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Evidence for three genetic loci involved in both anorexia nervosa risk and variation of body mass index

A Corrigendum to this article was published on 26 July 2016


The maintenance of normal body weight is disrupted in patients with anorexia nervosa (AN) for prolonged periods of time. Prior to the onset of AN, premorbid body mass index (BMI) spans the entire range from underweight to obese. After recovery, patients have reduced rates of overweight and obesity. As such, loci involved in body weight regulation may also be relevant for AN and vice versa. Our primary analysis comprised a cross-trait analysis of the 1000 single-nucleotide polymorphisms (SNPs) with the lowest P-values in a genome-wide association meta-analysis (GWAMA) of AN (GCAN) for evidence of association in the largest published GWAMA for BMI (GIANT). Subsequently we performed sex-stratified analyses for these 1000 SNPs. Functional ex vivo studies on four genes ensued. Lastly, a look-up of GWAMA-derived BMI-related loci was performed in the AN GWAMA. We detected significant associations (P-values <5 × 10−5, Bonferroni-corrected P<0.05) for nine SNP alleles at three independent loci. Interestingly, all AN susceptibility alleles were consistently associated with increased BMI. None of the genes (chr. 10: CTBP2, chr. 19: CCNE1, chr. 2: CARF and NBEAL1; the latter is a region with high linkage disequilibrium) nearest to these SNPs has previously been associated with AN or obesity. Sex-stratified analyses revealed that the strongest BMI signal originated predominantly from females (chr. 10 rs1561589; Poverall: 2.47 × 10−06/Pfemales: 3.45 × 10−07/Pmales: 0.043). Functional ex vivo studies in mice revealed reduced hypothalamic expression of Ctbp2 and Nbeal1 after fasting. Hypothalamic expression of Ctbp2 was increased in diet-induced obese (DIO) mice as compared with age-matched lean controls. We observed no evidence for associations for the look-up of BMI-related loci in the AN GWAMA. A cross-trait analysis of AN and BMI loci revealed variants at three chromosomal loci with potential joint impact. The chromosome 10 locus is particularly promising given that the association with obesity was primarily driven by females. In addition, the detected altered hypothalamic expression patterns of Ctbp2 and Nbeal1 as a result of fasting and DIO implicate these genes in weight regulation.

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We express our gratitude to all participants. We thank the following sources for funding or research: the German Ministry for Education and Research (National Genome Research Net-Plus 01GS0820 and 01KU0903; AS, MK and the CSCC were supported by 01EO1002, 01EO1502), the German Research Foundation (DFG; HI865/2-1, SFB940/1, SCHE1648/1-3, TS226/3-1), the European Community's Seventh Framework Programme (FP7/2007-2013) under grant agreement no. 245009 and no. 262055, and the National Institutes of Health (NIH; R01DK075787), funding to MHT from the Alexander von Humboldt Foundation, the Helmholtz Alliance ICEMED—Imaging and Curing Environmental Metabolic Diseases, through the Initiative and Networking Fund of the Helmholtz Association, the Helmholtz cross-program topic 'Metabolic Dysfunction.' the WTCCC3 WT088827/Z/09 entitled 'A genome-wide association study of anorexia nervosa.' We would like to thank the Exome Aggregation Consortium and the groups that provided exome variant data for comparison. A full list of contributing groups can be found at AH was supported by the ‘Landesprogramm für Geschlechtergerechte Hochschulen - Programmstrang Förderung von Denominationen in der Genderforschung.' The Children’s Hospital of Philadelphia/Price Foundation gratefully thank all the patients and their families who were enrolled in this study, as well as all the control subjects who donated blood samples to Children's Hospital of Philadelphia (CHOP) for genetic research purposes. We thank the Price Foundation for their support of the Collaborative Group effort that was responsible for recruitment of patients, collection of clinical information and provision of the DNA samples used in this study. We also thank the Klarman Family Foundation for supporting the study. We thank the technical staff at the Center for Applied Genomics at CHOP for producing the genotypes used for analyses and the nursing, medical assistant and medical staff for their invaluable help with sample recruitments. CTB and NJS are funded in part by the Scripps Translational Sciences Institute Clinical Translational Science Award (Grant Number U54 RR0252204-01). All genome-wide genotyping was funded by an Institute Development Award to the Center for Applied Genomics from the CHOP. 2011–2014 Davis Foundation Postdoctoral Fellowship Program in Eating Disorders Research Award to YG and the 2012–2015 Davis Foundation Postdoctoral Fellowship Program in Eating Disorders Research Award to DL.

