Sex differences in the human peripheral blood transcriptome
- Rick Jansen1Email author,
- Sandra Batista5,
- Andrew I Brooks4,
- Jay A Tischfield4,
- Gonneke Willemsen2,
- Gerard van Grootheest1,
- Jouke-Jan Hottenga2,
- Yuri Milaneschi1,
- Hamdi Mbarek2,
- Vered Madar3,
- Wouter Peyrot1,
- Jacqueline M Vink2,
- Cor L Verweij6,
- Eco JC de Geus2,
- Johannes H Smit1,
- Fred A Wright3,
- Patrick F Sullivan5,
- Dorret I Boomsma†2 and
- Brenda WJH Penninx†1
© Jansen et al.; licensee BioMed Central Ltd. 2014
Received: 12 March 2013
Accepted: 14 January 2014
Published: 17 January 2014
Genomes of men and women differ in only a limited number of genes located on the sex chromosomes, whereas the transcriptome is far more sex-specific. Identification of sex-biased gene expression will contribute to understanding the molecular basis of sex-differences in complex traits and common diseases.
Sex differences in the human peripheral blood transcriptome were characterized using microarrays in 5,241 subjects, accounting for menopause status and hormonal contraceptive use. Sex-specific expression was observed for 582 autosomal genes, of which 57.7% was upregulated in women (female-biased genes). Female-biased genes were enriched for several immune system GO categories, genes linked to rheumatoid arthritis (16%) and genes regulated by estrogen (18%). Male-biased genes were enriched for genes linked to renal cancer (9%). Sex-differences in gene expression were smaller in postmenopausal women, larger in women using hormonal contraceptives and not caused by sex-specific eQTLs, confirming the role of estrogen in regulating sex-biased genes.
This study indicates that sex-bias in gene expression is extensive and may underlie sex-differences in the prevalence of common diseases.
Sexual dimorphism extends into marked cellular, metabolic, physiological and anatomical differences and leads to sex differences in disease prevalence, expression and severity of, for example, cardiovascular , and autoimmune  diseases, personality  and psychiatric disorders . Sex inequalities are an increasingly recognized challenge in both basic research and clinical medicine , and understanding the molecular mechanisms behind sex differences may lead to new insights into sex-specific pathophysiology and treatment opportunities .
Sex differences at the DNA sequence level are restricted to the sex chromosomes. On the X-chromosome, most genes are equally expressed across sex due to X-inactivation in women . The few unshared genes located on the Y chromosome are exclusively expressed in the testes, or are housekeeping genes with X-chromosome homologues that escape X-inactivation . However, genome regulation seems highly sex-specific at secondary epigenetic levels such as DNA methylation , DNase hypersensitivity , chromatin structure  and gene expression [12, 13]. Thus, a characterization of sex differences in genome regulation by gene expression will contribute to the understanding of the molecular basis of sexual dimorphism.
Animal studies have shown that sex-biased gene expression is highly tissue dependent [14, 15] and the evolution rates of sex-biased genes are higher than average [12, 16]. Two recent studies in mice reported sex differences in gene expression networks of correlated transcripts [17, 18]. Surprisingly few studies aimed at identifying and investigating sex-biased genes in humans, and only in small sample sizes (N < 250 [19–22]). Nonetheless, consistent evidence was obtained for sex-specific gene expression.
Sex-differences in gene expression will depend on the hormonal status of the group considered. For instance, during menopause, much of the female-specific hormone production ceases, with downstream effects on gene expression in adipose tissue , monocytes , and bone . In women using hormonal contraceptives, containing the hormones estrogen and progesterone, additional differences in gene expression may be evident as well.
For many genes, expression levels are influenced by DNA polymorphisms (eQTLs). Although the sexes do not differ at the autosomal DNA sequence level, sex differences in gene expression may be caused by sex-specific eQTLs  (i.e. some SNPs may influence gene expression in one sex, but not in the other).
Here we used microarrays to identify genome-wide sex-biased gene expression in the human peripheral blood transcriptome in a large sample (N = 5241 subjects) from the Netherlands. The sample size was sufficiently large to account for menopause status and hormonal contraceptive use. The identified sex-biased genes were characterized in terms of enrichment for functional gene ontology (GO) and disease categories, distribution across the autosomes and sex chromosomes, tissue specificity, evolution rates, participation in major gene expression networks and the extent to which sex differences in gene expression were caused by sex-specific eQTLs.
Demographic summary of sample
Total # subjects (after QC)
smoking status (percentage of smokers)
red blood cell count
Menopause status females (pre/post)
Contraceptive pill use (yes/no)
Sex effects on gene expression
Female-biased versus male-biased genes
From the sex-biased transcripts on the autosomes, 572 (57.7%) were upregulated in females (female-biased genes, Figure 1C), and 421 in males (male-biased genes, Figure 1B). For each sex-biased transcript the loge fold change was computed (Figure 1D). For female-biased transcripts the fold change was computed as the mean expression in females/mean expression in males, for male-biased genes we used -mean expression in males/mean expression in females. Most absolute loge fold changes were smaller than 0.08 (99%), for 22 transcripts the absolute loge fold change was larger than 0.08 (6 female-biased, targeting the genes ADM, CREB5, CNTNAP3, C9orf84, SORCS2 and GPR109A and 14 in men (KANK2, CTSG, MPO, BPI, GPER, DEFA4, EPB49, C19orf62, ERG, LCN2, CEACAM8, LTF, FECH and LTBP1), see Additional file 1 for sex-biased genes and corresponding fold changes and p-values).
On the X chromosome, 1643 transcripts from 739 genes were measured. Out of these, 127 transcripts from 51 genes were sex-biased; 103 (from 38 genes) were female-biased, and 24 (from 13 genes) male-biased. Seventeen of the corresponding loge fold changes were larger than 0.08 (targeting the genes EIF1AX, PRKX, KDM5C, ZFX, KDM6A, XIST, VSIG4, TSIX and SCARNA9L). Only the loge fold changes of the genes XIST and TSIX were larger than 0.5. Of the 63 transcripts targeting 26 genes on the Y chromosome, 48 transcripts from 16 genes had expression levels in men that were higher than the noise measured in women; 12 transcripts had a loge fold change larger than 0.5, targeting the genes EIF1AY, DDX3Y KDM5D, CYorf15B, CYorf15A and UTY.
Genomic location of sex-biased genes
For each chromosome we tested whether the genes on that chromosome enriched the sex-, male- or female-biased genes. At the autosomes, the percentage of sex-biased genes differed only slightly between chromosomes, ranging from 1.6% on chromosome 20 to 4.2% on chromosome 14 (Figure 1E); none of the autosomes enriched the sex-biased genes (p > 0.05, Fisher's exact test). The distribution of the male- and female-biased genes over the autosomes was more variable, ranging from 0.4% at chromosome 20 to 2.3% at chromosome 18 (female-biased genes), and from 0.7% at chromosome 4 to 2.4% at chromosome 22 (male-biased gene), however none of the autosomes enriched female or male-biased genes. As expected, female-biased genes were enriched for genes at the X-chromosome (5.1%), and male-biased genes for genes at the Y chromosome (61%).
