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Mejhert N, Gabriel KR, Frendo-Cumbo S, Krahmer N, Song J, Kuruvilla L, Chitraju C, Boland S, Jang DK, von Grotthuss M, Costanzo MC, Rydén M, Olzmann JA, Flannick J, Burtt NP, Farese RV, Walther TC. The Lipid Droplet Knowledge Portal: A resource for systematic analyses of lipid droplet biology. Dev Cell 2022; 57:387-397.e4. [PMID: 35134345 PMCID: PMC9129885 DOI: 10.1016/j.devcel.2022.01.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 11/16/2021] [Accepted: 12/31/2021] [Indexed: 12/15/2022]
Abstract
Lipid droplets (LDs) are organelles of cellular lipid storage with fundamental roles in energy metabolism and cell membrane homeostasis. There has been an explosion of research into the biology of LDs, in part due to their relevance in diseases of lipid storage, such as atherosclerosis, obesity, type 2 diabetes, and hepatic steatosis. Consequently, there is an increasing need for a resource that combines datasets from systematic analyses of LD biology. Here, we integrate high-confidence, systematically generated human, mouse, and fly data from studies on LDs in the framework of an online platform named the "Lipid Droplet Knowledge Portal" (https://lipiddroplet.org/). This scalable and interactive portal includes comprehensive datasets, across a variety of cell types, for LD biology, including transcriptional profiles of induced lipid storage, organellar proteomics, genome-wide screen phenotypes, and ties to human genetics. This resource is a powerful platform that can be utilized to identify determinants of lipid storage.
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Affiliation(s)
- Niklas Mejhert
- Department of Molecular Metabolism, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; Department of Cell Biology, Harvard Medical School, Boston, MA 02115, USA; Department of Medicine (H7), Karolinska Institutet, Huddinge, 141 86 Stockholm, Sweden
| | - Katlyn R Gabriel
- Department of Molecular Metabolism, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; Department of Cell Biology, Harvard Medical School, Boston, MA 02115, USA; Howard Hughes Medical Institute, Boston, MA 02115, USA
| | - Scott Frendo-Cumbo
- Department of Medicine (H7), Karolinska Institutet, Huddinge, 141 86 Stockholm, Sweden
| | - Natalie Krahmer
- Institute for Diabetes and Obesity, Helmholtz Zentrum München, 85764 Neuherberg, Germany; German Center for Diabetes Research, Neuherberg, Germany
| | - Jiunn Song
- Department of Molecular Metabolism, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; Department of Cell Biology, Harvard Medical School, Boston, MA 02115, USA
| | - Leena Kuruvilla
- Primary Pharmacology Group, Discovery Sciences, Pfizer Inc., Groton, CT 06340, USA
| | - Chandramohan Chitraju
- Department of Molecular Metabolism, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; Department of Cell Biology, Harvard Medical School, Boston, MA 02115, USA
| | - Sebastian Boland
- Department of Molecular Metabolism, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; Department of Cell Biology, Harvard Medical School, Boston, MA 02115, USA
| | - Dong-Keun Jang
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - Marcin von Grotthuss
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - Maria C Costanzo
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - Mikael Rydén
- Department of Medicine (H7), Karolinska Institutet, Huddinge, 141 86 Stockholm, Sweden
| | - James A Olzmann
- Department of Molecular and Cell Biology, University of California Berkeley, Berkeley, CA 94720, USA; Department of Nutritional Sciences and Toxicology, University of California Berkeley, Berkeley, CA 94720, USA; Miller Institute for Basic Research in Science, University of California Berkeley, Berkeley, CA 94720, USA; Chan Zuckerberg Biohub, San Francisco, CA 94158, USA
| | - Jason Flannick
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA; Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | - Noël P Burtt
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - Robert V Farese
- Department of Molecular Metabolism, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; Department of Cell Biology, Harvard Medical School, Boston, MA 02115, USA; Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Center on the Causes and Prevention of Cardiovascular Disease (CAP-CVD), Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - Tobias C Walther
