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Esposito D, Cruciani G, Zaccaro L, Di Carlo E, Spitoni GF, Manti F, Carducci C, Fiori E, Leuzzi V, Pascucci T. A Systematic Review on Autism and Hyperserotonemia: State-of-the-Art, Limitations, and Future Directions. Brain Sci 2024; 14:481. [PMID: 38790459 PMCID: PMC11119126 DOI: 10.3390/brainsci14050481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 04/29/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
Hyperserotonemia is one of the most studied endophenotypes in autism spectrum disorder (ASD), but there are still no unequivocal results about its causes or biological and behavioral outcomes. This systematic review summarizes the studies investigating the relationship between blood serotonin (5-HT) levels and ASD, comparing diagnostic tools, analytical methods, and clinical outcomes. A literature search on peripheral 5-HT levels and ASD was conducted. In total, 1104 publications were screened, of which 113 entered the present systematic review. Of these, 59 articles reported hyperserotonemia in subjects with ASD, and 26 presented correlations between 5-HT levels and ASD-core clinical outcomes. The 5-HT levels are increased in about half, and correlations between hyperserotonemia and clinical outcomes are detected in a quarter of the studies. The present research highlights a large amount of heterogeneity in this field, ranging from the characterization of ASD and control groups to diagnostic and clinical assessments, from blood sampling procedures to analytical methods, allowing us to delineate critical topics for future studies.
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Affiliation(s)
- Dario Esposito
- Department of Human Neuroscience, Unit of Child Neurology and Psychiatry, Sapienza University of Rome, Via dei Sabelli 108, 00185 Rome, Italy; (D.E.); (F.M.)
| | - Gianluca Cruciani
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Via degli Apuli 1, 00185 Rome, Italy; (G.C.); (G.F.S.)
| | - Laura Zaccaro
- Department of Psychology, Sapienza University, Via dei Marsi 78, 00185 Rome, Italy; (L.Z.); (T.P.)
| | - Emanuele Di Carlo
- Department of Experimental Medicine, Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy; (E.D.C.); (C.C.)
| | - Grazia Fernanda Spitoni
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Via degli Apuli 1, 00185 Rome, Italy; (G.C.); (G.F.S.)
- Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Fondazione Santa Lucia, Via Ardeatina 306-354, 00179 Rome, Italy
| | - Filippo Manti
- Department of Human Neuroscience, Unit of Child Neurology and Psychiatry, Sapienza University of Rome, Via dei Sabelli 108, 00185 Rome, Italy; (D.E.); (F.M.)
| | - Claudia Carducci
- Department of Experimental Medicine, Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy; (E.D.C.); (C.C.)
| | - Elena Fiori
- Rome Technopole Foundation, P.le Aldo Moro, 5, 00185 Rome, Italy;
| | - Vincenzo Leuzzi
- Department of Human Neuroscience, Unit of Child Neurology and Psychiatry, Sapienza University of Rome, Via dei Sabelli 108, 00185 Rome, Italy; (D.E.); (F.M.)
| | - Tiziana Pascucci
- Department of Psychology, Sapienza University, Via dei Marsi 78, 00185 Rome, Italy; (L.Z.); (T.P.)
- Centro “Daniel Bovet”, Sapienza University, P.le Aldo Moro 5, 00185 Rome, Italy
- Fondazione Santa Lucia Istituto di Ricovero e Cura a Carattere Scientifico, Via Ardeatina 306, 00179 Rome, Italy
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Higazi AM, Kamel HM, Abdel-Naeem EA, Abdullah NM, Mahrous DM, Osman AM. Expression analysis of selected genes involved in tryptophan metabolic pathways in Egyptian children with Autism Spectrum Disorder and learning disabilities. Sci Rep 2021; 11:6931. [PMID: 33767242 PMCID: PMC7994393 DOI: 10.1038/s41598-021-86162-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/07/2021] [Indexed: 01/31/2023] Open
Abstract
Autism Spectrum Disorder (ASD) and learning disabilities are neurodevelopmental disabilities characterized by dramatically increasing incidence rates, yet the exact etiology for these disabilities is not identified. Impairment in tryptophan metabolism has been suggested to participate in the pathogenesis of ASD, however, further validation of its involvement is required. Additionally, its role in learning disabilities is still uninvestigated. Our objective was to evaluate some aspects of tryptophan metabolism in ASD children (N = 45) compared to children with learning disabilities (N = 44) and healthy controls (N = 40) by measuring the expression levels of the MAOA, HAAO and AADAT genes using real-time RT-qPCR. We also aimed to correlate the expression patterns of these genes with parental ages at the time of childbirth, levels of serum iron, and vitamin D3 and zinc/copper ratio, as possible risk factors for ASD. Results demonstrated a significant decrease in the expression of the selected genes within ASD children (p < 0.001) relative to children with learning disabilities and healthy controls, which significantly associated with the levels of our targeted risk factors (p < 0.05) and negatively correlated to ASD scoring (p < 0.001). In conclusion, this study suggests that the expression of the MAOA, HAAO and AADAT genes may underpin the pathophysiology of ASD.
