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Georgiou M, Robson AG, Fujinami K, de Guimarães TAC, Fujinami-Yokokawa Y, Daich Varela M, Pontikos N, Kalitzeos A, Mahroo OA, Webster AR, Michaelides M. Phenotyping and genotyping inherited retinal diseases: Molecular genetics, clinical and imaging features, and therapeutics of macular dystrophies, cone and cone-rod dystrophies, rod-cone dystrophies, Leber congenital amaurosis, and cone dysfunction syndromes. Prog Retin Eye Res 2024; 100:101244. [PMID: 38278208 DOI: 10.1016/j.preteyeres.2024.101244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 01/28/2024]
Abstract
Inherited retinal diseases (IRD) are a leading cause of blindness in the working age population and in children. The scope of this review is to familiarise clinicians and scientists with the current landscape of molecular genetics, clinical phenotype, retinal imaging and therapeutic prospects/completed trials in IRD. Herein we present in a comprehensive and concise manner: (i) macular dystrophies (Stargardt disease (ABCA4), X-linked retinoschisis (RS1), Best disease (BEST1), PRPH2-associated pattern dystrophy, Sorsby fundus dystrophy (TIMP3), and autosomal dominant drusen (EFEMP1)), (ii) cone and cone-rod dystrophies (GUCA1A, PRPH2, ABCA4, KCNV2 and RPGR), (iii) predominant rod or rod-cone dystrophies (retinitis pigmentosa, enhanced S-Cone syndrome (NR2E3), Bietti crystalline corneoretinal dystrophy (CYP4V2)), (iv) Leber congenital amaurosis/early-onset severe retinal dystrophy (GUCY2D, CEP290, CRB1, RDH12, RPE65, TULP1, AIPL1 and NMNAT1), (v) cone dysfunction syndromes (achromatopsia (CNGA3, CNGB3, PDE6C, PDE6H, GNAT2, ATF6), X-linked cone dysfunction with myopia and dichromacy (Bornholm Eye disease; OPN1LW/OPN1MW array), oligocone trichromacy, and blue-cone monochromatism (OPN1LW/OPN1MW array)). Whilst we use the aforementioned classical phenotypic groupings, a key feature of IRD is that it is characterised by tremendous heterogeneity and variable expressivity, with several of the above genes associated with a range of phenotypes.
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Affiliation(s)
- Michalis Georgiou
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom; Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Anthony G Robson
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom.
| | - Kaoru Fujinami
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom; Laboratory of Visual Physiology, Division of Vision Research, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
| | - Thales A C de Guimarães
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom.
| | - Yu Fujinami-Yokokawa
- UCL Institute of Ophthalmology, University College London, London, United Kingdom; Laboratory of Visual Physiology, Division of Vision Research, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, Tokyo, Japan; Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan.
| | - Malena Daich Varela
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom.
| | - Nikolas Pontikos
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom.
| | - Angelos Kalitzeos
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom.
| | - Omar A Mahroo
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom; Section of Ophthalmology, King s College London, St Thomas Hospital Campus, London, United Kingdom; Physiology, Development and Neuroscience, University of Cambridge, Downing Street, Cambridge, United Kingdom; Department of Translational Ophthalmology, Wills Eye Hospital, Philadelphia, PA, USA.
| | - Andrew R Webster
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom.
| | - Michel Michaelides
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom.
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Grissim G, Walesa A, Follett HM, Higgins BP, Goetschel K, Heitkotter H, Carroll J. Longitudinal Assessment of OCT-Based Measures of Foveal Cone Structure in Achromatopsia. Invest Ophthalmol Vis Sci 2024; 65:16. [PMID: 38587442 PMCID: PMC11005076 DOI: 10.1167/iovs.65.4.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/24/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose Achromatopsia (ACHM) is an autosomal recessive retinal disease associated with reduced or absent cone function. There is debate regarding the extent to which cone structure shows progressive degeneration in patients with ACHM. Here, we used optical coherence tomography (OCT) images to evaluate outer nuclear layer (ONL) thickness and ellipsoid zone (EZ) integrity over time in individuals with ACHM. Methods Sixty-three individuals with genetically confirmed ACHM with follow-up ranging from about 6 months to 10 years were imaged using either Bioptigen or Cirrus OCT. Foveal cone structure was evaluated by assessing EZ integrity and ONL thickness. Results A total of 470 OCT images were graded, 243 OD and 227 OS. The baseline distribution of EZ grades was highly symmetrical between eyes (P = 0.99) and there was no significant interocular difference in baseline ONL thickness (P = 0.12). The EZ grade remained unchanged over the follow-up period for 60 of 63 individuals. Foveal ONL thickness showed a clinically significant change in only 1 of the 61 individuals analyzed, although detailed adaptive optics imaging revealed no changes in cone density in this individual. Conclusions ACHM appears to be a generally stable condition, at least over the follow-up period assessed here. As cones are the cellular targets for emerging gene therapies, stable EZ and ONL thickness demonstrate therapeutic potential for ACHM, although other aspects of the visual system need to be considered when determining the best timing for therapeutic intervention.