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CMB is a grant recipient from Shire Pharmaceuticals, and none of the other authors declared.

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GENETIC CONSORTIUM FOR ANOREXIA NERVOSA (GCAN) Vesna Boraska Perica, Christopher S Franklin, James AB Floyd, Laura M Thornton, Laura M Huckins, Lorraine Southam, N William Rayner, Ioanna Tachmazidou, Kelly L Klump, Janet Treasure, Cathryn M Lewis, Ulrike Schmidt, Federica Tozzi, Kirsty iezebrink, Johannes Hebebrand, Philip Gorwood, Roger AH Adan, Martien JH Kas, Angela Favaro, Paolo Santonastaso, Fernando Fernández-Aranda, Monica Gratacos, Filip Rybakowski, Monika Dmitrzak-Weglarz, Jaakko Kaprio, Anna Keski-Rahkonen, Anu Raevuori-Helkamaa, Eric F Van Furth, Margarita CT Slof-Op’t Landt, James I Hudson, Ted Reichborn-Kjennerud, Gun Peggy S Knudsen, Palmiero Monteleone, Allan S Kaplan, Andreas Karwautz, Hakon Hakonarson, Wade H Berrettini, Yiran Guo, Dong Li, Nicholas J Schork, Gen Komaki, Tetsuya Ando, Hidetoshi Inoko, Tõnu Esko, Krista Fischer, Katrin Männik, Andres Metspalu, Jessica H Baker, Roger D Cone, Jennifer Dackor, Janiece E DeSocio, Christopher E Hilliard, Julie K O'Toole, Jacques Pantel, Jin P Szatkiewicz, Chrysecolla Taico, Stephanie Zerwas, Sara E Trace, Oliver S P Davis, Sietske Helder, Katharina Bühren, Roland Burghardt, Martina de Zwaan, Karin Egberts, Stefan Ehrlich, Beate Herpertz-Dahlmann, Wolfgang Herzog, Hartmut Imgart, André Scherag, Susann Scherag, Stephan Zipfel, Claudette Boni, Nicolas Ramoz, Audrey Versini, Marek K Brandys, Unna N Danner, Carolien de Kove, Judith Hendriks, Bobby P C Koeleman, Roel A Ophoff, Eric Strengman, Annemarie A van Elburg, Alice Bruson, Maurizio Clementi, Daniela Degortes, Monica Forzan, Elena Tenconi, Elisa Docampo, Geòrgia Escaramí Susana Jiménez-Murcia, Jolanta Lissowska, Andrzej Rajewski, Neonila Szeszenia-Dabrowska, Agnieszka Slopien, Joanna Hauser, Leila Karhunen, Ingrid Meulenbelt, P Eline Slagboom, Alfonso Tortorella, Mario Maj, George Dedoussis, Dimitris Dikeos, Fragiskos Gonidakis, Konstantinos Tziouvas, Artemis Tsitsika, Hana Papezova, Lenka Slachtova, Debora Martaskova, James L Kennedy, Robert D Levitan, Zeynep Yilmaz, Julia Huemer, Doris Koubek, Elisabeth Merl, Gudrun Wagner, Paul Lichtenstein, Gerome Breen, Sarah Cohen-Woods, Anne Farmer, Peter McGuffin, Sven Cichon, Ina Giegling, Stefan Herms, Dan Rujescu, Stefan Schreiber, H-Erich Wichmann, Christian Dina, Rob Sladek, Giovanni Gambaro, Nicole Soranzo, Antonio Julia, Sara Marsal, Raquel Rabionet, Valerie Gaborieau, Danielle M Dick, Aarno Palotie, Samuli Ripatti, Elisabeth Widén, Ole A Andreassen, Thomas Espeseth, Astri Lundervold, Ivar Reinvang, Vidar M Steen, Stephanie Le Hellard, Morten Mattingsdal, Ioanna Ntalla, Vladimir Bencko, Lenka Foretova, Vladimir Janout, Marie Navratilova, Steven Gallinger, Dalila Pinto, Stephen W Scherer, Harald Aschauer, Laura Carlberg, Alexandra Schosser, Lars Alfredsson, Bo Ding, Lars Klareskog, Leonid Padyukov, Chris Finan, Gursharan Kalsi, Marion Roberts, Darren W Logan, Leena Peltonen, Graham R S Ritchie, Jeff C Barrett, Xavier Estivill, Anke Hinney, Patrick F Sullivan, David A Collier, Eleftheria Zeggini, and Cynthia M Bulik.