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Affiliation(s)
- Aliaa M. Higazi
- grid.411806.a0000 0000 8999 4945Clinical and Molecular Chemistry Unit, Department of Clinical and Chemical Pathology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Hanan M. Kamel
- grid.411806.a0000 0000 8999 4945Clinical and Molecular Chemistry Unit, Department of Clinical and Chemical Pathology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Emad A. Abdel-Naeem
- grid.411806.a0000 0000 8999 4945Immunology Unit, Department of Clinical and Chemical Pathology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Noha M. Abdullah
- grid.411806.a0000 0000 8999 4945Clinical and Molecular Chemistry Unit, Department of Clinical and Chemical Pathology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Doaa M. Mahrous
- grid.411806.a0000 0000 8999 4945Department of Pediatrics, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ashraf M. Osman
- grid.411806.a0000 0000 8999 4945Clinical and Molecular Chemistry Unit, Department of Clinical and Chemical Pathology, Faculty of Medicine, Minia University, Minia, Egypt
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Nayar K, Sealock JM, Maltman N, Bush L, Cook EH, Davis LK, Losh M. Elevated Polygenic Burden for Autism Spectrum Disorder Is Associated With the Broad Autism Phenotype in Mothers of Individuals With Autism Spectrum Disorder. Biol Psychiatry 2021; 89:476-485. [PMID: 33229037 PMCID: PMC7901138 DOI: 10.1016/j.biopsych.2020.08.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 08/15/2020] [Accepted: 08/31/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a multifactorial neurodevelopmental disorder that encompasses a complex and heterogeneous set of traits. Subclinical traits that mirror the core features of ASD, referred to as the broad autism phenotype (BAP), have been documented repeatedly in unaffected relatives and are believed to reflect underlying genetic liability to ASD. The BAP may help inform the etiology of ASD by allowing the stratification of families into more phenotypically and etiologically homogeneous subgroups. This study explores polygenic scores related to the BAP. METHODS Phenotypic and genotypic information were obtained from 2614 trios from the Simons Simplex Collection. Polygenic scores of ASD (ASD-PGSs) were generated across the sample to determine the shared genetic overlap between the BAP and ASD. Maternal and paternal ASD-PGSs were explored in relation to BAP traits and their child's ASD symptomatology. RESULTS Maternal pragmatic language was related to child's social communicative atypicalities. In fathers, rigid personality was related to increased repetitive behaviors in children. Maternal (but not paternal) ASD-PGSs were related to the pragmatic language and rigid BAP domains. CONCLUSIONS Associations emerged between parent and child phenotypes, with more associations emerging in mothers than in fathers. ASD-PGS associations emerged with BAP in mothers only, highlighting the potential for a female protective factor, and implicating the polygenic etiology of ASD-related phenotypes in the BAP.
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Affiliation(s)
| | | | | | | | | | | | - Molly Losh
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois.
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Roberta B, Riva V, Cantiani C, Riboldi EM, Molteni M, Macchi Cassia V, Bulf H. Dysfunctions in Infants' Statistical Learning are Related to Parental Autistic Traits. J Autism Dev Disord 2021; 51:4621-4631. [PMID: 33582879 PMCID: PMC8531064 DOI: 10.1007/s10803-021-04894-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 12/02/2022]
Abstract
Statistical learning refers to the ability to extract the statistical relations embedded in a sequence, and it plays a crucial role in the development of communicative and social skills that are impacted in the Autism Spectrum Disorder (ASD). Here, we investigated the relationship between infants’ SL ability and autistic traits in their parents. Using a visual habituation task, we tested infant offspring of adults (non-diagnosed) who show high (HAT infants) versus low (LAT infants) autistic traits. Results demonstrated that LAT infants learned the statistical structure embedded in a visual sequence, while HAT infants failed. Moreover, infants’ SL ability was related to autistic traits in their parents, further suggesting that early dysfunctions in SL might contribute to variabilities in ASD symptoms.
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Affiliation(s)
- Bettoni Roberta
- Department of Psychology, Università degli Studi di Milano-Bicocca, Piazza Ateneo Nuovo, 1 (U6), 20126, Milano, Italy. .,NeuroMi, Milan Center for Neuroscience, Milano, Italy.