Gene ontology (GO) analysis of sex-biased genes
Female-biased genes were enriched for 52 biological process GO categories (BPGO) (p < 0.01, Bonferroni correction, see Additional file 2 for significant GO categories and female-biased genes therein), with as top hit immune system process (31.6% of female-biased genes are in this category, p < 1e-25). Significant subcategories included response to cytokine stimulus (11.3%, p < 1e-10), response to type 1 interferon (3.6%, p < 1e-7) and lymphocyte differentiation (5.6%, p < 1e-5). Male-biased genes were not enriched for any BPGO category. The female-biased genes were enriched for 7 cellular component GO (CCGO) categories (top hits are cell surface (8.3%, p < 1e-6) and integral to membrane (31.3%, p < 1e-5)). Male-biased genes were enriched for 11 CCGO categories, with as top hit cytoplasm (73.4%, p < 1e-10) and significant subcategory lysome (6.4%, p < 1e-4). In Additional file 3 the hierarchical network structure of the significant GO categories is visualized.
Ingenuity pathway analysis (IPA) of sex-biased genes
From the IPA biological functions, autoimmune disease (22%, FDR < 1e-11 (Fisher's exact test)) and rheumatoid arthritis (16%, FDR < 1e-11 (Fisher's exact test)) enriched the female-biased genes most significantly, among 21 other autoimmune diseases (Additional file 4). The upstream regulator lipopolysaccharide (LPS, 26%, p < 1e-27 (uncorrected p-value Fisher's exact test)) was most strongly associated with the female-biased genes, among many other regulators (Additional file 5) such as estradiol (18%, p < 1e-9 (uncorrected p-value Fisher's exact test)). Male-biased genes were most significantly enriched for genes linked to renal cancer (9%, FDR < 1e-5 (Fisher's exact test), Additional file 6). There were only few male-biased genes influenced by the same upstream regulators (Additional file 5, top hits were GATA (3%, p < 1e-5 (Fisher's exact test)) and HIPK2 (2%, p < 1e-4 (Fisher's exact test))).
eQTL analysis of sex-biased gene expression
eQTL analysis was performed using two sample subsets of 1523 men and 1373 premenopausal women who did not take hormonal contraceptives, for which genome-wide SNP and gene expression data were available (see Methods). For each of the 993 autosomal sex-biased transcripts, eQTLs were computed for men and women separately. At a FDR of 0.01 there were 7978 cis eQTLs (p < 6e-05) and 514 trans eQTLs (p < 2e-09)) for men, and 6731 cis eQTLs (p < 5.2e-05) and 197 trans eQTLs (p < 1.8e-09)) for women. For the pooled eQTLs (9659 cis, 545 trans eQTLs) genotype-sex interactions were assessed using a mixed model that included data from men and women. At a FDR of 0.05 no significant genotype-sex interactions were observed.
Sex-biased genes highly enrich modules of correlated transcripts
Evolution rates of sex-biased genes
To test whether sex-biased genes have evolved faster than non sex-biased genes, we tested for enrichment in two sets of genes that were previously identified as rapidly evolving: 244 genes from the Human PAML Browser  and 40 genes from a study comparing human and chimpanzee genomes . Sex-biased, male-biased and female-biased genes were not enriched for any of the two gene sets (Fisher's exact test, p > 0.05). Next, we tested whether dN, dS and dN/dS (the evolution rates) as provided by  were different in sex-biased, male-biased and female-biased genes compared to non sex-biased genes, but found no significant differences (all p > 0.05, Wilcoxon rank test).
Tissue specificity of sex-biased genes
We downloaded analysis results of two human studies that identified sex-biased genes in muscle  and in liver . In muscle, 63 sex-biased genes were identified on the autosomes which were enriched with the sex-biased genes we identified (8 genes identified in both tissues, p < 0.01 (Fisher's exact test), Additional file 8). On the X chromosome 5 genes were identified as sex-biased in muscle, of which 4 were also identified in blood (p < 0.001 (Fisher's exact test), Additional file 8). In liver, 862 sex-biased genes were identified on the autosomes which were enriched with the sex-biased genes we identified (36 genes identified in both tissues, p < 0.05 (Fisher's exact test), Additional file 8). On the X chromosome 50 genes were identified as sex-biased in liver, of which 18 were also identified in blood (p < 1e-9 (Fisher's exact test), Additional file 8).
Sex-biased genes in postmenopausal and hormonal contraceptive using women
Age specific sex effects on gene expression
Age has a strong influence on gene expression . To examine whether sex effects on gene expression are age-range specific, we separately analyzed the data for three age groups (men versus premenopausal women who did not use hormonal contraceptives, age ranges 17-30 (N = 1047), 31-40 (N = 1191) and 41-88 (N = 1170)). In these 3 age groups we identified 49, 103 and 34 autosomal sex-biased genes respectively (p < 1.2e-6, Additional file 9), which overlapped for >98% with the sex-biased genes identified in the total sample (with same direction of effect). The three sets of sex-biased genes identified in these age groups overlapped to a lesser extent with each other (>38%, Additional file 9). However, the fold changes between men and women of the sex-biased genes identified in the total sample were highly concordant between age ranges (Additional file 10), suggesting that the identified sex effects occur at all ages, but that some effects may be stronger at a certain age or may not have been identified due to reduced power in the smaller groups of selected ages.
At the DNA autosomal sequence level sexes do not differ, as established by a well-powered meta-analysis , suggesting an important role for higher molecular levels, such as the transcriptome, in the manifestation of sexual dimorphisms. Indeed, animal studies have shown that the transcriptome is highly differential between sexes [14, 15, 34, 35]. In humans, gene expression differences have been reported in liver , lymphoblastoid cell lines [19, 20], and muscle , but only in studies with relatively small sample sizes (N < 250). Here we analyzed the sex differences in the peripheral blood transcriptome by assessing 47,122 probe sets targeting 19,250 genes genome wide in a well-characterized large Dutch cohort (N = 5,241) taking into account the impact of hormonal contraceptive use and menopausal status in women.
Number of female- and male-biased genes
On the autosomes, we identified 582 genes (3.1% of all genes measured) that were differentially expressed between men and premenopausal women not using hormonal contraceptives. Of these genes, 57.7% were female-biased. The autosomes had rather similar proportions of sex-biased genes indicating the sex-biased genes can be found equally frequent across the entire genome, as opposed to what was found in liver  where several chromosomes enrich sex-biased genes. It is important to note that the filter criteria used for selecting probe sets highly influences the number of sex-biased genes; the percentage of sex-biased genes increased with the threshold for mean expression level from 3.1% up to 13.7%. Importantly, we have shown that hormonal contraceptives and menopause status, which were not taken into account in previous studies in humans, highly influence the number and effect sizes of sex differences in gene expression. Although it has been indicated that the percentage of sex-biased genes in non-human vertebrates is highly tissue dependent (e.g. ranging from 13.6% in the brain to 72% in the liver [14, 15]), our described range of 3.1-13.7% for sex-biased genes is comparable to that found in human liver (3.7%, ). Peripheral blood consists of a mixture of blood cell types (the main types are lymphocytes, neutrophiles and monocytes), hence the sex differences we identified must either be present in all subcell types or, when present in only one cell type, strong enough to be observed in the accumulative measurement. By stratifying the sample into three age groups we showed that the size of the sex effects may be age dependent for some genes, but the direction of the effects are highly concordant between age groups.
