Protein-altering variants associated with body mass index implicate pathways that control energy intake and expenditure in obesity.
Turcot V., Lu Y., Highland HM., Schurmann C., Justice AE., Fine RS., Bradfield JP., Esko T., Giri A., Graff M., Guo X., Hendricks AE., Karaderi T., Lempradl A., Locke AE., Mahajan A., Marouli E., Sivapalaratnam S., Young KL., Alfred T., Feitosa MF., Masca NGD., Manning AK., Medina-Gomez C., Mudgal P., Ng MCY., Reiner AP., Vedantam S., Willems SM., Winkler TW., Abecasis G., Aben KK., Alam DS., Alharthi SE., Allison M., Amouyel P., Asselbergs FW., Auer PL., Balkau B., Bang LE., Barroso I., Bastarache L., Benn M., Bergmann S., Bielak LF., Blüher M., Boehnke M., Boeing H., Boerwinkle E., Böger CA., Bork-Jensen J., Bots ML., Bottinger EP., Bowden DW., Brandslund I., Breen G., Brilliant MH., Broer L., Brumat M., Burt AA., Butterworth AS., Campbell PT., Cappellani S., Carey DJ., Catamo E., Caulfield MJ., Chambers JC., Chasman DI., Chen Y-DI., Chowdhury R., Christensen C., Chu AY., Cocca M., Collins FS., Cook JP., Corley J., Corominas Galbany J., Cox AJ., Crosslin DS., Cuellar-Partida G., D'Eustacchio A., Danesh J., Davies G., Bakker PIW., Groot MCH., Mutsert R., Deary IJ., Dedoussis G., Demerath EW., Heijer M., Hollander AI., Ruijter HM., Dennis JG., Denny JC., Di Angelantonio E., Drenos F., Du M., Dubé M-P., Dunning AM., Easton DF., Edwards TL., Ellinghaus D., Ellinor PT., Elliott P., Evangelou E., Farmaki A-E., Farooqi IS., Faul JD., Fauser S., Feng S., Ferrannini E., Ferrieres J., Florez JC., Ford I., Fornage M., Franco OH., Franke A., Franks PW., Friedrich N., Frikke-Schmidt R., Galesloot TE., Gan W., Gandin I., Gasparini P., Gibson J., Giedraitis V., Gjesing AP., Gordon-Larsen P., Gorski M., Grabe H-J., Grant SFA., Grarup N., Griffiths HL., Grove ML., Gudnason V., Gustafsson S., Haessler J., Hakonarson H., Hammerschlag AR., Hansen T., Harris KM., Harris TB., Hattersley AT., Have CT., Hayward C., He L., Heard-Costa NL., Heath AC., Heid IM., Helgeland Ø., Hernesniemi J., Hewitt AW., Holmen OL., Hovingh GK., Howson JMM., Hu Y., Huang PL., Huffman JE., Ikram MA., Ingelsson E., Jackson AU., Jansson J-H., Jarvik GP., Jensen GB., Jia Y., Johansson S., Jørgensen ME., Jørgensen T., Jukema JW., Kahali B., Kahn RS., Kähönen M., Kamstrup PR., Kanoni S., Kaprio J., Karaleftheri M., Kardia SLR., Karpe F., Kathiresan S., Kee F., Kiemeney LA., Kim E., Kitajima H., Komulainen P., Kooner JS., Kooperberg C., Korhonen T., Kovacs P., Kuivaniemi H., Kutalik Z., Kuulasmaa K., Kuusisto J., Laakso M., Lakka TA., Lamparter D., Lange EM., Lange LA., Langenberg C., Larson EB., Lee NR., Lehtimäki T., Lewis CE., Li H., Li J., Li-Gao R., Lin H., Lin K-H., Lin L-A., Lin X., Lind L., Lindström J., Linneberg A., Liu C-T., Liu DJ., Liu Y., Lo KS., Lophatananon A., Lotery AJ., Loukola A., Luan J., Lubitz SA., Lyytikäinen L-P., Männistö S., Marenne G., Mazul AL., McCarthy MI., McKean-Cowdin R., Medland SE., Meidtner K., Milani L., Mistry V., Mitchell P., Mohlke KL., Moilanen L., Moitry M., Montgomery GW., Mook-Kanamori DO., Moore C., Mori TA., Morris AD., Morris AP., Müller-Nurasyid M., Munroe PB., Nalls MA., Narisu N., Nelson CP., Neville M., Nielsen SF., Nikus K., Njølstad PR., Nordestgaard BG., Nyholt DR., O'Connel JR., O'Donoghue ML., Olde Loohuis LM., Ophoff RA., Owen KR., Packard