Red blood cell (RBC) transfusion remains a critical therapeutic intervention in sickle cell disease (SCD); however, the apparent propensity of some patients to regularly develop RBC alloantibodies after transfusion presents a significant challenge to finding compatible blood for so-called alloimmunization responders. Predisposing genetic loci have long been thought to contribute to the responder phenomenon, but to date, no definitive loci have been identified. We undertook a genome-wide association study of alloimmunization responder status in 267 SCD multiple transfusion recipients, using genetic estimates of ancestral admixture to bolster our findings. Analyses revealed single nucleotide polymorphisms (SNPs) on chromosomes 2 and 5 approaching genome-wide significance (minimum P = 2.0 × 10−8 and 8.4 × 10−8, respectively), with local ancestry analysis demonstrating similar levels of admixture in responders and nonresponders at implicated loci. Association at chromosome 5 was nominally replicated in an independent cohort of 130 SCD transfusion recipients, with meta-analysis surpassing genome-wide significance (rs75853687, Pmeta = 6.6 × 10−9), and this extended to individuals forming multiple (>3) alloantibodies (Pmeta = 9.4 × 10−5). The associated variant is rare outside of African populations, and orthogonal genome-wide haplotype analyses, contingent on local ancestry, revealed genome-wide significant sharing of a ∼60-kb haplotype of African ancestry at the chromosome 5 locus (Bayes Factor = 4.95). This locus overlaps a putative cis-acting enhancer predicted to regulate transcription of ADRA1B and the lncRNA LINC01847, both members of larger ontologies associated with immune regulation. Our findings provide potential insights to the pathophysiology underlying the development of alloantibodies and implicate non-RBC ancestry-limited loci in the susceptibility to alloimmunization.
Vitiligo is an autoimmune disease featuring destruction of melanocytes, which results in patchy depigemtation of skin and hair; two vitiligo GWAS studies identified multiple significant associations, including SNPs in 12q13.2 region. But one study ascribed the association to IKZF4 because it encodes a regulator of T cell activation and is associated with two autoimmune diseases; while the other study ascribed the association to PMEL because it encodes melanocyte protein and has the strongest differential expression between vitiligo lesions and perilesional normal skins. Here we show that vitiligo associated gene in 12q13.2 region is SUOX. Reanalyzing one GWAS dataset, we predicted tissuespecific gene-expression by leveraging Genotype-Tissue Expression (GTEx) datasets, and performed association mapping between the predicted gene-expressions and vitiligo status. SUOX expression is significantly associated with vitiligo in both Nerve (tibia) and Skin (sun exposed) tissues. Epigenetic marks encompass the most significant eQTL of SUOX in both nerve and skin tissues suggest a putative enhancer 3Kb downstream of SUOX. We silenced the putative enhancer using the CRISPR interference system and observed 50% decrease in SUOX expression in K562 cells, a cell line that has similar DNase hypersensitive sites and gene expression pattern to the skin tissue at SUOX locus. Our work provided an example to make sense GWAS hits through examining factors that affect gene expression both computationally and experimentally.
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