The sib transmission/disequilibrium test is a Mantel-Haenszel test

Children's Oncology Group's 2013 blueprint for research: epidemiology

Investigators worldwide have for over 40 years conducted case-control studies aimed at determining the causes of childhood cancer. The central challenge to conducting such research is the rarity of childhood cancer, thus many studies aggregate cases through clinical trials organizations such as COG. Rarity also precludes the use of prospective study designs, which are less prone to recall and selection biases. Despite these challenges a substantial literature on childhood cancer etiology has emerged but few strong environmental risk factors have been identified. Genetic studies are thus now coming to the fore with some success. The ultimate aim of epidemiologic studies is to reduce the population burden of childhood cancer by suggesting preventive measures or possibly by enabling early detection. Pediatr Blood Cancer 2013; 60: 1059-1062. © 2012 Wiley Periodicals, Inc.

Haplotype-association analysis

Association methods based on linkage disequilibrium (LD) offer a promising approach for detecting genetic variations that are responsible for complex human diseases. Although methods based on individual single nucleotide polymorphisms (SNPs) may lead to significant findings, methods based on haplotypes comprising multiple SNPs on the same inherited chromosome may provide additional power for mapping disease genes and also provide insight on factors influencing the dependency among genetic markers. Such insights may provide information essential for understanding human evolution and also for identifying cis-interactions between two or more causal variants. Because obtaining haplotype information directly from experiments can be cost prohibitive in most studies, especially in large scale studies, haplotype analysis presents many unique challenges. In this chapter, we focus on two main issues: haplotype inference and haplotype-association analysis. We first provide a detailed review of methods for haplotype inference using unrelated individuals as well as related individuals from pedigrees. We then cover a number of statistical methods that employ haplotype information in association analysis. In addition, we discuss the advantages and limitations of different methods.

Exact family-based association tests for biallelic data

Family-based study designs have an important role in the search for association between disease phenotypes and genetic markers. Unlike traditional case-control methods, family-based tests use within-family data to avoid identification of spurious associations that may result from population admixture. Many family-based association tests have been proposed to accommodate a variety of ascertainment schemes and patterns of missing data. In this report, we describe exact family-based association tests for biallelic data. Specifically, we discuss test of the null hypotheses "no linkage and no association" and "linkage, but no association". These tests, which are valid under various models for inheritance and patterns of missingness, utilize the procedure proposed by Rabinowitz and Laird [2000: Hum Hered 50:211-223] that provides a unified framework for family based association testing (FBAT). The conditioning approach implemented in FBAT makes an exact test conceptually straightforward, but computationally difficult since the minimum sufficient statistics upon which we condition do not have a conventional form. An exact test may be especially critical when accurate computation of the extreme area of the FBAT statistic is needed, such as when the study design necessitates multiple comparisons adjustments. We describe the exact approach as a useful alternative to the asymptotic test and show that the exact tests for biallelic data may be most useful for the recessive disease model.

Case-sibling gene-association studies for diseases with variable age at onset

Studies which compare cases to disease-free siblings are useful for assessing association between a genetic locus and a phenotypic trait, as they eliminate the possibility of confounding by population stratification. Many analytic methods for such family-based studies are based on a binary disease model. However, complex diseases have variable age at onset. Consequently, binary-outcome methods can be inefficient or biased. We review methods for analysing censored age-at-onset data from family studies, including stratified Cox regression and genotype-decomposition regression, an unstratified procedure which regresses age-at-onset on between- and within-family genotype components. We also introduce a retrospective likelihood for censored age-at-onset data, which requires an external estimate of the baseline hazard. Stratified Cox regression does not use controls who have not attained the age of their case sibling(s), potentially leading to a loss of efficiency. Both genotype-decomposition regression and the retrospective likelihood use these younger controls. We assess the performance of these methods via simulation studies. Stratified Cox regression and the retrospective likelihood have appropriate type I error rates in almost all situations studied; genotype-decomposition regression is often anti-conservative. Away from the null, confidence intervals for the relative risk derived from stratified Cox regression are anti-conservative when the disease is rare and case-rich families are sampled. The retrospective likelihood is more efficient than stratified Cox regression and its confidence intervals have correct coverage when the disease is rare or the estimate of the baseline hazard is reasonably accurate. These results suggest that when estimating genotype relative risks is the principal analytic goal, stratified Cox regression is appropriate as long as the disease is common; when the disease is rare, the retrospective likelihood may be more appropriate.

