Stage 1 exome-chip genotyping in GERAD/PERADES, ADGC …...W ASHU2 WHICAP Combined OR OR 1.85 1.56...
Transcript of Stage 1 exome-chip genotyping in GERAD/PERADES, ADGC …...W ASHU2 WHICAP Combined OR OR 1.85 1.56...
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Supplementary Figure 1
IGAP study design.
Stage 1 exome-chip genotyping in GERAD/PERADES, ADGC and CHARGE cohorts. Stage 2 genotyping and imputed genotyping of independent GERAD/PERADES, CHARGE and EADI samples. Stage 3 in silico analysis using ADGC HRC imputed GWAS data.
Nature Genetics: doi:10.1038/ng.3916
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Supplementary Figure 2
Quantile–quantile plots for the minimally adjusted (‘unadjusted’) model single-variant association analyses in SeqMeta.
(a) Plot showing all variants with minor allele count (MAC) ≥4, genomic inflation factor ( ) = 1.188. (b) Plot showing
variants with MAC ≥4 and MAF <0.05, genomic inflation factor ( ) = 1.066. (c) Plot showing variants with MAC ≥4 and
excluding all associations in the APOE region, genomic inflation factor ( ) = 1.102. (d) Plot showing variants with MAC ≥4,
with MAF <0.05, and excluding all associations in the APOE region, genomic inflation factor ( ) = 1.054. Although there is
some evidence of inflated association statistics, this inflation is consistent with inflation observed in previous exome array studies (Jeroen et al. Nat. Genet. 45, 197–201, 2013) and has been shown in multiple studies to be dramatically reduced with the exclusion of common variants, which on the exome array are mostly previously reported variants with strong associations in GWAS empaneled on the exome array, and regions of strong association, such as the APOE region in Alzheimer’s disease.
Nature Genetics: doi:10.1038/ng.3916
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PLCG2−rs72824905−C
Study
ADC7
CHOP
Miami
NorthShore
WashU
AGES
CHS
FHS
RS
GERAD v1.0
GERAD v1.1
GERAD/PERADES
ACE
IGAP_Swe
IGAP_Finland
IGAP_Bel
IGAP_Aus_Ger
IGAP_Gre
IGAP_Italy
IGAP_Spa
IGAP_UK
IGAP_USA
IGAP_Can
EADI_France
RS1
RS2
ACT
ADC1
ADC2
ADC3
ADC6
ADNI
CHAP
GSK
LOAD
MAYO
MIRAGE
MTV
NBB
OHSU
ROSMAP
ROSMAP2
TARC1
TGEN2
UMVUMSSM_B
UPITT
WASHU
WASHU2
WHICAP
Combined OR
OR
0.74
0.57
1.11
0.62
0.58
0.47
0.8
0.58
0.73
0.52
0.93
0.8
0.9
0.5
11.98
0.66
0.54
2.42
0.25
0.84
1.04
0.56
0.4
0.84
0.8
0.37
0.76
4.61
0
0.34
0.3
0.4
0.25
0.44
0.79
0.75
0.24
1.57
0.18
2.92
0.6
0.7
0.53
0.53
0.92
0.85
0.08
0.3
0.28
0.68
0.50 0.80 1.0 1.25 2.0 3.0
Supplementary Figure 3
Forest plot of rs72824905 (PLCG2) association with LOAD in combined (stage 1 + stage 2 + stage 3) analysis, shown by each cohort independently analyzed.
Cohort-specific odds ratios (ORs) are provided and denoted by blue squares, with 95% confidence intervals (CIs) denoted by blue lines. Individual study OR and combined OR are calculated using the SeqMeta package. The combined OR estimate for each cohort is represented by the blue diamond, where diamond width corresponds to 95% confidence interval bounds. Square and diamond heights are inversely proportional to the precision of the OR estimate.
Nature Genetics: doi:10.1038/ng.3916
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Supplementary Figure 4
PLCG2 conservation at human position 522 (p.P522R) across human, chimpanzee, rhesus monkey, mouse, rat, rabbit, horse, dog, and elephant.
The proline residue conserved across these species is indicated in red.
Nature Genetics: doi:10.1038/ng.3916
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Supplementary Figure 5
Regional plot of the conditional analysis performed at the PLCG2 locus in the stage 1 data set.
When conditioning on top hit rs72824905, indicated in purple, the most significant association is seen with rs200506549 (P = 6.52 × 10–4, MAF = 0.0019).
Nature Genetics: doi:10.1038/ng.3916
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ABI3−rs616338−C
Study
ADC7
CHOP
Miami
NorthShore
WashU
AGES
CHS
FHS
RS
GERAD v1.0
GERAD v1.1
GERAD/PERADES
ACE
IGAP_Swe
IGAP_Finland
IGAP_Bel
IGAP_Aus_Ger
IGAP_Gre
IGAP_Italy
IGAP_Spa
IGAP_UK
IGAP_USA
IGAP_Can
EADI_France
RS1
RS2
ACT
ADC1
ADC2
ADC3
ADC6
ADNI
CHAP
GSK
LOAD
MAYO
MIRAGE
MTV
NBB
OHSU
ROSMAP
ROSMAP2
TARC1
TGEN2
UMVUMSSM_B
UPITT
WASHU
WASHU2
WHICAP
Combined OR
OR
2.29
1.82
2.12
1.06
1.17
1.78
0.79
0.3
1.75
1.28
1.99
1.21
1.82
1.54
2.3
0.69
1.42
6.68
1.75
1.35
1.52
1.32
3.18
1.47
1.17
0.56
0.29
0.37
33.87
3.74
0.24
2.86
0.1
1.69
2.6
1.71
0.22
1.46
1.85
6.35
83.91
8.79
1.01
1.12
1.71
1.51
0.26
2.64
1.43
0.50 0.80 1.0 1.25 2.0 3.0
Supplementary Figure 6
Forest plot of rs616338 (ABI3) association with LOAD in combined (stage 1 + stage 2 + stage 3) analysis, shown by each cohort independently analyzed.
Cohort-specific odds ratios (ORs) are provided and denoted by blue squares, with 95% confidence intervals (CIs) denoted by blue lines. Individual study OR and combined OR are calculated using the SeqMeta package. The combined OR estimate for each cohort is represented by the blue diamond, where diamond width corresponds to 95% confidence interval bounds. Square and diamond heights are inversely proportional to the precision of the OR estimate.
Nature Genetics: doi:10.1038/ng.3916
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Supplementary Figure 7
ABI3 conservation at human position 209 (p.S209F) across multiple species.
The serine amino acid conserved across species is indicated in red. Note that the reference allele at this site encodes a phenylalanine and is the rare allele. The common allele encodes a serine and is shown for the human sequence above. The serine residue conserved across these species is indicated in red.
Nature Genetics: doi:10.1038/ng.3916
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Supplementary Figure 8
Regional plot of the conditional analysis performed at the ABI3 locus in the stage 1 data set.
When conditioning on the top hit rs616338, indicated in purple, the most significant association is seen with rs141826857 (P = 1.89 × 10–5, MAF = 0.00018).
Nature Genetics: doi:10.1038/ng.3916
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TREM2−rs143332484−C
Study
ADC7
CHOP
Miami
NorthShore
WashU
AGES
CHS
FHS
RS
GERAD v1.0
GERAD v1.1
GERAD/PERADES
ACE
IGAP_Swe
IGAP_Finland
IGAP_Bel
IGAP_Aus_Ger
IGAP_Gre
IGAP_Italy
IGAP_Spa
IGAP_UK
IGAP_USA
IGAP_Can
EADI_France
RS1
RS2
ACT
ADC1
ADC2
ADC3
ADC6
ADNI
CHAP
GSK
LOAD
MAYO
MIRAGE
MTV
NBB
OHSU
ROSMAP
ROSMAP2
TARC1
TGEN2
UMVUMSSM_B
UPITT
WASHU
WASHU2
WHICAP
Combined OR
OR
1.85
1.56
3.2
1.4
1.32
0.34
0.94
2.33
1.11
1.51
2.06
3.51
7.92
1.73
4.27
0.99
2.49
2
3.42
17.61
1.75
1.04
1.72
0.31
8.42
1.7
3.81
0.34
0.67
1.34
3.01
0.64
1.7
7.82
>100
0.92
1.67
0.50 0.80 1.0 1.25 2.0 3.0
Supplementary Figure 9
Forest plot of rs143332484 (TREM2) association with LOAD in combined (stage 1 + stage 2 + stage 3) analysis, shown by each cohort independently analyzed.
Cohort-specific odds ratios (ORs) are provided and denoted by blue squares, with 95% confidence intervals (CIs) denoted
Nature Genetics: doi:10.1038/ng.3916
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by blue lines. Individual study OR and combined OR are calculated using the SeqMeta package. The combined OR estimate for each cohort is represented by the blue diamond, where diamond width corresponds to 95% confidence interval bounds. Square and diamond heights are inversely proportional to the precision of the OR estimate.
