A PheWAS approach in studying HLA-DRB1*1501

Abstract

HLA-DRB1 codes for a major histocompatibility complex class II cell surface receptor. Genetic variants in and around this gene have been linked to numerous autoimmune diseases. Most notably, an association between HLA-DRB1*1501 haplotype and multiple sclerosis (MS) has been defined. Utilizing electronic health records and 4235 individuals within Marshfield Clinic's Personalized Medicine Research Project, a reverse genetic screen coined phenome-wide association study (PheWAS) tested association of rs3135388 genotype (tagging HLA-DRB1*1501) with 4841 phenotypes. As expected, HLA-DRB1*1501 was associated with MS (International Classification of Disease version 9-CM (ICD9) 340, P=0.023), whereas the strongest association was with alcohol-induced cirrhosis of the liver (ICD9 571.2, P=0.00011). HLA-DRB1*1501 also demonstrated association with erythematous conditions (ICD9 695, P=0.0054) and benign neoplasms of the respiratory and intrathoracic organs (ICD9 212, P=0.042), replicating previous findings. This study not only builds on the feasibility/utility of the PheWAS approach, represents the first external validation of a PheWAS, but may also demonstrate the complex etiologies associated with the HLA-DRB1*1501 loci.

Figure 1

Manhattan plot of unadjusted −log10 (P-values) for all ICD9 and V codes as related to rs3135388 genotype. Highlighted are associations results for multiple sclerosis (MS) (ICD9 340, P=0.023), erythematous conditions (ICD9 695, P=0.0054), and alcohol-induced cirrhosis of liver (ICD9 571.2, P=0.00011). Grey diamonds represent ICD9 codes defined by “rule of 1,” while black squares represent phenotypes defined by “rule of 2.”