Reconstructing parental genotypes when testing for linkage in the presence of association

Various family-based association methods have recently been proposed that allow testing for linkage in the presence of linkage disequilibrium between a marker and a disease even if there is only incomplete parental-genotype information. For some families, it may be possible to reconstruct missing parental genotypes from the genotypes of their offspring. Treating such a reconstructed family as if parental genotypes have been typed, however, can introduce bias. The reconstruction-combined transmission/disequilibrium test (RC-TDT) and its X-chromosomal counterpart, XRC-TDT, employ parental-genotype reconstruction and correct for the biases involved in this reconstruction without relying on population marker allele frequencies. For the two tests, exact P values can be obtained by numerically calculating the convolution of the null distributions corresponding to the families in the sample.

No evidence for genetic association or linkage of the cathepsin D (CTSD) exon 2 polymorphism and Alzheimer disease

Two recent case-control studies have suggested a strong association of a missense polymorphism in exon 2 of the cathepsin D gene (CTSD) and Alzheimer disease (AD). However, these findings were not confirmed in another independent study. We analyzed this polymorphism in two large and independent AD study populations and did not detect an association between CTSD and AD. The first sample was family-based and included 436 subjects from 134 sibships discordant for AD that were analyzed using the sibship disequilibrium test (SDT, p = 0.68) and the sib transmission/disequilibrium test (Sib-TDT, p = 0.81). The second sample of 200 AD cases and 182 cognitively normal controls also failed to show significant differences in the allele or genotype distribution in cases versus controls (chi2, p = 0.91 and p = 0.88, respectively). In addition, two-point linkage analyses in an enlarged family sample (n = 670) did not show evidence for linkage of the chromosomal region around CTSD. Thus, our analyses on more than 800 subjects suggest that if an association between the CTSD exon 2 polymorphism and AD exists, it is likely to be smaller than previously reported.

Family-based association studies

Over the past decade, attention has turned from positional cloning of Mendelian disease genes to the dissection of complex diseases. Both theoretical and empirical studies have shown that traditional linkage studies may be inferior in power compared to studies that directly utilize allele status. Case-control association studies, as an alternative, are subject to bias due to population stratification. As a compromise between linkage studies and case-control studies, family-based association designs have received great attention recently due to their potentially higher power to identify complex disease genes and their robustness in the presence of population substructure. In this review, we first describe the basic family-based association design involving one affected offspring with its two parents, all genotyped for a biallelic genetic marker. Extensions of the original transmission disequilibrium tests to multiallelic markers, families with multiple siblings, families with incomplete parental genotypes, and general pedigree structures are discussed. Further developments of statistical methods to study quantitative traits, to analyse genes on the X chromosome, to incorporate multiple tightly linked markers, to identify imprinting genes, and to detect gene-environment interactions are also reviewed. Finally, we discuss the implications of the completion of the Human Genome Project and the identification of hundreds of thousands of genetic polymorphisms on employing family-based association designs to search for complex disease genes.

Genomic control for association studies

A dense set of single nucleotide polymorphisms (SNP) covering the genome and an efficient method to assess SNP genotypes are expected to be available in the near future. An outstanding question is how to use these technologies efficiently to identify genes affecting liability to complex disorders. To achieve this goal, we propose a statistical method that has several optimal properties: It can be used with case control data and yet, like family-based designs, controls for population heterogeneity; it is insensitive to the usual violations of model assumptions, such as cases failing to be strictly independent; and, by using Bayesian outlier methods, it circumvents the need for Bonferroni correction for multiple tests, leading to better performance in many settings while still constraining risk for false positives. The performance of our genomic control method is quite good for plausible effects of liability genes, which bodes well for future genetic analyses of complex disorders.

A discordant-sibship test for disequilibrium and linkage: no need for parental data

The sibship disequilibrium test (SDT) is designed to detect both linkage in the presence of association and association in the presence of linkage (linkage disequilibrium). The test does not require parental data but requires discordant sibships with at least one affected and one unaffected sibling. The SDT has many desirable properties: it uses all the siblings in the sibship; it remains valid if there are misclassifications of the affectation status; it does not detect spurious associations due to population stratification; asymptotically it has a chi2 distribution under the null hypothesis; and exact P values can be easily computed for a biallelic marker. We show how to extend the SDT to markers with multiple alleles and how to combine families with parents and data from discordant sibships. We discuss the power of the test by presenting sample-size calculations involving a complex disease model, and we present formulas for the asymptotic relative efficiency (which is approximately the ratio of sample sizes) between SDT and the transmission/disequilibrium test (TDT) for special family structures. For sib pairs, we compare the SDT to a test proposed both by Curtis and, independently, by Spielman and Ewens. We show that, for discordant sib pairs, the SDT has good power for testing linkage disequilibrium relative both to Curtis's tests and to the TDT using trios comprising an affected sib and its parents. With additional sibs, we show that the SDT can be more powerful than the TDT for testing linkage disequilibrium, especially for disease prevalence >.3.