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Du Y, Kong N, Zhang J. Genetic Mechanism Revealed of Age-Related Macular Degeneration Based on Fusion of Statistics and Machine Learning Method. Front Genet 2021; 12:726599. [PMID: 34422023 PMCID: PMC8375266 DOI: 10.3389/fgene.2021.726599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/13/2021] [Indexed: 11/13/2022] Open
Abstract
Age-related macular degeneration (AMD) is the most common cause of irreversible vision loss in the developed world which affects the quality of life for millions of elderly individuals worldwide. Genome-wide association studies (GWAS) have identified genetic variants at 34 loci contributing to AMD. To better understand the disease pathogenesis and identify causal genes for AMD, we applied random walk (RW) and support vector machine (SVM) to identify AMD-related genes based on gene interaction relationship and significance of genes. Our model achieved 0.927 of area under the curve (AUC), and 65 novel genes have been identified as AMD-related genes. To verify our results, a statistics method called summary data-based Mendelian randomization (SMR) has been implemented to integrate GWAS data and transcriptome data to verify AMD susceptibility-related genes. We found 45 genes are related to AMD by SMR. Among these genes, 37 genes overlap with those found by SVM-RW. Finally, we revealed the biological process of genetic mutations leading to changes in gene expression leading to AMD. Our results reveal the genetic pathogenic factors and related mechanisms of AMD.
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Affiliation(s)
- Yongyi Du
- Department of Ophthalmology, Panyu Central Hospital, Guangzhou, China
| | - Ning Kong
- Department of Ophthalmology, Panyu Central Hospital, Guangzhou, China
| | - Jibin Zhang
- Department of Stomatology, Panyu Central Hospital, Guangzhou, China
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2
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Hu ML, Quinn J, Xue K. Interactions between Apolipoprotein E Metabolism and Retinal Inflammation in Age-Related Macular Degeneration. Life (Basel) 2021; 11:life11070635. [PMID: 34210002 PMCID: PMC8305051 DOI: 10.3390/life11070635] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/24/2021] [Accepted: 06/27/2021] [Indexed: 02/07/2023] Open
Abstract
Age-related macular degeneration (AMD) is a multifactorial retinal disorder that is a major global cause of severe visual impairment. The development of an effective therapy to treat geographic atrophy, the predominant form of AMD, remains elusive due to the incomplete understanding of its pathogenesis. Central to AMD diagnosis and pathology are the hallmark lipid and proteinaceous deposits, drusen and reticular pseudodrusen, that accumulate in the subretinal pigment epithelium and subretinal spaces, respectively. Age-related changes and environmental stressors, such as smoking and a high-fat diet, are believed to interact with the many genetic risk variants that have been identified in several major biochemical pathways, including lipoprotein metabolism and the complement system. The APOE gene, encoding apolipoprotein E (APOE), is a major genetic risk factor for AMD, with the APOE2 allele conferring increased risk and APOE4 conferring reduced risk, in comparison to the wildtype APOE3. Paradoxically, APOE4 is the main genetic risk factor in Alzheimer’s disease, a disease with features of neuroinflammation and amyloid-beta deposition in common with AMD. The potential interactions of APOE with the complement system and amyloid-beta are discussed here to shed light on their roles in AMD pathogenesis, including in drusen biogenesis, immune cell activation and recruitment, and retinal inflammation.
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Affiliation(s)
- Monica L. Hu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC 3002, Australia;
| | - Joel Quinn
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK;
| | - Kanmin Xue
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK;
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
- Correspondence:
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Viturino MG, Neto JM, Bajano FF, Costa SM, Roque AB, Borges GF, Ananina G, Rim PH, Medina FM, Costa FF, Vasconcellos JPD, Melo MBD. Evaluation of APOE polymorphisms and the risk for age-related macular degeneration in a Southeastern Brazilian population. Exp Biol Med (Maywood) 2021; 246:1148-1155. [PMID: 33467888 DOI: 10.1177/1535370220985466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study aimed to evaluate the role of APOE polymorphisms (rs429358 and rs7412) in the risk of age-related macular degeneration in a sample of the Southeastern Brazilian population. Seven hundred and five unrelated individuals were analyzed, 334 with age-related macular degeneration (case group), and 371 without the disease (control group). In the case group, patients were further stratified according to disease phenotypes, divided into dry and wet age-related macular degeneration, and non-advanced and advanced age-related macular degeneration. APOE polymorphisms (rs429358 and rs7412) were evaluated through polymerase chain reaction and direct sequencing. In the comparison of cases vs. controls, none of the associations reached statistical significance, considering the Bonferroni-adjusted P-value, although there was a suggestive protection for the E3/E4 genotype (OR = 0.626; P-value = 0.037) and E4 carriers (OR = 0.6515; P-value = 0.047). Statistically significant protection for both the E3/E4 genotype and E4 carriers was observed in the comparisons: advanced age-related macular degeneration vs. controls (OR = 0.3665, P-value = 0.491 × 10-3 and OR = 0.4031, P-value = 0.814 × 10-3, respectively), advanced age-related macular degeneration vs. non-advanced age-related macular degeneration (OR = 0.2529, P-value = 0.659 × 10-4 and OR = 0.2692, P-value = 0.631 × 10-4, respectively). In the comparison of wet age-related macular degeneration vs. control, protection was statistically significant only for E3/E4 (OR = 0.4052, P-value = 0.001). None of the comparisons demonstrated any significant association for E2 genotypes or E2 carriers in age-related macular degeneration risk in this study. Findings suggest a protective role of the E4 haplotype in the APOE gene in the risk for advanced and wet forms of age-related macular degeneration, in a sample of the Brazilian population. To our knowledge, this is the first Brazilian study to show the association between APOE polymorphisms and age-related macular degeneration.
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Affiliation(s)
- Marina Gm Viturino
- Department of Ophthalmology, Faculty of Medical Sciences, University of Campinas, Campinas, SP 13083-887, Brazil
| | - Jamil M Neto
- Department of Ophthalmology, Faculty of Medical Sciences, University of Campinas, Campinas, SP 13083-887, Brazil
| | - Flávia F Bajano
- Laboratory of Human Genetics, Center for Molecular Biology and Genetic Engineering (CBMEG), University of Campinas, Campinas, SP 13083-875, Brazil
| | - Sueli Ms Costa
- Laboratory of Human Genetics, Center for Molecular Biology and Genetic Engineering (CBMEG), University of Campinas, Campinas, SP 13083-875, Brazil
| | - Alicia B Roque
- Department of Ophthalmology, Faculty of Medical Sciences, University of Campinas, Campinas, SP 13083-887, Brazil
| | - Gessica Fs Borges
- Department of Ophthalmology, Faculty of Medical Sciences, University of Campinas, Campinas, SP 13083-887, Brazil
| | - Galina Ananina
- Laboratory of Human Genetics, Center for Molecular Biology and Genetic Engineering (CBMEG), University of Campinas, Campinas, SP 13083-875, Brazil
| | - Priscila Hh Rim
- Department of Ophthalmology, Faculty of Medical Sciences, University of Campinas, Campinas, SP 13083-887, Brazil
| | - Flávio M Medina
- Department of Ophthalmology, Faculty of Medical Sciences, University of State of Rio de Janeiro, Rio de Janeiro, RJ 20551-030, Brazil
| | - Fernando F Costa
- Hematology and Hemotherapy Center, University of Campinas, Campinas, SP 13083-878, Brazil
| | - José Pc de Vasconcellos
- Department of Ophthalmology, Faculty of Medical Sciences, University of Campinas, Campinas, SP 13083-887, Brazil
| | - Mônica B de Melo
- Laboratory of Human Genetics, Center for Molecular Biology and Genetic Engineering (CBMEG), University of Campinas, Campinas, SP 13083-875, Brazil
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Fernández‐Vega B, García M, Olivares L, Álvarez L, González‐Fernández A, Artime E, Fernández‐Vega Cueto A, Cobo T, Coca‐Prados M, Vega JA, González‐Iglesias H. The association study of lipid metabolism gene polymorphisms with AMD identifies a protective role for APOE-E2 allele in the wet form in a Northern Spanish population. Acta Ophthalmol 2020; 98:e282-e291. [PMID: 31654486 DOI: 10.1111/aos.14280] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 09/28/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE To elucidate the potential role of eleven single nucleotide polymorphisms (SNPs) in the most relevant lipid metabolism genes in Northern Spanish patients with age-related macular degeneration (AMD). METHODS A case-control study of 228 unrelated native Northern Spanish patients diagnosed with AMD (73 dry and 155 wet) and 95 healthy controls was performed. DNA was isolated from peripheral blood and genotyped for the SNPs APOE rs429358 and rs7412; CTEP rs3764261; LIPC rs10468017 and rs493258; LPL rs12678919; ABCA1 rs1883025; ABCA4 rs76157638, rs3112831 and rs1800555; and SCARB1 rs5888, using TaqMan probes. An additional association study of ε2, ε3 and ε4 major isoforms of APOE gene with AMD has been carried out. RESULTS The allele and genotype frequencies for each of the eleven sequence variants in the lipid metabolism genes did not show significant differences when comparing AMD cases and controls. Statistical analysis revealed that APOE-ε2 carrier genotypes were less frequently observed in patients with wet AMD compared to controls (5.8% versus 13.7%, respectively: p = 3.28 × 10-2 ; OR = 0.42, 95% CI: 0.19-0.95). The frequency of the allele T of rs10468017 (LIPC gene) was lower in dry AMD cases compared to controls (15.8 versus 27.9%, respectively: p = 8.4 × 10-3 OR = 0.57, 95% CI: 0.33-0.98). CONCLUSIONS Our results suggest a protective role for APOE-ε2 allele to wet AMD in the Northern Spanish population.
