Proteome-wide Mendelian randomisation of lung function to identify potential therapeutic targets for respiratory disease

Background Despite multiple clinical trials, disease-modifying treatments for COPD are currently limited. Since many drugs target proteins, identifying causality between proteins and lung function informs understanding of COPD pathophysiology and may suggest novel targets. We used Mendelian randomisation (MR) to prioritise proteins as potentially causal for lung function. For prioritised proteins, we explored their potential suitability as drug targets by predicting their effects on a range of clinical outcomes. Methods We used genome-wide association study (GWAS) data on 2923 proteins (N=48 195, UK Biobank) to identify single genetic variants (cis-pQTLs) associated with protein levels (P≤5×10 −9 , variant ≤100 kb of a transcription start site). We performed cis-pQTL-MR analyses of four spirometric traits (N=149 166, 36 independent cohorts). Sensitivity analyses included colocalisation and reverse direction MR. We report associations between cis-pQTLs for prioritised proteins and multiple clinical respiratory outcomes, and use phenome-wide analysis to explore potential adverse effects or drug repurposing opportunities. Findings 1841 proteins had a suitable cis-pQTL. We implicated 16 proteins as potentially causal for lung function (p<1.71×10 −5 ): six proteins have not been implicated by previous lung function GWAS or MR (DTD1, PILRA, PTPRK, TDRKH, GRHPR, NUDT5), and we provide corroborative evidence for 10 proteins. We add to the literature identifying surfactant protein D (SFTPD) as a candidate, yet predict that integrin subunit alpha V (ITGAV) inhibition could impair some lung function measures, mimicking adverse results from a recent trial. Interpretation Our approach identifies proteins (some novel) which are potentially therapeutic targets for respiratory disease, and which warrant follow-up for utility and safety.