A Joint History of the Nature of Genetic Variation and the Nature of Schizophrenia KS Kendler

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A Joint History of the Nature of Genetic Variation and the Nature of Schizophrenia KS Kendler Molecular Psychiatry (2015) 20, 77–83 © 2015 Macmillan Publishers Limited All rights reserved 1359-4184/15 www.nature.com/mp EXPERT REVIEW A joint history of the nature of genetic variation and the nature of schizophrenia KS Kendler This essay traces the history of concepts of genetic variation and schizophrenia from Darwin and Mendel to the present. For Darwin, the important form of genetic variation for evolution is continuous in nature and small in effect. Biometricians led by Pearson agreed and developed statistical genetic approaches utilizing trait correlations in relatives. Mendel studied discontinuous traits and subsequent Mendelians, led by Bateson, assumed that important genetic variation was large in effect producing discontinuous phenotypes. Although biometricians studied ‘insanity’, schizophrenia genetics under Kraepelin and Rüdin utilized Mendelian approaches congruent with their anatomical-clinical disease model of dementia praecox. Fisher showed, assuming many genes of small effect, Mendelian and Biometrical models were consilient. Echoing prior conflicts, psychiatric genetics since then has utilized both biometrical models, largely in twins, and Mendelian models, based on advancing molecular techniques. In 1968, Gottesman proposed a polygenic model for schizophrenia based on a threshold version of Fisher’s theory. Since then, rigorous studies of the schizophrenia spectrum suggest that genetic risk for schizophrenia is more likely continuous than categorical. The last 5 years has seen increasingly convincing evidence from genome-wide association study (GWAS) and sequencing that genetic risk for schizophrenia is largely polygenic, and congruent with Fisher’s and Gottesman’s models. The gap between biometrical and molecular Mendelian models for schizophrenia has largely closed. The efforts to ground a categorical biomedical model of schizophrenia in Mendelian genetics have failed. The genetic risk for schizophrenia is widely distributed in human populations so that we all carry some degree of risk. Molecular Psychiatry (2015) 20, 77–83; doi:10.1038/mp.2014.94; published online 19 August 2014 …Variations, as Darwin and most breeders recognized, were of the faith that despite a current inability to discern pathological two types. There were sports, large discontinuous variations, lesions, the disorders were still fundamentally ‘organic’ and the relatively rare … [and] there were the less obvious but more ‘lesions’ might, in the meantime, be defined using physiological pervasive and plentiful minor variations which occurred in or psychological concepts (for example, ‘irritation’ or ‘negative 2 every character of the organism. (Provine,1 p. 5) symptoms’). This definition was based on a promissory note that individual psychotic disorders reflected distinct diseases which This essay sketches a joint history of the concepts of genetic would one day be traced to discrete pathological processes. variation and schizophrenia from the time of Darwin and Mendel This approach remained dominant in the 20th century as in the mid-19th century to the present. The nature of genetic illustrated by the following from the famous German psychiatrist, variation can be thought of both at the individual level (Are most Kurt Schneider: important differences in individuals the result of single genes of large effect or many genes of small effect?) and at the population We do not know the disease processes underlying cyclothymia level (Is the distribution of genetic liability normal or very bumpy [his term for manic-depressive illness] and schizophrenia. with a small proportion of individuals at high risk and the rest at However, diseases do underlie them. The frequent hereditary low risk?). nature, the fact that most of these disease run in families, the general physical changes often present … [and] above all … they destroy cohesion, interrupt the meaningful order, the THE PARADIGM OF PSYCHIATRIC ILLNESS continuity of meaning which characterizes normal develop- 5 The origin of our current anatomical-clinical concept of schizo- ment of life. (Moran and Smith, p. 377) phrenia arose in Europe in the late 19th century.2 Major influences included the discovery of microbial causes of disease and the One of Schneider’s prominent justifications for this biomedical associated move toward etiological models of illness,3 the rise of view of psychiatric illness is the hereditary/familial nature of the neuropathology and the ability to observe directly brain lesions, disorders. and the successful century long search for the cause of general paresis of the insane.4 Key features of this anatomo-clinical view of psychiatric illness included: (i) the rejection