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Attention deficit hyperactivity disorder (ADHD) is a complex disorder with heterogeneous clinical presentations that manifest variability in long-term outcomes. The genetic contributions to this clinical heterogeneity, however, are not well understood. Here, we study 14 084 individuals diagnosed with ADHD to identify several genetic factors underlying clinical heterogeneity. One genome-wide significant locus was specifically associated with an autism spectrum disorder (ASD) diagnosis among individuals diagnosed with ADHD and it was not previously associated with ASD nor ADHD, individually. We used a novel approach to compare profiles of polygenic scores for groups of individuals diagnosed with ADHD and uncovered robust evidence that biology is an important factor in on-going clinical debates. Specifically, individuals diagnosed with ASD and ADHD, substance use disorder (SUD) and ADHD, or first diagnosed with ADHD in adulthood had different profiles of polygenic scores for ADHD and multiple other psychiatric, cognitive, and socio-behavioral traits. A polygene overlap between an ASD diagnosis in ADHD and cognitive performance was replicated in an independent, typically developing cohort. Our unique approach uncovered evidence of genetic heterogeneity in a widely studied complex disorder, allowing for timely contributions to the understanding of ADHD etiology and providing a model for similar studies of other disorders.

BackgroundMild cognitive impairment is a common yet complex condition that is often underdiagnosed in the early stages. Miro Health is a mobile platform for the self-administration of sensor-based cognitive and behavioral assessments that was developed to measure factors typical of legacy neuropsychological tests in addition to behaviors that are currently left to subjective clinical impression such as eye movement, language, and processing speed.ObjectiveStudies were conducted to measure Miro Health’s concurrent validity, test-retest reliability, and amnestic MCI classification performance.MethodSpearman correlations were calculated to estimate the concurrent validity of Miro Health variables with legacy neuropsychological test variables using data from 160 study participants. Fifty-nine healthy controls were assessed at three time points to evaluate the test-retest reliability of Miro Health scores. Reliability was quantified with the scores’ intraclass correlations. Learning effects were measured as trends. In addition, a machine learning algorithm combined Miro Health variable scores into a Risk Score designed to distinguish 65 healthy controls (HC), 38 MCI participants (21 amnestic MCI (aMCI), and 17 non-amnestic MCI (naMCI)).ResultsSignificant correlations of Miro Health variables with legacy neuropsychological test variables were observed. Longitudinal studies show agreement of subsequent measurements and minimal learning effects. The Risk Score distinguished aMCI from healthy controls with an Area Under the Receiver Operator Curve (AUROC) of 0.97; the naMCI participants and controls were separated with an AUROC of 0.80, and the combined MCI group (aMCI + naMCI) was separated from healthy controls with an AUROC of 0.89.ConclusionMiro Health includes valid and reliable versions of variable scores that are analogous to legacy neuropsychological variable scores and a machine-learning derived risk score that effectively distinguishes HCs and individuals with MCI.

The potential association between rare germline genetic variants and prostate cancer (PrCa) susceptibility has been understudied due to challenges with assessing rare variation. Furthermore, although common risk variants for PrCa have shown limited individual effect sizes, their cumulative effect may be of similar magnitude as high penetrance mutations. To identify rare variants associated with PrCa susceptibility, and better characterize the mechanisms and cumulative disease risk associated with common risk variants, we analyzed large population-based cohorts, custom genotyping microarrays, and imputation reference panels in an integrative study of PrCa genetic etiology. In particular, 11,649 men (6,196 PrCa cases, 5,453 controls) of European ancestry from the Kaiser Permanente Research Program on Genes, Environment and Health, ProHealth Study, and California Men’s Health Study were genotyped and meta-analyzed with 196,269 European-ancestry male subjects (7,917 PrCa cases, 188,352 controls) from the UK Biobank. Six novel loci were genome-wide significant in our meta-analysis, including two rare variants (minor allele frequency < 0.01, at 3p21.31 and 8p12). Gene-based rare variant tests implicated a previously discovered PrCa gene (HOXB13) as well as a novel candidate (ILDR1) highly expressed in prostate tissue. Haplotypic patterns of long-range linkage disequilibrium were observed for rare genetic variants atHOXB13and other loci, reflecting their evolutionary history. Furthermore, a polygenic risk score (PRS) of 187 known, largely common PrCa variants was strongly associated with risk in non-Hispanic whites (90thvs. 10thdecile OR = 7.66,P= 1.80*10-239). Many of the 187 variants exhibited functional signatures of gene expression regulation or transcription factor binding, including a six-fold difference in log-probability of Androgen Receptor binding at the variant rs2680708 (17q22). Our finding of two novel rare variants associated with PrCa should motivate further consideration of the role of low frequency polymorphisms in PrCa, while the considerable effect of PrCa PRS profiles should prompt discussion of their role in clinical practice.

