How 23andMe predicted my likelihood of developing the “disease of kings.”

By Samantha Ancona Esselmann, Ph.D., 23andMe Product Scientist

Are you at elevated probability for hypertension, gout, or one thing else? Right here’s how 23andMe decided your end result…

Just a few weeks after California entered its first pandemic lockdown, my mom referred to as to inform me she’d felt a sudden, stabbing ache in her foot. It harm a lot that she thought she’d damaged a bone, and a frantic journey to pressing care revealed she was probably experiencing signs of gout.

My mom was shocked by the analysis. She’d learn sufficient historic novels to know that gout was once called “the wealthy man’s illness” and “the illness of kings,” because of its affiliation with alcohol and wealthy meals like pink meat. How may she—a lady who lives by the motto “moderation in all issues”—have a situation lengthy related to extra and intemperance?

It made me surprise if gout has something to do with genetics.

A visual description of gout.


In October 2020, only a few months after my mom’s analysis, 23andMe launched a brand new report for 23andMe+ members, powered by consented 23andMe analysis members, that recognized new hyperlinks between genetics and gout. My report advised me that I had an “elevated probability” of growing gout, and that an estimated 19% of feminine analysis members with genetic outcomes and ancestry like mine are anticipated to develop gout by their 70s.

Given my mom’s analysis, I wasn’t shocked by my elevated probability, however I was shocked to study that my end result was generated utilizing over 20,000 genetic markers — also called DNA variants. How may the mixed impact of so many components be analyzed ?

So, I “sat down” (just about) with different 23andMe scientists who walked me by how 23andMe creates these cutting-edge predictions. It’s related not only for gout, but additionally for understanding how 23andMe creates its Sort 2 Diabetes report, or our current report on eczema (atopic dermatitis). In every case the experiences analyze lots of, hundreds, or tens of hundreds of various DNA variants all throughout the genome to calculate the probability of growing a situation.

Right here’s what I realized

Making 23andMe’s polygenic rating for gout

1. First, we examine DNA variants related to gout.
23andMe scientists in contrast the DNA variants of many 23andMe analysis members who mentioned they’ve gout to the variants of many members who mentioned they don’t have gout. Throughout this course of, the scientists found hundreds of variants throughout many alternative genes which are extra widespread amongst individuals with gout, which suggests these variants are thought-about to be “related” with gout. 


This course of is known as a “Genome-wide Affiliation Examine,” or just, a “GWAS” (pronounced Jee-Wahss). DNA variants present in a GWAS can present clues concerning the organic mechanisms underlying a situation. These variants may also assist scientists estimate the probability of somebody growing a situation sooner or later.

What else does a GWAS let you know?

  • DNA variants recognized within the GWAS might be related to both an elevated or a decreased probability of growing the situation. 
  • A number of the variants present in a GWAS might be very strongly related to the situation, whereas others could also be solely weakly related. The energy of the variant’s affiliation with a situation can be referred to as the variant’s “impact measurement.” 
  • A weak affiliation with a excessive statistical confidence often means the variant has a small, however actual impact. A low-confidence, weak affiliation may imply that there have been merely not sufficient individuals within the examine to permit researchers to confidently establish variants with small impact sizes. 
  • Simply because a DNA variant is statistically related to a situation doesn’t essentially imply that it causes the situation. That’s as a result of variants which are bodily shut to one another in your genome are typically inherited collectively, which makes it tough to determine which of the linked variants really causes elevated probability. However, that’s okay! For the needs of predicting a situation, researchers don’t have to know which variants are biologically concerned, so long as they discover a collection of variants in the identical genetic “neighborhood” as those that trigger the situation.


2. Subsequent, a pc trains itself to foretell gout.

Now we now have an inventory of DNA variants related to an elevated probability of gout in a bunch of parents who already know they’ve gout, so we are able to attempt to use that info to foretell whether or not different individuals are more likely to develop gout.

How can we do that?

Varied mixtures of DNA variants related to gout are fed into a pc algorithm. 

On this step, referred to as “coaching,” the pc’s purpose is to make use of the DNA variants discovered within the genome broad affiliation examine as a reference to assist it learn to establish patterns within the information and to foretell gout accurately in a bunch of individuals whose historical past of gout is already recognized.  

At this stage, the trick is that the pc technically is aware of the “fact” about who has gout and who doesn’t have gout. This manner, it might shortly examine whether or not or not it’s getting higher at predicting gout.

However, understanding the mixed affect of hundreds of variants to foretell gout is not any easy process. Simply take into consideration how sophisticated it may be to guess the worth of a house: There are many components that may affect a house’s worth, from sq. footage and variety of bedrooms to neighborhood comps. In the actual world, these variables will not be unbiased, and so they can affect one another in actually complicated methods, for instance: The relative significance of sq. footage could be decrease in a walkable metropolis heart than it’s within the suburbs.

On its first attempt, the pc in all probability received’t be excellent at predicting anybody’s probability of growing gout. In any case, how good would you be at guessing the worth of a house based mostly on every of its options for those who’d solely ever seen one itemizing?

So, the pc goes again to the drafting board, quickly adjusting and tuning the affect, or “weight,” of hundreds of DNA variants till it finds one of the best set of parameters to foretell gout.

For any individual, the pc will add up the mixed, adjusted weight of all of the variants and assign a probability rating, referred to as a “polygenic rating” (polygenic means “many genes”).

Throughout this “coaching” stage, if somebody had beforehand advised us that they had gout, they’d be extra more likely to obtain a excessive rating. If somebody advised us they didn’t have gout, they’d be extra more likely to obtain a low rating.

