Literature DB >> 34717601

CTNNA3 genetic polymorphism may be a new genetic signal of type 2 diabetes in the Chinese Han population: a case control study.

Yunjun Zhang1, Xiaoman Zhou1, Wanjuan Dai2, Juan Sun1, Mei Lin1, Yutian Zhang1, Yipeng Ding3.   

Abstract

BACKGROUND: Type 2 Diabetes (T2D) is the result of a combination of genes and environment. The identified genetic loci can only explain part of T2D risk. Our study is aimed to explore the association between CTNNA3 single nucleotide polymorphisms (SNPs) and T2D risk.
METHODS: We conducted a 'case-control' study among 1002 Chinese Han participants. Four candidate SNPs of CTNNA3 were selected (rs10822745 C/T, rs7920624 A/T, rs2441727 A/G, rs7914287 A/G), and logistic regression analysis was used to evaluate the association between candidate SNPs and T2D risk. We used single factor analysis of variance to analyze the differences of clinical characteristics among different genotypes. In this study, haplotype analysis was conducted by plink1.07 and Haploview software and linkage disequilibrium (LD) was calculated. The interaction of candidate SNPs in T2D risk was evaluated by multi-factor dimensionality reduction (MDR). Finally, we conducted a false-positive report probability (FPRP) analysis to detect whether the significant findings were just chance or noteworthy observations.
RESULTS: The results showed that CTNNA3-rs7914287 was a risk factor for T2D ('T': OR = 1.33, p = 0.003; 'TT': OR = 2.21, p = 0.001; 'TT' (recessive): OR = 2.09, p = 0.001; Log-additive: OR = 1.34, p = 0.003). The results of subgroup analysis showed that rs7914287 was significantly associated with the increased risk of T2D among participants who were older than 60 years, males, smoking, drinking, or BMI > 24. We also found that rs2441727 was associated with reducing the T2D risk among participants who were older than 60 years, smoking, or drinking. In addition, rs7914287 was associated with T2D patients with no retinal degeneration; rs10822745 and rs7920624 were associated with the course of T2D patients. High density lipoprotein levels had significant differences under different genotypes of rs10822745. Under the different genotypes of rs7914287, the levels of aspartate aminotransferase, alanine aminotransferase and gamma-glutamyltransferase were also significantly different.
CONCLUSION: We found that CTNNA3 genetic polymorphisms can be used as a new genetic signal of T2D risk in Chinese Han population. Especially, CTNNA3-rs7914287 showed an outstanding and significant association with T2D risk in both overall analysis and subgroup analysis.
© 2021. The Author(s).

Entities:  

Keywords:  CTNNA3; Case–control study; Single nucleotide polymorphisms; Type 2 diabetes

Mesh:

Substances:

Year:  2021        PMID: 34717601      PMCID: PMC8556947          DOI: 10.1186/s12920-021-01105-8

Source DB:  PubMed          Journal:  BMC Med Genomics        ISSN: 1755-8794            Impact factor:   3.063


Introduction

Type 2 diabetes (T2D) is non-insulin-dependent diabetes, is a form of diabetes is much more prevalent.The prevalence of T2D is getting higher and higher worldwide. T2D and its complications have reached the level of an epidemic, which has attracted great attention in the field of scientific research [1]. A number of studies have confirmed that T2D is a complex disease affected by multiple factors and is the result of the interaction between genes and the environment [1-4]. Evidence from genetic epidemiology indicates that the occurrence of type 2 diabetes has a strong genetic basis [5-8]. In recent years, with the improvement and application of molecular epidemiology or genetic testing technology, some T2D-related genetic loci have been identified one after another [9-15], but it can only explain the T2D risk among part of population [1, 16]. Therefore, it is necessary to discover new genetic signals of T2D in different populations, which will provide valuable references for clinical diagnosis and early prevention of T2D. CTNNA3 can encode αT-catenin protein and is a member of the α-catenin family of cell–cell adhesion molecules [17]. Chiarella, S. E., et al. have proposed that CTNNA3 may be the most relevant type of α-catenin in human diseases [18]. In a recent genome-wide association study on Metabolic Syndrome of African Lineage (MetS), single nucleotide polymorphism (SNPs) of CTNNA3 were reported can be new genetic signals of metabolic syndrome risk. There have been studies have reported that people with MetS have at least a five-fold increase in the risk of T2D [19, 20]. But so far, there is no report about the association between CTNNA3 SNPs and T2D risk. Therefore, in order to explore the association between CTNNA3 SNPs and T2D risk, we conducted a 'case–control' study among a total of 1,002 Chinese Han population. We not only conducted an overall analysis, but also divided participants according to the known potential environmental risk factors of T2D for subgroup analysis, such as drinking [21], smoking [22], age [23], etc. Finally, the association between candidate SNPs and T2D risk will be evaluated. Our study will provide data supplement for genetic loci associated with T2D risk in Chinese Han population, and lay a certain theoretical foundation for the individualized prevention and treatment of T2D.

Materials and methods

Study subjects

In this study, a ‘case–control’ study design was used to analyze the association between SNPs and T2D risk among 1002 participants (501 cases and 501 controls). Case group: (1) T2D patients who are outpatients or hospitalized in Hainan General Hospital. (2) Patients who were diagnosed as T2D for the first time or who have been clearly diagnosed as T2D (Fasting blood glucose (FBG) ≥ 7.0 mmol/L, OGTT 2 h blood glucose ≥ 11.1 mmol/L or random blood glucose ≥ 11.1 mmol/L). (3) No history of other complicated diseases (malignant tumors, cardiovascular disease history, etc.). (4) No history of genetic diseases. Control group: (1) Healthy individuals undergoing physical examination at the same hospital's health examination center during the same period. (2) FBG ≤ 6.1 mmol/L. (3) No complicated chronic diseases, and tumor patients or people with tumor history are excluded. (4) Recruit healthy individuals who match the case group in terms of age and gender (excluding confounding factors caused by differences in the distribution of exposure factors in the case/control group). In this study, questionnaire survey on demographic and epidemiological information among all participants was conducted by a professional doctor. The contents of the questionnaire include gender, height, weight, smoking/drinking status, whether diabetic patients were accompanied by retinopathy, and the course of T2D. After obtaining the informed consent of all participants, we collected their peripheral blood samples for subsequent DNA extraction. The study was approved by the ethics committee of Hainan General Hospital.

Selection of SNPs

The specific steps for selecting SNPs are as follows: (1) We obtained the physical position of the CTNNA3 on the Chromosome 10: 65,912,457–67,763,637 through the e!GRCh37 database (http://asia.ensembl.org/Homo_sapiens/Info/Index). In the VCF to PED Converter window (http://grch37.ensembl.org/Homo_sapiens/Tools/VcftoPed), we entered the gene location, selected the CHB and CHS population, and downloaded the ped and info file for the variations of CTNNA3. (2) Then we used Haploview software for quality control (HWE > 0.01, MAF > 0.05, Min Genotype > 75%, and Tagger r2 > 0.8) to select tagSNP. Finally, four SNPs of CTNNA3 (rs10822745 C/T, rs7920624 A/T, rs2441727 A/G, rs7914287 A/G) were selected for our study.’ You can check the revisions from the ‘Methods-Selection of SNPs.

