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Perry DJ, Wasserfall CH, Oram RA, Williams MD, Posgai A, Muir AB, Haller MJ, Schatz DA, Wallet MA, Mathews CE, Atkinson MA, Brusko TM. Application of a Genetic Risk Score to Racially Diverse Type 1 Diabetes Populations Demonstrates the Need for Diversity in Risk-Modeling. Sci Rep 2018; 8:4529. [PMID: 29540798 PMCID: PMC5852207 DOI: 10.1038/s41598-018-22574-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 02/22/2018] [Indexed: 01/26/2023] Open
Abstract
Prior studies identified HLA class-II and 57 additional loci as contributors to genetic susceptibility for type 1 diabetes (T1D). We hypothesized that race and/or ethnicity would be contextually important for evaluating genetic risk markers previously identified from Caucasian/European cohorts. We determined the capacity for a combined genetic risk score (GRS) to discriminate disease-risk subgroups in a racially and ethnically diverse cohort from the southeastern U.S. including 637 T1D patients, 46 at-risk relatives having two or more T1D-related autoantibodies (≥2AAb+), 790 first-degree relatives (≤1AAb+), 68 second-degree relatives (≤1 AAb+), and 405 controls. GRS was higher among Caucasian T1D and at-risk subjects versus ≤ 1AAb+ relatives or controls (P < 0.001). GRS receiver operating characteristic AUC (AUROC) for T1D versus controls was 0.86 (P < 0.001, specificity = 73.9%, sensitivity = 83.3%) among all Caucasian subjects and 0.90 for Hispanic Caucasians (P < 0.001, specificity = 86.5%, sensitivity = 84.4%). Age-at-diagnosis negatively correlated with GRS (P < 0.001) and associated with HLA-DR3/DR4 diplotype. Conversely, GRS was less robust (AUROC = 0.75) and did not correlate with age-of-diagnosis for African Americans. Our findings confirm GRS should be further used in Caucasian populations to assign T1D risk for clinical trials designed for biomarker identification and development of personalized treatment strategies. We also highlight the need to develop a GRS model that accommodates racial diversity.
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Affiliation(s)
- Daniel J Perry
- Departments of Pathology, Immunology, and Laboratory Medicine, College of Medicine, Gainesville, Florida, USA
| | - Clive H Wasserfall
- Departments of Pathology, Immunology, and Laboratory Medicine, College of Medicine, Gainesville, Florida, USA
| | - Richard A Oram
- Institute for Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
- National Institute for Health Research, Exeter Clinical Research Facility, Exeter, UK
| | - MacKenzie D Williams
- Departments of Pathology, Immunology, and Laboratory Medicine, College of Medicine, Gainesville, Florida, USA
| | - Amanda Posgai
- Departments of Pathology, Immunology, and Laboratory Medicine, College of Medicine, Gainesville, Florida, USA
| | - Andrew B Muir
- Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Michael J Haller
- Department of Pediatrics, College of Medicine, Gainesville, Florida, USA
| | - Desmond A Schatz
- Department of Pediatrics, College of Medicine, Gainesville, Florida, USA
| | - Mark A Wallet
- Departments of Pathology, Immunology, and Laboratory Medicine, College of Medicine, Gainesville, Florida, USA
| | - Clayton E Mathews
- Departments of Pathology, Immunology, and Laboratory Medicine, College of Medicine, Gainesville, Florida, USA
| | - Mark A Atkinson
- Departments of Pathology, Immunology, and Laboratory Medicine, College of Medicine, Gainesville, Florida, USA
- Department of Pediatrics, College of Medicine, Gainesville, Florida, USA
| | - Todd M Brusko
- Departments of Pathology, Immunology, and Laboratory Medicine, College of Medicine, Gainesville, Florida, USA.
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52
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Insel R, Dutta S, Hedrick J. Type 1 Diabetes: Disease Stratification. Biomed Hub 2017; 2:111-126. [PMID: 31988942 PMCID: PMC6945911 DOI: 10.1159/000481131] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 08/30/2017] [Indexed: 12/13/2022] Open
Abstract
Type 1 diabetes, a disorder characterized by immune-mediated loss of functional pancreatic beta cells, is a disease continuum with specific presymptomatic stages with defined risk of progression to symptomatic disease. Prognostic biomarkers have been developed for disease staging and for stratification of subjects that address the heterogeneity in rate of disease progression. Using biomarkers for stratification of subjects at different stages of type 1 diabetes will enable smaller and shorter intervention clinical trials with greater effect size. Addressing the heterogeneity of the disease will allow precision medicine-based approaches to prevention and interception of presymptomatic stages of disease and treatment and cure of symptomatic disease.
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Affiliation(s)
| | | | - Joseph Hedrick
- Disease Interception Accelerator - T1D, Janssen Research & Development, LLC, Raritan, NJ, USA
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Buckner JH, Greenbaum CJ. Stacking the Deck: Studies of Patients with Multiple Autoimmune Diseases Propelled Our Understanding of Type 1 Diabetes as an Autoimmune Disease. THE JOURNAL OF IMMUNOLOGY 2017; 199:3011-3013. [DOI: 10.4049/jimmunol.1701299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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