From noncoding variant to phenotype via SORT1 at the 1p13 cholesterol locus

Recent genome-wide association studies (GWASs) have identified a locus on chromosome 1p13 strongly associated with both plasma low-density lipoprotein cholesterol (LDL-C) and myocardial infarction (MI) in humans. Here we show through a series of studies in human cohorts and human-derived hepatocytes that a common noncoding polymorphism at the 1p13 locus, rs12740374, creates a C/EBP (CCAAT/enhancer binding protein) transcription factor binding site and alters the hepatic expression of the SORT1 gene. With small interfering RNA (siRNA) knockdown and viral overexpression in mouse liver, we demonstrate that Sort1 alters plasma LDL-C and very low-density lipoprotein (VLDL) particle levels by modulating hepatic VLDL secretion. Thus, we provide functional evidence for a novel regulatory pathway for lipoprotein metabolism and suggest that modulation of this pathway may alter risk for MI in humans. We also demonstrate that common noncoding DNA variants identified by GWASs can directly contribute to clinical phenotypes. Lipid concentration in the blood is a major risk factor for coronary artery disease, and one that can be targeted for therapeutic intervention. A genome-wide association study (GWAS) in more than 100,000 individuals of European ancestry has been used to identify 95 genetic variants linked to plasma lipids. Among associated loci are those involved in cholesterol metabolism, known targets of cholesterol-lowering drugs and novel loci that contribute to normal variation in lipid traits and to extreme lipid phenotypes. One locus identified in the study as being associated with both plasma low-density lipoprotein cholesterol and coronary artery disease forms the focus of a second paper in this issue. The locus, on chromosome 1p13, is shown to create a binding site for C/EBP transcription factors and to alter SORT1 gene expression in the liver. Modulating Sort1 levels in the mouse liver alters plasma lipoprotein levels, potentially explaining why variation at this locus is associated with heart disease. This finding identifies the sortilin pathway as a possible target for therapeutic intervention and illustrates how GWAS results can be used as a production line for drug targets. A non-coding polymorphism at a locus associated with myocardial infarction in humans creates a CCAAT/enhancer binding protein transcription factor binding site and alters the hepatic expression of the SORT1 gene. These authors show that modulating Sort1 levels in mouse liver alters levels of plasma low-density lipoprotein cholesterol and very low-density lipoprotein, potentially explaining why polymorphisms at this locus are associated with heart disease.