DNA extraction and genotyping

DNA extraction and purification were performed according to the instructions of the kit (GoldMag Co. Ltd. Xi’an, China). We store the purified DNA in an ultra-low temperature refrigerator (−80 ℃) until needed in the next experiment. We used MassARRAY Assay Design software to design all primers we need. The genotyping in this study was conducted by the MassARRAY system (Agena, San Diego, CA, USA). In order to reduce experimental errors and ensure the reliability and repeatability of experimental results, we randomly select 10% of DNA samples for repeatability testing. The repetition rate of experimental results needs to be > 99%.

Statistical analysis

The differences in demographic characteristics (age, gender, BMI, etc.) were tested by SPSS version 21.0 software (SPSS, Chicago, IL, USA) (χ2 test/t-test). After testing whether the four candidate genetic loci of CTNNA3 meet Hardy–Weinberg equilibrium (SPSS version 21.0 software), we used logistic regression model to calculate the odds ratio (OR) and 95% confidence interval (CI). Then, according to the value of OR and CI, the association between CTNNA3 candidate SNPs and T2D risk was estimated (OR value represents relative risk; OR = 1: this factor has no effect on T2D risk; OR < 1: T2D protective factor; OR > 1: T2D risk factor). Using the wild-type allele as a reference, the online tool software plink 1.07 was used to estimate multiple genetic models. The statistical results obtained were adjusted by age and gender, and all tests were two-sided tests. In addition, we conducted a false-positive report probability (FPRP) analysis to detect whether the significant findings were just chance or noteworthy observations [24]. In this study, haplotype analysis was conducted by plink1.07 and Haploview software and linkage disequilibrium (LD) was calculated. Finally, the interaction of candidate SNPs in T2D risk was evaluated by multi-factor dimensionality reduction (MDR).

Results

Sample overview and collection

There was no genetic relationship among all participants in our study. Among them, the average age of T2D patients was 59.86 ± 12.86 years old, males 359 (72%), females 142 (28%). The average age of healthy individuals was 59.60 ± 10.09 years, males 359 (72%), females 142 (28%). The basic demographic and epidemiological information was shown in Table 1. There was no statistical difference between the case and the control group in gender (p = 0.528) or age (p = 0.714).
Table 1

Characteristics of patients with type 2 diabetes and healthy individuals

CharacteristicsCasesControlP
n = 501n = 501
Age (years)Mean ± SD59.86 ± 12.8659.60 ± 10.090.714
 > 60240 (48%)262 (52%)
 ≤ 60261 (52%)239 (48%)
GenderMale359 (72%)359 (72%)0.528
Female142 (28%)142 (28%)
Course of disease > 10 versus ≤ 10 years194 (39%)306 (61%)
No retinal degenerationYes70 (14%)
No240 (48%)
SmokingYes218 (44%)124 (25%)0.593
No281 (56%)173 (35%)
DrinkingYes109 (22%)127 (25%) < 0.0001
No385 (77%)143 (29%)
BMI (kg/m2)BMI > 24239 (48%)187 (37%)0.089
BMI ≤ 24203 (41%)123 (25%)

Course of disease: the length of time the case has suffered from T2D (participants are divided by the average of the length of time)

BMI, Body mass index

Characteristics of patients with type 2 diabetes and healthy individuals Course of disease: the length of time the case has suffered from T2D (participants are divided by the average of the length of time) BMI, Body mass index

Genotyping and information about candidate SNPs

The 4 candidate genetic loci of CNNTA3 (rs10822745 C/T, rs7920624 A/T, rs2441727 A/G, rs7914287 A/G) were successfully genotyped. As shown in Table 2, all candidate SNPs met HWE (p > 5%). The results of HaploReg showed that the candidate SNPs were regulated by a variety of factors, and the specific factors were detailed in Table 2.
Table 2

The basic information and HWE about the selected SNPs of CTNNA3

GeneSNP IDFunctionChr: positionAlleles(A/B)MAFHWE(P value)Haploreg 4.1
CasesControls
CTNNA3rs10822745Intronic10: 66,194,307C/T0.4290.4170.646Motifs changed
CTNNA3rs7920624Intronic10: 66,203,428A/T0.4880.4980.929Motifs changed
CTNNA3rs2441727Intronic10: 66,465,128A/G0.1820.2040.406NHGRI/EBI GWAS hits
CTNNA3rs7914287Intronic10: 67,590,805T/C0.3550.2920.124

HWE, Hardy–Weinberg equilibrium; Alleles (A/B), minor/major allele; SNP, single nucleotide polymorphisms; MAF, minor allele frequency

p > 0.05 indicates that the genotypes were in Hardy–Weinberg Equilibrium

The basic information and HWE about the selected SNPs of CTNNA3 HWE, Hardy–Weinberg equilibrium; Alleles (A/B), minor/major allele; SNP, single nucleotide polymorphisms; MAF, minor allele frequency p > 0.05 indicates that the genotypes were in Hardy–Weinberg Equilibrium

Evaluation of association between candidate SNPs and T2D risk (overall analysis)

The evaluation results of the association between candidate SNPs and T2D risk (Table 3) showed that only CNNTA3 rs7914287 had a significant association with the T2D risk among participants. Specifically, rs7914287 can significantly increase the T2D risk under allele (T vs. C: OR = 1.33, CI 1.10–1.61, p = 0.003), homozygous (TT vs. CC: OR = 2.21, CI 1.41–3.47, p = 0.001), recessive (TT vs. TC-CC: OR = 2.09, CI 1.36–3.22, p = 0.001), and log-additive models (OR = 1.34, CI 1.10–1.62, p = 0.003). We did not find any evidence that the remaining three candidate SNPs were associated with the T2D risk.
Table 3

Analysis of the association between susceptibility of type 2 diabetes and single nucleotide polymorphism of CTNNA3

