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. 2025 Jul 23;16(1):6774.
doi: 10.1038/s41467-025-61721-1.

Genome-wide association study of pulpal and apical diseases

Aino Salminen  1 , Kati Hyvärinen  2 , Jarmo Ritari  2 , Jussi M Leppilahti  3   4   5 , Ulla Palotie  6 , Ville Vuollo  3   5 , Oleg Kambur  7   8   9   10 ; FinnGen; Estonian Biobank Research Team; Kadri Reis  11 , Anu Reigo  11 , Priit Palta  11 , Markus Perola  7 , Juha Sinisalo  12 , Aki S Havulinna  7   13   14 , Päivi Mäntylä  8 , Ulvi Kahraman Gürsoy  15 , A Liisa Suominen  8   16 , David P Rice  6 , Vuokko Anttonen  17 , Pekka Nieminen  6 , Pirkko J Pussinen  6   8
Collaborators, Affiliations

Genome-wide association study of pulpal and apical diseases

Aino Salminen et al. Nat Commun. .

Abstract

Infections of the dental pulp are common sequelae of microbial activity and host susceptibility, affecting >80% of adult population. We performed a genome-wide association study on endodontic infections utilizing Finnish health registry and genotype data from FinnGen. Cases [132,124 (27.2%)] had at least one ICD10-diagnosis code of pulpal or apical diseases, whereas 353,106 individuals without diagnoses served as controls. We investigated two clinical sub-phenotypes, Pulpitis and Necrosis of pulp or apical periodontitis. Our analysis resulted in significant associations in 12 chromosomes and 15 independent loci, such as those near HORMAD2 gene and those in the HLA region. The imputed HLA alleles, especially DRB1 * 04:01 and DQB1 * 03:01, were associated with endodontic infections. Bioinformatic analysis of the top variants indicated several potential regulatory variants which are involved in MHC class II protein complex, humoral immune responses, and antigen processing. Our study widens understanding on how immune dysregulation resulting from immunogenetic variation is involved in the pathogenesis of endodontic infections.

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Conflict of interest statement

