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Genetically Predicted Glucose-Dependent Insulinotropic Polypeptide (GIP) Levels and Cardiovascular Disease Risk Are Driven by Distinct Causal Variants in the GIPR Region.

Accepted version
Peer-reviewed

Type

Article

Change log

Authors

Bowker, Nicholas 
Hansford, Robert 
Burgess, Stephen 
Foley, Christopher N 
Auyeung, Victoria PW 

Abstract

There is considerable interest in GIPR agonism to enhance the insulinotropic and extrapancreatic effects of GIP, thereby improving glycemic and weight control in type 2 diabetes (T2D) and obesity. Recent genetic epidemiological evidence has implicated higher GIPR-mediated GIP levels in raising coronary artery disease (CAD) risk, a potential safety concern for GIPR agonism. We therefore aimed to quantitatively assess whether the association between higher GIPR-mediated fasting GIP levels and CAD risk is mediated via GIPR or is instead the result of linkage disequilibrium (LD) confounding between variants at the GIPR locus. Using Bayesian multitrait colocalization, we identified a GIPR missense variant, rs1800437 (G allele; E354), as the putatively causal variant shared among fasting GIP levels, glycemic traits, and adiposity-related traits (posterior probability for colocalization [PPcoloc] > 0.97; PP explained by the candidate variant [PPexplained] = 1) that was independent from a cluster of CAD and lipid traits driven by a known missense variant in APOE (rs7412; distance to E354 ∼770 Kb; R 2 with E354 = 0.004; PPcoloc > 0.99; PPexplained = 1). Further, conditioning the association between E354 and CAD on the residual LD with rs7412, we observed slight attenuation in association, but it remained significant (odds ratio [OR] per copy of E354 after adjustment 1.03; 95% CI 1.02, 1.04; P = 0.003). Instead, E354's association with CAD was completely attenuated when conditioning on an additional established CAD signal, rs1964272 (R 2 with E354 = 0.27), an intronic variant in SNRPD2 (OR for E354 after adjustment for rs1964272: 1.01; 95% CI 0.99, 1.03; P = 0.06). We demonstrate that associations with GIP and anthropometric and glycemic traits are driven by genetic signals distinct from those driving CAD and lipid traits in the GIPR region and that higher E354-mediated fasting GIP levels are not associated with CAD risk. These findings provide evidence that the inclusion of GIPR agonism in dual GIPR/GLP1R agonists could potentiate the protective effect of GLP-1 agonists on diabetes without undue CAD risk, an aspect that has yet to be assessed in clinical trials.

Description

Keywords

Adult, Aged, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Female, Finland, Gastric Inhibitory Polypeptide, Genetic Predisposition to Disease, Genetic Variation, Genome-Wide Association Study, Genotype, Humans, Male, Middle Aged, Receptors, Gastrointestinal Hormone, Risk Factors, United Kingdom

Journal Title

Diabetes

Conference Name

Journal ISSN

0012-1797
1939-327X

Volume Title

Publisher

American Diabetes Association

Rights

All rights reserved
Sponsorship
MRC (MC_PC_13048)
Medical Research Council (MC_UU_12015/1)
MRC (MC_UU_00006/1)
MRC (MC_PC_13046)
Medical Research Council (MC_UU_12012/3)
Medical Research Council (MR/N003284/1)
MRC (MC_UU_00014/3)
Medical Research Council (G1000143)
Medical Research Council (G0401527)
Wellcome Trust (204623/Z/16/Z)
Medical Research Council (MC_UU_00002/7)
Medical Research Council (MC_PC_12012)
Medical Research Council (G0401527/1)