The findings, published today in Nature, identify several potential targets for new diabetes treatments, but also reveal the complexity of the disease that needs to be addressed by efforts to develop more personalised strategies for treatment and prevention.
Type 2 diabetes is a growing threat to global health, with one in 10 people either having the disease or predicted to develop it during their lifetime. For any given individual, the risk of developing this form of diabetes is influenced by the pattern of genetic changes inherited from their parents, and environmental factors such as levels of exercise and choice of diet.
A better understanding of precisely how these factors contribute to type 2 diabetes will enable researchers to develop new ways of treating and preventing this condition, as well as offering the prospect for targeting those treatments towards those most likely to benefit, and those least likely to suffer harm.
Previous studies have identified over 80 areas in the genome that are associated with type 2 diabetes. However, these studies focused on the role of common DNA differences that appear frequently in the population, and they generally stopped short of identifying exactly which DNA sequence changes, or which specific genes, were responsible for this risk.
Today’s study explored the impact of changes in the DNA sequence on diabetes risk at a more detailed level. Some individuals had their entire genome sequenced while for others, sequencing was restricted to the part of the genome that codes directly for proteins (the exome).
Scientists compared the genetic variation between individuals who had type 2 diabetes and those who did not. This allowed them to test the contribution made by rare, ‘private’ DNA differences, as well as those that are common and shared between people.
They found that most of the genetic risk of type 2 diabetes can be attributed to common, shared differences in the genetic code, each of which contributes a small amount to an individual’s risk of disease. Some researchers had thought that genetic risk would instead be dominated by rare changes, unique to an individual and their relatives.
This finding means that future efforts to develop a personalised approach to treatment and prevention will need to be tailored toward an individual’s broader genetic profile, non-genetic risk factors and clinical features.
Researchers also identified over a dozen type 2 diabetes risk genes where the DNA sequence changes altered the composition of the proteins they encode. This implicates those specific genes and proteins directly in the development of type 2 diabetes.
One such variant – in the TM6SF2 gene - has been shown to alter the amount of fat stored in the liver, which in turn results in an increase in the risk of type 2 diabetes. Discoveries such as these point to new opportunities for developing drugs that might interrupt the development of the disease.
Mark McCarthy, from the Wellcome Trust Centre for Human Genetics at the University of Oxford, one of three senior authors on the paper, said: “This study highlights both the challenges we face, and the opportunities that exist, in resolving the complex processes underlying a disease such as type 2 diabetes. In this study, we have been able to highlight, with unprecedented precision, a number of genes directly involved in the development of type 2 diabetes. These represent promising avenues for efforts to design new ways to treat or prevent the disease.”
Joint senior author Professor Michael Boehnke, Richard G Cornell Distinguished University Professor of Biostatistics, Director, Center for Statistical Genetics, University of Michigan School of Public Health, added: “Our study has taken us to the most complete understanding yet of the genetic architecture of type 2 diabetes. With this in-depth analysis we have obtained a more complete picture of the number and characteristics of the genetic variants that influence type 2 diabetes risk.”
Data and discoveries generated through this project are available through the type 2 diabetes genetics portal (http://www.type2diabetesgenetics.org) developed as part of the Accelerating Medicines Partnership.
Jason Flannick, co-lead author and Senior Group Leader at the Broad Institute of Harvard and MIT and Research Associate at the Massachusetts General Hospital, said: "Our study tells us that genetic risk for type 2 diabetes reflects hundreds or even thousands of different genetic variants, most of them shared across populations. This large range of genetic effects may challenge efforts to deliver personalised (or precision) medicine. However, to ensure that these challenges can be taken up by the wider research community, we have made the data from our study publicly accessible for researchers around the world in the hope that this will accelerate efforts to understand, prevent and treat this condition.”
Paper cited:
Fuchsberger C, Flannick, J. The genetic architecture of type 2 diabetes. Nature. doi:10.1038/nature18642.
This research was funded by over 60 funders including the Wellcome Trust, the US National Institutes of Health, the UK Medical Research Council, and the European Commission.
Contact @ WellcomeEmily PritchardWellcome TrustT: 020 7611 8615E: [email protected]
Contact @ Broad InstitutePaul GoldsmithE: [email protected]T: 617-714-8600
Contact @ University of MichiganLaurel Thomas GnageyE [email protected]T 734-647-1841
For further information and podcasts about this research please see: http://www.mccarthy.well.ox.ac.uk
About Wellcome Wellcome exists to improve health for everyone by helping great ideas to thrive. We’re a global charitable foundation, both politically and financially independent. We support scientists and researchers, take on big problems, fuel imaginations and spark debate.
About the University of OxfordOxford University’s Medical Sciences Division is one of the largest biomedical research centres in Europe, with over 2,500 people involved in research and more than 2,800 students. From the genetic and molecular basis of disease to the latest advances in neuroscience, Oxford is at the forefront of medical research. The University is rated the best in the world for medicine and life sciences, and it is home to the UK’s top-ranked medical school. Prof McCarthy’s research is based at the Wellcome Trust Centre for Human Genetics (www.well.ox.ac.uk), the Oxford Centre for Diabetes, Endocrinology and Metabolism (www.ocdem.ox.ac.uk), and the Oxford NIHR Biomedical Research Centre (http://www.oxfordbrc.nihr.ac.uk).
About the Broad Institute of MIT and HarvardThe Broad Institute of MIT and Harvard was launched in 2004 to empower this generation of creative scientists to transform medicine. The Broad Institute seeks to describe all the molecular components of life and their connections; discover the molecular basis of major human diseases; develop effective new approaches to diagnostics and therapeutics; and disseminate discoveries, tools, methods, and data openly to the entire scientific community.
Founded by MIT, Harvard, Harvard-affiliated hospitals, and the visionary Los Angeles philanthropists Eli and Edythe L. Broad, the Broad Institute includes faculty, professional staff, and students from throughout the MIT and Harvard biomedical research communities and beyond, with collaborations spanning over a hundred private and public institutions in more than 40 countries worldwide. For further information about the Broad Institute, go to http://www.broadinstitute.org.
About the University of MichiganThe University of Michigan School of Public Health has been Doing a World of Good in promoting health and preventing disease since 1941, and is consistently ranked among the top schools in the country. Its 140+ faculty and researchers and 1,000+ students in the school's 6 academic departments and dozens of collaborative centers and institutes are forging new solutions to complex health challenges, including chronic disease, health care quality and finance, emerging genetic technologies, climate change and environmental factors, socioeconomic inequalities and their impact on health, community-based health interventions, nutritional impacts, infectious disease, and the globalization of health. We also offer myriad opportunities for students to experience public health in the real world through public health practice, internships, entrepreneurial training, and more. Whether making new discoveries in the lab or researching and educating in the field, our faculty, students, and alumni are deployed around the globe to promote and protect our health.
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