Genetic overlap analysis of endometriosis and asthma identifies shared loci implicating sex hormones and thyroid signalling pathways
Authors: Adewuyi E O , Mehta D ,   International Endogene Consortium (IEC), Sapkota Yadav , Yoshihara Kosuke , Nyegaard Mette , Steinthorsdottir Valgerdur , Morris Andrew P , Fassbender Amelie , Rahmioglu Nilufer , De Vivo Immaculata , Buring Julie E , Zhang Futao , Edwards Todd L , Jones Sarah , Dorien O , Peterse Daniëlle , Rexrode Kathryn M , Ridker Paul M , Schork Andrew J , MacGregor Stuart , Martin Nicholas G , Becker Christian M , Adachi Sosuke , Enomoto Takayuki , Takahashi Atsushi , Kamatani Yoichiro , Matsuda Koichi , Kubo Michiaki , Thorleifsson Gudmar , Geirsson Reynir T , Thorsteinsdottir Unnur , Wallace Leanne M , Yang Jian , Velez Edwards Digna R , Low Siew-Kee , Zondervan Krina T , Missmer Stacey A , D’Hooghe Thomas , Stefansson Kari , Tung Joyce Y , Montgomery Grant W , Chasman Daniel I , Nyholt Dale R ,   23andMe Research Team, Agee Michelle , Alipanahi Babak , Auton Adam , Bell Robert K , Bryc Katarzyna , Elson Sarah L , Fontanillas Pierre , Furlotte Nicholas A , Huber Karen E , Kleinman Aaron , Litterman Nadia K , McIntyre Matthew H , Mountain Joanna L , Noblin Elizabeth S , Northover Carrie A M , Pitts Steven J , Sathirapongsasuti J Fah , Sazonova Olga V , Shelton Janie F , Shringarpure Suyash , Tian Chao , Vacic Vladimir , Wilson Catherine H , Nyholt D R 
Published: October 2021

Abstract

STUDY QUESTION
Is there a shared genetic or causal association of endometriosis with asthma or what biological mechanisms may underlie their potential relationships?

SUMMARY ANSWER
Our results confirm a significant but non-causal association of endometriosis with asthma implicating shared genetic susceptibility and biological pathways in the mechanisms of the disorders, and potentially, their co-occurrence.

WHAT IS KNOWN ALREADY
Some observational studies have reported a pattern of co-occurring relationship between endometriosis and asthma; however, there is conflicting evidence and the aetiology, as well as the underlying mechanisms of the relationship, remain unclear.

STUDY DESIGN, SIZE, DURATION
We applied multiple statistical genetic approaches in the analysis of well-powered, genome-wide association study (GWAS) summary data to comprehensively assess the relationship of endometriosis with asthma. Endometriosis GWAS from the International Endogene Consortium (IEC, 17 054 cases and 191 858 controls) and asthma GWAS from the United Kingdom Biobank (UKB, 26 332 cases and 375 505 controls) were analysed. Additional asthma data from the Trans-National Asthma Genetic Consortium (TAGC, 19 954 cases and 107 715 controls) were utilized for replication testing.

PARTICIPANTS/MATERIALS, SETTING, METHODS
We assessed single-nucleotide polymorphism (SNP)-level genetic overlap and correlation between endometriosis and asthma using SNP effect concordance analysis (SECA) and linkage disequilibrium score regression analysis (LDSC) methods, respectively. GWAS meta-analysis, colocalization (GWAS-PW), gene-based and pathway-based functional enrichment analysis methods were applied, respectively, to identify SNP loci, genomic regions, genes and biological pathways shared by endometriosis and asthma. Potential causal associations between endometriosis and asthma were assessed using Mendelian randomization (MR) methods.

MAIN RESULTS AND THE ROLE OF CHANCE
SECA revealed significant concordance of SNP risk effects across the IEC endometriosis and the UKB asthma GWAS. Also, LDSC analysis found a positive and significant genetic correlation (rG = 0.16, P = 2.01 × 10−6) between the two traits. GWAS meta-analysis of the IEC endometriosis and UKB asthma GWAS identified 14 genome-wide significant (Pmeta-analysis &lt; 5.0 × 10−8) independent loci, five of which are putatively novel. Three of these loci were consistently replicated using TAGC asthma GWAS and reinforced in colocalization and gene-based analyses. Additional shared genomic regions were identified in the colocalization analysis. MR found no evidence of a significant causal association between endometriosis and asthma. However, combining gene-based association results across the GWAS for endometriosis and asthma, we identified 17 shared genes with a genome-wide significant Fisher’s combined P-value (FCPgene) &lt;2.73 × 10−6. Additional analyses (independent gene-based analysis) replicated evidence of gene-level genetic overlap between endometriosis and asthma. Biological mechanisms including ‘thyroid hormone signalling’, ‘abnormality of immune system physiology’, ‘androgen biosynthetic process’ and ‘brain-derived neurotrophic factor signalling pathway’, among others, were significantly enriched for endometriosis and asthma in a pathway-based analysis.

LARGE SCALE DATA
The GWAS for endometriosis data were sourced from the International Endogen Consortium (IEC) and can be accessed by contacting the consortium. The GWAS data for asthma are freely available online at Lee Lab (https://www.leelabsg.org/resources) and from the Trans-National Asthma Genetic Consortium (TAGC).

LIMITATIONS, REASONS FOR CAUTION
Given we analysed GWAS datasets from mainly European populations, our results may not be generalizable to other ancestries.

WIDER IMPLICATIONS OF THE FINDINGS
This study provides novel insights into mechanisms underpinning endometriosis and asthma, and potentially their observed relationship. Findings support a co-occurring relationship of endometriosis with asthma largely due to shared genetic components. Agents targeting ‘selective androgen receptor modulators’ may be therapeutically relevant in both disorders. Moreover, SNPs, loci, genes and biological pathways identified in our study provide potential targets for further investigation in endometriosis and asthma.

STUDY FUNDING/COMPETING INTEREST(S)
National Health and Medical Research Council (NHMRC) of Australia (241,944, 339,462, 389,927, 389,875, 389,891, 389,892, 389,938, 443,036, 442,915, 442,981, 496,610, 496,739, 552,485, 552,498, 1,026,033 and 1,050,208), Wellcome Trust (awards 076113 and 085475) and the Lundbeck Foundation (R102-A9118 and R155-2014-1724). All researchers had full independence from the funders. Authors do not have any conflict of interest.