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Research ArticleArticle

Schizophrenia Genetics and Neuropsychiatric Features in Childhood-onset Systemic Lupus Erythematosus

Ana C. Ulloa, Fangming Liao, Raffaella L. Carlomagno, Talia Diaz, Daniela Dominguez, Deborah M. Levy, Lawrence Ng, Andrea M. Knight and Linda T. Hiraki
The Journal of Rheumatology October 2021, jrheum.210363; DOI: https://doi.org/10.3899/jrheum.210363
Ana C. Ulloa
LTH is supported by The Arthritis Society Stars Career Award. A.C. Ulloa, MPH, Genetics & Genome Biology, Research Institute, The Hospital for Sick Children; F. Liao, MSc, R.L. Carlomagno, MD, T. Diaz, MD, D. Dominguez, MD, MSc, L. Ng, BSc, A.M. Knight, MD, MSCE, Division of Rheumatology, The Hospital for Sick Children; D.M. Levy, MD, MS, Division of Rheumatology, The Hospital for Sick Children, and Department of Pediatrics, The University of Toronto; L.T. Hiraki, MD, FRCPC, ScD, Genetics & Genome Biology, Research Institute, and Division of Rheumatology, The Hospital for Sick Children, and Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.T. Hiraki, Peter Gilgan Centre for Research and Learning, 686 Bay St., Toronto, ON M5G 0A4, Canada. Email: linda.hiraki@sickkids.ca. Accepted for publication September 23, 2021.
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Fangming Liao
LTH is supported by The Arthritis Society Stars Career Award. A.C. Ulloa, MPH, Genetics & Genome Biology, Research Institute, The Hospital for Sick Children; F. Liao, MSc, R.L. Carlomagno, MD, T. Diaz, MD, D. Dominguez, MD, MSc, L. Ng, BSc, A.M. Knight, MD, MSCE, Division of Rheumatology, The Hospital for Sick Children; D.M. Levy, MD, MS, Division of Rheumatology, The Hospital for Sick Children, and Department of Pediatrics, The University of Toronto; L.T. Hiraki, MD, FRCPC, ScD, Genetics & Genome Biology, Research Institute, and Division of Rheumatology, The Hospital for Sick Children, and Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.T. Hiraki, Peter Gilgan Centre for Research and Learning, 686 Bay St., Toronto, ON M5G 0A4, Canada. Email: linda.hiraki@sickkids.ca. Accepted for publication September 23, 2021.
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Raffaella L. Carlomagno
LTH is supported by The Arthritis Society Stars Career Award. A.C. Ulloa, MPH, Genetics & Genome Biology, Research Institute, The Hospital for Sick Children; F. Liao, MSc, R.L. Carlomagno, MD, T. Diaz, MD, D. Dominguez, MD, MSc, L. Ng, BSc, A.M. Knight, MD, MSCE, Division of Rheumatology, The Hospital for Sick Children; D.M. Levy, MD, MS, Division of Rheumatology, The Hospital for Sick Children, and Department of Pediatrics, The University of Toronto; L.T. Hiraki, MD, FRCPC, ScD, Genetics & Genome Biology, Research Institute, and Division of Rheumatology, The Hospital for Sick Children, and Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.T. Hiraki, Peter Gilgan Centre for Research and Learning, 686 Bay St., Toronto, ON M5G 0A4, Canada. Email: linda.hiraki@sickkids.ca. Accepted for publication September 23, 2021.
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Talia Diaz
LTH is supported by The Arthritis Society Stars Career Award. A.C. Ulloa, MPH, Genetics & Genome Biology, Research Institute, The Hospital for Sick Children; F. Liao, MSc, R.L. Carlomagno, MD, T. Diaz, MD, D. Dominguez, MD, MSc, L. Ng, BSc, A.M. Knight, MD, MSCE, Division of Rheumatology, The Hospital for Sick Children; D.M. Levy, MD, MS, Division of Rheumatology, The Hospital for Sick Children, and Department of Pediatrics, The University of Toronto; L.T. Hiraki, MD, FRCPC, ScD, Genetics & Genome Biology, Research Institute, and Division of Rheumatology, The Hospital for Sick Children, and Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.T. Hiraki, Peter Gilgan Centre for Research and Learning, 686 Bay St., Toronto, ON M5G 0A4, Canada. Email: linda.hiraki@sickkids.ca. Accepted for publication September 23, 2021.
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Daniela Dominguez
