Gene networks driven by genetic variation for plasma cortisol in hepatic and adipose tissues implicate corticosteroid binding globulin in modulating tissue glucocorticoid action and cardiovascular risk

Genome wide association meta-analyses (GWAMA) by the CORtisol NETwork (CORNET) consortium identified genetic variants spanning the SERPINA6/SERPINA1 locus on chromosome 14 associated with morning plasma cortisol, cardiovascular disease (CVD), and SERPINA6 mRNA expression encoding corticosteroid binding globulin (CBG) in liver. These and other findings indicate that higher plasma cortisol levels are causally associated with cardiovascular disease, however, the mechanisms by which variations in CBG lead to CVD are undetermined. Using genomic and transcriptomic data from The Stockholm Tartu Atherosclerosis Reverse Networks Engineering Task (STARNET) study, we identified plasma cortisol linked Single Nucleotide Polymorphisms (SNPs) that are trans-associated with genes from 7 different vascular and metabolic tissues, finding the highest representation of trans-genes in liver, subcutaneous adipose and visceral abdominal adipose tissue (FDR = 15%). We identified a sub-set of cortisol-associated trans-genes that are putatively regulated by the Glucocorticoid Receptor (GR), the primary transcription factor activated by cortisol. Using causal inference, we identified GR-regulated trans-genes that are responsible for the regulation of tissue specific gene networks. Cis-expression Quantitative Trait Loci (eQTLs) were used as genetic instruments for identification of pairwise causal relationships from which gene networks could be reconstructed. Gene networks were identified in liver, subcutaneous fat and visceral abdominal fat, including a high confidence gene network specific to subcutaneous adipose (FDR = 10%) under the regulation of the interferon regulatory transcription factor, IRF2. These data identify a plausible pathway through which variation in liver CBG production perturbs cortisol-regulated gene networks in peripheral tissues and thereby promote CVD. ### Competing Interest Statement The authors have declared no competing interest.