A brief history of human disease genetics

Abstract

A primary goal of human genetics is to identify DNA sequence variants that influence biomedical traits, particularly those related to the onset and progression of human disease. Over the past 25 years, progress in realizing this objective has been transformed by advances in technology, foundational genomic resources and analytical tools, and by access to vast amounts of genotype and phenotype data. Genetic discoveries have substantially improved our understanding of the mechanisms responsible for many rare and common diseases and driven development of novel preventative and therapeutic strategies. Medical innovation will increasingly focus on delivering care tailored to individual patterns of genetic predisposition.

Fig. 1 |. Growth in the discovery of disease-associated genetic variation.

The cumulative numbers of genes harbouring variants causal for rare, monogenic diseases and traits and of significant GWAS associations implicated in common, complex diseases and traits are shown. Left, the advent of high-throughput sequencing technologies and availability of reference genomes from diverse populations has supported a fourfold increase in the discovery of rare disease-causing genes between 1999 and 2019. Right, international efforts such as the Human Genome Project and the HapMap Project, combined with GWAS and sequencing studies, have supported identification of more than 60,000 genetic associations across thousands of human diseases and traits. Centre, more recent developments have brought a synthesis of the rareand common-variant approaches based around the combination of sequence-informed analyses in large cohorts. Key events contributing to these themes are depicted in the timeline. GA4GH, Global Alliance for Genomics and Health; ExAC, Exome Aggregation Consortium.

Fig. 2 |. Genetic discovery is paralleled by advances in functional genomics technologies.

Top, the growth in the number of genetic loci associated by GWAS with human traits and diseases (bars) and of variant-to-function studies (area under line, not to scale). Bottom, foundational technological and computational advances over the last decade that enabled (1) development of systematic, genome-wide catalogues of functional elements across multiple cell types and tissues (blue); (2) mapping of QTLs in the context of gene expression, metabolites, proteins and regulatory elements (red); (3) engineering of genes, genetic elements and genetic variation at increasing scale (orange); and (4) systematic tissue-specific surveys of regulatory elements and transcription (grey). scRNA-seq, single-cell RNA-sequencing analysis; ChIA-PET, chromatin interaction analysis by paired-end tag sequencing; ChIP–seq, chromatin immunoprecipitation followed by sequencing; FAIRE-seq, formaldehyde-assisted isolation of regulatory elements with sequencing; DHS-seq, DNase I-hypersensitive sites sequencing; ATAC-seq, assay for transposase-accessible chromatin using sequencing; MPRA, massively parallel reporter assay; STARR-seq, self-transcribing active regulatory region sequencing; CNN: convolutional neural networks. For further details and primary literature on many of these assays, see ref..