Nature Genetics: doi:10.1038/ng.3916
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TREM2−rs75932628−C
Study
ADC7
CHOP
Miami
NorthShore
WashU
AGES
CHS
FHS
RS
GERAD v1.0
GERAD v1.1
GERAD/PERADES
ACE
IGAP_Swe
IGAP_Finland
IGAP_Bel
IGAP_Aus_Ger
IGAP_Gre
IGAP_Italy
IGAP_Spa
IGAP_UK
IGAP_USA
IGAP_Can
EADI_France
RS1
RS2
ACT
ADC1
ADC2
ADC3
ADC6
ADNI
CHAP
GSK
LOAD
MAYO
MIRAGE
MTV
NBB
OHSU
ROSMAP
ROSMAP2
TARC1
TGEN2
UMVUMSSM_B
UPITT
WASHU
WASHU2
WHICAP
Combined OR
OR
1.67
3.03
2.31
1.38
1.45
4.07
2.01
4.13
1.89
1.35
1.94
2.69
4.47
0.62
2.33
2.77
4.19
3.34
0.47
2.15
2.63
4.06
12.45
0.09
0.85
7.82
>100
8.13
1.68
2.59
0.79
3.03
0.78
0.14
2.01
3.35
3.53
7.86
0.74
85.11
2.94
2.46
0.50 0.80 1.0 1.25 2.0 3.0
Supplementary Figure 10
Forest plot of rs75932628 (TREM2) association with LOAD in combined (stage 1 + stage 2 + stage 3) analysis, shown by each cohort independently analyzed.
Cohort-specific odds ratios (ORs) are provided and denoted by blue squares, with 95% confidence intervals (CIs) denoted by blue lines. Individual study OR and combined OR are calculated using the SeqMeta package. The combined OR estimate for each cohort is represented by the blue diamond, where diamond width
Nature Genetics: doi:10.1038/ng.3916
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corresponds to 95% confidence interval bounds. Square and diamond heights are inversely proportional to the precision of the OR estimate.
Nature Genetics: doi:10.1038/ng.3916
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b
a
c
Supplementary Figure 11
Regional plots of the conditional analyses performed at the TREM2 locus in the stage 1 data set.
(a) When conditioning on rs75932628 (p.R47H), indicated in purple, the most significant association is seen with
Nature Genetics: doi:10.1038/ng.3916
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rs143332484 (p.R62H) (P = 3.38 × 10–9). (b) When conditioning on rs143332484 (p.R62H), indicated in purple, the most significant association is seen with (rs75932628 (p.R47H) P = 5.12 × 10–12). (c) When conditioning on both rs143332484 (p.R62H) and rs75932628 (p.R47H), both indicated in purple, the most significant association is seen with rs143539514 (P = 1.51 × 10–3).
Nature Genetics: doi:10.1038/ng.3916
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Supplementary Figure 12
Gene expression profiles (RNA-seq) of PLCG2, ABI3, and TREM2 from transcriptome data from six cell types from human temporal lobe cortex (pink) and transcriptome data from seven cell types from mouse whole cortex (blue).
(a–c) Across species, PLCG2 (a), ABI3 (b), and TREM2 (c) show high expression in microglia/macrophage cells (Zhang et al. Neuron 89, 27–53, 2016). Figure downloaded from http://web.stanford.edu/group/barres_lab/brainseq2/brainseq2.html.
Nature Genetics: doi:10.1038/ng.3916
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Supplementary Figure 13
Schematic of the PLCG2 protein from the Protein Data Bank.
The location of p.P522R upstream of a SH2 domain is indicated by the dashed blue line.
Nature Genetics: doi:10.1038/ng.3916
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Supplementary Figure 14
Schematic of the ABI3 protein from the Protein Data Bank.
The location of p.S209F is indicated by the dashed blue line.
Nature Genetics: doi:10.1038/ng.3916
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Supplementary Figure 15
Schematic of the TREM2 protein from the Protein Data Bank.
The location of p.R62H is indicated by the dashed blue line and that of p.R47H is indicated by the solid blue line.
Nature Genetics: doi:10.1038/ng.3916
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1
RarecodingvariantsinPLCG2,ABI3andTREM2implicatemicroglial-mediatedinnateimmunityinAlzheimer’sdisease1. SampleCohorts…………………………………………………………………………….22. QualityControlandAnalyses………………………..….…………………………103. SingleVariantFindings…………………………………………………………………114. Gene-wideFindings………………………..….………………………..………….….125. GeneExpression………………………………………………………………………….126. FunctionalAnnotation………………………..….…………………………………..137. References………………………..….………………………………………………..…..158. SupplementaryTableLegends………………………..….……………………….23
Nature Genetics: doi:10.1038/ng.3916
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2
1.SampleCohortsGERAD/PERADES:
Stage1:CasesandcontrolswererecruitedbytheMedicalResearchCouncil(MRC)GeneticResourceforLOAD(CardiffUniversity;InstituteofPsychiatry,London;UniversityofCambridge);theAlzheimer’sResearchUK(ARUK)Collaboration(UniversityofNottingham;UniversityofManchester;UniversityofSouthampton;UniversityofBristol;Queen’sUniversityBelfast);MRCPRIONUnit,UniversityCollegeLondon,UK;UniversityofOxford,UK;WashingtonUniversity,StLouis,UnitedStates;CompetenceNetworkofDementia(CND)andDepartmentofPsychiatry,UniversityofBonn,Germany;UniversityofHalle,Germany;UniversityHospital,Saarland,Germany;UniversityMedicalCentre,Hamburg,Germany;UniversityDulsburg-Essen,Germany;UniversidadAutônomadeMadrid,Spain;UniversidadAutônomadeBarcelona,Spain;UniversityofCantabriaandIDIVAL,Santander,Spain;UniversityofNavarra,Pamplona,Spain;SantaLuciaFoundation,Rome,Italy;AristotleUniversity,Thessaloniki,Greece;CIBERNED,Madrid,Spain;CSIC-UAM,Madrid,Spain;HospitalUniversitarioCentralAsturias,Oviedo,Spain.
Stage2:CasesandcontrolswererecruitedbytheMRCGeneticResourceforLOAD;
MRCPRIONUnit,UniversityCollegeLondon,UK;SantaLuciaFoundation,Rome,Italy;CIBERNED,Madrid,Spain;CSIC-UAM,Madrid,Spain;HospitalUniversitarioCentralAsturias,Oviedo,Spain;ARUKcollaboration;KingsCollegeLondon,London,UK;UniversityofPerugia,Perugia,Italy;CatholicUniversityofRome,Rome,Italy;RegionalNeurogeneticCentre(CRN),ASPCatanzaro,LameziaTerme,Italy;MemoryclinicandResearchCenter,InstitutCatalàdeNeurociènciesAplicades,Barcelona,Spain;UniversityofMilan,Milan,Italy;UniversityofBonn,Bonn,Germany;QueensUniversity,Belfast,NorthernIreland;UniversityofDuisburg-Essen,Germany;KlinikumderUniversitätMünchen,Munich,GermanyandGermanCenterforNeurodegenerativeDiseases(DZNE,Munich),Munich,Germany;UniversityofBristol,Bristol,UK;CardiffUniversity,Cardiff,UK;UniversityofSouthampton,SouthamptonUK;UniversityofNottingham,Nottingham,UK;MayoClinic,Jacksonville,Florida,USA.
Alllate-onsetAlzheimer’sdisease(LOAD)caseswereagedover60andmetcriteriaforeitherprobable(NINCDS-ADRDA,DSM-IV)ordefinite(CERAD)AD.AllelderlycontrolswerescreenedfordementiausingtheMiniMentalStateExamination(MMSE)orADAS-cog,weredeterminedtobefreefromdementiaatneuropathologicalexaminationorhadaBraakscoreof2.5orlower.Controlsampleswerechosentomatchcasesamplesforage,gender,ethnicityandCountryoforigin.Informedconsentwasobtainedforallresearchparticipants,andtherelevantindependentethicalcommitteesapprovedstudyprotocols.CHARGE:
Stage1:AgeGene/EnvironmentSusceptibility–Reykjavikstudy(AGES):TheAGESstudyhas
beendescribedpreviously1.Thestudywasinitiatedin2002toexaminegeneticsusceptibilityandgene/environmentinteractionsrelatedtodiseaseanddisabilityinoldage.TheAGESstudyiscomprisedof5764individualsdrawnfromtheReykjavikStudy,apopulation-basedcohortcomprisedofindividualsbornbetween1907and1935and
Nature Genetics: doi:10.1038/ng.3916
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followedsince1967bytheIcelandicHeartAssociation.3219individualschosenrandomlyamong5307AGESindividualswith‘mid-life’dataavailablefromtheReykjavikStudyweregenotypedonagenome-wideassociation(GWA)array.2983werefurthergenotypedfortheEC.AgewascodedinyearswheretheageofcaseswastheageatthevisitwhereLOADwasfirstdiagnosedandtheageofcontrolswastheageatthelastvisitindividualwasstillfreeofLOADpathology.