LTH is supported by The Arthritis Society Stars Career Award. A.C. Ulloa, MPH, Genetics & Genome Biology, Research Institute, The Hospital for Sick Children; F. Liao, MSc, R.L. Carlomagno, MD, T. Diaz, MD, D. Dominguez, MD, MSc, L. Ng, BSc, A.M. Knight, MD, MSCE, Division of Rheumatology, The Hospital for Sick Children; D.M. Levy, MD, MS, Division of Rheumatology, The Hospital for Sick Children, and Department of Pediatrics, The University of Toronto; L.T. Hiraki, MD, FRCPC, ScD, Genetics & Genome Biology, Research Institute, and Division of Rheumatology, The Hospital for Sick Children, and Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.T. Hiraki, Peter Gilgan Centre for Research and Learning, 686 Bay St., Toronto, ON M5G 0A4, Canada. Email: linda.hiraki@sickkids.ca. Accepted for publication September 23, 2021.
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Deborah M. Levy
LTH is supported by The Arthritis Society Stars Career Award. A.C. Ulloa, MPH, Genetics & Genome Biology, Research Institute, The Hospital for Sick Children; F. Liao, MSc, R.L. Carlomagno, MD, T. Diaz, MD, D. Dominguez, MD, MSc, L. Ng, BSc, A.M. Knight, MD, MSCE, Division of Rheumatology, The Hospital for Sick Children; D.M. Levy, MD, MS, Division of Rheumatology, The Hospital for Sick Children, and Department of Pediatrics, The University of Toronto; L.T. Hiraki, MD, FRCPC, ScD, Genetics & Genome Biology, Research Institute, and Division of Rheumatology, The Hospital for Sick Children, and Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.T. Hiraki, Peter Gilgan Centre for Research and Learning, 686 Bay St., Toronto, ON M5G 0A4, Canada. Email: linda.hiraki@sickkids.ca. Accepted for publication September 23, 2021.
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Lawrence Ng
LTH is supported by The Arthritis Society Stars Career Award. A.C. Ulloa, MPH, Genetics & Genome Biology, Research Institute, The Hospital for Sick Children; F. Liao, MSc, R.L. Carlomagno, MD, T. Diaz, MD, D. Dominguez, MD, MSc, L. Ng, BSc, A.M. Knight, MD, MSCE, Division of Rheumatology, The Hospital for Sick Children; D.M. Levy, MD, MS, Division of Rheumatology, The Hospital for Sick Children, and Department of Pediatrics, The University of Toronto; L.T. Hiraki, MD, FRCPC, ScD, Genetics & Genome Biology, Research Institute, and Division of Rheumatology, The Hospital for Sick Children, and Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.T. Hiraki, Peter Gilgan Centre for Research and Learning, 686 Bay St., Toronto, ON M5G 0A4, Canada. Email: linda.hiraki@sickkids.ca. Accepted for publication September 23, 2021.
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Andrea M. Knight
LTH is supported by The Arthritis Society Stars Career Award. A.C. Ulloa, MPH, Genetics & Genome Biology, Research Institute, The Hospital for Sick Children; F. Liao, MSc, R.L. Carlomagno, MD, T. Diaz, MD, D. Dominguez, MD, MSc, L. Ng, BSc, A.M. Knight, MD, MSCE, Division of Rheumatology, The Hospital for Sick Children; D.M. Levy, MD, MS, Division of Rheumatology, The Hospital for Sick Children, and Department of Pediatrics, The University of Toronto; L.T. Hiraki, MD, FRCPC, ScD, Genetics & Genome Biology, Research Institute, and Division of Rheumatology, The Hospital for Sick Children, and Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.T. Hiraki, Peter Gilgan Centre for Research and Learning, 686 Bay St., Toronto, ON M5G 0A4, Canada. Email: linda.hiraki@sickkids.ca. Accepted for publication September 23, 2021.
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Linda T. Hiraki
LTH is supported by The Arthritis Society Stars Career Award. A.C. Ulloa, MPH, Genetics & Genome Biology, Research Institute, The Hospital for Sick Children; F. Liao, MSc, R.L. Carlomagno, MD, T. Diaz, MD, D. Dominguez, MD, MSc, L. Ng, BSc, A.M. Knight, MD, MSCE, Division of Rheumatology, The Hospital for Sick Children; D.M. Levy, MD, MS, Division of Rheumatology, The Hospital for Sick Children, and Department of Pediatrics, The University of Toronto; L.T. Hiraki, MD, FRCPC, ScD, Genetics & Genome Biology, Research Institute, and Division of Rheumatology, The Hospital for Sick Children, and Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.T. Hiraki, Peter Gilgan Centre for Research and Learning, 686 Bay St., Toronto, ON M5G 0A4, Canada. Email: linda.hiraki@sickkids.ca. Accepted for publication September 23, 2021.
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Abstract