- Department of Molecular Metabolism, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; Department of Cell Biology, Harvard Medical School, Boston, MA 02115, USA; Howard Hughes Medical Institute, Boston, MA 02115, USA; Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Center on the Causes and Prevention of Cardiovascular Disease (CAP-CVD), Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
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Balasubramanian R, Hu J, Guasch-Ferre M, Li J, Sorond F, Zhao Y, Shutta KH, Salas-Salvado J, Hu F, Clish CB, Rexrode KM. Metabolomic Profiles Associated With Incident Ischemic Stroke. Neurology 2022; 98:e483-e492. [PMID: 34853177 PMCID: PMC8826464 DOI: 10.1212/wnl.0000000000013129] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/16/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Women have higher lifetime risk of stroke than men, and metabolic factors seem more strongly associated with stroke for women than men. However, few studies in either men or women have evaluated metabolomic profiles and incident stroke. METHODS We applied liquid chromatography-tandem mass spectrometry to measure 519 plasma metabolites in a discovery set of women in the Nurses' Health Study (NHS; 454 incident ischemic stroke cases, 454 controls) with validation in 2 independent, prospective cohorts: Prevención con Dieta Mediterránea (PREDIMED; 118 stroke cases, 791 controls) and Nurses' Health Study 2 (NHS2; 49 ischemic stroke cases, 49 controls). We applied logistic regression models with stroke as the outcome to adjust for multiple risk factors; the false discovery rate was controlled through the q value method. RESULTS Twenty-three metabolites were significantly associated with incident stroke in NHS after adjustment for traditional risk factors (q < 0.05). Of these, 14 metabolites were available in PREDIMED and 3 were significantly associated with incident stroke: methionine sulfoxide, N6-acetyllysine, and sucrose (q < 0.05). In NHS2, one of the 23 metabolites (glucuronate) was significantly associated with incident stroke (q < 0.05). For all 4 metabolites, higher levels were associated with increased risk. These 4 metabolites were used to create a stroke metabolite score (SMS) in the NHS and tested in PREDIMED. Per unit of standard deviation of SMS, the odds ratio for incident stroke was 4.12 (95% confidence interval [CI] 2.26-7.51) in PREDIMED, after adjustment for risk factors. In PREDIMED, the area under the receiver operating characteristic curve (AUC) for the model including SMS and traditional risk factors was 0.70 (95% CI 0.75-0.79) vs the AUC for the model including the traditional risk factors only of 0.65 (95% CI 0.70-0.75), corresponding to a 5% improvement in risk prediction with SMS (p < 0.005). DISCUSSION Metabolites associated with stroke included 2 amino acids, a carboxylic acid, and sucrose. A composite SMS including these metabolites was associated with ischemic stroke and showed improvement in risk prediction beyond traditional risk factors. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that a SMS accurately predicts incident ischemic stroke risk.
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Affiliation(s)
- Raji Balasubramanian
- From the Department of Biostatistics and Epidemiology (R.B., Y.Z., K.H.S.), University of Massachusetts-Amherst; Division of Women's Health (J.H., K.M.R.) and Channing Division of Network Medicine, Department of Medicine (M.G.-F., F.H.), Brigham and Women's Hospital, Harvard Medical School; Departments of Nutrition (M.G.-F., J.L., F.H.) and Epidemiology (J.L., F.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Davee Department of Neurology, Division of Stroke and Neurocritical Care (F.S.), Northwestern Feinberg School of Medicine, Chicago, IL; Departament de Bioquímica i Biotecnologia, Unitat de Nutrició (J.S.S.), Universitat Rovira i Virgili, Reus; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN) (J.S.-S.), Institute of Health Carlos III, Madrid; Nutrition Unit, Pere Virgili Research Institute (IISPV) (J.S.-S.), University Hospital of Sant Joan de Reus, Spain; and Broad Institute of the Massachusetts Institute of Technology and Harvard University (C.B.C.), Cambridge.