Competing interests: The authors declare no competing interests. Ethics: All studies were done in accordance with the Declaration of Helsinki. Based on the Finnish biobank act, participants entered the FinnGen study by signing an informed consent for biobank research12. Alternatively, separate research cohorts, collected prior the Finnish Biobank Act came into effect (in September 2013) and start of FinnGen (August 2017), were collected based on study-specific consents and later transferred to the Finnish biobanks after approval by Fimea (Finnish Medicines Agency), the National Supervisory Authority for Welfare and Health. Recruitment protocols followed the biobank protocols approved by Fimea. The Coordinating Ethics Committee of the Hospital District of Helsinki and Uusimaa approved the FinnGen study protocol Nr HUS/990/2017. The FinnGen study is approved by Finnish Institute for Health and Welfare (permit numbers: THL/2031/6.02.00/2017, THL/1101/5.05.00/2017, THL/341/6.02.00/2018, THL/2222/6.02.00/2018, THL/283/6.02.00/2019, THL/1721/5.05.00/2019 and THL/1524/5.05.00/2020), Digital and population data service agency (permit numbers: VRK43431/2017-3, VRK/6909/2018-3, VRK/4415/2019-3), the Social Insurance Institution (permit numbers: KELA 58/522/2017, KELA 131/522/2018, KELA 70/522/2019, KELA 98/522/2019, KELA 134/522/2019, KELA 138/522/2019, KELA 2/522/2020, KELA 16/522/2020), Findata permit numbers THL/2364/14.02/2020, THL/4055/14.06.00/2020, THL/3433/14.06.00/2020, THL/4432/14.06/2020, THL/5189/14.06/2020, THL/5894/14.06.00/2020, THL/6619/14.06.00/2020, THL/209/14.06.00/2021, THL/688/14.06.00/2021, THL/1284/14.06.00/2021, THL/1965/14.06.00/2021, THL/5546/14.02.00/2020, THL/2658/14.06.00/2021, THL/4235/14.06.00/2021, Statistics Finland (permit numbers: TK-53-1041-17 and TK/143/07.03.00/2020 (earlier TK-53-90-20) TK/1735/07.03.00/2021, TK/3112/07.03.00/2021) and Finnish Registry for Kidney Diseases permission/extract from the meeting minutes on 4th July 2019. The Biobank Access Decisions for FinnGen samples and data utilized in FinnGen Data Freeze 12 include: THL Biobank BB2017_55, BB2017_111, BB2018_19, BB_2018_34, BB_2018_67, BB2018_71, BB2019_7, BB2019_8, BB2019_26, BB2020_1, BB2021_65, Finnish Red Cross Blood Service Biobank 7.12.2017, Helsinki Biobank HUS/359/2017, HUS/248/2020, HUS/430/2021 §28, §29, HUS/150/2022 §12, §13, §14, §15, §16, §17, §18, §23, §58, §59, HUS/128/2023 §18, Auria Biobank AB17-5154 and amendment #1 (August 17 2020) and amendments BB_2021-0140, BB_2021-0156 (August 26 2021, Feb 2 2022), BB_2021-0169, BB_2021-0179, BB_2021-0161, AB20-5926 and amendment #1 (April 23 2020) and it´s modifications (Sep 22 2021), BB_2022-0262, BB_2022-0256, Biobank Borealis of Northern Finland_2017_1013, 2021_5010, 2021_5010 Amendment, 2021_5018, 2021_5018 Amendment, 2021_5015, 2021_5015 Amendment, 2021_5015 Amendment_2, 2021_5023, 2021_5023 Amendment, 2021_5023 Amendment_2, 2021_5017, 2021_5017 Amendment, 2022_6001, 2022_6001 Amendment, 2022_6006 Amendment, 2022_6006 Amendment, 2022_6006 Amendment_2, BB22-0067, 2022_0262, 2022_0262 Amendment, Biobank of Eastern Finland 1186/2018 and amendment 22§/2020, 53§/2021, 13§/2022, 14§/2022, 15§/2022, 27§/2022, 28§/2022, 29§/2022, 33§/2022, 35§/2022, 36§/2022, 37§/2022, 39§/2022, 7§/2023, 32§/2023, 33§/2023, 34§/2023, 35§/2023, 36§/2023, 37§/2023, 38§/2023, 39§/2023, 40§/2023, 41§/2023, Finnish Clinical Biobank Tampere MH0004 and amendments (21.02.2020 & 06.10.2020), BB2021-0140 8§/2021, 9§/2021, §9/2022, §10/2022, §12/2022, 13§/2022, §20/2022, §21/2022, §22/2022, §23/2022, 28§/2022, 29§/2022, 30§/2022, 31§/2022, 32§/2022, 38§/2022, 40§/2022, 42§/2022, 1§/2023, Central Finland Biobank 1-2017, BB_2021-0161, BB_2021-0169, BB_2021-0179, BB_2021-0170, BB_2022-0256, BB_2022-0262, BB22-0067, Decision allowing to continue data processing until 31st Aug 2024 for projects: BB_2021-0179, BB22-0067,BB_2022-0262, BB_2021-0170, BB_2021-0164, BB_2021-0161, and BB_2021-0169, and Terveystalo Biobank STB 2018001 and amendment 25th Aug 2020, Finnish Hematological Registry and Clinical Biobank decision 18th June 2021, Arctic biobank P0844: ARC_2021_1001. The activities of the EstBB are regulated by the Human Genes Research Act. Individual level data analysis in EstBB was carried out under ethical approval 1.1-12/624 from the Estonian Committee on Bioethics and Human Research (Estonian Ministry of Social Affairs), using data according to release application 6-7/GI/33501 from the Estonian Biobank. An informed consent was obtained from participants in the NFBC1966/1986 cohort. The ethics committees of the Northern Ostrobothnia Hospital District in Oulu and the Helsinki University Hospital, Finland, approved the study plans.

Figures

Fig. 1
Fig. 1. Manhattan plots of the GWAS results in the discovery cohort.
The overall population derived from FinnGen (data release 12) including 485,230 individuals. The phenotypes were constructed based on national health register diagnoses codes. Associations between each SNP and phenotypes were analyzed with REGENIE using an additive model. Each SNP is plotted as a data point with chromosomal position on the x-axis and p-values on the y-axis on a negative logarithmic scale. The genes nearest to the lead SNPs are shown. The red line indicates the threshold for genome-wide significance p < 5 * 10-8. A Phenotype Pulpal and apical diseases with 132,124 cases and 353,106 controls (genomic inflation factor λ = 1.13). B Phenotype Pulpitis with 48,120 cases (λ = 1.10). C Phenotype Necrosis of pulp or apical periodontitis with 103,832 cases (λ = 1.12).
Fig. 2
Fig. 2. Genetic correlations.
We assessed genetic correlation between endodontic infections and other FinnGen clinical phenotypes using linkage disequilibrium score regression. Pairwise genetic correlations (rg) between the phenotypes and their heritability estimates were used to quantify the shared genetic variance relative to the square root of their respective SNP heritability estimates. In total, 31 phenotypes were analysed and assessed for correlation with 3 endodontic phenotypes. Markers indicate the estimated magnitude of genetic correlation (rg) and error bars represent standard errors.
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