Associations of genetically determined iron status across the phenome: A mendelian randomization study

• Published in: PLoS medicine 2019-06, Vol.16 (6), p.e1002833-e1002833
• Main Authors: Gill, Dipender, Benyamin, Beben, Moore, Luke S P, Monori, Grace, Zhou, Ang, Koskeridis, Fotios, Evangelou, Evangelos, Laffan, Mike, Walker, Ann P, Tsilidis, Konstantinos K, Dehghan, Abbas, Elliott, Paul, Hyppönen, Elina, Tzoulaki, Ioanna
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anemia; Bias; Biology and Life Sciences; Biomarkers - blood; Biomedical research; Cardiovascular disease; Cellulitis; Cohort Studies; Councils; Dementia; Demographic aspects; Epidemiology; Female; Ferritin; Genes; Genetic aspects; Genetic diversity; Genetic research; Genetic variance; Genetics; Genome-wide association studies; Genome-Wide Association Study - methods; Genomes; Health; Health aspects; Health risks; Hemochromatosis; Heterogeneity; Humans; Hygiene; Hypercholesterolemia; Infections; Instruments (Equipment); Iron; Iron (Nutrient); Iron - blood; Iron deficiency; Iron deficiency anemia; Lipids; Male; Medical research; Medical schools; Medicine and Health Sciences; Mendelian Randomization Analysis - methods; Metabolism; Middle Aged; Minority & ethnic groups; Novels; Nutrient deficiency; Occupational health; Phenotype; Phenotypes; Physiological aspects; Population; Prospective Studies; Proteases; Public health; Randomization; Research centers; Restless legs syndrome; Risk factors; Serine; Skin; Statistical analysis; Transferrin; Transferrins; University colleges; Women
• ISSN: 1549-1676; 1549-1277; 1549-1676
• DOI: 10.1371/journal.pmed.1002833

Iron is integral to many physiological processes, and variations in its levels, even within the normal range, can have implications for health. The objective of this study was to explore the broad clinical effects of varying iron status. Genome-wide association study (GWAS) summary data obtained from 48,972 European individuals (55% female) across 19 cohorts in the Genetics of Iron Status Consortium were used to identify 3 genetic variants (rs1800562 and rs1799945 in the hemochromatosis gene [HFE] and rs855791 in the transmembrane protease serine 6 gene [TMPRSS6]) that associate with increased serum iron, ferritin, and transferrin saturation and decreased transferrin levels, thus serving as instruments for systemic iron status. Phenome-wide association study (PheWAS) of these instruments was performed on 424,439 European individuals (54% female) in the UK Biobank who were aged 40-69 years when recruited from 2006 to 2010, with their genetic data linked to Hospital Episode Statistics (HES) from April, 1995 to March, 2016. Two-sample summary data mendelian randomization (MR) analysis was performed to investigate the effect of varying iron status on outcomes across the human phenome. MR-PheWAS analysis for the 3 iron status genetic instruments was performed separately and then pooled by meta-analysis. Correction was made for testing of multiple correlated phenotypes using a 5% false discovery rate (FDR) threshold. Heterogeneity between MR estimates for different instruments was used to indicate possible bias due to effects of the genetic variants through pathways unrelated to iron status. There were 904 distinct phenotypes included in the MR-PheWAS analyses. After correcting for multiple testing, the 3 genetic instruments for systemic iron status demonstrated consistent evidence of a causal effect of higher iron status on decreasing risk of traits related to anemia (iron deficiency anemia: odds ratio [OR] scaled to a standard deviation [SD] increase in genetically determined serum iron levels 0.72, 95% confidence interval [CI] 0.64-0.81, P = 4 × 10-8) and hypercholesterolemia (hypercholesterolemia: OR 0.88, 95% CI 0.83-0.93, P = 2 × 10-5) and increasing risk of traits related to infection of the skin and related structures (cellulitis and abscess of the leg: OR 1.25, 95% CI 1.10-1.42, P = 6 × 10-4). The main limitations of this study relate to possible bias from pleiotropic effects of the considered genetic variants and misclassification of diagnoses in the H