title: Candidate gene analysis supports a role for polymorphisms at TCF7L2 as risk factors for type 2 diabetes in Sudan.
abstract: BACKGROUND
  Genetic susceptibility to type 2 diabetes (T2D) is multifactorial. A growing number of genes have been identified as risk factors for T2D across multiple ethnicities in trans-ancestry meta-analysis of large-scale genome-wide association studies. Few studies have looked at these genes in Sub-Saharan African populations. This study was undertaken to look for associations between T2D and single nucleotide polymorphisms (SNPs) in a number of the top candidate genes in a selected Sudanese population.
  
  
  METHODS
  A total 240 T2D cases and 128 unrelated healthy control subjects were included in this study. Age, sex, weight and height were recorded, blood pressure and biochemical profiles of glucose and lipids were analysed. Single nucleotide polymorphism (SNP) genotyping was performed using the Sequenom MassARRAY® system. Fourteen SNPs were selected across 7 genes: CAPN10 (rs2975760 and rs5030952), PPARG (rs17036314 and rs1801282), IGF2BP2 (rs4402960 and rs1470579), CDKAL1 (rs9465871), HHEX (rs1111875), TCF7L2 (rs7903146, rs11196205 and rs12255372), and KCNJ11 (rs5215, rs1800467 and rs5219). Allelic and haplotype association analyses were performed under additive models in PLINK. P ≤ 0.007 (=0.05/7 genes) was the P-value required to achieve correction for multiple testing.
  
  
  RESULTS
  A significant genetic association between the SNPs rs7903146 (odds ratio 1.69, 95 % confidence interval 1.21-2.38, P = 0.002) and rs12255372 (odds ratio 1.70, 95 % confidence interval 1.20-2.41, P = 0.003) at TCF7L2 and T2D was found in Sudanese population. These associations were retained after adjusting for age, sex and BMI (e.g. rs7903146: odds ratio 1.70, P adj:age/sex/BMI = 0.005). The strongest haplotype association (odds ratio 2.24; P adj:age/sex/BMI = 0.0003) comprised the two point haplotype T_C across rs7903146 and rs11196205. Stepwise logistic regression demonstrated that SNP rs7903146 added significant main effects to rs11196205 or rs12255372, whereas the reverse was not true, indicating that the main effect for association with T2D in this population is most strongly tagged by SNP rs7903146. Adjusted analyses also provided support for protection from T2D associated with minor alleles at SNPs rs2975760 at CAPN10 (odds ratio 0.44, 95 % confidence interval 0.20-0.97, P adj:age/sex/BMI = 0.042) and rs1111876 at HHEX (odds ratio 0.60, 95 % confidence interval 0.39- 0.93, P adj:age/sex/BMI = 0.022).
  
  
  CONCLUSIONS
  Multiethnic associations between T2D and SNPs at TCF7L2, CAPN10 and HHEX extend to Sub-Saharan Africa, specifically Sudan.
authors.affiliation: Central Laboratory, Ministry of Science and Technology, Khartoum, Sudan.
authors.forename: Amir T
authors.initials: AT
authors.lastname: Ibrahim
authors.affiliation: Institute of Endemic Disease, University of Khartoum, P. O. Box 102 Khartoum, Sudan.
authors.forename: Ayman
authors.initials: A
authors.lastname: Hussain
authors.affiliation: Central Laboratory, Ministry of Science and Technology, Khartoum, Sudan.
authors.forename: Mohamed A M
authors.initials: MA
authors.lastname: Salih
authors.affiliation: Tuti Health Centre, Khartoum, Sudan.
authors.forename: Omima Abdeen
authors.initials: OA
authors.lastname: Ibrahim
authors.affiliation: Telethon Kids Institute, University of Western Australia, Subiaco, Australia.
authors.forename: Sarra E
authors.initials: SE
authors.lastname: Jamieson
authors.affiliation: Institute of Endemic Disease, University of Khartoum, P. O. Box 102 Khartoum, Sudan.
authors.forename: Muntaser E
authors.initials: ME
authors.lastname: Ibrahim
authors.affiliation: Telethon Kids Institute, University of Western Australia, Subiaco, Australia.
authors.forename: Jenefer M
authors.initials: JM
authors.lastname: Blackwell
authors.affiliation: Institute of Endemic Disease, University of Khartoum, P. O. Box 102 Khartoum, Sudan.
authors.forename: Hiba S
authors.initials: HS
authors.lastname: Mohamed
keywords: Genetic association study; Genetic polymorphism; Sudan; Type 2 diabetes mellitus