SNP IDModelGenotypeCaseControlAdjusted by age and gender
OR (95% CI)p
rs10822745AlleleC430 (42.91%)417 (41.70%)1.05 (0.88–1.26)0.582
T572 (57.09%)583 (58.30%)1.00
GenotypeCC87 (17.4%)84 (16.8%)1.10 (0.76–1.59)0.631
CT256 (51.1%)249 (49.8%)1.09 (0.82–1.44)0.558
TT158 (31.5%)167 (33.4%)1.00
DominantCC-CT343 (68.5%)333 (66.6%)1.09 (0.84–1.42)0.528
TT158 (31.5%)167 (33.4%)1.00
RecessiveCC87 (17.4%)84 (16.8%)1.04 (0.75–1.45)0.811
CT-TT414 (82.6%)416 (83.2%)1.00
Log-additive1.05 (0.88–1.26)0.575
rs7920624AlleleA485 (48.79%)498 (49.80%)0.96 (0.81–1.15)0.653
T509 (51.21%)502 (50.20%)1.00
GenotypeAA110 (22.1%)123 (24.6%)0.91 (0.64–1.31)0.623
AT265 (53.3%)252 (50.4%)1.08 (0.80–1.46)0.629
TT122 (24.6%)125 (25%)1.00
DominantAA-AT375 (75.5%)375 (75%)1.02 (0.77–1.37)0.872
TT122 (24.6%)125 (25%)1.00
RecessiveAA110 (22.1%)123 (24.6%)0.87 (0.65–1.17)0.349
AT-TT387 (77.9%)377 (75.4%)1.00
Log-additive0.96 (0.80–1.15)0.637
rs2441727AlleleA182 (18.16%)202 (20.45%)0.86 (0.69–1.08)0.197
G820 (81.84%)786 (79.55%)1.00
GenotypeAA17 (3.4%)17 (3.4%)0.91 (0.46–1.83)0.802
AG148 (29.5%)168 (34%)0.81 (0.62–1.06)0.128
GG336 (67.1%)309 (62.5%)1.00
DominantAA-AG165 (32.9%)185 (37.5%)0.82 (0.63–1.07)0.137
GG336 (67.1%)309 (62.5%)1.00
RecessiveAA17 (3.4%)17 (3.4%)0.98 (0.49–1.95)0.955
AG-GG484 (96.6%)477 (96.6%)1.00
Log-additive0.86 (0.69–1.08)0.192
rs7914287AlleleT355 (35.50%)284 (29.22%)1.33 (1.10–1.61)0.003*
C645 (64.50%)688 (70.78%)1.00
GenotypeTT68 (13.6%)34 (7%)2.21 (1.41–3.47)0.001*
TC219 (43.8%)216 (44.4%)1.12 (0.86–1.46)0.389
CC213 (42.6%)236 (48.6%)1.00
DominantTT-TC287 (57.4%)250 (51.4%)1.27 (0.99–1.63)0.062
CC213 (42.6%)236 (48.6%)1.00
RecessiveTT68 (13.6%)34 (7%)2.09 (1.36–3.22)0.001*
TC-CC432 (86.4%)452 (93%)1.00
Log-additive1.34 (1.10–1.62)0.003*

SNP, Single nucleotide polymorphisms; OR, odds ratio; CI, Confidence interval

p < 0.05, bold text and '*' indicate statistical significance

“–” indicates Log-additive model

Analysis of the association between susceptibility of type 2 diabetes and single nucleotide polymorphism of CTNNA3 SNP, Single nucleotide polymorphisms; OR, odds ratio; CI, Confidence interval p < 0.05, bold text and '*' indicate statistical significance “–” indicates Log-additive model

Evaluation of association between candidate SNPs and T2D risk (subgroup analysis)

Age and gender The results showed (Table 4) that CNNTA3 rs2441727 can significantly reduce the T2D risk in participants who were aged ≤ 60 years old under multiple genetic models (heterozygote: OR = 0.58, CI 0.39–0.87, p = 0.008; dominant: OR = 0.64, CI 0.44–0.93, p = 0.021). rs7914287 was not only a risk factor for T2D in participants aged > 60 years old (allele: OR = 1.37, CI 1.06–1.79, p = 0.018; homozygote: OR = 2.22, CI 1.18–4.17, p = 0.013; dominant: OR = 1.56, CI 1.08–2.25, p = 0.019; recessive: OR = 1.85, CI 1.02–3.35, p = 0.044; log-additive: OR = 1.47, CI 1.11–1.94, p = 0.007), but also a risk factor for T2D in participants aged ≤ 60 years old (homozygote: OR = 2.71, CI 1.36–5.42, p = 0.005; recessive: OR = 2.73, CI 1.40–5.32, p = 0.003; log-additive: OR = 1.33, CI 1.01–1.75, p = 0.041). In the gender stratification analysis, rs7914287 can significantly increase the T2D risk in male participants (Allele: OR = 2.33, CI 1.07–3.67, p = 0.012; homozygote: OR = 2.20, CI 1.29–3.77, p = 0.004; recessive: OR = 2.08, CI 1.24–3.49, p = 0.005; log-additive: OR = 2.33, CI 1.06–3.67, p = 0.013).
Table 4

The SNPs of CTNNA3 associated with susceptibility of type 2 diabetes in the subgroup tests (age and gender)