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Affiliation(s)
- Garrett Grissim
- School of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Ashleigh Walesa
- Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Hannah M. Follett
- Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Brian P. Higgins
- Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Kaitlin Goetschel
- Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Heather Heitkotter
- Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Joseph Carroll
- Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
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Taskin HO, Wivel J, Aguirre GD, Beltran WA, Aguirre GK. Cone-Driven, Geniculocortical Responses in Canine Models of Outer Retinal Disease. Transl Vis Sci Technol 2024; 13:18. [PMID: 38241039 PMCID: PMC10807495 DOI: 10.1167/tvst.13.1.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Purpose Canine models of inherited retinal degeneration are used for proof of concept of emerging gene and cell-based therapies that aim to produce functional restoration of cone-mediated vision. We examined functional magnetic resonance imaging (MRI) measures of the postretinal response to cone-directed stimulation in wild-type (WT) dogs, and in three different retinal disease models. Methods Temporal spectral modulation of a uniform field of light around a photopic background was used to target the canine L/M (hereafter "L") and S cones and rods. Stimuli were designed to separately target the postreceptoral luminance (L+S) and chrominance (L-S) pathways, the rods, and all photoreceptors jointly (light flux). These stimuli were presented to WT, and mutant PDE6B-RCD1, RPGR-XLPRA2, and NPHP5-CRD2 dogs during pupillometry and functional MRI (fMRI). Results Pupil responses in WT dogs to light flux, L+S, and rod-directed stimuli were consistent with responses being driven by cone signals alone. For WT animals, both luminance and chromatic (L-S) stimuli evoked fMRI responses in the lateral geniculate nucleus or visual cortex; RCD1 animals with predominant rod loss had similar responses. Responses to cone-directed stimulation were reduced in XLPRA2 and absent in CRD2. NPHP5 gene augmentation restored the cortical response to luminance stimulation in a CRD2 animal. Conclusions Cone-directed stimulation during fMRI can be used to measure the integrity of luminance and chrominance responses in the dog visual system. The NPHP5-CRD2 model is appealing for studies of recovered cone function. Translational Relevance fMRI assessment of cone-driven cortical response provides a tool to translate cell/gene therapies for vision restoration.
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Affiliation(s)
- Huseyin O. Taskin
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jacqueline Wivel
- Division of Experimental Retinal Therapies, Department of Clinical Sciences & Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gustavo D. Aguirre
- Division of Experimental Retinal Therapies, Department of Clinical Sciences & Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - William A. Beltran
- Division of Experimental Retinal Therapies, Department of Clinical Sciences & Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Geoffrey K. Aguirre
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Taskin HO, Wivel J, Aguirre GD, Beltran WA, Aguirre GK. Cone-driven, geniculo-cortical responses in canine models of outer retinal disease. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.12.13.571523. [PMID: 38168165 PMCID: PMC10760074 DOI: 10.1101/2023.12.13.571523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Purpose Canine models of inherited retinal degeneration are used for proof-of-concept of emerging gene and cell-based therapies that aim to produce functional restoration of cone-mediated vision. We examined functional MRI measures of the post-retinal response to cone-directed stimulation in wild type (WT) dogs, and in three different retinal disease models. Methods Temporal spectral modulation of a uniform field of light around a photopic background was used to target the canine L/M (hereafter "L") and S cones and rods. Stimuli were designed to separately target the post-receptoral luminance (L+S) and chrominance (L-S) pathways, the rods, and all photoreceptors jointly (light flux). These stimuli were presented to WT, and mutant PDE6B-RCD1, RPGR-XLPRA2, and NPHP5-CRD2 dogs during pupillometry and fMRI. Results Pupil responses in WT dogs to light flux, L+S, and rod-directed stimuli were consistent with responses being driven by cone signals alone. For WT animals, both luminance and chromatic (L-S) stimuli evoked fMRI responses in the lateral geniculate nucleus (LGN) or visual cortex; RCD1 animals with predominant rod loss had similar responses. Responses to cone-directed stimulation were reduced in XLPRA2 and absent in CRD2. NPHP5 gene augmentation restored the cortical response to luminance stimulation in a CRD2 animal. Conclusions Cone-directed stimulation during fMRI can be used to measure the integrity of luminance and chrominance responses in the dog visual system. The NPHP5-CRD2 model is appealing for studies of recovered cone function. Translational Relevance fMRI assessment of cone driven cortical response provides a tool to translate cell/gene therapies for vision restoration.
