Multi-ancestry GWAS of Fuchs corneal dystrophy highlights roles of laminins, collagen, and endothelial cell regulation

Fuchs endothelial corneal dystrophy (FECD) is a leading indication for corneal transplantation, but its molecular pathophysiology remains poorly understood. We performed genome-wide association studies (GWAS) of FECD in the Million Veteran Program (MVP) and meta-analyzed with the previous largest FECD GWAS, finding twelve significant loci (eight novel). We further confirmed the TCF4 locus in admixed African and Hispanic/Latino ancestries, and found an enrichment of European-ancestry haplotypes at TCF4 in FECD cases. Among the novel associations are low frequency missense variants in laminin genes LAMA5 and LAMB1 which, together with previously reported LAMC1, form laminin-511 (LM511). AlphaFold 2 protein modeling suggests that mutations at LAMA5 and LAMB1 may destabilize LM511 by altering inter-domain interactions or extracellular matrix binding. Finally, phenome-wide association scans and co-localization analyses suggest that the TCF4 CTG18.1 trinucleotide repeat expansion leads to dysregulation of ion transport in the corneal endothelium and has pleiotropic effects on renal function.

Treatment of early cancer of the breast (T1N0M0 and T2N0M0) on the basis of histologic characteristics

This is a retrospective study of the results of various types of surgical treatment of early breast cancer staged histologically using the following characteristics: (1) poor cytologic differentiation, (2) lymphatic permeation, (3) blood vessel invasion, or (4) invasion of the tumor into the surrounding soft tissue. Four hundred and three patients who had early tumors of the breast--228 T1N0M0 (tumor 2 cm or less in diameter, no nodal involvement, and no metastasis) and 175 T2N0M0 (tumor 2 to 5 cm in diameter, no nodal involvement, and no metastasis)--were treated at St. Vincent's Hospital and Medical Center between January 1, 1965, and December 31 1976. Eighty-three were classified as being at low risk 190 at intermediate risk, and 130 at high risk. At 10 years, 100% of the low-risk group were alive; 99% were free of disease, and any type of mastectomy performed--radical, modified radical, or total--was adequate. At 10 years, 44% of those at high risk were alive, and 30% were free of disease. Radiotherapy improved life expectancy when added to radical mastectomy in the high-risk group. We recommend a prior excisional biopsy for proper histologic evaluation to allow a more appropriate choice of surgical procedure.