| | - Valentina Riva
- Child Psychopathology Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Chiara Cantiani
- Child Psychopathology Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Elena Maria Riboldi
- Child Psychopathology Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Massimo Molteni
- Child Psychopathology Unit, Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Viola Macchi Cassia
- Department of Psychology, Università degli Studi di Milano-Bicocca, Piazza Ateneo Nuovo, 1 (U6), 20126, Milano, Italy.,NeuroMi, Milan Center for Neuroscience, Milano, Italy
| | - Hermann Bulf
- Department of Psychology, Università degli Studi di Milano-Bicocca, Piazza Ateneo Nuovo, 1 (U6), 20126, Milano, Italy.,NeuroMi, Milan Center for Neuroscience, Milano, Italy
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Gutiérrez-Sacristán A, De Niz C, Kothari C, Kong SW, Mandl KD, Avillach P. GenoPheno: cataloging large-scale phenotypic and next-generation sequencing data within human datasets. Brief Bioinform 2021; 22:55-65. [PMID: 32249310 PMCID: PMC7820848 DOI: 10.1093/bib/bbaa033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/31/2020] [Indexed: 12/17/2022] Open
Abstract
Precision medicine promises to revolutionize treatment, shifting therapeutic approaches from the classical one-size-fits-all to those more tailored to the patient's individual genomic profile, lifestyle and environmental exposures. Yet, to advance precision medicine's main objective-ensuring the optimum diagnosis, treatment and prognosis for each individual-investigators need access to large-scale clinical and genomic data repositories. Despite the vast proliferation of these datasets, locating and obtaining access to many remains a challenge. We sought to provide an overview of available patient-level datasets that contain both genotypic data, obtained by next-generation sequencing, and phenotypic data-and to create a dynamic, online catalog for consultation, contribution and revision by the research community. Datasets included in this review conform to six specific inclusion parameters that are: (i) contain data from more than 500 human subjects; (ii) contain both genotypic and phenotypic data from the same subjects; (iii) include whole genome sequencing or whole exome sequencing data; (iv) include at least 100 recorded phenotypic variables per subject; (v) accessible through a website or collaboration with investigators and (vi) make access information available in English. Using these criteria, we identified 30 datasets, reviewed them and provided results in the release version of a catalog, which is publicly available through a dynamic Web application and on GitHub. Users can review as well as contribute new datasets for inclusion (Web: https://avillachlab.shinyapps.io/genophenocatalog/; GitHub: https://github.com/hms-dbmi/GenoPheno-CatalogShiny).
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Affiliation(s)
| | - Carlos De Niz
- Department of Biomedical Informatics, Harvard Medical School
| | - Cartik Kothari
- Department of Biomedical Informatics, Harvard Medical School
| | - Sek Won Kong
- Department of Biomedical Informatics, Harvard Medical School; Computational Health Informatics Program, Boston Children's Hospital
| | - Kenneth D Mandl
- Department of Biomedical Informatics, Harvard Medical School; Computational Health Informatics Program, Boston Children's Hospital
| | - Paul Avillach
- Department of Biomedical Informatics, Harvard Medical School; Computational Health Informatics Program, Boston Children's Hospital
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Riva V, Marino C, Piazza C, Riboldi EM, Mornati G, Molteni M, Cantiani C. Paternal-but Not Maternal-Autistic Traits Predict Frontal EEG Alpha Asymmetry in Infants with Later Symptoms of Autism. Brain Sci 2019; 9:brainsci9120342. [PMID: 31779221 PMCID: PMC6956226 DOI: 10.3390/brainsci9120342] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/23/2019] [Accepted: 11/24/2019] [Indexed: 01/01/2023] Open
Abstract
Previous research found that the parental autism phenotype is associated with child autism spectrum disorder (ASD), even if the pathway between autistic traits in parents and child ASD is still largely unknown. Several studies investigated frontal asymmetry in alpha oscillation (FAA) as an early marker for ASD. However, no study has examined the mediational effect of FAA between parental autistic traits and child ASD symptoms in the general population. We carried out a prospective study of 103 typically developing infants and measured FAA as a mediator between both maternal and paternal autistic traits and child ASD traits. We recorded infant baseline electroencephalogram (EEG) at 6 months of age. Child ASD symptoms were measured at age 24 months by the Child Behavior Checklist 1½-5 Pervasive Developmental Problems Scale, and parental autistic traits were scored by the Autism spectrum Quotient questionnaire. The mediation model showed that paternal vs. maternal autistic traits are associated with greater left FAA which, in turn, is associated with more child ASD traits with a significant indirect effect only in female infants vs. male infants. Our findings show a potential cascade of effects whereby paternal autistic traits drive EEG markers contributing to ASD risk.
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Affiliation(s)
- Valentina Riva
- Child Psychopathology Unit, Scientific Institute IRCCS E. Medea, Bosisio Parini, 23842 Lecco, Italy; (E.M.R.); (G.M.); (M.M.); (C.C.)
- Correspondence: ; Tel.: +39-031-877924; Fax: +39-031-877499
| | - Cecilia Marino
- Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, ON M6J 1H4, Canada;
| | - Caterina Piazza
- Bioengineering Lab, Scientific Institute IRCCS E. Medea, Bosisio Parini, 23842 Lecco, Italy;
| | - Elena M Riboldi
- Child Psychopathology Unit, Scientific Institute IRCCS E. Medea, Bosisio Parini, 23842 Lecco, Italy; (E.M.R.); (G.M.); (M.M.); (C.C.)
| | - Giulia Mornati
- Child Psychopathology Unit, Scientific Institute IRCCS E. Medea, Bosisio Parini, 23842 Lecco, Italy; (E.M.R.); (G.M.); (M.M.); (C.C.)
| | - Massimo Molteni
- Child Psychopathology Unit, Scientific Institute IRCCS E. Medea, Bosisio Parini, 23842 Lecco, Italy; (E.M.R.); (G.M.); (M.M.); (C.C.)
| | - Chiara Cantiani
- Child Psychopathology Unit, Scientific Institute IRCCS E. Medea, Bosisio Parini, 23842 Lecco, Italy; (E.M.R.); (G.M.); (M.M.); (C.C.)