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Affiliation(s)
- Huseyin O. Taskin
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Jacqueline Wivel
- Division of Experimental Retinal Therapies, Department of Clinical Sciences & Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Gustavo D. Aguirre
- Division of Experimental Retinal Therapies, Department of Clinical Sciences & Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - William A. Beltran
- Division of Experimental Retinal Therapies, Department of Clinical Sciences & Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Geoffrey K. Aguirre
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
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Molz B, Herbik A, Baseler HA, de Best P, Raz N, Gouws A, Ahmadi K, Lowndes R, McLean RJ, Gottlob I, Kohl S, Choritz L, Maguire J, Kanowski M, Käsmann-Kellner B, Wieland I, Banin E, Levin N, Morland AB, Hoffmann MB. Achromatopsia-Visual Cortex Stability and Plasticity in the Absence of Functional Cones. Invest Ophthalmol Vis Sci 2023; 64:23. [PMID: 37847226 PMCID: PMC10584018 DOI: 10.1167/iovs.64.13.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 08/07/2023] [Indexed: 10/18/2023] Open
Abstract
Purpose Achromatopsia is a rare inherited disorder rendering retinal cone photoreceptors nonfunctional. As a consequence, the sizable foveal representation in the visual cortex is congenitally deprived of visual input, which prompts a fundamental question: is the cortical representation of the central visual field in patients with achromatopsia remapped to take up processing of paracentral inputs? Such remapping might interfere with gene therapeutic treatments aimed at restoring cone function. Methods We conducted a multicenter study to explore the nature and plasticity of vision in the absence of functional cones in a cohort of 17 individuals affected by autosomal recessive achromatopsia and confirmed biallelic disease-causing CNGA3 or CNGB3 mutations. Specifically, we tested the hypothesis of foveal remapping in human achromatopsia. For this purpose, we applied two independent functional magnetic resonance imaging (fMRI)-based mapping approaches, i.e. conventional phase-encoded eccentricity and population receptive field mapping, to separate data sets. Results Both fMRI approaches produced the same result in the group comparison of achromatopsia versus healthy controls: sizable remapping of the representation of the central visual field in the primary visual cortex was not apparent. Conclusions Remapping of the cortical representation of the central visual field is not a general feature in achromatopsia. It is concluded that plasticity of the human primary visual cortex is less pronounced than previously assumed. A pretherapeutic imaging workup is proposed to optimize interventions.
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Affiliation(s)
- Barbara Molz
- Department of Psychology, University of York, Heslington, York, United Kingdom
- Department of Ophthalmology, University Hospital, Otto-von-Guericke University, Magdeburg, Germany
- Language & Genetics Department, Max Planck Institute for Psycholinguistics, Nijmegen, the Netherlands
| | - Anne Herbik
- Department of Ophthalmology, University Hospital, Otto-von-Guericke University, Magdeburg, Germany
| | - Heidi A. Baseler
- Department of Psychology, University of York, Heslington, York, United Kingdom
- Hull York Medical School, University of York, Heslington, York, United Kingdom
- York Biomedical Research Institute, University of York, Heslington, York, United Kingdom
| | - Peter de Best
- fMRI Unit, Department of Neurology, Hadassah Medical Center, Jerusalem, Israel
| | - Noa Raz
- fMRI Unit, Department of Neurology, Hadassah Medical Center, Jerusalem, Israel
| | - Andre Gouws
- Department of Psychology, University of York, Heslington, York, United Kingdom
- York Neuroimaging Centre, Department of Psychology, University of York, York, United Kingdom
| | - Khazar Ahmadi
- Department of Ophthalmology, University Hospital, Otto-von-Guericke University, Magdeburg, Germany
| | - Rebecca Lowndes
- York Neuroimaging Centre, Department of Psychology, University of York, York, United Kingdom
| | - Rebecca J. McLean
- University of Leicester Ulverscroft Eye Unit, University of Leicester, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Irene Gottlob
- University of Leicester Ulverscroft Eye Unit, University of Leicester, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Susanne Kohl
