Widespread pleiotropy confounds causal relationships between complex traits and diseases inferred from Mendelian randomization

Abstract

A fundamental assumption in inferring causality of an exposure on complex disease using Mendelian randomization (MR) is that the genetic variant used as the instrumental variable cannot have pleiotropic effects. Violation of this no pleiotropy assumption can cause severe bias. Emerging evidence have supported a role for pleiotropy amongst disease-associated loci identified from GWA studies. However, the impact and extent of pleiotropy on MR is poorly understood. Here, we introduce a method called the Mendelian Randomization Pleiotropy RESidual Sum and Outlier (MR-PRESSO) test to detect and correct for pleiotropy in multi-instrument summary-level MR testing. We show using simulations that existing approaches are less sensitive to the detection of pleiotropy when it occurs in a subset of instrumental variables, as compared to MR-PRESSO. Next, we show that pleiotropy is widespread in MR, occurring in 41% amongst significant causal relationships (out of 4,250 MR tests total) from pairwise comparisons of 82 complex traits and diseases from summary level genome-wide association data. We demonstrate that pleiotropy causes distortion between-168% and 189% of the causal estimate in MR. Furthermore, pleiotropy induces false positive causal relationships-defined as those causal estimates that were no longer statistically significant in the pleiotropy corrected MR test but were previously significant in the naive MR test-in up to 10% of the MR tests using a P < 0.05 cutoff that is commonly used in MR studies. Finally, we show that MR-PRESSO can correct for distortion in the causal estimate in most cases. Our results demonstrate that pleiotropy is widespread and pervasive, and must be properly corrected for in order to maintain the validity of MR.