Dysfunctional nitric oxide signalling increases risk of myocardial infarction



Myocardial infarction, a leading cause of death in the Western world1, usually occurs when the fibrous cap overlying an atherosclerotic plaque in a coronary artery ruptures. The resulting exposure of blood to the atherosclerotic material then triggers thrombus formation, which occludes the artery2. The importance of genetic predisposition to coronary artery disease and myocardial infarction is best documented by the predictive value of a positive family history3. Next-generation sequencing in families with several affected individuals has revolutionized mutation identification4. Here we report the segregation of two private, heterozygous mutations in two functionally related genes, GUCY1A3 (p.Leu163Phefs*24) and CCT7 (p.Ser525Leu), in an extended myocardial infarction family. GUCY1A3 encodes the α1 subunit of soluble guanylyl cyclase (α1-sGC)5, and CCT7 encodes CCTη, a member of the tailless complex polypeptide 1 ring complex6, which, among other functions, stabilizes soluble guanylyl cyclase. After stimulation with nitric oxide, soluble guanylyl cyclase generates cGMP, which induces vasodilation and inhibits platelet activation7. We demonstrate in vitro that mutations in both GUCY1A3 and CCT7 severely reduce α1-sGC as well as β1-sGC protein content, and impair soluble guanylyl cyclase activity. Moreover, platelets from digenic mutation carriers contained less soluble guanylyl cyclase protein and consequently displayed reduced nitric-oxide-induced cGMP formation. Mice deficient in α1-sGC protein displayed accelerated thrombus formation in the microcirculation after local trauma. Starting with a severely affected family, we have identified a link between impaired soluble-guanylyl-cyclase-dependent nitric oxide signalling and myocardial infarction risk, possibly through accelerated thrombus formation. Reversing this defect may provide a new therapeutic target for reducing the risk of myocardial infarction.

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Figure 1: Pedigree of the extended MI family with several individuals suffering from myocardial infarctions.
Figure 2: Reduced expression and enzymatic activity of the identified sGC mutants in HEK 293 cells.
Figure 3: CCTη is required for sGC expression and function.
Figure 4: Reduced sGC expression and activity in platelets of double-mutation carriers.
Figure 5: Thrombus formation in-vivo in mice deficient for the α1-sGC (α1−/−).

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Data deposits

Variant data is available in ClinVar (http://www.ncbi.nlm.nih.gov/clinvar/) with accession numbers SCV000083870 for NM_001130683.2:c.488dup and SCV000083871 for NM_001166284.1:c.1313C>T.


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We thank all the family members who participated in this research. Without the continuous support of these patients over more than 15 years, the present work would not have been possible. We would like to thank S. Wrobel, S. Stark, A. Liebers, K. Franke, J. Stegmann-Frehse, M. Behrensen, M. Schmid, J. Eckhold, D. Wöllner, U. Krabbe and J. Simon for technical assistance. Furthermore, we would like to thank M. Becker, N. Buchholz, I. Demuth, R. Eckardt, H. Heekeren, U. Lindenberger, M. Lövdén, L. Müller, W. Nietfeld, G. Pawelec, F. Schmiedeck, T. Siedler and G. G. Wagner for their contributions to BASE-II. We also would like to thank S. Herterich and S. Gambaryan for advice, and B. Mayer, U. Hubauer, K.-H. Ameln and A. Großhennig for help with GerMIFS. We thank WTCCC+ and the WTCCC-CAD2 investigators for access to their data. The study is supported by the Deutsche Forschungsgemeinschaft and the German Federal Ministry of Education and Research (BMBF) in the context of the German National Genome Research Network (NGFN-2 (01GS0417) and NGFN-plus (01GS0832)), the FP6 and FP7 EU-funded integrated projects Cardiogenics (LSHM-CT-2006-037593), ENGAGE (201413), and GEUVADIS (261123), the binational BMBF/ANR funded project CARDomics (01KU0908A), the local focus programs ‘Kardiovaskuläre Genomforschung’ and ‘Medizinische Genetik’ of the Universität zu Lübeck, and the University Hospital of Regensburg, Germany. The German Federal Ministry for Education and Research provided funding for BASE-II (BMBF; grant no. 16SV5538). Support by NSFC grant 30730057 from the Chinese Government (to J.O.) is gratefully acknowledged. N.J.S. holds a Chair funded by the British Heart Foundation, and is supported by the Leicester NIHR Biomedical Research Unit in Cardiovascular Disease. U.W. is supported by the BMBF (01EO1003). M.M.N. is a member of the DFG-funded Excellence Cluster ImmunoSensation.

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J.E., C.H., F.J.K., T.M., N.J.S., H.S. and K.S. designed the study. Z.A., D.B., P.B., C.d.W., S.E., U.B.E., E.G., F.J.K., D.K., A.M., E.M., W.R., P.M.R., T.M.S. and M.E.Z. conducted the experiments. I.B., M.F., J.N., J.O., K.S., T.M.S., S.T. and C.W. analysed the data. A.J.B., L.B., P.S.B., C.B., A.S.H., P.H., S.K., S.-C.L., W.M., R.M., T.M., M.M.N., M.R., N.J.S., S.S., E.S.-T. and U.W. provided material, data and analysis tools. J.E., C.d.W., C.H., F.J.K., N.J.S. and H.S. wrote the paper. C.H. and H.S. contributed equally. See Supplementary Information for Members of CARDIoGRAM.

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Correspondence to Jeanette Erdmann or Christian Hengstenberg.

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The authors declare no competing financial interests.

Additional information

A list of authors and their affiliations appears in the Supplementary Information.

Supplementary information

Supplementary Information

This file contains Supplementary Materials and Methods, Supplementary Tables 1-7, Supplementary Figures 1-8 and funding and affiliation details for CARDIoGRAM. (PDF 3117 kb)

Thrombus formation in arterioles in vivo

An arteriole in cremaster-microcirculation with a diameter of about 40 µm. Blood flow is from bottom to top, the animal has received high molecular weight FITC-dextran intravenously which is photoexcited by illuminating the preparation at 450-490nm using mercury lamp at time point 01:07:00. This is visible as a light spot in arteriole, which reflects the excitation of the dye. Thrombus formation starts to be visible downstream of the excitated area in the upper right corner 42 s later. Thereafter, flow decelerates and comes to complete stop 88 s after starting the photoexcitation, which is turned-off at this point. (AVI 7116 kb)

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Erdmann, J., Stark, K., Esslinger, U. et al. Dysfunctional nitric oxide signalling increases risk of myocardial infarction. Nature 504, 432–436 (2013). https://doi.org/10.1038/nature12722

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