SNP IDModelGenotypeAge, yearsGender
OR (95% CI)pOR (95% CI)POR (95% CI)pOR (95% CI)p
 ≤ 60 (N = 500) > 60 (N = 502)Female (N = 284)Male (N = 718)
rs10822745AlleleC1.03 (0.80–1.32)0.8441.07 (0.83–1.38)0.5871.09 (0.78–1.53)0.6001.04 (0.84–1.28)0.749
T1.001.001.001.00
GenotypeCC1.09 (0.65–1.85)0.7391.05 (0.61–1.79)0.8721.20 (0.61–2.36)0.6011.05 (0.68–1.64)0.816
CT0.91 (0.61–1.36)0.6601.21 (0.81–1.81)0.3481.08 (0.64–1.82)0.7751.09 (0.78–1.52)0.613
TT1.001.001.001.00
DominantCC-CT0.96 (0.65–1.40)0.8191.17 (0.8–1.71)0.4261.11 (0.68–1.82)0.6751.08 (0.79–1.48)0.630
TT1.001.001.001.00
RecessiveCC1.16 (0.73–1.84)0.5410.93 (0.58–1.51)0.7711.15 (0.62–2.11)0.6591.00 (0.68–1.48)0.999
CT-TT1.001.001.001.00
Log-additive1.02 (0.79–1.32)0.8541.05 (0.81–1.37)0.6991.09 (0.78–1.52)0.6011.04 (0.84–1.29)0.742
rs7920624AlleleA1.13 (0.88–1.45)0.3291.05 (0.82–1.35)0.7000.95 (0.68–1.31)0.7370.97 (0.79–1.19)0.749
T1.001.001.001.00
GenotypeAA1.28 (0.76–2.14)0.3501.09 (0.65–1.83)0.7450.89 (0.46–1.73)0.7270.93 (0.60–1.42)0.720
AT1.02 (0.65–1.59)0.9491.47 (0.94–2.29)0.0921.00 (0.57–1.76)1.0001.11 (0.78–1.59)0.567
TT1.001.001.001.00
DominantAA-AT1.09 (0.72–1.67)0.6791.33 (0.87–2.03)0.1830.96 (0.57–1.64)0.8901.05 (0.75–1.48)0.779
TT1.001.001.001.00
RecessiveAA1.27 (0.84–1.90)0.2590.84 (0.55–1.28)0.4110.89 (0.51–1.54)0.6730.86 (0.61–1.22)0.399
AT-TT1.001.001.001.00
Log-additive1.14 (0.88–1.47)0.3361.04 (0.81–1.35)0.7550.94 (0.68–1.32)0.7330.96 (0.78–1.19)0.733
rs2441727AlleleA0.98 (0.71–1.35)0.8870.78 (0.58–1.07)0.1220.89 (0.60–1.33)0.5810.85 (0.65–1.11)0.238
G1.001.001.001.00
GenotypeAA0.46 (0.11–1.88)0.2810.73 (0.49–1.67)0.7480.95 (0.36–2.03)0.9330.82 (0.33–2.06)0.677
AG0.86 (0.43–1.26)0.7570.58 (0.39–0.87)0.008*0.80 (0.48–1.31)0.3710.82 (0.59–1.13)0.218
GG1.001.001.001.00
DominantAA-AG0.84 (0.70–1.48)0.9310.64 (0.44–0.93)0.021*0.83 (0.51–1.33)0.4330.82 (0.60–1.12)0.206
GG1.001.001.001.00
RecessiveAA0.45 (0.11–1.84)0.2670.57 (0.60–0.76)0.4550.94 (0.40–1.23)0.8120.88 (0.35–2.19)0.775
AG-GG1.001.001.001.00
Log-additive0.96 (0.68–1.36)0.8300.77 (0.57–1.05)0.1030.89 (0.60–1.33)0.5790.84 (0.64–1.11)0.228
rs7914287AlleleT1.31 (1.00–1.72)0.0521.37 (1.06–1.79)0.018*1.34 (0.94–1.90)0.1072.33 (1.07–3.67)0.012*
C1.001.001.001.00
GenotypeTT2.71 (1.36–5.42)0.0572.22 (1.18–4.17)0.013*2.26 (0.97–5.22)0.0582.20 (1.29–3.77)0.004*
TC0.99 (0.68–1.44)0.9521.43 (0.97–2.11)0.0701.11 (0.67–1.83)0.6811.12 (0.82–1.54)0.461
CC1.001.001.001.00
DominantTT-TC1.18 (0.82–1.68)0.3721.56 (1.08–2.25)0.019*1.27 (0.79–2.04)0.3301.27 (0.95–1.71)0.113
CC1.001.001.001.00
RecessiveTT2.73 (1.40–5.32)0.1201.85 (1.02–3.35)0.044*2.14 (0.96–4.76)0.0632.08 (1.24–3.49)0.005*
TC-CC1.001.001.001.00
Log-additive1.33 (1.01–1.75)0.0641.47 (1.11–1.94)0.007*1.35 (0.94–1.93)0.1062.33 (1.06–3.67)0.013*

SNP, Single nucleotide polymorphisms; OR, odds ratio; CI, Confidence interval

p < 0.05, bold text and '*' indicate statistical significance

“–” indicates Log-additive model

The SNPs of CTNNA3 associated with susceptibility of type 2 diabetes in the subgroup tests (age and gender) SNP, Single nucleotide polymorphisms; OR, odds ratio; CI, Confidence interval p < 0.05, bold text and '*' indicate statistical significance “–” indicates Log-additive model Smoking and drinking The results showed (Table 5) that rs2441727 significantly reduced the T2D risk in participants with a history of smoking (heterozygote: OR = 0.61, CI 0.41–0.92, p = 0.018; dominant: OR = 0.65, CI 0.44–0.97, p = 0.034). At the same time, rs2441727 reduced the T2D risk in drinking participants under the heterozygous genetic model (heterozygote: OR = 0.63, CI 0.42–0.94, p = 0.025). rs7914287 was a risk factor for T2D in smoking (allele: OR = 2.36, CI 1.01–4.82, p = 0.023; homozygote: OR = 2.50, CI 1.18–5.32, p = 0.017; recessive: OR = 2.44, CI 1.18–5.05, p = 0.016) and drinking participants (allele: OR = 1.41, CI 1.04–2.91, p = 0.025; homozygote: OR = 2.11, CI 1.34–5.20, p = 0.008; recessive: OR = 2.00, CI 1.33–4.77, p = 0.008).
Table 5

The SNPs of CTNNA3 associated with susceptibility of type 2 diabetes in the subgroup tests (smoking and drinking)

SNP IDModelGenotypeSmokingDrinking
OR (95% CI)pOR (95% CI)pOR (95% CI)pOR (95% CI)p
No (N = 454)Yes (N = 342)No (N = 528)Yes (N = 236)
rs10822745AlleleC0.96 (0.70–1.31)0.7771.11 (0.85–1.46)0.4471.13 (0.78–1.63)0.5241.05 (0.80–1.39)0.715
T1.001.001.001.00
GenotypeCC0.79 (0.40–1.56)0.5001.26 (0.73–2.17)0.4071.26 (0.57–2.76)0.5680.98 (0.57–1.69)0.954
CT1.25 (0.76–2.05)0.3771.11 (0.72–1.71)0.6281.21 (0.68–2.14)0.5181.43 (0.93–2.21)0.107
TT1.001.001.001.00
DominantCC-CT1.13 (0.70–1.8)0.6191.15 (0.77–1.73)0.4881.22 (0.71–2.11)0.4761.28 (0.86–1.91)0.230
TT1.001.001.001.00
RecessiveCC0.69 (0.38–1.27)0.2331.18 (0.73–1.91)0.4961.12 (0.55–2.27)0.7500.80 (0.50–1.30)0.375
CT-TT1.001.001.001.00
Log-additive0.95 (0.68–1.33)0.7731.12 (0.86–1.46)0.4031.14 (0.78–1.66)0.5051.05 (0.79–1.37)0.753
rs7920624AlleleA1.01 (0.74–1.39)0.9310.95 (0.73–1.25)0.7331.10 (0.77–1.59)0.5980.99 (0.75–1.29)0.921
T1.001.001.001.00
GenotypeAA1.03 (0.54–1.97)0.9180.89 (0.52–1.51)0.6591.23 (0.60–2.53)0.5740.97 (0.56–1.65)0.899
AT1.52 (0.88–2.63)0.1311.02 (0.65–1.60)0.9431.36 (0.73–2.55)0.3341.37 (0.86–2.19)0.182
TT1.001.001.001.00
DominantAA-AT1.36 (0.81–2.27)0.2490.97 (0.63–1.49)0.8981.31 (0.73–2.36)0.3611.22 (0.79–1.89)0.363
TT1.001.001.001.00
RecessiveAA0.77 (0.46–1.31)0.3420.88 (0.56–1.37)0.5671.01 (0.56–1.83)0.9780.78 (0.50–1.23)0.286
AT-TT1.001.001.001.00
Log-additive1.02 (0.74–1.42)0.8920.94 (0.72–1.23)0.6741.11 (0.78–1.59)0.5630.99 (0.75–1.31)0.937
rs2441727AlleleA1.01 (0.67–1.53)0.9530.79 (0.56–1.10)0.1540.97 (0.62–1.51)0.8960.80 (0.57–1.12)0.191
G1.001.001.001.00
GenotypeAA3.08 (0.36–6.41)0.3051.32 (0.41–4.29)0.6450.67 (0.15–2.95)0.5992.60 (0.57–5.82)0.215
AG0.88 (0.55–1.42)0.6070.61 (0.41–0.92)0.018*1.08 (0.63–1.87)0.7780.63 (0.42–0.94)0.025*
GG1.001.001.001.00
DominantAA-AG0.94 (0.58–1.50)0.7800.65 (0.44–0.97)0.034*1.04 (0.61–1.76)0.8920.69 (0.46–1.03)0.071
GG1.001.001.001.00
RecessiveAA0.82 (0.38–1.34)0.2870.57 (0.49–1.06)0.4480.65 (0.15–2.83)0.5700.27 (0.68–1.83)0.144
AG-GG1.001.001.001.00
Log-additive0.93 (0.66–1.55)0.9630.75 (0.54–1.06)0.1080.98 (0.62–1.56)0.9470.83 (0.58–1.17)0.281
rs7914287AlleleT1.36 (0.97–1.91)0.0782.36 (1.01–4.82)0.023*1.20 (0.81–1.77)0.3681.41 (1.04–2.91)0.025*
C1.001.001.001.00
GenotypeTT1.91 (0.87–4.21)0.1092.50 (1.18–5.32)0.017*1.33 (0.55–3.20)0.5272.11 (1.34–5.20)0.008*
TC1.29 (0.80–2.07)0.3021.06 (0.71–1.58)0.7881.21 (0.70–2.09)0.5011.08 (0.72–1.62)0.721
CC1.001.001.001.00
DominantTT-TC1.39 (0.89–2.19)0.1521.23 (0.83–1.81)0.2991.23 (0.73–2.07)0.4361.28 (0.86–1.90)0.219
CC1.001.001.001.00
RecessiveTT1.69 (0.79–3.60)0.1752.44 (1.18–5.05)0.016*1.21 (0.52–2.79)0.6552.00 (1.33–4.77)0.008*
TC-CC1.001.001.001.00
Log-additive1.35 (0.96–1.89)0.0891.34 (0.99–1.80)0.0551.17 (0.79–1.73)0.4281.41 (1.04–1.91)0.027*

