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Logo of nihpaAbout Author manuscriptsSubmit a manuscriptNIH Public Access; Author Manuscript; Accepted for publication in peer reviewed journal;
Nature. Author manuscript; available in PMC Apr 8, 2010.
Published in final edited form as:
PMCID: PMC2772655
NIHMSID: NIHMS144946

A GENOME-WIDE LINKAGE AND ASSOCIATION SCAN REVEALS NOVEL LOCI FOR AUTISM

Lauren A. Weiss,* Dan E. Arking,* and The Gene Discovery Project of Johns Hopkins the Autism Consortium**

Summary

Although autism is a highly heritable neurodevelopmental disorder, attempts to identify specific susceptibility genes have thus far met with limited success 1. Genome-wide association studies (GWAS) using half a million or more markers, particularly those with very large sample sizes achieved through meta-analysis, have shown great success in mapping genes for other complex genetic traits (http://www.genome.gov/26525384). Consequently, we initiated a linkage and association mapping study using half a million genome-wide SNPs in a common set of 1,031 multiplex autism families (1,553 affected offspring). We identified regions of suggestive and significant linkage on chromosomes 6q27 and 20p13, respectively. Initial analysis did not yield genome-wide significant associations; however, genotyping of top hits in additional families revealed a SNP on chromosome 5p15 (between SEMA5A and TAS2R1) that was significantly associated with autism (P = 2 × 10−7). We also demonstrated that expression of SEMA5A is reduced in brains from autistic patients, further implicating SEMA5A as an autism susceptibility gene. The linkage regions reported here provide targets for rare variation screening while the discovery of a single novel association demonstrates the action of common variants.

For a high-resolution genetic study of autism, we selected families with multiple affected individuals (multiplex) from the widely studied Autism Genetic Resource Exchange (AGRE) and US National Institute for Mental Health (NIMH) repositories (Supplementary Methods, Supplementary Table 1). Although the phenotypic heterogeneity in autism spectrum disorders is extensive, in our primary screen we selected families in which at least one proband met ADI-R criteria for diagnosis of autism and included additional siblings in the same nuclear family affected with any autism spectrum disorder. We previously reported an early copy number analysis that revealed a significant role for microdeletion and duplication of 16p11.2 in ASD causation 2; here, we present extensive genome-wide linkage and association analyses performed with this high density of SNPs and identify independent and novel genome-wide significant results by both linkage and association analyses.

A PUBLIC AUTISM DATASET

We combined families and samples from two sources for the primary genetic association screen. The AGRE sample included nearly 3,000 individuals from over 780 multiplex autism families in the AGRE collection 3 genotyped at the Broad Institute on the Affymetrix 5.0 platform, which includes over 500,000 SNPs. The NIMH sample included a total of 1,233 individuals from 341 multiplex nuclear families (258 of which were independent of the AGRE sample) genotyped at the Johns Hopkins Center for Complex Disease Genomics on Affymetrix 5.0 and 500K platforms, including the same SNP markers as were genotyped in the AGRE sample.

Before merging, we carefully filtered each data set separately to ensure the highest possible genotype quality for analysis, since technical genotyping artifacts can create false positive findings. We therefore examined the distribution of χ2 values for the highest quality data, and used a series of quality control (QC) filters designed to identify a robust set of SNPs, including data completeness for each SNP, Mendelian errors per SNP and per family, and a careful evaluation of inflation of association statistics as a function of allele frequency and missing data (see Methods). As 324 individuals were genotyped at both centers, we performed a concordance check to validate our approach. After excluding one sample mix-up, we obtained an overall genotype concordance between the two centers of 99.7% for samples typed on 500K at JHU and 5.0 at Broad and 99.9% for samples run on 5.0 arrays at both sites. The combined dataset, consisting of 1,031 nuclear families (856 with two parents) and a total of 1,553 affected offspring, was employed for genetic analyses (Supplementary Table 1). These data were publicly released in October, 2007 and are directly available from AGRE and NIMH.

For linkage analyses, the common AGRE/NIMH dataset was further merged with Illumina 550K genotype data generated at the Children’s Hospital of Philadelphia (CHOP) and available from AGRE, adding ~300 nuclear families (1,499 samples). We used the extensive overlap of samples between the AGRE/NIMH and the CHOP datasets (2,282 samples) to select an extremely high quality set of SNPs for linkage analysis. Specifically, we only included SNPs genotyped in both datasets with >99.5% concordance and ≤1 Mendelian error.

LINKAGE ANALYSIS

Linkage analysis involving high densities of markers, where clusters of markers are in linkage disequilibrium (LD), can falsely inflate the evidence for genetic sharing among siblings when neither parent is genotyped 4. To alleviate these concerns, we analyzed a pruned set of 16,311 highly polymorphic, high-quality autosomal SNPs which were filtered to remove any instances in which two nearby markers were correlated with r2>0.1, providing a marker density of ~0.25cM (see Methods). In this analysis of 878 families, four genomic regions showed LOD scores in excess of 2.0 and one region, 20p13, exceeded the formal genome-wide significance threshold of 3.6 5 (maximum LOD, 3.81; Figure 1a, Supplementary Table 2). Restricting analysis to only those families with both parents genotyped (784 families) showed that these results are not an artifact of missing parental data (Figure 1b). We further tested the stability of these results by varying the recombination map and halving the marker density by placing every other marker into two non-overlapping SNP sets (Methods Summary); all analyses showed consistent and strong linkage to the same regions (data not shown).

Figure 1
Genome-wide Linkage Results.

FAMILY-BASED ASSOCIATION ANALYSIS

We used the transmission disequilibrium test (TDT) across all SNPs passing quality control in the complete family dataset for association analyses since the TDT is not biased by population stratification. We estimated a threshold for genome-wide significance using both permutation (P < 2.5 × 10−7) and estimating the effective number of tests (P < 3.4 × 10−7) and use the more conservative, here (see Methods). No SNP met criteria for genome-wide significance at P < 2.5 × 10−7. However, we observed an excess of independent regions associated at P < 10−5 (6 observed vs. 1 expected) and P < 10−4 (30 observed vs. 15 expected) despite the lack of overall statistical inflation (λ = 1.03, Supplementary Figure 1), suggesting that common variants in autism exist, but that our initial scan did not have sufficient statistical power to identify them definitively (Supplementary Figure 2, Table 1).

For the TDT associations with P < 10−4, we additionally utilized the cases that were excluded from the TDT due to missing parental data. We matched 90 independent and unrelated cases with 1,476 NIMH control samples genotyped on the Affymetrix 500K arrays 6, and performed case-control association analysis (Supplementary Table 3), combining these results with the TDT data. Promisingly, we now observed 8 SNPs (in 7 independent regions) with association at P < 10−5(Table 1). Of note, comparing Caucasian with non-Caucasian samples in the AGRE/NIMH dataset, we did not observe significant heterogeneity for top results.

Table 1
Top TDT results and replication data.

Our strongest associations were at chromosome 4q13 (rs17088254, P = 8.5 × 10−6) between CENPC1, a centromere autoantigen, and EPHA5, an ephrin receptor potentially involved in neurodevelopment; at 5p15 (rs10513025, P = 1.7 × 10−6) in the EST DB512398, located between SEMA5A and TAS2R1; at 6p23 (rs7766973, P = 6.8 × 10−7) in JARID2, an ortholog of the mouse jumonji gene, encoding a nuclear protein essential for embryogenesis, especially neural tube formation; at 9p24 (rs4742409, P = 7.9 × 10−6) between PTPRD, a protein tyrosine phosphatase involved in neurite outgrowth, and JMJD2C, a jumonji-domain containing protein involved in tri-methyl specific demethylation; at 9q21 (rs952834, P = 7.8 × 10−6) between ZCCHC6, a zinc finger and CCHC domain containing protein, and GAS1, growth arrest specific protein; at 10q21 (rs7923367, P = 3.4 × 10−6) in CTNNA3, alpha 3 catenin, which may be involved in the formation of stretch-resistant cell-cell adhesion complexes; and two SNPs on 11p14 (rs12293188, P = 1.1 × 10−6; rs16910194, P = 3.7 × 10−6) in GAS2, a caspase-3 substrate that plays a role in regulating microfilament and cell shape changes during apoptosis and can modulate cell susceptibility to p53-dependent apoptosis by inhibiting calpain activity (Table 1).

