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Nature 460, 744-747 (6 August 2009) | doi:10.1038/nature08186; Received 16 March 2009; Accepted 5 June 2009; Published online 1 July 2009

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Common variants conferring risk of schizophrenia

Hreinn Stefansson1,48, Roel A. Ophoff2,3,48, Stacy Steinberg1,48, Ole A. Andreassen4, Sven Cichon5, Dan Rujescu6, Thomas Werge7, Olli P. H. Pietiläinen8,9, Ole Mors10, Preben B. Mortensen11, Engilbert Sigurdsson12,13, Omar Gustafsson1, Mette Nyegaard14, Annamari Tuulio-Henriksson15, Andres Ingason1, Thomas Hansen7, Jaana Suvisaari15, Jouko Lonnqvist15, Tiina Paunio16, Anders D. Børglum10,14, Annette Hartmann6, Anders Fink-Jensen17, Merete Nordentoft18, David Hougaard19, Bent Norgaard-Pedersen19, Yvonne Böttcher1, Jes Olesen20, René Breuer21, Hans-Jürgen Möller22, Ina Giegling6, Henrik B. Rasmussen7, Sally Timm23, Manuel Mattheisen5, István Bitter24, János M. Réthelyi24, Brynja B. Magnusdottir12,13, Thordur Sigmundsson12,13, Pall Olason1, Gisli Masson1, Jeffrey R. Gulcher1, Magnus Haraldsson12,13, Ragnheidur Fossdal1, Thorgeir E. Thorgeirsson1, Unnur Thorsteinsdottir1,13, Mirella Ruggeri25, Sarah Tosato25, Barbara Franke26, Eric Strengman2, Lambertus A. Kiemeney27, †Genetic Risk and Outcome in Psychosis (GROUP), Ingrid Melle4, Srdjan Djurovic28, Lilia Abramova29, Vasily Kaleda29, Julio Sanjuan30, Rosa de Frutos31, Elvira Bramon32, Evangelos Vassos32,33, Gillian Fraser34, Ulrich Ettinger32,33, Marco Picchioni32, Nicholas Walker35, Timi Toulopoulou33, Anna C. Need36, Dongliang Ge36, Joeng Lim Yoon37, Kevin V. Shianna36, Nelson B. Freimer3, Rita M. Cantor3,37, Robin Murray32,33, Augustine Kong1, Vera Golimbet29, Angel Carracedo38, Celso Arango39, Javier Costas40, Erik G. Jönsson41, Lars Terenius41, Ingrid Agartz41, Hannes Petursson12,13, Markus M. Nöthen42, Marcella Rietschel21, Paul M. Matthews43, Pierandrea Muglia44, Leena Peltonen8,9, David St Clair34, David B. Goldstein36, Kari Stefansson1,13 & David A. Collier32,45

