title: Genetic interactions in the β-adrenoceptor/G-protein signal transduction pathway and survival after coronary artery bypass grafting: a pilot study.
abstract: BACKGROUND
  In heart failure, β-adrenergic receptor (βAR) stimulation desensitizes the receptor, uncouples the downstream Gαs protein, and diminishes signal transduction. We tested the hypotheses that haplotype-tagging single-nucleotide polymorphisms (htSNPs) within the Gαs gene (GNAS) (i) are functionally active and alter Gαs expression, (ii) influence survival after coronary artery bypass grafting (CABG), and (iii) interact with βAR SNPs.
  
  
  METHODS
  Amplification of GNAS intron 1 was followed by cloning, reporter assays, electrophoretic mobility shift assays, and western blots. In a pilot study, 185 patients on βAR blockade undergoing CABG were studied prospectively. The primary endpoint was cardiac-related mortality at 1 yr.
  
  
  RESULTS
  Two htSNPs defined three common haplotypes with altered reporter activity, allele-specific transcription factor binding, and Gαs protein expression (highest in *3 carriers followed by *2 and *1 haplotypes, P=0.013). After CABG, mortality was GNAS diplotype-dependent: *3/*3: 0%; *3/*2: 2.4%; *3/*1: 2.9%; *2/*2: 4.5%; *2/*1: 9.1%; and *1/*1: 20.0% (P=0.004). While β(1)AR SNPs were not associated with mortality, β(2)AR Arg16 allele carriers were at higher risk than Gly16 allele carriers (P=0.008). Gene-gene interaction using gene-related risk alleles demonstrated the number of risk alleles to be independently associated with death (hazard ratio 2.3; 95% confidence interval: 1.5-3.5; P=0.0003). Carriers of the no-risk allele had higher maximum isoproterenol-stimulated adenylyl cyclase activities than risk allele carriers (P=0.003).
  
  
  CONCLUSIONS
  Interactions in the βAR/Gαs pathway may be associated with altered mortality after CABG. This could reconcile previously inconclusive data regarding the effects of βAR SNPs on cardiovascular prognosis.
authors.affiliation: Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen and Universitätsklinikum, Essen, Federal Republic of Germany. ulrich.frey@uk-essen.de
authors.forename: U H
authors.initials: UH
authors.lastname: Frey
authors.forename: E
authors.initials: E
authors.lastname: Kottenberg
authors.forename: M
authors.initials: M
authors.lastname: Kamler
authors.forename: K
authors.initials: K
authors.lastname: Leineweber
authors.forename: I
authors.initials: I
authors.lastname: Manthey
authors.forename: G
authors.initials: G
authors.lastname: Heusch
authors.forename: W
authors.initials: W
authors.lastname: Siffert
authors.forename: J
authors.initials: J
authors.lastname: Peters
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000401:mortality*; D005260:Female; D019205:GTP-Binding Protein alpha Subunits, Gs / Q000235:genetics*; D006239:Haplotypes; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D020641:Polymorphism, Single Nucleotide; D016016:Proportional Hazards Models; D011943:Receptors, Adrenergic, beta / Q000235:genetics*; D015398:Signal Transduction / Q000502:physiology*
chemical_list: D011943:Receptors, Adrenergic, beta; D019205:GTP-Binding Protein alpha Subunits, Gs