure. A novel missense mutation in GUCY1A3 in 3 subjects with a normal mean pulmonary artery pressure encodes an α 1 -A680T soluble guanylate cyclase (sGC) variant. Expression of the α 1 -A680T sGC variant in reporter cells resulted in higher cyclic guanosine monophosphate production compared with the wild-type enzyme and the purified α 1 -A680T sGC exhibited enhanced sensitivity to nitric oxide in vitro. Conclusions-The α 1 -A680T sGC variant may contribute to protection against high-altitude pulmonary hypertension and supports sGC as a pharmacological target for reducing pulmonary artery pressure in humans at altitude. We hypothesized that adult Kyrgyz highlanders who do not experience pulmonary hypertension at altitude may host gene mutations that are protective. We compared the exomes of resident ethnic Kyrgyz highlanders with and without pulmonary hypertension to identify candidate genes that may influence the pulmonary vascular response to hypoxia. An activating mutation was identified in the GUCY1A3 gene, encoding the α subunit of soluble guanylate cyclase (sGC).
Methods
SubjectsIn successive ...