A Brief History of Human Disease Genetics
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Review A brief history of human disease genetics https://doi.org/10.1038/s41586-019-1879-7 Melina Claussnitzer1,2,3, Judy H. Cho4,5,6, Rory Collins7,8, Nancy J. Cox9, Emmanouil T. Dermitzakis10,11, Matthew E. Hurles12, Sekar Kathiresan2,13,14, Eimear E. Kenny4,6,15, Received: 16 July 2019 Cecilia M. Lindgren2,16,17, Daniel G. MacArthur2,13,18, Kathryn N. North19,20, Sharon E. Plon21,22, Accepted: 13 November 2019 Heidi L. Rehm2,13,18,23, Neil Risch24, Charles N. Rotimi25, Jay Shendure26,27,28, Nicole Soranzo12,29 & Mark I. McCarthy17,30,31,32* Published online: 8 January 2020 A primary goal of human genetics is to identify DNA sequence variants that infuence biomedical traits, particularly those related to the onset and progression of human disease. Over the past 25 years, progress in realizing this objective has been transformed by advances in technology, foundational genomic resources and analytical tools, and by access to vast amounts of genotype and phenotype data. Genetic discoveries have substantially improved our understanding of the mechanisms responsible for many rare and common diseases and driven development of novel preventative and therapeutic strategies. Medical innovation will increasingly focus on delivering care tailored to individual patterns of genetic predisposition. medicine, which was previously restricted to a few specific clinical Anniversary indications, is poised to go mainstream. collection: This Review charts recent milestones in the history of human disease go.nature.com/ genetics and provides an opportunity to reflect on lessons learned by nature150 the human genetics community. We focus first on the long-standing division between genetic discovery efforts targeting rare variants with large effects and those seeking alleles that influence predispo- sition to common diseases. We describe how this division, with its For almost all human diseases, individual susceptibility is, to some echoes of the century-old debate between Mendelian and biometric degree, influenced by genetic variation. Consequently, characterizing views of human genetics, has obscured the continuous spectrum of the relationship between sequence variation and disease predisposi- disease risk alleles—across the range of frequencies and effect sizes— tion provides a powerful tool for identifying processes fundamental observed in the population, and outline how genome-wide analyses to disease pathogenesis and highlighting novel strategies for preven- in large biobanks are transforming genetic research by enabling a tion and treatment. comprehensive perspective on genotype–phenotype relationships. Over the past 25 years, advances in technology and analytical We describe how the expansion in the scale and scope of strategies approaches, often building on major community projects—such as for enumerating the functional consequences of genetic variation those that generated the human genome sequence1 and elaborated is transforming the torrent of genetic discoveries from the past dec- on that reference to capture sites of genetic variation2–6—have enabled ade into mechanistic insights, and the ways in which this knowledge many of the genes and variants that are causal for rare diseases to be increasingly underpins advances in clinical care. Finally, we reflect on identified and enabled a systematic dissection of the genetic basis of some of the challenges and opportunities that confront the field, and common multifactorial traits. There is growing momentum behind the principles that will, over the coming decade, drive the application the application of this knowledge to drive innovation in clinical care, of human genetics to enhance understanding of health and disease most obviously through developments in precision medicine. Genomic and maximize clinical benefit. 1Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. 2Broad Institute of MIT and Harvard Cambridge, Cambridge, MA, USA. 3Institute of Nutritional Science, University of Hohenheim, Stuttgart, Germany. 4Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 5Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 6Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 7Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK. 8UK Biobank, Stockport, UK. 9Vanderbilt Genetics Institute and Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. 10Department of Genetic Medicine and Development, University of Geneva Medical School, Geneva, Switzerland. 11Health 2030 Genome Center, Geneva, Switzerland. 