We found a significant but small overlap of sex-biased autosomal genes identified in peripheral blood with those previously identified in muscle or liver, further confirming substantial tissue specificity of sex-biased genes. Across tissue circulating exosomes contain RNA and could contribute to the overlapping expression profiles between muscle, liver and blood . Sex-biased X chromosome genes showed must larger overlap between tissues, indicating that escape from X-inactivation is highly similar between tissues. Previous studies have reported that sex-biased genes may evolve more rapidly than average in vertebrates , human brain  and liver . However, sex-biased genes in the peripheral blood transcriptome identified in our study did not include enrichment of fast evolving genes. In women, most genes on one X chromosome are not expressed due to X chromosome inactivation . Some genes escape X-inactivation and are expressed from both X chromosomes . We showed that in peripheral blood the X chromosome is enriched for female-biased genes; 5.1% of the genes measured on the X chromosome are female-biased. This percentage, however, is only slightly higher than the average percentage identified at the autosomes (3.1%), which shows a major role of autosomal genes in sex-specific gene expression.
The role of estradiol in gene expression sex differences
Estrogen is the primary female sex hormone and estrogenic activity is present at about two fold increased concentration in women as compared to men. Estradiol, the predominant estrogen in terms of absolute serum levels, activates estrogen receptors that bind to DNA sequences to activate or suppress gene expression, and many efforts have been made to find its target genes (up to 5000) in MCF-7 cancer cell line [39–41] because of its role in breast cancer . Here we show that in peripheral blood 18% of the identified sex-biased genes are known to be regulated by estradiol, and several additional findings suggest that the sex difference in estrogen levels underlie multiple sex differences in gene expression. First, from the 20 genes with high male/female fold changes, 7 are involved in common diseases and influenced by estrogen; GPER (g protein-coupled estrogen receptor-1, related to cancer ), ADM (coding for the peptide adrenomedulin, the main vasodilatory peptide involved in cardiovascular disease [44–46], LTF (lactoferrin, essential for the innate immune system and involved in cancer [47, 48]), LCN2 (lipocalin-2, innate immune system and cancer related ), MPO (myeloperoxidase), a biomarker for cardiovascular disease risk , ERG (Ets Related Gene, proposed as a mediator of estrogen effect on prostate cancer , LTBP1 (latent-transforming growth factor beta-binding protein 1, linked to coronary heart disease . This suggests that these genes mediate the effect of estrogen and thereby may contribute to the sex differences in the related diseases. Second, we showed that the sex differences in gene expression depend largely on the hormonal status of the subgroup of women considered. In postmenopausal women, in which estradiol levels are similar to those in men, we identified fewer sex-biased genes with smaller effect sizes as compared to premenopausal women. In hormonal contraceptive using women, with increased estradiol levels, we identified more sex-biased genes and larger effect sizes as compared to women not using hormonal contraceptives. Interestingly, the change in effect size was present for more than 65% of the female-biased genes, and for more than 85% of the male-biased genes. This gives an indication of the amount of sex-biased genes affected by estradiol, which is much higher than currently known from literature (IPA, 15% of sex-biased genes are known to be regulated by estradiol). In liver, sex differences in gene expression are mainly caused by sex-specific growth hormone secretion [21, 53]. Growth hormones are regulated by estrogen [54, 55], hence the effect of estrogen on sex-specific gene expression in peripheral blood may also be mediated by growth hormone secretion.
Immune system processes predominant in female-biased genes
The immune system function is known to be different between sexes; women produce more vigorous immune reactions and are more prone to autoimmune diseases . Here we identified a large number of genes that potentially contribute to the immune system sex differences; 31.6% of female-biased genes are in the GO category immune system process. From the 95 female-biased genes linked to the immune system, 45 are regulated by estradiol, which confirms the role of estrogen in the sex-specific immune system functioning . Most interestingly, Ingenuity Pathway Analysis revealed that female-biased genes are highly enriched for genes involved in the toll-like receptor (TLR4 and TLR3 pathways, known as LPS and poly I:C response patterns) driven innate immune defense, suggesting some intrinsic innate immune activity sex differences. Increased female expression of immunoglobulin is reflective of concomitant more active humoral immune activity. These functions are compatible with an activated leukocyte, cytokine production and type 1 interferon activity observed in the GO enrichment analysis and might explain why women are more resistant to certain infections, and suffer a high incidence of autoimmune diseases compared to men . For example, rheumatoid arthritis occurs almost twice as often in women as in men . Female-biased genes were enriched for genes linked to rheumatoid arthritis, including the gene IL6R, which is a well-known target in rheumatoid arthritis treatment . The identified female-biased genes provide a framework for future research to unravel the mechanism of sex-biased immune regulation and autoimmune diseases.
Annotation of male-biased genes
Surprisingly, male-biased genes were not enriched for GO categories, and thus serve a wide variety of biological functions. In IPA, however, male-biased genes were most significantly enriched for genes linked to renal cancer, including the well established renal cancer gene CSF1R . It is notable that a recent meta-analysis on sex differences in renal cell cancer presentation and survival showed a ratio of 1.65 of renal cell carcinoma for males compared to females . The cellular component GO categories indicate the part of a cell at which a gene product is located. Topographical categorization revealed that male-biased gene products occur more often intracellularly, in particular at the cytoplasm, whereas female-biased genes occur more often integral to the membrane.
Sex-specific eQTLs do not underly sex-biased gene expression
A previous study (in a smaller sample than the current one) showed that a substantial amount of eQTLs is sex-specific, but not for eQTLs from genes with sex-biased expression . Here we confirm this finding by showing that for the sex-biased genes there were no significant eQTL-sex interactions. This shows the importance of other factors, such as estradiol and other hormones, in causing gene expression sex differences.
Sex-biased genes in modules of correlated transcripts
WGCNA analyses resulted in highly similar modules of correlated transcripts for men and women, similar to findings in mice . The 9 modules were highly enriched for male or female-biased genes, indicating that sex-biased genes play an important role in the major gene expression networks. Module #2 and #3 contained each more than 30% female-biased genes and were enriched for the GO category immune system response, which shows that immune system genes operate in correlated groups that are partially sex-biased. Module #9 contained 31.4% male biased genes, enriched the GO category immune response (37%) and contained 92% stronger pairwise correlations in men than in women. This module contained the interleukin receptor IL2B gene, and IPA analysis showed that 11 of the 35 genes in this module are known to be regulated by the cytokine IL2, and 16 of them are related to cancer (Additional file 11) including the female-biased genes PRF1 and GZMH essential for natural killer (NK)-cell cytotoxicity [62, 63]. Module #6 contained 37.8% male-biased genes, was enriched for the GO term coagulation (50%) and 76% of the pairwise correlations in this module are higher in men than in women. IPA analysis shows that from this module 16 genes are regulated by TGFB1 (Additional file 11), and 17 genes are related to heart or vascular disease, including the male-biased genes PTGS1 (coding for COX-1, which is inhibited by aspirin  that has a protective effect on cardiac events ), ITGA2B, ITGB3, F13A and GP1BA which are candidate stroke risk genes . This suggests that the modules #9 and #6 may play a role in the sex differences in cancer and cardiovascular disease, respectively.