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Affiliation(s)
- Beatriz Fernández‐Vega
- Instituto Oftalmológico Fernández‐Vega Oviedo Spain
- Instituto Universitario Fernández‐Vega (Fundación de Investigación Oftalmológica, Universidad de Oviedo) Oviedo Spain
- Departamento de Morfología y Biología Celular Grupo SINPOS Universidad de Oviedo Oviedo Spain
| | - Montserrat García
- Instituto Oftalmológico Fernández‐Vega Oviedo Spain
- Instituto Universitario Fernández‐Vega (Fundación de Investigación Oftalmológica, Universidad de Oviedo) Oviedo Spain
| | - Lorena Olivares
- Instituto Universitario Fernández‐Vega (Fundación de Investigación Oftalmológica, Universidad de Oviedo) Oviedo Spain
| | - Lydia Álvarez
- Instituto Universitario Fernández‐Vega (Fundación de Investigación Oftalmológica, Universidad de Oviedo) Oviedo Spain
| | - Adrián González‐Fernández
- Instituto Universitario Fernández‐Vega (Fundación de Investigación Oftalmológica, Universidad de Oviedo) Oviedo Spain
| | - Enol Artime
- Instituto Universitario Fernández‐Vega (Fundación de Investigación Oftalmológica, Universidad de Oviedo) Oviedo Spain
| | - Andrés Fernández‐Vega Cueto
- Instituto Oftalmológico Fernández‐Vega Oviedo Spain
- Instituto Universitario Fernández‐Vega (Fundación de Investigación Oftalmológica, Universidad de Oviedo) Oviedo Spain
| | - Teresa Cobo
- Departamento de Cirugía y Especialidades Médico‐Quirúrgicas Universidad de Oviedo Oviedo Spain
| | - Miguel Coca‐Prados
- Department of Ophthalmology and Visual Science Yale University School of Medicine New Haven CT USA
| | - José A. Vega
- Departamento de Morfología y Biología Celular Grupo SINPOS Universidad de Oviedo Oviedo Spain
- Facultad de Ciencias de la Salud Universidad Autónoma de Chile Santiago de Chile Chile
| | - Héctor González‐Iglesias
- Instituto Oftalmológico Fernández‐Vega Oviedo Spain
- Instituto Universitario Fernández‐Vega (Fundación de Investigación Oftalmológica, Universidad de Oviedo) Oviedo Spain
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Heesterbeek TJ, Lorés-Motta L, Hoyng CB, Lechanteur YTE, den Hollander AI. Risk factors for progression of age-related macular degeneration. Ophthalmic Physiol Opt 2020; 40:140-170. [PMID: 32100327 PMCID: PMC7155063 DOI: 10.1111/opo.12675] [Citation(s) in RCA: 156] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/18/2020] [Indexed: 12/18/2022]
Abstract
Purpose Age‐related macular degeneration (AMD) is a degenerative disease of the macula, often leading to progressive vision loss. The rate of disease progression can vary among individuals and has been associated with multiple risk factors. In this review, we provide an overview of the current literature investigating phenotypic, demographic, environmental, genetic, and molecular risk factors, and propose the most consistently identified risk factors for disease progression in AMD based on these studies. Finally, we describe the potential use of these risk factors for personalised healthcare. Recent findings While phenotypic risk factors such as drusen and pigment abnormalities become more important to predict disease progression during the course of the disease, demographic, environmental, genetic and molecular risk factors are more valuable at earlier disease stages. Demographic and environmental risk factors such as age and smoking are consistently reported to be related to disease progression, while other factors such as sex, body mass index (BMI) and education are less often associated. Of all known AMD variants, variants that are most consistently reported with disease progression are rs10922109 and rs570618 in CFH, rs116503776 in C2/CFB/SKIV2L, rs3750846 in ARMS2/HTRA1 and rs2230199 in C3. However, it seems likely that other AMD variants also contribute to disease progression but to a lesser extent. Rare variants have probably a large effect on disease progression in highly affected families. Furthermore, current prediction models do not include molecular risk factors, while these factors can be measured accurately in the blood. Possible promising molecular risk factors are High‐Density Lipoprotein Cholesterol (HDL‐C), Docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), zeaxanthin and lutein. Summary Phenotypic, demographic, environmental, genetic and molecular risk factors can be combined in prediction models to predict disease progression, but the selection of the proper risk factors for personalised risk prediction will differ among individuals and is dependent on their current disease stage. Future prediction models should include a wider set of genetic variants to determine the genetic risk more accurately, and rare variants should be taken into account in highly affected families. In addition, adding molecular factors in prediction models may lead to preventive strategies and personalised advice.
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Affiliation(s)
- Thomas J Heesterbeek
- Departments of, Department of, Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Laura Lorés-Motta
- Departments of, Department of, Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of, Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carel B Hoyng
- Departments of, Department of, Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Yara T E Lechanteur
- Departments of, Department of, Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anneke I den Hollander
- Departments of, Department of, Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of, Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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Xiying M, Wenbo W, Wangyi F, Qinghuai L. Association of Apolipoprotein E Polymorphisms with Age-related Macular Degeneration Subtypes: An Updated Systematic Review and Meta-analysis. Arch Med Res 2017; 48:370-377. [PMID: 28889998 DOI: 10.1016/j.arcmed.2017.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 07/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIMS Age-related macular degeneration (AMD) is the worldwide leading cause of blindness among the elderly, especially in developed countries. The possible association between apolipoprotein E (ApoE) polymorphism (ε2, ε3, ε4) and AMD has been extensively investigated with conflicting results, especially when specifying different clinical phenotypes of AMD. Herein, we conducted a meta-analysis by integrating several recent large-sample studies to verify the effect of ApoE polymorphisms on AMD subtypes. METHODS The retrieve for targeted literature was conducted based on the PubMed, Embase, Cochrane library, and Web of Science. Summary odds ratio (OR) and its 95% confidence intervals (CIs) were used for estimation of risk. The p-value was adjusted due to the multiple comparison. RESULTS A total of 12 studies included in the final summary analysis, including 13842 cases and 38647 controls. ApoE ε4 carrier was inversely associated with early stage AMD (OR = 0.889, 95% CI = 0.82-0.97), geographic atrophy (OR = 0.594, 95% CI = 0.43-0.83) and neovascular AMD (OR = 0.670, 95% CI = 0.58-0.76). Stratification analysis by ethnicity revealed that the ApoE ε4 carriers was associated with neovascular AMD in both Caucasians (OR = 0.62, 95% CI = 0.47-0.83) and East Asians (OR = 0.68, 95% CI = 0.58-0.79). A significant association of ApoE ε2 carriers was only found with early AMD in Black and East Asian population, however small samples and limited studies restrict its generalization. CONCLUSION Our meta-analysis revealed a significantly protective role of ε4 on each subtypes of AMD, but no supportive evidence of the association of ε2 with AMD. Thus, further studies with larger samples are needed to understand the precise role of ε2 on AMD susceptibility.
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Affiliation(s)
- Mao Xiying
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Wu Wenbo
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fang Wangyi
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Liu Qinghuai
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu Province, China.
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Jabbarpoor Bonyadi MH, Yaseri M, Bonyadi M, Soheilian M, Karimi S. Association of Combined Complement Factor H Y402H and ARMS/LOC387715 A69S Polymorphisms with Age-related Macular Degeneration: A Meta-analysis. Curr Eye Res 2016; 41:1519-1525. [PMID: 27269047 DOI: 10.3109/02713683.2016.1158274] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Complement factor H (CFH) Y402H (rs1061170) and age-related maculopathy susceptibility2 (ARMS2)/LOC387715 A69S (rs10490924) polymorphisms shown to have significant association with age-related macular degeneration (AMD). In this meta-analysis, we pooled the results of the available association studies between combined ARMS2/LOC387715A69S-CFHY402H genotypes and AMD to estimate the possible synergistic or multiplicative effects. METHODS Heterogeneity of studies was evaluated using the Cochran Q-test and the I-square index. To modify the heterogeneity in the variables, we used random effects model. Meta-analysis was performed using STATA. To estimate the additive or supra-additive effects, we calculated relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), synergy index (S), and multiplicative index (V). RESULTS We included eight studies with 2915 AMD patients and 3505 control subjects. Considering the GGTT genotypes as reference lines, the pooled AMD Odds Ratios for stratified combined genotypes were 2.32 (95% CI 1.64-3.28) for GGnon-TT, 2.49 (95% CI 1.72-3.60) for non-GGTT, and 7.82 (95% CI 5.09-12.00) for non-GGnon-TT. Pooled synergy analysis revealed RERI = 4.08 (95% CI 3.15-5.27), AP = 0.50 (95% CI 0.42-0.57), S = 2.31 (95% CI 1.9-2.82), and V = 1.21 (95% CI 0.93-1.49). CONCLUSION This analysis revealed the synergistic and positive multiplicative effect of these two genes indicating that there is a common pathway of ARMS2/LOC387715 and CFH in AMD pathogenesis which may be the complement system pathway.
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Affiliation(s)
| | - Mehdi Yaseri
- b Department of Biostatistics and Epidemiology , Tehran University of Medical Sciences , Tehran , Iran
| | - Mortaza Bonyadi
- c Center of Excellence for Biodiversity, Faculty of Natural Sciences , University of Tabriz , Tabriz , Iran
| | - Masoud Soheilian
- a Ocular Tissue Engineering Research Center, Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Saeed Karimi
- a Ocular Tissue Engineering Research Center, Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences , Tehran , Iran
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Bakbak B, Ozturk BT, Zamani AG, Gonul S, Iyit N, Gedik S, Yıldırım MS. Association of Apolipoprotein E Polymorphism with Intravitreal Ranibizumab Treatment Outcomes in Age-Related Macular Degeneration. Curr Eye Res 2015; 41:862-6. [DOI: 10.3109/02713683.2015.1067325] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Berker Bakbak
- Department of Ophthalmology, Faculty of Medicine, Selcuk University, Konya, Turkey,
| | - Banu Turgut Ozturk
- Department of Ophthalmology, Faculty of Medicine, Selcuk University, Konya, Turkey,
| | - Ayşe Gul Zamani
- Department of Medical Genetics, Faculty of Medicine, Meram Necmettin Erbakan University, Konya, Turkey and
| | - Saban Gonul
- Department of Ophthalmology, Faculty of Medicine, Selcuk University, Konya, Turkey,
| | - Neslihan Iyit
- Department of Statistics, Faculty of Science Faculty, Selcuk University, Konya, Turkey
| | - Sansal Gedik
- Department of Ophthalmology, Faculty of Medicine, Selcuk University, Konya, Turkey,
| | - M. Selman Yıldırım
- Department of Medical Genetics, Faculty of Medicine, Meram Necmettin Erbakan University, Konya, Turkey and
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Current knowledge and trends in age-related macular degeneration: genetics, epidemiology, and prevention. Retina 2014; 34:423-41. [PMID: 24285245 DOI: 10.1097/iae.0000000000000036] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To address the most dynamic and current issues concerning human genetics, risk factors, pharmacoeconomics, and prevention regarding age-related macular degeneration. METHODS An online review of the database Pubmed and Ovid was performed, searching for the key words: age-related macular degeneration, AMD, pharmacoeconomics, risk factors, VEGF, prevention, genetics and their compound phrases. The search was limited to articles published since 1985 to date. All returned articles were carefully screened and their references were manually reviewed for additional relevant data. The webpage www.clinicaltrials.gov was also accessed in search of relevant research trials. RESULTS A total of 366 articles were reviewed, including 64 additional articles extracted from the references and 25 webpages and online databases from different institutions. At the end, only 244 references were included in this review. CONCLUSION Age-related macular degeneration is a complex multifactorial disease that has an uneven manifestation around the world but with one common denominator, it is increasing and spreading. The economic burden that this disease poses in developed nations will increase in the coming years. Effective preventive therapies need to be developed in the near future.
