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Barboni P, La Morgia C, Cascavilla ML, Hong EH, Battista M, Majander A, Caporali L, Starace V, Amore G, Renzo AD, Carbonelli M, Nucci P, Jurkute N, Chen BS, Panebianco R, De Negri AM, Sadun F, Parisi V, Bandello F, Sadun AA, Carelli V, Yu-Wai-Man P. Childhood-Onset Leber Hereditary Optic Neuropathy-Clinical and Prognostic Insights. Am J Ophthalmol 2022; 249:99-107. [PMID: 36543315 DOI: 10.1016/j.ajo.2022.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To investigate the clinical and molecular genetic features of childhood-onset Leber hereditary optic neuropathy (LHON) to gain a better understanding of the factors influencing the visual outcome in this atypical form of the disease. DESIGN Retrospective cohort study. METHODS We retrospectively included 2 cohorts of patients with LHON with onset of visual loss before the age of 12 years from Italy and the United Kingdom. Ophthalmologic evaluation, including best-corrected visual acuity, orthoptic evaluation, slit-lamp biomicroscopy, visual field testing, and optical coherence tomography, was considered. Patients were classified based on both the age of onset and the pattern of visual loss. RESULTS A total of 68 patients were stratified based on the age of onset of visual loss: group 1 (<3 years): 14 patients (20.6%); group 2 (≥3 to <9 years): 27 patients (39.7%); and group 3 (≥9 to ≤12 years): 27 patients (39.7%). Patients in group 2 achieved a better visual outcome than those in group 3. Patients in groups 1 and 2 had better mean deviation on visual field testing than those in group 3. The mean ganglion cell layer thickness on optical coherence tomography in group 2 was higher than those in groups 1 and 3. Patients were also categorized based on the pattern of visual loss as follows: Subacute Bilateral: 54 patients (66.7%); Insidious Bilateral: 14 patients (17.3%); Unilateral: 9 patients (11.1%); and Subclinical Bilateral: 4 patients (4.9%). CONCLUSIONS Children who lose vision from LHON before the age of 9 years have a better visual prognosis than those who become affected in later years, likely representing a "form frustre" of the disease.
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Affiliation(s)
- Piero Barboni
- From the Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan (P.B., M.L.C., M.B., V.S., F.B.); Department of ophthalmology, Studio Oculistico d'Azeglio (P.B., M.C.).
| | - Chiara La Morgia
- Department of ophthalmology, IRCCS Istituto delle Scienze Neurologiche di Bologna, (C.L.M., L.C., V.C.) Bologna, Italy
| | - Maria Lucia Cascavilla
- From the Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan (P.B., M.L.C., M.B., V.S., F.B.)
| | - Eun Hee Hong
- Moorfields Eye Hospital, London, United Kingdom (E.H.H., A.M., N.J., P.Y-W-M.); Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Korea (E.H.H.)
| | - Marco Battista
- From the Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan (P.B., M.L.C., M.B., V.S., F.B.)
| | - Anna Majander
- Moorfields Eye Hospital, London, United Kingdom (E.H.H., A.M., N.J., P.Y-W-M.); UCL Institute of Ophthalmology, University College London, London, United Kingdom (A.M., N.J., P.Y-W-M.); Department of Ophthalmology, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland (A.M.)
| | - Leonardo Caporali
- Department of ophthalmology, IRCCS Istituto delle Scienze Neurologiche di Bologna, (C.L.M., L.C., V.C.) Bologna, Italy
| | - Vincenzo Starace
- From the Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan (P.B., M.L.C., M.B., V.S., F.B.)
| | - Giulia Amore
- Unit of Neurology, Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna (G.A., M.C., V.C.)
| | | | - Michele Carbonelli
- Department of ophthalmology, Studio Oculistico d'Azeglio (P.B., M.C.); Unit of Neurology, Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna (G.A., M.C., V.C.)
| | - Paolo Nucci
- Department of Clinical Science and Community Health, University of Milan, Milan, (P.N.), Italy
| | - Neringa Jurkute
- Moorfields Eye Hospital, London, United Kingdom (E.H.H., A.M., N.J., P.Y-W-M.); UCL Institute of Ophthalmology, University College London, London, United Kingdom (A.M., N.J., P.Y-W-M.)
| | - Benson S Chen
- Cambridge Centre for Brain Repair and MRC Mitochondrial Biology Unit, Department of Clinical Neurosciences, University of Cambridge (B.S.C., P.Y-W-M.); Cambridge Eye Unit, Addenbrooke's Hospital, Cambridge University Hospitals, (B.S.C., P.Y-W-M.), Cambridge, United Kingdom
| | | | | | | | - Vincenzo Parisi
- IRCCS G.B. Bietti Foundation I.R.C.C.S., Rome (A.D.R., V.P.)
