Exome sequencing and analysis of 44,028 British South Asians enriched for high autozygosity

Genes and Health (G&H) is a biomedical study of adult British-Pakistani and -Bangladeshi research volunteers enriched for autozygosity. We performed whole exome sequencing in 44,028 G&H participants, establishing the largest publicly available South Asian exome resource linked to longitudinal electronic health records. We performed association analyses for 646 traits under additive and recessive models, and meta-analysis of 33 cardiometabolic traits with UK Biobank, finding more than 100 novel gene-phenotype associations such as ADAM15 with pulmonary oedema and ADCY6 with intracerebral haemorrhage. We identified 2,991 genes with rare biallelic predicted loss-of-function ("knockout") genotypes, 546 of which had not been previously reported. We show that the presence of knockouts in adults is associated with 2.2-times higher likelihood of drugs progressing beyond Phase 1 clinical trial. We further illustrate how their phenotypic profile can enhance efficacy and safety assessment of drug targets and aid in the interpretation of variants with ambiguous clinical significance in autosomal recessive disease genes.