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The Role of Twin Studies in IBD Research Dr Hannah Gordon Clinical Research Fellow Chelsea and Westminster Hospital.

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Presentation on theme: "The Role of Twin Studies in IBD Research Dr Hannah Gordon Clinical Research Fellow Chelsea and Westminster Hospital."— Presentation transcript:

1 The Role of Twin Studies in IBD Research Dr Hannah Gordon Clinical Research Fellow Chelsea and Westminster Hospital

2 Introduction Review History of twin studies Twin studies in IBD New molecular techniques in IBD UK IBD Nixon Twin and Multiplex Registry and Biobank

3 History of Twin Studies 1 st recorded 1875 Francis Galton (1) Description of twin pairs Personal traits Physical and mental health “Nature is far stronger than nurture” Monozygotic vs dizygotic distinguished 1914 (2)

4 Twin Studies – study design Classical Monozygotic vs dizygotic (nature vs nurture) Adoption Genetically identical individuals reared apart Longitudinal Correlation between environment and discordance over time Exercise and depression Offspring of twins Birth weight of children of MZ female twins more similar than birth weight of children of MZ male twins

5 Twin Studies in IBD – Inheritance Twin study 1988 showed CD MZ concordance 55% DZ concordance 3.8% (3) Figure 1: Range of Concordance of Crohn’s and UC between Twin Pairs (from Swedish, UK, Danish, Dutch and German Twin Populations (4)) Variation CC defined 1960s Genetic differences between populations Crohn’s has stronger genetic basis Strong environmental component Crohn’s DiseaseUlcerative Colitis Monozygotic20-55%6.3-17% Dizygotic0-3.6%0-6.3%

6 Twin studies: UC altered mucosal glycosylation presented in discordant MZ pairs (9) MZ concordance CD location and behaviour UC extent (5,6) monozygotic twin pairs x1CD x1 UC (7) X2 concordance DZ twins compared with other siblings (8) Shared uterus More similar childhood environment

7 Genome Wide Association Studies 163 SNPs associated with IBD (10,11)

8 The Microbiome – a living active ecosystem Trillions of microbes (10x number of human cells) (12) >1000 species level phylotypes Microbial genome 150x larger than human host (13) Changes during life Interactions with host (and each other) Obesity DM IBD CV disease

9 Study of Microbiota Megagenomics 16srRNA PCR sequencing and amplification (14) Metaproteomics Expressed gene products Metabolomics Metabolites of host-microbiota interactions High res NMR spect Multivariate statistical analysis “Metabolic fingerprint”

10 Microbiota of MZ twins: Healthy MZ twins have similar microbiota (15) Twins with CD have differing microbiota (concordant or discordant) (16) Microbiota tends towards phenotype rather than genotype (17) Inactive UC microbiota no different from healthy twin (18)

11 Metabolomics – “Fingerprints” in IBD Metabolomic profile of faecal water of A) CD (n=10), B) UC (n=10), C) Healthy control (n=13) (19) Key: 1, butyrate; 2, leucine; 3, propionate; 4, valine; 5, isoleucine; 6, threonine; 7, alanine; 8, lysine; 9, acetate; 10, glutamate; 11, succinate; 12, aspartic acid; 13, asparagine; 14, trimethylamine; 15, cysteine; 16, proline; 17, glycerol; 18, methylamine; 19, 5-aminosalicylic acid; 20, N -acetyl-5-aminosalicylic acid; 21, tyrosine; and 22, uracil

12 Metabolomic profiles IBD: CD Depletion of short chain fatty acids Decreased methylamine and trimethylamine UC Increased amino acids

13 Metabolomic profiles of Twins Difference between discordant MZ pairs (ICD and CCD) (20) Similarity between healthy MZ Differentiation between ICD and CCD ?Metabolites associated with SNPs higher in affected twin

14 Epigenetics – Blurring the distinction between nature and nurture “Heritable changes in gene expression that occur without alterations in DNA sequence” (11) Methylation gene silencing Histone modification Changes persist after mitosis ?persist after meiosis (transgenerational)

15 Epigenetics IBD – 50 genes with different methylation between patients with CD and controls (21) Twin studies – different methylation patterns SLE MZ discordant Role of twin studies ?timing of methylation ?Inheritance of methylation in offspring

16 MicroRNA Small non coding RNA molecule Transported from nucleus Forms protein complex Binds with mRNA mRNA degraded sooner and translated less How does it change in IBD? Distinct miRNA signatures in peripheral blood in CD vs UC vs Control (11) MiRNA NOD2 controls miRNA expression (24) MiRNA 29 deficient mice – worse colitis

17 Limitations of twin studies Sample size MZ twins 3/1000 births DZ twins 13/1000 births IBD prevalence UK 400/100,000

18 IBD Nixon TAM Registry and Biobank History Royal Free Dataset 250 twin pairs Study of MZ vs DZ concordance 1996 (23) Database revisited and reanalysed 2011 (6) Concordance of disease location and extent Childhood infection Current Contacting Twins from previous dataset Recruiting new Twin pairs Biobank

19 Conclusion Continuing relevance to twin studies in omics era(2) Microbiome Epigenetics Twin studies to date Evidence of genetic component Development Disease pattern Galton wrong – environmental factors predominate