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Whole Blood Serotonin Levels and Platelet 5-HT 2A Binding in Autism Spectrum Disorder. J Autism Dev Disord 2019; 49:2417-2425. [PMID: 30927179 DOI: 10.1007/s10803-019-03989-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Elevated whole blood serotonin (WB5-HT) is a well-replicated biomarker in autism spectrum disorder (ASD). Decreased platelet serotonin receptor 5-HT2A binding has been reported in ASD. WB5-HT levels and platelet 5-HT2A specific binding were obtained from 110 individuals with ASD and 18 controls. Individuals with ASD had significantly higher WB5-HT levels than controls. There was no difference in the platelet 5-HT2A specific binding between groups. Multiple regression analyses revealed that platelet 5-HT2A binding significantly predicted WB5-HT in the control sample but not in the ASD sample. These results indicate that the relationship between WB5-HT and platelet 5-HT2A binding differs depending on ASD diagnosis, suggesting differences in platelet 5-HT system regulation in ASD.
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Montgomery AK, Shuffrey LC, Guter SJ, Anderson GM, Jacob S, Mosconi MW, Sweeney JA, Turner JB, Sutcliffe JS, Cook EH, Veenstra-VanderWeele J. Maternal Serotonin Levels Are Associated With Cognitive Ability and Core Symptoms in Autism Spectrum Disorder. J Am Acad Child Adolesc Psychiatry 2018; 57:867-875. [PMID: 30392628 PMCID: PMC6531860 DOI: 10.1016/j.jaac.2018.06.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 05/28/2018] [Accepted: 06/20/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The serotonin (5-hydroxytryptamine [HT]) system has long been implicated in autism spectrum disorder (ASD). Whole-blood 5-HT level (WB5-HT) is a stable, heritable biomarker that is elevated in more than 25% of children with ASD. Recent findings indicate that the maternal 5-HT system may influence embryonic neurodevelopment, but maternal WB5-HT has not been examined in relation to ASD phenotypes. METHOD WB5-HT levels were obtained from 181 individuals (3-27 years of age) diagnosed with ASD, 99 of their fathers, and 119 of their mothers. Standardized assessments were used to evaluate cognitive, behavioral, and language phenotypes. RESULTS Exploratory regression analyses found relationships between maternal WB5-HT and nonverbal IQ (NVIQ), Autism Diagnostic Interview-Revised (ADI-R) Nonverbal Communication Algorithm scores, and overall adaptive function on the Vineland Adaptive Behavior Scales-II. Latent class analysis identified a three-class structure in the assessment data, describing children with low, intermediate, and high severity across measures of behavior, cognition, and adaptive function. Mean maternal WB5-HT differed across classes, with the lowest maternal WB5-HT levels seen in the highest-severity group (Welch F2,46.048 = 17.394, p < .001). Paternal and proband WB5-HT did not differ between classes. CONCLUSION Maternal WB5-HT is associated with neurodevelopmental outcomes in offspring with ASD. Prospective, longitudinal studies will be needed to better understand the relationship between the function of the maternal serotonin system during pregnancy and brain development. Further studies in animal models may be able to reveal the mechanisms underlying these findings.
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Affiliation(s)
- Alicia K. Montgomery
- Columbia University Medical Center, New York, NY, and the New York State Psychiatric Institute, New York, NY; Center for Autism and the Developing Brain, New York-Presbyterian Hospital, White Plains, NY
| | - Lauren C. Shuffrey
- New York State Psychiatric Institute, New York, NY, and the Center for Autism and the Developing Brain, New York-Presbyterian Hospital, White Plains, NY. They are also with the Sackler Institute for Developmental Psychobiology; Columbia University Medical Center, New York, NY
| | - Stephen J. Guter
- Institute for Juvenile Research at the University of Illinois at Chicago, IL
| | | | | | - Matthew W. Mosconi
- Kansas Center for Autism Research and Training, Overland Park. He is also with the Clinical Child Psychology Program and Schiefelbusch Institute for Life Span Studies at the University of Kansas, Lawrence
| | | | - J. Blake Turner
- Columbia University Medical Center, New York, NY, and the New York State Psychiatric Institute, New York, NY
| | | | - Edwin H. Cook
- Institute for Juvenile Research at the University of Illinois at Chicago, IL
| | - Jeremy Veenstra-VanderWeele
- New York State Psychiatric Institute, New York, NY, and the Center for Autism and the Developing Brain, New York-Presbyterian Hospital, White Plains, NY. They are also with the Sackler Institute for Developmental Psychobiology; Columbia University Medical Center, New York, NY.
