Abstract Body: Background: Patients with coronary artery disease (CAD) have increased risks of subsequent major adverse cardiovascular events (MACE). Currently, there are no reliable tools to predict recurrent MACE in CAD patients.
Objective: To determine if circulating long noncoding RNA (lncRNA) expression signature predicts recurrent MACE in CAD patients.
Methods: As part of the Taiwan Biosignature Study, this prospective nested case-control study included 168 CAD patients who experienced MACE during the follow-up and another 108 CAD patients who remained free of MACE after a≥24-month follow-up. Plasma lncRNAs were profiled to determine their prognostic values for MACE in CAD patients.
Results: Initially, RNA sequencing in 59 CAD patients (41 with recurrent MACE) revealed that a total of 124 plasma lncRNAs were dysregulated in CAD patients with recurrent MACE. Subsequent analyses showed that the expression signature of these lncRNAs classified CAD patients with vs. without recurrent MACE with an accuracy of 93%. Elevated levels of plasma lnc-NCF1-1, BRE-AS1, lnc-ZFAT-6, lnc-SLC46A3-5, lnc-CXCL3-2 and lnc-EBF3-4 were associated with increased risks of recurrent MACE. Additional studies in the remaining 217 CAD patients (127 with recurrent MACE) validated that increased plasma levels of lnc- NCF1-1, BRE-AS1, lnc-ZFAT-6, and lnc-EBF3-4 were significant predictors of recurrent MACE. In addition, lnc-SCORE, an index calculated from MACE-associated plasma lncRNA levels, was shown to be a strong independent predictor (adjusted HR, 2.70 [95% CI 1.78-4.09]) of recurrent MACE in CAD patients. BRE-AS1 and lnc-ZFAT-6, two endothelium-enriched MACE-associated lncRNAs, were specifically dysregulated in cardiomyopathy of ischemic, but not of non-ischemic, origin, suggesting their potential contribution to the development of myocardial ischemia. Moreover, knocking BRE-AS1 reversed hypoxia-induced upregulation of VCAM-1 in human aortic endothelial cells, suggesting its functional contribution to vascular inflammation upon ischemia.
Conclusions: This study shows the prognostic roles of circulating lncRNAs in predicting recurrent MACE in CAD patients. Endothelium-enriched lncRNA BRE-AS1 is involved in ischemia-induced vascular inflammation.