Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom.
National Health Service Blood and Transplant, Cambridge Biomedical Campus, Cambridge, United Kingdom.
Blood. 2023 Dec 14;142(24):2055-2068. doi: 10.1182/blood.2023020118.
Rare genetic diseases affect millions, and identifying causal DNA variants is essential for patient care. Therefore, it is imperative to estimate the effect of each independent variant and improve their pathogenicity classification. Our study of 140 214 unrelated UK Biobank (UKB) participants found that each of them carries a median of 7 variants previously reported as pathogenic or likely pathogenic. We focused on 967 diagnostic-grade gene (DGG) variants for rare bleeding, thrombotic, and platelet disorders (BTPDs) observed in 12 367 UKB participants. By association analysis, for a subset of these variants, we estimated effect sizes for platelet count and volume, and odds ratios for bleeding and thrombosis. Variants causal of some autosomal recessive platelet disorders revealed phenotypic consequences in carriers. Loss-of-function variants in MPL, which cause chronic amegakaryocytic thrombocytopenia if biallelic, were unexpectedly associated with increased platelet counts in carriers. We also demonstrated that common variants identified by genome-wide association studies (GWAS) for platelet count or thrombosis risk may influence the penetrance of rare variants in BTPD DGGs on their associated hemostasis disorders. Network-propagation analysis applied to an interactome of 18 410 nodes and 571 917 edges showed that GWAS variants with large effect sizes are enriched in DGGs and their first-order interactors. Finally, we illustrate the modifying effect of polygenic scores for platelet count and thrombosis risk on disease severity in participants carrying rare variants in TUBB1 or PROC and PROS1, respectively. Our findings demonstrate the power of association analyses using large population datasets in improving pathogenicity classifications of rare variants.
罕见遗传病影响数百万人,确定致病 DNA 变异对于患者护理至关重要。因此,估计每个独立变异的影响并改进其致病性分类势在必行。我们对 140414 名无关联的英国生物库(UKB)参与者进行了研究,发现他们每个人平均携带 7 种先前报道为致病性或可能致病性的变异。我们专注于在 12367 名 UKB 参与者中观察到的 967 种罕见出血、血栓和血小板疾病(BTPD)的诊断级基因(DGG)变异。通过关联分析,对于这些变异的一部分,我们估计了血小板计数和体积的效应大小,以及出血和血栓形成的优势比。一些常染色体隐性血小板疾病的致病变异在携带者中揭示了表型后果。如果是双等位基因,MPL 的功能丧失变异会导致慢性巨核细胞减少性血小板减少症,但出乎意料的是,携带者的血小板计数增加。我们还证明,全基因组关联研究(GWAS)确定的血小板计数或血栓形成风险的常见变异可能会影响 BTPD DGG 中罕见变异在相关止血障碍中的外显率。应用于包含 18410 个节点和 571917 个边的相互作用网络的传播分析表明,具有大效应大小的 GWAS 变异在 DGG 及其一阶相互作用者中富集。最后,我们说明了血小板计数和血栓形成风险的多基因评分对携带 TUBB1 或 PROC 和 PROS1 中罕见变异的参与者疾病严重程度的修饰作用。我们的研究结果表明,使用大型人群数据集进行关联分析在提高罕见变异的致病性分类方面具有强大的作用。
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