@article {127, title = {Rapid response to the alpha-1 adrenergic agent phenylephrine in the perioperative period is impacted by genomics and ancestry.}, journal = {Pharmacogenomics J}, volume = {21}, year = {2021}, month = {2021 Apr}, pages = {174-189}, abstract = {

The emergence of genomic data in biobanks and health systems offers new ways to derive medically important phenotypes, including acute phenotypes occurring during inpatient clinical care. Here we study the genetic underpinnings of the rapid response to phenylephrine, an α1-adrenergic receptor agonist commonly used to treat hypotension during anesthesia and surgery. We quantified this response by extracting blood pressure (BP) measurements 5 min before and after the administration of phenylephrine. Based on this derived phenotype, we show that systematic differences exist between self-reported ancestry groups: European-Americans (EA; n = 1387) have a significantly higher systolic response to phenylephrine than African-Americans (AA; n = 1217) and Hispanic/Latinos (HA; n = 1713) (31.3\% increase, p value < 6e-08 and 22.9\% increase, p value < 5e-05 respectively), after adjusting for genetic ancestry, demographics, and relevant clinical covariates. We performed a genome-wide association study to investigate genetic factors underlying individual differences in this derived phenotype. We discovered genome-wide significant association signals in loci and genes previously associated with BP measured in ambulatory settings, and a general enrichment of association in these genes. Finally, we discovered two low frequency variants, present at ~1\% in EAs and AAs, respectively, where patients carrying one copy of these variants show no phenylephrine response. This work demonstrates our ability to derive a quantitative phenotype suited for comparative statistics and genome-wide association studies from dense clinical and physiological measures captured for managing patients during surgery. We identify genetic variants underlying non response to phenylephrine, with implications for preemptive pharmacogenomic screening to improve safety during surgery.

}, issn = {1473-1150}, doi = {10.1038/s41397-020-00194-5}, author = {Wenric, Stephane and Jeff, Janina M and Joseph, Thomas and Yee, Muh-Ching and Belbin, Gillian M and Owusu Obeng, Aniwaa and Ellis, Stephen B and Bottinger, Erwin P and Gottesman, Omri and Levin, Matthew A and Kenny, Eimear E} } @article {126, title = {A common variant in PNPLA3 is associated with age at diagnosis of NAFLD in patients from a multi-ethnic biobank.}, journal = {J Hepatol}, volume = {72}, year = {2020}, month = {2020 06}, pages = {1070-1081}, abstract = {

BACKGROUND \& AIMS: The Ile138Met variant (rs738409) in the PNPLA3 gene has the largest effect on non-alcoholic fatty liver disease (NAFLD), increasing the risk of progression to severe forms of liver disease. It remains unknown if the variant plays a role in age of NAFLD onset. We aimed to determine if rs738409 impacts on the age of NAFLD diagnosis.

METHODS: We applied a novel natural language processing (NLP) algorithm to a longitudinal electronic health records (EHR) dataset of >27,000 individuals with genetic data from a multi-ethnic biobank, defining NAFLD cases (n~= 1,703) and confirming controls (n~= 8,119). We conducted i) a survival analysis to determine if age at diagnosis differed by rs738409 genotype, ii) a receiver operating characteristics analysis to assess the utility of the rs738409 genotype in discriminating NAFLD cases from controls, and iii) a phenome-wide association study (PheWAS) between rs738409 and 10,095 EHR-derived disease diagnoses.

RESULTS: The PNPLA3 G risk allele was associated with: i) earlier age of NAFLD diagnosis, with the strongest effect in Hispanics (hazard ratio 1.33; 95\% CI 1.15-1.53; p <0.0001) among whom a NAFLD diagnosis was 15\% more likely in risk allele carriers vs. non-carriers; ii) increased NAFLD risk (odds ratio 1.61; 95\% CI 1.349-1.73; p <0.0001), with the strongest effect among Hispanics (odds ratio 1.43; 95\% CI 1.28-1.59; p <0.0001); iii) additional liver diseases in a PheWAS (p <4.95~{\texttimes} 10) where the risk variant also associated with earlier age of diagnosis.

