Characterization of exome variants and their metabolic impact in 6,716 American Indians from Southwest US

Applying whole exome sequencing (WES) to populations with unique genetic architecture has the potential to reveal novel genes and variants associated with traits and diseases. We sequenced and analyzed the exomes of 6,716 individuals from an American Indian population in Southwest US (Southwestern American Indian, or SWAI) with well-characterized metabolic traits. We found that individuals of SWAI have distinct allelic architecture compared to individuals with European and East Asian ancestry, with many predicted loss-of-function (pLOF) and nonsynonymous variants that were highly enriched or private in SWAI. We evaluated gene-level associations with metabolic traits using pLOF and nonsynonymous variants in SWAI. Many of the candidate genes from previous GWAS studies for body mass index, type 2 diabetes, and plasma lipid levels were associated with respective traits in SWAI. Notably, these associations were mainly driven by pLOF and nonsynonymous variants that are unique or highly enriched in American Indians, many of which have not been observed in other populations or functionally characterized. Our study illustrates the utility and potential of WES in American Indians to prioritize candidate effector genes within GWAS loci and to find novel variants in known diseases genes with potential clinical impact.