REPLICATION STUDIES

To confirm whether any of these top results might indicate true susceptibility loci, we attempted to replicate these signals, as well as others with P < 10−4 in the initial TDT that met stringent genotyping quality criteria (Supplementary Table 3). We used several data sources to replicate the association results. First, we utilized additional autism family samples (318 trios collected by investigators of the Autism Consortium and in Montreal) with genome-wide Affymetrix 5.0/500K array data also genotyped at the Genetic Analysis Platform of the Broad Institute using the same conditions, QC, and analysis pipelines (Methods).

Second, independent Autism Genome Project (AGP) families, along with a set of Finnish families and a set of Iranian trios were used for replication of our top findings (n=1,755 trios). Two Sequenom replication pools were designed, attempting to include as many of the regions associated at P < 10−4 as possible. The full set of SNPs considered and those successfully genotyped are shown in Supplementary Table 3, with linkage disequilibrium (r2) noted for SNPs selected as proxies for Affymetrix markers. One of the eight SNPs with P < 10−5 (rs10513025) that failed in this Sequenom assay was subsequently replaced in a subset of AGP samples with a TaqMan assay. This assay showed 99.89% concordance with Affymetrix genotypes in the overlapping AGRE-NIMH samples (2,797/2,800 concordant genotypes), with manual review of the Affymetrix genotype calls also confirming the marker to be of extremely high quality (Supplementary Figure 4). In the independent replication effort, only rs10513025 was associated with P < 0.01 (Table 1).

Combining the scan and replication data, only rs10513025 met criteria for genome-wide significance defined by LD and permutation analyses (P < 2.5 × 10−7). To increase coverage of this region and fill in missing genotypes and SNPs that failed quality control, we performed imputation analysis. rs10513026 was highly (but not perfectly) correlated to the replicated chromosome 5 SNP (rs10513025) and showed even stronger association than originally observed with rs10513025 (Supplementary Figure 3). These and several other promising SNPs were directly genotyped in the original scan samples and, in fact, showed higher levels of significance (Table 2). Direct genotyping confirmed that rs10513026 showed stronger association than rs10513025 (P-value 4.5 × 10−6 vs. 9.8 × 10−6 in the re-genotyped scan trios), increasing the significance of this observation further. Several other promising results from this analysis were genotyped in a subset of scan samples, and, of note, the top SNP in imputation analysis (rs10874241, imputation P = 9.8 × 10−7, OR = 0.43) showed consistent results (OR = 0.4, P = 4 × 10−7) when directly genotyped (Supplementary Table 4).

Table 2
Chromosome 5p15 SNPs.

rs10513025 and neighbors are on chromosome 5p15 in a region of LD containing several other ESTs and TAS2R1, a bitter taste receptor (Supplementary Figure 3). The SNPs are ~80 kb upstream of semaphorin 5A (SEMA5A), a gene implicated in axonal guidance and known to be down-regulated in lymphoblastoid cell lines of autism cases versus healthy controls 7. An independent study at Children’s Hospital Boston using whole blood (SWK, LK, ZK, manuscript in preparation) confirms this lower expression (P = 0.0034) of SEMA5A in autism cases versus controls. To more completely evaluate the role of this locus in autism pathogenesis, we evaluated the entirety of 5p15 for copy-number variation. Despite excellent probe coverage throughout the locus, no common or rare copy number variants were detected in the entire AGRE scan in the region of LD surrounding the associated SNPs and the entire SEMA5A locus including 250 kb up and downstream (see Methods).

SEMA5A EXPRESSION IN AUTISTIC BRAINS

To directly test SEMA5A expression in brains from autistic patients, tissue samples from 20 cases with a primary diagnosis of autism and 10 controls were obtained through the Autism Tissue Program and the Harvard Brain Bank. Samples were dissected from Brodmann area 19 of the occipital lobe cortex, a region demonstrating differences between autism cases and controls in functional imaging studies, and subjected to quantitative PCR 8. SEMA5A expression, determined relative to MAP2 (neuron specific), was significantly lower in autism brains than controls after adjustment for the age at brain acquisition, post-mortem interval, and sex (P = 0.024, Figure 2).

Figure 2
SEMA5A Expression in Autism Brains

CANDIDATE AND LINKAGE REGION ASSOCIATION

We also analyzed our data for association signals at candidate genes or regions with prior evidence of involvement in autism. Although there are few well-replicated associations of biological candidate genes, there are many rare genetic variants, diseases, and syndromes associated with autism. Most of these loci have not been systematically assessed to see whether common variation in the gene or region might contribute to autism. We assessed four categories of candidate loci: 1) genes with previous evidence for association with common variation, 2) genes implicated by rare variants leading to autism, 3) genes causing Mendelian diseases associated with autism, and 4) regions where microdeletion or microduplication syndromes are associated with autism. For each gene, we included all SNPs passing basic quality criteria within 2 kb of the transcript.

Overall, there were no compelling results in these sets (all P > 10−4), considering the number of SNPs tested, and only two regions met criteria for region-wide (only SNPs in that gene/region considered) or set-wide (e.g. all candidate regions in the set of common variant genes considered) significance by permutation-testing (Supplementary Table 5). MECP2 (Rett syndrome) met criteria for region-wide association (P = 0.0071, 5 SNPs, Supplementary Table 5). Moreover, the Williams syndrome region was borderline for set-wide significance (P = 0.051, Supplementary Table 5). One SNP in particular showed strong association (rs2267831, P = 0.00012, OR = 0.56) – as this was a rare SNP with undertransmission of the minor allele, we genotyped a subset of families and observed similar, slightly less significant distortion (OR=0.61). The SNP is located within GTF2IRD1, a transcription factor within the critical region for the Williams syndrome cognitive behavioral profile 9,10,11.

There appears to be little overlap between the regions of strongest linkage and association in this study. A more detailed assessment of SNP and haplotype association in the most significant linkage regions did not yield common variation that could explain the evidence for linkage (Supplementary Table 6). This is an expected outcome if linkage signals arise from rare, high penetrance variation (for which the genotyping arrays do not offer an adequate proxy) while association is sensitive to common variation with lower penetrance (that cannot be detected by linkage). For example, a 0.3% variant that increases risk by 10-fold would readily be picked up by this informative linkage scan, but would very likely not be assessed by the common SNPs on the Affymetrix 5.0 array; by contrast, the modest and protective impact of the 5% variant at the SEMA5A rs10513025 creates no detectable excess allele sharing among siblings but is strongly detected by association.

During review of this manuscript, another GWAS was published which identified significant association to SNPs on chromosome 5p14 12. While there was significant overlap between study samples, each of these scans contained a large set of unique families, so we sought to evaluate independent evidence of the top SNP (rs4307059) reported at 5p14. This SNP happens to be directly genotyped by both Affymetrix and Illumina platforms. We have a sizable number (n=796) of affected subjects with two parents genotyped (and of predominantly similar European background). However, we observed no support for association at this locus (T:U 354:335 in favor of the minor allele, a trend in the opposite direction as reported).

DISCUSSION

Autism genes have been difficult to identify, despite the high heritability of autism spectrum disorders. Up to 10% of autism cases may be due to rare sequence and gene dosage variants, for example, mutations in NRXN1, NLGN3/4X, SHANK3, and copy number variants at 15q11–q13 and 16p11.2. A number of diseases of known etiology, including Rett syndrome, fragile X syndrome, neurofibromatosis type I, tuberous sclerosis, Potocki-Lupski syndrome, and Smith-Lemli-Opitz syndrome are also associated with autism 1,13. However, the remaining 90% of autism spectrum disorders, while highly familial, have unknown genetic etiology. A genome-wide linkage study using the Affymetrix 10K SNP array to genotype over 1,000 families found no genome-wide significant linkage signals, but documented suggestive linkage at 11p12–p13 and 15q23–q25 and reinforced a modest role for rare copy-number variants 14.