OR, odds ratio; CI, confidence interval

p < 0.05, bold text and '*' indicate statistical significance

“–” indicates Log-additive model

The SNPs of CTNNA3 associated with susceptibility of type 2 diabetes in the subgroup tests (smoking and drinking) OR, odds ratio; CI, confidence interval p < 0.05, bold text and '*' indicate statistical significance “–” indicates Log-additive model BMI The results showed (Table 6) that rs7914287 was a risk factor for T2D no matter in the participants with BMI ≤ 24 or BMI > 24. Specifically, among the participants with BMI ≤ 24, rs7914287 can significantly increase the T2D risk under allele (OR = 1.57, CI 1.11–2.24, p = 0.011), homozygote (OR = 3.66, CI 1.43–5.36, p = 0.007), recessive (OR = 2.25, CI 1.31–4.07, p = 0.011), and log-additive genetic models (OR = 1.60, CI 1.12–2.29, p = 0.010). Among the participants with BMI > 24, rs7914287 can also significantly increase the T2D risk under allele (OR = 1.45, CI 1.08–1.96, p = 0.014), homozygote (OR = 2.86, CI 1.32–6.24, p = 0.008), recessive (OR = 2.58, CI 1.22–4.47, p = 0.014), and log-additive genetic models (OR = 1.48, CI 1.09–2.01, p = 0.013).
Table 6

The SNPs of CTNNA3 associated with susceptibility of type 2 diabetes in the subgroup tests (BMI)

SNP IDModelGenotypeBMI
OR (95% CI)pOR (95% CI)p
 ≤ 24 (N = 326) > 24 (N = 426)
rs10822745AlleleC/T1.12 (0.81–1.54)0.4990.89 (0.68–1.17)0.415
HomozygoteCC/TT1.43 (0.69–2.95)0.3320.77 (0.44–1.37)0.375
HeterozygoteCT0.95 (0.58–1.56)0.8391.06 (0.68–1.67)0.793
DominantCC-CT/TT1.04 (0.64–1.67)0.8810.97 (0.63–1.50)0.905
RecessiveCC/CT-TT1.48 (0.77–2.85)0.2440.74 (0.45–1.22)0.237
Log-additive1.13 (0.81–1.59)0.4650.90 (0.68–1.19)0.448
rs7920624AlleleA/T1.05 (0.76–1.44)0.7631.12 (0.85–1.47)0.430
HomozygoteAA/TT1.13 (0.56–2.26)0.7331.25 (0.72–2.17)0.422
HeterozygoteAT1.16 (0.66–2.04)0.6101.28 (0.81–2.02)0.294
DominantAA-AT/TT1.15 (0.67–1.99)0.6131.27 (0.83–1.95)0.276
RecessiveAA/AT-TT1.01 (0.58–1.77)0.9631.07 (0.67–1.72)0.765
Log-additive1.06 (0.75–1.51)0.7271.13 (0.86–1.49)0.385
rs2441727AlleleA/G0.72 (0.48–1.08)0.1151.00 (0.70–1.41)0.993
HomozygoteAA/GG1.10 (0.19–6.24)0.9131.32 (0.32–5.51)0.705
HeterozygoteAG/GG0.64 (0.39–1.03)0.0680.96 (0.63–1.45)0.829
DominantAA-AG/GG0.66 (0.41–1.06)0.0820.97 (0.65–1.46)0.896
RecessiveAA/AG-GG1.30 (0.23–7.31)0.7651.34 (0.32–5.56)0.689
Log-additive1.16 (0.77–1.74)0.4841.00 (0.69–1.45)0.991
rs7914287AlleleT/C1.57 (1.11–2.24)0.0721.45 (1.08–1.96)0.014*
HomozygoteTT/CC3.66 (1.43–5.36)0.1202.86 (1.32–6.24)0.008*
HeterozygoteTC/CC1.27 (0.79–2.06)0.3251.24 (0.82–1.88)0.302
DominantTT-TC/CC1.52 (0.96–2.42)0.0731.42 (0.96–2.11)0.080
RecessiveTT/TC-CC2.25 (1.31–4.07)0.0932.58 (1.22–4.47)0.014*
Log-additive1.60 (1.12–2.29)0.1101.48 (1.09–2.01)0.013*

