Genome-wide association studies have identified hundreds of genetic variants associated with complex human diseases and traits, and have provided valuable insights into their genetic architecture. Most variants identified so far confer relatively small increments in risk, and explain only a small proportion of familial clustering, leading many to question how the remaining, 'missing' heritability can be explained. Here we examine potential sources of missing heritability and propose research strategies, including and extending beyond current genome-wide association approaches, to illuminate the genetics of complex diseases and enhance its potential to enable effective disease prevention or treatment.Many common human diseases and traits are known to cluster in families and are believed to be influenced by several genetic and environmental factors, but until recently the identification of genetic variants contributing to these 'complex diseases' has been slow and arduous 1 . Genome-wide association studies (GWAS), in which several hundred thousand to more than a million single nucleotide polymorphisms (SNPs) are assayed in thousands of individuals, represent a powerful new tool for investigating the genetic architecture of complex diseases 1, 2. In the past few years, these studies have identified hundreds of genetic variants associated with such conditions and have provided valuable insights into the complexities of their genetic architecture3 , 4.The genome-wide association (GWA) method represents an important advance compared to 'candidate gene' studies, in which sample sizes are generally smaller and the variants assayed are limited to a selected few, often on the basis of imperfect understanding of biological pathways and often yielding associations that are difficult to replicate 5,6. GWAS are also an important step beyond family-based linkage studies, in which inheritance patterns are related to several hundreds to thousands of genomic markers. Despite many clear successes in singlegene 'Mendelian' disorders7 , 8, the limited success of linkage studies in complex diseases has been attributed to their low power and resolution for variants of modest effect 9-11 .The underlying rationale for GWAS is the 'common disease, common variant' hypothesis, positing that common diseases are attributable in part to allelic variants present in more than 1-5% of the population12 -14. They have been facilitated by the development of commercial 'SNP chips' or arrays that capture most, although not all, common variation in the genome. Although the allelic architecture of some conditions, notably age-related macular degeneration, for the most part reflects the contributions of several variants of large effect (defined loosely here as those increasing disease risk by twofold or more), most common variants individually or in combination confer relatively small increments in risk (1.1-1.5-fold) and explain only a small proportion of heritability-the portion of phenotypic variance in a population attributable to additive ...

There is increasing evidence that genome-wide association (GWA) studies represent a powerful approach to the identification of genes involved in common human diseases. We describe a joint GWA study (using the Affymetrix GeneChip 500K Mapping Array Set) undertaken in the British population, which has examined approximately 2,000 individuals for each of 7 major diseases and a shared set of approximately 3,000 controls. Case-control comparisons identified 24 independent association signals at

Obesity is a serious international health problem that increases the risk of several common diseases. The genetic factors predisposing to obesity are poorly understood. A genome-wide search for type 2 diabetes–susceptibility genes identified a common variant in the FTO (fat mass and obesity associated) gene that predisposes to diabetes through an effect on body mass index (BMI). An additive association of the variant with BMI was replicated in 13 cohorts with 38,759 participants. The 16% of adults who are homozygous for the risk allele weighed about 3 kilograms more and had 1.67-fold increased odds of obesity when compared with those not inheriting a risk allele. This association was observed from age 7 years upward and reflects a specific increase in fat mass.