Many complex diseases have recently had great success with GWAS approaches, but most identified modest effects with odds ratios less than 1.3 (http://www.genome.gov/26525384). Our association analysis has excellent statistical power (>80%) to find effects of relatively common alleles (0.01–0.25 in frequency) explaining 1% of the variance in autism at the genome-wide significant level. It is near-perfectly powered for alleles down to 1% at the replication cut-off P < 10−4, assuming additive background genetic variance of 0.8 and shared environmental variance of 0.05 with prevalence of 0.006. One of the advantages of a family-based association test is that we avoid false positive results generated by population stratification, and in addition, we have performed careful quality control to reduce the chances of being misled by technical artifacts. However, the SNP coverage of the Affymetrix 5.0 chips is incomplete; in fact, a recent resequencing survey suggests that these arrays assay only 57% of variants with MAF > 5% at r2 = 0.8 15. We therefore cannot exclude untested variation of large effect in autism. The linkage analysis, assuming a fully informative marker in 800 sibpairs, should detect sibling allele sharing of at least 55.125% 16.

Our linkage analysis revealed two novel regions of linkage, 6q27 (LOD = 2.94) and 20p13 (LOD = 3.81), with the latter formally exceeding the threshold for genome-wide significance. There is some overlap between the more modest signals (LOD > 2 on chr15 and chr17) and previously reported suggestive signals, but little overlap with the most promising regions of common SNP association. This suggests that the regions of the genome showing linkage may harbor rare variation, potentially with allelic heterogeneity across families, which would require re-sequencing to uncover, as has been demonstrated for the 7q35 region17,18,19. Interestingly, several of these regions overlap with rare syndromes or genetic events known to be strong risk factors for autism. For example, an autism case with a translocation disrupting 15q25 has been reported, while the 17p region overlaps the Smith Magenis and Potocki-Lupski Syndrome region.

The initial TDT analysis of this large multiplex autism dataset, did not reveal any associations meeting criteria for genome-wide significance, suggesting that there are not many common loci of moderate to large effect size even in a highly heritable disorder like autism. Nevertheless, replication data in our study identified a novel locus with genome-wide significant evidence for association to autism. In addition, several other SNPs in the region show similarly strong association (rs10513026, rs16883317). We ascertained a large replication sample from independent family studies with a replication at P = 0.0061 and meta-analysis showed this association (P = 2.12 × 10−7) to meet criteria for genome-wide association in our experiment. This region on chromosome 5 harbors the gene encoding the bitter taste receptor, TAS2R1, and several uncharacterized ESTs and is adjacent to SEMA5A, a member of the semaphorin axonal guidance protein family, which has shown down-regulated expression in transformed B lymphocytes from autism samples15. We have further extended this finding by directly demonstrating lowered SEMA5A gene expression in autism brain tissue. This is an attractive candidate gene given that its protein is a bifunctional guidance molecule, which is both attractive and inhibitory for developing neurons. Interestingly, the SEMA5A receptor is plexin B3, which also signals through the tyrosine kinase MET, a previously reported autism susceptibility gene20,21.

Finally, we investigated whether different classes of genes or regions -- loci previously implicated by functional or positional candidate gene association studies, rare variants implicated in autism, Mendelian disorder genes with association to autism, or regions of copy number variation associated with autism -- showed association with common alleles included in our marker set. Although there were several nominally significant associations, only the Williams syndrome region (one SNP in GTF2IRD1) was borderline statistically significant (P = 0.051), after correcting for the microdeletion/duplication syndrome regions tested. In the category of Mendelian disorders associated with autism, MECP2, the gene for Rett syndrome, showed region-wise statistical significance. These results raise the possibility that Rett and Williams syndrome genes may contribute more generally to autism spectrum disorders. Although the genes in which common variation has been reported to be associated with autism do not show evidence for association, this cannot be interpreted as failure to replicate previous results in all cases, because much of the variation reported as associated is not captured on the Affymetrix platform (e.g. length polymorphisms, microsatellites, untagged SNPs such as the promoter variant at MET21). Instead, despite a high density of markers, our results suggest that we did not identify additional common variation with evidence for association. Overall however, our results imply that these postulated candidate regions, mostly based on rare events known to cause autism, are not among the regions with common alleles having the strongest risk effects for autism.

Interestingly, both our linkage and association analyses, from the primary and replication analyses, suggest that low frequency (<0.05) minor alleles may be common in autism. Intriguingly, the linkage studies reveal low frequency susceptibility alleles whereas the association analyses have uncovered rare alleles with odds ratios less than 0.6 (the common alleles in the population associated with increased risk for autism). This can occur when the ancestral allele, that was previously neutral or beneficial, now has detrimental effects revealed by an evolutionarily recent environment, or when a pleiotropic function of the allele is selectively advantageous, or when this variation is hitchhiking on a shared haplotype with a distinct beneficial allele 22. However, it is worth noting that our study design of ascertaining multiplex families is not well-powered to identify loci under this genetic model of common major alleles associated with autism susceptibility.

In summary, we report genome-wide significant linkage as well as an association of common genetic variation with autism. Our results will require follow-up to identify the functional variation in the linkage and association regions that we report here and to probe the functions of the relatively unstudied transcripts implicated. These results could provide completely novel insight into the biology and pathogenesis of a common neurodevelopmental disorder.

METHODS SUMMARY

SAMPLES AND GENOTYPING

Our primary samples are from the AGRE and NIMH Repositories. Replication with Affymetrix technology included NIMH controls, families collected by members of the Autism Consortium, and families ascertained from Montreal. Replication with Sequenom technology included the Autism Genome Project, Finnish, and Iranian subsets of Autism Consortium investigator-collected families. Details of the ascertainment for each sample collection, genotyping, and quality control processes can be found in Methods.

LINKAGE AND ASSOCIATION ANALYSIS

The linkage analysis was conducted with a pruned autosomal SNP set [see Methods for details of marker selection] and chromosome X set (670 SNPs) using the cluster option in MERLIN/MINX (r2 < 0.1) 23, yielding 16,581 independent markers. We performed confirmatory analysis on non-overlapping datasets by selecting alternate SNPs.

Association analysis was performed in PLINK24. The basic association test was a transmission disequilibrium test (TDT), and the extra cases vs. controls analysis was performed by allelic association, after excluding cases that were not well-matched to the controls, based on multi-dimensional scaling (λ < 1.1). Combining the TDT and case-control tests was performed using expected and observed allele counts by the formula: Zmeta = (ΣEXP − ΣOBS)/√ΣVAR. Meta-analysis of AGRE/NIMH and replication data was performed using the statistic (ZAGRE/NIMH+Zreplication)/√2. Gene-set analysis was performed in PLINK using the set-based TDT. Imputation-based association was performed in PLINK with the proxy-tdt command, using the HapMap CEU parent samples as the reference panel and information score >0.8. Haplotype analysis in the linkage regions was performed using 5-SNP sliding windows, as implemented in PLINK hap-tdt. See Methods section for details of determination of genome-wide significance thresholds.

METHODS

PRIMARY STUDY SAMPLES

All samples used in this study arose from investigations approved by the individual and respective Institutional Review Boards in the USA and at international sites where relevant. Informed consent was obtained for all adult study participants; for children under age 18, both the consent of the parents or guardians and the assent of the child were obtained.

