Abstract
Asthma, an inflammatory disorder of the airways, is the most common chronic disease of children worldwide. There are significant racial/ethnic disparities in asthma prevalence, morbidity, and mortality among US children. This trend is mirrored in obesity, which may share genetic and environmental risk factors with asthma. The majority of asthma biomedical research has been performed in populations of European decent. We sought to identify genetic risk factors for asthma in African American children. We also assessed the generalizability of genetic variants associated with asthma in European and Asian populations to African American children. Our study population consisted of 1227 (812 asthma cases, 415 controls) African American children with genome-wide single nucleotide polymorphism (SNP) data. Logistic regression was used to identify associations between SNP genotype and asthma status. We identified a novel variant in the PTCHD3 gene that is significantly associated with asthma (rs660498, p = 2.2 × 10−7) independent of obesity status. Approximately 5 % of previously reported asthma genetic associations identified in European populations replicated in African Americans. Our identification of novel variants associated with asthma in African American children, coupled with our inability to replicate the majority of findings reported in European Americans, underscores the necessity for including diverse populations in biomedical studies of asthma.
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References
Acock AC (2014) A gentle introduction to stata. Stata Press, College Station
Akhabir L, Sandford AJ (2011) Genome-wide association studies for discovery of genes involved in asthma. Respirology 16:396–406
Akinbami LJ, Moorman JE, Simon AE, Schoendorf KC (2014) Trends in racial disparities for asthma outcomes among children 0 to 17 years, 2001–2010. J Allergy Clin Immunol 134(547–553), e5
Alexander DH, Novembre J, Lange K (2009) Fast model-based estimation of ancestry in unrelated individuals. Genome Res 19:1655–1664
Barnes PJ (2001) Th2 cytokines and asthma: an introduction. Respir Res 2:64–65
Borrell LN, Nguyen EA, Roth LA, Oh SS, Tcheurekdjian H, Sen S, Davis A, Farber HJ, Avila PC, Brigino-Buenaventura E, Lenoir MA, Lurmann F, Meade K, Serebrisky D, Rodriguez-Cintron W, Kumar R, Rodriguez-Santana JR, Thyne SM, Burchard EG (2013) Childhood obesity and asthma control in the GALA II and SAGE II studies. Am J Respir Crit Care Med 187:697–702
Burchard EG (2014) Medical research: missing patients. Nature 513:301–302
Burchard EG, Oh SS, Foreman MG, Celedon JC (2015) Moving toward true inclusion of racial/ethnic minorities in federally funded studies. A key step for achieving respiratory health equality in the United States. Am J Respir Crit Care Med 191:514–521
Burdett TE, Hall PN (NHGRI), Hasting E (EBI), Hindorff LA (NHGRI), Junkins HA (NHGRI), Kiemm AK (NHGRI), MacArthur J (EBI), Manolio TA (NHGRI), Morales J (EBI), Parkinson H (EBI), Welter D (EBI) (2014) The NHGRI-EBI Catalog of published genome-wide association studies. www.ebi.ac.uk/gwas. Accessed 3 Feb 2016
Bustamante CD, Burchard EG, De la Vega FM (2011) Genomics for the world. Nature 475:163–165
Castro-Giner F, de Cid R, Gonzalez JR, Jarvis D, Heinrich J, Janson C, Omenaas ER, Matheson MC, Pin I, Anto JM, Wjst M, Estivill X, Kogevinas M (2010) Positionally cloned genes and age-specific effects in asthma and atopy: an international population-based cohort study (ECRHS). Thorax 65:124–131
