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Associations of genetically determined iron status across the phenome: A mendelian randomization study.

  • Gill, Dipender1
  • Benyamin, Beben2, 3, 4
  • Moore, Luke S P5, 6, 7
  • Monori, Grace1
  • Zhou, Ang2
  • Koskeridis, Fotios8
  • Evangelou, Evangelos1, 8
  • Laffan, Mike9
  • Walker, Ann P10
  • Tsilidis, Konstantinos K1, 8
  • Dehghan, Abbas1, 11, 12
  • Elliott, Paul1, 7, 11, 12, 13
  • Hyppönen, Elina2, 4, 14
  • Tzoulaki, Ioanna1, 8, 11
  • 1 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom. , (United Kingdom)
  • 2 Australian Centre for Precision Health, University of South Australia, Adelaide, Australia. , (Australia)
  • 3 Institute for Molecular Bioscience, University of Queensland, Brisbane, Australia. , (Australia)
  • 4 South Australian Health and Medical Research Institute, Adelaide, Australia. , (Australia)
  • 5 National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, United Kingdom. , (United Kingdom)
  • 6 Chelsea & Westminster NHS Foundation Trust, London, United Kingdom. , (United Kingdom)
  • 7 Imperial Biomedical Research Centre, Imperial College London and Imperial College NHS Healthcare Trust, London, United Kingdom. , (United Kingdom)
  • 8 Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece. , (Greece)
  • 9 Centre for Haematology, Imperial College London, United Kingdom. , (United Kingdom)
  • 10 Population Science & Experimental Medicine, Institute of Cardiovascular Science, University College London, London, United Kingdom. , (United Kingdom)
  • 11 Medical Research Council-Public Health England Centre for Environment, School of Public Health, Imperial College London, London, United Kingdom. , (United Kingdom)
  • 12 UK Dementia Research Institute, Imperial College London, London, United Kingdom. , (United Kingdom)
  • 13 Health Data Research UK-London, London, United Kingdom. , (United Kingdom)
  • 14 Population, Policy and Practice, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom. , (United Kingdom)
Published Article
PLoS Medicine
Public Library of Science
Publication Date
Jun 01, 2019
DOI: 10.1371/journal.pmed.1002833
PMID: 31220083


Iron is integral to many physiological processes, and variations in its levels, even within the normal range, can have implications for health. The objective of this study was to explore the broad clinical effects of varying iron status. Genome-wide association study (GWAS) summary data obtained from 48,972 European individuals (55% female) across 19 cohorts in the Genetics of Iron Status Consortium were used to identify 3 genetic variants (rs1800562 and rs1799945 in the hemochromatosis gene [HFE] and rs855791 in the transmembrane protease serine 6 gene [TMPRSS6]) that associate with increased serum iron, ferritin, and transferrin saturation and decreased transferrin levels, thus serving as instruments for systemic iron status. Phenome-wide association study (PheWAS) of these instruments was performed on 424,439 European individuals (54% female) in the UK Biobank who were aged 40-69 years when recruited from 2006 to 2010, with their genetic data linked to Hospital Episode Statistics (HES) from April, 1995 to March, 2016. Two-sample summary data mendelian randomization (MR) analysis was performed to investigate the effect of varying iron status on outcomes across the human phenome. MR-PheWAS analysis for the 3 iron status genetic instruments was performed separately and then pooled by meta-analysis. Correction was made for testing of multiple correlated phenotypes using a 5% false discovery rate (FDR) threshold. Heterogeneity between MR estimates for different instruments was used to indicate possible bias due to effects of the genetic variants through pathways unrelated to iron status. There were 904 distinct phenotypes included in the MR-PheWAS analyses. After correcting for multiple testing, the 3 genetic instruments for systemic iron status demonstrated consistent evidence of a causal effect of higher iron status on decreasing risk of traits related to anemia (iron deficiency anemia: odds ratio [OR] scaled to a standard deviation [SD] increase in genetically determined serum iron levels 0.72, 95% confidence interval [CI] 0.64-0.81, P = 4 × 10-8) and hypercholesterolemia (hypercholesterolemia: OR 0.88, 95% CI 0.83-0.93, P = 2 × 10-5) and increasing risk of traits related to infection of the skin and related structures (cellulitis and abscess of the leg: OR 1.25, 95% CI 1.10-1.42, P = 6 × 10-4). The main limitations of this study relate to possible bias from pleiotropic effects of the considered genetic variants and misclassification of diagnoses in the HES data. Furthermore, this work only investigated participants with European ancestry, and the findings may not be applicable to other ethnic groups. Our findings offer novel, to our knowledge, insight into previously unreported effects of iron status, highlighting a potential protective effect of higher iron status on hypercholesterolemia and a detrimental role on risk of skin and skin structure infections. Given the modifiable and variable nature of iron status, these findings warrant further investigation.

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