402: When Polygenic Scores Miss: Rare Variants in Misaligned Individuals

Baya N et al., The American Journal of Human Genetics 113, 1–19 (2026) - Baya et al. applied a misalignment framework to UK Biobank polygenic scores and exomes and found that individuals whose observed phenotypes deviate from polygenic expectation are enriched for rare damaging variants across multiple traits and diseases. Key terms: polygenic scores, rare variants, misalignment, liability threshold, UK Biobank. Study Highlights:The authors define 'misaligned' individuals whose covariate-residualized phenotypes differ markedly from PGS expectation and test enrichment for rare (MAF <0.1%) pLoF and damaging missense variants. In UK Biobank Europeans they replicate enrichments for canonical genes (e.g., ACAN, IGF1, APOB, LDLR) and identify novel exome-wide associations including COPB2, GORAB, KANK1, and ACSL6. Disease analyses support a liability-threshold model: T2D cases with HNF1A/HNF4A pLoFs had lower PRS, and CAD controls with protective ANGPTL3 variants had higher PRS. Misalignment classification helps prioritize individuals for rare-variant screening and can reveal pathogenic or protective genetic contributors. Conclusion:Deviation from polygenic expectation highlights individuals enriched for rare damaging variants, supporting a liability-threshold model where rare and common variants counteract or augment each other and offering a strategy to prioritize rare-disease genetic discovery. Music:Enjoy the music based on this article at the end of the episode. Article title:Individuals who deviate from polygenic expectation are enriched for damaging variants in genes linked to rare disease First author:Baya N Journal:The American Journal of Human Genetics 113, 1–19 (2026) DOI:10.1016/j.ajhg.2026.05.013 Reference:Baya N.A., Lassen F.H., Hill B., Venkatesh S.S., Currant H., Lindgren C.M., Palmer D.S., Individuals who deviate from polygenic expectation are enriched for damaging variants in genes linked to rare disease, The American Journal of Human Genetics 113, 1–19 (2026). doi:10.1016/j.ajhg.2026.05.013 License:This episode is based on an open-access article published under the Creative Commons Attribution 4.0 International License (CC BY 4.0) – https://creativecommons.org/licenses/by/4.0/ Support:Base by Base – Stripe donations: https://donate.stripe.com/7sY4gz71B2sN3RWac5gEg00 Official website https://basebybase.com On PaperCast Base by Base you'll discover the latest in genomics, functional genomics, structural genomics, and proteomics. Episode link: https://basebybase.com/episodes/polygenic-misalignment-rare-variants QC:This episode was checked against the original article PDF and publication metadata for the episode release published on 2026-06-25. QC Scope:- article metadata and core scientific claims from the narration- excludes analogies, intro/outro, and music- transcript coverage: Audited the transcript sections describing the misalignment framework, continuous-trait enrichments (height-related ACAN/IGF1, FBN1 for tall stature, LDL-C genes), BMD findings (COPB2/GORAB), LDL-C/HDL gene burdens (LDLR/APOB/PCSK9), dichotomous-trait results (T2D with HNF1A/HNF4A, CAD ANGPTL3), exome-wide discovery (7- transcript topics: Phenotypic misalignment framework and liability-threshold model; Continuous-trait misalignment analyses (height, LDL-C, BMI, BMD, HbA1c, IOP, age at menopause); Canonical gene enrichment for height and LDL-C (ACAN, IGF1, SHOX; LDLR, APOB, PCSK9); Damaging variant enrichment in FBN1 for height misalignment (taller-than-expected); Exome-wide discovery of misalignment genes (KANK1, ACSL6, NPL, COPB2, GORAB); Dichotomous-trait misalignment (T2D/HNF1A/HNF4A; CAD/ANGPTL3; OP) QC Summary:- factual score: 10/10- metadata score: 10/10- supported core claims: 6- claims flagge... Chapters (00:00:20) - What happens when your genetic destiny defies the odds?(00:02:51) - Polygenic scores: The financial(00:05:21) - Seeking rare genetic mutations in heart disease(00:09:48) - The genetic risk of heart disease(00:13:14) - Genetic misalignment: The future of disease triage