First genome-wide association study of esophageal atresia with or without tracheoesophageal fistula (EA/TEF) identifies three genetic risk loci at CTNNA3, FOXF1/FOXC2/FOXL1 and HNF1B

Esophageal atresia with or without tracheoesophageal fistula (EA/TEF) is the most common congenital malformation of the upper digestive tract. This study represents the first genome-wide association study (GWAS) to identify risk loci for EA/TEF. We used a European case-control sample comprising 764 EA/TEF patients and 5,778 controls and observed genome-wide significant associations at three loci. On chromosome 10q21 within the gene CTNNA3 (p = 2.11 × 10 −8 ; odds ratio [OR] = 3.94; 95% confidence interval [CI], 3.10–5.00), on chromosome 16q24 next to the FOX gene cluster (p = 2.25 × 10 −10 ; OR = 1.47; 95% CI, 1.38–1.55) and on chromosome 17q12 next to the gene HNF1B (p = 3.35 × 10 −16 ; OR = 1.75; 95% CI, 1.64–1.87). We next carried out an esophageal/tracheal transcriptome profiling in rat embryos at four selected embryonic time points. Based on these data and on already published data, the implicated genes at all three GWAS loci are promising candidates for EA/TEF development. We also analyzed the genetic EA/TEF architecture beyond the single marker level, which revealed an estimated single-nucleotide polymorphism (SNP)-based heritability of around 37% ± 14% standard deviation. In addition, we examined the polygenicity of EA/TEF and found that EA/TEF is less polygenic than other complex genetic diseases. In conclusion, the results of our study contribute to a better understanding on the underlying genetic architecture of ET/TEF with the identification of three risk loci and candidate genes. The first genome-wide association study (GWAS) for esophageal atresia (EA) revealed genome-wide significant associations on 10q21 within CTNNA3 , on 16q24 near the FOX gene cluster, and on 17q12 near HNF1B . Furthermore, the GWAS revealed an SNP-based heritability of 37% and evidence that EA is less polygenic than other multifactorial diseases. Keywords: genome-wide association study (GWAS); esophageal atresia (EA); multifactorial diseases; CTNNA3; FOXF1/FOXC2/FOXL1; HNF1B