Mapeamento por miscigenação em amostra de pacientes brasileiros com insuficiência cardíaca

Abstract

Cardiovascular diseases lead the causes of death in several countries, including Brazil, with the heart failure (HF) being one of the most frequent diseases. Associations between genetic ancestry and susceptibility to the development HF have already been reported in different populations. The present study aimed to estimate the global and local ancestry of 492 HF patients, and identify genomic regions and ancestry associated with HF, HF risk factors (diabetes and hypertension) and HF mortality, through admixture mapping (AM). Using 182,090 Single Nucleotide Polymorphisms (SNPs) common to our population and to three ancestral populations (European, African and Amerindian) the analyses of global and local ancestry were performed. All patients showed a higher proportion of European global ancestry, mean of 0.618±0.218. The AM analysis of HF and diabetes did not show any associated regions, in the three ancestries evaluated. In AM of hypertension there was a statistically significant association with African local ancestry on chromosome 2 (chr2p25.3) (p=4,65x10-5). In this region are mapped 7 non-coding RNAs, 2 long intergenic non-protein coding RNAs, 44.93% of the Syntrophin Gamma 2 gene (SNTG2) and the gene encoding a transmembrane protein (TMEM18). The AM analysis of HF mortality was performed with the same 492 HF patients, using casecontrol model, case group (n=248) was composed of patients who died at the end of 4 years of evaluation, and control group (n=244) included individuals who were still alive at the end of that period. A statistically significant association with European local ancestry on chromosome 6 (chr6p22.3) (p=6.805x10-5) was observed. In this region are mapped 30.74% of the gene Ataxin 1 (ATXN1) and the Guanosine Monophosphate Redutase gene (GMPR). The fine mapping in this region, with 7,916 SNPs, presented two genetic markers, rs1042391 and rs2142672, with significant results (p=1,140x10-4 , p=3,921×10-4 , respectively). The TT homozygous allele of rs1042391 was associated with 21% increase risk of HF death (HR=1.21, p=0,0013), while the CC homozygous allele of rs2142672 was associated with 51% increase risk of HF death (HR=1.51, p=0.0004). These are initial findings and, as such, should be considered as generating hypotheses. Despite this, it was demonstrated the utility of the AM study to identify regions with different genomic ancestry that may contribute to the risk of complex diseases in genetically mixed populations. These data may contribute to understand the genetic etiology of hypertension and mortality in HF patients, related to ancestry, and may serve as a starting point for functional studies in an attempt to deepen the knowledge of the biological processes that lead to hypertension and HF. Future studies are needed to replicate the associations found, to detect causal variables that lead these associations, and to explore clinical applications for gene regions consistently associated with death in patients with HF and hypertension.