Previously in The Spittoon, we discussed two papers that identified genetic variants associated with hemoglobin levels in circulating blood.

But blood consists of much more than hemoglobin, and it is responsible for much more than just transporting oxygen. This week Nature Genetics published the results of two of the largest blood studies to date, which together identified dozens of new variants associated with nine blood-related traits.

In addition to red blood cells, which carry hemoglobin, whole blood contains white blood cells—a crucial part of our immune system—and platelets, which are important for clotting. All of these cellular components are suspended in a protein-rich plasma that makes up most of the volume of blood, and maintains the pressure needed to deliver the blood’s cargo throughout a person’s body.

Like hemoglobin levels, measurements of other blood traits can be informative about health. An abnormally high white blood cell count and platelet volume have both been linked to an increased risk for heart attack. These measurements can also indicate the presence of infectious disease, immunological disorders or cancers.

Nicole Soranzo and her colleagues in the HaemGen consortium measured hemoglobin concentration (Hb), red blood cell count (RBC), red blood cell volume (MCV), platelet count (PLT), platelet volume (MPV), white blood cell count (WBC), the amount of hemoglobin per red blood cell (mean corpuscular hemoglobin content, or MCH), and the amount of hemoglobin relative to the size of the cell (mean corpuscular hemoglobin concentration, or MCHC) in more than 14,000 healthy individuals from Europe. They found sixteen new genetic associations with blood traits from fifteen genomic regions not previously thought to be involved.

Santhi Ganesh and her colleagues in the CHARGE consortium measured Hb, MCV, RBC, MCH, MCHC, and the percent of red blood cells in whole blood (hematocrit, or Hct) in more than 24,000 Caucasian individuals from the U.S. and Europe. Here, they found nine new associated variants from eleven previously unassociated genomic regions.

(23andMe customers can see their data for the SNPs currently covered by 23andMe’s service using the Browse Raw Data feature. See table at the end of this post.)

One of the advantages of these studies is the number of traits that they analyzed.

“Until now, few genome-wide association studies have looked beyond single traits,” Soranzo’s co-author Christian Geiger said in a press release. “But, through a systematic analysis of correlated traits we can begin to discover such shared genetic variants, forming the basis for understanding how these processes interact to influence health and disease.”

Both teams noted several genomic regions that play a broad role in blood-related health. The HBS1L-MYB, TFR2-EPO, TMPRSS6 and HFE regions were all associated with at least three different traits. These regions have also been connected to fetal hemoglobin levels and the iron-overload condition hemochromatosis. Of these newly associated variants, many are close to genes that present promising candidates for further research.

Soranzo’s team went further by investigating whether two of the variants associated with increased platelet volume (PLT) rs11066301 and rs11065987, were also associated with coronary artery disease. They analyzed these SNPs in about 9,500 people with coronary artery disease and 10,500 healthy controls. They found that at both SNPs, each copy of a G increased odds of coronary artery disease by about 1.15 times.

(23andMe customers can see their data for rs11065987 by using the Browse Raw Data feature. 23andMe does not report on rs11066301, but we do report on rs11066320, which correlates perfectly with rs110066301. For rs110066320, the A allele corresponds to increased PLT and higher odds of coronary artery disease.)

When the researchers looked more closely at the region where rs11066301 and rs11065987 are located, they found a block of ten SNPs that tend to be inherited together, and which are all associated with increased PLT and risk of coronary artery disease. They also confirmed previous findings from other researchers of association between celiac disease and type 1 diabetes with SNPs in this block.

Data for chimpanzees and multiple human populations point to a relatively recent event in human evolution where the above-mentioned genetic variants swept across European populations — but not East Asian or African populations. Because the block of SNPs is located in an area of the genome involved in immune response, the authors suggest that these mutations may have given some populations a survival advantage against infection, despite increasing the risk for certain diseases.