| | - Francesco Bandello
- From the Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan (P.B., M.L.C., M.B., V.S., F.B.)
| | - Alfredo A Sadun
- and Doheny Eye Institute/UCLA School of Medicine, Los Angeles, California, USA (A.A.S)
| | - Valerio Carelli
- Department of ophthalmology, IRCCS Istituto delle Scienze Neurologiche di Bologna, (C.L.M., L.C., V.C.) Bologna, Italy; Unit of Neurology, Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna (G.A., M.C., V.C.)
| | - Patrick Yu-Wai-Man
- Moorfields Eye Hospital, London, United Kingdom (E.H.H., A.M., N.J., P.Y-W-M.); UCL Institute of Ophthalmology, University College London, London, United Kingdom (A.M., N.J., P.Y-W-M.); Cambridge Centre for Brain Repair and MRC Mitochondrial Biology Unit, Department of Clinical Neurosciences, University of Cambridge (B.S.C., P.Y-W-M.); Cambridge Eye Unit, Addenbrooke's Hospital, Cambridge University Hospitals, (B.S.C., P.Y-W-M.), Cambridge, United Kingdom
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Newman NJ, Carelli V, Taiel M, Yu-Wai-Man P. Visual Outcomes in Leber Hereditary Optic Neuropathy Patients With the m.11778G>A (MTND4) Mitochondrial DNA Mutation. J Neuroophthalmol 2020; 40:547-557. [PMID: 32969847 DOI: 10.1097/wno.0000000000001045] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Leber hereditary optic neuropathy (LHON) is a maternally inherited bilaterally blinding optic neuropathy, predominantly affecting otherwise healthy young individuals, mostly men. The visual prognosis is generally poor, with most patients worsening to at least 20/200 visual acuity. The m.11778G>A (MTND4) mitochondrial DNA mutation is the most common cause of LHON and is associated with poor outcomes and limited potential for meaningful visual recovery. Treatments for LHON are limited, and clinical trials are hampered by inadequate data regarding the natural history of visual loss and recovery. In this article, we review the current literature specifically related to visual function of LHON patients with the m.11778G>A mutation. EVIDENCE ACQUISITION Literature review was performed using MEDLINE through PubMed, Cochrane Reviews Library, and Orpha.net with search terms of "Leber hereditary optic neuropathy," "LHON," "ND4," "G11778A," "visual acuity," "nadir," "natural history," and "registry." All English-language, peer-reviewed publications with study cohorts of at least 5 LHON patients with the molecularly confirmed m.11778G>A mutation were included. RESULTS Meta-analysis of 12 retrospective and 3 prospective studies provided visual function information on 695 LHON patients with the m.11778G>A mutation, 100 (14.4%) of whom were reported to have "recovered" some vision, although definitions of "recovery" varied among studies and idebenone use could not always be excluded. When incorporating age at onset of visual loss into the analyses, and specifically addressing those patients aged 15 years or older, meaningful visual recovery occurred in 23 of 204 (11.3%) patients. A younger age at onset, especially less than 12 years, portends a better visual prognosis and a different natural history of visual loss progression and recovery than in adults. CONCLUSIONS The classic presentation of LHON patients with the m.11778G>A mutation of severe visual loss with rare or poor recovery from nadir still holds true for most affected individuals. Among patients 15 years and older, recovery of meaningful vision likely occurs in less than 20% of patients, irrespective of how recovery is defined, and ultimate visual acuities of better than 20/200 are rare. Adequate prospective studies with sufficient sample sizes of genotypically homogeneous untreated LHON patients stratified by age, immediately enrolled when symptomatic, followed regularly for adequate periods of time with consistent measures of visual function, and analyzed with a standard definition of visual improvement are unfortunately lacking. Future clinical trials for LHON will require more standardized reporting of the natural history of this disorder.
