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Fujinami K, Waheed N, Laich Y, Yang P, Fujinami-Yokokawa Y, Higgins JJ, Lu JT, Curtiss D, Clary C, Michaelides M. Stargardt macular dystrophy and therapeutic approaches. Br J Ophthalmol 2024; 108:495-505. [PMID: 37940365 PMCID: PMC10958310 DOI: 10.1136/bjo-2022-323071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 10/06/2023] [Indexed: 11/10/2023]
Abstract
Stargardt macular dystrophy (Stargardt disease; STGD1; OMIM 248200) is the most prevalent inherited macular dystrophy. STGD1 is an autosomal recessive disorder caused by multiple pathogenic sequence variants in the large ABCA4 gene (OMIM 601691). Major advances in understanding both the clinical and molecular features, as well as the underlying pathophysiology, have culminated in many completed, ongoing and planned human clinical trials of novel therapies.The aims of this concise review are to describe (1) the detailed phenotypic and genotypic characteristics of the disease, multimodal imaging findings, natural history of the disease, and pathogenesis, (2) the multiple avenues of research and therapeutic intervention, including pharmacological, cellular therapies and diverse types of genetic therapies that have either been investigated or are under investigation and (3) the exciting novel therapeutic approaches on the translational horizon that aim to treat STGD1 by replacing the entire 6.8 kb ABCA4 open reading frame.
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Affiliation(s)
- Kaoru Fujinami
- Laboratory of Visual Physiology, Division of Vision Research, National Institute of Sensory Organs, NHO Tokyo Medical Center, Meguro-ku, Tokyo, Japan
- Institute of Ophthalmology, University College London, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Nadia Waheed
- Department of Ophthalmology, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Yannik Laich
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Eye Center, Medical Center, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Paul Yang
- Oregon Health and Science University Casey Eye Institute, Portland, Oregon, USA
| | - Yu Fujinami-Yokokawa
- Laboratory of Visual Physiology, Division of Vision Research, National Institute of Sensory Organs, NHO Tokyo Medical Center, Meguro-ku, Tokyo, Japan
- Institute of Ophthalmology, University College London, London, UK
- Department of Health Policy and Management, Keio University School of Medicine Graduate School of Medicine, Shinjuku-ku, Tokyo, Japan
| | | | - Jonathan T Lu
- SalioGen Therapeutics Inc, Lexington, Massachusetts, USA
| | - Darin Curtiss
- Applied Genetic Technologies Corporation, Alachua, Florida, USA
| | - Cathryn Clary
- SalioGen Therapeutics Inc, Lexington, Massachusetts, USA
| | - Michel Michaelides
- Institute of Ophthalmology, University College London, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Hashem SA, Georgiou M, Fujinami-Yokokawa Y, Laich Y, Varela MD, de Guimaraes TAC, Ali N, Mahroo OA, Webster AR, Fujinami K, Michaelides M. Genetics, Clinical Characteristics, and Natural History of PDE6B-Associated Retinal Dystrophy. Am J Ophthalmol 2024; 263:1-10. [PMID: 38364953 DOI: 10.1016/j.ajo.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE To analyze the clinical characteristics, natural history, and genetics of PDE6B-associated retinal dystrophy. DESIGN Retrospective, observational cohort study. METHODS Review of medical records and retinal imaging, including fundus autofluorescence (FAF) imaging and spectral-domain optical coherence tomography (SD-OCT) of patients with molecularly confirmed PDE6B-associated retinal dystrophy in a single tertiary referral center. Genetic results were reviewed, and the detected variants were assessed. RESULTS Forty patients (80 eyes) were identified and evaluated longitudinally. The mean age (±SD, range) was 42.1 years (± 19.0, 10-86) at baseline, with a mean follow-up time of 5.2 years. Twenty-nine (72.5%) and 27 (67.5%) patients had no or mild visual acuity impairment at baseline and last visit, respectively. Best-corrected visual acuity (BCVA) was 0.56 ± 0.72 LogMAR (range -0.12 to 2.80) at baseline and 0.63 ± 0.73 LogMAR (range 0.0-2.80) at the last visit. BCVA was symmetrical in 87.5% of patients. A hyperautofluorescent ring was observed on FAF in 48 and 46 eyes at baseline and follow-up visit, respectively, with a mean area of 7.11 ± 4.13 mm2 at baseline and mean of 6.13 ± 3.62 mm2 at the follow-up visit. Mean horizontal ellipsoid zone width at baseline was 1946.1 ± 917.2 µm, which decreased to 1763.9 ± 827.9 µm at follow-up. Forty-four eyes had cystoid macular edema at baseline (55%), and 41 eyes (51.3%) at follow-up. There were statistically significant changes during the follow-up period in terms of BCVA and the ellipsoid zone width. Genetic analysis identified 43 variants in the PDE6B gene, including 16 novel variants. CONCLUSIONS This study details the natural history of PDE6B-retinopathy in the largest cohort to date. Most patients had mild to no BCVA loss, with slowly progressive disease, based on FAF and OCT metrics. There is a high degree of disease symmetry and a wide window for intervention.
