Validating therapeutic targets through human genetics
Abstract
More than 90% of the compounds that enter clinical trials fail to demonstrate sufficient safety and efficacy to gain regulatory approval. Most of this failure is due to the limited predictive value of preclinical models of disease, and our continued ignorance regarding the consequences of perturbing specific targets over long periods of time in humans. 'Experiments of nature' - naturally occurring mutations in humans that affect the activity of a particular protein target or targets - can be used to estimate the probable efficacy and toxicity of a drug targeting such proteins, as well as to establish causal rather than reactive relationships between targets and outcomes. Here, we describe the concept of dose-response curves derived from experiments of nature, with an emphasis on human genetics as a valuable tool to prioritize molecular targets in drug development. We discuss empirical examples of drug-gene pairs that support the role of human genetics in testing therapeutic hypotheses at the stage of target validation, provide objective criteria to prioritize genetic findings for future drug discovery efforts and highlight the limitations of a target validation approach that is anchored in human genetics.
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Individual clinical tests, biomarkers, and prescription drug efficacy may vary across populations in their utility, but are fundamentally informed by the same underlying biology.
“Individual clinical tests, biomarkers, and prescription drug efficacy may vary across populations in their utility, but are fundamentally informed by the same underlying biology64,65.”
From Clinical use of current polygenic risk scores may exacerbate health disparities (2019) · cites this paper as [65]
Identifying allelic series can help prioritize candidate drug targets.
“Identifying allelic series, in which multiple variants in a gene associate with a phenotype with varying effect sizes, can help prioritize candidate drug targets13,14.”
From Rare variant associations with plasma protein levels in the UK Biobank (2023) · cites this paper as [13]
This enables more rigorous evaluation of the contribution of rare and common variants to trait susceptibility and supports enumeration of allelic series critical for studies of disease mechanism and therapeutic target optimization.
“This enables more rigorous evaluation of the contribution of rare and common variants to trait susceptibility48 and supports the enumeration of ‘allelic series’ (sets of alleles of varying frequency, effect size and direction that disrupt the same gene) critical for studies of disease mechanism and therapeutic target optimization89,96.”
From A brief history of human disease genetics (2020) · cites this paper as [89]
These findings inform prioritization of therapeutic targets, providing clues to potential on-target side effects and opportunities for drug repurposing.
“These findings inform the prioritization of therapeutic targets, providing clues to potential on-target side effects and opportunities for drug repurposing87–89.”
From A brief history of human disease genetics (2020) · cites this paper as [89]
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The UK Biobank resource with deep phenotyping and genomic data
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Li, J., Shringarpure, S., Wong, E., & Ho, A. (2026) · doi:10.64898/2026.06.29.735386
- Authors
- Plenge, R. M., Scolnick, E. M., & Altshuler, D.
- Affiliations
- Brigham and Women's Hospital (US)
- Broad Institute (US)
- Corresponding author
- Plenge, Robert M.
- Venue
- Nature Reviews Drug Discovery
- Published
- 2013-07-19
- Volume
- 12
- Issue
- 8
- Pages
- 581-594
- ISSN
- 1474-1776 (ISSN-L)
- 1474-1784
- OpenAlex
- W2143282831
- Cited by
- 712
- References
- 114
- Citations by year
- 2026: 44 · 2025: 61 · 2024: 88 · 2023: 39 · 2022: 42 · 2021: 48 · 2020: 53 · 2019: 64 · 2018: 51 · 2017: 57 · 2016: 59 · 2015: 55 · 2014: 44 · 2013: 7
- FWCI
- 6.75
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Nature Reviews Drug Discovery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetic Associations and Epidemiology
- Physical Sciences › Computer Science › Computational Theory and Mathematics › Computational Drug Discovery Methods
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genomics and Rare Diseases
- Keywords
- target validation, human genetics, natural mutation, drug development, clinical trial failure, preclinical models, dose-response curves, drug target prioritization, causal inference
- MeSH terms
- Clinical Trials as Topic, Genetics, Medical, Humans, Models, Biological, Pharmacogenetics, Biomarkers, Drugs, Investigational, Treatment Failure, Drug Discovery, Early Termination of Clinical Trials, Molecular Targeted Therapy
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