GENOMICS OF SUDDEN CARDIAC ARREST

描述（由申请人提供）：心脏骤停（SCA）是一个主要的公共卫生问题，每年在美国造成40多万人死亡。虽然环境因素明显有助于SCA的决定因素，但家族聚集研究和遗传性心律失常分子遗传学的进展表明，遗传因素赋予了一般人群对SCA的易感性。确定这些遗传因素不仅可以深入了解SCA的机制，还将对SCA的风险分层和预防具有重要的公共卫生意义。我们建议使用完整序列信息和单倍型分析系统地研究SCA和中间表型与参与心律失常发生的生物学重要分子途径变异的关系。具体来说，我们将研究SCA风险与候选基因变异的关系（目的1），这些候选基因是电生成和繁殖的近端决定因素（如心脏离子通道基因和连接蛋白）和影响这些近端决定因素的通路中的基因（如神经体液调节剂）。我们将在遗传和环境背景下探讨这些关联，研究与药物（Aim 2a）、运动（Aim 2b）和其他遗传因素（Aim 2c）的相互作用。我们还将研究遗传变异对中间定量表型的主要影响，如心电图QT间期、心率和心率变异性（目的3）。该应用程序代表了一个多中心合作的努力，有效地将基因组学的进展与四个正在进行的研究的材料结合起来，这些研究能够严格识别SCA表型或相关的中间表型。具体来说，我们将使用来自大型人群SCA病例库（心脏骤停血液库）、两项病例对照研究（心脏骤停血液研究和群体健康合作研究）和一项队列研究（心血管健康研究）的材料。

DESCRIPTION (provided by applicant): Sudden cardiac arrest (SCA) is a major public health concern, accounting for over 400,000 deaths in the US each year. While environmental factors clearly contribute to the determinants of SCA, familial aggregation studies and advances in the molecular genetics of inherited arrhythmias suggest that genetic factors confer susceptibility to SCA in the general population. Identifying these genetic factors will not only provide insight into the mechanisms of SCA, it will also have significant public health implications for risk stratification and prevention of SCA. We propose to systematically investigate the association of SCA and intermediate phenotypes with variations in biologically important molecular pathways involved in arrhythmogenesis using complete sequence information and haplotype analyses. Specifically, we will study the association of SCA risk with variation in candidate genes (Aim 1) that are proximal determinants of electrogenesis and propagation (e.g. cardiac ion channel genes and connexins) and genes in pathways that influence these proximal determinants (e.g. neurohumoral modulators). We will explore these associations in the context of the genetic and environmental milieu, investigating interactions with medications (Aim 2a), exercise (Aim 2b), and other genetic factors (Aim 2c). We will also examine main effects of genetic variation on intermediate quantitative phenotypes, such as ECG QT interval, heart rate, and heart rate variability (Aim 3). This application represents a multi-center collaborative effort to efficiently combine advances in genomics with material from four on-going studies that enable rigorous identification of the SCA phenotype or relevant intermediate phenotypes. Specifically, we will use material from a large population-based repository of SCA cases (Cardiac Arrest Blood Repository), two case-control studies (Cardiac Arrest Blood Study and Group Health Cooperative study), and a cohort study (Cardiovascular Health Study):