The present report represents an initial CNV analysis in the TGen cohort, a unique cohort of clinically characterized and neuropathologically verified individuals. After extensive QC, case (AD)/control association analyses using candidate gene and genome-wide approaches were performed. Genes enriched in cases relative to controls were determined, suggesting possible involvement of these genes in AD susceptibility.
Rates of deletions and duplications did not significantly differ between cases and controls. This is different from findings in the ADNI and NIA-LOAD/NCRAD Family studies and could be due to different participant selection criteria, random sampling variation, different QC criteria, and that the NIA-LOAD/NCRAD Family Study and TGen study analyses included only AD and control samples, whereas the ADNI study analyses included MCI samples in addition to AD and control samples.
The candidate gene approach revealed a number of interesting genes ( and ). The
HLA-DRA (major histocompatibility complex, class II, DR alpha) gene on chromosome 6 is a human leukocyte antigen (HLA) class II alpha chain paralogue which plays an important role in the immune system by presenting peptides derived from extracellular proteins. Variants in
HLA-DRA have been associated with Parkinson disease
[36],
[37] and multiple sclerosis
[38],
[39], but not with AD. Other
HLA alleles however have been investigated for a possible role in AD
[40]–
[43].
The
CHRFAM7A (
CHRNA7 (cholinergic receptor, nicotinic, alpha 7, exons 5–10) and
FAM7A (family with sequence similarity 7A, exons A–E) fusion) gene () is located on chromosome 15. It is formed as a hybrid of a partially duplicated
CHRNA7 gene and the
FAM7A gene
[44],
[45]. It is highly polymorphic and individuals with and without this gene have been identified. A 2-bp deletion polymorphism at position 497–498 in exon 6 of this gene has been observed to be significantly over-represented in participants with AD, dementia with Lewy bodies and Pick’s disease compared to controls
[46].
Although
CHRFAM7A is transcribed, its translation and possible function of the resulting protein is uncertain. The gene is expressed in the hippocampus, a brain region known to be first affected in AD. Recently, it has been suggested to possibly modulate α7 subunit receptor-mediated synaptic transmission and cholinergic anti-inflammatory response
[47]. It may also be a dominant negative modulator of
CHRNA7 function and important for receptor regulation in humans
[48]. Duplications overlapping the
CHRNA7 gene and an approximately 300 kb region upstream of the gene were identified in a previous study investigating the role of CNVs in AD
[16]. A meta-analysis using the
CHRFAM7A gene results from the ADNI, NIA-LOAD/NCRAD Family and TGen studies indicated a significant association of the gene with AD and/or MCI risk at an OR of 3.986. This association is striking relative to known AD markers and is similar to the OR for one copy of the
APOE ε4 allele. However, unlike the
APOE ε4 allele which is a change in a single base within the gene, CNV calls overlapping the
CHRFAM7A gene involves more than one base and often a large region with less than perfect definition of boundaries given available methodology. In addition, in a CNV analysis, a gene may be overlapped by deletions or duplications which may have different effects on the protein. Nonetheless, the strength of CNV signals overlapping the
CHRFAM7A gene in the present three samples warrants further investigation and replication in additional independent samples.
Two genes (
RELN and
DOPEY2) in the three studies were found to be overlapped by CNV calls from cases (AD and/or MCI) but not controls. The
RELN (reelin) gene on chromosome 7 encodes the glycoprotein reelin, which activates a signaling pathway required for proper positioning of neurons within laminated nervous system parenchyma. Gene variants have been associated with AD
[49] and the protein has been observed to have increased expression in pyramidal neurons of the hippocampus in AD individuals and in cognitively intact controls with AD-associated pathology
[50]. The
DOPEY2 (dopey family member 2, also known as
C21orf5) gene located on chromosome 21 in the Down syndrome critical region is a potential Down syndrome candidate gene
[51],
[52]. Overexpression of the gene may be associated with the neurological phenotypes and mental retardation observed in Down syndrome patients. Although the
DOPEY2 gene was identified in the candidate gene approach in the TGen study, CNV calls overlapping this gene also completely overlapped the
CBR3 (carbonyl reductase 3) and
CBR3-AS1 (
CBR3 antisense RNA 1). The CBR3 protein, which catalyzes reduction of carbonyl compounds to their corresponding alcohols, has been found to be differentially expressed in the cerebellum of patients with atypical cases of frontotemporal lobar degeneration with fused in sarcoma-positive inclusions compared to controls
[53]. Although
DOPEY2 is a known candidate, it is possible that
CBR3 and
CBR3-AS1 could be pathologic given their involvement in other neurodegenerative diseases. One AD sample (
APOE ε2/ε3 genotype, age at death

=

67) was identified with an
APP duplication. The patient started suffering from forgetfulness at approximately 59 years and was admitted to a nursing home at approximately age 63. The patient had no reported family history of dementia.
APP duplications have been associated with early-onset
[54]–
[57] but not late-onset AD, and it is possible that this patient may have had an early-onset sporadic form of AD (age at onset<60 or 65 years). Replication in independent samples and laboratory validation can help confirm the role of these genes in AD susceptibility.
The genome-wide approach revealed the candidate genes:
HLA-DRA and
CHRFAM7A as well as identified genes reported in the two previous studies. The
CSMD1,
HNRNPCL1,
IMMP2L and
SLC35F2 genes have not been previously associated with AD. The
NRXN1 gene has been associated with autism
[58], schizophrenia
[59], and has been shown to have reduced expression with increasing AD severity
[60]. The
ERBB4 gene may play a possible role in the progression of AD pathology
[61]–
[63].
It is important to note the limitations of the present report. Although the same software (PennCNV) was used in the three studies, different QC criteria were used for the selection of samples. The ADNI and NIA-LOAD/NCRAD Family study samples were genotyped on the Illumina Human610-Quad BeadChip and used similar QC criteria. The TGen study samples were genotyped on the Affymetrix Genome-Wide Human SNP 6.0 Array and thus we used a slightly different QC criteria. To our knowledge, there does not appear to be consensus on a well defined set of QC criteria for inclusion of the most appropriate samples in CNV analyses. The QC criterion applied in the present study may have been too stringent, leading to samples possibly having informative CNV data being excluded. A direct comparison of CNV calls from the three studies would be difficult as two different genotyping platforms were used. Probes from the two platforms may not correspond with each other with respect to their location. Replication in additional independent data sets and future molecular studies will help confirm the findings.
In sum, we have conducted an initial CNV analysis in samples from a cohort of clinically characterized and neuropathologically verified individuals. Rates of deletions and duplications did not significantly differ between cases and controls. Gene-based association analysis identified a number of genes including those reported in the ADNI and NIA-LOAD/NCRAD Family studies (CHRFAM7A, RELN and DOPEY2) as well as a new gene (HLA-DRA). Meta-analysis from the three studies revealed a significant association for CHRFAM7A with AD and/or MCI risk. Replication in independent samples will be necessary to confirm these findings. Targeted analyses of the identified regions will help determine the biological role of these variants. Overall, there appears to be some consistency of CNVs across AD cohorts and this variation holds promise for revealing novel risk factors and disease mechanisms.