title: Whole-Exome Sequencing to Identify Novel Biological Pathways Associated With Infertility After Pelvic Inflammatory Disease.
abstract: Ideal management of sexually transmitted infections (STI) may require risk markers for pathology or vaccine development. Previously, we identified common genetic variants associated with chlamydial pelvic inflammatory disease (PID) and reduced fecundity. As this explains only a proportion of the long-term morbidity risk, we used whole-exome sequencing to identify biological pathways that may be associated with STI-related infertility.
  
  
  
  We obtained stored DNA from 43 non-Hispanic black women with PID from the PID Evaluation and Clinical Health Study. Infertility was assessed at a mean of 84 months. Principal component analysis revealed no population stratification. Potential covariates did not significantly differ between groups. Sequencing kernel association test was used to examine associations between aggregates of variants on a single gene and infertility. The results from the sequencing kernel association test were used to choose "focus genes" (P < 0.01; n = 150) for subsequent Ingenuity Pathway Analysis to identify "gene sets" that are enriched in biologically relevant pathways.
  
  
  
  Pathway analysis revealed that focus genes were enriched in canonical pathways including, IL-1 signaling, P2Y purinergic receptor signaling, and bone morphogenic protein signaling.
  
  
  
  Focus genes were enriched in pathways that impact innate and adaptive immunity, protein kinase A activity, cellular growth, and DNA repair. These may alter host resistance or immunopathology after infection. Targeted sequencing of biological pathways identified in this study may provide insight into STI-related infertility.
authors.affiliation: From the *Department of Epidemiology and Biostatistics, Texas A&M University, College Station, TX; †Department of Pediatrics, ‡Department of Biostatistics, University of North Carolina Chapel Hill, Chapel Hill, NC; §Institute for Genome Sciences and Society, Texas A&M University, College Station, TX; ¶University of Texas School of Public Health, Houston, TX; and ∥Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Brandie D
authors.initials: BD
authors.lastname: Taylor
authors.forename: Xiaojing
authors.initials: X
authors.lastname: Zheng
authors.forename: Toni
authors.initials: T
authors.lastname: Darville
authors.forename: Wujuan
authors.initials: W
authors.lastname: Zhong
authors.forename: Kranti
authors.initials: K
authors.lastname: Konganti
authors.forename: Olayinka
authors.initials: O
authors.lastname: Abiodun-Ojo
authors.forename: Roberta B
authors.initials: RB
authors.lastname: Ness
authors.forename: Catherine M
authors.initials: CM
authors.lastname: O'Connell
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Haggerty
mesh_terms: D000328:Adult; D019485:Bone Morphogenetic Proteins / Q000032:analysis; D002690:Chlamydia Infections / Q000150:complications / Q000235:genetics*; D005260:Female; D006801:Humans; D007246:Infertility / Q000235:genetics* / Q000382:microbiology; D007375:Interleukin-1 / Q000032:analysis; D000292:Pelvic Inflammatory Disease / Q000150:complications / Q000235:genetics* / Q000382:microbiology; D025341:Principal Component Analysis; D058470:Receptors, Purinergic P2Y / Q000032:analysis; D015398:Signal Transduction / Q000235:genetics*; D000073359:Exome Sequencing
chemical_list: D019485:Bone Morphogenetic Proteins; D007375:Interleukin-1; D058470:Receptors, Purinergic P2Y