Center for Disease Control and Prevention (2014) How is BMI calculated? http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/. Accessed 4 Oct 2015
Chang CC, Chow CC, Tellier LC, Vattikuti S, Purcell SM, Lee JJ (2015) Second-generation PLINK: rising to the challenge of larger and richer datasets. Gigascience 4:7
Delaneau O, Marchini J, Zagury JF (2012) A linear complexity phasing method for thousands of genomes. Nat Methods 9:179–181
Development Core Team R (2010) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna
Drake KA, Torgerson DG, Gignoux CR, Galanter JM, Roth LA, Huntsman S, Eng C, Oh SS, Yee SW, Lin L, Bustamante CD, Moreno-Estrada A, Sandoval K, Davis A, Borrell LN, Farber HJ, Kumar R, Avila PC, Brigino-Buenaventura E, Chapela R, Ford JG, Lenoir MA, Lurmann F, Meade K, Serebrisky D, Thyne S, Rodriguez-Cintron W, Sen S, Rodriguez-Santana JR, Hernandez RD, Giacomini KM, Burchard EG (2014) A genome-wide association study of bronchodilator response in Latinos implicates rare variants. J Allergy Clin Immunol 133:370–378
Fagnani C, Annesi-Maesano I, Brescianini S, D’Ippolito C, Medda E, Nistico L, Patriarca V, Rotondi D, Toccaceli V, Stazi MA (2008) Heritability and shared genetic effects of asthma and hay fever: an Italian study of young twins. Twin Res Hum Genet 11:121–131
Fahy JV (2015) Type 2 inflammation in asthma—present in most, absent in many. Nat Rev Immunol 15:57–65
Furmanski AL, Saldana JI, Ono M, Sahni H, Paschalidis N, D’Acquisto F, Crompton T (2013) Tissue-derived hedgehog proteins modulate Th differentiation and disease. J Immunol 190:2641–2649
Galanter JM, Gignoux CR, Torgerson DG, Roth LA, Eng C, Oh SS, Nguyen EA, Drake KA, Huntsman S, Hu D, Sen S, Davis A, Farber HJ, Avila PC, Brigino-Buenaventura E, LeNoir MA, Meade K, Serebrisky D, Borrell LN, Rodriguez-Cintron W, Estrada AM, Mendoza KS, Winkler CA, Klitz W, Romieu I, London SJ, Gilliland F, Martinez F, Bustamante C, Williams LK, Kumar R, Rodriguez-Santana JR, Burchard EG (2014) Genome-wide association study and admixture mapping identify different asthma-associated loci in Latinos: the Genes-environments & Admixture in Latino Americans study. J Allergy Clin Immunol 134:295–305
Genomes Project C, Abecasis GR, Altshuler D, Auton A, Brooks LD, Durbin RM, Gibbs RA, Hurles ME, McVean GA (2010) A map of human genome variation from population-scale sequencing. Nature 467:1061–1073
Ghahramani Seno MM, Kwan BY, Lee-Ng KK, Moessner R, Lionel AC, Marshall CR, Scherer SW (2011) Human PTCHD3 nulls: rare copy number and sequence variants suggest a non-essential gene. BMC Med Genet 12:45
Global Asthma Network (2014) The Global Asthma Report 2014. Auckland, New Zealand
Gonzalez JR, Caceres A, Esko T, Cusco I, Puig M, Esnaola M, Reina J, Siroux V, Bouzigon E, Nadif R, Reinmaa E, Milani L, Bustamante M, Jarvis D, Anto JM, Sunyer J, Demenais F, Kogevinas M, Metspalu A, Caceres M, Perez-Jurado LA (2014) A common 16p11.2 inversion underlies the joint susceptibility to asthma and obesity. Am J Hum Genet 94:361–372
Gorina Y (2012) QuickStats: asthma* death rates, by race and age group - United States, 2007–2009. In (MMWR) MaMWR (ed.). Centers for Disease Control and Prevention
Guerrero AD, Mao C, Fuller B, Bridges M, Franke T, Kuo AA (2016) Racial and ethnic disparities in early childhood obesity: growth trajectories in body mass index. J Racial Ethn Health Disparities 3:129–137
Hoffjan S, Nicolae D, Ober C (2003) Association studies for asthma and atopic diseases: a comprehensive review of the literature. Respir Res 4:14