Circulating cell-free DNA (cfDNA) in the bloodstream originates from dying cells and is a promising non-invasive biomarker for cell death. Here, we develop a method to accurately estimate the relative abundances of cell types contributing to cfDNA. We leverage the distinct DNA methylation profile of each cell type throughout the body. Decomposing the cfDNA mixture is difficult, as fragments from relevant cell types may only be present in a small amount. We propose an algorithm, CelFiE, that estimates cell type proportion from both whole genome cfDNA input and reference data. CelFiE accommodates low coverage data, does not rely on CpG site curation, and estimates contributions from multiple unknown cell types that are not available in reference data. In simulations we show that CelFiE can accurately estimate known and unknown cell type of origin of cfDNA mixtures in low coverage and noisy data. Simulations also demonstrate that we can effectively estimate cfDNA originating from rare cell types composing less than 0.01% of the total cfDNA. To validate CelFiE, we use a positive control: cfDNA extracted from pregnant and non-pregnant women. CelFiE estimates a large placenta component specifically in pregnant women (p = 9.1 × 10−5). Finally, we use CelFiE to decompose cfDNA from ALS patients and age matched controls. We find increased cfDNA concentrations in ALS patients (p = 3.0 × 10−3). Specifically, CelFiE estimates increased skeletal muscle component in the cfDNA of ALS patients (p = 2.6 × 10−3), which is consistent with muscle impairment characterizing ALS. Quantification of skeletal muscle death in ALS is novel, and overall suggests that CelFiE may be a useful tool for biomarker discovery and monitoring of disease progression.

Large-scale cohorts with combined genetic and phenotypic data, coupled with methodological advances, have produced increasingly accurate genetic predictors of complex human phenotypes called polygenic risk scores (PRS). In addition to the potential translational impacts of identifying at-risk individuals, PRS are being utilized for a growing list of scientific applications including causal inference, identifying pleiotropy and genetic correlation, and powerful gene-based and mixed model association tests. Existing PRS approaches rely on external large-scale genetic cohorts that have also measured the phenotype of interest. They further require matching on ancestry and genotyping platform or imputation quality. In this work we present a novel reference-free method to produce PRS that does not rely on an external cohort. We show that naive implementations of reference-free PRS either result in substantial over-fitting or prohibitive increases in computational time. We show that our algorithm avoids both of these issues, and can produce informative in-sample PRS over any existing cohort without over-fitting. We then demonstrate several novel applications of reference-free PRS including detection of pleiotropy across 246 metabolic traits and efficient mixed-model association testing.

Genetic studies of metabolites have identified thousands of variants many of which are associated with downstream metabolic and obesogenic disorders. However, these studies have relied on univariate analyses, reducing power and limiting context specific understanding. Here we aim to provide an integrated perspective of the genetic basis of metabolites by leveraging the Finnish Metabolic Syndrome In Men (METSIM) cohort, a unique genetic resource which contains metabolic measurements across distinct timepoints as well as detailed information on statin usage. We increase effective sample size by an average of two-fold by applying the Covariates for Multi-phenotype Studies (CMS) approach, identifying 588 significant SNP-metabolite associations, including 248 novel associations. We further show that many of these SNPs are master metabolic regulators, balancing the relative proportion of dozens of metabolite levels. We then identify the first associations to changes in metabolic levels across time as well as evidence of genetic interaction with statin use. Finally, we show an overall decrease in genetic control of metabolic processes with age.

Identification of trans-eQTLs has been limited by a heavy multiple testing burden, read-mapping biases, and hidden confounders. To address these issues, we developed GBAT, a powerful gene-based method that allows robust detection of trans gene regulation. Using simulated and real data, we show that GBAT drastically increases detection of trans-gene regulation over standard trans-eQTL analyses.