Genetic Studies of Autism Spectrum Disorder in Asians
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Overview Taiwanese Journal of Psychiatry (Taipei) Vol. 29 No. 3 2015 • 139 • Genetic Studies of Autism Spectrum Disorder in Asians Luke Y. Tsai, M.D.* The genetics of autism spectrum disorder (ASD) has been studied for more than three decades. Earlier twin and family studies have provided some support for a genetic rȏle in the development of ASD. More recent molecular techniques have identifi ed more than 400 potential genes involved in etiology of ASD. But many of the genes have also been identifi ed as potential genes for other neuropsychiatric disorders. The fi eld of ASD genetics has concluded that ASD as defi ned for the last three decades is a heterogeneous clinical disorder with heterogeneous genetic eti- ologies. This overview is to focus on the ethnic differences as a potential factor of the heterogeneous etiologies. In this overview, the author attempts to compile all available published ASD genetic studies in Asian populations to explore the direc- tions for future comparisons between Asian and Western ASD genetic studies. It is concluded that the quantity of the Asian ASD genetic studies is still quite limited, though there are a few studies indeed have found some ethnic differences in certain candidate genes for ASD. Key words: candidate gene, genome wide, copy number variation, ethnic difference (Taiwanese Journal of Psychiatry [Taipei] 2015; 29: 139-54) infantile autism in almost 400 siblings of autistic Introduction individuals in the literature. However, the 7 (1.8%) undocumented cases of autism among sib- When Kanner (1943) fi rst described infantile lings, did suggest a familial clustering of autism. autism, he suggested that it was resulted from an There were only 18 pairs of twins reported in the inborn defect of presumably constitutional origin literature before 1976. Hanson and Gottesman [1]. Over the next three decades, the possible rȏle (1976) concluded that the data were inadequate of genetic factors tended to be dismissed. In an for genetic analysis and there was no report on extensive review and analysis of the literature, offspring of autistic individuals. They concluded Hanson and Gottesman (1976) concluded that that the cause of infantile autism is unlikely to be there was no clear evidence exsits to indicate that genetic [2]. This conclusion is also supported by genetic factors play a rôle in infantile autism [2]. the lacking of identifi ed chromosome anomalies They found no adequately documented cases of associated with infantile autism [3] and by the lit- Departments of Psychiatry and Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, U.S.A. Received: October 2, 2015; accepted: October 7, 2015 *Corresponding author. No. 2385, Placid Way, Ann Arbor, 48105, Michigan, U.S.A. E-mail: Luke Y. Tsai <[email protected]> • 140 • Autism Spectrum Disorder erature review carried out by Smalley et al. (1988), showing only some 2% of cases with two autistic Search Strategy and children in the same family [4]. Identifi cation of Since then and over the last three decades, Relevant Studies considerable evidence has accumulated to support the thought that genetic factors may play a con- To identify the studies that support the ge- tributory hereditary rȏle in the devel-opment of netic role of the development of ASD, I conducted ASD in a subgroup of individuals with such a dis- a systematic literature search to locate the pub- order. Furthermore, the development of new tech- lished studies up to August 2015 that examined nologies in both molecular genetics and cytoge- the genetics of ASD in Chinese, Japanese and netics has substantially enhanced our capacity to Korean populations. The scope of the search was investigate the rôle of genetics in ASD. Attention limited to English-language journal articles. has turned to a more detailed consideration of spe- Publications were identifi ed by conducting cifi c aspects of genetic factors relating to the de- searches in the major scientifi c literature databas- velopment of ASD. es Pub-Med, MEDLINE, and PsycINFO. Search In this overview, I will focus on the genetic was also conducted by entering the following studies of ASD in Asian populations including terms: autism, autistic disorder, Asperger’s disor- ethnic Chinese, Japanese, and Koreans because der, PDD-NOS, pervasive developmental disor- some genetic studies have found “clear ethnic dif- der, autism spectrum disorder, gene, and genetics. ferences” in certain ASD related gene [e.g., gam- Key fi ndings and the bibliographies of many pre- ma-aminobutyric acid-A receptor subunit β3 vious reviews of genetics of ASD were incorpo- (GABRB3) gene [5], or confl icting results in dif- rated into the selection of studies. Reference lists ferent ethnic background [e.g., neuroligin 3 from relevant articles in recent editions of key (NLGN3) and neuroligin 4X (NLGN4X) genes [6]; journals likely to publish such genetic studies CD38 gene [7]. I hope that such a review would (e.g., Journal of Child