The Role of Genetics in the Etiology of Schizophrenia
Section snippets
The phenotypic conundrum
The definition of caseness is fundamental to research design decisions. Bipolar disorder, schizoaffective disorder, and schizophrenia share some phenotypic aspects in common, both in terms of symptoms and also therapeutics, with all responding to antipsychotic drugs. Kraepelin7 defined dementia praecox as a group of psychotic conditions with a tendency toward poor prognosis. He grouped under the term “manic-depressive psychoses” a set of conditions that included periodic and circular insanity,
Complex genetics
Knowledge of the molecular mechanisms of schizophrenia pathophysiology remains very incomplete. False starts and research dead ends have taught the field the need for caution; the biological complexity of schizophrenia is much higher than was anticipated. This complexity also applies to simple Mendelian disorders, which although easily analyzed by studying pedigrees, can present unexpectedly intricate biology. Yet, the architecture of schizophrenia is incommensurably more difficult than simple
Evidence for environmental factors
The long-standing and influential belief that the incidence of schizophrenia is unaffected by place and time has been recently disproved, opening a remarkably productive period for the study of schizophrenia epidemiology. New epidemiological results show specific circumstances where risk for schizophrenia is increased, including various obstetric complications25, 26; urban birth or residence; famines; migrant status; and seasonal effects (by prenatal infections [eg, influenza]).2 Other
Evidence for genetic factors
The modern twin and adoption studies were instrumental in rejecting psychological hypotheses of schizophrenia causation37 and became the main foundation for the search of molecular genetic risk factors.
Adoption studies
Such studies allow dissection of genetic from environmental contributions to a disorder in ways that twin studies cannot (see review,57 which also explores methodological strengths and weaknesses of these approaches). The high-risk adoptees approach evaluates adopted away offspring of parents with schizophrenia to see if risk for schizophrenia (or often also schizophrenia spectrum disorders) is elevated. These studies have found an elevated risk for psychosis in such offspring, whether the
Darwinian paradox
Schizophrenia has long been known to be associated with decreased fertility,39, 71 which is explained by the behavioral and social characteristics of schizophrenia. Fertility is substantially compromised in both genders,72, 73 although more markedly in males. Decreased fertility is anticipated to increase because of the delayed marriage patterns in Western societies, whereas age of onset for schizophrenia has not changed. It is expected that natural selection decreases the population
First modern association studies
Before the availability of GWAS, most gene association studies consisted of tests of candidate gene involvement. Close to 800 genes have been tested for association (see www.schizophreniaforum.org/res/sczgene).84 This makes schizophrenia one of the most studied disorders through a candidate gene approach. Unfortunately, none of them as of today can be considered fully established. Because samples frequently lacked sufficient statistical power, the problem of nonreplication has been far from
GWAS
Genome-wide studies, in combination with system biology approaches, yield comprehensive information and have been demonstrated to be more useful to deal with complex phenotypes. In direct opposition to candidate gene studies, GWAS interrogate markers of common variation across the human genome one at a time, investigating all genes and most of the nongenic regions, whether or not they were previously implicated by pathophysiological hypotheses. The large number of tests in a GWAS makes the
Meta-analysis of GWAS data and the major histocompatibility complex locus
The initial attempts to map schizophrenia to the major histocompatibility complex (MHC) started in the 1970s,104 only a few years after the discovery of the human HLA system.105 Many attempts since then had been made, and some yielded suggestive evidence,106 but definitive evidence of MHC involvement was only recently obtained from a combined analysis of GWAS data. Three GWAS studies published jointly in 2009 (ISC, MGS, and Schizophrenia Genetics Consortium [SGENE]), reaching a total EA sample
Polygenic contributions to schizophrenia
Many genetic variants, each with a very small effect, combined together, make substantial contributions to disorder risk under a polygenic model, first hypothesized for schizophrenia four decades ago.100 Simulations show that even a disorder with 1000 risk loci with low mean relative risks (RR = 1.04), when evaluated in a large scale (10,000 cases and 10,000 controls), GWAS still allows prediction of individual disorder risk with an accuracy greater than 0.75 by using 75 loci explaining
Rare CNVs and schizophrenia
CNVs are stretches of genomic deletions and duplications ranging from 1 kb to several Mb, and are likely to have larger phenotypic effects than SNPs. Only rare (<1%) and large (>100 kb) CNVs have been implicated in schizophrenia,138, 139, 140, 141, 142, 143, 144 as reflected by overall CNV burden and individual CNV loci. Supporting evidence for association of specific rare and large CNVs with schizophrenia is emerging at 1q21.1, 2p16.3 (NRXN1), 15q11.2, 15q13.2, 16p11.2, and 22q11.21 (see Table
Pleiotropy and overlap with bipolar disorder and autism
Pleiotropy refers to the common phenomenon of variation in a gene simultaneously affecting different phenotypes. Although examples abound in model organisms (eg, flies),149 evidence for pleiotropy in humans is also available, such as genes for body weight and height,150 and also for such disorders as type 2 diabetes151 and prostate cancer.152 The molecular genetic overlaps between schizophrenia and bipolar disorder and between schizophrenia and autism are consistent with pleiotropy; but shared
Challenges for the field of schizophrenia genetics
After over a quarter century of molecular genetics work in schizophrenia, advances in biotechnology and statistics applied to the study of large and well-characterized clinical samples have made possible the discovery of individual susceptibility loci with subsequent replication. A comprehensive discussion of what comes next after a successful GWAS is outside the scope of this article. Selected for discussion are a handful of issues that have been instrumental to generate progress until now,
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This review was supported by funding from the NIH grant 5U01M0H79469-03 to Pablo V. Gejman, and by The Paul Michael Donovan Charitable Foundation.