Difference between the lung of a COPD patient and an unaffected one. Image taken from the NHLBI website (one of the leading institutes in providing information on various diseases; click on image to access the source)
Many of us will either suffer or have a relative/friend who suffers from a disease called Chronic Obstructive Pulmonary Disease (COPD, click on link for details) which is a progressive respiratory disease characterised by decreasing lung function (struggling to inhale/exhale air, irreversible airflow obstruction), very likely accompanied by chronic infections. COPD has a prevalence of over 2% in the UK population (corresponding to approx. 1 million in the UK, probably a lower bound estimate due to many undiagnosed cases; this figure is approx. 16 million in the USA) and is currently the third biggest killer in the world (only behind cancers and heart-related diseases) – costing the lives of millions (in the USA alone, number of deaths attributed to COPD is over 100 thousand); and the health services, billions of pounds.
Contrary to the well-known genetic disorders such as Cystic Fibrosis and Huntington’s disease, which are diseases caused entirely by a person’s genetic makeup and caused by mutations in a single gene, COPD is a (very!) complex disease with many genes and environmental factors (e.g. smoking, pollutants) contributing to the development/progression of the disease. This complexity makes it much harder to dissect the causes and find potential (genetic) targets for cures or therapies. However, we do know that smoking is by far the biggest risk factor with up to 90% of those who go on to develop clinically significant COPD being smokers. But only a minority (<25%) of all smokers develop COPD, indicating the strong role genetics can play in the progression of this disorder. Also not all COPD patients are smokers (up to 25% in some populations), indicating that – at least in some patients – genetics can play a rather determining role. I must stress that all the statistics I provide here can vary considerably from population to population due to different lifestyles and genetic backgrounds.
I – together with a large group of collaborators – search for genetic predictors of lung function, which helps us to identify which individuals are more likely to develop the disease and potentially understand the underlying biology/pathology of respiratory diseases such as COPD and asthma, and related traits such as smoking behaviour. To do this, we carry out what is called a genome-wide association study (GWAS, click on link for details), where we obtain the genetic data (millions of data points) from tens of thousands of COPD (or asthma) patients and ‘controls’ (people with normal lung function). To ensure that our results are not biased by different ethnicities, life styles and related individuals, we collect all the relevant information about the participants and make sure that we control for them in the statistical models that we use. GWASs have been extremely successful in the identification of successful targets for other diseases and have led to the field of Genetic Epidemiology (GE, click on link for details) to come to the fore of population-based medicine. GE requires extensive understanding of Statistics (needed to make sense of the very large datasets), Bioinformatics (application of computer software to the management of large biological data), Programming (needed to change data formats, manage very large data), Genetics (needed for interpretation of results) and Epidemiology (branch of medicine which deals with how often diseases occur in different groups of people, and why); thus requires inter-disciplinary collaborations.
GWAS results are traditionally presented with a Manhattan plot (due to its resemblance of the city’s skyline) where the genetic variants corresponding to the dots above the top grey line (representing P-values less than 5e-8 i.e. 0.00000005) are usually followed up with additional studies to validate their plausibility. Image taken from Wikipedia (click on image to access source)
The inferences we make from these studies can shed light in to which genes and biological pathways play key roles in causing COPD. We then follow up these newly identified genes and pathways to analyse whether there are molecules which could be used to target these and be potential drugs for treating COPD patients. Our results can be of immense help to Pharmaceutical companies (and ultimately to patients), as many clinical trials initiated without genetic line of evidence have failed, costing the public and these companies billions of pounds.
As smoking is the biggest risk factor for respiratory diseases like COPD, I am – also with the contribution of many collaborators – in the process of analysing whether some people are more likely to start smoking, stop after starting, and smoke more than usual when they start smoking. The results can have huge implications as many people struggle to stop smoking, and when they do, research suggests that up to 90% (figure differs between populations) of them start to smoke again within the first year after quitting. Smoking is not only a huge contributor to the risk of developing COPD, but also to lung (biggest killer amongst all cancers), mouth, throat, kidney, liver, pancreas, stomach and colon cancer (not an exhaustive list). In the UK alone, these cancers cause the slow and painful death of tens of thousands, alongside a huge psychological and financial burden on the families and public resources.
The “lung” and the short of it (stealing a phrase thought up by my colleagues at the University of Leicester, click on link to see who they are) is that COPD is a disease that is going to affect many of us, and any useful finding which leads to cures and/or therapies could increase the life years of COPD patients and affect the lives of thousands of people directly, and millions indirectly (e.g. families of COPD sufferers, cost to the NHS). Finding targets to help people stop smoking can potentially have even bigger implications as many continue to smoke, despite huge efforts and funding allocated to smoking prevention and cessation.
A nice TED talk about the world of Data science and Genetic Epidemiology
Addition to post (09/02/17): A Circos plot presenting results from our latest lung function GWAS (Wain et al, 2017; Nature Genetics) was shortlisted (title: Breathtaking genes) and displayed in the Images of Research exhibition (9th Feb 2017) organised by the University of Leicester
An ordinary blog by an ordinary bloke 