(APOL1) Gene and Nondiabetic Nephropathy in African Americans
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CLINICAL COMMENTARY www.jasn.org The Apolipoprotein L1 (APOL1) Gene and Nondiabetic Nephropathy in African Americans Barry I. Freedman,* Jeffrey B. Kopp,† Carl D. Langefeld,‡ Giulio Genovese,§ David J. Friedman,§ George W. Nelson, Cheryl A. Winkler,¶ Donald W. Bowden,** and Martin R. Pollak§†† *Department of Internal Medicine/Nephrology, ‡Department of Public Health Sciences/Biostatistical Sciences, and **Department of Biochemistry and Centers for Diabetes Research and Human Genomics, Wake Forest University School of Medicine, Winston-Salem, North Carolina; †Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; §Department of Internal Medicine/Nephrology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; ¶Basic Research Laboratory, SAIC-National Cancer Institute, National Institutes of Health–Frederick, Frederick, Maryland; and ††Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, Massachusetts ABSTRACT Mapping by admixture linkage disequilibrium (LD) detected strong association be- some 22q was detected using admixture tween nonmuscle myosin heavy chain 9 gene (MYH9) variants on chromosome 22 and mapping (mapping by admixture link- nondiabetic nephropathy in African Americans. MYH9-related variants were posited to age disequilibrium [LD]) followed by be the probable, but not necessarily the definitive, causal variants as a result of fine mapping.5 MYH9, expressed in the impressive statistical evidence of association, renal expression, and a role in autosomal kidney and previously associated with dominant MYH9 disorders characterized by progressive glomerulosclerosis (Epstein glomerulosclerosis in patients with auto- and Fechtner syndromes). Dense mapping within MYH9 revealed striking LD patterns somal dominant MYH9 disorders,6 was and racial variation in risk allele frequencies, suggesting population genetic factors rapidly identified as potentially responsi- such as selection may be operative in this region. Genovese and colleagues examined ble in independent reports from two in- large chromosomal regions adjacent to MYH9 using genome-wide association meth- vestigative groups (National Institute of ods and non-HapMap single nucleotide polymorphisms identified in Yoruba from the Diabetes and Digestive and Kidney Dis- 1000 Genomes project. Statistically stronger associations were detected between two eases [NIDDK] and National Cancer In- independent sequence variants in the Apolipoprotein L1 gene (APOL1) and nondia- stitute) and the NIDDK-supported Fam- betic nephropathy in African Americans, with odds ratios of 10.5 in idiopathic FSGS ily Investigation of Nephropathy and and 7.3 in hypertension-attributed ESRD. These kidney disease risk variants likely rose Diabetes [FIND].1,2 Marked association to high frequency in Africa because they confer resistance to trypanosomal infection was also demonstrated in African Amer- and protect from African sleeping sickness. Risk variants in MYH9 and APOL1 are in strong LD, and the genetic risk that was previously attributed to MYH9 may reside, in Published online ahead of print. Publication date part or in whole, in APOL1, although more complex models of risk cannot be excluded. available at www.jasn.org. This association likely explains racial disparities in nondiabetic nephropathy as a result The views in this article are those of the authors and of the high prevalence of risk alleles in individuals of African ancestry. do not necessarily represent the views of the De- partment of Health and Human Services; neither J Am Soc Nephrol 21: 1422–1426, 2010. doi: 10.1681/ASN.2010070730 does mention of trade names, commercial products, or organizations imply endorsement by the US gov- ernment (C.A.W. and G.W.N.). Correspondence: Dr. Barry I. Freedman, Section on Polymorphisms in the nonmuscle myo- E1 risk haplotype associations in idio- Nephrology, Wake Forest University School of Medi- cine, Medical Center Boulevard, Winston-Salem, NC sin heavy chain 9 (MYH9) gene exhibit pathic FSGS and HIV-associated collaps- 27157-1053. Phone: 336-716-6192; Fax: 336-716- strong association with nondiabetic ing glomerulopathy (also termed HIV- 4318; E-mail: [email protected]; or Dr. Martin R. chronic kidney disease (CKD) in African associated nephropathy) ranges from 5 Pollak, Division of Nephrology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA Americans. The increased risk attribut- in African Americans to 8 in European 02215. Phone: 617-632-9880; Fax: 617-632-9890; E- able to this genomic region is among the Americans with statistical evidence mail: [email protected] Ͻ ϫ Ϫ27 highest observed in any complex genetic reaching P 1.0 10 . Copyright © 2010 by the American Society of trait.1–4 The odds ratio (OR) for MYH9 Evidence for association on chromo- Nephrology 1422 ISSN : 1046-6673/2109-1422 J Am Soc Nephrol 21: 1422–1426, 2010 www.jasn.org CLINICAL COMMENTARY icans with ESRD clinically attributed