Case-only genome-wide interaction study of disease risk, prognosis and treatment.

Case-control genome-wide association (GWA) studies have facilitated the identification of susceptibility loci for many complex diseases; however, these studies are often not adequately powered to detect gene-environment (G x E) and gene-gene (G x G) interactions. Case-only studies are more efficient than case-control studies for detecting interactions and require no data on control subjects. In this article, we discuss the concept and utility of the case-only genome-wide interaction (COGWI) study, in which common genetic variants, measured genome-wide, are screened for association with environmental exposures or genetic variants of interest. An observed G-E (or G-G) association, as measured by the case-only odds ratio (OR), suggests interaction, but only if the interacting factors are unassociated in the population from which the cases were drawn. The case-only OR is equivalent to the interaction risk ratio. In addition to risk-related interactions, we discuss how the COGWI design can be used to efficiently detect G x G, G x E and pharmacogenetic interactions related to disease outcomes in the context of observational clinical studies or randomized clinical trials. Such studies can be conducted using only data on individuals experiencing an outcome of interest or individuals not experiencing the outcome of interest. Sharing data among GWA and COGWI studies of disease risk and outcome can further enhance efficiency. Sample size requirements for COGWI studies, as compared to case-control GWA studies, are provided. In the current era of genome-wide analyses, the COGWI design is an efficient and straightforward method for detecting G x G, G x E and pharmacogenetic interactions related to disease risk, prognosis and treatment response.