Past studies using candidate gene approaches have been promising and have provided valuable insights into the genetic architecture of the complex trait of acute lung injury; however, these studies also have had recognized limitations (
28,
35–
37). For several reasons it has been difficult to assemble a large enough cohort of clinically identical individuals to perform a genome-wide association study in humans. Adding to this barrier are the difficulties in establishing functional significance of genetic associations (
38). Thus, using genome-wide association approaches to identification of candidate genes and related pathways (
39) in mice could be a valued additional approach (
21).
Previously, considerable interstrain differences have been reported in acute lung injury susceptibility (
24,
25). In this study with acrolein, we observed an approximately 2.5-fold difference in survival time between the most sensitive and resistant strains, and thus this trait was amenable to mapping. In past decades, QTL mapping has identified chromosomal regions containing genes affecting cancer, diabetes, hypertension, and other disease-related phenotypes. However, a major obstacle of identifying QTL genes is the difficulty of resolving large chromosomal regions (
10–
20 cM) into sufficiently small intervals to make positional cloning practical. With advances in genome sequencing, dense SNP maps have proven successful in the refinement of previous QTL regions and the identification of new genetic determinants of complex traits (
21).
One concern about any SNP association study is that variants identified in genome-wide association study may confer a relatively small increment of risk (explaining 1–3% to the population variance) (
28,
35–
38). Here, we present a strategy to overcome this limitation in which SNPs within 1 Mbp of an association are assessed for functional consequences to survival in the mice tested. A threshold of 10% or greater survival time between the most sensitive and resistant strains was set for further assessment of candidates. Type I error was diminished by comparing the phenotype (i.e., individual survival time) of every member of the population with the corresponding strain genotype. This approach also limits the associated SNPs to those with feasible functional consequence to expression (eSNP) or amino acid sequence (cnSNP).
Of the candidate genes identified, only
Mycn has been associated with respiratory failure. Mice with a
Mycn mutation (that reduces expression through alternative splicing) die at birth due to respiratory failure (
40). However, this effect is probably due to defective lung development (
41) and abnormal branching morphogenesis (
42), because complete ablation of the gene is embryonic lethal. The other candidate genes identified in this study have not previously been associated with acute lung injury. Nonetheless, these genes are present in the lung and the corresponding proteins have functions related to the cell stress signaling in lung injury.
As with any study, this investigation has several limitations. Although acrolein-induced acute lung injury has relevance to smoke inhalation, numerous other agents (either chemical or infectious) can elicit acute lung injury (
43). Until these other forms or phenotypes (e.g., lavage protein) of acute lung injury are evaluated, generalization to other forms of this condition is not warranted. Supportive evidence by another genetic approach (e.g., traditional back-cross or F2 cohort) that likewise identified the candidate genes identified with this haplotype association mapping analysis would strengthen the associations found in this study. In addition, although this approach may improve the assessment of the results obtained from a haplotype mapping analysis, functional assessment of each candidate gene will require further studies (e.g, gene-targeted or transgenic mice). Last, animal models are limited in that species differences in lung structure and function can diminish applicability to humans. Despite these limitations, the identified genes and related pathways may help to direct future human genetic studies that evaluate such pathways using selected tagSNPs.
One of the leading candidate genes was
Acvr1. In mice,
Acvr1 gene targeting produces a morphological gastrulation defect, which is embryonic lethal (
44–
46). In humans, mutations in the glycine-serine–rich (GS) activation domain or sites that interact with the GS domain of ACVR1 have been associated with fibrodysplasia ossificans progressiva, which is characterized by progressive heterotopic ossification that can lead to respiratory difficulties (
47,
48). The ACVR1 GS domain is involved in phosphorylation and human mutations lead to a gain of function (i.e., augmented signaling) (
49). In mice, postnatal expression of mutant ACVR1 can lead to ectopic ossification, but only when combined with infection. Corticosteroid inhibited ossification in mice, suggesting that mutant ACVR1 and inflammation are both required for ectopic ossification (
50).
