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Am J Respir Cell Mol Biol. 2017 Mar;56(3):332-341. doi: 10.1165/rcmb.2016-0172OC.

Sex-Based Genetic Association Study Identifies CELSR1 as a Possible Chronic Obstructive Pulmonary Disease Risk Locus among Women.

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1 Channing Division of Network Medicine and.
2 Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
3 Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.
4 Harvard School of Public Health, Boston, Massachusetts.
5 Department of Medicine, University College London, London, United Kingdom.
6 Thoracic Institute, Hospital Clinic, Barcelona, Spain.
7 Department of Clinical Science, University of Bergen, Bergen, Norway.
8 Department of Geriatric Medicine Ullevaal, Institute of Clinical Medicine, Oslo University Hospital University of Oslo, Oslo, Norway.
9 Boston University School of Medicine, Boston, Massachusetts.
10 Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts.
11 National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts.
12 Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Denver, Colorado.
13 Division of Pulmonary Sciences and Critical Care Medicine, National Jewish Health, Denver, Colorado; and.
14 Johns Hopkins School of Public Health, Baltimore, Maryland.


Chronic obstructive pulmonary disease (COPD) is a complex disease with strong environmental and genetic influences and sexually dimorphic features. Although genetic risk factors for COPD have been identified, much of the heritability remains unexplained. Sex-based genetic association studies may uncover additional COPD genetic risk factors. We studied current and former smokers from COPD case-control cohorts (COPDGene non-Hispanic whites and African Americans, Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-Points, and Genetics of Chronic Obstructive Lung Disease). COPD was defined as post-bronchodilator forced expiratory volume in 1 second/forced vital capacity less than 0.70 and forced expiratory volume in 1 second percent predicted less than 80. Testing was performed across all cohorts and combined in a meta-analysis adjusted for age, pack-years, and genetic ancestry. We first performed genome-wide single-nucleotide polymorphism (SNP)-by-sex interaction testing on the outcome of COPD affection status. We performed sex-stratified association testing for SNPs with interaction P less than 10-6. We examined over 8 million SNPs in four populations, including 6,260 subjects with COPD (40.6% female) and 5,269 smoking control subjects (47.3% female). The SNP rs9615358 in the cadherin gene CELSR1 approached genome-wide significance for an interaction with sex (P = 1.24 × 10-7). In the sex-stratified meta-analysis, this SNP was associated with COPD among females (odds ratio, 1.37 [95% confidence interval, 1.25-1.49]; P = 3.32 × 10-7) but not males (odds ratio, 0.90 [95% confidence interval, 0.79-1.01]; P = 0.06). CELSR1 is involved in fetal lung development. In a human fetal lung tissue dataset, we observed greater CELSR1 expression in female compared with male samples. This SNP-by-sex genome-wide association analysis identified the fetal lung development gene, CELSR1, as a potential sex-specific risk factor for COPD. Identifying sex-specific genetic risk factors may reveal new insights into sexually dimorphic features of COPD.


chronic obstructive pulmonary disease; genetics; genome-wide association study; growth and development; sex

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