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10
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Logue MW, Schu M, Vardarajan BN, Farrell J, Lunetta KL, Jun G, Baldwin CT, DeAngelis MM, Farrer LA. Search for age-related macular degeneration risk variants in Alzheimer disease genes and pathways. Neurobiol Aging 2014; 35:1510.e7-18. [PMID: 24439028 PMCID: PMC3961547 DOI: 10.1016/j.neurobiolaging.2013.12.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 11/22/2013] [Accepted: 12/12/2013] [Indexed: 12/17/2022]
Abstract
Several lines of inquiry point to overlapping molecular mechanisms between late-onset Alzheimer disease (AD) and age-related macular degeneration (AMD). We evaluated summarized results from large genome-wide association studies for AD and AMD to test the hypothesis that AD susceptibility loci are also associated with AMD. We observed association of both disorders with genes in a region of chromosome 7, including PILRA and ZCWPW1 (peak AMD SNP rs7792525, minor allele frequency [MAF] = 19%, odds ratio [OR] = 1.14, p = 2.34 × 10(-6)), and with ABCA7 (peak AMD SNP rs3752228, MAF = 0.054, OR = 1.22, p = 0.00012). Next, we evaluated association of AMD with genes in AD-related pathways identified by canonical pathway analysis of AD-associated genes. Significant associations were observed with multiple previously identified AMD risk loci and 2 novel genes: HGS (peak SNP rs8070488, MAF = 0.23, OR = 0.91, p = 7.52 × 10(-5)), which plays a role in the clathrin-mediated endocytosis signaling pathway, and TNF (peak SNP rs2071590, MAF = 0.34, OR = 0.89, p = 1.17 × 10(-5)), which is a member of the atherosclerosis signaling and the LXR/RXR activation pathways. Our results suggest that AMD and AD share genetic mechanisms.
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Affiliation(s)
- Mark W. Logue
- Department of Medicine (Biomedical Genetics), Boston University Schools of Medicine and Public Health, Boston, MA, 02118, USA.,Department of Biostatistics, Boston University Schools of Medicine and Public Health, Boston, MA, 02118, USA
| | - Matthew Schu
- Department of Medicine (Biomedical Genetics), Boston University Schools of Medicine and Public Health, Boston, MA, 02118, USA
| | - Badri N. Vardarajan
- Department of Medicine (Biomedical Genetics), Boston University Schools of Medicine and Public Health, Boston, MA, 02118, USA
| | - John Farrell
- Department of Medicine (Biomedical Genetics), Boston University Schools of Medicine and Public Health, Boston, MA, 02118, USA
| | - Kathryn L. Lunetta
- Department of Biostatistics, Boston University Schools of Medicine and Public Health, Boston, MA, 02118, USA
| | - Gyungah Jun
- Department of Medicine (Biomedical Genetics), Boston University Schools of Medicine and Public Health, Boston, MA, 02118, USA.,Department of Ophthalmology, Boston University Schools of Medicine and Public Health, Boston, MA, 02118, USA.,Department of Biostatistics, Boston University Schools of Medicine and Public Health, Boston, MA, 02118, USA
| | - Clinton T. Baldwin
- Department of Medicine (Biomedical Genetics), Boston University Schools of Medicine and Public Health, Boston, MA, 02118, USA
| | | | - Lindsay A. Farrer
- Department of Medicine (Biomedical Genetics), Boston University Schools of Medicine and Public Health, Boston, MA, 02118, USA.,Department of Neurology, Boston University Schools of Medicine and Public Health, Boston, MA, 02118, USA.,Department of Ophthalmology, Boston University Schools of Medicine and Public Health, Boston, MA, 02118, USA.,Department of Epidemiology, Boston University Schools of Medicine and Public Health, Boston, MA, 02118, USA.,Department of Biostatistics, Boston University Schools of Medicine and Public Health, Boston, MA, 02118, USA.,Corresponding Author: Dr. Lindsay A. Farrer, Boston University School of Medicine, Biomedical Genetics L320, 72 East Concord Street, Boston, MA 02118, Tel: (617) 638-5393, Fax: (617) 638-4275,
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Oczos J, Grimm C, Barthelmes D, Sutter F, Menghini M, Kloeckener-Gruissem B, Berger W. Regulatory regions of the paraoxonase 1 (PON1) gene are associated with neovascular age-related macular degeneration (AMD). AGE (DORDRECHT, NETHERLANDS) 2013; 35:1651-1662. [PMID: 22956172 PMCID: PMC3776091 DOI: 10.1007/s11357-012-9467-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 08/20/2012] [Indexed: 06/01/2023]
Abstract
Physiological stress response and oxidative damage are factors for aging processes and, as such, are thought to contribute to neovascular age-related macular degeneration (AMD). Paraoxonase 1 (PON1) is an enzyme that plays an important role in oxidative stress and aging. We investigated association of DNA sequence variants (SNP) within the upstream regulatory region of the PON1 gene with neovascular AMD in 305 patients and 288 controls. Four of the seven tested SNPs (rs705379, rs705381, rs854573, and rs757158) were more frequently found in AMD patients compared to controls (P = 0.0099, 0.0295, 0.0121, and 0.0256, respectively), and all but one (SNP rs757158) are in linkage disequilibrium. Furthermore, haplotype TGGCCTC conferred protection (odds ratio (OR) = 0.76, (CI) = 0.60-0.97) as it was more frequently found in control individuals, while haplotype CGATGCT increased the risk (OR = 1.55, CI = 1.09-2.21) for AMD. These results were also reflected when haplotypes for the untranscribed and the 5'untranslated regions (5'UTR) were analyzed separately. To assess haplotype correlation with levels of gene expression, the three SNPs within the 5'UTR were tested in a luciferase reporter assay. In retinal pigment epithelium-derived ARPE19 cells, we were able to measure significant differences in reporter levels, while this was not observed in kidney-derived HEK293 cells. The presence of the risk allele A (SNP rs705381) caused an increase in luciferase activity of approximately twofold. Our data support the view that inflammatory reactions mediated through anti-oxidative activity may be relevant to neovascular age-related macular degeneration.
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Affiliation(s)
- Jadwiga Oczos
- />Institute of Medical Molecular Genetics, University of Zurich, Schwerzenbach, Switzerland
- />Lab for Retinal Cell Biology, Department of Ophthalmology, University of Zurich, Zurich, Switzerland
- />Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
| | - Christian Grimm
- />Lab for Retinal Cell Biology, Department of Ophthalmology, University of Zurich, Zurich, Switzerland
- />Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
- />Zurich Center of Neuroscience (ZNZ), Zurich, Switzerland
| | - Daniel Barthelmes
- />Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
- />Save Sight Institute, University of Sydney, Sydney, Australia
| | - Florian Sutter
- />Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
| | - Moreno Menghini
- />Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
| | - Barbara Kloeckener-Gruissem
- />Institute of Medical Molecular Genetics, University of Zurich, Schwerzenbach, Switzerland
- />Department of Biology, ETH Zurich, Zurich, Switzerland
| | - Wolfgang Berger
- />Institute of Medical Molecular Genetics, University of Zurich, Schwerzenbach, Switzerland
- />Zurich Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
- />Zurich Center of Neuroscience (ZNZ), Zurich, Switzerland
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Thakkinstian A, McEvoy M, Chakravarthy U, Chakrabarti S, McKay GJ, Ryu E, Silvestri G, Kaur I, Francis P, Iwata T, Akahori M, Arning A, Edwards AO, Seddon JM, Attia J. The association between complement component 2/complement factor B polymorphisms and age-related macular degeneration: a HuGE review and meta-analysis. Am J Epidemiol 2012; 176:361-72. [PMID: 22869612 DOI: 10.1093/aje/kws031] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The authors performed a systematic review of the association of complement component 2(C2)/complement factor B (CFB) gene polymorphisms with age-related macular degeneration (AMD). In total, data from 19 studies published between 2006 and 2011 were pooled for 4 polymorphisms: rs9332739 and rs547154 in the C2 gene and rs4151667 and rs641153 in the CFB gene. Data extraction and assessments for risk of bias were independently performed by 2 reviewers. Allele frequencies and allele and genotypic effects were pooled. Heterogeneity and publication bias were explored. Pooled minor allele frequencies for all 4 SNPs were between 4.7% and 9.6% for all polymorphisms, except for an Indian population in which the C allele at rs9332739 was the major allele. For the C2 polymorphisms, the minor C allele at rs9332739 and the minor T allele at rs547154 carried estimated relative risks (odds ratios) of 0.55 (95% confidence interval (CI): 0.46, 0.65) and 0.47 (95% CI: 0.39, 0.57), respectively. For the CFB polymorphisms, the minor A alleles at rs4151667 and rs614153 carried estimated risks of 0.54 (95% CI: 0.45, 0.64) and 0.41 (95% CI: 0.34, 0.51), respectively. These allele effects contributed to an absolute lowering of the risk of all AMD in Caucasian populations by 2.0%-6.0%. This meta-analysis provides a robust estimate of the protective association of C2/CFB with AMD.
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Affiliation(s)
- Ammarin Thakkinstian
- Section for Epidemiology and Biostatistics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Leveziel N, Tilleul J, Puche N, Zerbib J, Laloum F, Querques G, Souied EH. Genetic factors associated with age-related macular degeneration. Ophthalmologica 2011; 226:87-102. [PMID: 21757876 DOI: 10.1159/000328981] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 04/27/2011] [Indexed: 11/19/2022]
Abstract
Age-related macular degeneration (AMD) is a complex, multifactorial disease associated with environmental and genetic factors. This review emphasizes the clinical impact of the major genetic factors mainly located in the complement factor H gene and on the 10q26 locus, and their current and future implications for the management of AMD.
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Affiliation(s)
- Nicolas Leveziel
- Department of Ophthalmology, Hôpital Intercommunal de Créteil, University of Paris XII, Créteil, France.