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Rubenstein E, Chawla D. Broader autism phenotype in parents of children with autism: a systematic review of percentage estimates. JOURNAL OF CHILD AND FAMILY STUDIES 2018; 27:1705-1720. [PMID: 29731598 PMCID: PMC5933863 DOI: 10.1007/s10826-018-1026-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The broader autism phenotype (BAP) is a collection of sub-diagnostic autistic traits more common in families of individuals with autism spectrum disorder (ASD) than in the general population. BAP is a latent construct that can be defined using different domains, measured using multiple instruments, and reported using different techniques. Therefore, estimates of BAP may vary greatly across studies. Our objective was to systematically review studies that reported occurrence of BAP in parents of children with ASD in order to quantify and describe heterogeneity in estimates. We systematically searched PubMed and Scopus using PRISMA guidelines for studies quantifying percentage of parents of children with ASD who had BAP We identified 41 studies that measured BAP in parents of children with ASD. These studies used eight different instruments, four different forms of data collection, and had a wide range of sample sizes (N=4 to N=3299). Percentage with BAP ranged from 2.6% to 80%. BAP was more prevalent in fathers than mothers. Parental BAP may be an important tool for parsing heterogeneity in ASD etiology and for developing parent-mediated ASD interventions. However, the variety in measurement instruments and variability in study samples limits our ability to synthesize estimates. To improve measurement of BAP and increase consistency across studies, universal methods should be accepted and adopted across studies. A more consistent approach to BAP measurement may enable efficient etiologic research that can be meta-analyzed and may allow for a larger evidence base that can be used to account for BAP when developing parent-mediated interventions.
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Affiliation(s)
- Eric Rubenstein
- University of North Carolina Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC
- University of Wisconsin-Madison, Waisman Center, Madison, WI
| | - Devika Chawla
- University of North Carolina Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC
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Wang M, Ji Z, Wang S, Kim J, Yang H, Jiang X, Ohno-Machado L. Mechanisms to protect the privacy of families when using the transmission disequilibrium test in genome-wide association studies. Bioinformatics 2017; 33:3716-3725. [PMID: 29036461 PMCID: PMC5860319 DOI: 10.1093/bioinformatics/btx470] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 05/29/2017] [Accepted: 07/20/2017] [Indexed: 11/12/2022] Open
Abstract
MOTIVATION Inappropriate disclosure of human genomes may put the privacy of study subjects and of their family members at risk. Existing privacy-preserving mechanisms for Genome-Wide Association Studies (GWAS) mainly focus on protecting individual information in case-control studies. Protecting privacy in family-based studies is more difficult. The transmission disequilibrium test (TDT) is a powerful family-based association test employed in many rare disease studies. It gathers information about families (most frequently involving parents, affected children and their siblings). It is important to develop privacy-preserving approaches to disclose TDT statistics with a guarantee that the risk of family 're-identification' stays below a pre-specified risk threshold. 'Re-identification' in this context means that an attacker can infer that the presence of a family in a study. METHODS In the context of protecting family-level privacy, we developed and evaluated a suite of differentially private (DP) mechanisms for TDT. They include Laplace mechanisms based on the TDT test statistic, P-values, projected P-values and exponential mechanisms based on the TDT test statistic and the shortest Hamming distance (SHD) score. RESULTS Using simulation studies with a small cohort and a large one, we showed that that the exponential mechanism based on the SHD score preserves the highest utility and privacy among all proposed DP methods. We provide a guideline on applying our DP TDT in a real dataset in analyzing Kawasaki disease with 187 families and 906 SNPs. There are some limitations, including: (1) the performance of our implementation is slow for real-time results generation and (2) handling missing data is still challenging. AVAILABILITY AND IMPLEMENTATION The software dpTDT is available in https://github.com/mwgrassgreen/dpTDT. CONTACT mengw1@stanford.edu. SUPPLEMENTARY INFORMATION Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- Meng Wang
- Department of Genetics, Stanford University, Stanford, CA, USA
| | - Zhanglong Ji
- Department of Biomedical Informatics, UC San Diego, La Jolla, CA, USA
| | - Shuang Wang
- Department of Biomedical Informatics, UC San Diego, La Jolla, CA, USA
| | - Jihoon Kim
- Department of Biomedical Informatics, UC San Diego, La Jolla, CA, USA
| | - Hai Yang
- Department of Biomedical Informatics, UC San Diego, La Jolla, CA, USA
| | - Xiaoqian Jiang
- Department of Biomedical Informatics, UC San Diego, La Jolla, CA, USA
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Richard AE, Scheffer IE, Wilson SJ. Features of the broader autism phenotype in people with epilepsy support shared mechanisms between epilepsy and autism spectrum disorder. Neurosci Biobehav Rev 2017; 75:203-233. [DOI: 10.1016/j.neubiorev.2016.12.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 12/15/2016] [Accepted: 12/20/2016] [Indexed: 12/29/2022]