We showed that sex-biased genes occur in large numbers throughout the human peripheral blood transcriptome, suggesting an important role of sex-specific gene expression in sexual dimorphisms. Estrogen appears to be a key regulator of sex-biased genes, also shown by the effect of menopause and hormonal contraceptives on gene expression sex differences. Sex-biased genes are highly enriched with genes linked to common diseases and may contribute to sex-differences in these diseases. Understanding the molecular mechanisms behind sex inequalities can lead to new insights into sex-specific pathophysiology and treatment opportunities.
The two parent projects that supplied data for this study are large-scale longitudinal studies: the Netherlands Study of Depression and Anxiety (NESDA)  and the Netherlands Twin Registry . NESDA and NTR studies were approved by the Central Ethics Committee on Research Involving Human Subjects of the VU University Medical Center, Amsterdam (IRB number IRB-2991 under Federalwide Assurance 3703; IRB/institute codes, NESDA 03-183; NTR 03-180), and all subjects provided written informed consent. The sample consisted of 5391 subjects (before QC), 3327 participants from NTR (2 MZ triplets, 708 MZ twin pairs, 658 DZ twin pairs, 338 siblings from these twins and 251 unrelated individuals) and 2064 unrelated participants from NESDA. The age of the participants ranged from 17 to 88 years (mean 38, SD 13) and 65% of the sample was female. As part of the NESDA and NTR biobank protocols, data on menopause status and medication use, including hormonal contraceptives were collected in all participants.
Blood sampling, RNA and DNA extraction
The NTR and NESDA blood sampling and RNA extraction procedures have been described in detail previously [69, 70]. In short; for NTR, venous blood samples were drawn between 0700-1100 after an overnight fast and usually in the subjects’ homes. Within 20 minutes of sampling, heparinized whole blood was transferred into PAXgene Blood RNA tubes (Qiagen) and stored at -20°C. The PAXgene tubes were shipped to the Rutgers University Cell and DNA Repository (RUCDR), USA. Average time between blood sampling and RNA extraction was 211 weeks (included in mixed model for gene expression). Upon registration of samples, RNA was extracted using Qiagen Universal liquid handling system (PAXgene extraction kits as per the manufacturer's protocol).
From the NESDA subjects, serial venous whole blood samples were obtained (8–10 am, after overnight fasting) in one 7-mL heparin-coated tube (Greiner Bio-One, Monroe, North Carolina). Between 10 and 60 min after blood draw, 2.5 mL of blood was transferred into a PAXgene tube (Qiagen, Valencia, California). This tube was kept at room temperature for a minimum of 2 hours and then stored at -20°C. Average time between blood sampling and RNA extraction was 113 weeks (included in mixed model for gene expression). Total RNA was extracted at the VU University Medical Center (Amsterdam) according to the manufacturer’s protocol (Qiagen) as described previously .
For both NESDA and NTR samples high molecular weight genomic DNA was isolated from frozen blood in EDTA tubes using Puregene DNA isolation kits (Qiagen).
Gene expression measurements
Gene expression assays were conducted at the Rutgers University Cell and DNA Repository (RUCDR, http://www.rucdr.org). RNA quality and quantity was assessed by Caliper AMS90 with HT DNA5K/RNA LabChips. RNA samples that showed abnormal ribosomal subunits in the electropherograms were removed. NTR and NESDA samples were randomly assigned to plates with seven plates containing subjects from both studies to better inform array QC and study comparability. For cDNA synthesis, 50 ng of RNA was reverse-transcribed and amplified in a plate format on a Biomek FX liquid handling robot (Beckman Coulter) using Ovation Pico WTA reagents per the manufacturer’s protocol (NuGEN). Products purified from single primer isothermal amplification (SPIA) were then fragmented and labeled with biotin using Encore Biotin Module (NuGEN). Prior to hybridization, the labeled cDNA was analyzed using electrophoresis to verify the appropriate size distribution (Caliper AMS90 with a HT DNA 5 K/RNA LabChip). Samples were hybridized to Affymetrix U219 array plates (GeneTitan) to enable high-throughput gene expression profiling of 96 samples at a time. The U219 array contains 530,467 probes for 49,293 transcripts. All probes are 25 bases in length and designed to be “perfect match” complements to a designated transcript. Array hybridization, washing, staining, and scanning were carried out in an Affymetrix GeneTitan System per the manufacturer’s protocol.
Genome-wide SNP measurements and QC
Genotyping was conducted using Affymetrix Genome-Wide Human SNP Array 6.0 containing 931,946 SNPs, per the manufacturer’s protocol. The resulting data were required to pass standard Affymetrix QC metrics (contrast QC > 0.4) before further analysis. SNP QC included removal of SNPs for non-unique mapping of probe sequences to NCBI Build 37/UCSC hg19, low minor allele frequency (< 0.005), substantial deviation from HapMap3 CEU founder allele frequencies, deviation from Hardy-Weinberg equilibrium (pHWE < 1×10-8), and high missingness (> 0.05). After genotyping QC, 666 K autosomal SNPs were available. Subjects were eliminated from analysis for high missingness (> 0.05), outlying genome-wide homozygosity or ancestry, discrepant genetic and phenotypic sex, or twin relatedness not consistent with monozygosity or dizygosity.
Gene expression QC
With r i the average of correlations for sample i, and r the average of all correlations. Larger values of D corresponded to poor quality; 80 samples with D > 5 were removed, decreasing the final number of subjects to 5,241.
Mixed models for gene expression
Linear mixed models allow for the correction for the presence of twin families in a sample . For each of the 47,122 probe sets a mixed model was fit with gene expression as dependent variable. Independent model covariates were selected based on significance of the variable in the fitted mixed models. Several covariates that did not come out significantly were not included in the final model (alcohol use, education level, time between RNA amplification and RNA fragmentation, time between RNA fragmentation and RNA hybridization). Inclusion of depression status and psychotropic medication use as covariates in the mixed model did not affect the principle findings. Fixed effect covariates included in the final model were sex, age, body mass index (BMI, weight/height 2 in kg/m), smoking status (yes/no current smoking), D (see above), hemoglobin (mmol/L), group (NTR or NESDA), time of blood sampling, month of blood sampling, time between blood sampling and RNA extraction, and the time between RNA extraction and RNA amplification. Random effects were plate, well, family ID and zygosity (one factor for each monozygotic twin pair, for each other individual different factors ). In Additional file 12, for each of the variables the amount of probe sets for which the variable was significant is denoted. Mixed models and resulting p-values were computed using the R function lmer from the package lme4.
eQTL analysis was first performed in a screening step by MatrixeQTL . Prior to eQTL analysis for each gene expression probeset the data was transformed into a normal distribution using an inverse quantile normal transformation. Genotypes were coded as 0, 1 or 2 and for each SNP-transcript pair a linear regression model was fitted including the covariates sex, age, body mass index, smoking status, D (see above), hemoglobin (mmol/L), group (NTR or NESDA), time of blood sampling, month of blood sampling, time between blood sampling and RNA extraction, time between RNA extraction and RNA amplification, plate and well plus three principle components (PCs) from the genotype data  and 5 PCs from the transformed expression data. Cis-eQTLs are transcript-associated SNPs with distance < 1 Mb of transcript site. The trans-eQTLs are the complementary set of SNPs. In the screening step, males and woman were screened using MatrixeQTL as if the individuals were all unrelated. Benjamini-Hochberg q-value estimation was performed separately for cis- and trans-eQTLs. For each of the 993 autosomal sex-biased transcripts eQTLs were selected for men and women separately, and then pooled. For these eQTLs genotype-sex interactions were assessed using the full mixed model that included both men and women, with as independent variables genotype, sex, their interaction and the other covariate also used in the mixed model for gene expression (see above).
