Unraveling the role of non-coding rare variants in epilepsy

ImportanceDespite the use of very large cohorts, the discovery of new variants has leveled off in recent years in epilepsy studies and consequently, most of the heritability is still unexplained. Rare non-coding variants have been largely ignored in studies on epilepsy, although non-coding single nucleotide variants can have a significant impact on gene expression. ObjectiveTo determine if rare non-coding deleterious variants are associated with epilepsy. DesignThis is a case-control study made possible by the CENet cohort. SettingThis was initially a multicenter study (families and trios), although the sequencing was processed at the same facility and for the present case-control study, only unrelated individuals were drawn. ParticipantsPatients used in this study are affected either by genetic generalized epilepsy (GGE), non-acquired focal epilepsy (NAFE) or are called mixed (phenotype that differs from other affected relatives). Controls are unaffected parents from developmental and epileptic encephalopathy trios. Main Outcomes and MeasuresTo assess the functional impact of non-coding variants, ExPecto, a deep learning algorithm was used. A binomial logistic regression was performed to compare the burden of rare non-coding deleterious variants between cases and controls. ResultsWe had access to WGS from 123 GGE, 112 NAFE and 12 mixed for a total of 247 patients, as well as 377 controls. Rare non-coding highly deleterious variants were associated with GGE (OR 2.74; 95% CI 1.20-6.22), but not with NAFE (OR 0.85; 95% CI 0.27-2.67) or all epilepsy cases (OR 1.54; 95% CI 0.77-3.11) when compared with controls. Conclusion and RelevanceIn this study we showed that rare non-coding deleterious variants are associated with epilepsy, specifically with GGE. Larger WGS epilepsy cohort will be needed to investigate those effects at a greater resolution. Nevertheless, we demonstrated the importance of studying non-coding regions in epilepsy, a disease where new discoveries are scarce, and a high proportion of the heritability is yet to be explained. Key pointsO_ST_ABSQuestionC_ST_ABSAre non-coding single nucleotide variants (SNV) associated with epilepsy? FindingsIn this study we showed that patients with generalized genetic epilepsy (GGE) had significantly more rare non-coding deleterious variants than controls and non-acquired focal epilepsy (NAFE) patients. The study included 247 epilepsy patients and 377 controls who were sequenced for the whole genome. MeaningRare non-coding SNV are associated with epilepsy, more specifically with GGE.