Projecting genetic associations through gene expression patterns highlights disease etiology and drug mechanisms

Understanding how dysregulated transcriptional processes result in tissue-specific pathology requires a mechanistic interpretation of expression regulation across different cell types. It has been shown that this insight is key for the development of new therapies. These mechanisms can be identified with transcriptome-wide association studies (TWAS), which have represented an important step forward to test the mediating role of gene expression in GWAS associations. However, due to pervasive eQTL sharing across tissues, TWAS has not been successful in identifying causal tissues, and other methods generally do not take advantage of the large amounts of RNA-seq data publicly available. Here we introduce a polygenic approach that leverages gene modules (genes with similar co-expression patterns) to project both gene-trait associations and pharmacological perturbation data into a common latent representation for a joint analysis. We observed that diseases were significantly associated with gene modules expressed in relevant cell types, such as hypothyroidism with T cells and thyroid, hypertension and lipids with adipose tissue, and coronary artery disease with cardiomyocytes. Our approach was more accurate in predicting known drug-disease pairs and revealed stable trait clusters, including a complex branch involving lipids with cardiovascular, autoimmune, and neuropsychiatric disorders. Furthermore, using a CRISPR-screen, we show that genes involved in lipid regulation exhibit more consistent trait associations through gene modules than individual genes. Our results suggest that a gene module perspective can contextualize genetic associations and prioritize alternative treatment targets when GWAS hits are not druggable.