Psychology and Psychiatry, build a database for future ASD genetic studies of Autism, Journal of Autism and Developmental comparisons between various ethnic groups to Disorders, Research of Autism Spectrum Disorder) help clarify the relevance of the genes to ASD. were also used to identify the relevant studies. Due to the limited space allowed for this overview paper, only the summaries of the identi- Twin Studies fi ed relevant studies are presented here. Readers of the Taiwanese Journal of Psychiatry are re- ‧ Ishijima and Kurita (2007) reported a pair of ferred to other related references for the details of Japanes MZ male twins concordant for DSM- the functions of the genes which are presented in IV Asperger’s disorder [8]. this paper. Family Studies ‧ To investigate the behavioral problems and par- enting style among children with autism and their siblings in an ethnic Chinese population, Tsai LY • 141 • Gau et al. (2010) recruited a total of 151 chil- dren with DSM-IV autistic disorder, aged 3-12 Cytogenetics and years, 134 siblings without autism, and 113 Chromosome Abnormalities normally developing controls. The investiga- tors found that children with autism had signifi - Cytogenetics mainly investigates chromo- cantly more severe behavioral problems, and some abnormalities, such as translocation, inver- obtained less affection and more overprotection sion, deletion, and duplication. Studies of the loca- and authoritarian controlling from their parents tion of chromosomal abnormalities and breakpoints than the unaffected siblings. But compared to can be extremely useful in the identifi cation and the controls, unaffected siblings have shown mapping of genes predisposing to any monogenic some behavioral problems. The investigators or polygenic disease. To date, there have been suggested that the unaffected siblings may be at many reports in the literature of chromosome ab- risk for developing the wide range of behav- normalities in autism covering a broad spectrum of ioral problems and impaired parent–child inter- anomalies, including terminal and interstitial dele- actions as exhibited by their siblings with au- tions, balanced and unbalanced translocations and tism [9]. inversions. The following is the study summaries, reporting chromosomal abnormalities in Asian in- Studies of Personality Traits dividuals with ASD or autistic behaviors: and Behavioral Characteristics Chromosome 2 - Deletion: a patient with au- tistic behavior, at 2p15-16.1 [11]; a 3 years and 4 ‧ Shen et al. (2011) reported the clinical and ge- months old girl with autistic features, at 2q24.2- nomic characteristics of three 16p11.2 deletion q24.3 [12]. carriers in a Chinese family. The father carries Chromosome 4 - Deletion: an 8 years old boy a de novo 16p11.2 deletion, and it was transmit- with ASD at 4q35.1-35.2 [13]. ted to the proband and sib. The proband pre- Chromosome 8 - Deletion: a 12-year-old boy sented with ASD, intellectual disability, learn- with ASD at 8p23.2-pter [13]. ing diffi culty, congenital malformations such as Chromosome 9 - Mosaic tetrasomy 9p: A atrial septal defect and scoliosis. His dysmor- 20-year-old female patient with autism [14]. phic features include myopia and strabismus, Chromosome 18 - Duplication: A 7-year-old fl at and broad nasal bridge, etc. While the fa- girl with autism, at 18q12.1 [15]. ther shared same neurodevelopmental prob- Chromosome X - Deletion: 2 brothers with lems as the proband, the younger brother does autistic behavior, at Xp11.22 [16]; Duplication: a not show many of the proband’s phenotypes. female with ASD, in Xp11.22-p11.23 [17]; Fragile The authors comment that their study demon- X: 8 children with ASD [18]. strates the different developmental trajectory Sex chromosomeaneuploidy – 2 ASD cases and discordant phenotypes among family mem- with 47, XXY, one ASD case with 47, XYY [19]. bers with the same 16p11.2 deletion and further Reciprocal chromosomal translocation be- illustrates the phenotypic complexity and het- tween long arms of chromosomes 4 and 14, desig- erogeneity of the 16p11.2 deletion [10]. nated t(4;14)(q31.3;q24.1) - in a patient with Asperger’s disorder [19]. • 142 • Autism Spectrum Disorder chromosomal abnormality; and has been located Candidate Genes positionally by linkage studies [22]. Over the last two decades, many candidate The fi rst molecular genetic studies of autism gene studies have been conducted, and more than took form in candidate gene association studies. 100 functional or positional candidate genes have The introduction of cost-effective resequencing been tested directly. The majority of them did not has made it possible to build on cytogenetic stud- reveal a conclusive evidence of involvement in ies and obtain evidence for the involvement of ASD by showing clear picture of either positive specifi c candidate genes in the ASDs. Candidate association at a certain gene or genomic locus or gene study is hypothesis-driven research which identifi cation of disease-relevant variations or choses several candidate genes for additional mutations.