SNPs associated with blood-related traits

* In some cases, 23andMe does not cover the original SNP, so a proxy SNP that correlates perfectly with the original in Europeans is reported instead.

SNPwatch gives you the latest news about research linking various traits and conditions to individual genetic variations. These studies are exciting because they offer a glimpse into how genetics may affect our bodies and health; but in most cases, more work is needed before this research can provide information of value to individuals. For that reason it is important to remember that like all information we provide, the studies we describe in SNPwatch are for research and educational purposes only. SNPwatch is not intended to be a substitute for professional medical advice; you should always seek the advice of your physician or other appropriate healthcare professional with any questions you may have regarding diagnosis, cure, treatment or prevention of any disease or other medical condition.

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It’s well established that defects in the cellular machinery that controls cell division can lead to cancer.  Now, new research shows that the risk for both brain and skin cancer can also be impacted by common DNA variations near a set of growth-regulating genes.

Five reports, published online this week in the journal Nature Genetics, show that variants near the CDKN2A and CDKN2B genes increase the risk of certain types of tumors.  Previous research has implicated these “tumor suppressor” genes in both skin and brain cancer. Mutations in CDKN2A are found in about 2% of all people with melanoma, and outright deletion of CDKN2A and CDKN2B is seen in approximately half of all brain tumors.

Two of the reports (Wrensch et al. and Shete et al.) focused on gliomas, which account for approximately 80% of all primary brain cancers and generally have a dismal prognosis.

The remaining three papers were skin cancer studies.  Two of these (Bishop et al. and Falchi et al.) focused on melanoma, while the third (Stacey et al.) looked at basal cell carcinoma.  Melanoma accounts for less than 5% of all skin cancers, but is responsible for most skin cancer deaths. Basal cell carcinoma is also serious, though not usually deadly, and is the most common type of cancer overall in people with European ancestry.

(In addition to SNPs near the CDKN2A and CDKN2B genes, several other SNPs were identified for each type of cancer.  23andMe customers can use the links in the table at the end of this post to see their data for all of these SNPs using the Browse Raw Data feature.  SNPs near the CDKN2A/CDKN2B genes are in bold.)

The disease-associated variants near the CDKN2A and CDKN2B genes were distinct for the three types of cancer studied.  This could mean that they each have separate risk-increasing effects, or that they are all pointing researchers in the direction of a single variant in the region that is involved in glioma, melanoma and basal cell carcinoma.

It’s no surprise that these genes, which play important roles in some of the most basic cellular processes, appear to be involved in several types of cancer. In fact, variation in and around CDKN2A and CDKN2B might be important for other diseases as well.  Previous research has also implicated SNPs near these genes in coronary artery disease and type 2 diabetes.

As more research is done, we can probably expect to see more variants in this region of DNA associated with more diseases.  It will be fascinating to see how they all connect to each other, and more importantly, what new insight they give scientists into how tiny DNA changes can have big health consequences.

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Lifestyle factors such as smoking or a high-fat diet are well-established contributors to heart attack risk, because they encourage the accumulation of sticky plaques inside the arteries that supply the heart with oxygen- and nutrient-rich blood.

Though genetics plays an almost equal role in the accumulation of plaques in the coronary arteries, the specific genes involved in the process are largely unknown.  Only one region of DNA on chromosome 9 has consistently been linked to heart disease.

(23andMe customers can learn more in the Heart Attack Research Report.)

Now five studies, published online yesterday in the journal Nature Genetics, have identified a bumper crop of genetic variations associated with coronary artery disease (the build up of plaque) and heart attack.  Although more work will be needed to confirm these associations and figure out exactly how they affect risk, these results are a major step forward in understanding the biology of heart disease. Eventually the variations identified in these and future studies may be useful for prediction, prevention or treatment of coronary artery disease and heart attack.

Four of the studies looked at the effects of individual SNPs on coronary artery disease or heart attack. 23andMe customers can check their data for many of these using the information at the end of this post. The fifth study looked at the effect of a combination of four SNPs.  23andMe cannot currently provide customers with the type of data described in this study.