Hoffmann TJ, Zhan Y, Kvale MN, Hesselson SE, Gollub J, Iribarren C, Lu Y, Mei G, Purdy MM, Quesenberry C, Rowell S, Shapero MH, Smethurst D, Somkin CP, Van den Eeden SK, Walter L, Webster T, Whitmer RA, Finn A, Schaefer C, Kwok PY, Risch N (2011) Design and coverage of high throughput genotyping arrays optimized for individuals of East Asian, African American, and Latino race/ethnicity using imputation and a novel hybrid SNP selection algorithm. Genomics 98:422–430
Howie BN, Donnelly P, Marchini J (2009) A flexible and accurate genotype imputation method for the next generation of genome-wide association studies. PLoS Genet 5, e1000529
Howie B, Marchini J, Stephens M (2011) Genotype imputation with thousands of genomes. G3 (Bethesda) 1:457–70
Imai K, Keele L, Tingley D (2010) A general approach to causal mediation analysis. Psychol Methods 15:309–334
International HapMap C, Altshuler DM, Gibbs RA, Peltonen L, Altshuler DM, Gibbs RA, Peltonen L, Dermitzakis E, Schaffner SF, Yu F, Peltonen L, Dermitzakis E, Bonnen PE, Altshuler DM, Gibbs RA, de Bakker PI, Deloukas P, Gabriel SB, Gwilliam R, Hunt S, Inouye M, Jia X, Palotie A, Parkin M, Whittaker P, Yu F, Chang K, Hawes A, Lewis LR, Ren Y, Wheeler D, Gibbs RA, Muzny DM, Barnes C, Darvishi K, Hurles M, Korn JM, Kristiansson K, Lee C, McCarrol SA, Nemesh J, Dermitzakis E, Keinan A, Montgomery SB, Pollack S, Price AL, Soranzo N, Bonnen PE, Gibbs RA, Gonzaga-Jauregui C, Keinan A, Price AL, Yu F, Anttila V, Brodeur W, Daly MJ, Leslie S, McVean G, Moutsianas L, Nguyen H, Schaffner SF, Zhang Q, Ghori MJ, McGinnis R, McLaren W, Pollack S, Price AL, Schaffner SF, Takeuchi F, Grossman SR, Shlyakhter I, Hostetter EB, Sabeti PC, Adebamowo CA, Foster MW, Gordon DR, Licinio J, Manca MC, Marshall PA, Matsuda I, Ngare D, Wang VO, Reddy D, Rotimi CN, Royal CD, Sharp RR, Zeng C, Brooks LD, McEwen JE (2010) Integrating common and rare genetic variation in diverse human populations. Nature 467:52–58
Joseph M, Elliott M, Zelicoff A, Qian Z, Trevathan E, Chang JJ (2016) Racial disparity in the association between body mass index and self-reported asthma in children: a population-based study. J Asthma:1–7
Lloyd CM, Hessel EM (2010) Functions of T cells in asthma: more than just T(H)2 cells. Nat Rev Immunol 10:838–848
Manning AK, Hivert MF, Scott RA, Grimsby JL, Bouatia-Naji N, Chen H, Rybin D, Liu CT, Bielak LF, Prokopenko I, Amin N, Barnes D, Cadby G, Hottenga JJ, Ingelsson E, Jackson AU, Johnson T, Kanoni S, Ladenvall C, Lagou V, Lahti J, Lecoeur C, Liu Y, Martinez-Larrad MT, Montasser ME, Navarro P, Perry JR, Rasmussen-Torvik LJ, Salo P, Sattar N, Shungin D, Strawbridge RJ, Tanaka T, van Duijn CM, An P, de Andrade M, Andrews JS, Aspelund T, Atalay M, Aulchenko Y, Balkau B, Bandinelli S, Beckmann JS, Beilby JP, Bellis C, Bergman RN, Blangero J, Boban M, Boehnke M, Boerwinkle E, Bonnycastle LL, Boomsma DI, Borecki IB, Bottcher Y, Bouchard C, Brunner E, Budimir D, Campbell H, Carlson O, Chines PS, Clarke R, Collins FS, Corbaton-Anchuelo A, Couper D, de Faire U, Dedoussis GV, Deloukas P, Dimitriou M, Egan JM, Eiriksdottir G, Erdos MR, Eriksson JG, Eury E, Ferrucci L, Ford I, Forouhi NG, Fox CS, Franzosi MG, Franks PW, Frayling TM, Froguel P, Galan P, de Geus E, Gigante B, Glazer NL, Goel A, Groop L, Gudnason V, Hallmans G, Hamsten A, Hansson O, Harris TB, Hayward C, Heath S, Hercberg S, Hicks AA, Hingorani A, Hofman A, Hui J, Hung J et al (2012) A genome-wide approach accounting for body mass index identifies genetic variants influencing fasting glycemic traits and insulin resistance. Nat Genet 44:659–669