| | - Jie Hu
- From the Department of Biostatistics and Epidemiology (R.B., Y.Z., K.H.S.), University of Massachusetts-Amherst; Division of Women's Health (J.H., K.M.R.) and Channing Division of Network Medicine, Department of Medicine (M.G.-F., F.H.), Brigham and Women's Hospital, Harvard Medical School; Departments of Nutrition (M.G.-F., J.L., F.H.) and Epidemiology (J.L., F.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Davee Department of Neurology, Division of Stroke and Neurocritical Care (F.S.), Northwestern Feinberg School of Medicine, Chicago, IL; Departament de Bioquímica i Biotecnologia, Unitat de Nutrició (J.S.S.), Universitat Rovira i Virgili, Reus; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN) (J.S.-S.), Institute of Health Carlos III, Madrid; Nutrition Unit, Pere Virgili Research Institute (IISPV) (J.S.-S.), University Hospital of Sant Joan de Reus, Spain; and Broad Institute of the Massachusetts Institute of Technology and Harvard University (C.B.C.), Cambridge
| | - Marta Guasch-Ferre
- From the Department of Biostatistics and Epidemiology (R.B., Y.Z., K.H.S.), University of Massachusetts-Amherst; Division of Women's Health (J.H., K.M.R.) and Channing Division of Network Medicine, Department of Medicine (M.G.-F., F.H.), Brigham and Women's Hospital, Harvard Medical School; Departments of Nutrition (M.G.-F., J.L., F.H.) and Epidemiology (J.L., F.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Davee Department of Neurology, Division of Stroke and Neurocritical Care (F.S.), Northwestern Feinberg School of Medicine, Chicago, IL; Departament de Bioquímica i Biotecnologia, Unitat de Nutrició (J.S.S.), Universitat Rovira i Virgili, Reus; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN) (J.S.-S.), Institute of Health Carlos III, Madrid; Nutrition Unit, Pere Virgili Research Institute (IISPV) (J.S.-S.), University Hospital of Sant Joan de Reus, Spain; and Broad Institute of the Massachusetts Institute of Technology and Harvard University (C.B.C.), Cambridge
| | - Jun Li
- From the Department of Biostatistics and Epidemiology (R.B., Y.Z., K.H.S.), University of Massachusetts-Amherst; Division of Women's Health (J.H., K.M.R.) and Channing Division of Network Medicine, Department of Medicine (M.G.-F., F.H.), Brigham and Women's Hospital, Harvard Medical School; Departments of Nutrition (M.G.-F., J.L., F.H.) and Epidemiology (J.L., F.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Davee Department of Neurology, Division of Stroke and Neurocritical Care (F.S.), Northwestern Feinberg School of Medicine, Chicago, IL; Departament de Bioquímica i Biotecnologia, Unitat de Nutrició (J.S.S.), Universitat Rovira i Virgili, Reus; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN) (J.S.-S.), Institute of Health Carlos III, Madrid; Nutrition Unit, Pere Virgili Research Institute (IISPV) (J.S.-S.), University Hospital of Sant Joan de Reus, Spain; and Broad Institute of the Massachusetts Institute of Technology and Harvard University (C.B.C.), Cambridge
| | - Farzaneh Sorond
- From the Department of Biostatistics and Epidemiology (R.B., Y.Z., K.H.S.), University of Massachusetts-Amherst; Division of Women's Health (J.H., K.M.R.) and Channing Division of Network Medicine, Department of Medicine (M.G.-F., F.H.), Brigham and Women's Hospital, Harvard Medical School; Departments of Nutrition (M.G.-F., J.L., F.H.) and Epidemiology (J.L., F.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Davee Department of Neurology, Division of Stroke and Neurocritical Care (F.S.), Northwestern Feinberg School of Medicine, Chicago, IL; Departament de Bioquímica i Biotecnologia, Unitat de Nutrició (J.S.S.), Universitat Rovira i Virgili, Reus; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN) (J.S.-S.), Institute of Health Carlos III, Madrid; Nutrition Unit, Pere Virgili Research Institute (IISPV) (J.S.-S.), University Hospital of Sant Joan de Reus, Spain; and Broad Institute of the Massachusetts Institute of Technology and Harvard University (C.B.C.), Cambridge
| | - Yibai Zhao
