Endothelin 1 gene as a modifier in dilated cardiomyopathy

• Two rare variations; G>A and a C>T at c.90 and c.119 were observed.
• Secondary mRNA structures of variants with less stability affect protein folding.
• Heterozygotes (3A/4A) were found to be at higher risk for DCM (OR 4.12, p = 0.0001).
• 4A-T was found to be the risk haplotype for DCM (OR 5.90, p = 0.0001).
• Overall, females carrying the risk alleles (4A, T) were at high risk for DCM.

Dilated cardiomyopathy (DCM) is a myocardial disease of unknown etiology with left ventricular dilatation and impaired myocardial contractility leading to heart failure. It is considered to be a multifactorial disorder with the interplay of both genetic and environmental factors. One of the possible genes implicated in DCM is endothelin 1 (EDN1). The genetic variants of EDN1 may be involved in the pathophysiology of DCM hence the entire EDN1 gene was screened to examine for the possible genotypic associations with DCM. A total of 115 DCM patients and 250 control subjects were included in the present study. PCR based SSCP analysis was carried out followed by commercial sequencing. Screening of EDN1 revealed two common and two rare polymorphisms. Allelic and genotypic frequencies were estimated in patient and control groups by appropriate statistical tests. The heterozygotes of insertion variation (+ 138A) were found to exhibit four-fold increase risk to DCM (OR = 4.12, 95% CI 2.10–8.08; p = 0.0001). The two rare variants (G>A transition (rs150035515) at c.90 and C>T transition (rs149399492) at c.119) observed in the present study were found to be unique in DCM. The secondary mRNA structures of these variations were found to have less free energy than wild type. The haplotype analysis revealed 4A–T to be risk haplotype for DCM (OR 5.90, 95% CI 2.29–15.25, p = 0.0001). In conclusion, EDN1 polymorphisms (+ 138A, A30A, T40I) appear to play a significant role in the pathogenesis of DCM, as they influence the stability of protein. The increased EDN1 production may lead to constriction of coronary arteries, reducing coronary blood flow which may in turn increase the load on left ventricle, impairing contractility of the heart resulting in a DCM phenotype, an end stage of heart failure.