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14
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Thakkinstian A, McKay GJ, McEvoy M, Chakravarthy U, Chakrabarti S, Silvestri G, Kaur I, Li X, Attia J. Systematic review and meta-analysis of the association between complement component 3 and age-related macular degeneration: a HuGE review and meta-analysis. Am J Epidemiol 2011; 173:1365-79. [PMID: 21576320 DOI: 10.1093/aje/kwr025] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The authors performed a meta-analysis to estimate the magnitude of polymorphism effects for the complement component C3 gene (C3) and their possible mode of action on age-related macular degeneration (AMD). The meta-analysis included 16 and 7 studies for rs2230199 and rs1047286, respectively. Data extraction and risk of bias assessments were performed in duplicate, and heterogeneity and publication bias were explored. There was moderate evidence for association between both polymorphisms and AMD in Caucasians. For rs2230199, patients with CG and GG genotypes were 1.44 (95% confidence interval (CI): 1.33, 1.56) and 1.88 (95% CI: 1.59, 2.23) times more likely to have AMD than patients with the CC genotype. For rs1047286, GA and AA genotypes had 1.27 (95% CI: 1.15, 1.41) and 1.70 (95% CI: 1.27, 2.11) times higher risk of AMD than did GG genotypes. These gene effects suggested an additive model. The population attributable risks for the GG/GC and AA/GA genotypes are approximately 5%-10%. Subgroup analysis by ethnicity indicates that these variants are very infrequent in Asians and that the observed gene effects are based largely on the high frequency within Caucasian populations. This meta-analysis supports the association between C3 and AMD and provides a robust estimate of the genetic risk.
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Affiliation(s)
- Ammarin Thakkinstian
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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15
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DeAngelis MM, Silveira AC, Carr EA, Kim IK. Genetics of age-related macular degeneration: current concepts, future directions. Semin Ophthalmol 2011; 26:77-93. [PMID: 21609220 PMCID: PMC4242505 DOI: 10.3109/08820538.2011.577129] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Age-related macular degeneration (AMD) is a progressive degenerative disease which leads to blindness, affecting the quality of life of millions of Americans. More than 1.75 million individuals in the United States are affected by the advanced form of AMD. The etiological pathway of AMD is not yet fully understood, but there is a clear genetic influence on disease risk. To date, the 1q32 (CFH) and 10q26 (PLEKHA1/ARMS2/HTRA1) loci are the most strongly associated with disease; however, the variation in these genomic regions alone is unable to predict disease development with high accuracy. Therefore, current genetic studies are aimed at identifying new genes associated with AMD and their modifiers, with the goal of discovering diagnostic or prognostic biomarkers. Moreover, these studies provide the foundation for further investigation into the pathophysiology of AMD by utilizing a systems-biology-based approach to elucidate underlying mechanistic pathways.
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Affiliation(s)
- Margaret M. DeAngelis
- Ocular Molecular Genetics Institute, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Alexandra C. Silveira
- Ocular Molecular Genetics Institute, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Elizabeth A. Carr
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Ivana K. Kim
- Retina Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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Meta-based evidence for apolipoprotein E epsilon2/epsilon3/epsilon4 polymorphism in association with hypertension among Chinese. J Hum Hypertens 2011; 25:725-31. [PMID: 21228824 DOI: 10.1038/jhh.2010.116] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Mounting evidence suggests that hypertension is strongly linked to a variety of lipoprotein metabolism abnormalities. Apolipoprotein E gene (ApoE) is one such candidate with its common ɛ2/ɛ3/ɛ4 polymorphism ranking high in hypertension association. To derive more specific information, we pinpoint our research scope in Chinese to test whether this polymorphism is associated with hypertension via a meta-analysis. Random-effects model was performed irrespective of the between study heterogeneity. Data and study quality were assessed in duplicate. Publication bias was evaluated using the fail-safe number. Overall, 12 studies with 14 study groups totalling 1532 hypertensive patients and 2172 controls were identified. Carriers of ApoE ɛ2 allele had no significant increased risk for hypertension (pooled odds ratio (OR)=1.04; 95% confidence interval (CI): 0.80-1.35; P=0.78), compared with those carrying ɛ3 allele, whereas those with ɛ4 allele had a significant increased risk for hypertension (pooled OR=2.03; 95% CI: 1.61-2.55; P<0.00001). After excluding those with other small nationalities, we observed comparison of ApoE ɛ2 with ɛ3 allele yielded a pooled OR of 0.99 (95% CI: 0.82-1.19; P=0.89) among Han Chinese, and that of ɛ4 with ɛ3 yielded a pooled OR of 1.99 (95% CI: 1.48-2.67; P<0.00001). The fail-safe number at the level of 0.05 supported these significant associations. Taken together, our results expand previous findings and show that ApoE ɛ4 allele is associated with a twofold increased risk of developing hypertension in Chinese.
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Niu W, Qi Y, Qian Y, Gao P, Zhu D. The relationship between apolipoprotein E ɛ2/ɛ3/ɛ4 polymorphisms and hypertension: a meta-analysis of six studies comprising 1812 cases and 1762 controls. Hypertens Res 2009; 32:1060-6. [DOI: 10.1038/hr.2009.164] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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18
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Fritsche LG, Freitag-Wolf S, Bettecken T, Meitinger T, Keilhauer CN, Krawczak M, Weber BHF. Age-related macular degeneration and functional promoter and coding variants of the apolipoprotein E gene. Hum Mutat 2009; 30:1048-53. [PMID: 19384966 DOI: 10.1002/humu.20957] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Age-related macular degeneration (AMD) is a frequent, multifactorial disease of the central retina and a major cause of irreversible vision loss in industrialized countries. Apolipoprotein E (APOE) has been consistently associated with AMD, particularly its two functional isoforms E2 (predisposing) and E4 (protective). The biological correlate of this association, however, is still unclear. In this study, we have defined an extended haplotype block encompassing the entire APOE gene locus, including known coding as well as cis-regulatory promoter variants. Of the five extended APOE haplotypes common in the general population, two were found to be significantly associated with AMD, namely G-G-G-G-epsilon2 (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.19-2.12) and T-G-A-G-epsilon4 (OR, 0.76; 95% CI, 0.58-0.99). When analyzing common extended haplotype combinations, T-C-G-G-epsilon3/T-G-A-G-epsilon4 exhibited the most prominent effect (OR, 0.32; 95% CI, 0.20-0.51). Intriguingly, we also found one extended epsilon3-haplotype, G-G-G-A-epsilon3, to be protective in the homozygous state (OR, 0.65; 95% CI, 0.49-0.87). Since single nucleotide polymorphism (SNP) rs405509:G>T is a constituent of the extended epsilon-haplotype block and is known to significantly influence APOE promoter activity, we hypothesize that both the relative rate of APOE isoform expression in conjunction with established functional differences of the respective isoforms may be crucial in mediating AMD pathology. This would also imply that genotyping of the core epsilon-haplotypes alone is not sufficient to estimate AMD risk, but that determination of extended haplotype combinations, including the functional promoter SNP rs405509, is required instead.
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Affiliation(s)
- Lars G Fritsche
- Institute of Human Genetics, University of Regensburg, Regensburg, Germany
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Loane E, Nolan JM, O'Donovan O, Bhosale P, Bernstein PS, Beatty S. Transport and Retinal Capture of Lutein and Zeaxanthin with Reference to Age-related Macular Degeneration. Surv Ophthalmol 2008; 53:68-81. [DOI: 10.1016/j.survophthal.2007.10.008] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Lotery A, Trump D. Progress in defining the molecular biology of age related macular degeneration. Hum Genet 2007; 122:219-36. [PMID: 17659362 DOI: 10.1007/s00439-007-0406-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2007] [Accepted: 07/11/2007] [Indexed: 01/15/2023]
Abstract
Age related macular degeneration (AMD) is an extremely prevalent complex genetic disorder. Its incidence rises exponentially in the elderly to a frequency of 1 in 2 in the general population by age 85. It affects approximately 25 million people and is the commonest cause of irreversible visual loss in the Western world. It is therefore a major public health problem. However, until recently its aetiology was unknown. Our understanding of both the molecular biology of AMD and the relevant clinical treatments has progressed dramatically in the last 2 years. Two genes of large effect have been identified which together contribute to over 70% of the population attributable risk of AMD. Treatments which inhibit expression of vascular endothelial growth factor have been developed which can rescue vision in the "wet" form of the disease. The association of complement factor H with AMD highlights the importance of the alternative complement pathway in the development of AMD whilst the pathophysiology of the serine protease HTRA1 is now under intensive study. This review will give an insight into these developments and will summarise our current knowledge of the molecular biology of AMD.
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Affiliation(s)
- Andrew Lotery
- Clinical Neurosciences Division, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK.
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22
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Patel N, Adewoyin T, Chong NV. Age-related macular degeneration: a perspective on genetic studies. Eye (Lond) 2007; 22:768-76. [PMID: 17491602 DOI: 10.1038/sj.eye.6702844] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
AIM Age-related macular degeneration (AMD) is a common macular disease in the developed world and recent studies have shown that specific genes may be associated with it and may contribute to a higher risk of developing AMD. OBJECTIVE Our objective was to review systematically recent publications related to the genetics of AMD and provide relevant information that would help both scientists and clinicians in advising patients. METHOD A systematic search was performed on PubMed, Medline, and National Library of Medicine as well as ARVO abstracts using key words relevant to the genetic associations of AMD. RESULTS The most important genetic associations in AMD involved the complement factor H (CFH) gene, which showed that possession of the variant Y402H polymorphism significantly increases the risk for AMD. Protective genes have also been identified such as those on either factor B (BFor complement factor B (CFB)) or complement component 2 (C2) genes. The genes involved in inherited macular dystrophies such as ATP-binding cassette, subfamily A (ABC1), member 4 (ABCA4), vitelliform macular dystrophy (VMD2), tissue inhibitor of matrix metalloproteinase-3 (TIMP3), and EFEMP1have yielded some important information but further confirmatory work has yet to establish a clear association with AMD. CONCLUSION Patients with AMD possess specific genetic variants of the CFHgene, which put them at a higher risk of developing the disease. Other unaffected individuals may possess certain protective genetic variants, which could prevent them from developing AMD. Further research will no doubt shed light on other such mechanisms and these will be useful in identifying possible direct targets for drugs or indirectly through modulation of the genes responsible for disease presentation.
