Genome and Transcriptome-Wide Analyses Identify Multiple Candidate Genes and a Significant Polygenic Contribution in Bicuspid Aortic Valve

Disease areas:

• clinical signs and symptoms
• heart and blood vessels

Last updated:

31 May 2026

Author(s):

Sébastien Thériault, Jacob A. Holdcraft, Dinara Sharipova, Adèle Faucherre, Radoslaw M. Debiec, Gina M. Peloso, Baravan Al-Kassou, Sary Aranki, Elena Ashikhmina Swan, Andrea Ballotta, Michele Bellino, Hanna M. Björck, Anne Sophie Boureau, Peter S. Braund, François Corriveau, François Dagenais, Lasse Folkersen, Amalia Forte, Michael D. Francke, Alessandro Frigiola, Svetlana Gorbatov, Dongchuan Guo, Karam M. Habchi, Mahyar Heydarpour, Eric M. Isselbacher, Chris Jopling, Fabien Laporte, Solena Le Scouarnec, Zhonglin Li, Peter Lichtner, Carlo Maj, Hasanga D. Manikpurage, Christopher P. Nelson, Thy B. Nguyen, Russell A. Norris, Chin Siang Ong, Philippe Pibarot, Tanmoy Roychowdhury, Berardo Sarubbi, Floriane Simonet, Thoralf Sundt, Ida Surakka, Idit Tessler, Cristen J. Willer, Susanne Wittmann, Bo Yang, Igor Berezovets, Stefanie A. Doppler, Martina Dreßen, Katharina Knoll, Thomas Puehler, Heribert Schunkert, Jean-François Avierinos, Malenka M. Bissell, Aidan P. Bolger, Yohan Bossé, Eduardo Bossone, María Brion, Rodolfo Citro, Carlo de Vincentiis, G. Michael Deeb, Alessandro Della Corte, Christian Dina, Ronen Durst, Stephan Ensminger, Per Eriksson, Arturo Evangelista, Anders Franco-Cereceda, Dan Gilon, Betti Giusti, Simon L. Hetherington, Gordon S. Huggins, Markus Krane, Thierry Le Tourneau, Giuseppe Limongelli, Patrick Mathieu, David Messika-Zeitoun, Hector I. Michelena, Dianna Milewicz, Jochen D. Muehlschlegel, David R. Murdock, Georg Nickenig, Stefano Nistri, Markus M. Nöthen, Francesca Pluchinotta, Siddharth K Prakash, Nilesh J. Samani, Jean-Jacques Schott, Tom R. Webb, Stéphane Zaffran, Salim Abdelilah-Seyfried, Kim Eagle, Johannes Schumacher, Teresa Trenkwalder, Simon C. Body

Publish date:

6 February 2026

Journal:

Circulation

PubMed ID:

41645906

DOI:

10.1161/circulationaha.125.074752

Abstract

BACKGROUND: Bicuspid aortic valve (BAV) is a frequent congenital heart defect with a high heritability. Despite this, only a limited number of genes have been associated with the disease, and the molecular mechanisms remain unexplained in most cases. This study aimed to further understand the genetic architecture of BAV.

METHODS: A genome-wide association study meta-analysis including 9631 cases among 65 677 participants was performed. Genes were prioritized using transcriptomic analyses based on RNA sequencing in relevant tissues, including human fetal and adult aortic valves. The impact of the knockdown or knockout of 4 candidate genes on cardiac development was verified in zebrafish. A polygenic risk score was developed, its association with BAV was evaluated in an independent cohort, and its association with a wide range of phenotypes (n=976) was evaluated in UK Biobank (n=355 618 individuals).

RESULTS: Thirty-six genomic loci were identified, including 32 that were not described previously. Among the prioritized genes, KANK2 and ERBB4 were identified as potentially causal through transcriptomic analyses, colocalization, and Mendelian randomization based on gene expression in human aortic valves (n=484), whereas PRDM6 and STRN were prioritized using similar analyses from aortic (n=326) and left ventricular tissues (n=326), respectively. Targeting 4 candidate genes (WNT4, LEF1, STRN, and KANK2) in zebrafish led to disruption in cardiac development. A polygenic risk score was associated with an odds ratio of 2.07 (95% CI, 1.90-2.25; P=5.43×10^-62) per SD for BAV and significantly associated with thoracic aortic aneurysm and atrial fibrillation in UK Biobank.

CONCLUSIONS: This study supports a significant polygenic contribution to BAV, where the combination of multiple common variants in genes involved in heart morphogenesis disrupts aortic valve development.