CONCLUSION: Given the role of the rs738409 in NAFLD diagnosis age, our results suggest that stratifying risk within populations known to have an enhanced risk of liver disease, such as Hispanic carriers of the rs738409 variant, would be effective in earlier identification of those who would benefit most from early NAFLD prevention and treatment strategies.

LAY SUMMARY: Despite clear associations between the PNPLA3 rs738409 variant and elevated risk of progression from non-alcoholic fatty liver disease (NAFLD) to more severe forms of liver disease, it remains unknown if PNPLA3 rs738409 plays a role in the age of NAFLD onset. Herein, we found that this risk variant is associated with an earlier age of NAFLD and other liver disease diagnoses; an observation most pronounced in Hispanic Americans. We conclude that PNPLA3 rs738409 could be used to better understand liver disease risk within vulnerable populations and identify patients that may benefit from early prevention strategies.

}, issn = {1600-0641}, doi = {10.1016/j.jhep.2020.01.029}, author = {Walker, Ryan W and Belbin, Gillian M and Sorokin, Elena P and Van Vleck, Tielman and Wojcik, Genevieve L and Moscati, Arden and Gignoux, Christopher R and Cho, Judy and Abul-Husn, Noura S and Nadkarni, Girish and Kenny, Eimear E and Loos, Ruth J F} } @article {89, title = {A positively selected FBN1 missense variant reduces height in Peruvian individuals.}, journal = {Nature}, volume = {582}, year = {2020}, month = {2020 06}, pages = {234-239}, abstract = {

On average, Peruvian individuals are among the shortest in the world. Here we show that Native American ancestry is associated with reduced height in an ethnically diverse group of Peruvian individuals, and identify a population-specific, missense variant in the FBN1 gene (E1297G) that is significantly associated with lower height. Each copy of the minor allele (frequency of 4.7\%) reduces height by 2.2~cm (4.4~cm in homozygous individuals). To our knowledge, this is the largest effect size known for a common height-associated variant. FBN1 encodes the extracellular matrix protein fibrillin~1, which is a major structural component of microfibrils. We observed less densely packed fibrillin-1-rich microfibrils with irregular edges in the skin of individuals who were homozygous for G1297 compared with individuals who were homozygous for E1297. Moreover, we show that the E1297G locus is under positive selection in non-African populations, and that the E1297 variant shows subtle evidence of positive selection specifically within the Peruvian population. This variant is also significantly more frequent in coastal Peruvian populations than in populations from the Andes or the Amazon, which suggests that short stature might be the result of adaptation to factors that are associated with the coastal environment in Peru.

}, keywords = {Body Height, Female, Fibrillin-1, Gene Frequency, Genome-Wide Association Study, Heredity, Humans, Indians, South American, Male, Microfibrils, Mutation, Missense, Peru, Selection, Genetic}, issn = {1476-4687}, doi = {10.1038/s41586-020-2302-0}, author = {Asgari, Samira and Luo, Yang and Akbari, Ali and Belbin, Gillian M and Li, Xinyi and Harris, Daniel N and Selig, Martin and Bartell, Eric and Calderon, Roger and Slowikowski, Kamil and Contreras, Carmen and Yataco, Rosa and Galea, Jerome T and Jimenez, Judith and Coit, Julia M and Farro{\~n}ay, Chandel and Nazarian, Rosalynn M and O{\textquoteright}Connor, Timothy D and Dietz, Harry C and Hirschhorn, Joel N and Guio, Heinner and Lecca, Leonid and Kenny, Eimear E and Freeman, Esther E and Murray, Megan B and Raychaudhuri, Soumya} } @article {73, title = {Exome sequencing reveals a high prevalence of BRCA1 and BRCA2 founder variants in a diverse population-based biobank.}, journal = {Genome Med}, volume = {12}, year = {2019}, month = {2019 Dec 31}, pages = {2}, abstract = {

BACKGROUND: Pathogenic variants in BRCA1 and BRCA2 (BRCA1/2) lead to increased risk of breast, ovarian, and other cancers, but most variant-positive individuals in the general population are unaware of their risk, and little is known about prevalence in non-European populations. We investigated BRCA1/2 prevalence and impact in the electronic health record (EHR)-linked BioMe Biobank in New York City.

