Penetrance of Hemochromatosis in HFE Genotypes Resulting in p.Cys282Tyr and p.[Cys282Tyr];[His63Asp] in the eMERGE Network

Carlos J. Gallego, Amber Burt, Agnes S. Sundaresan, Zi Ye, Christopher Shaw, David R. Crosslin, Paul K. Crane, S. Malia Fullerton, Kris Hansen, David Carrell, Helena Kuivaniemi, Kimberly Derr, Mariza De Andrade, Catherine A. McCarty, Terrie E. Kitchner, Brittany K. Ragon, Sarah C. Stallings, Gabriella Papa, Joseph Bochenek, Maureen E. SmithSharon A. Aufox, Jennifer A. Pacheco, Vaibhav Patel, Elisha M. Friesema, Angelika Ludtke Erwin, Omri Gottesman, Glenn S. Gerhard, Marylyn Ritchie, Arno G. Motulsky, Iftikhar J. Kullo, Eric B. Larson, Gerard Tromp, Murray H. Brilliant, Erwin Bottinger, Joshua C. Denny, Dan M. Roden, Marc S. Williams, Gail P. Jarvik

Research output: Contribution to journalArticlepeer-review

42 Scopus citations


Hereditary hemochromatosis (HH) is a common autosomal-recessive disorder associated with pathogenic HFE variants, most commonly those resulting in p.Cys282Tyr and p.His63Asp. Recommendations on returning incidental findings of HFE variants in individuals undergoing genome-scale sequencing should be informed by penetrance estimates of HH in unselected samples. We used the eMERGE Network, a multicenter cohort with genotype data linked to electronic medical records, to estimate the diagnostic rate and clinical penetrance of HH in 98 individuals homozygous for the variant coding for HFE p.Cys282Tyr and 397 compound heterozygotes with variants resulting in p.[His63Asp];[Cys282Tyr]. The diagnostic rate of HH in males was 24.4% for p.Cys282Tyr homozygotes and 3.5% for compound heterozygotes (p < 0.001); in females, it was 14.0% for p.Cys282Tyr homozygotes and 2.3% for compound heterozygotes (p < 0.001). Only males showed differences across genotypes in transferrin saturation levels (100% of homozygotes versus 37.5% of compound heterozygotes with transferrin saturation > 50%; p = 0.003), serum ferritin levels (77.8% versus 33.3% with serum ferritin > 300 ng/ml; p = 0.006), and diabetes (44.7% versus 28.0%; p = 0.03). No differences were found in the prevalence of heart disease, arthritis, or liver disease, except for the rate of liver biopsy (10.9% versus 1.8% [p = 0.013] in males; 9.1% versus 2% [p = 0.035] in females). Given the higher rate of HH diagnosis than in prior studies, the high penetrance of iron overload, and the frequency of at-risk genotypes, in addition to other suggested actionable adult-onset genetic conditions, opportunistic screening should be considered for p.[Cys282Tyr];[Cys282Tyr] individuals with existing genomic data.

Original languageEnglish
Pages (from-to)512-520
Number of pages9
JournalAmerican Journal of Human Genetics
Issue number4
StatePublished - 2015


  • HFE
  • eMERGE Network
  • hemochromatosis
  • hereditary hemochromatosis
  • iron overload
  • multicenter cohort
  • p.Cys282Tyr
  • penetrance
  • return of results


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