- Molecular Genetics Laboratory, Institute for Ophthalmic Research, Centre for Ophthalmology, University Clinics Tübingen, Tübingen, Germany
| | - Lars Choritz
- Department of Ophthalmology, University Hospital, Otto-von-Guericke University, Magdeburg, Germany
| | - John Maguire
- School of Optometry and Vision Sciences, University of Bradford, Bradford, United Kingdom
- Department of Neurophysiology, Children's Health Ireland (CHI) at Crumlin, Dublin, Ireland
| | - Martin Kanowski
- Department of Neurology, University Hospital, Otto-von-Guericke University, Magdeburg, Germany
| | - Barbara Käsmann-Kellner
- Department of Ophthalmology, Saarland University Hospital and Medical Faculty of the Saarland University Hospital, Homburg, Germany
| | - Ilse Wieland
- Department for Molecular Genetics, Institute for Human Genetics, University Hospital, Otto-von-Guericke University, Magdeburg, Germany
| | - Eyal Banin
- Center for Retinal and Macular Degenerations, Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Netta Levin
- fMRI Unit, Department of Neurology, Hadassah Medical Center, Jerusalem, Israel
| | - Antony B. Morland
- Department of Psychology, University of York, Heslington, York, United Kingdom
- York Biomedical Research Institute, University of York, Heslington, York, United Kingdom
- York Neuroimaging Centre, Department of Psychology, University of York, York, United Kingdom
| | - Michael B. Hoffmann
- Department of Ophthalmology, University Hospital, Otto-von-Guericke University, Magdeburg, Germany
- Center for Behavioral Brain Sciences, Magdeburg, Germany
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Wang H, Liu Z, Zhang Y, Tao D, Li L. Achromatopsia Showing Compound Heterozygous Mutations in ATF6 by Whole Exome Sequencing: A Rare Case Report. J Pediatr Ophthalmol Strabismus 2023; 60:e65-e69. [PMID: 37747165 DOI: 10.3928/01913913-20230814-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Achromatopsia, inherited in an autosomal recessive manner, is a rare condition featured by dysfunction of cone photoreceptors responsible for high-acuity vision in daylight. To date, its pathogenesis and genetic mechanism are still not well defined due to the rarity of cases. In this study, the authors describe a patient with achromatopsia who was diagnosed based on the combination of whole exome sequencing, ocular examination, fundus photography, and fundus fluorescein angiography. A 1-year-old girl presented due to absence of the foveal reflex, severe photophobia, and pigment mottling. Fundus photography and fundus fluorescein angiography were performed on admission. Blood samples were extracted from the proband and her parents. Whole exome sequencing detected two ATF6 variants (c.533C>A and c.82+1G>T), which were confirmed through Sanger sequencing. According to the American College of Medical Genetics guidelines, both c.533C>A and c.82+1G>T variants in ATF6 were predicted as pathogenic mutations (PVS1, PM2, PM3). The patient was diagnosed as having achromatopsia with pathogenicity of ATF6 variants (c.533C>A and c.82+1G>T). [J Pediatr Ophthalmol Strabismus. 2023;60(5):e65-e69.].
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Käsmann-Kellner B, Hoffmann MB. [Achromatopsia : Clinical aspects, diagnostics, genes, brain and quality of life]. DIE OPHTHALMOLOGIE 2023; 120:975-986. [PMID: 37638972 DOI: 10.1007/s00347-023-01904-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/29/2023]
Abstract
Achromatopsia or rod monochromatism is a congenital autosomal recessive retinal dystrophy which leads to dysfunctional cones, with decreased visual acuity, extremely limited color vision, nystagmus and photophobia. Due to the initially normally appearing ocular morphology, the diagnosis is often delayed. With imaging procedures, e.g., fluorescence-autofluorescence (FAF) and optical coherence tomography (OCT), different morphological forms of achromatopsia can be discriminated that do not seem to have a differential effect on visual function. Crucial is the provision of specific edge filters. Mutations in six genes are known to cause achromatopsia. For the two most frequent genes, CNGA3 and CNGB3, gene addition therapies are currently being tested. Such future approaches should be applied before the manifestation of sensory-related amblyopia in the visual cortex. Accordingly, state of the art management of achromatopsia should provide a diagnosis in early childhood including genotyping.