WELLCOME TRUST CASE CONTROL CONSORTIUM 3 (WTCCC3) Carl A Anderson, Jeffrey C Barrett, James AB Floyd, Christopher S Franklin, Ralph McGinnis, Nicole Soranzo, Eleftheria Zeggini, Jennifer Sambrook, Jonathan Stephens, Willem H Ouwehand, Wendy L McArdle, Susan M Ring, David P Strachan, Graeme Alexander, Cynthia M Bulik, David A Collier, Peter J Conlon, Anna Dominiczak, Audrey Duncanson, Adrian Hill, Cordelia Langford, Graham Lord, Alexander P Maxwell, Linda Morgan, Leena Peltonen, Richard N Sandford, Neil Sheerin, Frederik O Vannberg, Hannah Blackburn, Wei-Min Chen, Sarah Edkins, Mathew Gillman, Emma Gray, Sarah E Hunt, Suna Nengut-Gumuscu, Simon Potter, Stephen S Rich, Douglas Simpkin, and Pamela Whittaker.

GENETIC INVESTIGATION OF ANTHROPOMETRIC TRAITS CONSORTIUM (GIANT) de Bakker P, Bültmann U, Geleijnse M, Harst Pv, Koppelman G, Rosmalen JG, van Rossum L, Smidt H, Swertz MA, Stolk RP, Alizadeh B, de Boer R, Boezen HM, Bruinenberg M, Franke L, van der Harst P, Hillege H, van der Klauw M, Navis G, Ormel J, Postma D, Rosmalen J, Slaets J, Snieder H, Stolk R, Wolffenbuttel B, Wijmenga C, Berg J, Blackwood D, Campbell H, Cavanagh J, Connell J, Connor M, Cunningham-Burley S, Deary I, Dominiczak A, Ellis P, FitzPatrick B, Ford I, Gertz R, Grau A, Haddow G, Jackson C, Kerr S, Lindsay R, McGilchrist M, McIntyre D, Morris A, Morton R, Muir W, Murray G, Palmer C, Pell J, Philp A, Porteous D, Porteous M, Procter R, Ralston S, Reid D, Sinnott R, Smith B, Clair DS, Sullivan F, Sweetland M, Ure J, Watt G, Wolf R, Wright A, Berndt SI, Gustafsson S, Mägi R, Ganna A, Wheeler E, Feitosa MF, Justice AE, Monda KL, Croteau- Chonka DC, Day FR, Esko T, Fall T, Ferreira T, Gentilini D, Jackson AU, Luan J, Randall JC, Vedantam S, Willer CJ, Winkler TW, Wood AR, Workalemahu T, Hu YJ, Lee SH, Liang L, Lin DY, Min JL, Neale BM, Thorleifsson G, Yang J, Albrecht E, Amin N, Bragg-Gresham JL, Cadby G, den Heijer M, Eklund N, Fischer K, Goel A, Hottenga JJ, Huffman JE, Jarick I, Johansson A, Johnson T, Kanoni S, Kleber ME, König IR, Kristiansson K, Kutalik Z, Lamina C, Lecoeur C, Li G, Mangino M, McArdle WL, Medina-Gomez C, Müller-Nurasyid M, Ngwa JS, Nolte IM, Paternoster L, Pechlivanis S, Perola M, Peters MJ, Preuss M, Rose LM, Shi J, Shungin D, Smith AV, Strawbridge RJ, Surakka I, Teumer A, Trip MD, Tyrer J, Van Vliet- Ostaptchouk JV, Vandenput L, Waite LL, Zhao JH, Absher D, Asselbergs FW, Atalay M, Attwood AP, Balmforth AJ, Basart H, Beilby J, Bonnycastle LL, Brambilla P, Bruinenberg M, Campbell H, Chasman DI, Chines PS, Collins FS, Connell JM, Cookson W, de Faire U, de Vegt F, Dei M, Dimitriou M, Edkins S, Estrada