TY - JOUR
T1 - Genetic Predisposition to Symptomatic Lumbar Disk Herniation in Pediatric and Young Adult Patients
AU - Theodore, Nicholas
AU - Ahmed, Ali Karim
AU - Fulton, Travis
AU - Mousses, Spyro
AU - Yoo, Christopher
AU - Goodwin, Courtney Rory
AU - Danielson, Jill
AU - Sciubba, Daniel M.
AU - Giers, Morgan B.
AU - Kalani, Mohammad Yashar S.
N1 - Publisher Copyright:
© 2019 Lippincott Williams and Wilkins. All rights reserved.
PY - 2019/6/1
Y1 - 2019/6/1
N2 - Study Design.Case-control whole-genome sequencing analysis of a highly select, young cohort with symptomatic lumbar disk herniation (LDH) compared with the standard variation in a large reference population.Objective.To assess genetic influences predisposing pediatric and young adult patients to symptomatic LDH.Summary of Background Data.LDH has traditionally been attributed to natural weakening or mechanical insult, but recent literature supports a potential genetic influence.Methods.Young patients with symptomatic, clinically confirmed LDH who underwent surgical treatment were included. Patients were younger than the average age of presentation, limiting the influence of environmental risks. DNA collected from these patients was compared with a reference genome (1000 Genomes Project). A genome-wide association study using whole-genome sequencing was used to characterize genetic mutations potentially associated with LDH.Results.Among the 61 candidate genes flagged, 20 had missense mutations in 2 or more LDH cases. Missense mutations in collagen-encoding genes were observed in 12 of 15 patients (80%). A potential association with clinical presentation was indicated by odds ratios of key single-nucleotide polymorphism (SNP) variants in genes that encode collagen. Relative to the reference population, the LDH cohort demonstrated two statistically significant SNP variants in the gene encoding for aggrecan, a protein that facilitates load-bearing properties in the cartilaginous end plate. Aggrecan genes SNPs rs3817428 and rs11638262 were significantly associated with decreased odds of symptomatic LDH: odds ratio 0.05 (0.02-0.11) and 0.04 (0-0.26), respectively (P<1×10-7 for both).Conclusion.These results suggest that collagen-encoding variants may be a genetic risk factor for LDH. They also shed new light on the role of variants that impact aggrecan, which sustains the cartilaginous end plate. Genetic predisposition to LDH may therefore be related to a multimodal combination of mutations that affect the nucleus pulposus, annulus fibrosus, and the cartilaginous end plates.Level of Evidence: 4.
AB - Study Design.Case-control whole-genome sequencing analysis of a highly select, young cohort with symptomatic lumbar disk herniation (LDH) compared with the standard variation in a large reference population.Objective.To assess genetic influences predisposing pediatric and young adult patients to symptomatic LDH.Summary of Background Data.LDH has traditionally been attributed to natural weakening or mechanical insult, but recent literature supports a potential genetic influence.Methods.Young patients with symptomatic, clinically confirmed LDH who underwent surgical treatment were included. Patients were younger than the average age of presentation, limiting the influence of environmental risks. DNA collected from these patients was compared with a reference genome (1000 Genomes Project). A genome-wide association study using whole-genome sequencing was used to characterize genetic mutations potentially associated with LDH.Results.Among the 61 candidate genes flagged, 20 had missense mutations in 2 or more LDH cases. Missense mutations in collagen-encoding genes were observed in 12 of 15 patients (80%). A potential association with clinical presentation was indicated by odds ratios of key single-nucleotide polymorphism (SNP) variants in genes that encode collagen. Relative to the reference population, the LDH cohort demonstrated two statistically significant SNP variants in the gene encoding for aggrecan, a protein that facilitates load-bearing properties in the cartilaginous end plate. Aggrecan genes SNPs rs3817428 and rs11638262 were significantly associated with decreased odds of symptomatic LDH: odds ratio 0.05 (0.02-0.11) and 0.04 (0-0.26), respectively (P<1×10-7 for both).Conclusion.These results suggest that collagen-encoding variants may be a genetic risk factor for LDH. They also shed new light on the role of variants that impact aggrecan, which sustains the cartilaginous end plate. Genetic predisposition to LDH may therefore be related to a multimodal combination of mutations that affect the nucleus pulposus, annulus fibrosus, and the cartilaginous end plates.Level of Evidence: 4.
KW - aggrecan
KW - cartilaginous end plate
KW - collagen
KW - collagen-encoding genes
KW - genome-wide association study
KW - intervertebral disk disease
KW - lumbar disk herniation
KW - missense mutation
KW - next-generation sequencing
KW - single-nucleotide polymorphism
KW - variants
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U2 - 10.1097/BRS.0000000000002949
DO - 10.1097/BRS.0000000000002949
M3 - Article
C2 - 30475332
AN - SCOPUS:85067042336
SN - 0362-2436
VL - 44
SP - E640-E649
JO - Spine
JF - Spine
IS - 11
ER -