Multi-ancestry genome- and phenome-wide association studies of diverticular disease in electronic health records with natural language processing enriched phenotyping algorithm

Genetic Determinants of Colonic Diverticulosis-A Systematic Review

Background: Colonic diverticulosis is a common condition, particularly in the elderly population. While dietary habits, obesity, smoking, and physical inactivity contribute to its pathogenesis, emerging evidence highlights a genetic predisposition affecting extracellular matrix (ECM) remodeling, inflammation, and connective tissue integrity. The aim of this systematic review was to summarize genetic determinants of colonic diverticulosis. Methods: The PubMed® database was searched for original studies in humans. The inclusion criteria were named genetic factor and confirmed diverticulosis. Patients with diverticulitis and diverticular diseases were excluded from this review. Results: Out of 137 publications, 10 articles met the inclusion criteria: six large association studies (GWAS) and four cross-sectional studies. The genes regulating ECM turnover, including TIMP1, MMP3, and MMP9, are involved in diverticulosis development. The TIMP1 (rs4898) T allele has been associated with increased susceptibility, potentially due to its role in ECM remodeling. Similarly, MMP3 (rs3025058) and MMP9 (rs3918242) polymorphisms contribute to altered collagen degradation. The COL3A1 (rs3134646) variant coding modified collagen type III may promote diverticular formation. Other genes, such as ARHGAP15 (rs4662344, rs6736741), affect cytoskeletal dynamics. Identified in GWAS studies, gene candidates may be grouped into blood group and immune system-related genes (ABO, HLA-DQA1, HLA-H, OAS1, TNFSF13, FADD), extracellular matrix and connective tissue genes (COL6A1, COLQ, EFEMP1, ELN, HAS2, TIMP2), signaling and cell communication (BMPR1B, WNT4, RHOU, PHGR1, PCSK5), nervous system and neurodevelopment (BDNF, CACNB2, GPR158, SIRT1, SCAPER, TRPS1), metabolism and transporters (SLC25A28, SLC35F3, RBKS, PPP1R14A, PPP1R16B), lipids and cholesterol (LDAH, LYPLAL1, STARD13), transcription and gene regulation (ZBTB4, UBTF, TNRC6B), apoptosis (FADD, PIAS1), and poorly characterized genes (C1TNF7, ENSG00000224849, ENSG00000251283, LINC01082, DISP2, SNX24, THEM4, UBL4B, UNC50, WDR70, SREK1IP1). Conclusions: There are a number of gene variants that probably predispose to colonic diverticulosis. Detailed characterization of the multigene background of diverticulosis will enable appropriate therapeutic or preventive interventions in the future.

Unmet social needs and diverticulitis: a phenotyping algorithm and cross-sectional analysis

OBJECTIVE

To validate a phenotyping algorithm for gradations of diverticular disease severity and investigate relationships between unmet social needs and disease severity.

MATERIALS AND METHODS

An algorithm was designed in the All of Us Research Program to identify diverticulosis, mild diverticulitis, and operative or recurrent diverticulitis requiring multiple inpatient admissions. This was validated in an independent institution and applied to a cohort in the All of Us Research Program. Distributions of individual-level social barriers were compared across quintiles of an area-level index through fold enrichment of the barrier in the fifth (most deprived) quintile relative to the first (least deprived) quintile. Social needs of food insecurity, housing instability, and care access were included in logistic regression to assess association with disease severity.

RESULTS

Across disease severity groups, the phenotyping algorithm had positive predictive values ranging from 0.87 to 0.97 and negative predictive values ranging from 0.97 to 0.99. Unmet social needs were variably distributed when comparing the most to the least deprived quintile of the area-level deprivation index (fold enrichment ranging from 0.53 to 15). Relative to a reference of diverticulosis, an unmet social need was associated with greater odds of operative or recurrent inpatient diverticulitis (OR [95% CI] 1.61 [1.19-2.17]).

DISCUSSION

Understanding the landscape of social barriers in disease-specific cohorts may facilitate a targeted approach when addressing these needs in clinical settings.

CONCLUSION

Using a validated phenotyping algorithm for diverticular disease severity, unmet social needs were found to be associated with greater severity of diverticulitis presentation.

Similar but Distinct Comorbidity Patterns Between Polycystic Ovary Syndrome and Endometriosis in Korean Women: A Nationwide Cohort Study

BACKGROUND

Polycystic ovary syndrome (PCOS) and endometriosis are widely recognized as significant risk factors affecting the reproductive health of women. The underlying mechanisms impacting fertility may vary, potentially leading to divergent outcomes. We aimed to examine and contrast the prevalence patterns of diseases coexisting with PCOS and endometriosis, using a large-scale nationwide insurance claims data from Asian women of reproductive age.