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Chen R, Davis LK, Guter S, Wei Q, Jacob S, Potter MH, Cox NJ, Cook EH, Sutcliffe JS, Li B. Leveraging blood serotonin as an endophenotype to identify de novo and rare variants involved in autism. Mol Autism 2017; 8:14. [PMID: 28344757 PMCID: PMC5361831 DOI: 10.1186/s13229-017-0130-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 03/10/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Autism spectrum disorder (ASD) is one of the most highly heritable neuropsychiatric disorders, but underlying molecular mechanisms are still unresolved due to extreme locus heterogeneity. Leveraging meaningful endophenotypes or biomarkers may be an effective strategy to reduce heterogeneity to identify novel ASD genes. Numerous lines of evidence suggest a link between hyperserotonemia, i.e., elevated serotonin (5-hydroxytryptamine or 5-HT) in whole blood, and ASD. However, the genetic determinants of blood 5-HT level and their relationship to ASD are largely unknown. METHODS In this study, pursuing the hypothesis that de novo variants (DNVs) and rare risk alleles acting in a recessive mode may play an important role in predisposition of hyperserotonemia in people with ASD, we carried out whole exome sequencing (WES) in 116 ASD parent-proband trios with most (107) probands having 5-HT measurements. RESULTS Combined with published ASD DNVs, we identified USP15 as having recurrent de novo loss of function mutations and discovered evidence supporting two other known genes with recurrent DNVs (FOXP1 and KDM5B). Genes harboring functional DNVs significantly overlap with functional/disease gene sets known to be involved in ASD etiology, including FMRP targets and synaptic formation and transcriptional regulation genes. We grouped the probands into High-5HT and Normal-5HT groups based on normalized serotonin levels, and used network-based gene set enrichment analysis (NGSEA) to identify novel hyperserotonemia-related ASD genes based on LoF and missense DNVs. We found enrichment in the High-5HT group for a gene network module (DAWN-1) previously implicated in ASD, and this points to the TGF-β pathway and cell junction processes. Through analysis of rare recessively acting variants (RAVs), we also found that rare compound heterozygotes (CHs) in the High-5HT group were enriched for loci in an ASD-associated gene set. Finally, we carried out rare variant group-wise transmission disequilibrium tests (gTDT) and observed significant association of rare variants in genes encoding a subset of the serotonin pathway with ASD. CONCLUSIONS Our study identified USP15 as a novel gene implicated in ASD based on recurrent DNVs. It also demonstrates the potential value of 5-HT as an effective endophenotype for gene discovery in ASD, and the effectiveness of this strategy needs to be further explored in studies of larger sample sizes.
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Affiliation(s)
- Rui Chen
- Molecular Physiology & Biophysics, Vanderbilt University, Nashville, TN USA.,Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN USA
| | - Lea K Davis
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN USA.,Division of Genetic Medicine, Department of Medicine, Vanderbilt University, Nashville, TN USA
| | - Stephen Guter
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL USA
| | - Qiang Wei
- Molecular Physiology & Biophysics, Vanderbilt University, Nashville, TN USA.,Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN USA
| | - Suma Jacob
- Department of Psychiatry, University of Minnesota, Minneapolis, MN USA
| | - Melissa H Potter
- Molecular Physiology & Biophysics, Vanderbilt University, Nashville, TN USA.,Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN USA
| | - Nancy J Cox
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN USA.,Division of Genetic Medicine, Department of Medicine, Vanderbilt University, Nashville, TN USA
| | - Edwin H Cook
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL USA
| | - James S Sutcliffe
- Molecular Physiology & Biophysics, Vanderbilt University, Nashville, TN USA.,Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN USA
| | - Bingshan Li
- Molecular Physiology & Biophysics, Vanderbilt University, Nashville, TN USA.,Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN USA
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13
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Dell’Osso L, Luche RD, Gesi C, Moroni I, Carmassi C, Maj M. From Asperger's Autistischen Psychopathen to DSM-5 Autism Spectrum Disorder and Beyond: A Subthreshold Autism Spectrum Model. Clin Pract Epidemiol Ment Health 2016; 12:120-131. [PMID: 27867417 PMCID: PMC5095893 DOI: 10.2174/1745017901612010120] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 08/27/2016] [Accepted: 08/27/2016] [Indexed: 01/11/2023]
Abstract
Growing interest has recently been devoted to partial forms of autism, lying at the diagnostic boundaries of those conditions previously diagnosed as Asperger's Disorder. This latter includes an important retrieval of the European classical psychopathological concepts of adult autism to which Hans Asperger referred in his work. Based on the review of Asperger's Autistische Psychopathie, from first descriptions through the DSM-IV Asperger's Disorder and up to the recent DSM-5 Autism Spectrum Disorder, the paper aims to propose a Subthreshold Autism Spectrum Model that encompasses not only threshold-level manifestations but also mild/atypical symptoms, gender-specific features, behavioral manifestations and personality traits associated with Autism Spectrum Disorder. This model includes, but is not limited to, the so-called broad autism phenotype spanning across the general population that does not fully meet Autism Spectrum Disorder criteria. From this perspective, we propose a subthreshold autism as a unique psychological/behavioral model for research that could help to understand the neurodevelopmental trajectories leading from autistic traits to a broad range of mental disorders.