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Affiliation(s)
- N Patel
- Laser and Retinal Research Unit, Kings College Hospital, London, UK
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Baird PN, Richardson AJ, Robman LD, Dimitrov PN, Tikellis G, McCarty CA, Guymer RH. Apolipoprotein (APOE) gene is associated with progression of age-related macular degeneration (AMD). Hum Mutat 2006; 27:337-42. [PMID: 16453339 DOI: 10.1002/humu.20288] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Progression of age-related macular degeneration (AMD), the leading cause of blindness in the elderly, was followed in a cohort of 238 individuals from a single center. Individuals with an epsilon (epsilon)2 genotype (c.526C>T of reference sequence NM_000041.2) of the apolipoprotein (APOE) gene were found to be strongly associated with disease with a significant 4.8-fold increased relative risk compared to individuals with an epsilon4 genotype (c.388T>C of reference sequence NM_000041.2) (odds ratio [OR], 4.8; 95% confidence interval [CI], 1.19-19.09) and a nearly significant three-fold increased relative risk compared to individuals with an epsilon3 genotype (reference sequence NM_000041.2) (OR, 2.8; 95% CI, 0.96-19.09). This finding was present only in females who progressed with AMD, which suggests that there may be a gender-specific role in progression of AMD in individuals with an epsilon2 allele. A gender-related factor is therefore implicated either directly or indirectly in the AMD disease process.
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Affiliation(s)
- Paul N Baird
- Centre for Eye Research Australia, University of Melbourne, East Melbourne, Australia.
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Wang JJ. Genetic and modifiable risk factors for age-related macular degeneration. EXPERT REVIEW OF OPHTHALMOLOGY 2006. [DOI: 10.1586/17469899.1.2.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dewan A, Liu M, Hartman S, Zhang SSM, Liu DTL, Zhao C, Tam POS, Chan WM, Lam DSC, Snyder M, Barnstable C, Pang CP, Hoh J. HTRA1 promoter polymorphism in wet age-related macular degeneration. Science 2006; 314:989-92. [PMID: 17053108 DOI: 10.1126/science.1133807] [Citation(s) in RCA: 573] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Age-related macular degeneration (AMD), the most common cause of irreversible vision loss in individuals aged older than 50 years, is classified as either wet (neovascular) or dry (nonneovascular). Inherited variation in the complement factor H gene is a major risk factor for drusen in dry AMD. Here we report that a single-nucleotide polymorphism in the promoter region of HTRA1, a serine protease gene on chromosome 10q26, is a major genetic risk factor for wet AMD. A whole-genome association mapping strategy was applied to a Chinese population, yielding a P value of <10(-11). Individuals with the risk-associated genotype were estimated to have a likelihood of developing wet AMD 10 times that of individuals with the wild-type genotype.
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Affiliation(s)
- Andrew Dewan
- Department of Epidemiology and Public Health, Yale University, 60 College Street, New Haven, CT 06520, USA
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Thakkinstian A, Bowe S, McEvoy M, Smith W, Attia J. Association between apolipoprotein E polymorphisms and age-related macular degeneration: A HuGE review and meta-analysis. Am J Epidemiol 2006; 164:813-22. [PMID: 16916985 DOI: 10.1093/aje/kwj279] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A possible association between apolipoprotein E polymorphisms and age-related macular degeneration has been investigated numerous times, with conflicting results. A previous analysis pooling results from four studies (Schmidt et al., Ophthalmic Genet 2002;23:209-23) suggested an association, but those investigators did not document allele frequencies, the magnitude of the association, or the possible genetic mode of action. Thus, the authors searched MEDLINE from 1966 to December 2005 for any English-language studies reporting genetic associations. Data and study quality were assessed in duplicate. Pooling was performed while checking for heterogeneity and publication bias. Frequencies of the E2 and E4 alleles in Caucasians were approximately 8% and 15%, respectively. Allele- and genotype-based tests of association indicated a risk effect of up to 20% for E2 and a protective effect of up to 40% for E4. E2 appeared to act in a recessive mode and E4 in a dominant mode. There appears to be a differential effect of the E2 and E4 alleles on the risk of age-related macular degeneration, although the possibility of survivor bias needs to be ruled out more definitively.
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Affiliation(s)
- Ammarin Thakkinstian
- Clinical Epidemiology Unit, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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27
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Hill JM, Bhattacharjee PS, Neumann DM. Apolipoprotein E alleles can contribute to the pathogenesis of numerous clinical conditions including HSV-1 corneal disease. Exp Eye Res 2006; 84:801-11. [PMID: 17007837 PMCID: PMC2217677 DOI: 10.1016/j.exer.2006.08.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2006] [Revised: 07/19/2006] [Accepted: 08/03/2006] [Indexed: 11/18/2022]
Abstract
Apolipoprotein E (ApoE) alleles have been reported to affect the clinical outcome of numerous cardiovascular, neurodegenerative, and viral infectious diseases, including atherosclerosis, Alzheimer's disease (AD), hepatitis C, and HIV. The major alleles of ApoE are 2, 3, and 4. ApoE genotypes have been hypothesized to regulate many biological functions, resulting in significant changes in the onset and/or outcome (severity and duration) of several clinical conditions. Based on genetic analyses in human and animal studies using knockout (ApoE -/-) mice and mice transgenic for human 3 and 4, we present evidence that strongly suggests that the ApoE alleles can regulate the pathogenesis of ocular herpes simplex virus type 1 (HSV-1) infections. This review will summarize the major studies that support this hypothesis. Significant gender based differences in HSV-1 pathogenesis have also been reported, suggesting that hormonal regulation combined with ApoE genotype plays a significant role in HSV-1 pathogenesis. Identification of specific mechanisms in ocular HSV-1 infections related to the ApoE alleles and gender could lead to therapeutic intervention based on the properties of the apoE isoforms. While many clinical investigations have been reported and, to a lesser extent, transgenic mouse studies have been conducted, no specific mechanisms of how ApoE induces or alters clinical disease are known.
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Affiliation(s)
- James M Hill
- Department of Ophthalmology, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA.
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29
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Haddad S, Chen CA, Santangelo SL, Seddon JM. The Genetics of Age-Related Macular Degeneration: A Review of Progress to Date. Surv Ophthalmol 2006; 51:316-63. [PMID: 16818082 DOI: 10.1016/j.survophthal.2006.05.001] [Citation(s) in RCA: 225] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Age-related macular degeneration (AMD) is the leading cause of vision loss and blindness among older adults in the USA and throughout the developed world. Etiological research suggests that AMD is a complex disease, caused by the actions and interactions of multiple genes and environmental factors. Familial aggregation studies, twin studies, and segregation analyses have provided strong evidence for the heritability of AMD, and linkage and association studies have been conducted to localize the disease-causing genes. Whole genome linkage scans have implicated nearly every chromosome in the human genome, with the most replicated signals residing on 1q25-31 and 10q26. Association studies have identified a major risk variant within the complement factor H gene (CFH), and recent reports suggest that PLEKHA1/LOC387715 and the BF/C2 regions may be major risk loci for AMD as well. Several other genes have had at least one positive association finding and deserve further exploration. Among these, apolipoprotein E (APOE) may be a minor risk locus. Additional genes will likely be identified, and future studies should explore the potential interactions of these genes with other genes as well as environmental factors.
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Affiliation(s)
- Stephen Haddad
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, 02114, USA
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30
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Lam CY, Fan BJ, Wang DY, Tam POS, Yung Tham CC, Leung DYL, Ping Fan DS, Chiu Lam DS, Pang CP. Association of Apolipoprotein E Polymorphisms With Normal Tension Glaucoma in a Chinese Population. J Glaucoma 2006; 15:218-22. [PMID: 16778644 DOI: 10.1097/01.ijg.0000212217.19804.a7] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the role of apolipoprotein E (APOE) polymorphisms in primary open angle glaucoma (POAG). METHODS A cohort of 400 unrelated Chinese POAG patients was examined, including 294 cases of high tension glaucoma (HTG) and 106 with normal tension glaucoma (NTG). Also studied were 300 unrelated Chinese control subjects. The genotypes of the APOE polymorphisms in exon 4 and in the promoter at positions -491, -427, and -219 were determined by polymerase chain reaction and restriction endonuclease analysis. Frequencies of the genotypes were compared between patients and controls by chi test or Fisher exact test. The association of APOE polymorphisms with POAG phenotypes including age at diagnosis, intraocular pressure (IOP) at diagnosis, highest IOP, cup-disc ratio, and visual field score was investigated by the Kruskal-Wallis test. RESULTS No significant difference was detected in the frequencies of APOE promoter polymorphisms between POAG patients and control subjects (P>0.0125). For the exon 4 polymorphism, when compared with control subjects, the frequency of epsilon 4 carriers was significantly lower in patients with NTG (P=0.008; odds ratio=0.36, 95% confidence interval=0.17, 0.79) but not in HTG (P=0.07). Compared with -219TT, the -219G carriers had a significant higher age at diagnosis (P=0.0046). No significant association was found between other APOE polymorphisms and POAG phenotypes (P>0.07). CONCLUSIONS Our findings suggest that the APOE epsilon 4 allele confers a protective effect against NTG, whereas the APOE promoter polymorphisms do not contribute to POAG risk. However, the APOE -219G carriers tended to have later-onset POAG.
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Affiliation(s)
- Ching Yan Lam
- Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Kowloon, Hong Kong
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Klein R, Klein BEK, Knudtson MD, Wong TY, Cotch MF, Liu K, Burke G, Saad MF, Jacobs DR. Prevalence of age-related macular degeneration in 4 racial/ethnic groups in the multi-ethnic study of atherosclerosis. Ophthalmology 2006; 113:373-80. [PMID: 16513455 DOI: 10.1016/j.ophtha.2005.12.013] [Citation(s) in RCA: 249] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2005] [Revised: 12/01/2005] [Accepted: 12/01/2005] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To describe the prevalence of age-related macular degeneration (AMD) in 4 racial/ethnic groups (white, black, Hispanic, and Chinese) that participated in the second examination of the Multi-ethnic Study of Atherosclerosis (MESA). DESIGN Prospective cohort study. PARTICIPANTS Six thousand one hundred seventy-six 45- to 85-year-old subjects selected from 6 United States communities. METHODS Fundus images were taken using a 45 degrees digital camera through dark-adapted pupils and were graded for drusen size, type, area, increased retinal pigment, retinal pigment epithelial depigmentation, neovascular lesions, and geographic atrophy using the modified Wisconsin Age-Related Maculopathy Grading System. MAIN OUTCOME MEASURE Age-related macular degeneration. RESULTS Prevalences of AMD were 2.4% (black), 4.2% (Hispanic), 4.6% (Chinese), to 5.4% (white) (P<0.001 for any differences among groups). The highest prevalence of any AMD occurred in those 75 to 84 years old, varying from 7.4% in blacks to 15.8% in whites and Chinese (P = 0.03). Estimated prevalences of late AMD were 0.3% (black), 0.2% (Hispanic), 0.6% (white), and 1.0% (Chinese). These differences were marginally significant (age and gender adjusted, P = 0.08). The frequency of exudative AMD was highest in Chinese (age- and gender-adjusted odds ratio, 4.30; 95% confidence interval, 1.30-14.27) compared with whites. Differences in age, gender, pupil size, body mass index, smoking, alcohol drinking history, diabetes, and hypertension status did not explain the variability among the 4 racial/ethnic groups. CONCLUSIONS Low prevalences of AMD were found in the MESA cohort in all groups. A lower prevalence of AMD was found in blacks compared with whites. The higher prevalence of exudative AMD in Chinese needs further study.
