Linkage analysis of left ventricular outflow tract malformations (aortic valve stenosis, coarctation of the aorta, and hypoplastic left heart syndrome)

The left ventricular outflow tract (LVOT) malformations aortic valve stenosis (AVS), coarctation of the aorta (CoA), and hypoplastic left heart syndrome (HLHS) are significant causes of infant mortality. These three malformations are thought to share developmental pathogenetic mechanisms. A strong genetic component has been demonstrated earlier, but the underlying genetic etiologies are unknown. Our objective was to identify genetic susceptibility loci for the broad phenotype of LVOT malformations. We genotyped 411 microsatellites spaced at an average of 10 cM in 43 families constituting 289 individuals, with an additional 5 cM spaced markers for fine mapping. A non-parametric linkage (NPL) analysis of the combined LVOT malformations gave three suggestive linkage peaks on chromosomes 16p12 (NPL score (NPLS) = 2.52), 2p23 (NPLS = 2.41), and 10q21 (NPLS = 2.14). Individually, suggestive peaks for AVS families occurred on chromosomes 16p12 (NPLS = 2.64), 7q36 (NPLS = 2.31), and 2p25 (NPLS = 2.14); and for CoA families on chromosome 1q24 (NPLS = 2.61), 6p23 (NPLS = 2.29), 7p14 (NPLS = 2.27), 10q11 (NPLS = 1.98), and 2p15 (NPLS = 2.02). Significant NPLS in HLHS families were noted for chromosome 2p15 (NPLS = 3.23), with additional suggestive peaks on 19q13 (NPLS = 2.16) and 10q21 (NPLS = 2.07). Overlapping linkage signals on 10q11 (AVS and CoA) and 16p12 (AVS, CoA, and HLHS) led to higher NPL scores when all malformations were analyzed together. In conclusion, we report suggestive evidence for linkage to chromosomes 2p23, 10q21, and 16p12 for the LVOT malformations of AVS, CoA, and HLHS individually and in a combined analysis, with a significant peak on 2p15 for HLHS. Overlapping linkage peaks provide evidence for a common genetic etiology.