AGRE samples

The Autism Genetic Resource Exchange (AGRE) curates a collection of DNA and phenotypic data from multiplex families with autism spectrum disorder (ASD) available for genetic research 3. We genotyped individuals from 801 families, selecting those with at least one child meeting criteria for autism by the Autism Diagnostic Interview-Revised (ADI-R) 25, while the second affected child had an AGRE classification of autism, broad spectrum (patterns of impairment along the spectrum of pervasive developmental disorders, including PDD-NOS and Asperger syndrome) or Not Quite Autism (NQA, individuals who are no more than one point away from meeting autism criteria on any or all of the social, communication, and/or behavior domains and meet criteria for “age of onset”; or, individuals who meet criteria on all domains, but do not meet criteria for the “age of onset”). We excluded probands with widely discrepant classifications of affection status via the ADI-R and ADOS that could not be reconciled. We also excluded families with known chromosomal abnormalities (where karyotyping was available), and those with inconsistencies in genetic data (generating excess Mendelian segregation errors or showing genotyping failure on a test panel of 24 SNPs used to check gender and sample identity with the full array data). The self-reported race/ethnicity of these samples is 69% white, 12% Hispanic/Latino, 10% unknown, 5% mixed, 2.5% each Asian and African American, less than 1% Native Hawaiian/Pacific Islander and American Indian/Native Alaskan.

NIMH samples

The NIMH Autism Genetics Initiative maintains a collection of DNA from multiplex and simplex families with ASD. We genotyped individuals from 341 nuclear families, 258 of which were independent of the AGRE dataset, with at least one child meeting criteria for autism by the ADI-R, and a second child considered affected using the same criteria as described for the AGRE dataset above. Similar exclusion criteria were used, including known chromosomal abnormalities and excess non-Mendelian inheritance. The self-reported race/ethnicity of these samples is 83% white, 4% Hispanic, 2% unknown, 7% mixed, 3% Asian, and 1% African American.

Merged dataset for primary screening

We utilized the Birdseed algorithm for genotype calling at both genotyping centers26,27. As 324 individuals were genotyped at both centers, we performed a concordance check. One sample showed substantial differences between the two centers, but no excess of Mendelian errors, indicating that a sample mix-up occurred in which each center genotyped a different sibling that was identified as the same sample. Excluding this sample, overall genotype concordance between the two centers was 99.72%.

Before merging data, we examined the distribution of chi-square values and used a series of quality control (QC) filters designed to identify a robust set of SNPs. We discovered that filtering AGRE genotypes to 98% completeness and less than 10 MEs was sufficient to remove SNPs that artificially inflated the chi-square distribution for SNPs with MAF (minor allele frequency) > 0.05. For MAF < 0.05, we observed much greater inflation (λ = 1.17), due entirely to a strong excess of SNPs with under-transmission of the minor allele (OR < 1). While the same filters yielded high-quality results for SNPs with over-transmission of the minor allele (λ = 1.04), we found that much stricter filtering was required for rarer SNPs with OR<1 (missing data < .005). This is not unexpected based on a well-documented bias in the TDT: if missing data are preferentially biased against heterozygotes or rare homozygotes, significant, artificial over-transmission of the common allele is expected 28,29. To achieve comparable quality for the NIMH dataset, we filtered on 96% completeness and fewer than 4 MEs. Our final QQ plot for the combined dataset is shown in Supplementary Figure 1 and has a λ ~ 1.03, less than that observed in the Wellcome Trust Case Control Consortium paper for five of the seven phenotypes studied 30. The combined data set, consisting of 1,031 families (856 with two parents) and a total of 1,553 affected offspring, was employed for association testing.

For linkage analyses, the combined AGRE/NIMH dataset was further merged with Illumina 550K genotype data generated at the Children’s Hospital of Philadelphia (CHOP) and available from AGRE, adding ~300 nuclear families (1,499 samples). We used the extensive overlap of samples between the AGRE/NIMH and the CHOP datasets (2,282 samples) to select an extremely high quality set of SNPs for linkage analysis. Specifically, we required SNPs to be on both the Affymetrix 500K/5.0 and Illumina 550K platforms, with >99.5% concordance across platforms. We further restricted SNPs to MAF > 0.2, < 1% missing data, Hardy Weinberg P> 0.01, and no more than 1 ME. This left ~36,000 SNPs of outstanding quality. For autosomal SNPs, we further pruned using PLINK to remove SNPs with r2 > 0.1, yielding 16,311 SNPs.

REPLICATION SAMPLES

NIMH control samples

Controls obtained from the NIMH Genetics Repository were genotyped on the Affymetrix 500K platform at the Broad Institute Genetic Analysis Platform for another study 6. Of these, 1,494 matched well with our sample, and were used as controls to compare with the cases and parents in our study.

Montreal samples

Subjects diagnosed with autism spectrum disorders with both of their parents were recruited from clinics specializing in the diagnosis of Pervasive Developmental Disorders (PDD), readaptation centers, and specialized schools in the Montreal and Quebec City regions, Canada, as described 31. Subjects with ASD were diagnosed by child psychiatrists and psychologists expert in the evaluation of ASD. Evaluation based on the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria included the use of the Autism Diagnostic Interview-Revised (ADI-R)25 and the Autism Diagnostic Observation Schedule (ADOS)32. As an additional screening tool for the diagnosis of ASD, the Autism Screening Questionnaire, which is derived from the ADI-R, was completed 33. Furthermore, all proband medical charts were reviewed by a child psychiatrist expert in PDD to confirm their diagnosis and exclude subjects with any co-morbid disorders. Exclusion criteria were: (1) an estimated mental age < 18 months, (2) a diagnosis of Rett syndrome or Childhood Disintegrative Disorder and (3) evidence of any psychiatric and neurological conditions including: birth anoxia, rubella during pregnancy, fragile X syndrome, encephalitis, phenylketonuria, tuberous sclerosis, Tourette and West syndromes. Subjects with these conditions were excluded based on parental interview and chart review. However, participants with a co-occurring diagnosis of semantic-pragmatic disorder (due to its large overlap with PDD), attention deficit hyperactivity disorder (seen in a large number of patients with ASD during development), and idiopathic epilepsy (related to the core syndrome of ASD) were eligible for the study.

Santangelo EDSP family samples

Families were ascertained for having one or more autistic children and at least one non-autistic child aged 16 or older for an extremely discordant sib-pair linkage study. Recruitment took place in Massachusetts and surrounding states through contacts with parent support and patient advocacy groups, brochures, newsletters, and the study web site. Parents were interviewed about their children, and non-autistic children were interviewed about themselves. An informant/caregiver, usually the proband’s mother, was interviewed using the Autism Diagnostic Instrument-Revised (ADI-R) to confirm the diagnosis of autism at age 4–5 years25,34. Families were included if the affected children met Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria for autistic disorder and their non-autistic siblings (aged 16 and older) did not display any of the broader autism phenotype traits, which were assessed with the (M-PAS-R), the Pragmatic Language Scale (PLS), and the Friendship Interview 35,36. Probands were excluded if they had medical conditions associated with autism such as fragile X syndrome or gross CNS injury, or if they were under four years of age, due to the possible uncertainty in diagnosis at younger ages. Twenty-nine families met eligibility criteria for the study and comprised the final sample for analysis.

High Functioning Autism family samples

Families were included if their affected child had been previously diagnosed with Autism or Asperger syndrome, had a level of intellectual functioning above the range of mental retardation (i.e., Full Scale, Verbal, and Performance IQ > 70), chronological age between 6 and 21 years, and an absence of significant medical or neurological disorders (including fragile X syndrome and tuberous sclerosis). Families were ascertained and recruited through the Acute Residential Treatment (ART) programs and outpatient child and adolescent services at McLean Hospital, as well as through associated hospitals and clinics. Brochures and a website were also utilized. Thirty-three families (133 participants) were enrolled in the study. Participation was voluntary.

MGH-Finnish collaborative samples

Altogether 58 individuals with a diagnosis of High Functioning Autism (HFA) or Asperger’s Syndrome (AS) were recruited in Finland. Fifty-two children and adolescents aged 8 to 15 years were identified from patient-records at the Oulu University Hospital in 2003. These children and adolescents have been evaluated for HFA/AS at the Oulu University Hospital. In addition, six children (3 boys, 3 girls) 11 years of age were recruited from an epidemiological study conducted in 2001 37.

