Abstract:
BACKGROUNDS : Genetic diversity is greatest within Africa, in particular the KhoeSan click-speaking peoples of
southern Africa. South African populations represent admixture fractions including differing degrees of African,
African-KhoeSan and non-African genetic ancestries. Within the United States, African ancestry has been linked to
prostate cancer presentation and mortality. Together with environmental contributions, genetics is a significant risk
factor for high-risk prostate cancer, defined by a pathological Gleason score ≥ 8.
METHODS : Using genotype array data merged with ancestry informative reference data, we investigate the
contribution of African ancestral fractions to high-risk prostate cancer. Our study includes 152 South African men of
African (Black) or African-admixed (Coloured) ancestries, in which 40% showed high-risk prostate cancer.
RESULTS : Genetic fractions were determined for averaging an equal African to non-African genetic ancestral
contribution in the Coloured; we found African ancestry to be linked to high-risk prostate cancer (P-value = 0.0477).
Adjusting for age, the associated African ancestral fraction was driven by a significant KhoeSan over Bantu
contribution, defined by Gleason score ≥ 8 (P-value = 0.02329) or prostate specific antigen levels ≥20 ng/ml (Pvalue
= 0.03713). Additionally, we observed the mean overall KhoeSan contribution to be increased in Black patients
with high-risk (11.8%) over low-risk (10.9%) disease. Linking for the first time KhoeSan ancestry to a common
modern disease, namely high-risk prostate cancer, we tested in this small study the validity of using KhoeSan
ancestry as a surrogate for identifying potential high-risk prostate cancer risk loci. As such, we identified four loci
within chromosomal regions 2p11.2, 3p14, 8q23 and 22q13.2 (P-value = all age-adjusted < 0.01), two of which have
previously been associated with high-risk prostate cancer.
CONCLUSIONS : Our study suggests that ancient KhoeSan ancestry may be linked to common modern diseases,
specifically those of late onset and therefore unlikely to have undergone exclusive selective pressure. As such we show
within a uniquely admixed South African population a link between KhoeSan ancestry and high-risk prostate cancer,
which may explain the 2-fold increase in presentation in Black South Africans compared with African Americans.