Objective We examined the association between schizophrenia genetic susceptibility loci and neuropsychiatric systemic lupus erythematosus (NPSLE) features in childhood-onset SLE (cSLE) participants.

Methods Study participants from the Lupus Clinic at the Hospital for Sick Children, Toronto, met ≥ 4 of the American College of Rheumatology and/or SLE International Collaborating Clinics SLE classification criteria and were genotyped using the Illumina Multi-Ethnic Global Array or the Global Screening Array. Ungenotyped single-nucleotide polymorphisms (SNPs) were imputed, and ancestry was genetically inferred. We calculated 2 additive schizophrenia-weighted polygenic risk scores (PRS) using (1) genome-wide significant SNPs (P < 5 × 10–8), and (2) an expanded list of SNPs with significance at P < 0.05. We defined 2 outcomes compared to absence of NPSLE features: (1) any NPSLE feature, and (2) subtypes of NPSLE features (psychosis and nonpsychosis NPSLE). We completed logistic and multinomial regressions, first adjusted for inferred ancestry only and then added for variables significantly associated with NPSLE in our cohort (P < 0.05).

Results We included 513 participants with cSLE. Median age at diagnosis was 13.8 years (IQR 11.2–15.6), 83% were female, and 31% were of European ancestry. An increasing schizophrenia genome-wide association PRS was not associated with NPSLE (OR 1.04, 95% CI 0.87–1.26, P = 0.62), nor with the NPSLE subtypes, psychosis (OR 0.97, 95% CI 0.73–1.29, P = 0.84) and other nonpsychosis NPSLE (OR 1.08, 95% CI 0.88–1.34, P = 0.45), in ancestry-adjusted models. Results were similar for the model including covariates (ancestry, malar rash, oral/nasal ulcers, arthritis, lymphopenia, Coombs-positive hemolytic anemia, lupus anticoagulant, and anticardiolipin antibodies) and for the expanded PRS estimates.

Conclusion We did not observe an association between known risk loci for schizophrenia and NPSLE in a multiethnic cSLE cohort. This work warrants further validation.

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Schizophrenia Genetics and Neuropsychiatric Features in Childhood-onset Systemic Lupus Erythematosus
Ana C. Ulloa, Fangming Liao, Raffaella L. Carlomagno, Talia Diaz, Daniela Dominguez, Deborah M. Levy, Lawrence Ng, Andrea M. Knight, Linda T. Hiraki
The Journal of Rheumatology Oct 2021, jrheum.210363; DOI: 10.3899/jrheum.210363

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Schizophrenia Genetics and Neuropsychiatric Features in Childhood-onset Systemic Lupus Erythematosus
Ana C. Ulloa, Fangming Liao, Raffaella L. Carlomagno, Talia Diaz, Daniela Dominguez, Deborah M. Levy, Lawrence Ng, Andrea M. Knight, Linda T. Hiraki
The Journal of Rheumatology Oct 2021, jrheum.210363; DOI: 10.3899/jrheum.210363
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