BACKGROUNDThere is considerable variation in disease behavior among patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 . Genomewide association analysis may allow for the identification of potential genetic factors involved in the development of Covid-19. METHODSWe conducted a genomewide association study involving 1980 patients with Covid-19 and severe disease (defined as respiratory failure) at seven hospitals in the Italian and Spanish epicenters of the SARS-CoV-2 pandemic in Europe. After quality control and the exclusion of population outliers, 835 patients and 1255 control participants from Italy and 775 patients and 950 control participants from Spain were included in the final analysis. In total, we analyzed 8,582,968 single-nucleotide polymorphisms and conducted a meta-analysis of the two case-control panels. RESULTSWe detected cross-replicating associations with rs11385942 at locus 3p21.31 and with rs657152 at locus 9q34.2, which were significant at the genomewide level (P<5×10 −8 ) in the meta-analysis of the two case-control panels (odds ratio, 1.77; 95% confidence interval [CI], 1.48 to 2.11; P = 1.15×10 −10 ; and odds ratio, 1.32; 95% CI, 1.20 to 1.47; P = 4.95×10 −8 , respectively). At locus 3p21.31, the association signal spanned the genes SLC6A20, LZTFL1, CCR9, FYCO1, CXCR6 and XCR1. The association signal at locus 9q34.2 coincided with the ABO blood group locus; in this cohort, a blood-group-specific analysis showed a higher risk in blood group A than in other blood groups (odds ratio, 1.45; 95% CI, 1.20 to 1.75; P = 1.48×10 −4 ) and a protective effect in blood group O as compared with other blood groups (odds ratio, 0.65; 95% CI, 0.53 to 0.79; P = 1.06×10 −5 ). CONCLUSIONSWe identified a 3p21.31 gene cluster as a genetic susceptibility locus in patients with Covid-19 with respiratory failure and confirmed a potential involvement of the ABO blood-group system. (Funded by Stein Erik Hagen and others.

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Recent population-based 1-4 and clinical studies 5 have identified a range of factors associated with human gut microbiome variation. Murine quantitative trait loci 6 , human twin studies 7 and microbiome genome-wide association studies (mGWAS) 1,3,8-12 have provided evidence for genetic contributions to microbiome composition. Despite this, there is still poor overlap in genetic association across human studies. Using appropriate taxon-specific models along with support from independent cohorts, we show association between human host genotype and gut microbiome variation. We also suggest that interpretation of applied analyses using genetic associations is complicated by the likely overlap between genetic contributions and heritable components of host environment. Using fecal derived 16S rRNA gene sequences and host genotype data from the Flemish Gut Flora Project (FGFP, n=2223) and two German cohorts (FoCus, n=950, PopGen n=717), we identify genetic associations involving multiple microbial traits (MTs). Two of these associations achieved a study-level p-value threshold of 1.57x10−10; an association between Ruminococcus and rs150018970 near RAPGEF1 on chromosome 9, and between Coprococcus and rs561177583 within LINC01787 on chromosome 1. Exploratory analysis was undertaken using 11 other genomewide associations with strong evidence for association (p-value < 2.5x10 −08) and a previously reported signal of association between rs4988235 (MCM6/LCT) and Bifidobacterium. Across these 14 SNPs there was evidence of signal overlap with other GWAS including those for age at menarche and cardiometabolic traits. Mendelian randomization (MR) analysis was able to estimate associations between MTs and disease (including Bifidobacterium and body composition), however in the absence of clear microbiome driven effects, caution is needed in interpretation. Overall, this work marks a growing catalog of genetic associations which will provide insight into the contribution of host genotype to gut microbiome. Despite this, the uncertain origin of association signals will likely complicate future work looking to dissect function or use associations for causal inference analysis. Main Human host-microbiome mGWAS are still in their infancy and feature a paucity of overlap for even the most compelling signals across studies 13. This is an observation influenced by environmental variables dominating microbial trait variation 1 and the complications of variation in sample collection, storage conditions, DNA extraction method, PCR primers, and amplicon versus shotgun sequencing 14. While recent advances are Postdoctoral Fellowship (1221620N). SVS is supported by Marie Curie Actions FP7 People

doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.

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