- From the Department of Biostatistics and Epidemiology (R.B., Y.Z., K.H.S.), University of Massachusetts-Amherst; Division of Women's Health (J.H., K.M.R.) and Channing Division of Network Medicine, Department of Medicine (M.G.-F., F.H.), Brigham and Women's Hospital, Harvard Medical School; Departments of Nutrition (M.G.-F., J.L., F.H.) and Epidemiology (J.L., F.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Davee Department of Neurology, Division of Stroke and Neurocritical Care (F.S.), Northwestern Feinberg School of Medicine, Chicago, IL; Departament de Bioquímica i Biotecnologia, Unitat de Nutrició (J.S.S.), Universitat Rovira i Virgili, Reus; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN) (J.S.-S.), Institute of Health Carlos III, Madrid; Nutrition Unit, Pere Virgili Research Institute (IISPV) (J.S.-S.), University Hospital of Sant Joan de Reus, Spain; and Broad Institute of the Massachusetts Institute of Technology and Harvard University (C.B.C.), Cambridge
| | - Katherine H Shutta
- From the Department of Biostatistics and Epidemiology (R.B., Y.Z., K.H.S.), University of Massachusetts-Amherst; Division of Women's Health (J.H., K.M.R.) and Channing Division of Network Medicine, Department of Medicine (M.G.-F., F.H.), Brigham and Women's Hospital, Harvard Medical School; Departments of Nutrition (M.G.-F., J.L., F.H.) and Epidemiology (J.L., F.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Davee Department of Neurology, Division of Stroke and Neurocritical Care (F.S.), Northwestern Feinberg School of Medicine, Chicago, IL; Departament de Bioquímica i Biotecnologia, Unitat de Nutrició (J.S.S.), Universitat Rovira i Virgili, Reus; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN) (J.S.-S.), Institute of Health Carlos III, Madrid; Nutrition Unit, Pere Virgili Research Institute (IISPV) (J.S.-S.), University Hospital of Sant Joan de Reus, Spain; and Broad Institute of the Massachusetts Institute of Technology and Harvard University (C.B.C.), Cambridge
| | - Jordi Salas-Salvado
- From the Department of Biostatistics and Epidemiology (R.B., Y.Z., K.H.S.), University of Massachusetts-Amherst; Division of Women's Health (J.H., K.M.R.) and Channing Division of Network Medicine, Department of Medicine (M.G.-F., F.H.), Brigham and Women's Hospital, Harvard Medical School; Departments of Nutrition (M.G.-F., J.L., F.H.) and Epidemiology (J.L., F.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Davee Department of Neurology, Division of Stroke and Neurocritical Care (F.S.), Northwestern Feinberg School of Medicine, Chicago, IL; Departament de Bioquímica i Biotecnologia, Unitat de Nutrició (J.S.S.), Universitat Rovira i Virgili, Reus; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN) (J.S.-S.), Institute of Health Carlos III, Madrid; Nutrition Unit, Pere Virgili Research Institute (IISPV) (J.S.-S.), University Hospital of Sant Joan de Reus, Spain; and Broad Institute of the Massachusetts Institute of Technology and Harvard University (C.B.C.), Cambridge
| | - Frank Hu
- From the Department of Biostatistics and Epidemiology (R.B., Y.Z., K.H.S.), University of Massachusetts-Amherst; Division of Women's Health (J.H., K.M.R.) and Channing Division of Network Medicine, Department of Medicine (M.G.-F., F.H.), Brigham and Women's Hospital, Harvard Medical School; Departments of Nutrition (M.G.-F., J.L., F.H.) and Epidemiology (J.L., F.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Davee Department of Neurology, Division of Stroke and Neurocritical Care (F.S.), Northwestern Feinberg School of Medicine, Chicago, IL; Departament de Bioquímica i Biotecnologia, Unitat de Nutrició (J.S.S.), Universitat Rovira i Virgili, Reus; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN) (J.S.-S.), Institute of Health Carlos III, Madrid; Nutrition Unit, Pere Virgili Research Institute (IISPV) (J.S.-S.), University Hospital of Sant Joan de Reus, Spain; and Broad Institute of the Massachusetts Institute of Technology and Harvard University (C.B.C.), Cambridge
| | - Clary B Clish
