Most of us know our first cousins, aunts/uncles, and grandparents, however our knowledge of more distant relationships in our genealogy is often incomplete. This extends to medical history within our extended family, especially concerning late-onset diseases that might present in distant relatives, including our primary focus of two overlapping neurodegenerative diseases: motor neuron disease (MND) and frontotemporal dementia (FTD).
Genetic factors are the only proven causes of MND and FTD, yet only ~15% of MND patients and ~30% of FTD patients have an identified genetic cause of disease. The binary classification of patients, based on presence/absence of a family history of MND and/or FTD, directly influences the methodologies chosen to find disease-linked genetic variants. Linkage analysis has been successful in disease-gene identification in highly-penetrant MND or FTD families, while genome-wide association studies (GWAS) have uncovered risk alleles in sporadic patients. However, for smaller reduced-penetrance families or cohorts lacking statistical power for GWAS, alternative methods are required.
We have used identity-by-descent (IBD) analysis as an alternative method for gene discovery in a large integrated cohort of both hereditary and sporadic MND and FTD cases. Our rationale is that IBD analysis can uncover distant unknown relatives who are also affected with MND and/or FTD, to effectively join branches of a family pedigree. IBD results can be further leveraged to pinpoint inherited genomic regions as putative disease loci to search for disease-linked variants using whole-genome sequencing.
Our IBD analysis on SNP genotype data from >3,000 MND and FTD patients from Australia, New Zealand and the United Kingdom has created more than 40 ‘new’ families for gene discovery efforts; linked hereditary and sporadic patients with a known disease-causing variant; and successfully uncovered the genetic cause of disease in 15 MND patients; highlighting the power of IBD analysis in gene discovery.