No Gene Is an Island: The Flip-Flop Phenomenon

An increasing number of publications are replicating a previously reported disease-marker association but with the risk allele reversed from the previous report. Do such “flip-flop” associations confirm or refute the previous association findings? We hypothesized that these associations may indeed be confirmations but that multilocus effects and variation in interlocus correlations contribute to this flip-flop phenomenon. We used theoretical modeling to demonstrate that flip-flop associations can occur when the investigated variant is correlated, through interactive effects or linkage disequilibrium, with a causal variant at another locus, and we show how these findings could explain previous reports of flip-flop associations.