title: Mutations in smooth muscle alpha-actin (ACTA2) cause coronary artery disease, stroke, and Moyamoya disease, along with thoracic aortic disease.
abstract: The vascular smooth muscle cell (SMC)-specific isoform of alpha-actin (ACTA2) is a major component of the contractile apparatus in SMCs located throughout the arterial system. Heterozygous ACTA2 mutations cause familial thoracic aortic aneurysms and dissections (TAAD), but only half of mutation carriers have aortic disease. Linkage analysis and association studies of individuals in 20 families with ACTA2 mutations indicate that mutation carriers can have a diversity of vascular diseases, including premature onset of coronary artery disease (CAD) and premature ischemic strokes (including Moyamoya disease [MMD]), as well as previously defined TAAD. Sequencing of DNA from patients with nonfamilial TAAD and from premature-onset CAD patients independently identified ACTA2 mutations in these patients and premature onset strokes in family members with ACTA2 mutations. Vascular pathology and analysis of explanted SMCs and myofibroblasts from patients harboring ACTA2 suggested that increased proliferation of SMCs contributed to occlusive diseases. These results indicate that heterozygous ACTA2 mutations predispose patients to a variety of diffuse and diverse vascular diseases, including TAAD, premature CAD, ischemic strokes, and MMD. These data demonstrate that diffuse vascular diseases resulting from either occluded or enlarged arteries can be caused by mutations in a single gene and have direct implications for clinical management and research on familial vascular diseases.
authors.affiliation: The University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
authors.forename: Dong-Chuan
authors.initials: DC
authors.lastname: Guo
authors.forename: Christina L
authors.initials: CL
authors.lastname: Papke
authors.forename: Van
authors.initials: V
authors.lastname: Tran-Fadulu
authors.forename: Ellen S
authors.initials: ES
authors.lastname: Regalado
authors.forename: Nili
authors.initials: N
authors.lastname: Avidan
authors.forename: Ralph Jay
authors.initials: RJ
authors.lastname: Johnson
authors.forename: Dong H
authors.initials: DH
authors.lastname: Kim
authors.forename: Hariyadarshi
authors.initials: H
authors.lastname: Pannu
authors.forename: Marcia C
authors.initials: MC
authors.lastname: Willing
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Sparks
authors.forename: Reed E
authors.initials: RE
authors.lastname: Pyeritz
authors.forename: Michael N
authors.initials: MN
authors.lastname: Singh
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Dalman
authors.forename: James C
authors.initials: JC
authors.lastname: Grotta
authors.forename: Ali J
authors.initials: AJ
authors.lastname: Marian
authors.forename: Eric A
authors.initials: EA
authors.lastname: Boerwinkle
authors.forename: Lorraine Q
authors.initials: LQ
authors.lastname: Frazier
authors.forename: Scott A
authors.initials: SA
authors.lastname: LeMaire
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Coselli
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Estrera
authors.forename: Hazim J
authors.initials: HJ
authors.lastname: Safi
authors.forename: Sudha
authors.initials: S
authors.lastname: Veeraraghavan
authors.forename: Donna M
authors.initials: DM
authors.lastname: Muzny
authors.forename: David A
authors.initials: DA
authors.lastname: Wheeler
authors.forename: James T
authors.initials: JT
authors.lastname: Willerson
authors.forename: Robert K
authors.initials: RK
authors.lastname: Yu
authors.forename: Sanjay S
authors.initials: SS
authors.lastname: Shete
authors.forename: Steven E
authors.initials: SE
authors.lastname: Scherer
authors.forename: C S
authors.initials: CS
authors.lastname: Raman
authors.forename: L Maximilian
authors.initials: LM
authors.lastname: Buja
authors.forename: Dianna M
authors.initials: DM
authors.lastname: Milewicz
mesh_terms: D000199:Actins / Q000235:genetics* / Q000378:metabolism; D000293:Adolescent; D000328:Adult; D000784:Aortic Dissection / Q000235:genetics* / Q000473:pathology; D017545:Aortic Aneurysm, Thoracic / Q000235:genetics* / Q000473:pathology; D049109:Cell Proliferation; D002478:Cells, Cultured; D003324:Coronary Artery Disease / Q000235:genetics* / Q000473:pathology; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D008297:Male; D008875:Middle Aged; D008958:Models, Molecular; D009072:Moyamoya Disease / Q000235:genetics* / Q000473:pathology; D009154:Mutation; D032389:Myocytes, Smooth Muscle / Q000378:metabolism; D020033:Protein Isoforms / Q000235:genetics / Q000378:metabolism; D020521:Stroke / Q000235:genetics*; D055815:Young Adult
chemical_list: C541116:ACTA2 protein, human; D000199:Actins; D020033:Protein Isoforms