BSMS205 · Genetics

Genetic Architecture
of Traits & Disorders

Chapter 19 · Part III · Complex Traits
A question from Chapter 18

GWAS gave us hundreds of hits.
Why can't we predict who gets sick?

Genetic architecture · the working definition

architecture = (allele frequency) × (effect size) × (locus count)
  • Allele frequency · how rare or common
  • Effect size · how strong each variant pushes risk
  • Locus count · how many sites contribute

The city analogy

City

  • A few skyscrapers — huge, rare
  • Many houses — small, common
  • Roads, utilities, neighborhoods

Genome

  • A few rare-large mutations
  • Many common-small variants
  • Modifiers, interactions, context

The canonical picture

Allele frequency vs effect size — the canonical 4-zone plot for Alzheimer's disease
Figure 1. The master picture for genetic architecture: allele frequency on the x-axis, effect size on the y-axis. Rare-large variants in the upper left, common-small variants in the lower right. Andrews et al. 2023, EBioMedicine.

Roadmap for today

  1. What does an architecture look like?
  2. Case study · Alzheimer's disease
  3. Case study · autism spectrum disorder
  4. Genetic heterogeneity → biological convergence
  5. Why architecture matters · drugs, PRS, counseling
  6. The omnigenic horizon
  7. Summary · bridge to Part IV
§ 1

What does an
architecture look like?

The four zones

FrequencyEffectWhat lives here
RareLargeMendelian mutations · APP, PSEN1, BRCA1
RareSmallHard to find · usually invisible
CommonLargeAlmost empty · selection removes them
CommonSmallGWAS hits · the polygenic background

Why no common-large?

A common allele with a large harmful effect
gets removed by selection.
  • Strong effect → reduced reproduction
  • Allele frequency drops over generations
  • Result: the upper-right zone is nearly empty

Common-small or rare-large?

Rare-large

  • Mendelian disease genes
  • Family pedigrees, exome sequencing
  • ~1% of cases each

Common-small

  • GWAS-style signals
  • Hundreds of thousands of cases
  • Tiny effects · summed via PRS

Most diseases sit on the spectrum between.

Variant types contribute too

  • SNVs · single-letter changes
  • Indels · small insertions / deletions
  • CNVs · duplications and deletions of segments
  • Structural variants · large rearrangements
  • Regulatory variants · noncoding, change expression
The composite reality

No single "disease gene"

  • Most traits show a composite architecture
  • Mixture of rare + common + modifiers
  • Same diagnosis · many genetic routes
Many roads · same destination.
§ 2

Case study
Alzheimer's disease

Three layers of risk

LayerExamplesFrequencyEffect (OR)
Rare-largeAPP, PSEN1, PSEN2< 1%~100×
Strong commonAPOE ε4/ε4~2%~12×
Common-smallGWAS hits (TREM2, ABCA1…)5 – 40%1.1 – 1.5×

Layer 1 · early-onset familial AD

  • Three genes: APP · PSEN1 · PSEN2
  • Symptoms before age 65 — sometimes 30s–40s
  • Penetrance ~100% if you carry one
  • But: explains < 1% of all AD cases

Layer 2 · APOE ε4

~12×
risk for ε4/ε4 homozygotes
  • 3 alleles: ε2 · ε3 · ε4
  • ~15% of Europeans carry at least one ε4
  • 1 copy: ~3× risk · 2 copies: ~12×
  • Common and strong — rare combo

Layer 3 · the polygenic background

  • Large meta-GWAS · hundreds of thousands of cases
  • Implicated pathways:
    • Immune · microglia (TREM2)
    • Lipid · cholesterol handling (ABCA1, APOE)
    • Synaptic · neuron–neuron signaling
  • Each hit small · together they shift risk

Convergence · microglial efferocytosis

Prioritized AD risk genes converge on microglial efferocytosis pathway
Figure 2. Many AD risk genes — both rare and common — converge on microglial efferocytosis: the process by which microglia clear dead cells and debris. Andrews et al. 2023, EBioMedicine.

Risk accumulates · the K-ROAD cohort

K-ROAD cohort showing accumulating genetic risk for Alzheimer's
Figure 3. Korean Rare Alzheimer's Database (K-ROAD): more risk factors → higher amyloid burden, lower MMSE, worse memory. Risk is cumulative. K-ROAD 2025, Nat Commun.

Why a Korean cohort matters

  • Most GWAS data: European ancestry
  • Allele frequencies differ by population
  • K-ROAD captures Korean-specific signals
  • Same architecture · different dot positions
The picture has the same shape.
The dots sit in different places.