OR, odds ratio; CI, confidence interval

p < 0.05, bold text and '*' indicate statistical significance

“–” indicates Log-additive model

The SNPs of CTNNA3 associated with susceptibility of type 2 diabetes in the subgroup tests (BMI) OR, odds ratio; CI, confidence interval p < 0.05, bold text and '*' indicate statistical significance “–” indicates Log-additive model No retinal degeneration and course of T2D The results showed (Table 7) that rs7914287 was associated with T2D patients who have no retinal egeneration under multiple genetic models (allele: p = 0.022, homozygote: p = 0.004, recessive: p = 0.003, log-additive: p = 0.021). We also found that the candidate SNPs associated with the course of T2D were rs10822745 (allele: p = 0.022, homozygote: p = 0.017, recessive: p = 0.027, log-additive: p = 0.023), rs7920624 (allele: p = 0.030), and rs2441727 (allele: p = 0.030; heterozygote: p = 0.001; dominant: p = 0.001; log-additive: p = 0.003).
Table 7

The SNPs of CTNNA3 associated with susceptibility of type 2 diabetes in the subgroup tests (no retinal degeneration and course of type 2 diabetes)

SNP IDModelGenotypeNo retinal degeneration(No retinal degeneration in cases vs. ≤ control)(N = 741)Course of type 2 diabetes (> 10 vs. ≤ 10 years)(N = 500)
OR (95% CI)pOR (95% CI)p
rs10822745AlleleC/T1.07 (0.86–1.33)0.5520.74 (0.57–0.96)0.022*
HomozygoteCC/TT1.07 (0.66–1.72)0.7950.49 (0.28–0.88)0.017*
HeterozygoteCT1.30 (0.92–1.85)0.1390.83 (0.55–1.25)0.368
DominantCC-CT/TT1.24 (0.89–1.74)0.2040.73 (0.49–1.09)0.120
RecessiveCC/CT-TT0.90 (0.59–1.38)0.6310.55 (0.33–0.94)0.027*
Log-additive1.07 (0.86–1.35)0.5400.73 (0.55–0.96)0.023*
rs7920624AlleleA/T0.95 (0.76–1.18)0.6471.33 (1.03–1.72)0.030*
HomozygoteAA/TT0.88 (0.55–1.41)0.6021.73 (1.00–3.01)0.052
HeterozygoteAT1.29 (0.88–1.90)0.1871.50 (0.94–2.40)0.091
DominantAA-AT/TT1.16 (0.80–1.67)0.4301.56 (1.00–2.45)0.051
RecessiveAA/AT-TT0.74 (0.50–1.08)0.1181.30 (0.84–2.03)0.238
Log-additive0.95 (0.76–1.19)0.6401.31 (1.00–1.73)0.051
rs2441727AlleleA/G0.81 (0.61–1.08)0.1521.33 (1.03–1.72)0.030*
HomozygoteAA/GG0.56 (0.20–1.54)0.2610.61 (0.22–1.68)0.336
HeterozygoteAG/GG0.83 (0.59–1.16)0.2680.49 (0.32–0.76)0.001*
DominantAA-AG/GG0.80 (0.58–1.11)0.1880.50 (0.33–0.76)0.001*
RecessiveAA/AG-GG0.59 (0.22–1.64)0.3140.74 (0.27–2.04)0.558
Log-additive0.80 (0.60–1.08)0.1400.59 (0.41–0.84)0.003*
rs7914287AlleleT/C1.31 (1.04–1.66)0.022*1.10 (0.85–1.44)0.466
HomozygoteTT/CC2.20 (1.29–3.75)0.004*1.23 (0.70–2.16)0.479
HeterozygoteTC/CC1.07 (0.77–1.49)0.6820.89 (0.60–1.34)0.587
DominantTT-TC/CC1.23 (0.90–1.68)0.2000.97 (0.66–1.41)0.859
RecessiveTT/TC-CC2.13 (1.28–3.54)0.003*1.30 (0.76–2.21)0.334
Log-additive1.32 (1.04–1.68)0.021*1.05 (0.80–1.37)0.721

OR, odds ratio; CI, confidence interval

p < 0.05, bold text and '*' indicate statistical significance

“–” indicates Log-additive model

The SNPs of CTNNA3 associated with susceptibility of type 2 diabetes in the subgroup tests (no retinal degeneration and course of type 2 diabetes) OR, odds ratio; CI, confidence interval p < 0.05, bold text and '*' indicate statistical significance “–” indicates Log-additive model Differences in clinical indicators under different genotypes We also evaluated the impact of 4 candidate CTNNA3 SNPs on the level of clinical indicators under different genotypes. The result showed (Table 8) that high density lipoprotein levels had significant differences under different genotypes of CTNNA3 rs10822745 (p = 0.013). The level of aspartate aminotransferase (p = 0.037), alanine aminotransferase (p = 0.044) and gamma-glutamyltransferase (p = 0.029) also had significant differences under different genotypes of rs7914287. There was no significant difference between the remaining candidate SNPs and the level of clinical indicators (Additional file 1: Table S1).
Table 8

Clinical characteristics of patients (N = 501) based on the genotypes of selected SNPs

Characteristicsrs10822745rs7914287
TTTCCCpTTTCCCp
FBS7.22 ± 2.937.46 ± 3.467.23 ± 4.010.7707.34 ± 3.037.31 ± 3.447.39 ± 3.480.976
GHbA1c8.11 ± 1.998.17 ± 2.167.71 ± 1.830.2127.6 ± 1.798.18 ± 1.998.11 ± 2.20.135
TC3.5 ± 1.483.57 ± 1.483.73 ± 4.430.7633.32 ± 1.593.64 ± 3.033.59 ± 1.470.598
TG2.89 ± 3.412.66 ± 2.682.57 ± 2.410.6702.44 ± 3.552.83 ± 2.62.69 ± 2.970.651
HDL1.03 ± 0.280.99 ± 0.241.26 ± 1.630.013*1.08 ± 0.331.1 ± 1.040.99 ± 0.250.306
Urea6.36 ± 2.396.76 ± 3.946.1 ± 2.190.2066.27 ± 1.716.4 ± 2.446.72 ± 4.210.494
Cr70.78 ± 55.4673.38 ± 56.9265.54 ± 29.610.49368.02 ± 29.2868.17 ± 26.3375.44 ± 74.010.320
Cys-c0.99 ± 0.471.02 ± 0.481 ± 0.340.7090.98 ± 0.381.03 ± 0.341 ± 0.570.690
AST21.57 ± 13.0822.01 ± 16.4621.49 ± 11.820.93922.62 ± 12.8423.41 ± 19.1719.84 ± 8.590.037*
ALT24.68 ± 24.8724.62 ± 27.3925.22 ± 23.210.98223.08 ± 14.1428.07 ± 34.9121.97 ± 15.680.044*
GGT30.88 ± 24.834.61 ± 39.4132.67 ± 57.540.65229.63 ± 19.138.54 ± 54.7528.72 ± 20.70.029*
LPa205.49 ± 210.61214.26 ± 223.75246.77 ± 241.110.392199.82 ± 199.91230.56 ± 219.36209.44 ± 233.490.516

p <0.05, bold text and ‘*’ represent statistical significance

FBS, fasting blood glucose; GHbA1c, glycosylated hemoglobin A1c; TC, total cholesterol; TG, triacylglycerol; HDL, high density lipoprotein; Cr, creatinine; Cys-c, cystatin c; AST, aspartate aminotransferase; ALT, alanine aminotransferase; GGT, gamma-glutamyltransferase; LPa, lysophosphatidic acid