DiagnosisofLOADinAGES–TheFolsteinMMSEandtheDigitSymbolSubstitutionTest(DSST)wereadministeredtoallparticipantsandpersonswhoscoredbelowapre-determinedthresholdonthesetests(≤23ontheMMSEor≤17ontheDSST)wereadministeredasecond,diagnostictestbattery.BasedonperformanceontheTrailsBandtheReyAuditoryVerbalLearningtest(RAVLT),asubsetoftheseindividualswithaRAVLTscore≤18orTrailsBscore≥8(ratiooftimetakenforTrailsB/TrailsAcorrectedforthenumbercorrect)wentontoathirdstep,whichincludedaneurologicalexaminationandastructuredinformantinterviewaboutmedicalhistoryandsocial,cognitive,anddailyfunctioning.MRIwasacquiredasapartofthecorestudyprotocol.Apanelthatincludedageriatrician,neurologist,neuropsychologist,andneuroradiologistreachedaconsensusdiagnosisofdementiabasedontheDiagnosticandStatisticalManualofMentalDisorders,FourthEdition(DSM-IV)guidelines2.Therewere319casesofdementiadiagnosedinthefirst5764AGESparticipantsandofthese123alsohadgenotypingandbrainMRI.Internationaldiagnosticguidelines,includingtheNationalInstituteofNeurologicalandCommunicativeDisordersandStroke–AlzheimerDiseaseandRelatedDisordersAssociation(NINCDS-ADRDA)criteriaforprobableandpossibleAlzheimerDiseaseandtheAlzheimer’sDiseaseDiagnosisandTreatmentCenter’s(ADDTC)StateofCaliforniacriteriaforprobableandpossiblevasculardementia(VaD)withorwithoutAD,werefollowed.TheAGESstudyidentified3subtypes:possible/probableADwithoutVaD(includedinanalysis),mixedAD(casesthatmetcriteriaforbothADandVaD,includedinanalysis),and,possible/probableVaDorotherdementiawithoutAD(excludedfromanalysis).3316individualsparticipatedinthefollow-upvisit(AGES-2)andwereexaminedusingthesameprotocolasusedduringtheAGES-1visitfordiagnosisofdementiaandAD.Controlswerethosestillfreeofdementiaandmildcognitiveimpairmentatlastassessment.Studyapproval–TheAGESstudywasapprovedbytheIcelandicNationalBioethicsCommittee(VSN00-063),andbytheNationalInstituteonAgingIntramuralInstitutionalReviewBoard.Informedconsentwasobtainedfromallparticipants.
CardiovascularHealthStudy(CHS):TheCHSisapopulation-basedcohortstudyofriskfactorsforcoronaryheartdiseaseandstrokeinadults≥65yearsconductedacrossfourfieldcenters3.TheoriginalpredominantlyCaucasiancohortof5201personswasrecruitedin1989-1990fromrandomsamplesoftheMedicareeligibilitylists;subsequently,anadditionalpredominantlyAfrican-Americancohortof687personswasenrolledforatotalsampleof5888.Bloodsamplesweredrawnonallparticipantsattheirbaselineexamination;DNAwasextractedfrombloodfromparticipantswhodonatedDNAsamplesforstorageandprovidedinformedconsentforparticipationinDNAstudies(~95%ofallCHSparticipants).AlthoughCHSisapopulation-basedsampleweempiricallyestimatedcrypticrelatednessbasedongenotypesofaLD-prunedsetofcommonECvariants.ForthisweusedPLINKv1.074(http://pngu.mgh.harvard.edu/purcell/plink/).Weidentifiedclustersof
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individualswith‘PI_HAT’>0.15or‘Z0’<0.4(‘PI_HAT’istheempiricalestimateoftwicethekinshipcoefficientandZ0istheempiricalestimateoftheprobabilityofsharingzeroallelesidenticalbydecent).Amongtheseclusters,wekeptonlyoneindividualforanalysis,givingpreferencetocasesovercontrols.Covariatesinthemodelswereageinyears,sex,andfieldcenter.AgewastheageatLOADdiagnosisforcasesortheageatlastfollow-upevaluationforcontrols.
DiagnosisofLOADinCHS–TheADsampleforCHSincludedallprevalentcasesidentifiedin1992andincidenteventsidentifiedbetween1992andDecember2006.Briefly,personswereexaminedannuallyfromenrolmentto1999,andtheexaminationincludeda30minutesscreeningcognitivebattery5.In1992-94andagain,in1997-99,participantswereinvitedtoundergobrainMRIanddetailedcognitiveandneurologicalassessmentaspartoftheCHSCognitionStudy5.Personswithprevalentdementiawereidentified,andallotherswerefolloweduntil1999forthedevelopmentofincidentdementiaandAD.Sincethen,CHSparticipantsattheMarylandandPennsylvaniacentershaveremainedunderongoingdementiasurveillance6.Beginningin1988/89,allparticipantscompletedtheModifiedMini-MentalStateExamination(3MSE)andtheDSSTattheirannualvisits,andtheBentonVisualRetentionTest(BVRT)from1994to1998.TheTelephoneInterviewforCognitiveStatus(TICS)wasusedwhenparticipantsdidnotcometotheclinic.FurtherinformationoncognitionwasobtainedfromproxiesusingtheInformantQuestionnaireforCognitiveDeclineintheElderly(IQCODE),andthedementiaquestionnaire(DQ).SymptomsofdepressionweremeasuredwiththemodifiedversionoftheCenterforEpidemiologyStudiesDepressionScale(CES-D).In1991-94,3608participantshadanMRIofthebrainandthiswasrepeatedin1997-98.TheCHSstaffalsoobtainedinformationfromparticipantsandnext-of-kinregardingvisionandhearing,thecircumstancesoftheillness,historyofdementia,functionalstatus,pharmaceuticaldruguse,andalcoholconsumption.Dataoninstrumentalactivitiesofdailyliving(IADL),andactivitiesofdailyliving(ADL)werealsocollected.Personssuspectedtohavecognitiveimpairmentbasedonthescreeningtestslistedaboveunderwentaneuropsychologicalandaneurologicalevaluation.Theneuropsychologicalbatteryincludedthefollowingtests:theAmericanversionoftheNationalReadingtest(AMNART),Raven’sColouredProgressiveMatrices,CaliforniaVerbalLearningTest(CVLT),amodifiedRey-Osterreithfigure,theBostonNamingtest,theVerbalfluencytest,theBlockdesigntest,theTrailsAandBtests,theBaddeley&PapagnoDividedAttentionTask,theStroop,DigitSpanandGroovedPegboardTests.Theresultsoftheneuropsychologicalbatterywereclassifiedasnormalorabnormal(>1.5standarddeviationsbelowindividualsofcomparableageandeducation)basedonnormativedatacollectedfromasampleof250unimpairedsubjects.Theneurologicalexamincludedabriefmentalstatusexamination,aswellasacompleteexaminationofothersystems.TheexamineralsocompletedtheUnifiedParkinson’sDiseaseRatingScale(UPDRS)andtheHachinskiIschemicScale.Aftercompletingtheneurologicalexam,theneurologistclassifiedtheparticipantasnormal,havingmildcognitiveimpairment(MCI),ordementia.Internationaldiagnosticguidelines,includingtheNINCDS-ADRDAcriteriaforprobableandpossibleADandtheADDTC’sStateofCaliforniacriteriaforprobableandpossiblevasculardementia(VaD)withorwithoutAD,werefollowed.CHSidentified3subtypes:possible/probableADwithoutVaD(categorizedaspureAD,includedinanalysis)andmixedAD(forcasesthatmetcriteriafor
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bothADandVaD,includedinanalysis),and,possible/probableVaDwithoutAD(excludedfromcurrentstudy).