Although named activin A receptor, type 1 (a.k.a. activin receptor-like kinase 2, Alk2), ACVR1 does not bind activins (a.k.a. inhibins), but binds BMP2, 4, 6, and 7, through a heteromeric complex with BMPR2 (
51–
54) (Figure E5, Table E4). Critical to respiratory organogenesis and development (
55,
56), BMPs elicit various effects in adult tissues through type I and II receptors, which in turn phosphorylate receptor-regulated R-SMAD protein (primarily SMAD1, 5, and 8) (
57,
58). On activation, R-SMAD proteins associate with the common mediator SMAD4 and translocate to the nucleus, where they act as transcription factors to regulate expression of target genes, including the inhibitory SMADs (I-SMAD), SMAD6, and SMAD7 (
59). SMAD6 and SMAD7 inhibit/modulate TGFB/BMP signaling by interfering with the activation of other SMADS (
59–
61), thereby providing negative feedback control (
62).
In this study we found that lung ACVR1 transcripts decreased more in the sensitive SM/J than the resistant 129X1/SvJ mice.
In vitro, an
Acvr1 promoter region SNP rs6406107 diminished nuclear protein-binding capacity of a labeled probe and was associated with decreased survival in mice. This SNP could lead to diminished ACVR1 transcript levels because the A-allele would eliminate a putative ELK1 binding site. ELK1 can be phosphorylated by a TNF-initiated, JUN-mediated mechanism in pulmonary epithelial cells (
63). A possible consequence of decreased ACVR1 transcripts would be augmented TGFB/BMP signaling. This is consistent with increases in transcripts encoded by TGFB target genes noted in the microarray. Previously, TGFB/BMP signaling has been associated with adverse effects during acute lung injury (
64–
66). Active TGFB1 is increased in edema fluid obtained from patients with acute lung injury (
67–
70), and TGFB1 decreases pulmonary endothelial (
71) or epithelial integrity (
72) and diminishes epithelial fluid transport (
73,
74). The determination whether ACVR1 may serve to limit TGFB/BMP signaling during lung injury is worthy of future investigation.
Compared with 129X1/SvJ mice, several stress-response transcripts (e.g., CACYBP, DNAJA1, FKBP4, HSPA1A, NFAT5, and STIP1) decreased more in the SM/J lung. Inasmuch as these transcripts encoded chaperon proteins, a decrease could destabilize existing proteins (i.e., aggregation and unfolding of newly translated proteins) and diminish the effectiveness of ubiquitin-proteasome pathway (
75,
76). Ubiquitin-proteasome proteins may interact with other candidates identified (
77). For example, ACVR1 interacts with FANCL (
78) and modulates SMURF2 ubiquitination of various proteins, including SMADs. Two candidate genes,
Rfwd2 and
Cacybp, encode proteins with ubiquitin-protein ligase activity. Besides limiting TP53 (a.k.a. p53) (
79), RFWD2 suppresses JUN (
80) and FOXO1 (
81) and other transcription factor accumulation and thereby limits cell stress (
82). For example, JUN diminishes surfactant-associated protein B synthesis and thereby increases mortality during acute lung injury (
3,
83), and FOXO1 is critical to maintaining claudin 5 in acrolein-induced acute lung injury (
84).
In summary, haplotype association mapping, microarray/qRT-PCR analyses, and in silico SNP analysis identified 11 candidate genes (Acvr1, Arhgap15, Cacnb4, Cacybp, Ccdc148, Fancl, Mycn, Mgat4a, Rfwd2, Tgfbr3, and Tnn) associated with acrolein-induced acute lung injury in mice. Several genes were related and encoded receptors (ACVR1, TGFBR3), transcription factors (MYCN, possibly CCDC148), and ubiquitin-proteasome (RFWD2, FANCL, CACYBP) proteins that may interact to modulate cell signaling. The Acvr1 SNP rs6406107 eliminates a putative transcription factor binding site and diminished DNA–protein binding making this gene worthy of future investigations in acute lung injury.