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Affiliation(s)
- Ronald Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin 53726-2336, USA.
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Fan BJ, Tam POS, Choy KW, Wang DY, Lam DSC, Pang CP. Molecular diagnostics of genetic eye diseases. Clin Biochem 2006; 39:231-9. [PMID: 16412407 DOI: 10.1016/j.clinbiochem.2005.11.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2005] [Revised: 11/01/2005] [Accepted: 11/25/2005] [Indexed: 01/26/2023]
Abstract
Eye diseases can be simple or complex, and mostly of heterogeneous molecular genetics. Some eye diseases are caused by mutations in a single gene, but some diseases, such as primary open angle glaucoma, can be due to sequence variations in multiple genes. In some diseases, both genetic and epigenetic mechanisms are involved, as was recently revealed in the mechanism of retinoblastoma. Disease causative mutations and phenotypes may vary by ethnicity and geography. To date, more than a hundred candidate genes for eye diseases are known, although less than 20 have definite disease-causing mutations. The three common genetic eye diseases, primary open angle glaucoma, age-related macular degeneration, and retinitis pigmentosa, all have known gene mutations, but these account for only a portion of the patients. While the search for eye disease genes and mutations still goes on, known mutations have been utilized for diagnosis. Genetic markers for pre-symptomatic and pre-natal diagnosis are available for specific diseases such as primary open angle glaucoma and retinoblastoma. This paper reviews the molecular basis of common genetic eye diseases and the available genetic markers for clinical diagnosis. Difficulties and challenges in molecular investigation of some eye diseases are discussed. Establishment of ethnic-specific disease databases that contain both clinical and genetic information for identification of genetic markers with diagnostic, prognostic, or pharmacological value is strongly advocated.
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Affiliation(s)
- Bao Jian Fan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, 147K Argyle Street, Kowloon, Hong Kong
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33
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Epidemiology of Age-Related Macular Degeneration. Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50064-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
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Gotoh N, Kuroiwa S, Kikuchi T, Arai J, Arai S, Yoshida N, Yoshimura N. Apolipoprotein E polymorphisms in Japanese patients with polypoidal choroidal vasculopathy and exudative age-related macular degeneration. Am J Ophthalmol 2004; 138:567-73. [PMID: 15488782 DOI: 10.1016/j.ajo.2004.05.025] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2004] [Indexed: 11/19/2022]
Abstract
PURPOSE To study the genotypes, allelic frequencies, and polymorphisms of apolipoprotein E (Apo E) in unrelated Japanese patients with polypoidal choroidal vasculopathy (PCV) or exudative age-related macular degeneration (AMD) and control subjects without macular degeneration. DESIGN Cross-sectional study. METHODS Blood samples from 225 subjects older than 50 years were used. The 225 subjects included 58 patients with PCV, 85 with AMD, and 82 without macular degeneration. Coding exons of the Apo E gene were amplified by polymerase chain reaction, and the DNA sequences were determined by direct sequencing with an automated sequencer. RESULTS Apo E epsilon3/epsilon3 was the most frequent genotype with a prevalence of 79.3% in PCV patients, 76.5% in AMD patients, and 67.1% in the control subjects. However, the differences in the percentages were not statistically significant among the three groups. The most frequently found allele in the three groups was epsilon3. Patients with PCV and AMD were less likely to have epsilon2 and epsilon4 than the control subjects, but the differences were not statistically significant. Five minor Apo E single nucleotide polymorphisms, including epsilon5 and epsilon7, were found. CONCLUSION Japanese patients with PCV and AMD were less likely to have epsilon2 and epsilon4 polymorphisms, but the differences from the normals were not statistically significant for the Apo E genotypes and allelic frequencies.
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Affiliation(s)
- Norimoto Gotoh
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Japan
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35
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Weeks DE, Conley YP, Tsai HJ, Mah TS, Schmidt S, Postel EA, Agarwal A, Haines JL, Pericak-Vance MA, Rosenfeld PJ, Paul TO, Eller AW, Morse LS, Dailey JP, Ferrell RE, Gorin MB. Age-related maculopathy: a genomewide scan with continued evidence of susceptibility loci within the 1q31, 10q26, and 17q25 regions. Am J Hum Genet 2004; 75:174-89. [PMID: 15168325 PMCID: PMC1216053 DOI: 10.1086/422476] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2004] [Accepted: 05/07/2004] [Indexed: 11/03/2022] Open
Abstract
Age-related maculopathy (ARM), or age-related macular degeneration, is one of the most common causes of visual impairment in the elderly population of developed nations. In a combined analysis of two previous genomewide scans that included 391 families, containing up to 452 affected sib pairs, we found linkage evidence in four regions: 1q31, 9p13, 10q26, and 17q25. We now have added a third set of families and have performed an integrated analysis incorporating 530 families and up to 736 affected sib pairs. Under three diagnostic models, we have conducted linkage analyses using parametric (heterogeneity LOD [HLOD] scores under an autosomal dominant model) and nonparametric (Sall statistic) methods. There is ongoing evidence of susceptibility loci within the 1q31, 10q26, and 17q25 regions. If we treat the third set of families as a replication set, then two regions (10q26 and 17q25) are replicated, with LOD scores >1.0. If we pool all our data together, then four regions (1q31, 2q14.3, 10q26, and 17q25) show HLOD or Sall scores > or =2.0. Within the 1q31 region, we observed an HLOD of 2.72 (genomewide P=.061) under our least stringent diagnostic model, whereas the 17q25 region contained a maximal HLOD of 3.53 (genomewide P=.007) under our intermediate diagnostic model. We have evaluated our results with respect to the findings from several new independent genomewide linkage studies and also have completed ordered subset analyses (OSAs) with apolipoprotein E alleles, smoking history, and age at onset as stratifying covariates. The OSAs generate the interesting hypothesis that the effect of smoking on the risk of ARM is accentuated by a gene in the 10q26 region--a region implicated by four other studies.
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Affiliation(s)
- Daniel E. Weeks
- Departments of Human Genetics and Biostatistics, University of Pittsburgh Graduate School of Public Health, University of Pittsburgh School of Nursing, and Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh; Center for Human Genetics, Department of Medicine, and Duke Eye Center, Department of Ophthalmology, Duke University Medical Center, Durham, NC; Department of Ophthalmology and Center for Human Genetics Research, Vanderbilt University Medical Center, Nashville; Department of Ophthalmology, University of Miami, Bascom Palmer Eye Institute, Miami; Smith-Kettlewell Eye Research Institute, San Francisco; Department of Ophthalmology, University of California–Davis, Davis, CA; and Department of Ophthalmology, Case Western Reserve University, Cleveland
| | - Yvette P. Conley
- Departments of Human Genetics and Biostatistics, University of Pittsburgh Graduate School of Public Health, University of Pittsburgh School of Nursing, and Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh; Center for Human Genetics, Department of Medicine, and Duke Eye Center, Department of Ophthalmology, Duke University Medical Center, Durham, NC; Department of Ophthalmology and Center for Human Genetics Research, Vanderbilt University Medical Center, Nashville; Department of Ophthalmology, University of Miami, Bascom Palmer Eye Institute, Miami; Smith-Kettlewell Eye Research Institute, San Francisco; Department of Ophthalmology, University of California–Davis, Davis, CA; and Department of Ophthalmology, Case Western Reserve University, Cleveland
| | - Hui-Ju Tsai
- Departments of Human Genetics and Biostatistics, University of Pittsburgh Graduate School of Public Health, University of Pittsburgh School of Nursing, and Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh; Center for Human Genetics, Department of Medicine, and Duke Eye Center, Department of Ophthalmology, Duke University Medical Center, Durham, NC; Department of Ophthalmology and Center for Human Genetics Research, Vanderbilt University Medical Center, Nashville; Department of Ophthalmology, University of Miami, Bascom Palmer Eye Institute, Miami; Smith-Kettlewell Eye Research Institute, San Francisco; Department of Ophthalmology, University of California–Davis, Davis, CA; and Department of Ophthalmology, Case Western Reserve University, Cleveland
| | - Tammy S. Mah
- Departments of Human Genetics and Biostatistics, University of Pittsburgh Graduate School of Public Health, University of Pittsburgh School of Nursing, and Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh; Center for Human Genetics, Department of Medicine, and Duke Eye Center, Department of Ophthalmology, Duke University Medical Center, Durham, NC; Department of Ophthalmology and Center for Human Genetics Research, Vanderbilt University Medical Center, Nashville; Department of Ophthalmology, University of Miami, Bascom Palmer Eye Institute, Miami; Smith-Kettlewell Eye Research Institute, San Francisco; Department of Ophthalmology, University of California–Davis, Davis, CA; and Department of Ophthalmology, Case Western Reserve University, Cleveland
| | - Silke Schmidt
- Departments of Human Genetics and Biostatistics, University of Pittsburgh Graduate School of Public Health, University of Pittsburgh School of Nursing, and Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh; Center for Human Genetics, Department of Medicine, and Duke Eye Center, Department of Ophthalmology, Duke University Medical Center, Durham, NC; Department of Ophthalmology and Center for Human Genetics Research, Vanderbilt University Medical Center, Nashville; Department of Ophthalmology, University of Miami, Bascom Palmer Eye Institute, Miami; Smith-Kettlewell Eye Research Institute, San Francisco; Department of Ophthalmology, University of California–Davis, Davis, CA; and Department of Ophthalmology, Case Western Reserve University, Cleveland
| | - Eric A. Postel