FraminghamHeartStudy(FHS):TheFHSisathreegenerationalprospectivecohortthathasbeendescribedindetailpreviously7–9.Individualswereinitiallyrecruitedin1948inFramingham,MA,USAtoevaluatecardiovasculardiseaseriskfactors.Thesecond-generationcohort(5,124offspringoftheoriginalcohort)wasrecruitedbetween1971and1975.Thethird-generationcohort(4095grandchildrenoftheoriginalcohort)wascollectedbetween2002and2005.6946European-AmericanindividualsweregenotypedusingtheEC.Participants≤60yearsatthetimeofblooddrawforDNAextractionwereexcludedpriortoanalysis.Becausethestatisticaltestsuseddidnotaccountforfamilystructure,weexcludedrelatedparticipants.Usinggenome-wideidentity-by-descent,wefirstidentified7pairsofrelatedcases,andexcludedtheyoungerofthetwoineachpair,ortheonewiththemostmissingdata.Wethenexcluded151controlswhowererelatedtocases,andfinally,weexcluded439controlsrelatedtoothercontrols,applyingthesameage/missingdataruleasforrelatedcases.Covariatesusedwereageinyearsandsex,whereagewastheageatLOADdiagnosisforcasesortheageatlastfollow-upevaluationforcontrols.DiagnosisofLOADinFHS–FHSparticipantswerescreenedateachbiennialexaminationforpossiblecognitivedeclinethroughanumberofmechanisms,includingmeasuresoftheFolsteinMini-MentalStatusExamination(MMSE)10,referralbyFHSstaffandphysiciansatregularclinicexams,byself,familyorprimarycarephysician,referralfollowinghealthupdatesorancillarystudiesbyotherFHSworkinggroups,andreferralfromneuropsychologicaltestingincludedindedicatedproject.Participants“flagged”asbeingatriskfordevelopingdementiaunderwentcompleteneuropsychologicalevaluation.Iftheneuropsychologicaltestingorneurologicalevaluationsuggestedadeclineincognitivefunction,andothersourcesofdatacouldnotclarifyifthepersonhadMCIorAD,weadministeredastructuredfamilyinterview.Wethendeterminedwhethereachpersonfulfilledcriteriaforadiagnosisofdementia,theprobabledateofonset,andtypeofdementiaataconsensusreviewconductedbyapanelcomprisingatleastonebehaviouralneurologistandoneneuropsychologist.ParticipantswithdementiametcriteriaoutlinedintheFourtheditionoftheDiagnosticandStatisticalManualofMentalDisorders(DSM-IV)criteria2,andwererequiredtohavesymptomsforatleast6months.ParticipantswithADmetNINCDS-ADRDAcriteriafordefinite,probable,orpossibleAD11.
Rotterdamstudy(RS):TheRSisanongoingprospectivepopulation-basedcohortstudy,focusedonchronicdisablingconditionsoftheelderly12.ThestudycomprisesanoutbredethnicallyhomogenouspopulationofDutchCaucasianorigin.Therationaleofthestudyhasbeendescribedindetailelsewhere12.Insummary,7983menandwomenaged55yearsorolder,livinginOmmoord,asuburbofRotterdam,theNetherlands,wereinvitedtoparticipate.3163individualsweregenotypedfortheEC.Thiscohortwasextendedwith3,011participantswhohadbecome55yearsofageorhadmovedintothedistrictsincethestartofthestudy(RSII).
IntheRStherearesomesmallfamiliesduetoinclusionofparentsaswellaschildrenlivingbothinOmmoord.FrompairsofsubjectswithempiricalIBD>0.4onewasexcluded,withapreferenceofkeepingcases.Inthestage2in-silicoreplication,related
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subjectswerealsoexcluded,withapreferencetokeepcasesovercontrols.Agewascodedinyearsforageofonsetforcasesandageatcensoringorageatlastscreeningforcontrols.DiagnosisofLOADinRS–IntheRSparticipantswerescreenedforprevalentdementiaatbaselineusingathree-stageprocessdescribedindetailelsewhere13.Thosefreeofdementiaremainedundersurveillanceforincidentdementia,adeterminationmadeusingrecordslinkageandassessmentatthreesubsequentre-examinations.WeincludedallprevalentcasesandallincidenteventsuptoJanuary1st2014.ScreeningwasdonewiththeFolsteinMini-MentalStatusExamination(MMSE)10andtheGeriatricMentalSchedule(GMS)14organiclevelforallpersons.Screen-positives(MMSE<26orGMSorganiclevel>0)underwenttheCAMDEX15.Personswhoweresuspectedofhavingdementiaunderwentmoreextensiveneuropsychologicaltesting.Whenavailable,imagingdatawereused.Inaddition,allparticipantshavebeencontinuouslymonitoredformajorevents(includingdementia)throughautomatedlinkageofthestudydatabasewithdigitizedmedicalrecordsfromgeneralpractitioners,theRegionalInstituteforOutpatientMentalHealthCareandthemunicipality.InadditionphysicianfilesfromnursinghomesandgeneralpractitionerrecordsofparticipantswhomovedoutoftheOmmoorddistrictwerereviewedtwiceayear.Forsuspecteddementiaevents,additionalinformation(includingneuroimaging)wasobtainedfromhospitalrecordsandresearchphysiciansdiscussedavailableinformationwithaneurologistexperiencedindementiadiagnosisandresearchtoverifyalldiagnoses.Dementiawasdiagnosedinaccordancewithinternationallyacceptedcriteriafordementia(DiagnosticandStatisticalManualofMentalDisorders,RevisedThirdEdition,DSM-III-R16),andADusingtheNINCDS-ADRDAcriteriaforpossible,probableanddefiniteAD11.TheNationalInstituteofNeurologicalDisordersandStroke–AssociationInternationalepourlaRechercheetl’EnseignementenNeurosciences(NINDSAIREN)criteriawereusedtodiagnosevasculardementia.Thefinaldiagnosiswasdeterminedbyapanelofaneurologist,neurophysiologist,andresearchphysicianandthediagnosesofADandVaDwerenotmutuallyexclusive.
StudyApproval–TheRotterdamStudyhasbeenapprovedbytheMedicalEthicsCommitteeoftheErasmusMCandbytheMinistryofHealth,WelfareandSportoftheNetherlandsimplementingtheWetBevolkingsonderzoek:ERGO(PopulationStudiesAct:RotterdamStudy).Allparticipantsprovidedwritteninformedconsenttoparticipateinthestudyandtoobtaininformationfromtheirtreatingphysicians.Datacanbeobtaineduponrequest.RequestsshouldbedirectedtowardsthemanagementteamoftheRotterdamStudy([email protected]),whichhasaprotocolforapprovingdatarequests.Becauseofrestrictionsbasedonprivacyregulationsandinformedconsentoftheparticipants,datacannotbemadefreelyavailableinapublicrepository.
Stage2:HRCimputeddataintheRotterdamStudy:TheRotterdamStudyIandRotterdam
StudyIIwereimputedtotheHaplotypeReferenceConsortiumreference(HRC)panel17,18.Imputationwasperformedontheweb-serviceprovidedbytheMichiganImputationserver(dateofpipeline17-12-2015).PreviouslydescribedgenotypeQCwasperformedpriortoimputations19.Inshortgenotypeswerepre-phasedwithSHAPEIT220andimputedusingMinimac3.Imputedgenotypeswithlowimputationquality(Rsq<0.5)wereexcluded.Subjectsincludedinthestage1analysiswereexcludedfromthestage2analysis.Inthe
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RotterdamStudyIIonlycontrolswithanage>75wereincludedtodecreasethecasetocontrolratio.
GenotypedData:Anadditional3,273case-controlsampleswereobtainedforreplicationfromcentersinAustria(1center)andSpain(1center).ClinicaldiagnosesofprobableADwereallestablishedaccordingtotheDSM-III-RandNINCDS-ADRDAcriteria.ControlsweredefinedassubjectswithoutDMS-III-Rdementiacriteriaandwithintegrityoftheircognitivefunctions(MMS>25).ADGC:
Stage1:CasesandcontrolsweretakenfrommultipleADGCdatasets21,22andpartitionedintofivesubsetsforgenotypingandsubsequentanalyses.Thefivesubsetsincluded:(1)7,091individualsselectedfrommultipleADGCdatasetsweregenotypedattheRobertS.BoasCenterforGenomicsandHumanGenetics,FeinsteinInstituteforMedicalResearch,Manhasset,NewYork(NorthShore);(2)2,024individualsfromtheADGC“UMVUMSSM”datasetweregenotypedattheJohnP.HussmanInstituteforHumanGenomics,UniversityofMiami,Miami,Florida(Miami);(3)1,374individualsfromtheADGC“WashU”datasetweregenotypedatWashingtonUniversity,St.Louis,Missouri(WashU);(4)6,082individualsfrommultipleAlzheimer’sDiseaseCenter(ADC)genotypingwavesweregenotypedattheCenterforAppliedGenomics,TheChildren’sHospitalofPhiladelphia,Philadelphia,Pennsylvania(CHOP);and(5)all1,528subjectsintheseventhwaveofADCsamplesweregenotypedatCHOP(ADC7).Perindividualsourcestudies,allsubjectswererecruitedunderprotocolsapprovedbytheappropriateInstitutionalReviewBoards.CaseslivingattimeofrecruitmentwereadjudicatedaspossibleorprobableADpriortoanalysesaccordingtoNINCDS/ADRDAcriteria11whereasaffectionstatusofalldeceasedcaseswasconfirmedthroughautopsy.Sampleswithage-at-onsetorage-at-examlessthan60years,missingcovariates,orcontrolswithMMSE<26werecensored.