When the pc thinks it has discovered the very best mixture of parameters for the “coaching” group, we’re able to check how properly it performs. 

3. Then, we check how properly the pc predicts gout.

Earlier than the pc graduates from coaching, we check its efficiency in a new group of individuals, a few of whom have advised us they’ve gout and a few of whom don’t have gout.

Why can we do that? We carry out this step as a result of the pc typically overestimates its capability to foretell gout within the coaching step, and there’s an opportunity that the group of individuals we chosen for coaching the pc is biased. For instance, what for those who educated a pc to foretell the sale worth of a home, however you solely educated it on homes with one bed room? If you later ask the pc to foretell the worth of a four-bedroom home, it may fail as a result of it hasn’t encountered massive homes earlier than.

At this testing stage, we additionally be sure that to regulate and validate the pc mannequin for individuals with ancestry from totally different components of the world.

4. Your probability of growing gout is reported to you.

Now, we now have a pc algorithm that may predict probability for gout based mostly on over 20,000 DNA variants. At this level, the educated pc algorithm is able to estimate your probability of growing gout by analyzing your distinctive mixture of DNA variants. 

We ship your DNA variants by this educated pc algorithm, and it computes your probability of growing gout as a polygenic rating.


If the percentages related along with your rating are no less than 1.5 instances larger than the typical odds, your chances are reported to you as “elevated.” In case your odds are lower than 1.5 instances larger than common, then your chances are reported to you as “typical.”

Your customized polygenic rating is then translated right into a lifetime likelihood of growing gout for individuals with genetics, self-reported intercourse, and ancestry like yours.

Placing all of it collectively: what does it actually imply for me?

Gout quick information

  • The T-Rex named “Sue,” found in South Dakota within the 90s, could have suffered from gout.
  • Galen, a 2nd century C.E. Greek doctor and thinker within the Roman Empire, acknowledged gout as one thing that could possibly be inherited.
  • The phrase “gout” comes from the Latin phrase gutta, that means “a drop,” a reference to the historic perception that an excessive amount of of one of many 4 bodily humors would “drop” right into a joint, inflicting ache. The phrase “gutter” additionally comes from gutta.
  • Gout may have precipitated the U.S. Revolutionary Warfare. Affected by signs of gout, British parliamentarian William Pitt the Elder was absent from British parliament when new types of taxation had been being imposed on British colonies within the Americas. Had Pitt (who was famously against taxing colonists with out giving them parliamentary illustration) been current in parliament throughout these periods, he could have been capable of block the inflammatory laws, presumably stopping — or no less than delaying — the Revolutionary Warfare.

    23andMe tells me that an estimated 19% of feminine analysis members with ancestry and genetic outcomes like mine develop gout by their 70s, which places me squarely in an “elevated probability” class. 

    Does this imply that if there have been 5 carbon copies of me, certainly one of them would undoubtedly develop gout in her life?

    Not essentially. As a substitute, it implies that one in 5 girls with ancestry and genetics like mine will develop gout of their lives.

    My colleagues urged me to keep in mind that each feminine of European descent whose information contributed to this prediction has her personal distinctive way of life, household well being historical past, and genetic ancestry. Some drink excessively or eat pink meat each day. Some are underweight. Some are overweight. Some have current ancestors from Eire, whereas others have current ancestors from Greece.

    And all of that variation will get compacted — flattened right into a single output. Meaning it’s attainable that my household historical past, way of life, and ancestry may have an effect on my possibilities of growing gout in ways in which 23andMe’s prediction — based mostly totally on genetics — merely can’t account for.

    Sooner or later, scientists at 23andMe would like to develop the power to account for variables like atmosphere, way of life, and household historical past along with DNA.

    If my ancestry weren’t European, would this end result be much less correct?

    Okay, actual speak. Traditionally, it has been simpler for tutorial teams and corporations like 23andMe to offer extra correct genetic probability estimates to individuals of European descent. Why? As a result of there have been way more genetic research on people with European ancestry up to now. And, usually talking, extra information means higher pc fashions.

    However, at 23andMe we need to launch experiences that additionally work properly for individuals of non-European ancestry. So, how are we working to enhance outcomes for purchasers with non-European ancestry?

    • Whereas it’s true that almost all of the 23andMe database consists of individuals of European descent, 23andMe has essentially the most Latino/Hispanic and African American analysis members of any genetic database on the earth.
    • This implies we are able to alter and check our pc fashions on individuals from many backgrounds to verify in addition they work properly for non-Europeans.
    • As extra individuals with non-European ancestry select to take part in 23andMe analysis, our capability to estimate genetic probability for a lot of traits and well being circumstances will improve for people with non-European ancestry

    What’s the takeaway?

    Merely this: in comparison with most different feminine 23andMe analysis members with European ancestry, I’m considerably extra probably to develop gout in my life due to my genetics.

    The brilliant aspect is there’s nonetheless an 81% likelihood that I received’t develop gout in my life, and I could possibly cut back my possibilities much more by way of life modifications. What can I do?

    Restrict my consumption of pink meat? Simple!

    Restrict my alcohol consumption? Engaged on it!

    Purpose for low-fat or nonfat dairy? I’ll attempt, however I stay with a German, so this could possibly be tough…

    Keep a wholesome weight? It comes and goes…

    And, for those who had been questioning…since her analysis, my mom has been extra cautious to drink a lot of water and to restrict her alcohol consumption.

    She hasn’t had one other gout flare-up since.

    Learn extra from 23andMe about polygenic modeling in our weblog:

    Because of different members of the 23andMe product crew for his or her insights and suggestions, particularly Peter Chisnell, Becca Krock., James Ashenhurst.,  and Alisa Lehman. 

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