Allele-specific NKX2-5 binding underlies multiple genetic associations with human EKG traits

Genetic variation affecting the binding of transcription factors (TFs) has been proposed as a major mechanism underlying susceptibility to common disease. NKX2-5, a key cardiac development TF, has been associated with electrocardiographic (EKG) traits through GWAS, but the extent to which differential binding of NKX2-5 contributes to these traits has not yet been studied. Here, we analyzed transcriptomic and epigenomic data generated from iPSC-derived cardiomyocyte lines (iPSC-CMs) from seven whole-genome sequenced individuals in a three-generational family. We identified ~2,000 single nucleotide variants (SNVs) associated with allele-specific effects (ASE) on NKX2-5 binding. These ASE-SNVs were enriched for altered TF motifs (both cognate and other cardiac TFs), and were positively correlated with changes in H3K27ac in iPSC-CMs, suggesting they impact cardiac enhancer activity. We found that NKX2-ASE-SNVs were significantly enriched for being heart-specific eQTLs and EKG GWAS variants, suggesting that altered NKX2-5 binding at multiple sites across the genome influences EKG traits. We used a fine-mapping approach to integrate iPSC-CM molecular phenotype data with a GWAS for heart rate, and determined that NKX2-5 ASE variants are likely causal for numerous known, as well as previously unidentified, heart rate loci. Analyzing Hi-C and gene expression data from iPSC-CMs at these heart rate loci, we identified several genes likely to be causally involved in heart rate variability. Our study demonstrates that differential binding of NKX2-5 is a common mechanism underlying genetic association with EKG traits, and shows that characterizing variants associated with differential binding of development TFs in iPSC-derived cell lines can identify novel loci and mechanisms influencing complex traits.