K, Evans DM, Farrall M, Ferrario MM, Ferrières J, Franke L, Frau F, Gejman PV, Grallert H, Grönberg H, Gudnason V, Hall AS, Hall P, Hartikainen AL, Hayward C, Heard-Costa NL, Heath AC, Hebebrand J, Homuth G, Hu FB, Hunt SE, Hyppönen E, Iribarren C, Jacobs KB, Jansson JO, Jula A, Kähönen M, Kathiresan S, Kee F, Khaw KT, Kivimaki M, Koenig W, Kraja AT, Kumari M, Kuulasmaa K, Kuusisto J, Laitinen JH, Lakka TA, Langenberg C, Launer LJ, Lind L, Lindström J, Liu J, Liuzzi A, Lokki ML, Lorentzon M, Madden PA, Magnusson PK, Manunta P, Marek D, März W, Mateo Leach I, McKnight B, Medland SE, Mihailov E, Milani L, Montgomery GW, Mooser V, Mühleisen TW, Munroe PB, Musk AW, Narisu N, Navis G, Nicholson G, Nohr EA, Ong KK, Oostra BA, Palmer CN, Palotie A, Peden JF, Pedersen N, Peters A, Polasek O, Pouta A, Pramstaller PP, Prokopenko I, Pütter C, Radhakrishnan A, Raitakari O, Rendon A, Rivadeneira F, Rudan I, Saaristo TE, Sambrook JG, Sanders AR, Sanna S, Saramies J, Schipf S, Schreiber S, Schunkert H, Shin SY, Signorini S, Sinisalo J, Skrobek B, Soranzo N, Stancakova A, Stark K, Stephens JC, Stirrups K, Stolk RP, Stumvoll M, Swift AJ, Theodoraki EV, Thorand B, Tregouet DA, Tremoli E, Van der Klauw MM, van Meurs JB, Vermeulen SH, Viikari J, Virtamo J, Vitart V, Waeber G, Wang Z, Widen E, Wild SH, Willemsen G, Winkelmann BR, Witteman JC, Wolffenbuttel BH, Wong A, Wright AF, Zillikens M, Amouyel P, Boehm BO, Boerwinkle E, Boomsma DI, Caulfield MJ, Chanock SJ, Cupples L, Cusi D, Dedoussis GV, Erdmann J, Eriksson JG, Franks PW, Froguel P, Gieger C, Gyllensten U, Hamsten A, Harris TB, Hengstenberg C, Hicks AA, Hingorani A, Hinney A, Hofman A, Hovingh KG, Hveem K, Illig T, Jarvelin MR, Jöckel KH, Keinanen-Kiukaanniemi SM, Kiemeney LA, Kuh D, Laakso M, Lehtimäki T, Levinson DF, Martin NG, Metspalu A, Morris AD, Nieminen MS, Njølstad I, Ohlsson C, Oldehinkel AJ, Ouwehand WH, Palmer LJ, Penninx B, Power C, Province MA, Psaty BM, Qi L, Rauramaa R, Ridker PM, Ripatti S, Salomaa V, Samani NJ, Snieder H, Sørensen TI, Spector TD, Stefansson K, Tönjes A, Tuomilehto J, Uitterlinden AG, Uusitupa M, van der Harst P, Vollenweider P, Wallaschofski H, Wareham NJ, Watkins H, Wichmann H-, Wilson JF, Abecasis GR, Assimes TL, Barroso I, Boehnke M, Borecki IB, Deloukas P, Fox CS, Frayling T, Groop LC, Haritunian T, Heid IM, Hunter D, Kaplan RC, Karpe F, Moffatt M, Mohlke KL, O'Connell JR, Pawitan Y, Schadt EE, Schlessinger D, Steinthorsdottir V, Strachan DP, Thorsteinsdottir U, van Duijn CM, Visscher PM, Di Blasio AM, Hirschhorn JN, Lindgren CM, Morris AP, Meyre D, Scherag A, McCarthy MI, Speliotes EK, North KE, Loos RJ, Ingelsson E.