McGarry ME, Castellanos E, Thakur N, Oh SS, Eng C, Davis A, Meade K, LeNoir MA, Avila PC, Farber HJ, Serebrisky D, Brigino-Buenaventura E, Rodriguez-Cintron W, Kumar R, Bibbins-Domingo K, Thyne SM, Sen S, Rodriguez-Santana JR, Borrell LN, Burchard EG (2015) Obesity and bronchodilator response in black and Hispanic children and adolescents with asthma. Chest 147:1591–1598
McGeachie MJ, Stahl EA, Himes BE, Pendergrass SA, Lima JJ, Irvin CG, Peters SP, Ritchie MD, Plenge RM, Tantisira KG (2013) Polygenic heritability estimates in pharmacogenetics: focus on asthma and related phenotypes. Pharmacogenet Genomics 23:324–328
Melen E, Himes BE, Brehm JM, Boutaoui N, Klanderman BJ, Sylvia JS, Lasky-Su J (2010) Analyses of shared genetic factors between asthma and obesity in children. J Allergy Clin Immunol 126(631–7):e1–e8
Melen E, Granell R, Kogevinas M, Strachan D, Gonzalez JR, Wjst M, Jarvis D, Ege M, Braun-Fahrlander C, Genuneit J, Horak E, Bouzigon E, Demenais F, Kauffmann F, Siroux V, Michel S, von Berg A, Heinzmann A, Kabesch M, Probst-Hensch NM, Curjuric I, Imboden M, Rochat T, Henderson J, Sterne JA, McArdle WL, Hui J, James AL, William Musk A, Palmer LJ, Becker A, Kozyrskyj AL, Chan-Young M, Park JE, Leung A, Daley D, Freidin MB, Deev IA, Ogorodova LM, Puzyrev VP, Celedon JC, Brehm JM, Cloutier MM, Canino G, Acosta-Perez E, Soto-Quiros M, Avila L, Bergstrom A, Magnusson J, Soderhall C, Kull I, Scholtens S, Marike Boezen H, Koppelman GH, Wijga AH, Marenholz I, Esparza-Gordillo J, Lau S, Lee YA, Standl M, Tiesler CM, Flexeder C, Heinrich J, Myers RA, Ober C, Nicolae DL, Farrall M, Kumar A, Moffatt MF, Cookson WO, Lasky-Su J (2013) Genome-wide association study of body mass index in 23 000 individuals with and without asthma. Clin Exp Allergy 43:463–474
Mohanan S, Tapp H, McWilliams A, Dulin M (2014) Obesity and asthma: pathophysiology and implications for diagnosis and management in primary care. Exp Biol Med (Maywood) 239:1531–1540
National Center for Biotechnology Information (2009) Database of Genotypes and Phenotypes (dbGAP). National Library of Medicine, Bethesda
National Institutes of Health (2015) Precision medicine initiative cohort program
Nieminen MM, Kaprio J, Koskenvuo M (1991) A population-based study of bronchial asthma in adult twin pairs. Chest 100:70–75
Nishimura KK, Galanter JM, Roth LA, Oh SS, Thakur N, Nguyen EA, Thyne S, Farber HJ, Serebrisky D, Kumar R, Brigino-Buenaventura E, Davis A, LeNoir MA, Meade K, Rodriguez-Cintron W, Avila PC, Borrell LN, Bibbins-Domingo K, Rodriguez-Santana JR, Sen S, Lurmann F, Balmes JR, Burchard EG (2013) Early-life air pollution and asthma risk in minority children. The GALA II and SAGE II studies. Am J Respir Crit Care Med 188:309–318
Ober C, Yao TC (2011) The genetics of asthma and allergic disease: a 21st century perspective. Immunol Rev 242:10–30
Oh SS, White MJ, Gignoux CR, Burchard EG (2016) Making Precision Medicine Socially Precise. Take a Deep Breath. Am J Respir Crit Care Med 193:348–350
Pankov Iu A (2013) Major gene mutations associated with obesity and diabetes mellitus. Mol Biol (Mosk) 47:38–49
Parekh N, Guffanti G, Lin Y, Ochs-Balcom HM, Makarem N, Hayes R (2015) Insulin receptor variants and obesity-related cancers in the Framingham Heart Study. Cancer Causes Control 26:1189–1195
Pino-Yanes M, Corrales A, Cumplido J, Poza P, Sanchez-Machin I, Sanchez-Palacios A, Figueroa J, Acosta-Fernandez O, Buset N, Garcia-Robaina JC, Hernandez M, Villar J, Carrillo T, Flores C (2013) Assessing the validity of asthma associations for eight candidate genes and age at diagnosis effects. PLoS One 8, e73157