METHODS

We analyzed health insurance and examination data of 157,662 Korean women aged 15-45 years, drawn from the Korea National Health Insurance Service-National Sample Cohort database. International Classification of Disease, Tenth Revision codes were mapped to phenome-wide association study codes (phecodes). Subsequently, multivariate logistic regression was performed to assess the comorbidity patterns among patients diagnosed with PCOS and endometriosis and healthy control groups.

RESULTS

Our analysis revealed that PCOS was correlated with a wider range of metabolic disorders and symptoms, such as hyperlipidemia, type 2 diabetes, various gastrointestinal (GI) issues, and an array of pregnancy-related complications. Conversely, endometriosis was more prevalent among benign neoplasms of female reproductive and digestive organs, endometrial hyperplasia, and angina pectoris. Notably, infertility and glaucoma demonstrated significant associations with both conditions. Furthermore, a comparison of symptom-related codes in women with endometriosis revealed a predominance of pain-related symptoms, whereas those with PCOS exhibited a broader spectrum, encompassing pain, pruritus, GI problems, cough, fever, menstrual cycle disorders, edema, and dizziness.

CONCLUSION

PCOS and endometriosis, which are prevalent gynecological disorders affecting similar age groups of women, rarely co-occur and exhibit unique comorbidity profiles. Tailored healthcare strategies that take into account these distinct patterns have the potential to enhance long-term healthcare outcomes of affected patients. Further research is required to elucidate the underlying mechanisms and contrasting comorbidity profiles between PCOS and endometriosis.

CCN3/NOV as a potential therapeutic target for diverticular disease: A proteome-wide Mendelian randomization study

Genome-wide association studies (GWAS) identified over 100 susceptibility loci and candidate causal genes for diverticular disease (DD) at the transcriptional level. However, effective therapeutics or preventions based on underlying disease mechanisms remain to be elucidated. In this study, we explored potential causal genes for DD at the protein level. We used 2 GWAS summary statistics of DD; 1 was obtained from the United Kingdom Biobank (UKBB) with 31,917 cases and 419,135 controls, and the other from the FinnGen consortium with 30,649 cases and 301,931 controls. For the primary analysis, we employed proteome-wide Mendelian randomization (MR) studies using 738 cis-acting protein quantitative trait loci (pQTLs) for 735 plasma proteins from the 5 published studies. For external validation, we conducted 2-sample MR analyses using plasma pQTLs of the screened proteins from another study by deCODE genetics. Moreover, we performed a series of sensitivity analyses including reverse MR and Bayesian colocalization tests. The primary MR identified 4 plasma proteins that were associated with DD risk including CCN3/NOV (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.97-0.99; P = 1.2 × 10-11 for UKBB. OR, 0.73; 95% CI, 0.66-0.81; P = 7.2 × 10-10 for FinnGen). The validation MR well replicated the primary result of CCN3/NOV (OR, 0.95; 95% CI, 0.93-0.96; P = 1.9 × 10-11 for UKBB. OR, 0.43; 95% CI, 0.33-0.56; P = 7.0 × 10-10 for FinnGen). Sensitivity analyses supported the causal association. We prioritized plasma CCN3/NOV protein as a protective factor for DD for follow-up functional studies to elucidate the disease mechanisms and therapeutics.

Multiancestry transferability of a polygenic risk score for diverticulitis

OBJECTIVE

Polygenic risk scores (PRS) for diverticular disease must be evaluated in diverse cohorts. We sought to explore shared genetic predisposition across the phenome and to assess risk stratification in individuals genetically similar to European, African and Admixed-American reference samples.

METHODS

A 44-variant PRS was applied to the All of Us Research Program. Phenome-wide association studies (PheWAS) identified conditions linked with heightened genetic susceptibility to diverticular disease. To evaluate the PRS in risk stratification, logistic regression models for symptomatic and for severe diverticulitis were compared with base models with covariates of age, sex, body mass index, smoking and principal components. Performance was assessed using area under the receiver operating characteristic curves (AUROC) and Nagelkerke's R2.

RESULTS

The cohort comprised 181 719 individuals for PheWAS and 50 037 for risk modelling. PheWAS identified associations with diverticular disease, connective tissue disease and hernias. Across ancestry groups, one SD PRS increase was consistently associated with greater odds of severe (range of ORs (95% CI) 1.60 (1.27 to 2.02) to 1.86 (1.42 to 2.42)) and of symptomatic diverticulitis ((95% CI) 1.27 (1.10 to 1.46) to 1.66 (1.55 to 1.79)) relative to controls. European models achieved the highest AUROC and Nagelkerke's R2 (AUROC (95% CI) 0.78 (0.75 to 0.81); R2 0.25). The PRS provided a maximum R2 increase of 0.034 and modest AUROC improvement.

CONCLUSION

Associations between a diverticular disease PRS and severe presentations persisted in diverse cohorts when controlling for known risk factors. Relative improvements in model performance were observed, but absolute change magnitudes were modest.