Stage3:HRC-ImputedADGCGWASdatasets:Stage3replicationincludedgenotype
probabilitiesfromimputationtotheHaplotypeReferenceConsortium(HRC)referencepanels17,18onallADGCsamplesnotgenotypedontheexomechipandfromdatasetswithmorethan50samplesremainingafterexcludingexomechip-genotypedsamples.TheseincludedsamplesfromtheAdultChangesinThought(ACT)/ElectronicMedicalRecordsandGenetics(eMERGE)study;theNationalInstituteonAging(NIA)AlzheimerDiseaseCenters(ADCs)(waves1-3and6);theAlzheimerDiseaseNeuroimagingInitiative(ADNI)Study;theMulti-SiteCollaborativeStudyforGenotype-PhenotypeAssociationsinAlzheimer’sDisease(GenADA)Study;theUniversityofMiami/VanderbiltUniversity/Mt.SinaiSchoolofMedicine(UM/VU/MSSM);theMulti-InstitutionalResearchinAlzheimer'sGeneticEpidemiology(MIRAGE)Study;OregonHealthandScienceUniversity(OHSU);theNCRAD/NIA-LOADStudy;theTranslationalGenomicsResearchInstituteseries2(TGEN2)dataset;theMayoClinicJacksonville;theRushUniversityReligiousOrdersStudy/MemoryandAgingProject(ROSMAP)andChicagoHealthandAgingProject(CHAP);theUniversityofPittsburgh(UP);WashingtonUniversity(WU)inSt.Louis;theTexasAlzheimer’sResearchandCareConsortium(TARCC);theNetherlandsBrainBank(NBB);andtheWashingtonHeights-InwoodColumbiaAgingProject(WHICAP).Detaileddescriptionsofthe
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ascertainmentandevaluationofsubjectsintheACT/eMERGE,ADCwaves,ADNI,GenADA,UM/VU/MSSM,MIRAGE,OHSU,NCRAD/NIA-LOAD,TGEN2,Mayo,ROSMAP,UP,andWUcohortshavebeenprovidedelsewhere21,22;briefdescriptionsincludedherenoteanydifferencesbetweendatausedinthisstudyanddatausedinpreviousstudiesbytheADGCandIGAPstudy,includingshortsummariesoftheCHAP,TARCC,NBB,andWHICAPdatasets.AnalyseswererestrictedtoindividualsofEuropeanancestryduetotheinsufficientnumberofnon-EuropeansamplesavailableforimputationinHRC.AllsubjectswererecruitedunderprotocolsapprovedbytheappropriateInstitutionalReviewBoards.
ChicagoHealthandAgingProject(CHAP):CHAPisanon-goingcommunitybasedstudyofindividualsfromageographicallydefinedcommunityof3neighbourhoodsinChicago,Illinois(MorganPark,WashingtonHeights,andBeverly),with6,158participantsinthefirstphaseofthestudy(78.7%overall;80.5%oftheblacks,74.6%ofthewhites)23.Datawerecollectedincyclesofapproximately3years;eachconsistingofanin-homeinterviewofallparticipantsandclinicalevaluationofarandom,stratifiedsample.Thebaselinecyclemeasureddiseaseprevalenceandprovidedriskfactordatapriortoincidentdiseaseonset.Acohortof3,838personsfreeofADwasidentified;729personsweresampledforbaselineclinicalevaluation.Personsinthedisease-freecohorthadeithergoodcognitivefunctionatbaseline,orifcognitivefunctionwasintermediateorpoor,werefreefromADatthebaselineclinicalevaluation.Thisdisease-freecohortwasevaluatedforincidentdiseaseafteranaverageof4.1years.Samplingforincidentclinicalevaluationwasbasedonage,sex,race,andchangeincognitivefunction(i.e.,stableorimproved,smalldecline,orlargedecline).ThesamplesetavailableintheADGCforgeneticanalysesincluded32ADcasesand197personsfreeofADattimeoflastassessment(allsubjectswereage65yearsorolderatlastassessment).
NetherlandsBrainBank(NBB):TheNBBisadepartmentoftheNetherlandsInstituteforNeuroscience,aninstituteoftheRoyalNetherlandsAcademyofArtsandSciences.TheNBBisanon-profitorganizationthatcollectshumanbraintissuefromdonorswithavarietyofneurologicalandpsychiatricdisordersandbraintissuefromnon-diseaseddonors,aswellasanonymizedsummariesofdonors'medicalrecordstobemadeavailableforneuroscienceresearch24.ThesamplesetavailableintheADGCforgeneticanalysesincluded215pathologically-confirmedADcasesand85subjectsfreeofAlzheimer’spathologyatautopsy.Allcaseswereage65yearsorolderattimeofdiagnosis,andallcontrolswereage65yearsorolderattimeofdeath.
TexasAlzheimer’sResearchandCareConsortium(TARCC):TheTARCCisacollaborativeAlzheimer’sresearcheffortdirectedandfundedbytheTexasCouncilonAlzheimer’sDiseaseandRelatedDisorders(theCouncil),aspartoftheDarrellKRoyalTexasAlzheimer’sInitiative.ComposedofBaylorCollegeofMedicine(BCM),TexasTechUniversityHealthSciencesCenter(TTUHSC),UniversityofNorthTexasHealthScienceCenter(UNTHSC),theUTSouthwesternMedicalCenteratDallas(UTSW),UniversityofTexasHealthScienceCenteratSanAntonio(UTHSCSA),TexasA&MHealthScienceCenter(TAMHSC),andtheUniversityofTexasatAustin(UTA),thisconsortiumwascreatedtoestablishacomprehensiveresearchcohortofwellcharacterizedsubjectstoaddressbetter
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diagnosis,treatment,andultimatelypreventionofAD25.Theresultingprospectivecohort,theTexasHarrisAlzheimer'sResearchStudy,containsclinical,neuropsychiatric,genetic,andbloodbiomarkerdataonmorethan3,000participantsdiagnosedwithAlzheimer'sdisease(AD),mildcognitiveimpairment(MCI),andcognitivelynormalindividuals.Longitudinaldata/samplecollectionandfollow-uponparticipantsoccursonanannualbasis.Twowavesofcase-controldatafromTARCCwereexaminedaspartofgeneticanalysesintheADGC.DatafromtheTARCCincluded323casesand181controlsinthefirstwave,with84casesand115controlsinthesecondwave.AllTARCCsubjectsweregreaterthan65yearsofageatdiseaseonset(cases)oratlastdisease-freeexam(non-cases).
TheWashingtonHeights-HamiltonHeights-InwoodColumbiaAgingProject(WHICAP):WHICAPisacommunity-basedlongitudinalstudyofaginganddementiaamongelderly,urban-dwellingresidents26,27.Beginningenrolmentin1989,WHICAPhasfollowedmorethan5,900residentsover65yearsofage,includingwhite,AfricanAmerican,andHispanicparticipants.Detailedclinicalassessmentswereperformedatapproximately24-monthintervalsoverthe7yearsoftheinitialstudy.AllinterviewswereconductedineitherEnglishorSpanish.Thechoiceoflanguagewasdecidedbythesubjectinordertoensurethebestperformance,andthemajorityofassessmentswereperformedinthesubject’shome,whichincludedmedical,neurological,andneuropsychologicalevaluations.Resultsoftheneurological,psychiatricandneuropsychologicalassessmentswerereviewedinaconsensusconferencecomprisedofneurologists,psychiatrists,andneuropsychologists.Basedonthisreviewallparticipantswereassignedtooneofthreecategories:dementia,cognitiveimpairmentornormalcognitivefunction.ThesamplesetavailableintheADGCforgeneticanalysesincluded73ADcasesand570subjectswithnormalcognitivefunction.EADI:
Stage2:The2,012ADcaseswereascertainedbyneurologistsfromBordeaux,Dijon,Lille,Montpellier,Paris,Rouen,andwereidentifiedasofEuropeanancestry.ClinicaldiagnosisofprobableADwasestablishedaccordingtotheDSM-III-RandNINCDS-ADRDAcriteria21,28.The6,502Controlswereselectedfromthe3CStudy29.Thiscohortisapopulation-based,prospective(10-yearsfollow-up)studyoftherelationshipbetweenvascularfactorsanddementia.IthasbeencarriedoutinthreeFrenchcities:Bordeaux(southwestFrance),Montpellier(southeastFrance)andDijon(centraleasternFrance).