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Affiliation(s)
- Shaima Awadh Hashem
- From the Moorfields Eye Hospital (S.A.H., M.G., Y.L., M.D.V., T.A.C.d.G., N.A., O.A.M., A.R.W., K.F., M.M.), London, United Kingdom; UCL Institute of Ophthalmology, University College London (S.A.H., M.G., Y.F.Y., Y.L., M.D.V., T.A.C.d.G., O.A.M., A.R.W., K.F., M.M.), London, United Kingdom
| | - Michalis Georgiou
- From the Moorfields Eye Hospital (S.A.H., M.G., Y.L., M.D.V., T.A.C.d.G., N.A., O.A.M., A.R.W., K.F., M.M.), London, United Kingdom; UCL Institute of Ophthalmology, University College London (S.A.H., M.G., Y.F.Y., Y.L., M.D.V., T.A.C.d.G., O.A.M., A.R.W., K.F., M.M.), London, United Kingdom; Jones Eye Institute, University of Arkansas for Medical Sciences (M.G.), Little Rock, Arkansas, USA
| | - Yu Fujinami-Yokokawa
- UCL Institute of Ophthalmology, University College London (S.A.H., M.G., Y.F.Y., Y.L., M.D.V., T.A.C.d.G., O.A.M., A.R.W., K.F., M.M.), London, United Kingdom; Laboratory of Visual Physiology, Division of Vision Research (Y.F.Y.), National Institute of Sensory Organs, NHONHO Tokyo Medical Center, Tokyo, Japan; Department of Health Policy and Management (Y.F.Y.), Keio University School of Medicine, Tokyo, Japan
| | - Yannik Laich
- From the Moorfields Eye Hospital (S.A.H., M.G., Y.L., M.D.V., T.A.C.d.G., N.A., O.A.M., A.R.W., K.F., M.M.), London, United Kingdom; UCL Institute of Ophthalmology, University College London (S.A.H., M.G., Y.F.Y., Y.L., M.D.V., T.A.C.d.G., O.A.M., A.R.W., K.F., M.M.), London, United Kingdom; Eye Center, Faculty of Medicine, University Freiburg (Y.L.), Germany
| | - Malena Daich Varela
- From the Moorfields Eye Hospital (S.A.H., M.G., Y.L., M.D.V., T.A.C.d.G., N.A., O.A.M., A.R.W., K.F., M.M.), London, United Kingdom; UCL Institute of Ophthalmology, University College London (S.A.H., M.G., Y.F.Y., Y.L., M.D.V., T.A.C.d.G., O.A.M., A.R.W., K.F., M.M.), London, United Kingdom
| | - Thales A C de Guimaraes
- From the Moorfields Eye Hospital (S.A.H., M.G., Y.L., M.D.V., T.A.C.d.G., N.A., O.A.M., A.R.W., K.F., M.M.), London, United Kingdom; UCL Institute of Ophthalmology, University College London (S.A.H., M.G., Y.F.Y., Y.L., M.D.V., T.A.C.d.G., O.A.M., A.R.W., K.F., M.M.), London, United Kingdom
| | - Naser Ali
- From the Moorfields Eye Hospital (S.A.H., M.G., Y.L., M.D.V., T.A.C.d.G., N.A., O.A.M., A.R.W., K.F., M.M.), London, United Kingdom
| | - Omar A Mahroo
- From the Moorfields Eye Hospital (S.A.H., M.G., Y.L., M.D.V., T.A.C.d.G., N.A., O.A.M., A.R.W., K.F., M.M.), London, United Kingdom; UCL Institute of Ophthalmology, University College London (S.A.H., M.G., Y.F.Y., Y.L., M.D.V., T.A.C.d.G., O.A.M., A.R.W., K.F., M.M.), London, United Kingdom; Section of Ophthalmology, King's College London, St Thomas' Hospital Campus (O.A.M.), London, United Kingdom; Department of Physiology, Development and Neuroscience, University of Cambridge (O.A.M.), Cambridge, United Kingdom
| | - Andrew R Webster
- From the Moorfields Eye Hospital (S.A.H., M.G., Y.L., M.D.V., T.A.C.d.G., N.A., O.A.M., A.R.W., K.F., M.M.), London, United Kingdom; UCL Institute of Ophthalmology, University College London (S.A.H., M.G., Y.F.Y., Y.L., M.D.V., T.A.C.d.G., O.A.M., A.R.W., K.F., M.M.), London, United Kingdom
| | - Kaoru Fujinami
- From the Moorfields Eye Hospital (S.A.H., M.G., Y.L., M.D.V., T.A.C.d.G., N.A., O.A.M., A.R.W., K.F., M.M.), London, United Kingdom; UCL Institute of Ophthalmology, University College London (S.A.H., M.G., Y.F.Y., Y.L., M.D.V., T.A.C.d.G., O.A.M., A.R.W., K.F., M.M.), London, United Kingdom; Laboratory of Visual Physiology, Division of Vision Research (Y.F.Y.), National Institute of Sensory Organs, NHONHO Tokyo Medical Center, Tokyo, Japan
| | - Michel Michaelides
- From the Moorfields Eye Hospital (S.A.H., M.G., Y.L., M.D.V., T.A.C.d.G., N.A., O.A.M., A.R.W., K.F., M.M.), London, United Kingdom; UCL Institute of Ophthalmology, University College London (S.A.H., M.G., Y.F.Y., Y.L., M.D.V., T.A.C.d.G., O.A.M., A.R.W., K.F., M.M.), London, United Kingdom.
