# TCF21 is a causal coronary artery disease gene that modulates coronary smooth muscle phenotypic transition via epigenetic mechanisms

> **NIH NIH F32** · STANFORD UNIVERSITY · 2022 · $66,790

## Abstract

PROJECT SUMMARY
More than 161 genetic loci have been associated with coronary artery disease (CAD) through the genome
wide association studies (GWAS) conducted by the CARDIoGRAMplusC4D consortium. However, despite
such advances in the understanding of coronary disease, therapeutic targets beyond lipid lowering therapies
have yet to reach the clinical stage. At this critical juncture for discovery, there is a need for better mechanistic
characterization of the genetic CAD risk loci at the single cell level to simultaneously study the genetic and
epigenetic phenomena underlying disease risk. The Quertermous laboratory has previously identified TCF21
as the CAD associated gene mapped by GWAS at the 6q23.2 locus. A combination of smooth muscle cell
(SMC) lineage tracing and single cell RNA sequencing has shown that Tcf21 is upregulated and promotes
SMC de-differentiation, proliferation and migration into atherosclerotic plaque. TCF21 expression contributes to
the phenotypic transition of SMC to the protective fibrous cap, producing fibroblast-like cells termed
“fibromyocytes” (FMC). We are now studying this transitional state at multiple developmental time points with
single cell transcriptomics and epigenomics in the ApoE knockout model of atherosclerosis and find wide
variation in chromatin accessibility associated with the SMC-FMC transitional cell state. While loss of Tcf21
produces more than a 50% decrease in FMC, there remains a subpopulation of SMC that can contribute to
FMC and the fibrous cap. The gene regulatory networks that cooperate with TCF21 to promote SMC transition,
and the downstream target genes of these networks remain unknown. The central hypothesis underlying
this proposal is that TCF21 exerts a protective effect toward CAD risk through its ability to promote
phenotypic transition of SMC in the setting of vascular wall stress. To address this hypothesis, the
applicant will study a SMC-specific model of Tcf21 over-expression in the setting of vascular disease and
characterize the disease consequences of increased Tcf21 action through cutting-edge transcriptomic and
epigenetic tools to simultaneously evaluate single cell gene transcription and chromatin accessibility through
combined scRNAseq with scATACseq in vascular tissue. Aim 1 will examine the overall effect of increased
Tcf21 expression on SMC phenotype as well as atherosclerotic plaque cellular composition and anatomy in
transgenic over-expressing animals. Aim 2 will elucidate the transcriptional and epigenetic mechanisms by
which Tcf21 mediates SMC de-differentiation and transition to the FMC phenotype using analysis of single cell
multi-omic RNAseq and ATACseq. This study will address fundamental questions related to vascular disease
pathophysiology, including: i) does TCF21 over-expression increase the SMC to FMC transition, ii) does
increased SMC to FMC transition promote a more stable plaque phenotype, and iii) how does TCF21 regulate
the epigenetic and transcriptiona...

## Key facts

- **NIH application ID:** 10536419
- **Project number:** 1F32HL165819-01
- **Recipient organization:** STANFORD UNIVERSITY
- **Principal Investigator:** DANIEL YUHANG LI
- **Activity code:** F32 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $66,790
- **Award type:** 1
- **Project period:** 2022-09-02 → 2025-09-01

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10536419

## Citation

> US National Institutes of Health, RePORTER application 10536419, TCF21 is a causal coronary artery disease gene that modulates coronary smooth muscle phenotypic transition via epigenetic mechanisms (1F32HL165819-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10536419. Licensed CC0.

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