Rare penetrant mutations confer severe risk of common diseases

[INTRODUCTION] Genome-wide association studies (GWASs) have identified thousands of common genetic variants that are predictive of common disease susceptibility, but these variants individually have mild effects on disease owing to the effects of natural selection. By contrast, rare genetic variants can have large effects on common disease risk, but their use in genetic risk prediction has been limited to date owing to the difficulty of distinguishing pathogenic from benign variants and estimating the magnitude of their effects.[RATIONALE] PrimateAI-3D is a three-dimensional convolutional neural network for missense variant–effect prediction, which was trained with common genetic variants from the population sequencing of 233 primate species. By applying this method to estimate the pathogenicity of rare coding variants in 454,712 UK Biobank individuals, we aimed to improve rare-variant association tests and genetic risk prediction for common diseases and complex traits.[RESULTS] We performed rare-variant burden tests for 90 well-powered, clinically relevant phenotypes in the UK Biobank exome dataset. Stratifying missense variants with PrimateAI-3D greatly improved gene discovery, revealing 73% more significant gene-phenotype associations (false discovery rate <0.05) compared with not using PrimateAI-3D. When benchmarked against prior studies, gene-phenotype pairs identified with our method were better supported by orthogonal genetic evidence from GWAS and genes from related Mendelian disorders. In addition, PrimateAI-3D scores showed the strongest correlation among existing variant interpretation algorithms for predicting the quantitative effects of rare variants on continuous clinical phenotypes. Having validated our method for finding gene-phenotype relationships, we next constructed a rare-variant polygenic risk score (PRS) model by combining the rare-variant genes for each phenotype, weighting variants by their PrimateAI-3D prediction score and the direction and effect size of each associated gene. For comparison, we constructed common-variant PRS models and evaluated the performance of the two models for genetic risk prediction in a withheld-test subset of the cohort. Although common variants better explained overall population variance, rare-variant PRSs had more power at the ends of the distribution to identify individuals at the greatest risk for disease, and thus may be more relevant for population genetic screening and risk management. By contrast to common-variant PRS models derived from European populations that show poor generalization to non-Europeans, rare-variant PRSs were substantially more portable to different cohorts and ancestry groups that were not seen during model training. Moreover, because they incorporate orthogonal information from nonoverlapping sets of variants, we combined rare- and common-variant PRS models into a unified model and observed further improvement in genetic risk prediction for common diseases. To understand the extent by which rare-variant PRSs can be expected to improve with increases in discovery cohort size, we repeated our analyses in down-sampled subsets of the UK Biobank cohort. We found that the number of genes contributing to the rare-variant PRS increased linearly, with no signs of plateauing at a half-million exomes. Newly discovered rare-variant genes were strongly enriched at GWAS loci, forming allelic series with effect sizes that were ~10-fold larger on average than the respective common GWAS variant. Among well-powered GWAS loci that could be unambiguously assigned to a single gene, the majority showed subthreshold signal on the rare-variant burden test, indicating that rare penetrant variants exist at a large fraction of GWAS loci and can be incorporated into the rare-variant PRS with further advances in cohort size and variant effect prediction.[CONCLUSION] Understanding the impact of rare variants in common diseases is of prime interest for both precision medicine and the discovery of drug targets. By leveraging advances in variant effect prediction, we have demonstrated major improvements in rare-variant burden testing and genetic risk prediction. Notably, we observed that nearly all individuals carried at least one rare penetrant variant for the phenotypes we examined, demonstrating the utility of personal genome sequencing for otherwise healthy individuals in the general population.T.M.B. is supported by funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement no. 864203), PID2021-126004NB-100 (MICIIN/FEDER, UE) and Secretaria d’Universitats i Recerca, and CERCA Programme del Departament d’Economia i Coneixement de la Generalitat de Catalunya (GRC 2021 SGR 00177).Peer reviewe

Personalized early detection and prevention of breast cancer: ENVISION consensus statement

