Genetic approaches to understanding the pathophysiology of complex human traits

Genetic approaches to understanding the pathophysiology of complex human traits, for example, hypertension, can complement physiologic analyses and are likely to improve our ability to treat or prevent the disease. A particularly useful approach is to perform linkage analysis with candidate genes using intermediate phenotypes. This has proven successful so far in identifying two genes involved in hypertension. The first was a fusion gene mutation which linked the regulatory region of the 11B-hydroxylase gene to the coding sequence for the protein of aldosterone synthetase. This mutant gene is responsible for the condition glucocorticoid-remediable aldosteronism (GRA). The intermediate phenotype used was increased levels of the adrenal steroids 18-oxo and hydroxycortisol. The gene for GRA was identified using a pedigree approach. It is likely, to identify other genes in hypertension, that the most appropriate population to be affected would be sib pairs, that is, sibling pairs who both have hypertension. In a recent study the angiotensinogen gene also was linked to hypertension in individuals who had severe or early onset hypertension. In addition, a variant of the angiotensinogen gene, substitution of threonine rather than methionine at codon 235, was specifically associated with hypertension. In a separate study, the T235 homozygote of the angiotensinogen gene was associated with the non-modulating intermediate phenotype of essential hypertension. Since converting enzyme inhibitors appear to correct the specific defect underlying the elevated blood pressure in non-modulators, identification of the gene potentially associated with non-modulation raises the strong possibility that genetic screening will allow for more specific therapy.