Discovery of GJC1 (Cx45) as a New Gene Underlying Congenital Heart Disease and Arrhythmias

SIMPLE SUMMARY: Congenital heart disease is associated with substantial mortality and morbidity as well as socioeconomic burden, and increasing research underscores the genetic basis for it. In this study, a genome-wide genotyping with microsatellite markers followed by linkage analysis was performed in a Chinese family suffering congenital heart disease and arrhythmias, and a novel genetic locus linked to the disease was located on chromosome 17q21.31-q21.33. Sequencing assays of the candidate genes at the locus revealed a novel heterozygous mutation in the GJC1 gene coding for Cx45, NM_005497.4:c.550A>G;p.R184G, which was in co-segregation with the disease in the whole family and was not detected in 516 control individuals. Electrophysiological analyses showed that the mutation significantly diminished the coupling conductance in homomeric cell pairs (R184G/R184G) and in cell pairs expressing R184G/Cx45 or R184G/Cx43, in a dominant-negative mode. Fluorescent dye uptake experiments demonstrated no apparent change of the R184G mutation on the Cx45 hemichannels. These findings define a new genetic locus for congenital heart disease and arrhythmias on chromosome 17q21.31-q21.33 and indicate GJC1 as a new gene predisposing to the disease. ABSTRACT: As the most prevalent type of birth malformation, congenital heart disease (CHD) gives rise to substantial mortality and morbidity as well as a socioeconomic burden. Although aggregating investigations highlight the genetic basis for CHD, the genetic determinants underpinning CHD remain largely obscure. In this research, a Chinese family suffering from autosomal dominant CHD (atrial septal defect) and arrhythmias was enrolled. A genome-wide genotyping with microsatellite markers followed by linkage assay as well as sequencing analysis was conducted. The functional effects of the discovered genetic mutation were characterized by dual patch-clamp electrophysiological recordings in N2A cells and propidium iodide uptake assays in HeLa cells. As a result, a novel genetic locus for CHD and arrhythmias was located on chromosome 17q21.31-q21.33, a 4.82-cM (5.12 Mb) region between two markers of D17S1861 and D17S1795. Sequencing assays of the genes at the mapped locus unveiled a novel heterozygous mutation in the GJC1 gene coding for connexin 45 (Cx45), NM_005497.4:c.550A>G;p.R184G, which was in co-segregation with the disease in the whole family and was not observed in 516 unrelated healthy individuals or gnomAD. Electrophysiological analyses revealed that the mutation significantly diminished the coupling conductance in homomeric cell pairs (R184G/R184G) and in cell pairs expressing either R184G/Cx45 or R184G/Cx43. Propidium iodide uptake experiments demonstrated that the Cx45 R184G mutation did not increase the Cx45 hemichannel function. This investigation locates a new genetic locus linked to CHD and arrhythmias on chromosome 17q21.31-q21.33 and indicates GJC1 as a novel gene predisposing to CHD and arrhythmias, implying clinical implications for prognostic risk assessment and personalized management of patients affected with CHD and arrhythmias.