METHODS: Exome sequence data from 30,223 adult BioMe participants were evaluated for pathogenic variants in BRCA1/2. Prevalence estimates were made in population groups defined by genetic ancestry and self-report. EHR data were used to evaluate clinical characteristics of variant-positive individuals.

RESULTS: There were 218 (0.7\%) individuals harboring expected pathogenic variants, resulting in an overall prevalence of 1 in 139. The highest prevalence was in individuals with Ashkenazi Jewish (AJ; 1 in 49), Filipino and other~Southeast Asian (1 in 81), and non-AJ European (1 in 103) ancestry. Among 218 variant-positive individuals, 112 (51.4\%) harbored known founder variants: 80 had AJ founder variants (BRCA1 c.5266dupC and c.68_69delAG, and BRCA2 c.5946delT), 8 had a Puerto Rican founder variant (BRCA2 c.3922G>T), and 24 had one of 19 other founder variants. Non-European populations were more likely to harbor BRCA1/2 variants that were not classified in ClinVar or that had uncertain or conflicting evidence for pathogenicity (uncertain/conflicting). Within mixed ancestry populations, such as Hispanic/Latinos with genetic ancestry from Africa, Europe, and the Americas, there was a strong correlation between the proportion of African genetic ancestry and the likelihood of harboring an uncertain/conflicting variant. Approximately 28\% of variant-positive individuals had a personal history, and 45\% had a personal or family history of BRCA1/2-associated cancers. Approximately 27\% of variant-positive individuals had prior clinical genetic testing for BRCA1/2. However, individuals with AJ founder variants were twice as likely to have had a clinical test (39\%) than those with other pathogenic variants (20\%).

CONCLUSIONS: These findings deepen our knowledge about BRCA1/2 variants and associated cancer risk in diverse populations, indicate a gap in knowledge about potential cancer-related variants in non-European populations, and suggest that genomic screening in diverse patient populations may be an effective tool to identify at-risk individuals.

}, issn = {1756-994X}, doi = {10.1186/s13073-019-0691-1}, author = {Abul-Husn, Noura S and Soper, Emily R and Odgis, Jacqueline A and Cullina, Sinead and Bobo, Dean and Moscati, Arden and Rodriguez, Jessica E and Loos, Ruth J F and Cho, Judy H and Belbin, Gillian M and Suckiel, Sabrina A and Kenny, Eimear E} } @article {61, title = {Genetic diversity in populations across Latin America: implications for population and medical genetic studies.}, journal = {Curr Opin Genet Dev}, volume = {53}, year = {2018}, month = {2018 12}, pages = {98-104}, abstract = {

Hispanic/Latino (H/L) populations, although linked by culture and aspects of shared history, reflect the complexity of history and migration influencing the Americas. The original settlement by indigenous Americans, followed by postcolonial admixture from multiple continents, has yielded localized genetic patterns. In addition, numerous H/L populations appear to have signatures of pre-colonization and post-colonization bottlenecks, indicating that tens of millions of H/Ls may harbor signatures of founder effects today. Based on both population and medical genetic findings we highlight the extreme differentiation across the Americas, providing evidence for why H/Ls should not be considered a single population in modern human genetics. We highlight the need for additional sampling of understudied H/L groups, and ramifications of these findings for genomic medicine in one-tenth of the world{\textquoteright}s population.

}, keywords = {African Continental Ancestry Group, European Continental Ancestry Group, Genetic Variation, Genetics, Medical, Genetics, Population, Genome, Human, Genomics, Humans, Latin America}, issn = {1879-0380}, doi = {10.1016/j.gde.2018.07.006}, author = {Belbin, Gillian M and Nieves-Col{\'o}n, Maria A and Kenny, Eimear E and Moreno-Estrada, Andres and Gignoux, Christopher R} }