GO category enrichment
To test whether Gene Ontology  categories enriched sex-biased genes we used hypergeometric tests implemented in BINGO software . The reference gene set consisted of all genes measured by the U219 microarrays.
The correlation structure of gene expression was examined using unsigned co-expression networks constructed using the WGCNA package in R . Of all 47,122 probes a single probe of highest mean expression per gene was selected to be included in the network analysis using the CollapseRows function in WGCNA, resulting in the inclusion of 19,249 genes in the network. The choice of the probe of highest mean expression per gene has been shown to yield robust analysis across data sets . The network construction for each entire data set was performed in a single block of maximum size 20,000 genes using the blockwiseModules function in WGCNA . Using this block size in WGCNA ensured the theoretical advantage that the genes did not have to be pre-clustered by WGCNA. The network adjacency matrix is the gene pair-wise correlation matrix raised to the power of 6, chosen based on the scale-free topology criteria . Rather than just using adjacency weights between genes, the topological overlap measure (TOM) is computed from the adjacency matrix. For each pair of genes, TOM is the adjacency weights of all the paths between the genes of length at most two (i.e. the genes are directly connected or have one gene between them) scaled by the minimum connectivity of the either gene. The topological overlap dissimilarity, defined as 1-TOM, is used for the average linkage hierarchical clustering algorithm. The resultant clustering tree is used to define the modules from its branches using the hybrid dynamic tree cutting algorithm . The minimum module size was set to 30 and the cut-off for merging modules was set to 0.25. Each module is then characterized by its eigengene, the first principal component of the module expression data, which accounts for the greatest variation of the expression levels in the module. Genes were removed from modules if the correlations between their expression values and the module eigengenes were too low (less than 0.3). Modules were merged if the correlation between their eigengenes was high.
Availability of supporting data
Gene expression data used for this study will be available at dbGaP, accession number phs000486.v1.p1 (http://www.ncbi.nlm.nih.gov/projects/gap/cgi-bin/study.cgi?study_id=phs000486.v1.p1).
RJ and SB performed analysis. AB and JT generated molecular data. GW, VM and GvG provided data management support, JJH, YM and HM provided genotype data QC. RJ, WP JV, CLV, EG, JS, FW, PS, DB and BP wrote the manuscript. All authors read and approved the final manuscript.
Biological process GO
Cellular component GO
Weighted gene co-expression network analysis
- HC women:
Women using hormonal contraceptives
- NHC women:
Non-hormonal contraceptives using women
Ingenuity pathway analysis.
The Netherlands Study of Depression and Anxiety (NESDA) and the Netherlands Twin Register (NTR) were funded by the Netherlands Organization for Scientific Research (MagW/ZonMW grants 904-61-090, 985-10-002,904-61-193,480-04-004, 400-05-717, 912-100-20; Spinozapremie 56-464-14192; Geestkracht program grant 10-000-1002); the Center for Medical Systems Biology (NWO Genomics), Biobanking and Biomolecular Resources Research Infrastructure, VU University’s Institutes for Health and Care Research and Neuroscience Campus Amsterdam, NBIC/BioAssist/RK (2008.024); the European Science Foundation (EU/QLRT-2001-01254); the European Community's Seventh Framework Program (FP7/2007-2013); ENGAGE (HEALTH-F4-2007-201413); and the European Science Council (ERC, 230374). Gene-expression data was funded by the US National Institute of Mental Health (RC2 MH089951) as part of the American Recovery and Reinvestment Act of 2009.
- Choi BG, McLaughlin MA: Why men’s hearts break: cardiovascular effects of sex steroids. Endocrinol Metab Clin North Am. 2007, 36: 365-377. 10.1016/j.ecl.2007.03.011.PubMedView ArticleGoogle Scholar
- Whitacre CC: Sex differences in autoimmune disease. Nat Immunol. 2001, 2: 777-780. 10.1038/ni0901-777.PubMedView ArticleGoogle Scholar
- Vink JM, Bartels M, van Beijsterveldt TCEM, van Dongen J, van Beek JHDA, Distel MA, de Moor MHM, Smit DJA, Minica CC, Ligthart L, Geels LM, Abdellaoui A, Middeldorp CM, Hottenga JJ, Willemsen G, de Geus EJC, Boomsma DI: Sex differences in genetic architecture of complex phenotypes?. PLoS One. 2012, 7: e47371-10.1371/journal.pone.0047371.PubMed CentralPubMedView ArticleGoogle Scholar
- Nolen-Hoeksema S: Emotion regulation and psychopathology: the role of gender. Annu Rev Clin Psychol. 2012, 8: 161-187. 10.1146/annurev-clinpsy-032511-143109.PubMedView ArticleGoogle Scholar
- Kim AM, Tingen CM, Woodruff TK: Sex bias in trials and treatment must end. Nature. 2010, 465: 688-689. 10.1038/465688a.PubMedView ArticleGoogle Scholar
- Ober C, Loisel DA, Gilad Y: Sex-specific genetic architecture of human disease. Nat Rev Genet. 2008, 9: 911-922. 10.1038/nrg2415.PubMed CentralPubMedView ArticleGoogle Scholar
- Carrel L, Willard HF: X-inactivation profile reveals extensive variability in X-linked gene expression in females. Nature. 2005, 434: 400-404. 10.1038/nature03479.PubMedView ArticleGoogle Scholar
- Lahn BT, Page DC: Functional coherence of the human Y chromosome. Science. 1997, 278: 675-680. 10.1126/science.278.5338.675.PubMedView ArticleGoogle Scholar
- Jessen HM, Auger AP: Sex differences in epigenetic mechanisms may underlie risk and resilience for mental health disorders. Epigenetics. 2011, 6: 857-861. 10.4161/epi.6.7.16517.PubMed CentralPubMedView ArticleGoogle Scholar
