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Background  Genetic variation in  NOD2  and cigarette smoking are well-established risk factors for the development of Crohn's disease (CD). However, little is known about a potential interaction between these risk factors. We investigated gene-environment interactions between CD-associated  NOD2  alleles and cigarette smoking in a large sample of patients with CD.    Methods  Three previously reported CD-associated variants in  NOD2  (R702W, G908R, 1007fs) were genotyped in 1636 patients with CD continuously recruited between 1995 and 2010 based on physician referral. Data on history of smoking behaviour was obtained for all participants through a written questionnaire. Using a case-only design, we performed logistic regression analyses to investigate statistical interactions between  NOD2  risk alleles and smoking status.    Results  We detected a significant negative interaction between carriership of at least one of the  NOD2  risk alleles and history of ever having smoked (OR = 0.71;  p  = 0.005) as well as smoking at the time of CD diagnosis (OR = 0.68;  p  = 0.005). Subsequent separate analyses of the three variants revealed a significant negative interaction between the 1007fs variant and history of ever having smoked (OR = 0.64;  p  = 9 × 10 -4 ) and smoking at the time of CD diagnosis (OR = 0.53;  p  = 7 × 10 -5 ).    Conclusions  The observed significant negative gene-environment interaction suggests that the risk increase for CD conferred simultaneously by cigarette smoking and the 1007fs  NOD2  polymorphism is smaller than expected and may point to a biological interaction. Our findings warrant further investigation in epidemiological and functional studies to elucidate pathophysiology as well as to aid in the development of recommendations for disease prevention.

A case-only study of gene-environment interaction between genetic susceptibility variants in NOD2 and cigarette smoking in Crohn's disease aetiology