of unitary models THE BIOMETRICIANS of psychosis in favor of distinct diseases; (ii) an emphasis on Darwin’s theory of natural selection assumed widespread small symptom clusters, anatomical lesions and natural history; and (iii) trait variations in biological populations that impacted on fitness Departments of Psychiatry, and Human and Molecular Genetics, Virginia Institute of Psychiatric and Behavioral Genetics, Medical College of Virginia/Virginia Commonwealth University, Richmond, VA, USA. Correspondence: Dr KS Kendler, Psychiatry, Virginia Commonwealth University, VCU PO Box 980126, Richmond, 23298-0126 VA, USA. E-mail: [email protected] Received 18 March 2014; revised 30 April 2014; accepted 24 June 2014; published online 19 August 2014 History of nature of genetic variation and schizophrenia KS Kendler 78 and were transmitted across generations. A major debate In 1900, Mendel’s 1866 monograph was ‘rediscovered’ and his emerged in the late 19th century about whether this key assump- theory widely publicized, largely, because it fit well into the tion was correct.1 Did evolution act slowly on quantitative evolutionary framework of the re-discoverers. We will focus on variation or was it saltative, based on large changes (called one of them, Bateson, who became the ardent champion of ‘sports’)? Mendelism and saltative views of evolution in the Anglophonic Darwin’s cousin, Galton, had a complex role in this debate. He world.11,12 Evolution, he asserted, arose not from gradual small founded the field of human behavior genetics in his book shifts in quantitative characteristics but from large phenotypic ‘Hereditary Genius’ published 10 years after Darwin’s ‘Origin’.6 He changes in ‘one bound’. laid the groundwork for the ‘Biometrical approach’ to genetics by Given his viewpoints, it makes sense that Bateson greeted the collecting data in human relatives for a range of metrical traits and rediscovered Mendel with enthusiasm. Here was a biological basis encouraging similar work in other organisms. He prompted his for his saltative evolutionary view. The key concept of the younger and better mathematically trained associate, Pearson, to Mendelians, captured in their first ‘law’, was that the gene had a examine these data. From these efforts emerged our modern ‘unit character’ and was transmitted intact from generation to methods of regression and correlation. However, Galton disagreed generation. Furthermore, the effect of these unit characters with his more famous cousin about the nature of evolution, was large, producing distinct changes. At this early stage of favoring the theory of saltative evolution. Mendelism, the Mendelians assumed a one-to-one relationship Pearson, however, who emerged as the intellectual leader of between what we would now call ‘genotype’ and ‘phenotype’. the ‘Biometrical Geneticists’ in the last decade of the 19th century, Each gene affected one phenotype. Each phenotype was con- was a fervent Darwinian, convinced that continuous phenotypes trolled by one gene. were the material on which evolution worked, producing slow changes over long time intervals. The proper approach to genetics, he asserted, was to examine the association between THE START OF PSYCHIATRIC GENETICS continuous phenotypes in relatives—hence, the focus of the Modern psychiatric genetics began with the work of Ernst Rüdin Biometricians on their new ‘high-tech’ genetic tool: the correlation in the first decade of the 20th century. His daughter wrote: coefficient. This statistical technique assumed that the trait (and ‘Impressed by the recent rediscovery of the Mendelian laws, Rüdin implicitly the underlying genetic variation) was approximately hoped that by using the correct genetic methods, he would be normally distributed. able to uncover the proper Mendelian ratios for schizophrenia’. However, Pearson soon realized that this concept could be (Zebrin-Rudin and Kendler,13 p. 334) He began the first systematic applied to a dichotomous phenotype, assuming that it reflected family study of psychiatric illness in 1907 using admissions with a threshold imposed on an underlying normal distribution. definite schizophrenia to the Munich Psychiatric University He described this method in a 1901 essay ‘Mathematical Clinic.14 This study was undertaken in the same decade that the contributions to the theory of evolution VII, on the correlation very first of human medical traits including brachydactylism, of characters not quantitatively measurable’7 and called it a hemophilia, night-blindness and eye color were shown to have ‘tetrachoric correlation’. While it might seem common-sense to Mendelian segregation patterns.12 assume that discrete traits had to be due to discrete genes, nature Rüdin’s study utilized then ‘cutting edge’ methods of proband did not have to work that way. and age corrections, but included no control group.
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