- Ling G, Sugathan A, Mazor T, Fraenkel E, Waxman DJ: Unbiased, genome-wide In vivo mapping of transcriptional regulatory elements reveals sex differences in chromatin structure associated with sex-specific liver gene expression. Mol Cell Biol. 2010, 30: 5531-5544. 10.1128/MCB.00601-10.PubMed CentralPubMedView ArticleGoogle Scholar
- Sugathan A, Waxman DJ: Genome-wide analysis of chromatin states reveals distinct mechanisms of sex-dependent gene regulation in male and female mouse liver. Mol Cell Biol. 2013, 33 (18): 3594-3610. 10.1128/MCB.00280-13.PubMed CentralPubMedView ArticleGoogle Scholar
- Ellegren H, Parsch J: The evolution of sex-biased genes and sex-biased gene expression. Nat Rev Genet. 2007, 8: 689-698. 10.1038/nrg2167.PubMedView ArticleGoogle Scholar
- Gallach M, Domingues S, Betrán E: Gene duplication and the genome distribution of sex-biased genes. Int J Evol Biol. 2011, 2011: 989438-PubMed CentralPubMedView ArticleGoogle Scholar
- Yang X, Schadt EE, Wang S, Wang H, Arnold AP, Ingram-Drake L, Drake TA, Lusis AJ: Tissue-specific expression and regulation of sexually dimorphic genes in mice. Genome Res. 2006, 16: 995-1004. 10.1101/gr.5217506.PubMed CentralPubMedView ArticleGoogle Scholar
- Mank JE, Hultin-Rosenberg L, Webster MT, Ellegren H: The unique genomic properties of sex-biased genes: insights from avian microarray data. BMC Genomics. 2008, 9: 148-10.1186/1471-2164-9-148.PubMed CentralPubMedView ArticleGoogle Scholar
- Parsch J, Ellegren H: The evolutionary causes and consequences of sex-biased gene expression. Nat Rev Genet. 2013, 14: 83-87.PubMedView ArticleGoogle Scholar
- Gatti DM, Zhao N, Chesler EJ, Bradford BU, Shabalin AA, Yordanova R, Lu L, Rusyn I: Sex-specific gene expression in the BXD mouse liver. Physiol Genomics. 2010, 42: 456-468. 10.1152/physiolgenomics.00110.2009.PubMed CentralPubMedView ArticleGoogle Scholar
- Mozhui K, Lu L, Armstrong WE, Williams RW: Sex-specific modulation of gene expression networks in murine hypothalamus. Front Neurosci. 2012, 6: 63-PubMed CentralPubMedView ArticleGoogle Scholar
- McRae AF, Matigian NA, Vadlamudi L, Mulley JC, Mowry B, Martin NG, Berkovic SF, Hayward NK, Visscher PM: Replicated effects of sex and genotype on gene expression in human lymphoblastoid cell lines. Hum Mol Genet. 2007, 16: 364-373.PubMedView ArticleGoogle Scholar
- Zhang W, Bleibel WK, Roe CA, Cox NJ, Dolan ME: Gender-specific differences in expression in human lymphoblastoid cell lines. Pharmacogenet Genomics. 2007, 17: 447-450. 10.1097/FPC.0b013e3280121ffe.PubMed CentralPubMedView ArticleGoogle Scholar
- Zhang Y, Klein K, Sugathan A, Nassery N, Dombkowski A, Zanger UM, Waxman DJ: Transcriptional profiling of human liver identifies sex-biased genes associated with polygenic dyslipidemia and coronary artery disease. PLoS One. 2011, 6: e23506-10.1371/journal.pone.0023506.PubMed CentralPubMedView ArticleGoogle Scholar
- Welle S, Tawil R, Thornton CA: Sex-related differences in gene expression in human skeletal muscle. PLoS One. 2008, 3: e1385-10.1371/journal.pone.0001385.PubMed CentralPubMedView ArticleGoogle Scholar
- Gupta P, Harte AL, da Silva NF, Khan H, Barnett AH, Kumar S, Sturdee DW, McTernan PG: Expression of calcitonin gene-related peptide, adrenomedullin, and receptor modifying proteins in human adipose tissue and alteration in their expression with menopause status. Menopause. 2007, 14: 1031-1038.PubMedGoogle Scholar
- Dvornyk V, Liu Y, Lu Y, Shen H, Lappe JM, Lei S, Recker RR, Deng H: Effect of menopause on gene expression profiles of circulating monocytes: a pilot in vivo microarray study. J Genet Genomics. 2007, 34: 974-983. 10.1016/S1673-8527(07)60110-6.PubMedView ArticleGoogle Scholar
- Kósa JP, Balla B, Speer G, Kiss J, Borsy A, Podani J, Takács I, Lazáry A, Nagy Z, Bácsi K, Orosz L, Lakatos P: Effect of menopause on gene expression pattern in bone tissue of nonosteoporotic women. Menopause. 2009, 16: 367-377. 10.1097/gme.0b013e318188b260.PubMedView ArticleGoogle Scholar
- Dimas A, Nica A, Montgomery S, Stranger B, Raj T, Buil A, Giger T, Lappalainen T, Gutierrez-Arcelus M, McCarthy M, Dermitzakis E: Sex-biased genetic effects on gene regulation in humans. Genome Res. 2012, 22 (12): 2368-2375. 10.1101/gr.134981.111.PubMed CentralPubMedView ArticleGoogle Scholar
- Boomsma DI, Willemsen G, Sullivan PF, Heutink P, Meijer P, Sondervan D, Kluft C, Smit G, Nolen WA, Zitman FG, Smit JH, Hoogendijk WJ, van Dyck R, de Geus EJC, Penninx BWJH: Genome-wide association of major depression: description of samples for the GAIN major depressive disorder study: NTR and NESDA biobank projects. Eur J Hum Genet. 2008, 16: 335-342. 10.1038/sj.ejhg.5201979.PubMedView ArticleGoogle Scholar
- Langfelder P, Horvath S: WGCNA: an R package for weighted correlation network analysis. BMC Bioinformatics. 2008, 9: 559-10.1186/1471-2105-9-559.PubMed CentralPubMedView ArticleGoogle Scholar
- Nickel GC, Tefft D, Adams MD: Human PAML browser: a database of positive selection on human genes using phylogenetic methods. Nucleic Acids Res. 2008, 36 (Database issue): D800-D808.PubMed CentralPubMedGoogle Scholar
- Nielsen R, Bustamante C, Clark AG, Glanowski S, Sackton TB, Hubisz MJ, Fledel-Alon A, Tanenbaum DM, Civello D, White TJ, Sninsky J J, Adams MD, Cargill M: A scan for positively selected genes in the genomes of humans and chimpanzees. PLoS Biol. 2005, 3: e170-10.1371/journal.pbio.0030170.PubMed CentralPubMedView ArticleGoogle Scholar
- The Chimpanzee Sequencing and Analysis Consortium: Initial sequence of the chimpanzee genome and comparison with the human genome. Nature. 2005, 437: 69-87. 10.1038/nature04072.View ArticleGoogle Scholar