Pino-Yanes M, Thakur N, Gignoux CR, Galanter JM, Roth LA, Eng C, Nishimura KK, Oh SS, Vora H, Huntsman S, Nguyen EA, Hu D, Drake KA, Conti DV, Moreno-Estrada A, Sandoval K, Winkler CA, Borrell LN, Lurmann F, Islam TS, Davis A, Farber HJ, Meade K, Avila PC, Serebrisky D, Bibbins-Domingo K, Lenoir MA, Ford JG, Brigino-Buenaventura E, Rodriguez-Cintron W, Thyne SM, Sen S, Rodriguez-Santana JR, Bustamante CD, Williams LK, Gilliland FD, Gauderman WJ, Kumar R, Torgerson DG, Burchard EG (2015) Genetic ancestry influences asthma susceptibility and lung function among Latinos. J Allergy Clin Immunol 135:228–235
Purcell SM, Chang CC (2015) PLINK [Version 1.9]
Schaafsma D, Gosens R, Ris JM, Zaagsma J, Meurs H, Nelemans SA (2007) Insulin induces airway smooth muscle contraction. Br J Pharmacol 150:136–142
Sheehan WJ, Phipatanakul W (2015) Difficult-to-control asthma: epidemiology and its link with environmental factors. Curr Opin Allergy Clin Immunol 15:397–401
Shifman S, Kuypers J, Kokoris M, Yakir B, Darvasi A (2003) Linkage disequilibrium patterns of the human genome across populations. Hum Mol Genet 12:771–776
Shimizu I, Yoshida Y, Moriya J, Nojima A, Uemura A, Kobayashi Y, Minamino T (2013) Semaphorin3E-induced inflammation contributes to insulin resistance in dietary obesity. Cell Metab 18:491–504
Singh S, Prakash YS, Linneberg A, Agrawal A (2013) Insulin and the lung: connecting asthma and metabolic syndrome. J Allergy (Cairo) 2013:627384
Sobota RS, Shriner D, Kodaman N, Goodloe R, Zheng W, Gao YT, Edwards TL, Amos CI, Williams SM (2015) Addressing population-specific multiple testing burdens in genetic association studies. Ann Hum Genet 79:136–147
StataCorp (2011) Stata statistical software: release 12. StataCorp LP, College Station
Thakur N, Oh SS, Nguyen EA, Martin M, Roth LA, Galanter J, Gignoux CR, Eng C, Davis A, Meade K, LeNoir MA, Avila PC, Farber HJ, Serebrisky D, Brigino-Buenaventura E, Rodriguez-Cintron W, Kumar R, Williams LK, Bibbins-Domingo K, Thyne S, Sen S, Rodriguez-Santana JR, Borrell LN, Burchard EG (2013) Socioeconomic status and childhood asthma in urban minority youths. The GALA II and SAGE II studies. Am J Respir Crit Care Med 188:1202–1209
Thomsen SF, Ulrik CS, Kyvik KO, Sorensen TI, Posthuma D, Skadhauge LR, Steffensen I, Backer V (2007) Association between obesity and asthma in a twin cohort. Allergy 62:1199–1204
Tingley D, Yamamato T, Hirose K, Keele L, Imai K (2014) mediation: R Package for Causal Mediation Analysis. J Stat Softw 59:1–38
Torgerson DG, Ampleford EJ, Chiu GY, Gauderman WJ, Gignoux CR, Graves PE, Himes BE, Levin AM, Mathias RA, Hancock DB, Baurley JW, Eng C, Stern DA, Celedon JC, Rafaels N, Capurso D, Conti DV, Roth LA, Soto-Quiros M, Togias A, Li X, Myers RA, Romieu I, Van Den Berg DJ, Hu D, Hansel NN, Hernandez RD, Israel E, Salam MT, Galanter J, Avila PC, Avila L, Rodriquez-Santana JR, Chapela R, Rodriguez-Cintron W, Diette GB, Adkinson NF, Abel RA, Ross KD, Shi M, Faruque MU, Dunston GM, Watson HR, Mantese VJ, Ezurum SC, Liang L, Ruczinski I, Ford JG, Huntsman S, Chung KF, Vora H, Li X, Calhoun WJ, Castro M, Sienra-Monge JJ, del Rio-Navarro B, Deichmann KA, Heinzmann A, Wenzel SE, Busse WW, Gern JE, Lemanske RF Jr, Beaty TH, Bleecker ER, Raby BA, Meyers DA, London SJ, Mexico City Childhood Asthma Study (MCAAS), Gilliland FD, Children’s Health Study (CHS) and HARBORS study, Burchard EG, Genetics of Asthma in Latino Americans (GALA) Study, Study of Genes-Environment and Admixture in