Background:
Our previous GWAS identified genetic variants at six novel loci that were associated with a decline in left ventricular ejection fraction (LVEF),
p
< 1 × 10
−5
in 1,191 early breast cancer patients from the N9831 clinical trial of chemotherapy plus trastuzumab. In this study we sought replication of these loci.
Methods:
We tested the top loci from the GWAS for association with chemotherapy-related heart failure (CRHF) using 26 CRHF cases from N9831 and 984 patients from the Mayo Clinic Biobank which included CRHF cases (
N
= 12) and control groups of patients treated with anthracycline +/– trastuzumab without HF (
N
= 282) and patients with HF that were never treated with anthracycline or trastuzumab (
N
= 690). We further examined associated loci in the context of gene expression and rare coding variants using a TWAS approach in heart left ventricle and Sanger sequencing, respectively. Doxorubicin-induced apoptosis and cardiomyopathy was modeled in human iPSC-derived cardiomyocytes and endothelial cells and a mouse model, respectively, that were pre-treated with GsMTx-4, an inhibitor of TRPC6.
Results:
TRPC6 5
′ flanking variant rs57242572-T was significantly more frequent in cases compared to controls,
p
= 0.031, and rs61918162-T showed a trend for association,
p
= 0.065. The rs61918162 T-allele was associated with higher
TRPC6
expression in the heart left ventricle. We identified a single
TRPC6
rare missense variant (rs767086724, N338S, prevalence 0.0025% in GnomAD) in one of 38 patients (2.6%) with CRHF. Pre-treatment of cardiomyocytes and endothelial cells with GsMTx4 significantly reduced doxorubicin-induced apoptosis. Similarly, mice treated with GsMTx4 had significantly improved doxorubicin-induced cardiac dysfunction.
Conclusions:
Genetic variants that are associated with increased
TRPC6
expression in the heart and rare
TRPC6
missense variants may be clinically useful as risk factors for CRHF. GsMTx-4 may be a cardioprotective agent in patients with
TRPC6
risk variants. Replication of the genetic associations in larger well-characterized samples and functional studies are required.