All participants had full scale IQ scores greater than or equal to 80 measured with the Wechsler Intelligence Scale for Children—Third Revision 38. Furthermore, none of the children subjects were diagnosed with other developmental disorders (e.g., dysphasia, fragile X syndrome). Clinical diagnoses of HFA/AS were confirmed by administering the Autism Diagnostic Interview-Revised 25 and the Autism Diagnostic Observation Schedule 32. Of the 58 participants with HFA/AS, 35 met the diagnostic criteria for AS and 21 met the diagnostic criteria for HFA according to ICD-10 diagnostic criteria 39. Two participants met diagnostic criteria for PDD-NOS; these participants were excluded due to their manifesting different and less severe symptoms than our sample of children with HFA or AS.

Children’s Hospital Boston samples

Probands with a documented history of clinical diagnosis of ASD were recruited at Children’s Hospital Boston. To participate, they had to be over 24 months of age and have at least one biological parent or an affected sibling available. Subjects were excluded if they had an underlying metabolic disorder or any chronic systemic disease, an acquired developmental disability (e.g. birth asphyxia, trauma-related injury, meningitis, etc.), or cerebral palsy. All participants provided informed consent and a phenotyping battery was performed including the Autism Diagnostic Observation Schedule (ADOS), the Autism Diagnostic Interview- Revised (ADI-R) and other measures to assess cognitive status. 75% of subjects with a clinical diagnosis met strict research criteria for ASD on both ADI-R and ADOS. In addition, a complete family and medical history was obtained.

Homozygosity Mapping Collaborative for Autism (HMCA) samples

Families with cousin marriages and children affected by autism spectrum disorder (ASD) with or without mental retardation (MR) were recruited by multiple collaborators in the HMCA. The patients from Istanbul were evaluated by a child psychiatrist (Nahit M. Mukaddes) trained in the Autism Diagnostic Observation Schedule (ADOS) and Autism Diagnostic Interview - Revised (ADI-R), and who made diagnoses according to DSM-IV-TR criteria and the Childhood Autism Rating Scale (CARS). Patients from Kuwait were enrolled from the Kuwait Centre for Autism by Samira Al-Saad. In Jeddah, Saudi Arabia, patients were evaluated by both a developmental pediatrician (Soher Balkhy) and a pediatric neurologist (Generoso Gascon) and diagnoses were based on DSM-IV-TR criteria. In Lahore, Pakistan, a neurologist (Asif Hashmi) with training in the ADOS and ADI-R diagnosed patients using DSM-IV-TR criteria. In most settings, patients were enrolled from tertiary clinical centers and these patients had standard of care neuromedical assessments, including physical examination, medical and neurological history, fragile X testing, and other genetic and metabolic testing when indicated. MRI was obtained for patients in whom a brain malformation was suspected or seizures were present. In addition, IQ scores (usually from the Stanford-Binet) and adaptive behavior measures were obtained from the patients’ existing medical records. Secondary assessments were conducted on the most informative pedigrees by the Boston clinical team in collaboration with local multi-disciplinary teams. Clinical members of the Boston team included: developmental psychologists (Janice Ware, Elaine LeClaire, Robert M. Joseph), pediatric neurologists (Ganesh H. Mochida, Anna Poduri), a clinical geneticist (Wen-Han Tan), and a neuropsychiatrist (Eric M. Morrow). The secondary assessment battery was designed to obtain a comprehensive description of current and historical autism symptomatology, cognitive and adaptive functioning, and neurological and physical morphological status in the patient and pedigree. The secondary assessment included: neurologic examination; genetic dysmorphology examination; the CARS; the Social Communication Questionnaire (SCQ) administered with probing on par with the ADI-R by ADI-R reliable examiners; the ADOS (usually Module 1); the Vineland Adaptive Behavior Scales, Second Edition (VABS-II); Kaufman Brief Intelligence Test, Second Edition (KBIT-II). ADOS assessments were videotaped and dysmorphology findings were photographed for archival purposes.

AGP samples

Individuals typically received at least two of three evaluations for autism symptoms: ADI-R, ADOS and clinical evaluation. Of the 1,679 affected individuals from 1,443 families, 966 met criterion for autism on the ADI-R and ADOS and most of these also had a clinical evaluation of autism; 160 affected individuals met criteria for autism on one of the two diagnostic instruments (ADI-R, ADOS) but were missing information on the other instrument; and, 553 individuals met criteria for spectrum disorder on one or both instruments. Affected individuals were recruited from both simplex and multiplex families, 71% of this sample being from multiplex families. The majority of the families were of European ancestry (83%).

Finnish autism family samples

Families were recruited through university and central hospitals. Detailed clinical and medical examinations were performed by experienced child neurologists as described elsewhere40. Diagnoses were based on ICD-10 39 and DSM-IV 41 diagnostic nomenclatures. Families with known associated medical conditions or chromosomal abnormalities were excluded from the study. A total of 106 families included 400 individuals for whom genotype data was available. Of these, 111 had a diagnosis of infantile autism and 13 a diagnosis of Asperger syndrome. All families were Finnish, except for one family where the father was Turkish.

Iranian Trio samples

Eligible participants in this study were Iranian families with at least one child affected with ASD, including cases of autistic disorder, Asperger syndrome and pervasive developmental disorder-not otherwise specified (PDD-NOS). Eighty families (282 individuals) from Iran were ascertained and assessed. This sample was ascertained by screening and diagnostic testing of over 90,000 preschool children from Tehran in 2004. Diagnoses of children were made according to DSM-IV criteria via the ADI-R and the ADOS. Patients with abnormal karyotypes and dysmorphic features were excluded. Most of the families were father-mother-child trios but some had more than one affected child. All affected biological siblings were assessed with the same diagnostic tools. We have ascertained and assessed 80 families (282 individuals) from Iran.

AFFYMETRIX GENOTYPING

The AGRE samples were genotyped on Affymetrix 5.0 chips at the Genetic Analysis Platform of the Broad Institute, using standard protocols. The 5.0 chip was designed to genotype nearly 500,000 SNPs across the genome in order to enable genome-wide association studies 26,27. The NIMH controls were genotyped at the Broad Institute using the Affymetrix 500K Sty and Nsp chips, using a similar protocol 6. The Autism Consortium and Montreal replication samples were also genotyped at the Broad Institute under the same conditions. The NIMH autism samples were genotyped at the Johns Hopkins Center for Complex Disease on the Affymetrix 500K (Nsp and Sty) and 5.0 platforms using similar standard protocols.

Genotype calling for the 5.0 arrays was performed by Birdseed 26,27 and for the 500K arrays was performed by BRLMM. As basic QC filters for the data generated at the Broad Institute, we required that genotyping was >95% complete for each individual, and that each family had fewer than 10,000 Mendelian inheritance errors across the genome. We also required that each SNP had >95% genotyping, fewer than 15 Mendelian errors, Hardy-Weinberg Equilibrium P > 10−10, and minor allele frequency greater than 1%. For the AGRE sample, this left 2,883 high quality individuals genotyped for 399,147 SNPs with 99.6% average call rate. The basic filters for the data generated at Johns Hopkins were individual call rates > 95% for 5.0 arrays and > 90% for 500K arrays data, fewer than 5,000 Mendelian errors per family. Only monomorphic SNPs and those with greater than 50% missing data were dropped, for 498,216 SNPs. Our combined dataset had nearly 365,000 SNPs passing QC.

