Integrating Genetics and Environment to Find Causal Mechanisms for Multiple Sclerosis

Genome-wide association studies (GWAS) have identified hundreds of risk loci for multiple sclerosis (MS), but we have limited knowledge of the mechanisms through which genetic variants mediate risk. Similarly, epidemiological studies implicate numerous environmental risk factors in MS risk, but these cannot identify specific causal mechanisms. We review our current knowledge of genetic mechanisms in MS, including the critical role of expression quantitative trait locus (eQTL) mapping in translating genetic risk loci into causal mechanisms. Molecular and functional context has emerged as an important missing component of these studies, and we discuss how environmental risk factors can be modelled in a quantitative genetic context to identify disease mechanisms. In parallel, we highlight recent advances in which quantitative genetic methods establish a causal role for low vitamin D and obesity in MS, and to dissect the mechanisms through which these operate. As genetic, transcriptional, and epigenetic studies continue to expand, further mechanistic insights for MS are likely to come from the integration of genetic and environmental data.