Adenosine-to-inosine (A-to-I) RNA editing is a common RNA modification catalyzed by ADAR enzymes. ADAR1 serves a crucial function to edit specific immunogenic double stranded RNA (dsRNA) to prevent the dsRNA sensor, MDA5 ( IFIH1 ), activating an interferon stimulated gene (ISG) response. Discoveries in human genetics now implicate deficient ADAR1 RNA editing as a causal mechanism for coronary artery disease (CAD) risk. Here, we show that human atherosclerotic smooth muscle cells (SMCs) express immunogenic RNA at markedly higher levels compared to all other cell types. We demonstrate that ADAR1 is the master regulator of RNA editing in primary human coronary artery SMC (HCASMC) and loss of RNA editing causes activation of MDA5, characterized by upregulation of ISG genes (i.e. ISG15 ) and others with known roles in SMC phenotypic transition and CAD risk (i.e. KLF4 ). ADAR1 and MDA5 regulate SMC phenotypic modulation and calcification in vitro . In a high fat diet atherosclerosis model, scRNAseq analysis revealed SMC to have increasing ISG expression with phenotypic modulation. To evaluate SMC RNA editing in vivo , we generated a conditional SMC specific Adar1 KD mouse ( Adar1 flox/flox , Myh11 CreERT2 , ROSA tdT/+ , ApoE -/- ). At 2 weeks following SMC- Adar1 KD, we observed 50% mortality with a severe phenotype of elastin degradation and disarray, intravascular hemorrhage, and inflammatory cell infiltration in the aortic wall. scRNAseq of aortic tissue showed that SMC- Adar1 KD causes ISG activation and coordinates a complex transcriptional response throughout the vessel wall with robust macrophage cell infiltration. Through evaluation of ligand-receptor interaction, we show that Ccl5:Ccr5 is the principal regulator of cell infiltration following SMC- Adar1 KD. Through study of SMC- Adar1 haploinsufficiency in the atherosclerosis mouse model, we further reveal that MDA5 activation occurs in SMC phenotypic modulation and accelerates formation of chondromyocytes — indicating a cell type and context specific requirement of RNA editing. Through this work, we describe a fundamental new mechanism of CAD, where RNA editing and sensing of dsRNA mediates disease progression, promoting our understanding of disease causality and CAD genetic risk.
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