Note: In each table, “Effect” refers to the increase in odds for each copy of the risk version compared to two copies of the non-risk version of the SNP.


Study: Myocardial Infarction Genetics Consortium
Early-onset heart attack (men 50 years old or younger, women 60 years old or younger)
Cases: More than 12,000
Controls: More than 12,000
Populations studied: European ancestry; United States, Sweden, Finland, Spain, Italy, U.K., Germany, Ireland and Iceland

Study: Gudbjartsson et al.
Heart Attack
Cases: 6,650
Controls: 40,621
Populations studied: European ancestry; Iceland, United States, New Zealand and Italy

Study: Erdmann et al.
Coronary Artery Disease
Cases: 19,407
Controls: 21,366
Populations studied: European ancestry; United States, Sweden, Finland, Spain, Italy, U.K. and Germany

Study: Ozaki et al.
Heart Attack
Cases: 3,337
Controls: 3,891
Population studied: Asian ancestry; Japan

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Diabetics have to be worried about more than just their cholesterol when it comes to the health of their arteries. They also have to watch their blood sugar to help prevent the build up of fatty plaques that can block blood flow.

But new research from the Joslin Diabetes Center and Harvard Medical School shows that high blood sugar may be more dangerous to some diabetics than others.

Dr. Alessandro Doria and colleagues found that a genetic variant on chromosome 9 previously associated with coronary artery disease (CAD) risk in the general population has an even greater effect in diabetics with poor blood sugar control. These results, published online today in the Journal of the American Medical Association, could someday help doctors identify people with diabetes who are at higher risk of CAD earlier, allowing them to aggressively target these patients for intervention.

People with diabetes are at least twice as likely as those without to have heart disease. Some studies suggest that middle-aged diabetics have the same high heart attack risk as people without diabetes who have already suffered a heart attack.

The first of two study groups was composed of 322 diabetics with coronary artery disease and 412 without. The researchers found that the risk for CAD was about the same in people with either the AA or AG genotype at rs2383206, even if they had poorly controlled blood sugar.

Having the GG genotype at rs2383206, however, increased the odds of CAD by about two-fold for diabetics with well-controlled blood sugar. And when high blood sugar was thrown into the mix, the odds of CAD for people with two Gs went up higher still – about four times compared to the lowest risk group.

In people with the GG genotype and a long history of high blood sugar, the odds of CAD were increased about seven times compared to diabetics with a history of well-controlled blood sugar.

(The study looked at rs2383206, which is available to 23andMe customers who were genotyped on the second version of our custom chip. But people who were genotyped on the first version can use rs2383207, the SNP we feature in the Health and Traits research report on Heart Attack, as a substitute. The G version is riskier for both SNPs.)

In a separate study group of 475 diabetics who were followed for 10 years, people with the AA or AG genotype at rs2383206 had the same risk of dying in general, or from cardiovascular disease in particular, regardless of their blood sugar. But for people with the GG genotype, the risk of death went up by a factor of two when blood sugar was not under control.

Both groups of diabetics Doria et al. studied were of European ancestry.

“While good glucose control is important for all people with diabetes, testing for this predisposing variant may help doctors identify patients for whom better control is an absolute necessity,” said Doria in a statement. The authors estimate that 30% of diabetics will have two Gs at rs2383206.

The probability of clinically significant CAD is about 30% for type 2 diabetics in general. The authors say this number could shoot up to 60% for diabetics with the GG genotype at rs2383206 and poorly controlled blood sugar.

The authors admit that this is a small study that will need verification. They also note that their findings are at odds with a previous report that found no difference between the risk conferred by SNPs in the 9p21 chromosomal region (where rs2383206 lies) in diabetic vs. non-diabetic subjects. Due to a number of methodological differences between the two studies, Doria et al say that no direct comparison of the results is possible.

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