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Affiliation(s)
- Barbara Käsmann-Kellner
- Klinik für Augenheilkunde, Sektion KiOLoN: Kinderophthalmologie, Orthoptik, Low Vision und Neuroophthalmologie, Universitätsklinikum des Saarlandes UKS, Kirrbergerstr. 100, 66421, Homburg/Saar, Deutschland.
| | - Michael B Hoffmann
- Universitäts-Augenklinik Magdeburg, Magdeburg, Deutschland
- Center for Behavioral Brain Sciences, Magdeburg, Deutschland
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Michaelides M, Hirji N, Wong SC, Besirli CG, Zaman S, Kumaran N, Georgiadis A, Smith AJ, Ripamonti C, Gottlob I, Robson AG, Thiadens A, Henderson RH, Fleck P, Anglade E, Dong X, Capuano G, Lu W, Berry P, Kane T, Naylor S, Georgiou M, Kalitzeos A, Ali RR, Forbes A, Bainbridge J. First-in-Human Gene Therapy Trial of AAV8-hCARp.hCNGB3 in Adults and Children With CNGB3-associated Achromatopsia. Am J Ophthalmol 2023; 253:243-251. [PMID: 37172884 DOI: 10.1016/j.ajo.2023.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE To assess the safety and efficacy of AAV8-hCARp.hCNGB3 in participants with CNGB3-associated achromatopsia (ACHM). DESIGN Prospective, phase 1/2 (NCT03001310), open-label, nonrandomized clinical trial. METHODS The study enrolled 23 adults and children with CNGB3-associated ACHM. In the dose-escalation phase, adult participants were administered 1 of 3 AAV8-hCARp.hCNGB3 dose levels in the worse-seeing eye (up to 0.5 mL). After a maximum tolerated dose was established in adults, an expansion phase was conducted in children ≥3 years old. All participants received topical and oral corticosteroids. Safety and efficacy parameters, including treatment-related adverse events and visual acuity, retinal sensitivity, color vision, and light sensitivity, were assessed for 6 months. RESULTS AAV8-hCARp.hCNGB3 (11 adults, 12 children) was safe and generally well tolerated. Intraocular inflammation occurred in 9 of 23 participants and was mainly mild or moderate in severity. Severe cases occurred primarily at the highest dose. Two events were considered serious and dose limiting. All intraocular inflammation resolved following topical and systemic steroids. There was no consistent pattern of change from baseline to week 24 for any efficacy assessment. However, favorable changes were observed for individual participants across several assessments, including color vision (n = 6/23), photoaversion (n = 11/20), and vision-related quality-of-life questionnaires (n = 21/23). CONCLUSIONS AAV8-hCARp.hCNGB3 for CNGB3-associated ACHM demonstrated an acceptable safety and tolerability profile. Improvements in several efficacy parameters indicate that AAV8-hCARp.hCNGB3 gene therapy may provide benefit. These findings, with the development of additional sensitive and quantitative end points, support continued investigation.
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Affiliation(s)
- Michel Michaelides
- From UCL Institute of Ophthalmology (M.M., N.H., S.Z., A.J.S., A.G.R., T.K., M.G., A.K., R.R.A., J.B.), London, United Kingdom; Moorfields Eye Hospital NHS Foundation Trust (M.M., N.H., S.C.W., S.Z., N.K., A.G.R., R.H.H., M.G., A.K., J.B.), London, United Kingdom.