SEQUENOM GENOTYPING

SNPs were assayed using Sequenom technology for the AGP samples at three centers, namely Gulbenkian, Mt. Sinai, and Oxford: DNA from 1,629 families representing numerous recruiting sites was genotyped for 54 SNPs. SNPs with >3% missing data, namely rs4690464, rs10513025, and rs17088296, were excluded from analysis. The next step in our quality control process was to remove families with ≥4 Mendelian errors, out of 51 remaining loci, under the assumption that this indicated pedigree errors. Data from 110 families were removed due to Mendelian errors. Thereafter, SNPs were removed if they showed excessive Mendelian errors (>16) in the remaining families. Using this criterion, two more SNPs, rs155437 and rs1925058, were removed from analysis. It was apparent that DNA quality varied by study site and could be responsible for concomitant genotype quality differences. Therefore, we also evaluated rate of missing genotypes per locus and study site. Our analyses showed that DNA from a few population samples showed excess missingness for two SNPs, rs4742408 and rs7869239, relative to the remaining population samples. Specifically three population samples showed more than 7% missing genotypes for rs4742408 and rs7869239 whereas the remaining population samples had about 1% or less missing genotypes. Therefore, for these loci we deleted genotypes only from the samples showing excess missingness. As a final quality control step, we then evaluated missing genotypes for the remaining loci. If more than five loci were missing genotypes, the individual’s data was removed from analysis. By this criterion 76 additional families became uninformative for family-based association analysis, leaving 1,443 families for association analysis. The Finnish autism samples were genotyped in the Peltonen lab, and the Iranian trios were genotyped at the Broad Institute using very similar protocols. All samples were genotyped using aliquots from the same pooled primers and probes.

COPY NUMBER ANALYSIS

Because of previous reports of two large (>1 Mb), independent de novo deletions spanning this locus 42, we assessed the region surrounding rs10513025 and the entire SEMA5A locus for copy number variation that could either explain or provide independent evidence of the importance of this region to autism using Birdsuite 26 to analyze all Affymetrix 5.0 samples. Birdsuite genotypes previously annotated common copy number polymorphisms 27 and in parallel searches for novel copy number variants using an HMM. Probe coverage in the region was good, with no 50kb window having fewer than 10 probes and an average spacing between probes of 2.5 kb, allowing very good sensitivity for CNVs greater than 25kb. We found no deletions or duplications near this SNP, nor any overlapping the gene SEMA5A. The closest copy number variants upstream and downstream of this SNP appeared to be a rare (~2–3% frequency, previously annotated CNP) 40kb deletion from 288 kb from the 3′ end of SEMA5A, and a rare (~1% frequency, novel) 20kb deletion 356 kb upstream of the 5′ end of SEMA5A. Each of these appeared to be segregating polymorphisms, but fall far outside of the boundaries of SEMA5A and TAS2R1 and far beyond the linkage disequilibrium block containing rs10513025.

EXPRESSION ANALYSIS

Fresh-frozen brain tissue samples dissected from the cortex (Brodmann area 19) were obtained through the Autism Tissue Program (www.atpportal.org) from the Harvard Brain Bank and the NICHD Brain and Tissue Bank at the University of Maryland from 20 samples with a primary diagnosis of autism, and 10 controls. Total RNA was extracted using TRIzol reagent (Invitrogen, Carlsbad, CA) according to the manufacturer’s protocol. Complementary DNA (cDNA) was generated from 8μg of total RNA using the Superscript III First-Strand Synthesis kit (Invitrogen). cDNA was diluted 1:5 in 10mM Tris and 1μL of diluted cDNA was used per 10μL PCR reaction. Quantitative real-time PCR was performed on a Lightcycler 480 (Roche Applied Science, Indianapolis, IN) using 2X Taqman Gene Expression Master Mix and probes obtained from Applied Biosystems (ABI, Foster City, CA): SEMA5A (Hs01549381_m1), MAP2 (Hs01103234_g1), TBP (Hs00920497_m1), GAPDH (4333764F). For multiplex reactions, 0.5μL FAM-labeled SEMA5A probe and 0.5μL VIC-labeled MAP2 probe were used per 10μL reaction. The amount of SEMA5A relative to MAP2 was determined for each case using the ΔΔCt method 43. Comparison of SEMA5A to TBP and GAPDH yielded similar results. Logistic regression was performed on autism status, adjusting for age at death, post-mortem interval, sex, and SEMA5A expression, with a 1-sided P-value reported for the association of lower SEMA5A expression with autism status.

DETERMINATION OF SIGNIFICANCE

To determine an appropriate experimental threshold for genome-wide significance, permutation was performed on this dataset by gene-dropping, and genome-wide significance was estimated by taking the lowest P-value from each of 1000 permuted datasets and using the 50th as a threshold for P < 0.05 experiment-wide significance (P<2.5 × 10−7). To calculate an estimate of the effective number of tests (Teff), we used the following algorithm:

  1. Start with the most 5′ SNP on a chromosome (SNPi,j),where i=chromosome, and j=SNP position, and calculate pairwise LD with all downstream SNPs within 1 Mb (r2[SNP1,1 × SNP1,n])
  2. For SNP1,1, Teff(1,1)=1-max(r2[SNP1,1 × SNP1,n])
  3. For chromosome i, Teff(i)=j=1mTeff(i,j), where m=the total number of SNPs on a chromosome
  4. Teff=i=123Teff(i)

Since this algorithm only accounts for pair-wise LD, it provides a conservative estimate of the number of effective tests.

Supplementary Material

Acknowledgments

We thank all of the families who have participated in and contributed to the public resources that we have used in these studies. The Broad Institute Center for Genotyping and Analysis is supported by grant U54 RR020278 from the National Center for Research Resources. The Gene Discovery Project of Johns Hopkins was funded by grants from the National Institutes of Mental Health (MH60007, MH081754) and the Simons Foundation. This study was funded in part through a grant from the Autism Consortium of Boston. Support for the EDSP family sample was provided by the NLM Family foundation. Support for the MGH-Finnish collaborative sample was provided by NARSAD. Support for the HMCA came from NIMH (1R01 MH083565), the Nancy Lurie Marks (NLM) Family Foundation, the Simons Foundation. E.M.M. is supported by the NIMH (1K23MH080954). Support for the Iranian family sample was provided by the Special Education Organization of Iran, under the Iranian Ministry of Education. L.A.W. was supported by a Ruth L. Kirschstein National Research Service Award.

The collection of data and biomaterials that participated in the National Institute of Mental Health (NIMH) Autism Genetics Initiative has been supported by National Institute of Health grants MH52708, MH39437, MH00219, and MH00980; National Health Medical Research Council grant 0034328; and by grants from the Scottish Rite, the Spunk Fund, Inc., the Rebecca and Solomon Baker Fund, the APEX Foundation, the National Alliance for Research in Schizophrenia and Affective Disorders (NARSAD), the endowment fund of the Nancy Pritzker Laboratory (Stanford); and by gifts from the Autism Society of America, the Janet M. Grace Pervasive Developmental Disorders Fund, and families and friends of individuals with autism. The Principal Investigators and Co-Investigators were: Stanford University, Stanford: Neil Risch, Ph.D., Richard M. Myers, Ph.D., Donna Spiker, Ph.D., Linda J. Lotspeich, M.D., Joachim Hallmayer, M.D., Helena C. Kraemer, Ph.D., Roland D. Ciaranello, M.D., Luigi Luca Cavalli-Sforza, M.D.; University of Utah, Salt Lake City: William M. McMahon, M.D. and P. Brent Petersen. The Stanford team is indebted to the parent groups and clinician colleagues who referred families and extends their gratitude to the families with individuals with autism who were partners in this research.

The collection data and biomaterials also come from the Autism Genetic Resource Exchange (AGRE) collection. This program has been supported by a National Institute of Health grant MH64547 and the Cure Autism Now Foundation. The Principal Investigator is Daniel H. Geschwind, M.D., Ph.D. (UCLA). The Co-Principal Investigators include Stanley F. Nelson, M.D. and Rita Cantor, Ph.D. (UCLA), Christa Lese Martin, Ph.D. (U. Chicago), T. Conrad Gilliam, Ph.D (Columbia). Co-investigators include Maricela Alarcon Ph.D. (UCLA), Kenneth Lange, Ph.D. (UCLA), Sarah J. Spence M.D. Ph.D. (UCLA), David H. Ledbetter Ph.D. (Emory) and Hank Juo, M.D., Ph.D. (Columbia). Scientific oversight of the AGRE program is provided by a steering committee (Chair: Daniel H. Geschwind, M.D., Ph.D. Members: W. Ted Brown, M.D., Ph.D., Maja Bucan, Ph.D., Joseph Buxbaum, Ph.D., T. Conrad Gilliam, Ph.D., David Greenberg, Ph.D., David Ledbetter, Ph.D., Bruce Miller, M.D., Stanley F. Nelson, M.D., Jonathan Pevsner, Ph.D., Carol Sprouse, Ed.D., Gerard Schellenberg, Ph.D., Rudolph Tanzi, Ph.D.