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Affiliation(s)
- Nancy J Newman
- Departments of Ophthalmology (NJN), Neurology and Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, IRCCS Istituto Delle Scienze Neurologiche di Bologna (VC), UOC Clinica Neurologica, Bologna, Italy, Department of Biomedical and Neuromotor Sciences (DIBINEM) (VC), Unit of Neurology, University of Bologna, Bologna, Italy, GenSight Biologics (MT), Paris, France, Cambridge Centre for Brain Repair and MRC Mitochondrial Biology Unit (PY-W-M), Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom, Cambridge Eye Unit (PY-W-M), Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, United Kingdom, Moorfields Eye Hospital (PY-W-M), London, United Kingdom, and UCL Institute of Ophthalmology (PY-W-M), University College London, London, United Kingdom
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Ahn YJ, Park Y, Shin SY, Chae H, Kim M, Park SH. Genotypic and phenotypic characteristics of Korean children with childhood-onset Leber's hereditary optic neuropathy. Graefes Arch Clin Exp Ophthalmol 2020; 258:2283-2290. [PMID: 32506279 DOI: 10.1007/s00417-020-04757-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 05/11/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE We sought to identify the phenotypic and genotypic characteristics of Korean children with genetically confirmed Leber's hereditary optic neuropathy (LHON). METHODS The medical records of 64 genetically confirmed LHON patients were reviewed. Seventeen patients aged 13 years or younger with optic atrophy with positive mitochondrial DNA (mtDNA) mutations were considered to demonstrate childhood-onset LHON. The non-childhood-onset group included 47 patients with genetically confirmed LHON who experienced disease onset later than 13 years of age. The type of mtDNA mutation, visual acuity (VA), color vision, fundus photography, retinal nerve fiber layer (RNFL) thickness, and visual field were investigated. RESULTS Sequence analysis of the mitochondrial genome revealed five different kinds of LHON-associated mtDNA mutations among our childhood-onset patients, including m.11778G>A (58.8%), m.3496G>T (11.8%), m.3497C>T (5.9%), m.11696G>A (5.9%), and m.14502T>C (5.9%). The mean final best-corrected VA in the childhood-onset group was better than that in the non-childhood-onset group with the value of logMAR 0.29 (0.09-0.75) vs. 0.55 (0.27-1.29) (expressed as median (interquartile range); p = 0.05). Spontaneous visual recovery was observed in 35.3% of the childhood-onset group but in only 12.8% of the non-childhood-onset group (p = 0.04). Eight patients (47.1%) showed interocular asymmetry of the disease, with two presenting true unilateral involvement of the optic nerve and the other six patients demonstrating unilateral subclinical manifestations with bilateral optic atrophy. CONCLUSION Involvement of secondary mitochondrial mutations was confirmed in patients with childhood-onset LHON. Characteristic clinical features of childhood-onset LHON included a higher proportion of subacute or insidious onset of symptoms, better VA, higher spontaneous recovery, and asymmetrical ocular involvement.
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Affiliation(s)
- Ye Jin Ahn
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yooyeon Park
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sun Young Shin
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Hyojin Chae
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Myungshin Kim
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Shin Hae Park
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Zhang Y, Li X, Yuan J, Tian Z, Liu H, Wang D, Li B. Prognostic factors for visual acuity in patients with Leber's hereditary optic neuropathy after rAAV2-ND4 gene therapy. Clin Exp Ophthalmol 2019; 47:774-778. [PMID: 30968497 PMCID: PMC6767190 DOI: 10.1111/ceo.13515] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/19/2019] [Accepted: 04/02/2019] [Indexed: 12/21/2022]
Abstract
Importance Factors affecting visual acuity prognosis after gene therapy in Leber's hereditary optic neuropathy (LHON) patients with mutation at site 11 778 are unknown. Background To analyse correlations between visual acuity prognosis and baseline characteristics of LHON after rAAV2‐ND4 gene therapy. Design Retrospective study. Participants Fifty‐three LHON patients with a mutation at site 11 778. Methods Single‐eye intravitreal injection of rAAV2‐ND4. Main Outcome Measures Sex, onset age, duration of disease, best‐corrected visual acuity (BCVA), visual field index (VFI) and mean deviation (MD) were recorded for all patients at baseline. BCVA was recorded at 1‐ and 3‐month follow‐up visits after gene therapy. Correlations between BCVA prognosis and baseline characteristics were analysed by univariate analysis. Logistic regression analysis was performed on independent factors affecting BCVA prognosis. Results Univariate analysis showed significant differences in the VFI and MD of the injected eye between BCVA improvement and non‐improvement groups after 3 months of treatment, with greater VFI and smaller absolute MD in the BCVA improvement group. Logistic regression showed that VFI and baseline BCVA were independent prognostic factors for visual acuity. The correlation between VFI and MD was statistically significant. Conclusions and Relevance VFI and baseline BCVA were correlated with the visual acuity prognosis of LHON patients receiving gene therapy, with greater baseline VFI and better baseline BCVA predicting better visual acuity prognosis. MD was strongly correlated with VFI and might be correlated with gene therapy prognosis. This finding may form a basis for predicting the efficacy of gene therapy in these patients and guiding subsequent treatment.