Latino Americans (GALA2) and Study of African Americans, Asthma, Genes & Environments (SAGE), Martinez FD, Childhood Asthma Research and Education (CARE) Network, Weiss ST, Childhood Asthma Management Program (CAMP), Williams LK, Study of Asthma Phenotypes and Pharmacogenomic Interactions by Race-Ethnicity (SAPPHIRE), Barnes KC, Genetic Research on Asthma in African Diaspora (GRAAD) Study, Ober C, Nicolae DL (2011) Meta-analysis of genome-wide association studies of asthma in ethnically diverse North American populations. Nat Genet 43:887–892
Turner SD (2014) qqman: an R package for visualizing GWAS results using Q-Q and manhattan plots. biorXiv
Wang D (2000) sg154: confidence intervals for the ratio of two binomial proportions by Koopman’s method. Stata Technical Bulletin, 58 edn. Stata Press, College Station, TX
Wang L, Murk W, DeWan AT (2015) Genome-wide gene by environment interaction analysis identifies common SNPs at 17q21.2 that are associated with increased body mass index only among asthmatics. PLoS One 10, e0144114
Ward LD, Kellis M (2012) HaploReg: a resource for exploring chromatin states, conservation, and regulatory motif alterations within sets of genetically linked variants. Nucleic Acids Res 40:D930–D934
Welter D, MacArthur J, Morales J, Burdett T, Hall P, Junkins H, Klemm A, Flicek P, Manolio T, Hindorff L, Parkinson H (2014) The NHGRI GWAS Catalog, a curated resource of SNP-trait associations. Nucleic Acids Res 42:D1001–D1006
Xu Z, Taylor JA (2009) SNPinfo: integrating GWAS and candidate gene information into functional SNP selection for genetic association studies. Nucleic Acids Res 37:W600–W605
Xu S, Huang W, Wang H, He Y, Wang Y, Wang Y, Qian J, Xiong M, Jin L (2007) Dissecting linkage disequilibrium in African-American genomes: roles of markers and individuals. Mol Biol Evol 24:2049–2058
Xu M, Tantisira KG, Wu A, Litonjua AA, Chu JH, Himes BE, Damask A, Weiss ST (2011) Genome Wide Association Study to predict severe asthma exacerbations in children using random forests classifiers. BMC Med Genet 12:90
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The authors acknowledge the patients, families, recruiters, health care providers, and community clinics for their participation. In particular, the authors thank Sandra Salazar for her support as the SAGE II study coordinator. The authors also acknowledge the Lowell Science Research Program, Lowell High School, San Francisco, CA. This work was supported in part by the Sandler Foundation, the American Asthma Foundation, the RWJF Amos Medical Faculty Development Program, and the National Institutes of Health (ES015794 and MD006902).
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EGB has been funded by the National Institutes of Health (R01ES015794 and P60-MD006902), the Sandler Foundation, the RWJF Amos Medical Faculty Development Award, and the American Asthma Foundation. MPY has received honoraria for speaking at symposium from Affymetrix. The rest of the authors report no conflicts of interest in this work.
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Marquitta J. White and O. Risse-Adams contributed equally to this work.
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White, M.J., Risse-Adams, O., Goddard, P. et al. Novel genetic risk factors for asthma in African American children: Precision Medicine and the SAGE II Study. Immunogenetics 68, 391–400 (2016). https://doi.org/10.1007/s00251-016-0914-1
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DOI: https://doi.org/10.1007/s00251-016-0914-1