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Affiliation(s)
- Liliana Dell’Osso
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56100 Pisa, Italy
| | - Riccardo Dalle Luche
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56100 Pisa, Italy
| | - Camilla Gesi
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56100 Pisa, Italy
| | - Ilenia Moroni
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56100 Pisa, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56100 Pisa, Italy
| | - Mario Maj
- Department of Psychiatry, University of Naples SUN, Largo Madonna delle Grazie 1, 80138 Naples, Italy
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14
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The impact of genotype calling errors on family-based studies. Sci Rep 2016; 6:28323. [PMID: 27328765 PMCID: PMC4916415 DOI: 10.1038/srep28323] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 05/31/2016] [Indexed: 02/07/2023] Open
Abstract
Family-based sequencing studies have unique advantages in enriching rare variants, controlling population stratification, and improving genotype calling. Standard genotype calling algorithms are less likely to call rare variants correctly, often mistakenly calling heterozygotes as reference homozygotes. The consequences of such non-random errors on association tests for rare variants are unclear, particularly in transmission-based tests. In this study, we investigated the impact of genotyping errors on rare variant association tests of family-based sequence data. We performed a comprehensive analysis to study how genotype calling errors affect type I error and statistical power of transmission-based association tests using a variety of realistic parameters in family-based sequencing studies. In simulation studies, we found that biased genotype calling errors yielded not only an inflation of type I error but also a power loss of association tests. We further confirmed our observation using exome sequence data from an autism project. We concluded that non-symmetric genotype calling errors need careful consideration in the analysis of family-based sequence data and we provided practical guidance on ameliorating the test bias.
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15
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Francis SM, Kistner-Griffin E, Yan Z, Guter S, Cook EH, Jacob S. Variants in Adjacent Oxytocin/Vasopressin Gene Region and Associations with ASD Diagnosis and Other Autism Related Endophenotypes. Front Neurosci 2016; 10:195. [PMID: 27242401 PMCID: PMC4863894 DOI: 10.3389/fnins.2016.00195] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 04/20/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There has been increasing interest in oxytocin (peptide: OT, gene: OXT) as a treatment pathway for neurodevelopmental disorders such as Autism Spectrum Disorder (ASD). Neurodevelopmental disorders affect functional, social, and intellectual abilities. With advances in molecular biology, research has connected multiple gene regions to the clinical presentation of ASD. Studies have also shown that the neuropeptide hormones OT and arginine vasopressin (AVP) influence mammalian social and territorial behaviors and may have treatment potential for neurodevelopmental disorders. Published data examining molecular and phenotypic variation in ASD, such as cognitive abilities, are limited. Since most studies have focused on the receptors in the OT-AVP system, we investigated genetic variation within peptide genes for association with phenotypic ASD features that help identify subgroups within the spectrum. METHODS In this study, TDT analysis was carried out utilizing FBAT in 207 probands (156 trios) and a European Ancestry (EA) subsample (108 trios).The evolutionarily related and adjacent genes of OXT and AVP were studied for associations between the tagged single nucleotide polymorphisms and ASD diagnosis, social abilities, restrictive and repetitive behaviors, and IQ for cognitive abilities. Additionally, relationships with whole blood serotonin (WB5HT) were explored because of the developmental relationships connecting plasma levels of OT and WB5HT within ASD. RESULTS RESULTS indicate significant association between OXT rs6084258 (p = 0.001) and ASD. Associations with several endophenotypes were also noted: OXT rs6133010 was associated with IQ (full scale IQ, p = 0.008; nonverbal IQ, p = 0.010, verbal IQ, p = 0.006); and OXT rs4813625 and OXT rs877172 were associated with WB5HT levels (EA, p = 0.027 and p = 0.033, respectively). Additionally, we measured plasma OT (pOT) levels in a subsample (N = 54). RESULTS show the three polymorphisms, OXT rs6084258, OXT rs11697250, and OXT rs877172, have significant association with pOT (EA, p = 0.011, p = 0.010, and p = 0.002, respectively). CONCLUSIONS These findings suggest that SNPs near OXT and AVP are associated with diagnosis of ASD, social behaviors, restricted and repetitive behaviors, IQ, pOT, and WB5HT. Future studies need to replicate these findings and examine gene-interactions in other neurodevelopmental disorders. Mechanisms of action may influence early social and cognitive development that may or may not be limited to ASD diagnosis.