- From the Department of Biostatistics and Epidemiology (R.B., Y.Z., K.H.S.), University of Massachusetts-Amherst; Division of Women's Health (J.H., K.M.R.) and Channing Division of Network Medicine, Department of Medicine (M.G.-F., F.H.), Brigham and Women's Hospital, Harvard Medical School; Departments of Nutrition (M.G.-F., J.L., F.H.) and Epidemiology (J.L., F.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Davee Department of Neurology, Division of Stroke and Neurocritical Care (F.S.), Northwestern Feinberg School of Medicine, Chicago, IL; Departament de Bioquímica i Biotecnologia, Unitat de Nutrició (J.S.S.), Universitat Rovira i Virgili, Reus; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN) (J.S.-S.), Institute of Health Carlos III, Madrid; Nutrition Unit, Pere Virgili Research Institute (IISPV) (J.S.-S.), University Hospital of Sant Joan de Reus, Spain; and Broad Institute of the Massachusetts Institute of Technology and Harvard University (C.B.C.), Cambridge
| | - Kathryn M Rexrode
- From the Department of Biostatistics and Epidemiology (R.B., Y.Z., K.H.S.), University of Massachusetts-Amherst; Division of Women's Health (J.H., K.M.R.) and Channing Division of Network Medicine, Department of Medicine (M.G.-F., F.H.), Brigham and Women's Hospital, Harvard Medical School; Departments of Nutrition (M.G.-F., J.L., F.H.) and Epidemiology (J.L., F.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Davee Department of Neurology, Division of Stroke and Neurocritical Care (F.S.), Northwestern Feinberg School of Medicine, Chicago, IL; Departament de Bioquímica i Biotecnologia, Unitat de Nutrició (J.S.S.), Universitat Rovira i Virgili, Reus; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN) (J.S.-S.), Institute of Health Carlos III, Madrid; Nutrition Unit, Pere Virgili Research Institute (IISPV) (J.S.-S.), University Hospital of Sant Joan de Reus, Spain; and Broad Institute of the Massachusetts Institute of Technology and Harvard University (C.B.C.), Cambridge
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Campos AI, García-Marín LM, Byrne EM, Martin NG, Cuéllar-Partida G, Rentería ME. Insights into the aetiology of snoring from observational and genetic investigations in the UK Biobank. Nat Commun 2020; 11:817. [PMID: 32060260 PMCID: PMC7021827 DOI: 10.1038/s41467-020-14625-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/22/2020] [Indexed: 12/15/2022] Open
Abstract
Although snoring is common in the general population, its aetiology has been largely understudied. Here we report a genetic study on snoring (n ~ 408,000; snorers ~ 152,000) using data from the UK Biobank. We identify 42 genome-wide significant loci, with an SNP-based heritability estimate of ~10% on the liability scale. Genetic correlations with body mass index, alcohol intake, smoking, schizophrenia, anorexia nervosa and neuroticism are observed. Gene-based associations identify 173 genes, including DLEU7, MSRB3 and POC5, highlighting genes expressed in the brain, cerebellum, lungs, blood and oesophagus. We use polygenic scores (PGS) to predict recent snoring and probable obstructive sleep apnoea (OSA) in an independent Australian sample (n ~ 8000). Mendelian randomization analyses suggest a potential causal relationship between high BMI and snoring. Altogether, our results uncover insights into the aetiology of snoring as a complex sleep-related trait and its role in health and disease beyond it being a cardinal symptom of OSA. Snoring is common in the population and tends to be more prevalent in older and/or male individuals. Here, the authors perform GWAS for habitual snoring, identify 41 genomic loci and explore potential causal relationships with anthropometric and cardiometabolic disease traits.
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Affiliation(s)
- Adrián I Campos
- Genetic Epidemiology Lab, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Luis M García-Marín
- Genetic Epidemiology Lab, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Tecnológico de Monterrey, Escuela de Ingeniería y Ciencias, Zapopan, Jalisco, México
| | - Enda M Byrne
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Nicholas G Martin
- Genetic Epidemiology Lab, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Gabriel Cuéllar-Partida
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia. .,University of Queensland Diamantina Institute, Brisbane, QLD, Australia.
| | - Miguel E Rentería
- Genetic Epidemiology Lab, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia. .,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
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