The AGP work was supported by the following grants:

  1. The Hilibrand Foundation (Principal Investigator: Joachim Hallmayer)
  2. Autism Speaks (for the AGP)
  3. Grants from the National Institutes of Health (NIH): MH61009 (James S. Sutcliffe); MH55135 (Susan E. Folstein); MH55284 (Joseph Piven); HD055782 (Ellen M. Wijsman), NS042165 (Joachim F Hallmayer).
  4. Fundação para a Ciência e Tecnologia (POCTI/39636/ESP/2001) Fundação Calouste Gulbenkian (Astrid Vincente).
  5. INSERM, Fondation de France, Fondation Orange, Fondation pour la Recherche Médicale (Catalina Betancur/Marion Leboyer), and the Swedish Science Council (Christopher Gillberg)
  6. The Seaver Foundation (Joseph Buxbaum).
  7. The Children’s Medical & Research Foundation (CMRF), Our Lady’s Children’s Hospital, Crumlin, Ireland (Sean Ennis).
  8. The Medical Research Council (MRC) (Anthony Monaco/Anthony Bailey)

Fresh-frozen brain tissue samples were obtained through the Autism Tissue Program and the Harvard Brain Bank.

Author List

Writing Group: Lauren A. Weiss, Dan E. Arking, Mark J. Daly, Aravinda Chakravarti

JHU – NIMH Genome Scan Team: Dan E. Arking1, Camille W. Brune2, Kristen West1, Ashley O’Connor1, Gina Hilton1, Rebecca L. Tomlinson76, Andrew B. West76, Edwin H. Cook Jr.2, Aravinda Chakravarti1

Autism Consortium - AGRE Genome Scan Team: Lauren A. Weiss3,4,a, Todd Green3,4, Shun-Chiao Chang3, Stacey Gabriel4, Casey Gates4, Ellen Hanson5, Andrew Kirby3,4, Joshua Korn3,4, Finny Kuruvilla3,4, Steven McCarroll3,4, Eric Morrow3,4,6,b, Benjamin Neale3,4, Shaun Purcell3,4, Roksana Sasanfar3,7,Carrie Sougnez4, Christine Stevens4, David Altshuler3,4, James Gusella3,4, Susan L. Santangelo3, Pamela Sklar3,4, Rudolph Tanzi3, Mark J. Daly3,4

Replication Teams

Autism Genome Project Consortium (listed alphabetically): Richard Anney28, Anthony J. Bailey8, Gillian Baird9, Agatino Battaglia56, Tom Berney11, Catalina Betancur12, Sven Bölte13, Patrick F. Bolton14, Jessica Brian15, Susan E. Bryson16, Joseph D. Buxbaum17, Ines Cabrito51, Guiqing Cai17, Rita M. Cantor18, Edwin H. Cook Jr.2, Hilary Coon19, Judith Conroy25, Catarina Correia51, Christina Corsello20, Emily L. Crawford46, Michael L. Cuccaro21, Geraldine Dawson60, Maretha de Jonge23, Bernie Devlin24, Eftichia Duketis13, Sean Ennis25, Annette Estes22, Penny Farrar38, Eric Fombonne26, Christine M. Freitag13, Louise Gallagher28, Daniel H. Geschwind29, John Gilbert21, Michael Gill28, Christopher Gillberg53, Jeremy Goldberg30, Andrew Green25, Jonathan Green31, Stephen J. Guter2, Jonathan L. Haines32, Joachim Hallmayer33, Vanessa Hus20, Sabine M. Klauck34, Olena Korvatska55, Janine A. Lamb35, Magdalena Laskawiec8, Marion Leboyer54, Ann Le Couteur11, Bennett L. Leventhal2, Xiao-Qing Liu15, 44, Catherine Lord20, Linda Lotspeich33, Elena Maestrini58, Tiago Magalhaes51, William Mahoney36, Carine Mantoulan37, Helen McConachie11, Christopher J McDougle57, William M. McMahon19, Christian R. Marshall44, Judith Miller19, Nancy J. Minshew2, Anthony P. Monaco38, Jeff Munson22, John I Nurnberger Jr57, Guiomar Oliveira52, Alistair Pagnamenta38, Katerina Papanikolaou39, Jeremy R. Parr8, Andrew D. Paterson15, 44, Margaret A Pericak-Vance21, Andrew Pickles40, Dalila Pinto44, Joseph Piven41, David J Posey57, Annemarie Poustka34,x, Fritz Poustka13, Regina Regan25, Jennifer Reichert17, Katy Renshaw8, Wendy Roberts15, Bernadette Roge37, Michael L. Rutter42, Jeff Salt2, Gerard D. Schellenberg59, Stephen W. Scherer44, James S. Sutcliffe46, Peter Szatmari30, Katherine Tansey28, Ann P. Thompson30, John Tsiantis39, Herman Van Engeland23, Astrid M. Vicente51, Veronica J. Vieland10, Fred Volkmar47, Simon Wallace8, Thomas H. Wassink48, Ellen M. Wijsman49, Kirsty Wing38, Kerstin Wittemeyer37, Brian L. Yaspan46, Lonnie Zwaigenbaum50

The Homozygosity Mapping Collaborative for Autism (HMCA): Eric M. Morrow3,4,6,61,b, Seung-Yun Yoo4,6,61, Robert Sean Hill4,6,61, Nahit M. Mukaddes62, Soher Balkhy63, Generoso Gascon63,64, Samira Al-Saad66, Asif Hashmi65, Janice Ware5, Robert M. Joseph67, Elaine LeClair5, Jennifer N. Partlow6,61, Brenda Barry6,61, and Christopher A. Walsh4,6,61

MGH-Oulu Study: David Pauls3, Irma Moilanen68, Hanna Ebeling68, Marja-Leena Mattila68, Sanna Kuusikko68, Katja Jussila68, Jaakko Ignatius68

MGH-Iran Study: Roksana Sasanfar3,7, Ala Tolouei7, Majid Ghadami7, Maryam Rostami69, Azam Hosseinipour7, and Maryam Valujerdi7

MGH-EDSP Study: Susan L. Santangelo3, Kara Andresen3,70, Brian Winkloski3, Stephen Haddad3

Children’s Hospital Boston: Lou Kunkel6, Zak Kohane6, Tram Tran6, Sek Won Kong6, Stephanie Brewster O’Neil6, Ellen M. Hanson5, Rachel Hundley5, Ingrid Holm6, Heather Peters6, Elizabeth Baroni6, Aislyn Cangialose6, Lindsay Jackson6, Lisa Albers6, Ronald Becker6, Carolyn Bridgemohan6, Sandra Friedman6, Kerim Munir6, Ramzi Nazir6, Judith Palfrey6, Alison Schonwald6, Esau Simmons6, Leonard A. Rappaport5

Montreal: Julie Gauthier71, Laurent Mottron72, Ridha Joober26, Eric Fombonne26, Guy Rouleau72

