Genome-wide association study identifies distinct genetic contributions to prognosis and susceptibility in Crohn's disease

James Lee, Kenneth Smith and colleagues report a within-cases genome-wide association analysis for Crohn's disease to identify genetic loci specifically associated with disease severity and outcome. They find four loci associated with prognosis, none of which is associated with susceptibility to Crohn's disease. For most immune-mediated diseases, the main determinant of patient well-being is not the diagnosis itself but instead the course that the disease takes over time (prognosis) 1 , 2 , 3 . Prognosis may vary substantially between patients for reasons that are poorly understood. Familial studies support a genetic contribution to prognosis 4 , 5 , 6 , but little evidence has been found for a proposed association between prognosis and the burden of susceptibility variants 7 , 8 , 9 , 10 , 11 , 12 , 13 . To better characterize how genetic variation influences disease prognosis, we performed a within-cases genome-wide association study in two cohorts of patients with Crohn's disease. We identified four genome-wide significant loci, none of which showed any association with disease susceptibility. Conversely, the aggregated effect of all 170 disease susceptibility loci was not associated with disease prognosis. Together, these data suggest that the genetic contribution to prognosis in Crohn's disease is largely independent of the contribution to disease susceptibility and point to a biology of prognosis that could provide new therapeutic opportunities.