Pediatric stroke is a rare but highly penetrant disease with a strong genetic background. Although there are an increasing number of genome-wide association studies (GWASs) for stroke in adults, such studies for stroke of pediatric onset are lacking. Here we report the results of the first GWAS on pediatric stroke using a large cohort of 270 family-based trios. GWAS was performed using the Illumina 370 CNV single nucleotide polymorphisms array and analyzed using the transmission disequilibrium test as implemented in PLINK. An enrichment analysis was performed to identify additional true association signals among lower P value signals and searched for cumulatively associated genes within protein interaction data using dmGWAS. We observed clustering of association signals in 4 genes belonging to one family of metalloproteinases at high (ADAMTS12, P ؍ 2.9 ؋ 10 ؊6 ; ADAMTS2, P ؍ 8.0 ؋ 10 ؊6 ) and moderate (ADAMTS13, P ؍ 9.3 ؋ 10 ؊4 ; ADAMTS17, P ؍ 8.5 ؋ 10 ؊4 ) significance levels. Over-representation and gene-network
IntroductionPediatric stroke (PS) is a heterogeneous disorder associated with significant morbidity and mortality. It is recognized as an important childhood disease, with an incidence of 2.6-6.4 per 100 000 children per year. 1 Although PS is relatively rare, it is devastating to those affected as half of the survivors develop cognitive or motor disabilities. 2 Risk factors for stroke are different in children and adults, and classic risk factors, such as smoking, arteriosclerosis, or diabetes, are unlikely to contribute to pediatric stroke. The most prominent risk factors for stroke in children include underlying medical conditions (ie, cardiac disorders, metabolic diseases, cerebrovascular pathologies, and infectious diseases) 1 as well as many prothrombotic abnormalities. 3,4 Numerous association studies have established several genetic polymorphisms contributing to pediatric stroke risk. These candidate gene approaches identified several susceptibility genes for PS (ie, prothrombin, and GPX3). 3,4 However, genetic predisposition, environmental effects, and other risk factors can often not be disentangled because of the complex nature of PS etiology. Furthermore, a large proportion of missing heritability remains to be accounted for. 5 Genome-wide association studies (GWASs) offer a powerful approach to gene function discovery and are the current method of choice to dissect the genetic basis of complex diseases. Up-to-date, studies in families with a known first onset of pediatric stroke are lacking mainly because of limited sample size.Therefore, we performed a family-based GWAS for pediatric stroke in 270 families from Muenster, Germany composed of affected children and their parents. We identified several single nucleotide polymorphisms (SNPs), which are associated with PS at significance levels P Ͻ 10 Ϫ5 . In addition, we determined potential combined effects of SNPs contributing to stroke risk that may be missed through conventional single marker or haplotype association. We assessed ...