Genome-Wide Association Studies of Skeletal Phenotypes: What We Have Learned and Where We Are Headed
JCEM ONLINE Advances in Genetics—Clinical Review Genome-Wide Association Studies of Skeletal Phenotypes: What We Have Learned and Where We Are Headed Yi-Hsiang Hsu and Douglas P. Kiel Hebrew SeniorLife Institute for Aging Research (Y.-H.H., D.P.K.), Department of Medicine, Division of Downloaded from https://academic.oup.com/jcem/article/97/10/E1958/2833496 by guest on 28 September 2021 Gerontology, Beth Israel Deaconess Medical and Harvard Medical School, Boston, Massachusetts 02131; and Molecular and Integrative Physiological Sciences Program (Y.-H.H.), Harvard School of Public Health, Boston, Massachusetts 02115 Context: The primary goals of genome-wide association studies (GWAS) are to discover new mo- lecular and biological pathways involved in the regulation of bone metabolism that can be lev- eraged for drug development. In addition, the identified genetic determinants may be used to enhance current risk factor profiles. Evidence Acquisition: There have been more than 40 published GWAS on skeletal phenotypes, predominantly focused on dual-energy x-ray absorptiometry-derived bone mineral density (BMD) of the hip and spine. Evidence Synthesis: Sixty-six BMD loci have been replicated across all the published GWAS, con- firming the highly polygenic nature of BMD variation. Only seven of the 66 previously reported genes (LRP5, SOST, ESR1, TNFRSF11B, TNFRSF11A, TNFSF11, PTH) from candidate gene association studies have been confirmed by GWAS. Among 59 novel BMD GWAS loci that have not been reported by previous candidate gene association studies, some have been shown to be involved in key biological pathways involving the skeleton, particularly Wnt signaling (AXIN1, LRP5, CTNNB1, DKK1, FOXC2, HOXC6, LRP4, MEF2C, PTHLH, RSPO3, SFRP4, TGFBR3, WLS, WNT3, WNT4, WNT5B, WNT16), bone development: ossification (CLCN7, CSF1, MEF2C, MEPE, PKDCC, PTHLH, RUNX2, SOX6, SOX9, SPP1, SP7), mesenchymal-stem-cell differentiation (FAM3C, MEF2C, RUNX2, SOX4, SOX9, SP7), osteoclast differentiation (JAG1, RUNX2), and TGF-signaling (FOXL1, SPTBN1, TGFBR3).
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