20 References: 1.Galton, F. The history of twins, as a criterion of the relative powers of nature and nurture. J. Anthropol. Institute Great Britain Ireland 5, 391–406 (1876) 2.Dongen J, Slagboom P, Draisma H, Martin N, Boomsana DL. The continuing value of twin studies in the omics era. Nat Rev Genet. 2012 Sep;13(9):640-53 3.Tysk C, Lindberg E, Jarnerot G, et al. Ulcerative colitis and Crohn's disease in an unselected population of monozygotic and dizygotic twins. A study of heritability and the influence of smoking. Gut. 1988; 29: 990–996 4.Brant S. Update on the heritability of IBD: The importance of twin studies. Inflammatory Bowel Disease Vol 17, Issue 1, Pg 1-5 Jan 2011 5.Halfvarson J, Jess T, Bodin L, et al. Longitudinal concordance for clinical characteristics in a Swedish-Danish twin population with inflammatory bowel disease. Inflamm Bowel Dis. 2007; 13: 1536–1544. 6.Ng SC, Woodrow S, Patel N, Subhani J, Harbord M. Role of genetic and environmental factors in British twins with Inflamatory Bowel disease. Inflamm Bowel Dis. 2012 Apr;18(4):725-36. doi: 10.1002/ibd.2174 7.Halfvarson J. Genetics in twins with Crohn's disease: less pronounced than previously believed? Inflamm Bowel Dis. Epub ahead of print: 2010; June 8.Bengtson MB, Aamodt G, Vatn MH, Harris JR. Concordance for IBD among twins compared to ordinary siblings – a Nowegian population based study. J Crohns Colitis. 2010 Sep;4(3):312-8 9.Bodger K, Halfvarson J, Dodson AR, Campbell F, Wilson S, Lee R, Lindberg E, Järnerot G, Tysk C, Rhodes JM. Altered colonic glycoprotein expression in unaffected monozygotic twins of inflammatory bowel disease patients. Gut. 2006 Jul;55(7):973-7. Epub 2006 Feb 4 10.Jostins L, Ripke S, Weersma RK, et al. Host-microbe interactions have shaped the genetic architecture of inflammatory bowel disease. Nature. 2012;490:119–124 11.Ventham NT, Kennedy NA, Nimmo ER, Satsangi J. Beyond gene discovery in inflammatory bowel disease: the emerging role of epigenetics. Gastroenterology.2013 Aug;145(2):293-308 12.Nicholson JK, Holmes E, Kinross J, Burcelin R, Gibson G, Jia W, Pettersson S. Host-gut microbiota metabolic interatctions. Science. 2012 Jun 8;336(6086):1262-7 13.Qin, J., Li, R., Raes, J., Arumugam, M., Burgdorf, K.S., Manichanh, C., Nielsen, T., Pons, N., Levenez, F., and Yamada, T., et al A human gut microbial gene catalogue established by metagemonic sequencing.MetaHIT Consortium Nature 464, 59-65(2010) 14.Holmes E, Li JV, Marchesi JR, Nicholson JK. Gut microbiota composition and activity in relation to host metabolic phenotype and disease risk. Cell Metab. 2012;16(5):559-64. 15.Dicksved J, Halfvarson J, Rosenquist M, Jarnerot G, Tysk C, et al. (2008) Molecular analysis of the gut microbiota of identical twins with Crohn's disease. ISME Journal 2: 716–727 16.Erickson AR, Cantarel BL, Lamdela R, Darzi Y, Mongeodin EF, Pan C, Shah M, Halvarson J, Tysk C, Henrissat B, Rees J, Verberkmoes NC, Fraser CM, Hettich RL, Jannson JK. Integrated metagenomics/metaproteomics reveals human host-microbiota signatures of Crohn’s disease. 2012;7(11):e49138. doi: 10.1371/journal.pone.0049138. Epub 2012 Nov 28. 17.Willing B, Halfvarson J, Dicksved J, et al. Twin studies reveal specific imbalances in the mucosa-associated microbiota of patients with ileal Crohn's disease. Inflamm Bowel Dis. 2009; 15: 653–660 18.Willing BP, Dicksved J, Halfvarson J, Andersson AF, Lucio M, et al. (2010) A pyrosequencing study in twins shows that gastrointestinal microbial profiles vary with inflammatory bowel disease phenotypes. Gastroenterology 139: 1844–1854 19.Marchesi RJ, Holmes E, Khan F, Kochhar S, Scanlan P, Shanahan F, Willson ID, Wang Y. Rapid and noninvesive metabolomics characterization of inflammatory bowel disease. J. Proteome Res 2007 Feb;6(2):546-51. 20. Jansson J, Willing B, Lucio M, Fekete A, Dicksved J, et al. (2009) Metabolomics Reveals Metabolic Biomarkers of Crohn's Disease. PLoS One 4: e3686 21.Nimmo ER, Prendergast JG, Aldhous MC, et al. Genome-wide methylation profiling in Crohn’s disease identifies altered epigenetic regulation of key host defense mechanisms including the Th17 pathway. Inflamm Bowel Dis. 2012;18:889–899 22.Wu F, Guo NJ, Tian H, et al. Peripheral blood microRNAs distinguish active ulcerative colitis and Crohn’s disease. Inflamm Bowel Dis. 2012;17:241–250 23.Thompson N, Driscoll R, Pounder R E, Wakefield A J. Genetics versus environment in inflammatory bowel disease: results of a British twin study. BMJ. 1996 January 13; 312(7023): 95–96 24.Brain O, Owen B et al. The intracellular sensor NOD2 Induces MicroRNA-29 Expression In Human Dendritic Cells to limit IL23 release. Immunity 39 521–536, September 19, 2013

21 Inflammatory Bowel Diseases 2014 Bella Center Copenhagen, Denmark EACCME applied Register online at

22 CALLING ALL TWINS!!!!! If you know of any IBD patients who are part of a twin pair please contact me: Email: Tel: +44 (0)7834 705791

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