Imputation-Based Meta-Analysis of Severe Malaria in Three African Populations

Combining data from genome-wide association studies (GWAS) conducted at different locations, using genotype imputation and fixed-effects meta-analysis, has been a powerful approach for dissecting complex disease genetics in populations of European ancestry. Here we investigate the feasibility of applying the same approach in Africa, where genetic diversity, both within and between populations, is far more extensive. We analyse genome-wide data from approximately 5,000 individuals with severe malaria and 7,000 population controls from three different locations in Africa. Our results show that the standard approach is well powered to detect known malaria susceptibility loci when sample sizes are large, and that modern methods for association analysis can control the potential confounding effects of population structure. We show that pattern of association around the haemoglobin S allele differs substantially across populations due to differences in haplotype structure. Motivated by these observations we consider new approaches to association analysis that might prove valuable for multicentre GWAS in Africa: we relax the assumptions of SNP–based fixed effect analysis; we apply Bayesian approaches to allow for heterogeneity in the effect of an allele on risk across studies; and we introduce a region-based test to allow for heterogeneity in the location of causal alleles.Author Summary: Malaria kills nearly a million people every year, most of whom are young children in Africa. The risk of developing severe malaria is known to be affected by genetics, but so far only a handful of genetic risk factors for malaria have been identified. We studied over a million DNA variants in over 5,000 individuals with severe malaria from the Gambia, Malawi, and Kenya, and about 7,000 healthy individuals from the same countries. Because the populations of Africa are far more genetically diverse than those in Europe, it is necessary to use statistical models that can account for both broad differences between countries and subtler differences between ethnic groups within the same community. We identified known associations at the genes ABO (which affects blood type) and HBB (which causes sickle cell disease), and showed that the latter is heterogeneous across populations. We used these findings to guide the development of statistical tests for association that take this heterogeneity into account, by modelling differences in the strength and genomic location of effect across and within African populations.