Clinical characteristics of patients (N = 501) based on the genotypes of selected SNPs p <0.05, bold text and ‘*’ represent statistical significance FBS, fasting blood glucose; GHbA1c, glycosylated hemoglobin A1c; TC, total cholesterol; TG, triacylglycerol; HDL, high density lipoprotein; Cr, creatinine; Cys-c, cystatin c; AST, aspartate aminotransferase; ALT, alanine aminotransferase; GGT, gamma-glutamyltransferase; LPa, lysophosphatidic acid

FPRP analysis

The results of FPRP analysis showed that (Additional file 2: Table S2) the association between CTNNA3 rs7914287 and T2D risk in drinking participants was not noteworthy at the prior probability level of 0.25 and FPRP threshold of 0.2. The FPRP of the remaining significant results were all less than 0.2, which means that these positive results were noteworthy.

LD and haplotype analysis

The results of linkage disequilibrium and haplotype analysis of CTNNA3 polymorphism showed (Fig. 1): there is an LD block (D’ = 0.968, R2 = 0.665) composed of 2 SNPs (rs10822745 and rs7920624). However, logistic regression results showed that there was no statistically significant difference among the CTNNA3 haplotype frequencies in the cases and controls (Additional file 3: Table S3).
Fig. 1

Linkage disequilibrium (LD) plots containing four polymorphisms from CTNNA3. The lighter the color, the lower the degree of linkage. The numbers inside the diamonds indicate the D′ for pairwise analyses

Linkage disequilibrium (LD) plots containing four polymorphisms from CTNNA3. The lighter the color, the lower the degree of linkage. The numbers inside the diamonds indicate the D′ for pairwise analyses

Analysis of MDR

We used MDR to analyze and predict the interaction between SNP-SNP. Figure 2 was dendrogram analysis of SNP-SNP interaction. The color in the figure represents whether the effect of SNP-SNP on T2D risk is synergistic or redundant. The color in the figure represents whether the effect of SNP-SNP on T2D risk is synergistic or redundant. The blue line in the dendrogram indicates that candidate SNPs have a redundant role in regulating T2D risk (Fig. 2). The results (Table 9) showed that the four loci models (rs10822745, rs7920624, rs2441727, rs7914287) have the highest test accuracy. However, considering the small sample size, the rs7920624 and rs2441727 two-site model was regard as the overall best model, with a test accuracy of 0.541 and a good CVC (9/10).
Fig. 2

Dendrogram analysis of SNP-SNP interaction. The colors in the tree diagram represent synergy or redundancy

Table 9

SNP–SNP interaction models analyzed by the MDR method

ModelTraining Bal. AccTesting Bal. AccOR (95% CI)p valueCVC
rs79142870.5370.5201.35 (1.05–1.73)0.01919/10
rs7920624, rs24417270.5570.5411.58 (1.23–2.04)0.00039/10
rs7920624, rs2441727, rs79142870.5820.5251.96 (1.52–2.54) < 0.00019/10
rs10822745, rs7920624, rs2441727, rs79142870.6070.5432.41 (1.86–3.12) < 0.000110/10

MDR, multifactor dimensionality reduction; Bal. Acc., balanced accuracy; CVC, cross-validation consistency; OR, odds ratio; 95% CI, 95% confidence interval

p values were calculated using χ2 tests; p < 0.05 and bold text indicate statistical significance

Dendrogram analysis of SNP-SNP interaction. The colors in the tree diagram represent synergy or redundancy SNP–SNP interaction models analyzed by the MDR method MDR, multifactor dimensionality reduction; Bal. Acc., balanced accuracy; CVC, cross-validation consistency; OR, odds ratio; 95% CI, 95% confidence interval p values were calculated using χ2 tests; p < 0.05 and bold text indicate statistical significance

Discussion

The incidence of Type 2 diabetes has increased significantly worldwide, and the number of T2D patients in many countries is increasing year by year [1]. More and more studies have confirmed that genetic factors play an indispensable role in the T2D risk [2]. More and more efforts are also devoted to improving the status quo of T2D, but there are still some clinical challenges to be overcome. For example, the existing clinical markers are not fully applicable to clinical diagnosis [25]. It was estimated that the genetic signals that have been discovered can only explain 2% of the T2D risk [16]. Therefore, it is still an arduous and long-term task to discover more genetic polymorphisms related to T2D risk. There are relatively few studies on the association between CTNNA3 genetic polymorphisms and diseases. In recent reports, CTNNA3 single nucleotide polymorphisms in African populations can be used as new genetic signals for MetS, and MetS risk is closely associated with T2D risk [19, 20]. Our study is the first to explore the association between CTNNA3 SNPs and T2D risk in Chinese Han population, and we found strong evidence of potential association between them. In general, among the 4 candidate SNPs, only CTNNA3 rs7914287 was significantly associated with T2D risk in the Chinese Han population under allele, homozygous, recessive and log-additive models. It may be a risk factor for T2D. We found no evidence that the remaining three SNPs are associated with T2D risk among participants. Type 2 diabetes is most common in the elderly, but due to lack of physical activity and healthy eating habits [26-28], there are more and more obese patients among children, adolescents and young people, which in turn leads to type 2 diabetes [29]. Therefore, we divide the participants according to the current status of T2D incidence and the potential risk factors of T2D for subgroup analysis, with a view to provide a valuable reference for T2D risk assessment in specific populations. And subgroup analysis for potential risk factors is an effective way to remove the influence of confounding factors. Alcohol [21], smoking [22], and aging [23] have been reported as risk factors for T2D. In this study, rs2441727 significantly reduced the T2D risk among participants who were > 60 years old, smoking, or drinking, and it also showed a trend to reduce the risk of T2D among participants who were ≤ 60 years old, no smoking/drinking. Our results indicate that CTNNA3-rs2441727 may be a protective factor for T2D in Chinese Han population, and this protective effect is not affected by the potential environmental risk factors of T2D. However, a large sample size and further verification tests are necessary to ensure that our results are more accurate. Nevertheless, our study is the first to report the correlation between CTNNA3-rs2441727 and T2D risk. Whether in the overall or subgroup analysis (age > 60 years old, smoking, drinking, male, BMI > 24, and no retinal degeneration), CTNNA3-rs7914287 can increase the T2D risk under multiple genetic models among participants. However, it is worth noting that in the overall analysis, under the allelic inheritance model, the allele ‘T’ of rs7914287 seemed to show a tendency to reduce the risk of T2D, the result was not significant. We speculated that potential risk factors such as age > 60 years old, males, smoking or drinking may promote the allele ‘T’ of rs7914287 to become a risk factor for T2D. In addition, we also found that the results of our study are similar to previous studies: Kautzky–Willer et al. have reported that T2D risk has gender differences. And this gender difference may be affected by environmental factors such as age and obesity rate [30]. Our study also found that the association between CTNNA3-rs7914287 and T2D risk had gender differences. Increased BMI is strongly associated with T2D risk [31]. Our study also found that rs7914287 was significantly associated with T2D risk among participants with BMI > 24. In addition to the above findings, we found that CTNNA3-rs7914287 was a risk factor for T2D patients with no retinal degeneration. However, numerous studies have reported that retinal degeneration is closely related to T2D [32, 33]. Combined with the results of this study, CTNNA3-rs7914287 can significantly increase the risk of T2D participants and may not be affected by retinal degeneration or not. In summary, rs7914287 is a risk factor for T2D. And potential risk factors such as age > 60 years old, males, smoking or drinking et al. may have a synergistic effect with rs7914287 in increasing the risk of T2D. And we were also pleasantly surprised to find that the levels of AST, ALT and GGT of T2D patients were significantly different under different genotypes of rs7914287. And there were studies have reported that the increase in AST, ALT and GGT levels may be related to the increased risk of T2D [32, 34, 35]. In our study, the T2D participants had significantly higher AST, ALT and GGT levels under the rs7914287 TC genotype. Therefore, we speculate that CTNNA3-rs7914287 may increase the T2D risk by affecting the levels of AST, ALT and GGT. But this is just a speculation, CTNNA3-rs7914287 mechanism in the pathogenesis of T2D risk remains unclear, further research is needed. Nevertheless, our study suggest that CTNNA3 genetic polymorphism may be a new genetic signal of T2D risk in Chinese Han population, providing new ideas and valuable references for clinical early prevention and individualized treatment of T2D in Chinese Han population. It is worth noting that our study still has certain limitations. If the sample size is further expanded for research verification, it will be more helpful to confirm the results of our study.