Anadditional11,109case-controlsampleswereobtainedforreplicationfromcentersinBelgium(1center),Finland(1center),Italy(8centers),Spain(5centers),Sweden(2centers)andCanada(1center).ClinicaldiagnosesofprobableADwereallestablishedaccordingtotheDSM-III-RandNINCDS-ADRDAcriteria.ControlsweredefinedassubjectswithoutDMS-III-Rdementiacriteriaandwithintegrityoftheircognitivefunctions(MMS>25).
Forfullsamplecharacteristicsinstage1andstages2+3seeSupplementaryTables1
and2respectively.FordetailsofthestudydesignseeSupplementaryFigure1.
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2.QualityControlandAnalysesAPOEConditionalAnalyses
AsexpectedsignificantevidenceforassociationwithLOADwasidentifiedattheAPOElocuswithtwenty-twovariants.Anintronicproxyforthers429358variantdeterminingtheAPOEε4genotype(rs769449,OR=2.88,P<1x10-500,r2withrs429358=0.82),andtheexonicvariantAPOEε2genotypes(rs7412,OR=0.43,P=2.7x10-105)showedthestrongestassociations.Performingtwoconditionalmeta-analyses,adjustingforindependentlydeterminedAPOEgenotypesinallcohorts,oneadjustingforAPOEε4(coded0,1,2)asecondadjustingforAPOEε2(coded0,1,2),diminishedallassociationsignalsidentifiedwithallthegeneticvariantswithintheAPOEregion,thereforethese22variantswerenotconsideredfurther.Theleadvariantrs769449reducedfromP<1x10-500toP=1.1x10-5,whenadjustingforAPOEε4,andrs7412fromP=2.7x10-105toP=0.07,whenadjustingforAPOEε2.AdditionalQualityControl Twohundredsevenvariantsshowedsuggestiveevidenceforassociation(P≤0.0001)inanyofthefourmeta-analysesofthediscoverydataset.Onehundredandeighty-fivevariants,independentofAPOEε4andε2,werecarriedforwardforadditionalqualitycontrolthatinvolvedareviewofallstudyspecificgenotypeclusterplots.Wherevariantgenotypeclusterscouldbeimproved,theseweremanuallyre-clustered.Variantswhosegenotypeclustersweredeemedtoopoorforaccurategenotypecallingwereexcludedfromre-analysis.Re-calledvariantswerere-analysedaspreviouslydetailed.Afterre-analysistwentyvariantsthatnolongershowednominallysignificantassociation(P>0.05)wereexcluded.Wealsoexcludedseventy-onevariantsthathadaminorallelecount(MAC)oflessthan4,orthosevariantsthatwereobservedtobepolymorphicinonlyoneanalysiscohort,afterrecalling.Oftheremainingvariants50werecommon(MAF≥0.05),andtheobservedassociationswerenearknowngenome-widesignificantloci(SupplementaryTable5).Forty-threerarevariantslocatedoutsideoftheAPOEregionwereeligibleforreplicationandconsideredforadditionalgenotypingandinsilicoreplication(SupplementaryTable4).PreviouslyDescribedRiskLoci
WeobservedassociationatcommoncodingvariantsforanumberofADrisklocipreviouslyidentified(SupplementaryTable5).VariantsinAPOE,CLUandCR1showedgenome-widesignificantassociation(P<5x10-8)intheunadjustedanalysis,whilecommonvariantsnearBIN1,MS4A6A,CD33,HLA-region,ABCA7andINPP5Dshowedsuggestiveassociation(P<5x10-4).PreviouslydescribedgeneswithevidenceforassociationwithAD(TREML2,UNC5C,TTC3,PLXNA4,PLD3,MTHFR,CYP2D6,ADAM10,ZNF628,AKAP9,CD33,TRIP4,MAPT,SQSTM1,ATP5H/KCTD2)orfamilialADgenes(APP,PSEN1,PSEN2)areshowninSupplementaryTable5.Gene-wideAnalysis
VariantswereallocatedtogenesaccordingtheRefSeqdatabase.Variantswereassignedtogenesiftheywerelocatedwithinthegenomicsequencelyingbetweenthestartofthefirstandtheendofthelastexonofanytranscriptcorrespondingtothatgene,as
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definedbyNCBI.Gene-wideanalyseswereexaminedusingtheunifiedmethodimplementedinSKAT-O,wheretheoptimallinearcombinationoftheburdenandSKATtestsisimplemented36.Asinthesinglevariantanalyses,associationwithdiseasewastestedforineachcohortsetincludingthestudyspecificcovariatesunderboththeadjustedandunadjustedmodels.Analyseswereperformedincluding‘ALL’variants,variantswithaMAF<5%andvariantswithaMAF<1%.Testswererestrictedtoindividualgeneswithtwoormorepolymorphicvariants.Studyspecificresultswerecombinedinameta-analysisusingtheseqMetapackage.Variantswithingenesshowingstatisticallysignificantevidenceforassociation(P<2.5x10-6)underwentadditionalclusterplotinspectionandpoorlyperformingvariantswereremovedfromtheanalysis.PowerCalculations
Iftheallelefrequenciesincasesis0.003andincontrolsis0.001,thenthepowertodetectthisrarevariantwith5000casesand2500controlsat5%significancelevelis70%.Ifthenumberofcontrolsis18000,thenthepowerisincreasedupto98%atα=0.05and28%atα=1e-6(toaccountfor30,000genes).Thispowercalculationsareperformedusingfunctionpower.fisher.test()inRstatisticalsoftware.LinkageDisequilibriumCalculations
Linkagedisequilibrium(LD)calculationswereperformedusingPLINKv1.94andtheGERADv1.0dataset.HighD’valuesandlowr2valueswereidentifiedforalltheLDpairstested(SupplementaryTable14).ThisdiscrepancyinLDmeasuresistobeexpectedwhenanalysingrarevariants.TheD’calculationestimatesco-presenceoftheminoralleleatoneSNVcomparedtoareferencealleleatanotherSNV,whiler2isameasureofthecorrelationbetweenthepresenceorabsenceofaparticularalleleatthefirstSNVandthepresenceorabsenceofaparticularalleleatthesecondSNVandisthereforeaffectedbyallelefrequency.Forbi-allelicmarkers,themostcommonlyusedmeasuresforLDisr237,whichindicatesindependenceofthetestedSNVassociations.3.SingleVariantFindings
OutsideoftheAPOEregion,andexcludingtheknowncommonriskloci,fourSNVsreachedgenome-widesignificantevidenceforassociation(P<5x10-8),underboththeunadjustedandadjustedanalysismodels.SeeSupplementaryTables7and8respectively.
Aforestplotoftheassociationidentifiedatrs72824905inPLCG2isgiveninSupplementaryFigure3.Weidentifiedasecondindependent(r2=1.5x10-5)suggestivesignalwithstrongeffectwithinPLCG2atsynonymousSNVrs200506549(Pdiscovery=5.8x10-4,OR=2.0,MAF=0.0017).However,explorationintheStage3sample(N=12,616)didnotreplicatethisassociation(P=0.76,OR=0.89,MAF=0.0016).Allstage1associationstestedatthePLCG2geneareshowninSupplementaryTable9.
Aforestplotoftheassociationidentifiedatrs616338inABI3isgiveninSupplementaryFigure6.Allstage1associationstestedattheABI3geneareshowninSupplementaryTable12.
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Aforestplotoftheassociationidentifiedatrs143332484andrs75932628inTREM2aregiveninSupplementaryFigures9and10respectively.Allstage1associationstestedattheTREM2geneareshowninSupplementaryTable13.Itshouldbenotedthatthe61%(9.6%GERAD/PERADES,100%ADGC,81.8%CHARGEand33.7%EADI)ofthesamplesutilizedinthisstudyoverlapswiththatoftheGuerreiroetal.38,andthatRSstage1plusRS1stage3samplesoverlapwithJonssonetal.39,inwhichR47HrobustlyassociatedwithADstatus.