- Departments of Human Genetics and Biostatistics, University of Pittsburgh Graduate School of Public Health, University of Pittsburgh School of Nursing, and Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh; Center for Human Genetics, Department of Medicine, and Duke Eye Center, Department of Ophthalmology, Duke University Medical Center, Durham, NC; Department of Ophthalmology and Center for Human Genetics Research, Vanderbilt University Medical Center, Nashville; Department of Ophthalmology, University of Miami, Bascom Palmer Eye Institute, Miami; Smith-Kettlewell Eye Research Institute, San Francisco; Department of Ophthalmology, University of California–Davis, Davis, CA; and Department of Ophthalmology, Case Western Reserve University, Cleveland
| | - Anita Agarwal
- Departments of Human Genetics and Biostatistics, University of Pittsburgh Graduate School of Public Health, University of Pittsburgh School of Nursing, and Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh; Center for Human Genetics, Department of Medicine, and Duke Eye Center, Department of Ophthalmology, Duke University Medical Center, Durham, NC; Department of Ophthalmology and Center for Human Genetics Research, Vanderbilt University Medical Center, Nashville; Department of Ophthalmology, University of Miami, Bascom Palmer Eye Institute, Miami; Smith-Kettlewell Eye Research Institute, San Francisco; Department of Ophthalmology, University of California–Davis, Davis, CA; and Department of Ophthalmology, Case Western Reserve University, Cleveland
| | - Jonathan L. Haines
- Departments of Human Genetics and Biostatistics, University of Pittsburgh Graduate School of Public Health, University of Pittsburgh School of Nursing, and Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh; Center for Human Genetics, Department of Medicine, and Duke Eye Center, Department of Ophthalmology, Duke University Medical Center, Durham, NC; Department of Ophthalmology and Center for Human Genetics Research, Vanderbilt University Medical Center, Nashville; Department of Ophthalmology, University of Miami, Bascom Palmer Eye Institute, Miami; Smith-Kettlewell Eye Research Institute, San Francisco; Department of Ophthalmology, University of California–Davis, Davis, CA; and Department of Ophthalmology, Case Western Reserve University, Cleveland
| | - Margaret A. Pericak-Vance
- Departments of Human Genetics and Biostatistics, University of Pittsburgh Graduate School of Public Health, University of Pittsburgh School of Nursing, and Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh; Center for Human Genetics, Department of Medicine, and Duke Eye Center, Department of Ophthalmology, Duke University Medical Center, Durham, NC; Department of Ophthalmology and Center for Human Genetics Research, Vanderbilt University Medical Center, Nashville; Department of Ophthalmology, University of Miami, Bascom Palmer Eye Institute, Miami; Smith-Kettlewell Eye Research Institute, San Francisco; Department of Ophthalmology, University of California–Davis, Davis, CA; and Department of Ophthalmology, Case Western Reserve University, Cleveland
| | - Philip J. Rosenfeld
- Departments of Human Genetics and Biostatistics, University of Pittsburgh Graduate School of Public Health, University of Pittsburgh School of Nursing, and Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh; Center for Human Genetics, Department of Medicine, and Duke Eye Center, Department of Ophthalmology, Duke University Medical Center, Durham, NC; Department of Ophthalmology and Center for Human Genetics Research, Vanderbilt University Medical Center, Nashville; Department of Ophthalmology, University of Miami, Bascom Palmer Eye Institute, Miami; Smith-Kettlewell Eye Research Institute, San Francisco; Department of Ophthalmology, University of California–Davis, Davis, CA; and Department of Ophthalmology, Case Western Reserve University, Cleveland
| | - T. Otis Paul
- Departments of Human Genetics and Biostatistics, University of Pittsburgh Graduate School of Public Health, University of Pittsburgh School of Nursing, and Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh; Center for Human Genetics, Department of Medicine, and Duke Eye Center, Department of Ophthalmology, Duke University Medical Center, Durham, NC; Department of Ophthalmology and Center for Human Genetics Research, Vanderbilt University Medical Center, Nashville; Department of Ophthalmology, University of Miami, Bascom Palmer Eye Institute, Miami; Smith-Kettlewell Eye Research Institute, San Francisco; Department of Ophthalmology, University of California–Davis, Davis, CA; and Department of Ophthalmology, Case Western Reserve University, Cleveland
| | - Andrew W. Eller
- Departments of Human Genetics and Biostatistics, University of Pittsburgh Graduate School of Public Health, University of Pittsburgh School of Nursing, and Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh; Center for Human Genetics, Department of Medicine, and Duke Eye Center, Department of Ophthalmology, Duke University Medical Center, Durham, NC; Department of Ophthalmology and Center for Human Genetics Research, Vanderbilt University Medical Center, Nashville; Department of Ophthalmology, University of Miami, Bascom Palmer Eye Institute, Miami; Smith-Kettlewell Eye Research Institute, San Francisco; Department of Ophthalmology, University of California–Davis, Davis, CA; and Department of Ophthalmology, Case Western Reserve University, Cleveland
| | - Lawrence S. Morse
- Departments of Human Genetics and Biostatistics, University of Pittsburgh Graduate School of Public Health, University of Pittsburgh School of Nursing, and Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh; Center for Human Genetics, Department of Medicine, and Duke Eye Center, Department of Ophthalmology, Duke University Medical Center, Durham, NC; Department of Ophthalmology and Center for Human Genetics Research, Vanderbilt University Medical Center, Nashville; Department of Ophthalmology, University of Miami, Bascom Palmer Eye Institute, Miami; Smith-Kettlewell Eye Research Institute, San Francisco; Department of Ophthalmology, University of California–Davis, Davis, CA; and Department of Ophthalmology, Case Western Reserve University, Cleveland
| | - J. P. Dailey
- Departments of Human Genetics and Biostatistics, University of Pittsburgh Graduate School of Public Health, University of Pittsburgh School of Nursing, and Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh; Center for Human Genetics, Department of Medicine, and Duke Eye Center, Department of Ophthalmology, Duke University Medical Center, Durham, NC; Department of Ophthalmology and Center for Human Genetics Research, Vanderbilt University Medical Center, Nashville; Department of Ophthalmology, University of Miami, Bascom Palmer Eye Institute, Miami; Smith-Kettlewell Eye Research Institute, San Francisco; Department of Ophthalmology, University of California–Davis, Davis, CA; and Department of Ophthalmology, Case Western Reserve University, Cleveland
| | - Robert E. Ferrell
- Departments of Human Genetics and Biostatistics, University of Pittsburgh Graduate School of Public Health, University of Pittsburgh School of Nursing, and Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh; Center for Human Genetics, Department of Medicine, and Duke Eye Center, Department of Ophthalmology, Duke University Medical Center, Durham, NC; Department of Ophthalmology and Center for Human Genetics Research, Vanderbilt University Medical Center, Nashville; Department of Ophthalmology, University of Miami, Bascom Palmer Eye Institute, Miami; Smith-Kettlewell Eye Research Institute, San Francisco; Department of Ophthalmology, University of California–Davis, Davis, CA; and Department of Ophthalmology, Case Western Reserve University, Cleveland
| | - Michael B. Gorin
- Departments of Human Genetics and Biostatistics, University of Pittsburgh Graduate School of Public Health, University of Pittsburgh School of Nursing, and Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh; Center for Human Genetics, Department of Medicine, and Duke Eye Center, Department of Ophthalmology, Duke University Medical Center, Durham, NC; Department of Ophthalmology and Center for Human Genetics Research, Vanderbilt University Medical Center, Nashville; Department of Ophthalmology, University of Miami, Bascom Palmer Eye Institute, Miami; Smith-Kettlewell Eye Research Institute, San Francisco; Department of Ophthalmology, University of California–Davis, Davis, CA; and Department of Ophthalmology, Case Western Reserve University, Cleveland
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Schmidt S, Scott WK, Postel EA, Agarwal A, Hauser ER, De La Paz MA, Gilbert JR, Weeks DE, Gorin MB, Haines JL, Pericak-Vance MA. Ordered subset linkage analysis supports a susceptibility locus for age-related macular degeneration on chromosome 16p12. BMC Genet 2004; 5:18. [PMID: 15238159 PMCID: PMC481059 DOI: 10.1186/1471-2156-5-18] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2004] [Accepted: 07/06/2004] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Age-related macular degeneration (AMD) is a complex disorder that is responsible for the majority of central vision loss in older adults living in developed countries. Phenotypic and genetic heterogeneity complicate the analysis of genome-wide scans for AMD susceptibility loci. The ordered subset analysis (OSA) method is an approach for reducing heterogeneity, increasing statistical power for detecting linkage, and helping to define the most informative data set for follow-up analysis. OSA assesses the linkage evidence in subsets of potentially more homogeneous families by rank-ordering family-specific lod scores with respect to trait-associated covariates or phenotypic features. Here, we present results of incorporating five continuous covariates into our genome-wide linkage analysis of 389 microsatellite markers in 62 multiplex families: Body mass index (BMI), systolic (SBP) and diastolic (DBP) blood pressure, intraocular pressure (IOP), and pack-years of cigarette smoking. Chromosome-wide significance of increases in nonparametric multipoint lod scores in covariate-defined subsets relative to the overall sample was assessed by permutation. RESULTS Using a correction for testing multiple covariates, statistically significant lod score increases were observed for two chromosomal regions: 14q13 with a lod score of 3.2 in 28 families with average IOP </= 15.5 (p = 0.002), and 6q14 with a lod score of 1.6 in eight families with average BMI >/= 30.1 (p = 0.0004). On chromosome 16p12, nominally significant lod score increases (p </= 0.05), up to a lod score of 2.9 in 32 families, were observed with several covariate orderings. While less significant, this was the only region where linkage evidence was associated with multiple clinically meaningful covariates and the only nominally significant finding when analysis was restricted to advanced forms of AMD. Families with linkage to 16p12 had higher averages of SBP, IOP and BMI and were primarily affected with neovascular AMD. For all three regions, linkage signals at or very near the peak marker have previously been reported. CONCLUSION Our results suggest that a susceptibility gene on chromosome 16p12 may predispose to AMD, particularly to the neovascular form, and that further research into the previously suggested association of neovascular AMD and systemic hypertension is warranted.