| | - Nashila Hirji
- Moorfields Eye Hospital NHS Foundation Trust (M.M., N.H., S.C.W., S.Z., N.K., A.G.R., R.H.H., M.G., A.K., J.B.), London, United Kingdom
| | - Sui Chien Wong
- Moorfields Eye Hospital NHS Foundation Trust (M.M., N.H., S.C.W., S.Z., N.K., A.G.R., R.H.H., M.G., A.K., J.B.), London, United Kingdom; Great Ormond Street Hospital for Children (S.C.W., R.H.H.), London, United Kingdom
| | - Cagri G Besirli
- University of Michigan, Kellogg Eye Center (C.G.B.), Ann Arbor, Michigan, USA
| | - Serena Zaman
- From UCL Institute of Ophthalmology (M.M., N.H., S.Z., A.J.S., A.G.R., T.K., M.G., A.K., R.R.A., J.B.), London, United Kingdom; Moorfields Eye Hospital NHS Foundation Trust (M.M., N.H., S.C.W., S.Z., N.K., A.G.R., R.H.H., M.G., A.K., J.B.), London, United Kingdom
| | - Neruban Kumaran
- Moorfields Eye Hospital NHS Foundation Trust (M.M., N.H., S.C.W., S.Z., N.K., A.G.R., R.H.H., M.G., A.K., J.B.), London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust (N.K.), London, United Kingdom
| | | | - Alexander J Smith
- From UCL Institute of Ophthalmology (M.M., N.H., S.Z., A.J.S., A.G.R., T.K., M.G., A.K., R.R.A., J.B.), London, United Kingdom
| | | | - Irene Gottlob
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary (I.G.), Leicester, United Kingdom
| | - Anthony G Robson
- From UCL Institute of Ophthalmology (M.M., N.H., S.Z., A.J.S., A.G.R., T.K., M.G., A.K., R.R.A., J.B.), London, United Kingdom; Moorfields Eye Hospital NHS Foundation Trust (M.M., N.H., S.C.W., S.Z., N.K., A.G.R., R.H.H., M.G., A.K., J.B.), London, United Kingdom
| | - Alberta Thiadens
- Department of Ophthalmology, Erasmus Medical Center (A.T.), Rotterdam, the Netherlands
| | - Robert H Henderson
- Moorfields Eye Hospital NHS Foundation Trust (M.M., N.H., S.C.W., S.Z., N.K., A.G.R., R.H.H., M.G., A.K., J.B.), London, United Kingdom; Great Ormond Street Hospital for Children (S.C.W., R.H.H.), London, United Kingdom; UCL Great Ormond Street Institute of Child Health (R.H.H.), London, United Kingdom
| | - Penny Fleck
- Janssen Pharmaceuticals (P.F., E.A., X.D., G.C., W.L., P.B.), Raritan, New Jersey, USA
| | - Eddy Anglade
- Janssen Pharmaceuticals (P.F., E.A., X.D., G.C., W.L., P.B.), Raritan, New Jersey, USA
| | - Xiangwen Dong
- Janssen Pharmaceuticals (P.F., E.A., X.D., G.C., W.L., P.B.), Raritan, New Jersey, USA
| | - George Capuano
- Janssen Pharmaceuticals (P.F., E.A., X.D., G.C., W.L., P.B.), Raritan, New Jersey, USA
| | - Wentao Lu
- Janssen Pharmaceuticals (P.F., E.A., X.D., G.C., W.L., P.B.), Raritan, New Jersey, USA
| | - Pamela Berry
- Janssen Pharmaceuticals (P.F., E.A., X.D., G.C., W.L., P.B.), Raritan, New Jersey, USA
| | - Thomas Kane
- From UCL Institute of Ophthalmology (M.M., N.H., S.Z., A.J.S., A.G.R., T.K., M.G., A.K., R.R.A., J.B.), London, United Kingdom
| | - Stuart Naylor
- MeiraGTx (A.G., S.N., A.F.), New York, New York, USA
| | - Michalis Georgiou
- From UCL Institute of Ophthalmology (M.M., N.H., S.Z., A.J.S., A.G.R., T.K., M.G., A.K., R.R.A., J.B.), London, United Kingdom; Moorfields Eye Hospital NHS Foundation Trust (M.M., N.H., S.C.W., S.Z., N.K., A.G.R., R.H.H., M.G., A.K., J.B.), London, United Kingdom; Jones Eye Institute, University of Arkansas for Medical Sciences (M.G.), Little Rock, Arkansas, USA
| | - Angelos Kalitzeos
- From UCL Institute of Ophthalmology (M.M., N.H., S.Z., A.J.S., A.G.R., T.K., M.G., A.K., R.R.A., J.B.), London, United Kingdom; Moorfields Eye Hospital NHS Foundation Trust (M.M., N.H., S.C.W., S.Z., N.K., A.G.R., R.H.H., M.G., A.K., J.B.), London, United Kingdom
| | - Robin R Ali
- From UCL Institute of Ophthalmology (M.M., N.H., S.Z., A.J.S., A.G.R., T.K., M.G., A.K., R.R.A., J.B.), London, United Kingdom
| | | | - James Bainbridge
- From UCL Institute of Ophthalmology (M.M., N.H., S.Z., A.J.S., A.G.R., T.K., M.G., A.K., R.R.A., J.B.), London, United Kingdom; Moorfields Eye Hospital NHS Foundation Trust (M.M., N.H., S.C.W., S.Z., N.K., A.G.R., R.H.H., M.G., A.K., J.B.), London, United Kingdom
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