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A Web-Based Workflow for Selecting Gene- and Tissue-Specific Enhancers
Published on: July 18, 2025
Two novel and functional DNA sequence variants within an upstream enhancer of the human NKX2-5 gene in ventricular
Wenhui Huang1, Haihong Meng, Yuangang Qiao
1Shandong Provincial Key Laboratory of Cardiac Disease Diagnosis and Treatment, Jining Medical University Affiliated Hospital, Jining Medical University, Jining, Shandong 272029, China.
Abstract:
Mortality in patients with congenital heart disease (CHD) is significantly increased even with successful surgeries. The main causes are late cardiac complications, such as heart failure and arrhythmia, probably due to genetic defects. To date, genetic causes for CHD remain largely unknown. NKX2-5 gene encodes a highly conserved homeobox transcription factor, which is essential to the heart development in embryos and cardiac function in adults. Mutations in NKX2-5 gene have been implicated in diverse types of CHD, including ventricular septal defect (VSD). As NKX2-5 is a dosage-sensitive regulator, we have speculated that changed NKX2-5 levels may mediate CHD development by influencing cardiac gene regulatory network. In previous studies, we have analyzed the NKX2-5 gene promoter and a proximal enhancer in VSD patients. In the present study, we further genetically and functionally analyzed an upstream enhancer of the NKX2-5 gene in large cohorts of VSD patients (n=340) and controls (n=347). Two novel heterozygous DNA sequence variants (DSVs), g.17483576C>G and g.17483564C>T, were identified in three VSD patients, but none in controls. Functionally, these two DSVs significantly decreased the activity of the enhancer (P<0.01). Another novel heterozygous DSV, g.17483557Ins, was found in both VSD patients and controls with similar frequencies (P>0.05). Taken together, our data suggested that the DSVs within the upstream enhancer of the NKX2-5 gene may contribute to a small number of VSD. Therefore, genetic studies of CHD may provide insight into designing novel therapies for adult CHD patients.
Insights
Genetic variants in an NKX2-5 gene enhancer may contribute to congenital heart defects like ventricular septal defect (VSD). This finding could inform new therapies for adult congenital heart disease (CHD).
Area of Science:
- Cardiovascular Genetics
- Developmental Biology
- Molecular Cardiology
Background:
- Congenital heart disease (CHD) has high mortality due to late complications, often linked to unknown genetic factors.
- The NKX2-5 gene is crucial for heart development and function; mutations are associated with various CHDs, including ventricular septal defect (VSD).
- NKX2-5 acts as a dosage-sensitive regulator, suggesting altered gene expression levels may influence CHD development via gene regulatory networks.
Purpose of the Study:
- To genetically and functionally analyze an upstream enhancer of the NKX2-5 gene in patients with VSD.
- To investigate the role of DNA sequence variants (DSVs) in this enhancer in the development of VSD.
Main Methods:
- Genomic DNA analysis of large cohorts of VSD patients (n=340) and controls (n=347).
- Identification and characterization of novel heterozygous DNA sequence variants (DSVs) in the NKX2-5 upstream enhancer.
- Functional assessment of identified DSVs using enhancer activity assays.
Main Results:
- Two novel heterozygous DSVs (g.17483576C>G and g.17483564C>T) were identified in three VSD patients but not in controls.
- These two DSVs significantly reduced the enhancer activity (P<0.01).
- A third novel heterozygous DSV (g.17483557Ins) was found at similar frequencies in both VSD patients and controls (P>0.05).
Conclusions:
- The identified DSVs within the NKX2-5 upstream enhancer may contribute to a subset of VSD cases.
- These genetic findings highlight the importance of regulatory elements in CHD pathogenesis.
- Understanding genetic causes of CHD can guide the development of novel therapeutic strategies for adult patients.
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