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Protein-coding genetic variants that strongly affect disease risk can yield relevant clues to disease pathogenesis. Here we report exome-sequencing analyses of 20,791 individuals with type 2 diabetes (T2D) and 24,440 non-diabetic control participants from 5 ancestries. We identify gene-level associations of rare variants (with minor allele frequencies of less than 0.5%) in 4 genes at exome-wide significance, including a series of more than 30 SLC30A8 alleles that conveys protection against T2D, and in 12 gene sets, including those corresponding to T2D drug targets (P = 6.1 × 10-3) and candidate genes from knockout mice (P = 5.2 × 10-3). Within our study, the strongest T2D gene-level signals for rare variants explain at most 25% of the heritability of the strongest common single-variant signals, and the gene-level effect sizes of the rare variants that we observed in established T2D drug targets will require 75,000-185,000 sequenced cases to achieve exome-wide significance. We propose a method to interpret these modest rare-variant associations and to incorporate these associations into future target or gene prioritization efforts.

Original publication

DOI

10.1038/s41586-019-1231-2

Type

Journal article

Journal

Nature

Publication Date

06/2019

Volume

570

Pages

71 - 76

Addresses

Program in Metabolism, Broad Institute, Cambridge, MA, USA. flannick@broadinstitute.org.

Keywords

Broad Genomics Platform, DiscovEHR Collaboration, CHARGE, LuCamp, ProDiGY, GoT2D, ESP, SIGMA-T2D, T2D-GENES, AMP-T2D-GENES, Animals, Mice, Knockout, Humans, Mice, Diabetes Mellitus, Type 2, Case-Control Studies, Gene Frequency, Decision Support Techniques, Female, Male, Genome-Wide Association Study, Exome, Whole Exome Sequencing