The missing link between genetic association and regulatory function

The genetic basis of most complex traits is highly polygenic and dominated by non-coding alleles, and it is widely assumed that such alleles exert small regulatory effects on the expression of cis-linked genes. However, despite availability of expansive gene expression and epigenomic data sets, few variant-to-gene links have emerged. We identified 139 genes in which protein-coding variants cause severe or familial forms of nine human traits. We then computed the association between common complex forms of the same traits and non-coding variation, revealing that most such traits are also associated with non-coding variation in the vicinity of the same genes. However, we found colocalization evidence--the same variant influencing both the physiological trait and gene expression--for only 7% of genes, and transcriptome-wide association evidence with correct direction of effect for only 4% of genes, despite an abundance of eQTLs in most loci. Fine mapping variants to regulatory elements and assigning these to genes by linear distance similarly failed to implicate most genes in complex traits. These results contradict the hypothesis that most complex trait-associated variants coincide with currently ascertained expression quantitative trait loci. The field must confront this deficit, and pursue the "missing regulation."