12Wellcome Sanger Institute, Hinxton, UK. 13Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA. 14Verve Therapeutics, Cambridge, MA, USA. 15Center for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 16Big Data Institute at the Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK. 17Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK. 18Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA. 19Murdoch Children’s Research Institute, Parkville, Victoria, Australia. 20University of Melbourne, Parkville, Victoria, Australia. 21Departments of Pediatrics and Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA. 22Texas Children’s Cancer Center, Texas Children’s Hospital, Houston, TX, USA. 23Department of Pathology, Harvard Medical School, Boston, MA, USA. 24Institute for Human Genetics, University of California San Francisco, San Francisco, CA, USA. 25Center for Research on Genomics and Global Health, National Human Genome Research Institute, Bethesda, MD, USA. 26Department of Genome Sciences, University of Washington, Seattle, WA, USA. 27Brotman Baty Institute for Precision Medicine, Magnuson Health Sciences Building, Seattle, WA, USA. 28Howard Hughes Medical Institute, Seattle, WA, USA. 29Department of Haematology, University of Cambridge, Cambridge, UK. 30Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, UK. 31Oxford NIHR Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK. 32Human Genetics, Genentech, South San Francisco, CA, USA. *e-mail: [email protected] Nature | Vol 577 | 9 January 2020 | 179 Review Rare (monogenic) disease Common (complex) disease Genes harbouring variants causal for monogenic disease Genome-wide signicant association signals Type of discovery Resources Technologies Key ndings 0 1,000 2,000 3,000 4,000 80,000 60,000 40,000 20,000 0 1994 1994 1996 1996: DeCODE Genetics founded71,72 1996: Power of association vs linkage37 1996 1998 1998 2000 2000: Draft human genome1 2000 2001: NOD2 linkage for Crohn’s disease34,35 2002 2002 2003: Clinical microarray testing10 2003: HapMap resource2 2004 2004: Open data sharing (DECIPHER)17 2004 2005: Next-generation sequencing12 2005: First GWAS38,39 2006 2006: UKBiobank recruitment started74 2006 2007: Wellcome Trust Case-Control Consortium40 2008 2008: GWAS results catalogue initiated44 2008 2009: Clinical exome sequencing11 2009: Polygenic architecture of complex disease43 2010 2010: 1000 Genomes resource3 2010 2011: Exome-based diagnosis in trios13 2012 2012 2013: Launch of ClinVar, ClinGen and Matchmaker Exchange18,22,23 2014 2014: Genotype-driven 2014 disease discovery15,16 2015: Imputation servers accessible4 2016 2016: Population frequency 2016: Integration of GWAS and 2016 variant database (ExAC)5 sequence data for complex traits45 2017: UKBiobank GWAS completed74 2018: GWAS sample exceeding 1 million90 2018 2018 2018: Polygenic contribution to rare diseases93 Fig. 1 | Growth in the discovery of disease-associated genetic variation. The GWAS and sequencing studies, have supported identification of more than cumulative numbers of genes harbouring variants causal for rare, monogenic 60,000 genetic associations across thousands of human diseases and traits. diseases and traits and of significant GWAS associations implicated in Centre, more recent developments have brought a synthesis of the rare- and common, complex diseases and traits are shown. Left, the advent of high- common-variant approaches based around the combination of sequence- throughput sequencing technologies and availability of reference genomes informed analyses in large cohorts. Key events contributing to these themes from diverse populations has supported a fourfold increase in the discovery of are depicted in the timeline. GA4GH, Global Alliance for Genomics and rare disease-causing genes between 1999 and 2019. Right, international efforts Health160; ExAC, Exome Aggregation Consortium5. such as the Human Genome Project and the HapMap Project, combined with Completion of the draft human genome sequence1 reduced many Rare diseases, rare variants of the obstacles to disease-gene mapping and propelled a fourfold During the 1980s and 1990s, efforts to map disease genes were focused increase in the genes implicated as causal for rare, single-gene dis- on rare, monogenic and syndromic diseases and were mostly driven orders (Fig. 1). Microarray-based detection of structural variation10 by linkage analysis and fine mapping within large multiplex pedi- and exome- and genome-wide sequencing11,12 have been pivotal, bol- grees. Localization of genetic