Finland: Karola Rehnstrom73,74, Lennart von Wendt73,74, Leena Peltonen73,74,75

AFFILIATION LIST

1Center for Complex Disease Genomics, McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, Baltimore, MD 21205; 2Institute for Juvenile Research, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL; 3Center for Human Genetic Research, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114; 4Broad Institute of MIT and Harvard, Cambridge, MA 02142; 5Developmental Medicine Center, Children’s Hospital Boston, Boston, MA, 02115; 6Division of Genetics, Children’s Hospital Boston and Harvard Medical School, Boston, MA, 02115; 7Special Education Organization, Tehran, IRAN; 8University Department of Psychiatry, Warneford Hospital, Headington, Oxford, UK. 9Newcomen Centre, Guy’s Hospital, London, UK. 10Battelle Center for Mathematical Medicine, The Research Institute at Nationwide Children’s Hospital and The Ohio State University, Columbus, Ohio, USA. 11Child and Adolescent Mental Health, University of Newcastle, Sir James Spence Institute, Newcastle upon Tyne, UK. 12INSERM U952, Université Pierre et Marie Curie, Paris, France. 13Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, J.W Goethe University Frankfurt, Frankfurt, Germany. 14Department of Child and Adolescent Psychiatry, Institute of Psychiatry, London, UK. 15Autism Research Unit, The Hospital for Sick Children and Bloorview Kids Rehabilitation, University of Toronto, Toronto, Ontario, Canada. 16Department of Pediatrics and Psychology, Dalhousie University, Halifax, Nova Scotia, Canada. 17Laboratory of Molecular Neuropsychiatry, Seaver Autism Center for Research and Treatment, Departments of Psychiatry, Genetics and Genomic Sciences, and Neuroscience, Mount Sinai School of Medicine, New York, NY 10025, 18Department of Human Genetics, University of California - Los Angeles School of Medicine, Los Angeles, California, USA. 19Psychiatry Department, University of Utah Medical School, Salt Lake City, Utah, USA. 20Autism and Communicative Disorders Centre, University of Michigan, Ann Arbor, Michigan, USA. 21Miami Institute for Human Genomics, University of Miami, Miami, Florida, USA. 22Depts. of Psychology and Psychiatry, University of Washington, Seattle, Washington, USA. 23Department of Child Psychiatry, University Medical Center, Utrecht, The Netherlands. 24University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. 25School of Medicine and Medical Science University College, Dublin, Ireland. 26Division of Psychiatry, McGill University, Montreal, Quebec, Canada. 27Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany. 28Autism Genetics Group, Department of Psychiatry, School of Medicine, Trinity College Dublin, Ireland. 29Department of Neurology, University of California - Los Angeles School of Medicine, Los Angeles, California, USA. 30Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada. 31Academic Department of Child Psychiatry, Booth Hall of Children’s Hospital, Blackley, Manchester, UK. 32Centre for Human Genetics Research, Vanderbilt University Medical Centre, Nashville, Tennessee, USA. 33Child and Adolescent Psychiatry and Child Development, Stanford University School of Medicine, Stanford, California, USA. 34Deutsches Krebsforschungszentrum, Molekulare Genomanalyse, Heidelberg, Germany. 35Centre for Integrated Genomic Medical Research, University of Manchester, Manchester, UK. 36Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada. 37Centre d’Eudes et de Recherches en Psychopathologie, University de Toulouse Le Miral, Toulouse, France. 38Wellcome Trust Centre for Human Genetics, University of Oxford, UK. 39University Department of Child Psychiatry, Athens University, Medical School, Agia Sophia Children’s Hospital, Athens, Greece. 40Department of Medicine, School of Epidemiology and Health Science, University of Manchester, Manchester, UK. 41Carolina Institute for Developmental Disabilities, University of North Carolina, Chapel Hill, North Carolina, USA. 42Social, Genetic and Developmental Psychiatry Centre, Institute Of Psychiatry, London, UK. 43Veterans Affairs, Department of Medicine, University of Washington, Seattle, Washington, USA. 44The Centre for Applied Genomics and Program in Genetics and Genome Biology, The Hospital for Sick Children and Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada. 45Department of Pediatrics and Howard Hughes Medical Institute Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA. 46 Vanderbilt Kennedy Center and Center for Molecular Neuroscience, Vanderbilt University, Nashville, Tennessee, USA. 47Child Study Centre, Yale University, New Haven, Connecticut, USA. 48Department of Psychiatry, Carver College of Medicine, Iowa City, Iowa, USA. 49Department of Biostatistics and Medicine, University of Washington, Seattle, Washington, USA. 50Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada. 51Instituto Nacional de Saude Dr Ricardo Jorge Instituto Gulbenkian de Cîencia Lisbon, Portugal. 52Hospital Pediatrico de Coimbra Coimbra, Portugal. 53Department of Child and Adolescent Psychiatry, Goteborg University, Goteborg, Sweden. 54INSERM U995, Department of Psychiatry, Groupe hospitalier Henri Mondor-Albert Chenevier, AP-HP, Créteil, France. 55Department of Medicine, University of Washington, Seattle, Washington, USA. 56Stella Maris Institute, Department of Child and Adolescent Neurosciences, Italy. 57Department of Psychiatry, Indiana University School of Medicine, Indianapolis, USA 58Department of Biology, University of Bologna, Italy, 59Pathology and Laboratory Medicine, University of Pennsylvania, Pennsylvania, USA. 60Autism Speaks, USA. 61Department of Neurology and Howard Hughes Medical Institute, Beth Israel Deaconess Medical Center, Boston, MA. 62Department of Child Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. 63Department of Neurosciences and Pediatrics, King Faisal Specialist Hospital and Research Centre, Jeddah, Kingdom of Saudi Arabia. 64Clinical Neurosciences & Pediatrics, Brown University School of Medicine, Providence, Rhode Island. 65Department of Neurology, Combined Military Hospital, Lahore, Pakistan. 66Kuwait Center for Autism, Kuwait City, Kuwait. 67Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA. 68Department of Child Psychiatry and Department of Clinical Genetics, Oulu University Hospital and Oulu University, Oulu, FINLAND. 69Medical Genetic Diagnosis Department, National Institute for Genetic Engineering and Biotechnology, Tehran, Iran. 70Casa de Corazon, Taos, New Mexico. 71Centre de recherche du CHUM, Hôpital Notre-Dame, Montreal, Quebec, Canada. 72Sainte-Justine Hospital Research Center, Universite de Montreal, Montréal, Quebec, Canada. 73Department of Medical Genetics, University of Helsinki, Helsinki, Finland. 74Department of Molecular Medicine, National Public Health Institute, Helsinki, Finland. 75Wellcome Trust Sanger Institute, Hinxton, United Kingdom, 76Center for Neurodegeneration and Experimental Therapeutics, University of Alabama School of Medicine, Birmingham, AL.

aCurrent affiliation: Department of Psychiatry, Institute for Human Genetics, Center for Neurobiology and Psychiatry, UCSF, San Francisco, CA.

bCurrent affiliation: Deptartment of Molecular Biology, Cell Biology and Biochemistry, and Institute for Brain Science, Brown University, Providence, RI

xdeceased

Footnotes

AUTHOR CONTRIBUTION STATEMENT

LAW, DEA, MJD, AC led design and execution of joint scan analyses and manuscript writing.

JHU-NIMH Genome Scan Team: DEA and AC led study design and analysis of scan; CWB and EHC provided evaluation of phenotype data, phenotype definition from primary data and editing of the manuscript; KW, AO’C and GH conducted primary and replication genotyping with allele calling; RLT and ABW performed expression analysis and editing of the manuscript.

Autism Consortium-AGRE Genome Scan Team: LAW, TG and MJD performed data processing and analysis for the genome-wide association scan; S-C C, EH, EM, RS and SLS provided evaluation of phenotype data and phenotype definition from primary data; SG, CG, CS and CS led genotyping team; AK, JK, FK, SM, BN, and SP performed and evaluated allele calling and advised the analysis; MJD, LAW, RT, PS, SLS, JG, DA designed and initiated the study and provided manuscript comments and edits.

Replication Teams: Each replication team provided genotypes, phenotypes and analysis of top ranking SNPs from the combined genome-wide association scan and contributed comments during manuscript preparation.

DISCLOSURES: Aravinda Chakravarti is a paid member of the Scientific Advisory Board of Affymetrix, a role that is managed by the Committee on Conflict of Interest of the Johns Hopkins University School of Medicine.

Reprints and permissions information is available at www.nature.com/reprints.

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