Abstract: The European Collaborative on Personalized Early Detection and Prevention of Breast Cancer (ENVISION) brings together several international research consortia working on different aspects of the personalized early detection and prevention of breast cancer. In a consensus conference held in 2019, the members of this network identified research areas requiring development to enable evidence-based personalized interventions that might improve the benefits and reduce the harms of existing breast cancer screening and prevention programmes. The priority areas identified were: 1) breast cancer subtype-specific risk assessment tools applicable to women of all ancestries; 2) intermediate surrogate markers of response to preventive measures; 3) novel non-surgical preventive measures to reduce the incidence of breast cancer of poor prognosis; and 4) hybrid effectiveness–implementation research combined with modelling studies to evaluate the long-term population outcomes of risk-based early detection strategies. The implementation of such programmes would require health-care systems to be open to learning and adapting, the engagement of a diverse range of stakeholders and tailoring to societal norms and values, while also addressing the ethical and legal issues. In this Consensus Statement, we discuss the current state of breast cancer risk prediction, risk-stratified prevention and early detection strategies, and their implementation. Throughout, we highlight priorities for advancing each of these areas

Assessing the contribution of rare variants to complex trait heritability from whole-genome sequence data

[[abstract]]Analyses of data from genome-wide association studies on unrelated individuals have shown that, for human traits and diseases, approximately one-third to two-thirds of heritability is captured by common SNPs. However, it is not known whether the remaining heritability is due to the imperfect tagging of causal variants by common SNPs, in particular whether the causal variants are rare, or whether it is overestimated due to bias in inference from pedigree data. Here we estimated heritability for height and body mass index (BMI) from whole-genome sequence data on 25,465 unrelated individuals of European ancestry. The estimated heritability was 0.68 (standard error 0.10) for height and 0.30 (standard error 0.10) for body mass index. Low minor allele frequency variants in low linkage disequilibrium (LD) with neighboring variants were enriched for heritability, to a greater extent for protein-altering variants, consistent with negative selection. Our results imply that rare variants, in particular those in regions of low linkage disequilibrium, are a major source of the still missing heritability of complex traits and disease

Characterising the genetic basis of immune response variation to identify causal mechanisms underlying disease susceptibility

International audienceOver the last 10 years, genome-wide association studies (GWAS) have identified hundreds of susceptibility loci for autoimmune diseases. However, despite increasing power for the detection of both common and rare coding variants affecting disease susceptibility, a large fraction of disease heritability has remained unexplained. In addition, a majority of the identified loci are located in noncoding regions, and translation of disease-associated loci into new biological insights on the etiology of immune disorders has been lagging. This highlights the need for a better understanding of noncoding variation and new strategies to identify causal genes at disease loci. In this review, I will first detail the molecular basis of gene expression and review the various mechanisms that contribute to alter gene activity at the transcriptional and post-transcriptional level. I will then review the findings from 10 years of functional genomics studies regarding the genetics on gene expression, in particular in the context of infection. Finally, I will discuss the extent to which genetic variants that modulate gene expression at transcriptional and post-transcriptional level contribute to disease susceptibility and present strategies to leverage this information for the identification of causal mechanisms at disease loci in the era of whole genome sequencing

275 years of forestry meets genomics in Pinus sylvestris

Abstract Pinus sylvestris has a long history of basic and applied research that is relevant for both forestry and evolutionary studies. Its patterns of adaptive variation and role in forest economic and ecological systems have been studied extensively for nearly 275 years, detailed demography for a 100 years and mating system more than 50 years. However, its reference genome sequence is not yet available and genomic studies have been lagging compared to, for example, Pinus taeda and Picea abies, two other economically important conifers. Despite the lack of reference genome, many modern genomic methods are applicable for a more detailed look at its biological characteristics. For example, RNA‐seq has revealed a complex transcriptional landscape and targeted DNA sequencing displays an excess of rare variants and geographically homogenously distributed molecular genetic diversity. Current DNA and RNA resources can be used as a reference for gene expression studies, SNP discovery, and further targeted sequencing. In the future, specific consequences of the large genome size, such as functional effects of regulatory open chromatin regions and transposable elements, should be investigated more carefully. For forest breeding and long‐term management purposes, genomic data can help in assessing the genetic basis of inbreeding depression and the application of genomic tools for genomic prediction and relatedness estimates. Given the challenges of breeding (long generation time, no easy vegetative propagation) and the economic importance, application of genomic tools has a potential to have a considerable impact. Here, we explore how genomic characteristics of P. sylvestris, such as rare alleles and the low extent of linkage disequilibrium, impact the applicability and power of the tools