Identification of Genes Associated with Hirschsprung Disease, Based on Whole-genome Sequence Analysis, and Potential Effects on Enteric Nervous System Development

Abstract

Background & Aims Hirschsprung disease, or congenital aganglionosis, is believed to be oligogenic—caused by multiple genetic factors. We performed whole-genome sequence analyses of patients with Hirschsprung disease to identify genetic factors that contribute to disease development and analyzed the functional effects of these variants. Methods We performed whole-genome sequence analyses of 443 patients with short-segment disease, recruited from hospitals in China and Vietnam, and 493 ethnically matched individuals without Hirschsprung disease (controls). We performed genome-wide association analyses and gene-based rare variant burden tests to identify rare and common disease-associated variants and study their interactions. We obtained induced pluripotent stem cell (iPSC) lines from 4 patients with Hirschsprung disease and 2 controls, and used these to generate enteric neural crest cells for transcriptomic analyses. We assessed the neuronal lineage differentiation capability of iPSC-derived enteric neural crest cells using an in vitro differentiation assay. Results We identified 4 susceptibility loci, including 1 in the phospholipase D1 gene (PLD1; P=7.4x10–7). The patients had a significant excess of rare protein-altering variants in genes previously associated with Hirschsprung disease, and in the beta-secretase 2 gene (BACE2; P=2.9x10–6). The epistatic effects of common and rare variants across these loci provided a sensitized background that increased risk for the disease. In studies of the iPSCs, we observed common and distinct pathways associated with variants in RET that affect risk. In functional assays, we found variants in BACE2 to protect enteric neurons from apoptosis. We propose that alterations in BACE1 signaling via APP and BACE2 contribute to pathogenesis of Hirschsprung disease. Conclusions In whole-genome sequence analyses of patients with Hirschsprung disease, we identified rare and common variants associated with disease risk. Using iPSC cells, we discovered some functional effects of these variants.