Li, Donghui

Abstract Introduction: Obesity and diabetes are two major modifiable risk factors for pancreatic cancer. Genetic variation affecting the risk of obesity- and diabetes-related pancreatic cancer have yet to be comprehensively investigated at the genome-wide level. Aims: To identify novel gene-environment interactions (GxE) of obesity/diabetes on pancreatic cancer risk. Methods: We conducted a multi-stage genome-wide gene-diabetes and gene-obesity interaction study using GWAS data of 7095 cases and 10710 controls from Pancreatic Cancer Consortium (PanScan I, PanScan II and PanScan III) and Pancreatic Cancer Case Control Consortium (PanC4). About 870,000 SNPs, having MAF ≥ 0.005 and having been genotyped in at least one study, were analyzed. Missing genotypes were imputed using IMPUTE2 and the Haplotype Reference Consortium (HRC) reference panel. Case-control (CC) and case-only (CO) methods were used for SNP-level GxE analysis. Fixed-, random- and joint-effect models built in “rareGE” R package were used for gene-based GxE analysis. About 20,000 genes that have at least one SNP genotyped were included in the analysis. Age, gender and principal components accounting for subpopulation structure were adjusted in both SNP-level and gene-level analyses. Obesity was defined as body mass index ≥30 mg/m2. Diabetics with <3-year duration were excluded for gene-diabetes interaction analysis. The PanScan I, II, III and PanC4 datasets were analyzed separately followed by meta-analysis of the summary statistics. Fixed-effect and Fisher’s p-value based meta-analysis was applied for SNP-level and gene-level GxE analysis, respectively. Results: No genome-wide significant (P<5 x 10-8 ) interaction at the SNP level was detected in any of the PanScan or PanC4 datasets or in the meta-analysis. A significant interaction of diabetes and FAM63A (family with sequence similarity 63 member A) gene (P<2.5 x 10-6) was observed in the meta-analysis (PFixed= 3.4 x 10-5, PRandom= 1.9 x 10-6, PJoint= 6.8 x 10-7) . This interaction showed nominal significance in all individual dataset analyses. The corresponding P values for this interaction were 4.2 x 10-2, 3.8 x 10-2 and 6.8 x 10-2 in PanScan I, 2.8 x 10-2, 3.9 x 10-2 and 6.5 x 10-2 9.1 x 10-3, 2.2 x 10-4 and 8.8 x 10-6 in PanScan III, and 3.1 x 10-3, 3.4 x 10-3 and 8.8 x 10-3 in PanC4, respectively. Conclusions: In the largest genome-wide GxE analysis for pancreatic cancer to date, we identified a significant diabetes interacting gene in pancreatic cancer, which was consistently replicated in 4 individual GWAS studies. This observation identifies FAM63A as a candidate for future functional studies to understand its role in pancreatic cancer etiology. Further increasing the sample size may unveil additional genetic loci that contribute to the susceptibility to pancreatic cancer via G x E. Citation Format: Hongwei Tang, Lai Jiang, Laufey T. Amundadottir, Harvey A. Risch, Rachael S. Stolzenberg-Solomon, Alison P. Klein, Brian M. Wolpin, Gloria Petersen, Nilanjan Chatterjee, Donghui Li, Peter Kraft, Peng Wei. Genomewide gene-diabetes and gene-obesity interaction scan in 7095 cases and 10710 controls from Pancreatic Cancer Cohort Consortium and Pancreatic Cancer Case Control Consortium [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1295. doi:10.1158/1538-7445.AM2017-1295

The relationships between diabetes and pancreatic ductal adenocarcinoma (PDAC) are complex. Longstanding type 2 diabetes (T2DM) is a risk factor for pancreatic cancer, but increasing epidemiological data point to PDAC as also a cause of diabetes due to unknown mechanisms. New-onset diabetes is of particular interest to the oncology community as the differentiation of new-onset diabetes caused by PDAC as distinct from T2DM may allow for earlier diagnosis of PDAC. To address these relationships and raise awareness of the relationships between PDAC and diabetes, a symposium entitled Diabetes, Pancreatogenic Diabetes, and Pancreatic Cancer was held at the American Diabetes Association’s 76th Scientific Sessions in June 2016. This article summarizes the data presented at that symposium, describing the current understanding of the interrelationships between diabetes, diabetes management, and pancreatic cancer, and identifies areas where additional research is needed.