EARLY GROWTH GENETICS CONSORTIUM (EGG) Adair LS, Ang W, Atalay M, van Beijsterveldt T, Bergen N, Benke K, Berry DJ, Boomsma DI, Bradfield JP, Charoen P, Coin L, Cooper C, Cousminer DL, Das S, Davis OS, Dedoussis GV, Elliott P, Estivill X, Evans DM, Feenstra B, Flexeder C, Frayling T, Freathy RM, Gaillard R, Geller F, Gillman M, Grant SF, Groen-Blokhuis M, Goh LK, Guxens M, Hakonarson H, Hattersley AT, Haworth CM, Hadley D, Hebebrand J, Heinrich J, Hinney A, Hirschhorn JN, Hocher B, Holloway JW, Holst C, Hottenga JJ, Horikoshi M, Huikari V, Hypponen E, Iñiguez C, Jaddoe VW, Jarvelin MR, Kaakinen M, Kilpeläinen TO, Kirin M, Kowgier M, Lakka HM, Lakka TA, Lange LA, Lawlor DA, Lehtimäki T, Lewin A, Lindgren C, Lindi V, Maggi R, Marsh J, McCarthy MI, Melbye M, Middeldorp C, Millwood I, Mohlke KL, Mook-Kanamori DO, Murray JC, Nivard M, Nohr EA, Ntalla I, Oken E, Ong KK, O'Reilly PF, Palmer LJ, Panoutsopoulou K, Pararajasingham J, Pearson ER, Pennell CE, Power C, Price TS, Prokopenko I, Raitakari OT, Rodriguez A, Salem RM, Saw SM, Scherag A, Sebert S, Siitonen N, Simell O, Sørensen TI, Sovio U, Pourcain BS, Strachan DP, Sunyer J, Taal HR, Teo YY, Thiering E, Tiesler C, Timpson NJ, Uitterlinden AG, Valcárcel B, Warrington NM, White S, Widén E, Willemsen G, Wilson JF, Yaghootkar H, Zeggini E, Elks CE, Perry JR, Sulem P, Chasman DI, Franceschini N, He C, Lunetta KL, Visser JA, Byrne EM, Cousminer DL, Gudbjartsson DF, Esko T, Feenstra B, Hottenga JJ, Koller DL, Kutalik Z, Lin P, Mangino M, Marongiu M, McArdle PF, Smith AV, Stolk L, van Wingerden SH, Zhao JH, Albrecht E, Corre T, Ingelsson E, Hayward C, Magnusson PK, Smith EN, Ulivi S, Warrington M, Zgaga L, Alavere H, Amin N, Aspelund T, Bandinelli S, Barroso I, Berenson GS, Bergmann S, Blackburn H, Boerwinkle E, Buring JE, Busonero F, Campbell H, Chanock SJ, Chen W, Cornelis MC, Couper D, Coviello AD, d'Adamo P, de Faire U, de Geus EJ, Deloukas P, Döring A, Davey Smith G, Easton DF, Eiriksdottir G, Emilsson V, Eriksson J, Ferrucci L, Folsom AR, Foroud T, Garcia M, Gasparini P, Geller F, Gieger C, Gudnason V, Hall P, Hankinson SE, Ferreli L, Heath AC, Hernandez DG, Hofman A, Hu FB, Illig T, Järvelin MR, Johnson AD, Karasik D, Khaw KT, Kiel DP, Kilpeläinen TO, Kolcic I, Kraft P, Launer LJ, Laven JS, Li S, Liu J, Levy D, Martin NG, McArdle WL, Melbye M, Mooser V, Murray JC, Murray SS, Nalls MA, Navarro P, Nelis M, Ness AR, Northstone K, Oostra BA, Peacock M, Palmer LJ, Palotie A, Paré G, Parker AN, Pedersen NL, Peltonen L, Pennell CE, Pharoah P, Polasek O, Plump AS, Pouta A, Porcu E, Rafnar T, Rice JP, Ring SM, Rivadeneira F, Rudan I, Sala C, Salomaa V, Sanna S, Schlessinger D, Schork NJ, Scuteri A, Segrè AV, Shuldiner AR, Soranzo N, Sovio U, Srinivasan SR, Strachan DP, Tammesoo ML, Tikkanen E, Toniolo D, Tsui K, Tryggvadottir L, Tyrer J, Uda M, van Dam RM, van Meurs JB, Vollenweider P, Waeber G, Wareham NJ, Waterworth DM, Weedon MN, Wichmann HE, Willemsen G, Wilson JF, Wright AF, Young L, Zhai G, Zhuang WV, Bierut LJ, Boyd HA, Crisponi L, Demerath EW, van Duijn CM, Econs MJ, Harris TB, Hunter DJ, Loos RJ, Metspalu A, Montgomery GW, Ridker PM, Spector TD, Streeten EA, Stefansson K, Thorsteinsdottir U, Uitterlinden AG, Widen E, Murabito JM, Ong KK, Murray A.

THE PRICE FOUNDATION COLLABORATIVE GROUP Harry Brandt, Steve Crawford, Scott Crow, Manfred M Fichter, Katherine A Halmi, Craig Johnson, Allan S Kaplan, Maria La Via, James Mitchell, Michael Strober, Alessandro Rotondo, Janet Treasure, D Blake Woodside, Cynthia M Bulik, Pamela Keel, Kelly L Klump, Lisa Lilenfeld, Laura M Thornton, Kathy Plotnicov, Andrew W Bergen, Wade Berrettini, Walter Kaye and Pierre Magistretti.

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Hinney, A., Kesselmeier, M., Jall, S. et al. Evidence for three genetic loci involved in both anorexia nervosa risk and variation of body mass index. Mol Psychiatry 22, 192–201 (2017).

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