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Noncoding DNA is central to our understanding of human gene regulation and complex diseases1,2, and measuring the evolutionary sequence constraint can establish the functional relevance of putative regulatory elements in the human genome3,4,5,6,7,8,9. Identifying the genomic elements that have become constrained specifically in primates has been hampered by the faster evolution of noncoding DNA compared to protein-coding DNA10, the relatively short timescales separating primate species11, and the previously limited availability of whole-genome sequences12. Here we construct a whole-genome alignment of 239 species, representing nearly half of all extant species in the primate order. Using this resource, we identified human regulatory elements that are under selective constraint across primates and other mammals at a 5% false discovery rate. We detected 111,318 DNase I hypersensitivity sites and 267,410 transcription factor binding sites that are constrained specifically in primates but not across other placental mammals and validate their cis-regulatory effects on gene expression. These regulatory elements are enriched for human genetic variants that affect gene expression and complex traits and diseases. Our results highlight the important role of recent evolution in regulatory sequence elements differentiating primates, including humans, from other placental mammals.

[INTRODUCTION] Genome-wide association studies (GWASs) have identified thousands of common genetic variants that are predictive of common disease susceptibility, but these variants individually have mild effects on disease owing to the effects of natural selection. By contrast, rare genetic variants can have large effects on common disease risk, but their use in genetic risk prediction has been limited to date owing to the difficulty of distinguishing pathogenic from benign variants and estimating the magnitude of their effects., [RATIONALE] PrimateAI-3D is a three-dimensional convolutional neural network for missense variant–effect prediction, which was trained with common genetic variants from the population sequencing of 233 primate species. By applying this method to estimate the pathogenicity of rare coding variants in 454,712 UK Biobank individuals, we aimed to improve rare-variant association tests and genetic risk prediction for common diseases and complex traits., [RESULTS] We performed rare-variant burden tests for 90 well-powered, clinically relevant phenotypes in the UK Biobank exome dataset. Stratifying missense variants with PrimateAI-3D greatly improved gene discovery, revealing 73% more significant gene-phenotype associations (false discovery rate <0.05) compared with not using PrimateAI-3D. When benchmarked against prior studies, gene-phenotype pairs identified with our method were better supported by orthogonal genetic evidence from GWAS and genes from related Mendelian disorders. In addition, PrimateAI-3D scores showed the strongest correlation among existing variant interpretation algorithms for predicting the quantitative effects of rare variants on continuous clinical phenotypes. Having validated our method for finding gene-phenotype relationships, we next constructed a rare-variant polygenic risk score (PRS) model by combining the rare-variant genes for each phenotype, weighting variants by their PrimateAI-3D prediction score and the direction and effect size of each associated gene. For comparison, we constructed common-variant PRS models and evaluated the performance of the two models for genetic risk prediction in a withheld-test subset of the cohort. Although common variants better explained overall population variance, rare-variant PRSs had more power at the ends of the distribution to identify individuals at the greatest risk for disease, and thus may be more relevant for population genetic screening and risk management. By contrast to common-variant PRS models derived from European populations that show poor generalization to non-Europeans, rare-variant PRSs were substantially more portable to different cohorts and ancestry groups that were not seen during model training. Moreover, because they incorporate orthogonal information from nonoverlapping sets of variants, we combined rare- and common-variant PRS models into a unified model and observed further improvement in genetic risk prediction for common d, [CONCLUSION] Understanding the impact of rare variants in common diseases is of prime interest for both precision medicine and the discovery of drug targets. By leveraging advances in variant effect prediction, we have demonstrated major improvements in rare-variant burden testing and genetic risk prediction. Notably, we observed that nearly all individuals carried at least one rare penetrant variant for the phenotypes we examined, demonstrating the utility of personal genome sequencing for otherwise healthy individuals in the general population.