@article {82, title = {Electronic health record phenotypes associated with genetically regulated expression of CFTR and application to cystic fibrosis.}, journal = {Genet Med}, volume = {22}, year = {2020}, month = {2020 07}, pages = {1191-1200}, abstract = {

PURPOSE: The increasing use of electronic health records (EHRs) and biobanks offers unique opportunities to study Mendelian diseases. We described a novel approach to summarize clinical manifestations from patient EHRs into phenotypic evidence for cystic fibrosis (CF) with potential to alert unrecognized patients of the disease.

METHODS: We estimated genetically predicted expression (GReX) of cystic fibrosis transmembrane conductance regulator (CFTR) and tested for association with clinical diagnoses in the Vanderbilt University biobank (N = 9142 persons of European descent with 71 cases of CF). The top associated EHR phenotypes were assessed in combination as a phenotype risk score (PheRS) for discriminating CF case status in an additional 2.8 million patients from Vanderbilt University Medical Center (VUMC) and 125,305 adult patients including 25,314 CF cases from MarketScan, an independent external cohort.

RESULTS: GReX of CFTR was associated with EHR phenotypes consistent with CF. PheRS constructed using the EHR phenotypes and weights discovered by the genetic associations improved discriminative power for CF over the initially proposed PheRS in both VUMC and MarketScan.

CONCLUSION: Our study demonstrates the power of EHRs for clinical description of CF and the benefits of using a genetics-informed weighing scheme in construction of a phenotype risk score. This research may find broad applications for phenomic studies of Mendelian disease genes.

}, keywords = {Adult, Cystic Fibrosis, Cystic Fibrosis Transmembrane Conductance Regulator, Electronic Health Records, Humans, Mutation, Phenotype}, issn = {1530-0366}, doi = {10.1038/s41436-020-0786-5}, author = {Zhong, Xue and Yin, Zhijun and Jia, Gengjie and Zhou, Dan and Wei, Qiang and Faucon, Annika and Evans, Patrick and Gamazon, Eric R and Li, Bingshan and Tao, Ran and Rzhetsky, Andrey and Bastarache, Lisa and Cox, Nancy J} } @article {56, title = {GRIK5 Genetically Regulated Expression Associated with Eye and Vascular Phenomes: Discovery through Iteration among Biobanks, Electronic Health Records, and Zebrafish.}, journal = {Am J Hum Genet}, volume = {104}, year = {2019}, month = {2019 Mar 07}, pages = {503-519}, abstract = {

Although the use of model systems for studying the mechanism of mutations that have a large effect is common, we highlight here the ways that zebrafish-model-system studies of a gene, GRIK5, that contributes to the polygenic liability to develop eye diseases have helped to illuminate a mechanism that implicates vascular biology in eye disease. A gene-expression prediction derived from a reference transcriptome panel applied to BioVU, a large electronic health record (EHR)-linked biobank at Vanderbilt University Medical Center, implicated reduced GRIK5 expression in diverse eye diseases. We tested the function of GRIK5 by depletion of its ortholog in zebrafish, and we observed reduced blood vessel numbers and integrity in the eye and increased vascular permeability. Analyses of EHRs in >2.6 million Vanderbilt subjects revealed significant comorbidity of eye and vascular diseases (relative risks 2-15); this comorbidity was confirmed in 150 million individuals from a large insurance claims dataset. Subsequent studies in >60,000 genotyped BioVU participants confirmed the association of reduced genetically predicted expression of GRIK5 with comorbid vascular and eye diseases. Our studies pioneer an approach that allows a rapid iteration of the discovery of gene-phenotype relationships to the primary genetic mechanism contributing to the pathophysiology of human disease. Our findings also add dimension to the understanding of the biology driven by glutamate receptors such as GRIK5 (also referred to as GLUK5 in protein form) and to mechanisms contributing to human eye diseases.

}, issn = {1537-6605}, doi = {10.1016/j.ajhg.2019.01.017}, author = {Unlu, Gokhan and Gamazon, Eric R and Qi, Xinzi and Levic, Daniel S and Bastarache, Lisa and Denny, Joshua C and Roden, Dan M and Mayzus, Ilya and Breyer, Max and Zhong, Xue and Konkashbaev, Anuar I and Rzhetsky, Andrey and Knapik, Ela W and Cox, Nancy J} } @article {29, title = {Phenotype risk scores identify patients with unrecognized Mendelian disease patterns.}, journal = {Science}, volume = {359}, year = {2018}, month = {2018 Mar 16}, pages = {1233-1239}, abstract = {

Genetic association studies often examine features independently, potentially missing subpopulations with multiple phenotypes that share a single cause. We describe an approach that aggregates phenotypes on the basis of patterns described by Mendelian diseases. We mapped the clinical features of 1204 Mendelian diseases into phenotypes captured from the electronic health record (EHR) and summarized this evidence as phenotype risk scores (PheRSs). In an initial validation, PheRS distinguished cases and controls of five Mendelian diseases. Applying PheRS to 21,701 genotyped individuals uncovered 18 associations between rare variants and phenotypes consistent with Mendelian diseases. In 16 patients, the rare genetic variants were associated with severe outcomes such as organ transplants. PheRS can augment rare-variant interpretation and may identify subsets of patients with distinct genetic causes for common diseases.

}, keywords = {Databases, Genetic, DNA Mutational Analysis, Electronic Health Records, Exome, Genetic Association Studies, Genetic Diseases, Inborn, Genetic Predisposition to Disease, Genetic Variation, Humans, Phenotype, Risk Factors}, issn = {1095-9203}, doi = {10.1126/science.aal4043}, author = {Bastarache, Lisa and Hughey, Jacob J and Hebbring, Scott and Marlo, Joy and Zhao, Wanke and Ho, Wanting T and Van Driest, Sara L and McGregor, Tracy L and Mosley, Jonathan D and Wells, Quinn S and Temple, Michael and Ramirez, Andrea H and Carroll, Robert and Osterman, Travis and Edwards, Todd and Ruderfer, Douglas and Velez Edwards, Digna R and Hamid, Rizwan and Cogan, Joy and Glazer, Andrew and Wei, Wei-Qi and Feng, QiPing and Brilliant, Murray and Zhao, Zhizhuang J and Cox, Nancy J and Roden, Dan M and Denny, Joshua C} }