Xiao Qing-Ao, Li Xiao-Long, Qin Lei, Zhang Xiao-Lin
Department of Interventional Radiology, the First College of Clinical Medical Science, China Three Gorges University, Yichang, 443003, Hubei Province, China.
Department of Interventional Radiology, Yichang Central People's Hospital, Yichang, 443003, Hubei Province, China.
Sci Rep. 2025 Jul 1;15(1):22238. doi: 10.1038/s41598-025-08153-5.
Clinical guidelines recommend the use of statins to reduce portal pressure and alleviate portal hypertension (PH). However, there is a lack of population-level studies on the use of non-statin Low-Density Lipoprotein Cholesterol (LDL-c) reduction agents for the treatment of PH. This study utilized a novel method, Mendelian Randomization (MR) analysis, to investigate the impact of commonly used LDL-c-lowering medications on PH. Instrumental variables (IVs) for eight lipid-lowering drug-related genes were extracted from three large-scale LDL-c databases of Genome-Wide Association Studies (GWAS), followed by MR analysis. The MR results indicated that, compared to normal individuals, lower expression of CETP and NPC1L1 in whole blood (result of meta-analysis: CETP [OR: 0.322, 95%CI:0.130-0.795, P = 1.396e-02], NPC1L1 [OR: 0.057, 95%CI: 0.022-0.146, P = 2.670e-09]) is associated with reduced portal pressure. The IVs of target genes were subjected to MR analysis with coronary atherosclerosis (CAD) as a positive control, confirming that the IVs can effectively substitute for the biological function of the target gene, thereby further enhancing the reliability of the results. Subsequently, Summary-based Mendelian Randomization (SMR) analysis was conducted by using expression quantitative trait loci (eQTL) data to validate the results of the MR analysis. The SMR results suggested that only NPC1L1 is associated with PH (OR: 0.648, 95%CI: 0.472-0.891, P = 7.502e-3, P = 0.747) from genetic correlation. Additionally, mediation analysis indicates that the therapeutic effect of NPC1L1 inhibitors on PH is partially mediated by tissue factor (mediating effect accounted for 18.52%, and the P value was 0.01). Phenome-Wide MR indicated that NPC1L1 inhibitors may be associated with 23 diseases or symptoms. In addition, NPC1L1 had genetic correlation between and alkaline phosphatase as well as total bilirubin, but no genetic correlation with alanine aminotransferase, aspartate aminotransferase, direct bilirubin, or gamma glutamyltransferase. In conclusion, this study systematically analyzed the genetic correlation between lipid-lowering drug targets and PH. From a genetic correlation perspective, we revealed that the potential therapeutic effect of NPC1L1 on PH may not be mediated through the reduction of LDL-c but rather through the modulation of tissue factors. Additionally, the potential side effects associated with NPC1L1 inhibition also were explored.
临床指南推荐使用他汀类药物来降低门静脉压力并缓解门静脉高压(PH)。然而,关于使用非他汀类低密度脂蛋白胆固醇(LDL-c)降低剂治疗PH的人群水平研究尚属缺乏。本研究采用一种新方法,即孟德尔随机化(MR)分析,来探究常用的LDL-c降低药物对PH的影响。从三个全基因组关联研究(GWAS)的大规模LDL-c数据库中提取了八个与降脂药物相关基因的工具变量(IVs),随后进行MR分析。MR结果表明,与正常个体相比,全血中CETP和NPC1L1的表达降低(荟萃分析结果:CETP [OR:0.322,95%CI:0.130 - 0.795,P = 1.396e - 02],NPC1L1 [OR:0.057,95%CI:0.022 - 0.146,P = 2.670e - 09])与门静脉压力降低相关。将目标基因的IVs与冠状动脉粥样硬化(CAD)作为阳性对照进行MR分析,证实IVs能够有效替代目标基因的生物学功能,从而进一步提高结果的可靠性。随后,通过使用表达定量性状位点(eQTL)数据进行基于汇总的孟德尔随机化(SMR)分析,以验证MR分析的结果。SMR结果表明,从遗传相关性来看,只有NPC1L1与PH相关(OR:0.648,95%CI:0.472 - 0.891,P = 7.502e - 3,P = 0.747)。此外,中介分析表明,NPC1L1抑制剂对PH的治疗作用部分由组织因子介导(中介效应占18.52%,P值为0.01)。全表型MR表明,NPC1L1抑制剂可能与23种疾病或症状相关。此外,NPC1L1与碱性磷酸酶以及总胆红素之间存在遗传相关性,但与丙氨酸氨基转移酶、天冬氨酸氨基转移酶、直接胆红素或γ-谷氨酰转移酶无遗传相关性。总之,本研究系统分析了降脂药物靶点与PH之间的遗传相关性。从遗传相关性角度来看,我们揭示了NPC1L1对PH的潜在治疗作用可能不是通过降低LDL-c来介导,而是通过调节组织因子来实现。此外,还探讨了与NPC1L1抑制相关的潜在副作用。
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