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Affiliation(s)
- Sunday M Francis
- Department of Psychiatry, University of Minnesota Minneapolis, MN, USA
| | - Emily Kistner-Griffin
- Biostatistics Shared Resource, Hollings Cancer Center, Medical University of South Carolina Charleston, SC, USA
| | | | - Stephen Guter
- Department of Psychiatry, Institute of Juvenile Research, University of Illinois at Chicago Chicago, IL, USA
| | - Edwin H Cook
- Department of Psychiatry, Institute of Juvenile Research, University of Illinois at Chicago Chicago, IL, USA
| | - Suma Jacob
- Department of Psychiatry, University of Minnesota Minneapolis, MN, USA
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16
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Chen R, Wei Q, Zhan X, Zhong X, Sutcliffe JS, Cox NJ, Cook EH, Li C, Chen W, Li B. A haplotype-based framework for group-wise transmission/disequilibrium tests for rare variant association analysis. ACTA ACUST UNITED AC 2015; 31:1452-9. [PMID: 25568282 DOI: 10.1093/bioinformatics/btu860] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 12/23/2014] [Indexed: 12/30/2022]
Abstract
MOTIVATION A major focus of current sequencing studies for human genetics is to identify rare variants associated with complex diseases. Aside from reduced power of detecting associated rare variants, controlling for population stratification is particularly challenging for rare variants. Transmission/disequilibrium tests (TDT) based on family designs are robust to population stratification and admixture, and therefore provide an effective approach to rare variant association studies to eliminate spurious associations. To increase power of rare variant association analysis, gene-based collapsing methods become standard approaches for analyzing rare variants. Existing methods that extend this strategy to rare variants in families usually combine TDT statistics at individual variants and therefore lack the flexibility of incorporating other genetic models. RESULTS In this study, we describe a haplotype-based framework for group-wise TDT (gTDT) that is flexible to encompass a variety of genetic models such as additive, dominant and compound heterozygous (CH) (i.e. recessive) models as well as other complex interactions. Unlike existing methods, gTDT constructs haplotypes by transmission when possible and inherently takes into account the linkage disequilibrium among variants. Through extensive simulations we showed that type I error was correctly controlled for rare variants under all models investigated, and this remained true in the presence of population stratification. Under a variety of genetic models, gTDT showed increased power compared with the single marker TDT. Application of gTDT to an autism exome sequencing data of 118 trios identified potentially interesting candidate genes with CH rare variants. AVAILABILITY AND IMPLEMENTATION We implemented gTDT in C++ and the source code and the detailed usage are available on the authors' website (https://medschool.vanderbilt.edu/cgg). CONTACT bingshan.li@vanderbilt.edu or wei.chen@chp.edu SUPPLEMENTARY INFORMATION Supplementary data are available at Bioinformatics online.
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Affiliation(s)
- Rui Chen
- Department of Molecular Physiology and Biophysics, Vanderbilt University, TN, 37221, USA, Quantitative Biomedical Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA, Center for Quantitative Sciences, Vanderbilt University, TN, 37221, USA, Department of Medicine, University of Chicago, Chicago, IL, USA, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA, Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA and Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Qiang Wei
- Department of Molecular Physiology and Biophysics, Vanderbilt University, TN, 37221, USA, Quantitative Biomedical Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA, Center for Quantitative Sciences, Vanderbilt University, TN, 37221, USA, Department of Medicine, University of Chicago, Chicago, IL, USA, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA, Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA and Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Xiaowei Zhan
- Department of Molecular Physiology and Biophysics, Vanderbilt University, TN, 37221, USA, Quantitative Biomedical Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA, Center for Quantitative Sciences, Vanderbilt University, TN, 37221, USA, Department of Medicine, University of Chicago, Chicago, IL, USA, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA, Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA and Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Xue Zhong
- Department of Molecular Physiology and Biophysics, Vanderbilt University, TN, 37221, USA, Quantitative Biomedical Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA, Center for Quantitative Sciences, Vanderbilt University, TN, 37221, USA, Department of Medicine, University of Chicago, Chicago, IL, USA, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA, Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA and Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - James S Sutcliffe
- Department of Molecular Physiology and Biophysics, Vanderbilt University, TN, 37221, USA, Quantitative Biomedical Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA, Center for Quantitative Sciences, Vanderbilt University, TN, 37221, USA, Department of Medicine, University of Chicago, Chicago, IL, USA, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA, Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA and Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nancy J Cox
- Department of Molecular Physiology and Biophysics, Vanderbilt University, TN, 37221, USA, Quantitative Biomedical Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA, Center for Quantitative Sciences, Vanderbilt University, TN, 37221, USA, Department of Medicine, University of Chicago, Chicago, IL, USA, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA, Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA and Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Edwin H Cook
- Department of Molecular Physiology and Biophysics, Vanderbilt University, TN, 37221, USA, Quantitative Biomedical Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA, Center for Quantitative Sciences, Vanderbilt University, TN, 37221, USA, Department of Medicine, University of Chicago, Chicago, IL, USA, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA, Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA and Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chun Li
- Department of Molecular Physiology and Biophysics, Vanderbilt University, TN, 37221, USA, Quantitative Biomedical Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA, Center for Quantitative Sciences, Vanderbilt University, TN, 37221, USA, Department of Medicine, University of Chicago, Chicago, IL, USA, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA, Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA and Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wei Chen
- Department of Molecular Physiology and Biophysics, Vanderbilt University, TN, 37221, USA, Quantitative Biomedical Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA, Center for Quantitative Sciences, Vanderbilt University, TN, 37221, USA, Department of Medicine, University of Chicago, Chicago, IL, USA, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA, Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA and Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA Department of Molecular Physiology and Biophysics, Vanderbilt University, TN, 37221, USA, Quantitative Biomedical Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA, Center for Quantitative Sciences, Vanderbilt University, TN, 37221, USA, Department of Medicine, University of Chicago, Chicago, IL, USA, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA, Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA and Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bingshan Li
- Department of Molecular Physiology and Biophysics, Vanderbilt University, TN, 37221, USA, Quantitative Biomedical Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA, Center for Quantitative Sciences, Vanderbilt University, TN, 37221, USA, Department of Medicine, University of Chicago, Chicago, IL, USA, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA, Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA and Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
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