SOX17 Loss-of-Function Mutation Underlying Familial Pulmonary Arterial Hypertension

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  • Wang Tian-Ming
    Department of Pediatrics, Tongji Hospital, Tongji University School of Medicine
  • Wang Shan-Shan
    Department of Pediatrics, Tongji Hospital, Tongji University School of Medicine
  • Xu Ying-Jia
    Department of Cardiology, Shanghai Fifth People's Hospital, Fudan University
  • Zhao Cui-Mei
    Department of Cardiology, Tongji Hospital, Tongji University School of Medicine
  • Qiao Xiao-Hui
    Department of Pediatric Internal Medicine, Ningbo Women & Children's Hospital
  • Yang Chen-Xi
    Department of Cardiology, Shanghai Fifth People's Hospital, Fudan University
  • Liu Xing-Yuan
    Department of Pediatrics, Tongji Hospital, Tongji University School of Medicine
  • Yang Yi-Qing
    Department of Cardiology, Shanghai Fifth People's Hospital, Fudan University Cardiovascular Research Laboratory, Shanghai Fifth People's Hospital, Fudan University Central Laboratory, Shanghai Fifth People's Hospital, Fudan University

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<p>Pulmonary arterial hypertension (PAH) refers to a rare, progressive disorder that is characterized by occlusive pulmonary vascular remodeling, resulting in increased pulmonary arterial pressure, right-sided heart failure, and eventual death. Emerging evidence from genetic investigations of pediatric-onset PAH highlights the strong genetic basis underpinning PAH, and deleterious variants in multiple genes have been found to cause PAH. Nevertheless, PAH is of substantial genetic heterogeneity, and the genetic defects underlying PAH in the overwhelming majority of cases remain elusive. In this investigation, a consanguineous family suffering from PAH transmitted as an autosomal-dominant trait was identified. Through whole-exome sequencing and bioinformatic analyses as well as Sanger sequencing analyses of the PAH family, a novel heterozygous SOX17 mutation, NM_022454.4: c.379C>T; p. (Gln127*), was found to co-segregate with the disease in the family, with complete penetrance. The nonsense mutation was neither observed in 612 unrelated healthy volunteers nor retrieved in the population genetic databases encompassing the Genome Aggregation Database, the Exome Aggregation Consortium database, and the Single Nucleotide Polymorphism database. Biological analyses using a dual-luciferase reporter assay system revealed that the Gln127*-mutant SOX17 protein lost the ability to transcriptionally activate its target gene NOTCH1. Moreover, the Gln127*-mutant SOX17 protein exhibited no inhibitory effect on the function of CTNNB1-encode β-catenin, which is a key player in vascular morphogenesis. This research firstly links SOX17 loss-of-function mutation to familial PAH, which provides novel insight into the molecular pathogenesis of PAH, suggesting potential implications for genetic and prognostic risk evaluation as well as personalized prophylaxis of the family members affected with PAH.</p>

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