Anadditional3SNVsshowsuggestiveevidenceforassociation(Pcombined<1x10-6)withconsistentdirectionofeffectacrossstages(SupplementaryTables7and8).ConditionalAnalyses
ConditionalanalyseswereundertakenatthePLCG2,ABI3andTREM2lociusingtheGCTAtool40(usingthedefaultparameters)andthestage1unadjustedsummarystatisticsasinput.DatafromtheGERADv1.0datasetwasusedtocalculatethebackgroundLD.TheGERADv1.0datasetwasutilisedtoestablishLD(NGERADv1.0=5692).Wedidnotidentifysignificantorsuggestiveassociation(P<1x10-5)independentofthegenome-widesignificant(GWS)hits.Whenconditioningonrs72824905inPLCG2,thetophitisrs200506549,P=6.52x10-4(SupplementaryFigure5).Whenconditioningonrs616338inABI3,thetophitisrs141826857inB4GALNT2,P=1.89x10-5(SupplementaryFigure8),thisassociationdidnotreplicateinthestage2analysis(Pstage2=9.89x10-1,Pcombined=1.68x10-4).Whenconditioningonrs75932628inTREM2,rs143332484remainssignificantlyassociatedwithdiseaseat(P=3.38x10-9)(SupplementaryFigure11a),theoppositeisobserved,withrs75932628showingsignificantassociationwithdiseasewhenconditioningonrs143332484(P=5.12x10-12)(SupplementaryFigure11b).Whenconditioningonbothrs143332484andrs75932628inTREM2,thetophitisrs143539514,P=1.51x10-3,OR=1.84,MAF=0.0039(SupplementaryFigure11c).4.Gene-wideFindings
OutsideoftheAPOEregion(definedas1MBaroundtheAPOElocus),inboththeMAF<5%andMAF<1%unadjustedanalyses,onlytheTREM2geneshowedstatisticallysignificantevidenceforassociation,withMAF<5%Pgene-wide=1.42x10-15andMAF<1%Pgene-wide=1.01x10-13(SupplementaryTable10).Removalofthep.R47Handp.R62Hvariantsfromtheanalysesdiminishesthegene-wideassociation(P>2.5x10-6).However,theSKAT-OtestremainssuggestivewithP=6.3x10-3,andifaburdentestwasappliedP=4.1x10-3,suggestingthatmoreraredamagingvariantsincreasingriskonADmaybepresentinTREM2.IntheadjustedanalysisanovelassociationwiththeCBLN3geneisidentifiedwith2SNVsatthislocus(SupplementaryTable11).Bothvariantsinthisgeneareextremelyrareandthisfindingrequiresfurtherreplication.
5.GeneExpression
RNAsequencingwasalsousedtomeasuregeneexpressionlevelsinbrainsfromCRND8transgenicmousemodelat3,6and12monthsofage(n=12,12and14,
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respectively);PS1APPmodelatage12months(n=11)andwildtype(WT)miceat3,6and12monthsofage(n=12,12and10,respectively).Basedonourpreliminarydatawhichshowedexpressionchanges>2-foldininnateimmunitygenesbetweenTgvs.Non-Tgmice,basedonconservativeestimateofvarianceandgroupsizesof10,wehavean80%powerintheRNAseqstudiestodetecteffectsizesof1.8,2.2and2.8atanα<0.05,0.01and0.001.AllmicewerehousedinSPFconditionsinthesamefacility,fedstandardmousechow,andeuthanizedbyC02asphyxiation.Brainsweredissectedtoremovethecerebellumandmidbrain,andthe"forebrains"wereprocessedforRNAextractionandsequencinginamanneranalogoustothatdescribedforthehumanbrainsamples.Transgenicanimalsandtheirnon-transgeniclittermatesunderwentRNAseqinthesamebatch,whichincludedanimalsfrombothsexesandandallagegroupsassessed.Samplesweresequencedastriplicatesperlaneandrandomizedacrosstheflowcellsbyageandtransgene(+vs.-).RNAseqprocessingincludingalignmentandqualitycontrolwasdoneonallmousesamplesinanautomatedfashion.ThemouseRNAsequencingdataoverviewandanalyticmethodsareavailableatSynapsepagessyn3157182andsyn3435792,respectively.Multivariablelinearregressionwasusedtotestforassociationofgeneexpressionlevelswithtransgenicstate(Dx).Inallanalyses,adjustmentsweremadeonlyforsexandRNAintegritynumber(RIN),givenlimitedsamplesize.Meannormalizedgenereadcountsandstandarddeviations(sd)forthetransgenic(Tg)andWTgroupsareshown(SupplementaryTable20).TheRNAseqdatausedintheanalyseshavebeennormalizedusingConditionalQuantileNormalization(CQN)viatheBioconductorpackagecqn;accountingforsequencingdepth,genelength,andGCcontent.CQNapproximateslog2(RPKM)exceptattheextremesoftheexpressiondistribution.ThegeneexpressiondatashownhereinhavemeanCQN>-1.Levelsofall3genesincreasewithagebuttoagreaterextentforTgmiceforTrem2andAbi3.All3genesaresignificantlyhigherinCRND8brainsat12months.Trem2andAbi3arealsosignificantlyhigherinCRND8miceat6monthsandPS1APPmiceat12months.6.FunctionalAnnotation
ToinvestigatethefunctionaleffectofindexSNVsrs72824905andrs616338,thesurroundingsequencewasanalysedtoidentifypotentialcis-effects.VariantsinLD(r2>0.7)withtheindexSNVswereidentifiedusingHaploRegv4.148usingtheEuropeanpopulationfrom1000GenomesPhase149forLDcalculation.Additionally,theCommonGeneHaplotypeAllelesfeatureintheUniversityofCalifornia,SantaCruz(UCSC)genomebrowser50(https://genome.ucsc.edu),generatedfromimputationofthe1000GenomesPhase1data,wasusedtoidentifyvariantsonthesamehaplotypebackgroundastheindexSNVs.Thisapproachidentified8additionalvariantsthatmaybetaggedbytheindexSNVs(SupplementaryTable21).In-silicofunctionalanalysisofthevariantswasconductedusingAnnovar51andthefollowingdatabases:RefSeq52release69wasusedtoannotatevariantstogenes.TranscriptionfactorbindingsitescomputedwiththeTransfacMatrixDatabasev0.7(http://www.gene-regulation.com/pub/databases.html)weresourcedfromtheUCSCgenomeannotationtracks53fortheFeb2009assemblyofthehumangenome(http://www.ncbi.nlm.nih.gov/projects/genome/assembly/grc/).ThesnoRNAandmiRNAtrack,basedonthemiRBaseandsnoRNABaserelease54–58,aswellastheTargetScanS59–61microRNAsbindingsitetrack,weresourcedfromtheaboveUCSCassemblyandusedtoidentifyvariantsoverlappingmicroRNAsortheirregulatorysites.VariantspreviouslyidentifiedbypublishedGWASandcollectedintheCatalogofPublishedGenome-Wide
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AssociationStudiesattheNationalHumanGenomeResearchInstitute(NHGRI,accessedMarch2015)62wereflaggedusingdatafromthecorrespondingUCSCtrack.VariantswerealsoannotatedusingthedbNSFPv30adatabase63,64thatcompilespredictionsandconservationscoresfrom20sources,theCLINVARdatabaseofvariantswithclinicalsignificance65,andfunctionalpredictiontoolsGWAVA66release70,CADD67v1.0andDANN68.Finally,variantswereinvestigatedfortheireffectongeneexpressionusingeQTLdatafromBRAINEAC69,HaploRegv4.1andthosereportedbyKnightandco-workers70.PLCG2
PLCG2encodesphospholipaseCγ2(PLCγ2),anenzymeresponsibleforligand-mediatedsignallingincellsofthehematopoieticsystem,andplaysakeyroleintheregulationofimmuneresponses.Thep.P522RvariantidentifiedwithinPLCG2residesinaregionoftheproteinhighlyconservedacrosshuman,chimp,rhesusmonkey,mouse,rat,rabbit,horse,dogandelephant(SupplementaryFigures4and13).Functionalannotationsuggeststhattheprotectivevariant,whichencodesforanarginineresidue,affectschromatinstructureandpotentiallyproteinfolding.AswellasassociatingwithautoimmunediseasesPLAIDandAPLAID71,PLCG2hasbeenshowntoassociatewithinflammatoryconditionssuchasInflammatoryboweldisease72.ABI3
ThefunctionofABI3(previouslyknownasNESH)isfarfromunderstood.EarlystudiesindicatedthatoverexpressionofABI3ledtoareductionincellmotilityandreducedmetastasisinaninvivocancermodelattributedtoanapparentinteractionwithp21activatedkinase73.Whilstthisstudydidnotdemonstrateanimpactoncellproliferation,subsequentstudyofbothABI3andABI3BP(ABI3bindingprotein),reportedanimpactofitsexpressiononproliferationaswellasinvivocancercellgrowth74.ThesetumoursuppressingrolesforABI3areinterestinginthecontextofobservedlowexpressionofABI3incancercells75.GiventheassociationwehavemadebetweenABI3polymorphismswiththedevelopmentofAlzheimer’sdisease,thekeycontributionofABI3totheaetiologyofthediseaseandwhetheritisattributabletoalterationsincellgrowthandadhesion/migrationorotherwiseunknownfunctionsremainscompletelyunknown.Theriskvariantp.S209F,whichencodesaphenylalanineresidueispredictedtobedeleterious67,thevariantliesinaregionoftheproteinhighlyconservedacrosshuman,chimp,rhesusmonkey,mouse,rat,rabbit,dogandelephant(SupplementaryFigure7),whichisthoughttohavearoleinalteringchromatinstructure(SupplementaryFigure14).TREM2
TREM2isaTypeItransmembranereceptorproteinexpressedonmyeloidcells76,77,inthebrain,primaryTREM2expressionisonmicroglia.TREM2actstocontrolregulationofphagocytosisandsuppressionofinflammatoryreactivitysignallingpathways78–80.TREM2hasshowngeneticassociationwithmultipledementias81–85,includingAD38,39,andhasalsoshowndifferentialexpressioninAβplaque-associatedversusAβplaque-freetissuefromtransgenicmice86.Bothp.R47Handp.R62HarelocatedinaIg-likeV-typedomain(SupplementaryFigure15),suggestingthatthesevariantsaffectligandbinding/signaltransductionofTREM2.