CJ., Padmanabhan S., Palmer CNA., Palmer ND., Pasterkamp G., Patel AP., Pattie A., Pedersen O., Peissig PL., Peloso GM., Pennell CE., Perola M., Perry JA., Perry JRB., Pers TH., Person TN., Peters A., Petersen ERB., Peyser PA., Pirie A., Polasek O., Polderman TJ., Puolijoki H., Raitakari OT., Rasheed A., Rauramaa R., Reilly DF., Renström F., Rheinberger M., Ridker PM., Rioux JD., Rivas MA., Roberts DJ., Robertson NR., Robino A., Rolandsson O., Rudan I., Ruth KS., Saleheen D., Salomaa V., Samani NJ., Sapkota Y., Sattar N., Schoen RE., Schreiner PJ., Schulze MB., Scott RA., Segura-Lepe MP., Shah SH., Sheu WH-H., Sim X., Slater AJ., Small KS., Smith AV., Southam L., Spector TD., Speliotes EK., Starr JM., Stefansson K., Steinthorsdottir V., Stirrups KE., Strauch K., Stringham HM., Stumvoll M., Sun L., Surendran P., Swift AJ., Tada H., Tansey KE., Tardif J-C., Taylor KD., Teumer A., Thompson DJ., Thorleifsson G., Thorsteinsdottir U., Thuesen BH., Tönjes A., Tromp G., Trompet S., Tsafantakis E., Tuomilehto J., Tybjaerg-Hansen A., Tyrer JP., Uher R., Uitterlinden AG., Uusitupa M., Laan SW., Duijn CM., Leeuwen N., van Setten J., Vanhala M., Varbo A., Varga TV., Varma R., Velez Edwards DR., Vermeulen SH., Veronesi G., Vestergaard H., Vitart V., Vogt TF., Völker U., Vuckovic D., Wagenknecht LE., Walker M., Wallentin L., Wang F., Wang CA., Wang S., Wang Y., Ware EB., Wareham NJ., Warren HR., Waterworth DM., Wessel J., White HD., Willer CJ., Wilson JG., Witte DR., Wood AR., Wu Y., Yaghootkar H., Yao J., Yao P., Yerges-Armstrong LM., Young R., Zeggini E., Zhan X., Zhang W., Zhao JH., Zhao W., Zhao W., Zhou W., Zondervan KT., Rotter JI., Pospisilik JA., Rivadeneira F., Borecki IB., Deloukas P., Frayling TM., Lettre G., North KE., Lindgren CM., Hirschhorn JN., Loos RJF., CHD Exome+ Consortium None., EPIC-CVD Consortium None., ExomeBP Consortium None., Global Lipids Genetic Consortium None., GoT2D Genes Consortium None., EPIC InterAct Consortium None., INTERVAL Study None., ReproGen Consortium None., T2D-Genes Consortium None., MAGIC Investigators None., Understanding Society Scientific Group None.
Genome-wide association studies (GWAS) have identified >250 loci for body mass index (BMI), implicating pathways related to neuronal biology. Most GWAS loci represent clusters of common, noncoding variants from which pinpointing causal genes remains challenging. Here we combined data from 718,734 individuals to discover rare and low-frequency (minor allele frequency (MAF) < 5%) coding variants associated with BMI. We identified 14 coding variants in 13 genes, of which 8 variants were in genes (ZBTB7B, ACHE, RAPGEF3, RAB21, ZFHX3, ENTPD6, ZFR2 and ZNF169) newly implicated in human obesity, 2 variants were in genes (MC4R and KSR2) previously observed to be mutated in extreme obesity and 2 variants were in GIPR. The effect sizes of rare variants are ~10 times larger than those of common variants, with the largest effect observed in carriers of an MC4R mutation introducing a stop codon (p.Tyr35Ter, MAF = 0.01%), who weighed ~7 kg more than non-carriers. Pathway analyses based on the variants associated with BMI confirm enrichment of neuronal genes and provide new evidence for adipocyte and energy expenditure biology, widening the potential of genetically supported therapeutic targets in obesity.