Exome genotyping arrays to identify rare and low frequency variants associated with epithelial ovarian cancer risk

Rare and low frequency variants are not well covered inmost germline genotyping arrays and are understudied in relation to epithelial ovarian cancer (EOC) risk. To address this gap, we used genotyping arrays targeting rarer protein-coding variation in 8,165 EOC cases and 11,619 controls from the international Ovarian Cancer Association Consortium(OCAC). Pooled association analyses were conducted at the variant and gene level for 98,543 variants directly genotyped through two exome genotyping projects. Only common variants that represent or are in strong linkage disequilibrium(LD) with previously-identified signals at established loci reached traditional thresholds for exome-wide significance (P < 5.0×10^-7). One of themost significant signals (P_{all histologies}=1.01×10^-13;P_serous=3.54×10^-14) occurred at 3q25.31 for rs62273959, amissense variantmapping to the LEKR1 gene that is in LD (r²=0.90) with a previously identified 'best hit' (rs7651446)mapping to an intron of TIPARP. Suggestive associations (5.0×10^-5 > P≥5.0 ×10^-7) were detected for rare and low-frequency variants at 16 novel loci. Four raremissense variants were identified (ACTBL2 rs73757391 (5q11.2), BTD rs200337373 (3p25.1), KRT13 rs150321809 (17q21.2) and MC2R rs104894658 (18p11.21)), but only MC2R rs104894668 had a large effect size (OR=9.66). Genesmost strongly associated with EOC risk included ACTBL2 (P_AML=3.23×10^-5; P_SKAT-o=9.23×10^-4) and KRT13 (P_AML=1.67×10^-4; P_SKAT-o=1.07×10^-5), reaffirming variant-level analysis. In summary, this large study identified several rare and low-frequency variants and genes thatmay contribute to EOC susceptibility, albeit with possible small effects. Future studies that integrate epidemiology, sequencing, and functional assays are needed to further unravel the unexplained heritability and biology of this disease.