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Affiliation(s)
- Yong Zhang
- Department of Ophthalmology, Taihe Hospital (Affiliated Hospital of Hubei University of Medicine), Shiyan, China
| | - Xin Li
- Department of Ophthalmology, Taihe Hospital (Affiliated Hospital of Hubei University of Medicine), Shiyan, China
| | - Jiajia Yuan
- Department of Ophthalmology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen Tian
- Department of Ophthalmology, Taihe Hospital (Affiliated Hospital of Hubei University of Medicine), Shiyan, China
| | - Hongli Liu
- Department of Ophthalmology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Dan Wang
- Department of Ophthalmology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Bin Li
- Department of Ophthalmology, Taihe Hospital (Affiliated Hospital of Hubei University of Medicine), Shiyan, China.,Department of Ophthalmology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
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Wan X, Pei H, Zhao MJ, Yang S, Hu WK, He H, Ma SQ, Zhang G, Dong XY, Chen C, Wang DW, Li B. Efficacy and Safety of rAAV2-ND4 Treatment for Leber's Hereditary Optic Neuropathy. Sci Rep 2016; 6:21587. [PMID: 26892229 PMCID: PMC4759604 DOI: 10.1038/srep21587] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 01/26/2016] [Indexed: 11/09/2022] Open
Abstract
Leber's hereditary optic neuropathy (LHON) is a mitochondrially inherited disease leading to blindness. A mitochondrial DNA point mutation at the 11778 nucleotide site of the NADH dehydrogenase subunit 4 (ND4) gene is the most common cause. The aim of this study was to evaluate the efficacy and safety of a recombinant adeno-associated virus 2 (AAV2) carrying ND4 (rAAV2-ND4) in LHON patients carrying the G11778A mutation. Nine patients were administered rAAV2-ND4 by intravitreal injection to one eye and then followed for 9 months. Ophthalmologic examinations of visual acuity, visual field, and optical coherence tomography were performed. Physical examinations included routine blood and urine. The visual acuity of the injected eyes of six patients improved by at least 0.3 log MAR after 9 months of follow-up. In these six patients, the visual field was enlarged but the retinal nerve fibre layer remained relatively stable. No other outcome measure was significantly changed. None of the nine patients had local or systemic adverse events related to the vector during the 9-month follow-up period. These findings support the feasible use of gene therapy for LHON.
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Affiliation(s)
- Xing Wan
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Han Pei
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Min-jian Zhao
- Department of Oncology, Central Hospital, Ezhou City, China
| | - Shuo Yang
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei-kun Hu
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Heng He
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Si-qi Ma
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ge Zhang
- Department of Microbial and Biochemical Pharmacy, School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, China
| | - Xiao-yan Dong
- Beijing FivePlus Molecular Medicine Institute Co. Ltd., Beijing, China
| | - Chen Chen
- Center Genetic Diagnosis, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dao-wen Wang
- Center Genetic Diagnosis, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bin Li
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Jančić J, Dejanović I, Samardžić J, Radovanović S, Pepić A, Kosanović-Jaković N, Ćetković M, Kostić V. Leber hereditary optic neuropathy in the population of Serbia. Eur J Paediatr Neurol 2014; 18:354-9. [PMID: 24508359 DOI: 10.1016/j.ejpn.2014.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 01/13/2014] [Accepted: 01/19/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Leber hereditary optic neuropathy (LHON) is the most common mitochondrial disorder. However, few countries have published their population-based findings related to this multisystemic disease. THE AIM In order to get a better insight into the epidemiological and clinical picture of this maternally inherited disorder, we performed the first population-based clinical and molecular-genetic study of LHON in the Serbian population. METHODS Prospective study included patients who were diagnosed with LHON after detailed medical examination and molecular-genetic confirmation. RESULTS We identified 41 individuals from 12 genealogically unrelated families, carrying one of the three "primary" mitochondrial (mt) DNA point mutations associated with LHON. Fourteen of them were clinically affected, giving a minimum point prevalence of 1.9 per 1,000,000. The minimum point prevalence for mtDNA LHON mutations was 5.2 per 1,000,000. Male to female ratio was 6:1. Only one affected patient harboured mutant mtDNA in heteroplasmic condition. All patients were presented with common clinical findings. CONCLUSION We observed significantly lower prevalence and higher gender ratio than expected. However, frequencies of primary mutations, incidence of heteroplasmy and clinical findings are in accordance with other studies in Caucasoid populations. Our results might be a consequence of poor recognition and misdiagnosis due to lack of diagnostic possibilities of the entity in different region of our country or less likely be in part due to specific haplotype background of Serbian population which should be further investigated.
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Affiliation(s)
- Jasna Jančić
- Clinic of Neurology and Psychiatry for Children and Youth, Medical Faculty, University of Belgrade, Serbia.
| | - Ivana Dejanović
- Clinic of Neurology and Psychiatry for Children and Youth, Medical Faculty, University of Belgrade, Serbia
| | - Janko Samardžić
- Institute of Pharmacology and Toxicology, Medical Faculty, University of Belgrade, Serbia
| | | | - Ana Pepić
- Clinic of Neurology and Psychiatry for Children and Youth, Medical Faculty, University of Belgrade, Serbia
| | | | - Mila Ćetković
- Institute of Histology and Embryology, Medical Faculty, University of Belgrade, Serbia
| | - Vladimir Kostić
- Clinic of Neurology, Medical Faculty, University of Belgrade, Serbia
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