Conclusion

In summary, we found that CTNNA3 genetic polymorphisms can be used as a new genetic signal of T2D risk in Chinese Han population. Especially, CTNNA3-rs7914287 showed an outstanding and significant association with T2D risk in both overall analysis and subgroup analysis. Our study has provided valuable data supplements for the T2D susceptibility loci in Chinese Han population. Additional file 1. Supplemental table 1 Clinical characteristics of patients based on the genotypes of selected SNPs. Additional file 2. Supplementary table 2 The FPRP and statistical power values of the positive results in this study. Additional file 3. Supplemental table 3 Haplotype frequencies and the association with the risk of T2D.
  35 in total

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Authors:  George A Bray
Journal:  J Clin Endocrinol Metab       Date:  2004-06       Impact factor: 5.958

2.  A genome-wide association study identifies novel risk loci for type 2 diabetes.

Authors:  Robert Sladek; Ghislain Rocheleau; Johan Rung; Christian Dina; Lishuang Shen; David Serre; Philippe Boutin; Daniel Vincent; Alexandre Belisle; Samy Hadjadj; Beverley Balkau; Barbara Heude; Guillaume Charpentier; Thomas J Hudson; Alexandre Montpetit; Alexey V Pshezhetsky; Marc Prentki; Barry I Posner; David J Balding; David Meyre; Constantin Polychronakos; Philippe Froguel
Journal:  Nature       Date:  2007-02-11       Impact factor: 49.962

3.  Alcohol consumption and risk of pre-diabetes and type 2 diabetes development in a Swedish population.

Authors:  M Cullmann; A Hilding; C-G Östenson
Journal:  Diabet Med       Date:  2012-04       Impact factor: 4.359

4.  Genome-wide association analysis identifies loci for type 2 diabetes and triglyceride levels.

Authors:  Richa Saxena; Benjamin F Voight; Valeriya Lyssenko; Noël P Burtt; Paul I W de Bakker; Hong Chen; Jeffrey J Roix; Sekar Kathiresan; Joel N Hirschhorn; Mark J Daly; Thomas E Hughes; Leif Groop; David Altshuler; Peter Almgren; Jose C Florez; Joanne Meyer; Kristin Ardlie; Kristina Bengtsson Boström; Bo Isomaa; Guillaume Lettre; Ulf Lindblad; Helen N Lyon; Olle Melander; Christopher Newton-Cheh; Peter Nilsson; Marju Orho-Melander; Lennart Råstam; Elizabeth K Speliotes; Marja-Riitta Taskinen; Tiinamaija Tuomi; Candace Guiducci; Anna Berglund; Joyce Carlson; Lauren Gianniny; Rachel Hackett; Liselotte Hall; Johan Holmkvist; Esa Laurila; Marketa Sjögren; Maria Sterner; Aarti Surti; Margareta Svensson; Malin Svensson; Ryan Tewhey; Brendan Blumenstiel; Melissa Parkin; Matthew Defelice; Rachel Barry; Wendy Brodeur; Jody Camarata; Nancy Chia; Mary Fava; John Gibbons; Bob Handsaker; Claire Healy; Kieu Nguyen; Casey Gates; Carrie Sougnez; Diane Gage; Marcia Nizzari; Stacey B Gabriel; Gung-Wei Chirn; Qicheng Ma; Hemang Parikh; Delwood Richardson; Darrell Ricke; Shaun Purcell
Journal:  Science       Date:  2007-04-26       Impact factor: 47.728

5.  Maternal effect and familial aggregation in NIDDM. The CODIAB Study. CODIAB-INSERM-ZENECA Study Group.

Authors:  F Thomas; B Balkau; F Vauzelle-Kervroedan; L Papoz
Journal:  Diabetes       Date:  1994-01       Impact factor: 9.461

Review 6.  Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis.

Authors:  Vasanti S Malik; Barry M Popkin; George A Bray; Jean-Pierre Després; Walter C Willett; Frank B Hu
Journal:  Diabetes Care       Date:  2010-08-06       Impact factor: 19.112

7.  Association of Common Genetic Variants in Pre-microRNAs and Neuroblastoma Susceptibility: A Two-Center Study in Chinese Children.

Authors:  Jing He; Yan Zou; Xiaodan Liu; Jinhong Zhu; Jiao Zhang; Ruizhong Zhang; Tianyou Yang; Huimin Xia
Journal:  Mol Ther Nucleic Acids       Date:  2018-01-31       Impact factor: 8.886

Review 8.  Genetics of diabetes mellitus and diabetes complications.

Authors:  Joanne B Cole; Jose C Florez
Journal:  Nat Rev Nephrol       Date:  2020-05-12       Impact factor: 42.439

Review 9.  αT-catenin: A developmentally dispensable, disease-linked member of the α-catenin family.

Authors:  Sergio E Chiarella; Erik E Rabin; Lorena A Ostilla; Annette S Flozak; Cara J Gottardi
Journal:  Tissue Barriers       Date:  2018-05-10

Review 10.  Biomarkers for type 2 diabetes.

Authors:  Markku Laakso
Journal:  Mol Metab       Date:  2019-09       Impact factor: 7.422

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