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    BIRC6 Is Associated with Vulnerability of Carotid Atherosclerotic Plaque

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    Carotid atherosclerotic plaque rupture can lead to cerebrovascular accident (CVA). By comparing RNA-Seq data from vascular smooth muscle cells (VSMC) extracted from carotid atheroma surgically excised from a group of asymptomatic and symptomatic subjects, we identified more than 700 genomic variants associated with symptomatology (p < 0.05). From these, twelve single nucleotide polymorphisms (SNPs) were selected for further validation. Comparing genotypes of a hospital-based cohort of asymptomatic with symptomatic patients, an exonic SNP in the BIRC6 (BRUCE/Apollon) gene, rs35286811, emerged as significantly associated with CVA symptomatology (p = 0.002; OR = 2.24). Moreover, BIRC6 mRNA levels were significantly higher in symptomatic than asymptomatic subjects upon measurement by qPCR in excised carotid atherosclerotic tissue (p < 0.0001), and significantly higher in carriers of the rs35286811 risk allele (p < 0.0001). rs35286811 is a proxy of a GWAS SNP reported to be associated with red cell distribution width (RDW); RDW was increased in symptomatic patients (p < 0.03), but was not influenced by the rs35286811 genotype in our cohort. BIRC6 is a negative regulator of both apoptosis and autophagy. This work introduces BIRC6 as a novel genetic risk factor for stroke, and identifies autophagy as a genetically regulated mechanism of carotid plaque vulnerability.This work was financially supported by grants from the Departments of Education (Ref. PIBA2018-67) and Health (Ref. RIS3-2019222038) of the Basque Government, Vitoria-Gasteiz, Spain; by the Spanish Neurovascular Network (INVICTUSplus) (Ref. RD16/0019/0007) funded by the Instituto de Salud Carlos III, Ministerio de Ciencia e Innovaci√≥n, Madrid, Spain; and by the research project grant (IKERIKTUS) funded by the RefbioII Trans-Pyrenean Cooperation Network for Biomedical Research financed by Horizon 2020. I.A. is supported by the Marat√≥n EiTB 2017 for Funding of Research into Stroke, Bilbao, Spain (Ref. BIO18/IC/005); R.T.N. is the recipient of a fellowship from the Secretar√≠a Nacional de Ciencia y Tecnolog√≠a e Innovaci√≥n (SENACYT; Convocatoria Doctorado de Investigaci√≥n Ronda III, 2018; Ref. BIDP-III-2018-12) of the Gobierno Nacional, Rep√ļblica de Panam√°