APOL1 is the only member in this family could be due to rare and as-yet-undiscov- to hypertension in the absence of a kidney that produces a secreted protein, a prod- ered variation in this region of chromo- biopsy, thereby linking hypertension- uct known to be associated with HDL some 22. attributed ESRD (HA-ESRD) with FSGS particles in the circulation.11 These findings were extended to HA- and focal global glomerulosclerosis An association analysis comparing ESRD, including 1030 African American (FGGS).3,4 Furthermore, preliminary 205 African Americans who had biopsy- patients with HA-ESRD and 1025 geo- analysis of the African American Study of proven FSGS with 180 African American graphically matched control subjects Kidney Disease and Hypertension control subjects without nephropathy from the southeastern United States.10 (AASK) indicated that propensity to lose was performed using novel SNPs identi- This patient group again reveals the kidney function over time is associated fied in Yoruba participating in the 1000 strongest disease association with the G1 with MYH9 risk variants.7 Genomes project.10 These SNPs reveal tag SNP rs73885319 (S342G; P ϭ 1.1 ϫ The consistent evidence of associa- the strongest evidence of association 10Ϫ39); controlling for rs73885319, G2 tion provided an explanation for the within a 10-kb region in the last exon of indel rs71785313 was also strongly asso- long-observed excess risk for ESRD in in- APOL1, not in MYH9. The most robust ciated (P ϭ 8.8 ϫ 10Ϫ18). The OR for the dividuals of African ancestry relative to signal in this small sample includes a G1-G2 association with HA-ESRD was European ancestry. Much has transpired two-SNP haplotype consisting of de- 7.3 (95% CI 5.6 to 9.5), with a combined in the short time since the MYH9 associ- rived nonsynonymous coding variants G1-G2 P ϭ 10Ϫ63. This P value is 35 or- ation with CKD was first detected. Every- rs73885319 (S342G) and rs60910145 ders of magnitude stronger than for one has been awaiting identification of (I384M) in perfect LD (r2 ϭ 1.0), MYH9 in the same study population, causative polymorphisms and demon- termed the “G1” allele. The frequency with no overlap in OR (e.g., OR 2.38; stration that these affect renal function of the 342G:384M G1 allele was 52% in 95% CI 1.93 to 2.95; P ϭ 1.22 ϫ 10Ϫ15 and histology in animal and cell culture case patients and 18% in control sub- recessive, for the MYH9 E1 haplotype). models. Dense mapping and sequencing jects. After controlling for effects of the As for FSGS, controlling for the G1 and of MYH9 suggested the strongest associ- G1 allele, a second strong APOL1 signal G2 alleles revealed no residual associa- ations with CKD are with single nucleo- was identified, a 6-bp deletion termed tions in patients with HA-ESRD. tide polymorphisms (SNPs) in the 3Ј “G2” (rs71785313), which removes two The observed mode of inheritance of (centromeric) portion of the gene but amino acid residues. Because of the low the APOL1 kidney risk variants was fully have not identified functional variants.8 likelihood of recombination as a conse- recessive in the FSGS cohort (no effect for The global allele frequency patterns for quence of the close proximity of these al- one risk allele and an OR 10.5 for two risk MYH9 risk alleles and the extended hap- leles and the recent origin of these muta- alleles), whereas a mild dominant effect lotype homozygosity in West Africans tions, G2 seems mutually exclusive from was observed in the larger cohort with HA- suggest that the region encompassing G1; that is, they never appear together on ESRD (OR 1.26 for one risk allele and OR MYH9 may be under selective pressure.9 the same chromosome. The frequency of 7.3 for two risk alleles). Although a mild Recently Genovese et al.10 observed the G2 allele is 23% in case patients and dominant effect cannot be fully excluded, that genetic variation in the APOL1 gene, 15% in control subjects. The OR for asso- it is entirely possible that such an effect located immediately centromeric of ciation with biopsy-proven FSGS, contrast- could be explained by as-yet-undiscovered MYH9, is also strongly associated with ing patients with zero or one G1-G2 variants or by sporadic mutations in pa- nondiabetic CKD, and they presented risk alleles with those who have two tients with the recessive model. evidence that the statistical association is risk alleles (recessive effect), was 10.5 Importantly, these findings do not ex- stronger than that of MYH9. They sug- (95% confidence interval [CI] 6.0 to clude the possibility that additional rare gested these coding variants are in fact 18.4). Controlling for the effects of both variants in APOL1, MYH9, or nearby causally related to kidney disease and the G1 and G2 alleles by statistical tech- genes are involved in kidney disease sus- provided an explanation for selection of niques, no additional significant associa- ceptibility. Extended LD exists in this re- APOL1 kidney disease risk polymor- tions were observed, including in MYH9.