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Circulation. 2020 Jan 14;141(2):124-131. doi: 10.1161/CIRCULATIONAHA.119.044362. Epub 2019 Nov 11.

Genetic Interleukin 6 Signaling Deficiency Attenuates Cardiovascular Risk in Clonal Hematopoiesis.

Author information

1
Cardiovascular Research Center (A.G.B., J.P.P., P.N.), Massachusetts General Hospital, Boston.
2
Center for Genomic Medicine (A.G.B., J.P.P., S.K., P.N.), Massachusetts General Hospital, Boston.
3
Department of Medicine (A.G.B., J.P.P., S.K., P.N.), Harvard Medical School, Boston, MA.
4
Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge (A.G.B., J.P.P., G.K.G., N.G., S.G., S.K., P.N.).
5
Department of Pathology (G.K.G.), Harvard Medical School, Boston, MA.
6
Department of Pathology (G.K.G.), Brigham and Women's Hospital, Boston, MA.
7
Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (D.S.).
8
Center for Non-Communicable Diseases, Karachi, Pakistan (D.S.).
9
Division of Cardiology (P.L.), Brigham and Women's Hospital, Boston, MA.
10
Verve Therapeutics, Cambridge, MA (S.K.).

Abstract

BACKGROUND:

Clonal hematopoiesis of indeterminate potential (CHIP) refers to clonal expansion of hematopoietic stem cells attributable to acquired leukemic mutations in genes such as DNMT3A or TET2. In humans, CHIP associates with prevalent myocardial infarction. In mice, CHIP accelerates atherosclerosis and increases IL-6/IL-1β expression, raising the hypothesis that IL-6 pathway antagonism in CHIP carriers would decrease cardiovascular disease (CVD) risk.

METHODS:

We analyzed exome sequences from 35 416 individuals in the UK Biobank without prevalent CVD, to identify participants with DNMT3A or TET2 CHIP. We used the IL6R p.Asp358Ala coding mutation as a genetic proxy for IL-6 inhibition. We tested the association of CHIP status with incident CVD events (myocardial infarction, coronary revascularization, stroke, or death), and whether it was modified by IL6R p.Asp358Ala.

RESULTS:

We identified 1079 (3.0%) individuals with CHIP, including 432 (1.2%) with large clones (allele fraction >10%). During 6.9-year median follow-up, CHIP associated with increased incident CVD event risk (hazard ratio, 1.27 [95% CI, 1.04-1.56], P=0.019), with greater risk from large CHIP clones (hazard ratio, 1.59 [95% CI, 1.21-2.09], P<0.001). IL6R p.Asp358Ala attenuated CVD event risk among participants with large CHIP clones (hazard ratio, 0.46 [95% CI, 0.29-0.73], P<0.001) but not in individuals without CHIP (hazard ratio, 0.95 [95% CI, 0.89-1.01], P=0.08; Pinteraction=0.003). In 9951 independent participants, the association of CHIP status with myocardial infarction similarly varied by IL6R p.Asp358Ala (Pinteraction=0.036).

CONCLUSIONS:

CHIP is associated with increased risk of incident CVD. Among carriers of large CHIP clones, genetically reduced IL-6 signaling abrogated this risk.

KEYWORDS:

cardiovascular disease; exome; hematopoiesis; interleukin-6

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