- Lu T, Pan Y, Kao S-Y, Li C, Kohane I, Chan J, Yankner BA: Gene regulation and DNA damage in the ageing human brain. Nature. 2004, 429: 883-891. 10.1038/nature02661.PubMedView ArticleGoogle Scholar
- Boraska V, Jerončić A, Colonna V, Southam L, Nyholt DR, Rayner NW, Perry JRB, Toniolo D, Albrecht E, Ang W, Bandinelli S, Barbalic M, Barroso I, Beckmann JS, Biffar R, Boomsma D, Campbell H, Corre T, Erdmann J, Esko T, Fischer K, Franceschini N, Frayling TM, Girotto G, Gonzalez JR, Harris TB, Heath AC, Heid IM, Hoffmann W, Hofman A, et al: Genome-wide meta-analysis of common variant differences between men and women. Hum Mol Genet. 2012, 21: 4805-4815. 10.1093/hmg/dds304.PubMed CentralPubMedView ArticleGoogle Scholar
- Ranz JM, Castillo-Davis CI, Meiklejohn CD, Hartl DL: Sex-dependent gene expression and evolution of the drosophila transcriptome. Science. 2003, 300: 1742-1745. 10.1126/science.1085881.PubMedView ArticleGoogle Scholar
- Zhang Y, Sturgill D, Parisi M, Kumar S, Oliver B: Constraint and turnover in sex-biased gene expression in the genus Drosophila. Nature. 2007, 450: 233-237. 10.1038/nature06323.PubMed CentralPubMedView ArticleGoogle Scholar
- Ramachandran S, Palanisamy V: Horizontal transfer of RNAs: exosomes as mediators of intercellular communication. Wiley Interdiscip Rev RNA. 2012, 3: 286-293. 10.1002/wrna.115.PubMed CentralPubMedView ArticleGoogle Scholar
- Reinius B, Saetre P, Leonard JA, Blekhman R, Merino-Martinez R, Gilad Y, Jazin E: An evolutionarily conserved sexual signature in the primate brain. PLoS Genet. 2008, 4: e1000100-10.1371/journal.pgen.1000100.PubMed CentralPubMedView ArticleGoogle Scholar
- Morey C, Avner P: The demoiselle of X-inactivation: 50 years old and as trendy and mesmerising as ever. PLoS Genet. 2011, 7: e1002212-10.1371/journal.pgen.1002212.PubMed CentralPubMedView ArticleGoogle Scholar
- Carroll JS, Meyer CA, Song J, Li W, Geistlinger TR, Eeckhoute J, Brodsky AS, Keeton EK, Fertuck KC, Hall GF, Wang Q, Bekiranov S, Sementchenko V, Fox EA, Silver PA, Gingeras TR, Liu XS, Brown M: Genome-wide analysis of estrogen receptor binding sites. Nat Genet. 2006, 38: 1289-1297. 10.1038/ng1901.PubMedView ArticleGoogle Scholar
- Welboren W-J, van Driel MA, Janssen-Megens EM, van Heeringen SJ, Sweep FC, Span PN, Stunnenberg HG: ChIP-Seq of ERalpha and RNA polymerase II defines genes differentially responding to ligands. EMBO J. 2009, 28: 1418-1428. 10.1038/emboj.2009.88.PubMed CentralPubMedView ArticleGoogle Scholar
- Hah N, Danko CG, Core L, Waterfall JJ, Siepel A, Lis JT, Kraus WL: A rapid, extensive, and transient transcriptional response to estrogen signaling in breast cancer cells. Cell. 2011, 145: 622-634. 10.1016/j.cell.2011.03.042.PubMed CentralPubMedView ArticleGoogle Scholar
- Anderson E: The role of oestrogen and progesterone receptors in human mammary development and tumorigenesis. Breast Cancer Res. 2002, 4: 197-201. 10.1186/bcr452.PubMed CentralPubMedView ArticleGoogle Scholar
- Prossnitz ER, Barton M: The G-protein-coupled estrogen receptor GPER in health and disease. Nat Rev Endocrinol. 2011, 7: 715-726. 10.1038/nrendo.2011.122.PubMed CentralPubMedView ArticleGoogle Scholar
- Watanabe H, Takahashi E, Kobayashi M, Goto M, Krust A, Chambon P, Iguchi T: The estrogen-responsive adrenomedullin and receptor-modifying protein 3 gene identified by DNA microarray analysis are directly regulated by estrogen receptor. J Mol Endocrinol. 2006, 36: 81-89. 10.1677/jme.1.01825.PubMedView ArticleGoogle Scholar
- Schnoes KK, Jaffe IZ, Iyer L, Dabreo A, Aronovitz M, Newfell B, Hansen U, Rosano G, Mendelsohn ME: Rapid recruitment of temporally distinct vascular gene sets by estrogen. Mol Endocrinol. 2008, 22: 2544-2556. 10.1210/me.2008-0044.PubMed CentralPubMedView ArticleGoogle Scholar
- Potocki M, Ziller R, Mueller C: Mid-regional pro-adrenomedullin in acute heart failure: a better biomarker or just another biomarker?. Curr Heart Fail Rep. 2012, 9: 244-251. 10.1007/s11897-012-0096-6.PubMedView ArticleGoogle Scholar
- Teng C: Lactoferrin: the path from protein to gene. Biometals. 2010, 23: 359-364. 10.1007/s10534-010-9310-8.PubMedView ArticleGoogle Scholar
- Gibbons JA, Kanwar RK, Kanwar JR: Lactoferrin and cancer in different cancer models. Front Biosci (Schol Ed). 2011, 3: 1080-1088.View ArticleGoogle Scholar
- Rodvold JJ, Mahadevan NR, Zanetti M: Lipocalin 2 in cancer: when good immunity goes bad. Cancer Lett. 2012, 316: 132-138. 10.1016/j.canlet.2011.11.002.PubMedView ArticleGoogle Scholar
- Heslop CL, Frohlich JJ, Hill JS: Myeloperoxidase and C-reactive protein have combined utility for long-term prediction of cardiovascular mortality after coronary angiography. J Am Coll Cardiol. 2010, 55: 1102-1109. 10.1016/j.jacc.2009.11.050.PubMedView ArticleGoogle Scholar
- Bonkhoff H, Berges R: The evolving role of oestrogens and their receptors in the development and progression of prostate cancer. Eur Urol. 2009, 55: 533-542. 10.1016/j.eururo.2008.10.035.PubMedView ArticleGoogle Scholar
- Oklü R, Hesketh R: The latent transforming growth factor beta binding protein (LTBP) family. Biochem J. 2000, 352 (Pt 3): 601-610.PubMed CentralPubMedView ArticleGoogle Scholar
- Zhang Y, Laz EV, Waxman DJ: Dynamic, sex-differential STAT5 and BCL6 binding to sex-biased, growth hormone-regulated genes in adult mouse liver. Mol Cell Biol. 2012, 32: 880-896. 10.1128/MCB.06312-11.PubMed CentralPubMedView ArticleGoogle Scholar
- Meinhardt UJ, Ho KKY: Modulation of growth hormone action by sex steroids. Clin Endocrinol (Oxf). 2006, 65: 413-422. 10.1111/j.1365-2265.2006.02676.x.View ArticleGoogle Scholar
- Leung K-C, Johannsson G, Leong GM, Ho KKY: Estrogen regulation of growth hormone action. Endocr Rev. 2004, 25: 693-721. 10.1210/er.2003-0035.PubMedView ArticleGoogle Scholar