  1. deCODE genetics, Sturlugata 8, IS-101 Reykjavik, Iceland.
  2. Department of Medical Genetics and Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands.
  3. UCLA Center for Neurobehavioral Genetics, Charles E. Young Drive South, Los Angeles, California 90024, USA.
  4. Department of Psychiatry, Ullevål University Hospital and Institute of Psychiatry, University of Oslo, Kirkeveien 166, N-0407 Oslo, Norway.
  5. Department of Genomics, Life and Brain Center, University of Bonn, Sigmund-Freud-Strasse 25, D-53127 Bonn, Germany.
  6. Division of Molecular and Clinical Neurobiology, Department of Psychiatry, Ludwig-Maximilians-University, Nus zligbaumstrasse 7, 80336 Munich, Germany.
  7. Research Institute of Biological Psychiatry, Mental Health Centre Sct. Hans Copenhagen University Hospital, DK-4000 Roskilde, Denmark.
  8. Institute of Molecular Medicine, Biomedicum Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland.
  9. Wellcome Trust Sanger Institute, Hinxton, Cambridge CB10 1SA, UK.
  10. Centre for Psychiatric Research, Aarhus University Hospital, Risskov, Skovagervej 2, 8240 Risskov, Denmark.
  11. National Centre for Register-based Research, Aarhus University, Taasingegade 1, DK-8000 Aarhus, Denmark.
  12. Department of Psychiatry, National University Hospital, Hringbraut, 101 Reykjavik, Iceland.
  13. University of Iceland, School of Medicine, Laeknagardi, 101 Reykjavik, Iceland.
  14. Department of Human Genetics, The Bartholin Building, Aarhus University, DK-8000 Arhus C, Denmark.
  15. Department of Mental Health and Alcohol Research, National Public Health Institute, Mannerheimintie 166, FIN-00300 Helsinki, Finland.
  16. Department for Molecular Medicine, National Public Health Institute, Biomedicum, Haartmaninkatu 8, 00290 Helsinki, Finland.
  17. Mental Health Centre Rigshospitalet, Copenhagen University Hospital, DK-2100 Copenhagen Ø, Denmark.
  18. Psychiatric Centre Bisbebjerg, Building 13A, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark.
  19. Section of Neonatal Screening and Hormones, Department Clinical Chemistry and Immunology, The State Serum Institute, Artillerivej 5, 2300 Copenhagen S, Denmark.
  20. Department of Neurology, 57 Nordre Ringvej, Glostrup Hospital, Glostrup, DK-2600 Copenhagen, Denmark.
  21. Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, University of Heidelberg, J5, D-68159 Mannheim, Germany.
  22. Department of Psychiatry, Ludwig-Maximilians-University, Nus zligbaumstrasse 7, 80336 Munich, Germany.
  23. Mental Health Centre Frederiksberg, Copenhagen University Hospital, DK-2000 Frederiksberg, Denmark.
  24. Semmelweis University, Department of Psychiatry and Psychotherapy, Budapest 1083, Hungary.
  25. Section of Psychiatry and Clinical Psychology, University of Verona, Verona, 37134 Verona, Italy.
  26. Department of Human Genetics, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
  27. Department of Epidemiology and Biostatistics and Department of Urology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
  28. Department of Medical Genetics, Ulleval University Hospital and Institute of Psychiatry, University of Oslo, Kirkeveien 166, N-0407 Oslo, Norway.
  29. Mental Health Research Center, Russian Academy of Medical Sciences, Zagorodnoe sh. 2/2, 117152 Moscow, Russia.
  30. Unidad de Psiquiatría, Facultad de Medicina, Universidad de Valencia, CIBERSAM, 46010 Valencia, Spain.
  31. Departamento de Genética. Facultad de Biología, Universidad de Valencia, CIBERSAM, Spain.
  32. Division of Psychological Medicine, Institute of Psychiatry, King's College, London SE5 8AF, UK.
  33. Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College, London SE5 8AF, UK.
  34. Department of Mental Health, University of Aberdeen, Royal Cornhill Hospital, Aberdeen AB25 2ZD, UK.
  35. Ravenscraig hospital, Inverkip Road, Greenock PA16 9HA, UK.
  36. Institute for Genome Sciences and Policy, Center for Population Genomics and Pharmacogenetics, 4011 GSRB II 103 Research Drive, Duke University, DUMC Box 3471, Durham, North Carolina 27708, USA.
  37. Department of Human Genetics, UCLA, 695 Charles Young Drive South, Los Angeles, California 90095, USA.
  38. Fundación Pública Galega de Medicina Xenómica-Complexo Universitario Hospitalario de Santiago, and CIBER de Enfermedades Raras (CIBERER), IML- Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain.
  39. Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
  40. Fundación Pública Galega de Medicina Xenómica, and CIBER de Enfermedades Raras (CIBERER), 46010 Valencia, Spain.
  41. Department of Clinical Neuroscience, HUBIN project, Karolinska Institutet and Hospital, R5:00, SE-171 76 Stockholm, Sweden.
  42. Institute of Human Genetics, University of Bonn, Wilhelmstrasse 31, D-53111 Bonn, Germany.
  43. Clinical Imaging Centre, Clinical Pharmacology and Discovery Medicine, GlaxoSmithKline, Hammersmith Hospital, London W12 ONN, UK.
  44. Medical Genetics, GlaxoSmithKline R&D, Via A. Fleming 4, 37135 Verona, Italy.
  45. Psychiatric Laboratory, Department of Psychiatry, West China Hospital, Sichuan University, 610065 Sichuan, China.
  46. Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Postbus 85060, 3508 AB, Utrecht, The Netherlands.
  47. Academic Medical Centre University of Amsterdam, Department of Psychiatry, Amsterdam, NL326 Groot-Amsterdam, The Netherlands.
  48. Maastricht University Medical Centre, South Limburg Mental Health Research and Teaching Network, P. Debyelaan 25, 6229 HX Maastricht, Maastricht, The Netherlands.
  49. University Medical Center Groningen, Department of Psychiatry, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
  50. These authors contributed equally to this work.

Correspondence to: Kari Stefansson1,13 Correspondence and requests for materials should be addressed to K.S. (Email: kari.stefansson@decode.is).

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Schizophrenia is a complex disorder, caused by both genetic and environmental factors and their interactions. Research on pathogenesis has traditionally focused on neurotransmitter systems in the brain, particularly those involving dopamine. Schizophrenia has been considered a separate disease for over a century, but in the absence of clear biological markers, diagnosis has historically been based on signs and symptoms. A fundamental message emerging from genome-wide association studies of copy number variations (CNVs) associated with the disease is that its genetic basis does not necessarily conform to classical nosological disease boundaries. Certain CNVs confer not only high relative risk of schizophrenia but also of other psychiatric disorders1, 2, 3. The structural variations associated with schizophrenia can involve several genes and the phenotypic syndromes, or the 'genomic disorders', have not yet been characterized4. Single nucleotide polymorphism (SNP)-based genome-wide association studies with the potential to implicate individual genes in complex diseases may reveal underlying biological pathways. Here we combined SNP data from several large genome-wide scans and followed up the most significant association signals. We found significant association with several markers spanning the major histocompatibility complex (MHC) region on chromosome 6p21.3-22.1, a marker located upstream of the neurogranin gene (NRGN) on 11q24.2 and a marker in intron four of transcription factor 4 (TCF4) on 18q21.2. Our findings implicating the MHC region are consistent with an immune component to schizophrenia risk, whereas the association with NRGN and TCF4 points to perturbation of pathways involved in brain development, memory and cognition.