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8.SupplementaryTableLegendsSupplementaryTable1.Fulldescriptionofthedifferentstage1samplesfromtheGERAD/PERADES,ADGCandCHARGEconsortia.SupplementaryTable2.Fulldescriptionofthedifferentstage2andstage3samples/datasetsfromtheGERAD/PERADES,ADGC,CHARGEandEADIconsortia.SupplementaryTable3.Detailsofstage1callingsoftware(s)andqualitycontrolmetricsappliedacrosstheADGC,CHARGEandGERAD/PERADEScohorts.SupplementaryTable4.Tableof43variantseligibletobetakenforwardfromstage1,meetingP<1x10-4beforere-clusteringandP<0.05afterre-clustering.TheORforanumberofSNVsareextremelyhighduetoacombinationofthe‘one-step’approximationoftheeffectestimatefromthescore-testandtherarityoftheminorallele.SupplementaryTable5.ObservedassociationsatpreviouslyidentifiedGWSADriskloci.VariantsinAPOE,CLUandCR1showedgenome-widesignificantassociation(P<5x10-8)intheunadjustedanalysis,whilecommonvariantsnearBIN1,MS4A6A,CD33,HLA-region,ABCA7andINPP5Dshowedsuggestiveassociation(P<5x10-4).Also,rareandcommonvariationinpreviouslydescribedriskloci(TREML2,UNC5C,TTC3,PLXNA4,PLD3,MTHFR,CYP2D6,ADAM10,ZNF628,AKAP9,CD33,TRIP4,MAPT,SQSTM1,ATP5H/KCTD2,APP,PSEN1,PSEN2).ExcludingCD33commonvariantrs3865444,nosignificantevidenceforassociationwithLOADwasidentified.TheORforanumberofSNVsareextremelyhighduetoacombinationofthe‘one-step’approximationoftheeffectestimatefromseqMetaandtherarityoftheminorallele.SupplementaryTable6.ConcordanceofalternateallelecarriergenotypesforallreplicatedSNPsamongsampleswithbothexomechipgenotypingandwithGWASimputedtoHRC.Forcomparison,imputedgenotypeswereassignedifprobabilityofagivengenotypeexceeded0.9.Wherepercentconcordanceisabsent,SNPswereimputedwithhighprobabilityasmonomorphicacrossallsamplesexamined.SupplementaryTable7.ResultsofunadjustedanalysisoftheSNVsidentifiedaseligibleforreplicationinstage1.Resultsshowp-value,oddsratio,minorallelefrequencyandnumberofindividualsforeachstageofthestudy,aswellasthefinalcombinedanalysis.TheORforanumberofSNVsareextremelyhighduetoacombinationofthe‘one-step’approximationoftheeffectestimatefromtheseqMetaandtherarityoftheminorallele.SupplementaryTable8.ResultsofadjustedanalysisoftheSNVsidentifiedaseligibleforreplicationinstage1.Resultsshowp-value,oddsratio,minorallelefrequencyandnumberofindividualsforeachstageofthestudy,aswellasthefinalcombinedanalysis.TheORforanumberofSNVsareextremelyhighduetoacombinationofthe‘one-step’approximationoftheeffectestimatefromtheseqMetaandtherarityoftheminorallele.
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SupplementaryTable9.UnadjustedassociationwithsinglenucleotidevariationwithinthePLCG2geneonchromosome16.SupplementaryTable10.ResultsofunadjustedSKAT-Ogene-wideanalysisoftheSNVsinstage1.ResultsshownumberofSNVsincludedinanalysisatMAF≤0.01andMAF≤0.05andtheirrespectivep-valuesforallSNVswithP<1x10-5ateitherMAFthreshold.Tablealsoshowsgene-wideanalysisofPLCG2(P>1x10-5).SupplementaryTable11.ResultsofadjustedSKAT-Ogene-wideanalysisoftheSNVsinstage1.ResultsshownumberofSNVsincludedinanalysisatMAF≤0.01andMAF≤0.05andtheirrespectivep-valuesforallSNVswithP<1x10-5ateitherMAFthreshold.Tablealsoshowsgene-wideanalysisofPLCG2andABI3(P>1x10-5).SupplementaryTable12.UnadjustedassociationwithsinglenucleotidevariationwithintheABI3geneonchromosome17.SupplementaryTable13.UnadjustedassociationwithsinglenucleotidevariationwithintheTREM2geneonchromosome6.SupplementaryTable14.LinkagedisequilibriumcalculationsgeneratedfortheobservedSNVassociationsatthePLCG2andTREM2loci.SupplementaryTable15.EnrichmentfortheIGAPpathwayclustersbasedoncombininggene-widep-valuesfromvariantswithMAF<0.01withFisher’smethod.Theclustersrepresentingtheimmuneresponse,cholesteroltransport,hemostasis,Clathrin/AP2adaptorcomplexandproteinfolding,surviveBonferronifor8tests(p<0.00625).AconservativeanalysisremovingtheAPOEregionandthemoresignificantofanypairofgeneslessthan1Mbapart(toremovepotentialbiasresultingfromLDbetweengenes)isalsoshown.SupplementaryTable16.Significantpathways(FDR<0.01)fromananalysisoftherarevariantdata(MAF<1%)onall9,816pathwaysoriginallyanalysedintheIGAPGWAS.SupplementaryTable17.ALIGATORenrichmentanalysisofthe151genesintheoverlapofimmune-relatedgeneexpressionmodulesintheIGAPGWAS,stratifyingbymembershipoftheproteininteractionnetwork.Arangeofp-valuecutoffswereusedtodefinesignificantSNPs(andthegenescontainingthem).“Top5%”referstothetop5%ofgenesbeingcountedassignificant(correspondingtoSNPP<8.32x10-4)andwastheprimaryanalysisintheoriginalpathwayanalysisoftheIGAPdata.
SupplementaryTable18.Listofthe56genesintheprotein-proteininteractionnetwork,withgenebasedp-valuesintheIGAPcommonvariantGWASandinthepresentrarevariantstudy(unadjustedmodel).
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SupplementaryTable19Differentialexpressionofgenes(DEG)inhumantemporalcortex.Meannormalizedgenereadcountsandstandarddeviations(sd)fortheADandcontrol(con)groupsareshown.EffectofADdiagnosis(Dx.Beta,Dx.SE=standarderror),significanceofADdiagnosiseitheruncorrected,orcorrectedusingFDR-basedqvaluesareshown.All3genesaresignificantlyhigherinADtemporalcortexpriortocorrectingforcelltypes(Simplemodel),butthissignificanceisabolishedafteradjustingforcell-specificgenecounts(Comprehensivemodel).ThissuggeststhattheseelevationsarelikelyaconsequenceofchangesincelltypesthatoccurwithAD,mostlikelymicrogliosisgiventhatTREM2,PLCG2andABI3aremicroglia-enrichedgenes.SupplementaryTable20.Differentialexpressionofgenes(DEG)inbrainsfromCRND8transgenicmousemodelat3,6and12monthsofage(n=12,12and14,respectively);PS1APPmodelatage12months(n=11)andwildtype(WT)miceat3,6and12monthsofage(n=12,12and10,respectively).Meannormalizedgenereadcountsandstandarddeviations(sd)forthetransgenic(Tg)andWTgroupsareshown.Effectoftransgenicstate(Dx.Beta,Dx.SE=standarderror),significanceofTgstateeitheruncorrected,orcorrectedusingFDR-basedqvaluesareshown.Levelsofall3genesincreasewithagebuttoagreaterextentforTgmiceforTrem2andAbi3.All3genesaresignificantlyhigherinCRND8brainsat12months.Trem2andAbi3arealsosignificantlyhigherinCRND8miceat6monthsandPS1APPmiceat12months.SupplementaryTable21.FunctionalannotationofthePLCG2andABI3GWSSNVsandvariantsinLD(r2>0.7).AssociatedSNVsarehighlightedinblue.Interestingfindingsarehighlightedinred.Interpretationofdataisviathehandbookoftherelevantdatabase.
Nature Genetics: doi:10.1038/ng.3916