- Ansar Ahmed S, Penhale WJ, Talal N: Sex hormones, immune responses, and autoimmune diseases. Mechanisms of sex hormone action. Am J Pathol. 1985, 121: 531-551.PubMed CentralPubMedGoogle Scholar
- Oertelt-Prigione S: The influence of sex and gender on the immune response. Autoimmun Rev. 2012, 11: A479-A485. 10.1016/j.autrev.2011.11.022.PubMedView ArticleGoogle Scholar
- Oliver JE, Silman AJ: Why are women predisposed to autoimmune rheumatic diseases?. Arthritis Res Ther. 2009, 11: 252-10.1186/ar2825.PubMed CentralPubMedView ArticleGoogle Scholar
- Nishimoto N: Interleukin-6 in rheumatoid arthritis. Curr Opin Rheumatol. 2006, 18: 277-281. 10.1097/01.bor.0000218949.19860.d1.PubMedView ArticleGoogle Scholar
- Menke J, Kriegsmann J, Schimanski CC, Schwartz MM, Schwarting A, Kelley VR: Autocrine CSF-1 and CSF-1 receptor coexpression promotes renal cell carcinoma growth. Cancer Res. 2012, 72: 187-200. 10.1158/0008-5472.CAN-11-1232.PubMed CentralPubMedView ArticleGoogle Scholar
- Woldrich JM, Mallin K, Ritchey J, Carroll PR, Kane CJ: Sex differences in renal cell cancer presentation and survival: an analysis of the National Cancer Database, 1993-2004. J Urol. 2008, 179: 1709-1713. 10.1016/j.juro.2008.01.024. discussion 1713PubMedView ArticleGoogle Scholar
- Brennan AJ, Chia J, Trapani JA, Voskoboinik I: Perforin deficiency and susceptibility to cancer. Cell Death Differ. 2010, 17: 607-615. 10.1038/cdd.2009.212.PubMedView ArticleGoogle Scholar
- Kim T-D, Lee SU, Yun S, Sun H-N, Lee SH, Kim JW, Kim HM, Park S-K, Lee CW, Yoon SR, Greenberg PD, Choi I: Human microRNA-27a* targets Prf1 and GzmB expression to regulate NK-cell cytotoxicity. Blood. 2011, 118: 5476-5486. 10.1182/blood-2011-04-347526.PubMed CentralPubMedView ArticleGoogle Scholar
- Angiolillo DJ: The evolution of antiplatelet therapy in the treatment of acute coronary syndromes: from aspirin to the present day. Drugs. 2012, 72: 2087-2116. 10.2165/11640880-000000000-00000.PubMedView ArticleGoogle Scholar
- Antithrombotic Trialists’ Collaboration: Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002, 324: 71-86. 10.1136/bmj.324.7329.71.View ArticleGoogle Scholar
- Stankovic S, Majkic-Singh N: Genetic aspects of ischemic stroke: coagulation, homocysteine, and lipoprotein metabolism as potential risk factors. Crit Rev Clin Lab Sci. 2010, 47: 72-123. 10.3109/10408361003791520.PubMedView ArticleGoogle Scholar
- Penninx BWJH, Beekman ATF, Smit JH, Zitman FG, Nolen WA, Spinhoven P, Cuijpers P, De Jong PJ, Van Marwijk HWJ, Assendelft WJJ, Van Der Meer K, Verhaak P, Wensing M, De Graaf R, Hoogendijk WJ, Ormel J, Van Dyck R: The Netherlands Study of Depression and Anxiety (NESDA): rationale, objectives and methods. Int J Methods Psychiatr Res. 2008, 17: 121-140. 10.1002/mpr.256.PubMedView ArticleGoogle Scholar
- Boomsma DI, de Geus EJC, Vink JM, Stubbe JH, Distel MA, Hottenga J-J, Posthuma D, van Beijsterveldt TCEM, Hudziak JJ, Bartels M, Willemsen G: Netherlands twin register: from twins to twin families. Twin Res Hum Genet. 2006, 9: 849-857. 10.1375/twin.9.6.849.PubMedView ArticleGoogle Scholar
- Willemsen G, de Geus EJC, Bartels M, van Beijsterveldt CEMT, Brooks AI, Estourgie-van Burk GF, Fugman DA, Hoekstra C, Hottenga J-J, Kluft K, Meijer P, Montgomery GW, Rizzu P, Sondervan D, Smit AB, Spijker S, Suchiman HED, Tischfield JA, Lehner T, Slagboom PE, Boomsma DI: The Netherlands Twin Register biobank: a resource for genetic epidemiological studies. Twin Res Hum Genet. 2010, 13: 231-245. 10.1375/twin.13.3.231.PubMedView ArticleGoogle Scholar
- Spijker S, van de Leemput JCH, Hoekstra C, Boomsma DI, Smit AB: Profiling gene expression in whole blood samples following an in-vitro challenge. Twin Res. 2004, 7: 564-570.PubMedView ArticleGoogle Scholar
- Visscher PM, Benyamin B, White I: The use of linear mixed models to estimate variance components from data on twin pairs by maximum likelihood. Twin Res. 2004, 7: 670-674.PubMedView ArticleGoogle Scholar
- Shabalin AA: Matrix eQTL: ultra fast eQTL analysis via large matrix operations. Bioinformatics. 2012, 28: 1353-1358. 10.1093/bioinformatics/bts163.PubMed CentralPubMedView ArticleGoogle Scholar
- Abdellaoui A, Hottenga J-J, de Knijff P, Nivard MG, Xiao X, Scheet P, Brooks A, Ehli EA, Hu Y, Davies GE, Hudziak JJ, Sullivan PF, van Beijsterveldt T, Willemsen G, de Geus EJ, Penninx BWJH, Boomsma DI: Population structure, migration, and diversifying selection in the Netherlands. Eur J Hum Genet. 2013, 21 (11): 1277-85. 10.1038/ejhg.2013.48.PubMed CentralPubMedView ArticleGoogle Scholar
- Ashburner M, Ball CA, Blake JA, Botstein D, Butler H, Cherry JM, Davis AP, Dolinski K, Dwight SS, Eppig JT, Harris MA, Hill DP, Issel-Tarver L, Kasarskis A, Lewis S, Matese JC, Richardson JE, Ringwald M, Rubin GM, Sherlock G: Gene ontology: tool for the unification of biology. The gene ontology consortium. Nat Genet. 2000, 25: 25-29. 10.1038/75556.PubMed CentralPubMedView ArticleGoogle Scholar
- Maere S, Heymans K, Kuiper M: BiNGO: a Cytoscape plugin to assess overrepresentation of gene ontology categories in biological networks. Bioinformatics. 2005, 21: 3448-3449. 10.1093/bioinformatics/bti551.PubMedView ArticleGoogle Scholar
- Miller JA, Cai C, Langfelder P, Geschwind DH, Kurian SM, Salomon DR, Horvath S: Strategies for aggregating gene expression data: the collapseRows R function. BMC Bioinformatics. 2011, 12: 322-10.1186/1471-2105-12-322.PubMed CentralPubMedView ArticleGoogle Scholar
- Zhang B, Horvath S: A general framework for weighted gene co-expression network analysis. Stat Appl Genet Mol Biol. 2005, 4: Article17 Epub 2005 Aug 12Google Scholar
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