The composite Alzheimer model

  • Patient A · PSEN1 mutation · early-onset
  • Patient B · APOE ε4/ε4 · onset late 60s
  • Patient C · high PRS + vascular risk · onset late 70s
  • Same diagnosis · three different architectures
§ 3

Case study
Autism spectrum disorder

Four genetic contributors

Multiple genetic contributors to autism risk
Figure 4. ASD architecture has at least four contributing layers: de novo CNVs, de novo PTVs, inherited rare variants, and common SNP polygenic risk. Kim et al. 2025, Mol Cells.

De novo variants · the new mutation

  • Not inherited from either parent
  • Arise in sperm, egg, or early embryo
  • Two key flavors:
    • dnPTV · de novo protein-truncating
    • dnCNV · de novo copy-number
  • Each rare · together major contributor to severe ASD

Inherited rare + polygenic

Inherited rare

  • From parents who may not have ASD
  • Each tiny effect
  • Add up across the genome

Polygenic (common)

  • ~30–40% of liability
  • Standard GWAS-style variants
  • Modulates rare-variant effects

Convergence · synapse + chromatin

Network of ASD genes converging on synaptic and chromatin pathways
Figure 5. Despite hundreds of genes, ASD-associated variants converge on two major hubs: synaptic signaling and chromatin regulation. Satterstrom et al. 2020, Cell.

Mid-fetal cortex · timing matters

  • Many ASD genes peak in mid-fetal cortex
  • Specific developmental window · weeks 12–24
  • Timing × tissue × pathway = phenotype
  • Same gene · different impact at different ages

The female protective effect

more males than females diagnosed
  • Females need higher genetic burden
  • Affected females carry more rare variants
  • Biological + diagnostic factors
§ 4

Many roads
same destination

Genetic heterogeneity

  • Locus heterogeneity · different genes → same phenotype
  • Allelic heterogeneity · different mutations in same gene → different effects
  • Phenotypic heterogeneity · same variant → different patients

Biological convergence

DiseaseConvergent pathways
Alzheimer'sMicroglial clearance · lipid metabolism · amyloid
AutismSynaptic signaling · chromatin · neurodevelopment
DCM (heart)Sarcomere · cell adhesion · ECM
SchizophreniaSynapse · immune · dopamine

The river analogy

Many small streams · different starting points
flow into the same major rivers
and reach the same ocean.
  • Genes = streams · pathways = rivers · disease = ocean
  • Heterogeneity at the source · convergence downstream
§ 5

Why architecture
matters

Drug discovery · target the convergence

  • Don't fix every mutation · fix the pathway
  • AD: boost microglial efferocytosis (TREM2 agonists)
  • ASD: chromatin / synapse modulators
  • Heterogeneous patients · shared therapy

Polygenic risk scores · interpreting them

  • PRS sums many common-small effects
  • Top decile vs bottom · meaningful risk gap
  • But: works best in European ancestry
  • Architecture-aware PRS · across all layers

Genetic counseling · context matters

A pathogenic mutation alone
does not tell the whole story.
  • Same TTN variant · different outcomes
  • Polygenic background modifies penetrance
  • Family history + environment + PRS

Penetrance is modifiable

  • Penetrance = P(phenotype | genotype)
  • Modified by:
    • Polygenic background
    • Other rare variants (multi-hit)
    • Sex · age · environment
  • "100% penetrant" is a Mendelian myth in complex disease
§ 6

The omnigenic
horizon

Polygenic vs omnigenic

Polygenic

  • Hundreds of loci
  • Each tiny · sum matters
  • Pathway-focused

Omnigenic

  • Thousands · "all" expressed genes
  • Core genes + peripheral genes
  • Network-wide effects

Boyle, Li, Pritchard 2017 — provocative, debated, useful frame.

What the architecture is for

  • Predict who is at risk · and how much
  • Choose drug targets where convergence is strong
  • Counsel patients with full context
  • Build cohorts that span ancestries
  • Move from "disease gene" → disease landscape
§ 7

Summary

What to take away

  • Architecture = frequency × effect × locus count
  • Four zones · the upper-right is empty (selection)
  • AD: APP/PSEN + APOE ε4 + GWAS hits
  • ASD: de novo + inherited rare + polygenic
  • Many genes → shared pathways (convergence)
  • Drugs target the convergence · PRS sums the polygenic layer
After the midterm

From individuals
to populations.

Part IV · Chapter 20 · Allele Frequency