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Contribution of rare variants in monogenic diabetes-genes to early-onset type 2 diabetes - 14/09/22

Doi : 10.1016/j.diabet.2022.101353 
Serena Pezzilli a, Manoush Tohidirad a, Tommaso Biagini b, Maria Giovanna Scarale c, 1, Federica Alberico a, Luana Mercuri a, Gaia Chiara Mannino d, Monia Garofolo e, Tiziana Filardi f, Yaling Tang g, h, Fernando Giuffrida g, Christine Mendonca g, Francesco Andreozzi d, i, Marco Giorgio Baroni j, k, Raffaella Buzzetti f, Maria Gisella Cavallo f, Efisio Cossu l, Paola D'Angelo m, Salvatore De Cosmo n, Olga Lamacchia o, Frida Leonetti p, Susanna Morano f, Lelio Morviducci q, Giuseppe Penno d, Paolo Pozzilli r, Giuseppe Pugliese s, Giorgio Sesti s, Tommaso Mazza b, Alessandro Doria g, h, Vincenzo Trischitta c, f, 2, Sabrina Prudente a, 2,
a Research Unit of Metabolic and Cardiovascular Diseases, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy 
b Unit of Bioinformatics, Fondazione IRCSS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy 
c Research Unit of Diabetes and Endocrine Diseases, Fondazione IRCSS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy 
d Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy 
e Section of Diabetes and Metabolic Disease, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy 
f Department of Experimental Medicine, Sapienza University, Rome, Italy 
g Research Division, Joslin Diabetes Center, Boston, MA, United States 
h Department of Medicine, Harvard Medical School, Boston, MA United States 
i Research Center for the Prevention and Treatment of Metabolic Diseases (CR METDIS), University Magna Grecia, Catanzaro, Italy 
j Department of Clinical Medicine, Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy 
k Neuroendocrinology and Metabolic Diseases, IRCCS Neuromed, Pozzilli, Italy 
l Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy 
m Unit of Diabetology, Sandro Pertini Hospital, Rome, Italy 
n Department of Medicine, Fondazione IRCSS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy 
o Unit of Endocrinology, Department of Medical and Surgical Sciences, University Hospital of Foggia, Foggia, Italy 
p Diabetes Unit, Department of Medical-Surgical Sciences and Biotechnologies, Santa Maria Goretti Hospital, Sapienza University of Rome, Latina, Italy 
q Unit of Diabetology, S. Spirito Hospital – AslRM1, Rome, Italy 
r Department of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy 
s Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy 

Corresponding author.

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Highlights

Data on the genetic background of patients with early-onset type 2 diabetes are scarce and inconclusive.
Our data show that rare and possibly deleterious variants in monogenic diabetes genes are associated with early diabetes onset.
Common variants known to affect susceptibility to type 2 diabetes are also associated with anticipation of the disease. This effect is significantly higher in individuals carrying rare and deleterious variants in monogenic diabetes genes.
Our findings suggest that the genetic background of early-onset type 2 diabetes is based on a synergic effect of both rare and common variants.

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Abstract

Aim

This study investigated whether rare, deleterious variants in monogenic diabetes-genes are associated with early-onset type 2 diabetes (T2D).

Methods

A nested case-control study was designed from 9712 Italian patients with T2D. Individuals with age at diabetes onset ≤35 yrs (n = 300; cases) or ≥65 yrs (n = 300; controls) were selected and screened for variants in 27 monogenic diabetes-genes by targeted resequencing. Rare (minor allele frequency-MAF <1%) and possibly deleterious variants were collectively tested for association with early-onset T2D. The association of a genetic risk score (GRS) based on 17 GWAS-SNPs for T2D was also tested.

Results

When all rare variants were considered together, each increased the risk of early-onset T2D by 65% (allelic OR =1.64, 95% CI: 1.08–2.48, p = 0.02). Effects were similar when the 600 study participants were stratified according to their place of recruitment (Central-Southern Italy, 182 cases vs. 142 controls, or Rome urban area, 118 vs. 158, p for heterogeneity=0.53). Progressively less frequent variants showed increasingly stronger effects in the risk of early-onset T2D for those with MAF <0.001% (OR=6.34, 95% CI: 1.87–22.43, p = 0.003). One unit of T2D-GRS significantly increased the risk of early-onset T2D (OR 1.09, 95% CI: 1.01–1.18; p = 0.02). This association was stronger among rare variants carriers as compared to non-carriers (p = 0.02).

Conclusion

Rare variants in monogenic-diabetes genes are associated with an increased risk of early-onset T2D, and interact with common T2D susceptibility variants in shaping it. These findings might help develop prediction tools to identify individuals at high risk of developing T2D in early adulthood.

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Keywords : Type 2 diabetes, Early-onset type 2 diabetes, Rare variants, Monogenic diabetes, genetic risk score

Abbreviations : Type 2 diabetes, Minor Allele Frequency, Genetic Risk Score, Maturity Onset Diabetes of the Young, Genome Wide Association Studies


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Vol 48 - N° 5

Article 101353- septembre 2022 Retour au numéro
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