A small number of common susceptibility loci have been identified for pancreatic cancer, one of which is marked by rs401681 in the TERT–CLPTM1L gene region on chromosome 5p15.33. Because this region is characterized by low linkage disequilibrium, we sought to identify whether additional single nucleotide polymorphisms (SNPs) could be related to pancreatic cancer risk, independently of rs401681. We performed an in‐depth analysis of genetic variability of the telomerase reverse transcriptase (TERT) and the telomerase RNA component (TERC) genes, in 5,550 subjects with pancreatic cancer and 7,585 controls from the PANcreatic Disease ReseArch (PANDoRA) and the PanScan consortia. We identified a significant association between a variant in TERT and pancreatic cancer risk (rs2853677, odds ratio = 0.85; 95% confidence interval = 0.80–0.90, p = 8.3 × 10−8). Additional analysis adjusting rs2853677 for rs401681 indicated that the two SNPs are independently associated with pancreatic cancer risk, as suggested by the low linkage disequilibrium between them (r2 = 0.07, D′ = 0.28). Three additional SNPs in TERT reached statistical significance after correction for multiple testing: rs2736100 (p = 3.0 × 10−5), rs4583925 (p = 4.0 × 10−5) and rs2735948 (p = 5.0 × 10−5). In conclusion, we confirmed that the TERT locus is associated with pancreatic cancer risk, possibly through several independent variants.

Abstract Introduction Pancreatic cancer is a highly lethal malignancy due to late diagnosis and aggressiveness of the tumor. Characterization of high-risk populations for monitoring, intervention and early detection remains challenging. Obesity and diabetes are potentially modifiable contributors to pancreatic cancer. Genetic factors modifying the risk of obesity- and diabetes-induced pancreatic cancer have previously not been fully investigated at the genome-wide level. Hypothesis There are potential genetic factors modifying the associations between obesity/diabetes and pancreatic cancer. Methods Integrating genotype with risk factor data from a GWAS for the Pancreatic Cancer Case Control Consortium, we performed a genome-wide gene-environment interaction (G x E) scan for 457,688 SNPs in a discovery study of 2,028 cases and 2,109 controls using state-of-the-art methods including case-only (CO), case-control (CC), Empirical Hierarchical Bayes (EHB), Empirical-Bayes test (EB) and three 2-step approaches (DG2, EG2, DGEG2). Results We detected a genome-wide significant (P < 1.09 x 10-7 ) interaction of diabetes with rs13061928 (in CNTN4) in CO (P = 8.8 x 10-8 ), which was independent of diabetes in control group (P = 0.08). The minor allele was in a synergism with diabetes on the cancer risk: diabetics carrying GA/AA genotype had a 3.39-fold (95% CI: 2.47-4.65) increased disease risk compared with non-diabetics carrying GG genotype. Consistently, the SNP-diabetes interaction had a high ranking statistic in EHB (No.1) and high p-value ranks for EG2 and DGEG2 methods (No.1, P= 5.44 x 10-5). Conclusions These observations, once validated/confirmed, may help define at-risk subpopulation and initiate targeted intervention and prevention of pancreatic cancer. Genome-wide G x E analysis requires larger sample size than genetic main effects scan; combining the CO method with alternative methods may be the optimal scheme for genome-wide G x E analysis. Citation Format: Hongwei Tang, Eric J. Duell, Harvey A. Risch Risch, Sara H. Olson, H. Bas Bueno-de-Mesquita, Steven Gallinger, Elizabeth A. Holly, Gloria M. Petersen, Paige M. Bracci, Robert R. McWilliams, Mazda Jenab, Elio Riboli, Anne Tjønneland, Marie Christine Boutron-Ruault, Rudolf Kaaks, Dimitrios Trichopoulos, Salvatore Panico, Malin Sund, Petra H. M Peeters, Kay-Tee Khaw, Christopher I Amos, Donghui Li, Peng Wei. Genome-wide gene-diabetes and gene-obesity interaction scan in the pancreatic cancer case control consortium. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2214. doi:10.1158/1538-7445.AM2014-2214