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Affiliation(s)
- Silke Schmidt
- Center for Human Genetics, Duke University Medical Center, Durham, NC, USA
| | - William K Scott
- Center for Human Genetics, Duke University Medical Center, Durham, NC, USA
| | - Eric A Postel
- Duke Eye Center, Duke University Medical Center, Durham, NC, USA
| | - Anita Agarwal
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth R Hauser
- Center for Human Genetics, Duke University Medical Center, Durham, NC, USA
| | | | - John R Gilbert
- Center for Human Genetics, Duke University Medical Center, Durham, NC, USA
| | - Daniel E Weeks
- Department of Human Genetics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Michael B Gorin
- Department of Human Genetics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jonathan L Haines
- Center for Human Genetics Research, Vanderbilt University Medical Center, Nashville, TN, USA
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van Leeuwen R, Klaver CCW, Vingerling JR, Hofman A, de Jong PTVM. Epidemiology of age-related maculopathy: a review. Eur J Epidemiol 2004; 18:845-54. [PMID: 14561043 DOI: 10.1023/a:1025643303914] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Age-related maculopathy (ARM) is a degenerative disease of the retina and the leading cause of incurable blindness and visual impairment in industrialized countries. By definition, ARM is confined to the age-category above 50 years. The aetiology of ARM is still unknown, despite intensive research on many fronts. In this paper, we provide a review of the epidemiology of ARM. The most prominent findings were an exponential increase in frequency with age, a significant familial and genetic component, and a strong association with smoking. Other risk factors that were found less consistently were atherosclerosis, low intake of antioxidant nutrients, and cataract extraction. Future studies, both observational and experimental, will hopefully identify more risk factors that are amenable to prevention.
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Affiliation(s)
- Redmer van Leeuwen
- Department of Epidemiology and Biostatistics, Erasmus Medical Centre, Rotterdam, The Netherlands
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38
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Spaide RF, Armstrong D, Browne R. CHOROIDAL NEOVASCULARIZATION IN AGE-RELATED MACULAR DEGENERATION—WHAT IS THE CAUSE? Retina 2003; 23:595-614. [PMID: 14574243 DOI: 10.1097/00006982-200310000-00001] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Richard F Spaide
- Vitreous Retina Macula Consultants, New York, New York 10021, USA.
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Baum L, Chan WM, Li WY, Lam DSC, Wang PB, Pang CP. ABCA4 sequence variants in Chinese patients with age-related macular degeneration or Stargardt's disease. Ophthalmologica 2003; 217:111-4. [PMID: 12592048 DOI: 10.1159/000068553] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2001] [Indexed: 11/19/2022]
Abstract
ABCA4 gene sequence alterations cause Stargardt's disease (STGD) and may cause some age-related macular degeneration (AMD). We sought to shed light on these associations among Hong Kong Chinese by genotyping 140 AMD, 18 STGD and 95 normal control subjects for 15 ABCA4 exons which were reported to often contain AMD- or STGD-associated mutations. Sequence alterations R212H, T1428M, V1433I, T1572M, I2166M, IVS6-5T>G and IVS33+1G>T were found in AMD patients. T1428M and R2040X occurred in STGD patients. Control subjects displayed all the above missense alterations but no splicing or nonsense changes. Therefore, ABCA4 splicing mutations may be associated with a small proportion of AMD cases.
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Affiliation(s)
- Larry Baum
- Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Hong Kong, China
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40
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Schmidt S, Klaver C, Saunders A, Postel E, De La Paz M, Agarwal A, Small K, Udar N, Ong J, Chalukya M, Nesburn A, Kenney C, Domurath R, Hogan M, Mah T, Conley Y, Ferrell R, Weeks D, de Jong PTVM, van Duijn C, Haines J, Pericak-Vance M, Gorin M. A pooled case-control study of the apolipoprotein E (APOE) gene in age-related maculopathy. Ophthalmic Genet 2002; 23:209-23. [PMID: 12567264 DOI: 10.1076/opge.23.4.209.13883] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Age-related maculopathy (ARM) is a multifactorial disorder known to have a substantial genetic component. The epsilon4 allele of the apolipoprotein E gene (APOE-4) has previously been reported to have a protective effect on ARM risk, while the APOE-2 allele may increase disease risk. This study combined four independent data sets (three US and one European) of Caucasian ARM patients and controls in order to obtain better statistical power to examine the role of APOE in ARM. APOE genotype and allele frequencies were compared for 617 ARM cases and 1260 controls, adjusting for age and sex differences between the two groups via multiple logistic regression. The protective effect of the APOE-4 allele on ARM risk was confirmed (age- and sex-adjusted odds ratio (OR) for APOE-4 carriers 0.54, 95% confidence interval (CI) 0.41-0.70, p < 0.0001). The effect of APOE-4 did not differ significantly between males and females and was observed consistently for both atrophic and neovascular ARM. Evidence for an increased risk of ARM due to the APOE-2 allele was found for men, but not for women (OR for men 1.54, 95% CI 0.97-2.45; OR for women 0.74, 95% CI 0.52-1.06, p = 0.01 for interaction of sex and APOE-2 carrier status). These data confirm that the APOE-4 allele, or an allele in linkage disequilibrium with it, reduces the risk of ARM. They also suggest that the effect of the APOE-2 allele may vary by gender, and that APOE-2 may confer an increased risk only to males.
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Affiliation(s)
- Silke Schmidt
- Center for Human Genetics, Department of Medicine, Duke University Medical Center, Durham, NC, USA
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Pang CP, Lam DSC. Differential occurrence of mutations causative of eye diseases in the Chinese population. Hum Mutat 2002; 19:189-208. [PMID: 11857735 DOI: 10.1002/humu.10053] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Ethnic differences and geographic variations affect the frequencies and nature of human mutations. In the literature, descriptions of causative mutations of eye diseases in the Chinese population are few. In this paper we attempt to reveal molecular information on genetic eye diseases involving Chinese patients from published and unpublished works by us and other groups. Our studies on candidate genes of eye diseases in the Chinese population in Hong Kong include MYOC and TISR for primary open angle glaucoma, RHO and RP1 for retinitis pigmentosa, ABCA4 and APOE for age-related macular degeneration, RB1 for retinoblastoma, APC for familial adenomatous polyposis with congenital hypertrophy of retinal pigment epithelium, BIGH3/TGFBI for corneal dystrophies, PAX6 for aniridia and Reiger syndrome, CRYAA and CRYBB2 for cataracts, and mtDNA for Leber hereditary optic neuropathy. We have revealed novel mutations in most of these genes, and in RHO, RP1, RB1, BIGH3, and PAX6 we have reported mutations that contribute to better understanding of the functions and properties of the respective gene products. We showed absence of MYOC does not necessarily cause glaucoma. No disease causative mutations have been identified in MYOC or ABCA4. There are similarities in the patterns of sequence alterations and phenotype-genotype associations in comparison with other ethnic groups, while the MYOC, RB1, APC, and PAX6 genes have more Chinese-specific sequence alterations. Establishment of a mutation database specific for the Chinese is essential for identification of genetic markers with diagnostic, prognostic, or pharmacological values.
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Affiliation(s)
- Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Hong Kong, China.
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Simonelli F, Margaglione M, Testa F, Cappucci G, Manitto MP, Brancato R, Rinaldi E. Apolipoprotein E polymorphisms in age-related macular degeneration in an Italian population. Ophthalmic Res 2001; 33:325-8. [PMID: 11721184 DOI: 10.1159/000055688] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Apolipoprotein E (apoE) is an important regulator of cholesterol and lipid transport during compensatory synaptogenesis. Our purpose was to investigate the role of apoE gene polymorphisms in Italian patients with age-related macular degeneration (AMD). METHODS We used the polymerase chain reaction technique to analyze apoE genotypes in 87 patients with AMD, in 47 age-matched controls and in 1,287 individuals from a general reference population. RESULTS The frequency of allele epsilon4 carriers was significantly higher (p = 0.002) in the general population than in AMD patients, while the frequency of allele epsilon2 was higher in the patients (p = 0.069) with an increased risk for AMD in the patients versus the population-based controls (odds ratio = 1.7; 95% confidence interval: 1.0-2.9). Allele epsilon4 was associated with a decreased risk for AMD in the patients versus the population-based controls (odds ratio = 0.3; 95% confidence interval: 0.1-0.8). CLINICAL RELEVANCE These data suggest that apoE testing may represent a tool for the evaluation of the relative risk of AMD. Consequently, a preventive strategy can be initiated at an early stage of the disorder. CONCLUSION The apoE gene polymorphism showed a significant association with the risk of AMD. The lower frequency of the epsilon4 allele in AMD patients suggests that the apoE gene could play a protective role in the pathogenesis of the disease. In contrast, the epsilon2 allele was found associated with a slightly increased risk of AMD, although we did not find a statistically significant effect.
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Affiliation(s)
- F Simonelli
- Department of Ophthalmology, Seconda Università di Napoli, Italy.
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Weeks DE, Conley YP, Tsai HJ, Mah TS, Rosenfeld PJ, Paul TO, Eller AW, Morse LS, Dailey JP, Ferrell RE, Gorin MB. Age-related maculopathy: an expanded genome-wide scan with evidence of susceptibility loci within the 1q31 and 17q25 regions. Am J Ophthalmol 2001; 132:682-92. [PMID: 11704029 DOI: 10.1016/s0002-9394(01)01214-4] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE We seek to identify genetic loci that contribute to age-related maculopathy susceptibility. METHODS Families consisting of at least two siblings affected by age-related maculopathy were ascertained using eye care records and fundus photographs. Additional family members were used to increase the power to detect linkage. Microsatellite genotyping was conducted by the National Heart, Lung and Blood Institute Mammalian Genotyping Service and the National Institutes of Health Center for Inherited Disease Research. Linkage analyses were conducted with parametric (autosomal dominant; heterogeneity lod score) and nonparametric methods (S(all) statistic) using three diagnostic models. False-positive rates were determined from simulations using actual pedigrees and genotyping data. RESULTS Under our least stringent diagnostic model, model C, 860 affected individuals from 391 families (452 sib pairs) were genotyped. Sixty-five percent of the affected individuals had evidence of exudative disease. Four regions, 1q31, 9p13, 10q26, and 17q25, showed multipoint heterogeneity lod scores or S(all) scores of 2.0 or greater (under at least one model). Under our most stringent diagnostic model, model A, the 1q31 heterogeneity lod score was 2.46 between D1S1660 and D1S1647. Under model C, the 17q25 heterogeneity lod score at D17S928 was 3.16. Using a threshold of 1.5, additional loci on chromosomes 2 and 12 were identified. CONCLUSIONS The locus on chromosome 1q31 independently confirms a report by Klein and associates mapping an age-related maculopathy susceptibility gene to this region. Simulations indicate that the 1q31 and 17q25 loci are unlikely to be false positives. There was no evidence that other known macular or retinal dystrophy candidate gene regions are major contributors to the genetics of age-related maculopathy.
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Affiliation(s)
- D E Weeks
- Department of Human Genetics, University of Pittsburgh Graduate School of Public Health and School of Medicine, Pittsburgh, Pennsylvania 15261, USA
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