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Lang SJ, Dreesbach M, Laich Y, Glatz A, Boehringer D, Grewing V, Fritz M, Bucher F, Lagrèze WA, Maloca PM, Reinhard T, Lange C, Agostini H, Reich M. ZEISS PLEX Elite 9000 Widefield Optical Coherence Tomography Angiography as Screening Method for Early Detection of Retinal Hemangioblastomas in von Hippel-Lindau Disease. Transl Vis Sci Technol 2024; 13:8. [PMID: 38345551 PMCID: PMC10866155 DOI: 10.1167/tvst.13.2.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/03/2024] [Indexed: 02/15/2024] Open
Abstract
Purpose To evaluate early detection of retinal hemangioblastomas (RHs) in von Hippel-Lindau disease (VHLD) with widefield optical coherence tomography angiography (wOCTA) compared to the standard of care in ophthalmologic VHLD screening in a routine clinical setting. Methods We conducted prospective comparisons of three screening methods: wOCTA, standard ophthalmoscopy, and fluorescein angiography (FA), which was performed only in uncertain cases. The numbers of detected RHs were compared among the three screening methods. The underlying causes for the lack of detection were investigated. Results In 91 eyes (48 patients), 67 RHs were observed (mean, 0.74 ± 1.59 RH per eye). FA was performed in eight eyes. Ophthalmoscopy overlooked 25 of the 35 RHs detected by wOCTA (71.4%) due to the background color of the choroid (n = 5), small tumor size (n = 13), masking by a bright fundus reflex (n = 2), and masking by surrounding retinal scars (n = 5). However, wOCTA missed 29 RHs due to peripheral location (43.3%). The overall detection rates were up to 37% on the basis of ophthalmoscopy alone, up to 52% for wOCTA, and 89% for FA. Within the retinal area covered by wOCTA, the detection rates were up to 46.7% for ophthalmoscopy alone, up to 92.1% for wOCTA, and 73.3% for FA. Conclusions The overall low detection rate of RHs using wOCTA is almost exclusively caused by its inability to visualize the entire peripheral retina. Therefore, in unclear cases, FA is necessary after ophthalmoscopy. Translational Relevance Within the imageable retinal area, wOCTA shows a high detection rate of RHs and therefore may be suitable to improve screening for RHs in VHLD.
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Affiliation(s)
- Stefan J. Lang
- Eye Center, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Ophthalmology, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane (MHB), Brandenburg an der Havel, Germany
| | - Michelle Dreesbach
- Eye Center, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Yannik Laich
- Eye Center, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andreas Glatz
- Eye Center, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Boehringer
- Eye Center, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Viviane Grewing
- Eye Center, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marianne Fritz
- Eye Center, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Felicitas Bucher
- Eye Center, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wolf A. Lagrèze
- Eye Center, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter M. Maloca
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Thomas Reinhard
- Eye Center, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Clemens Lange
- Eye Center, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hansjuergen Agostini
- Eye Center, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Reich
- Eye Center, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Laich Y, Georgiou M, Fujinami K, Daich Varela M, Fujinami-Yokokawa Y, Hashem SA, Cabral de Guimaraes TA, Mahroo OA, Webster AR, Michaelides M. Best Vitelliform Macular Dystrophy Natural History Study Report 1: Clinical Features and Genetic Findings. Ophthalmology 2024:S0161-6420(24)00086-1. [PMID: 38278445 DOI: 10.1016/j.ophtha.2024.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/13/2024] [Accepted: 01/18/2024] [Indexed: 01/28/2024] Open
Abstract
PURPOSE To analyze the genetic findings, clinical spectrum, and natural history of Best vitelliform macular dystrophy (BVMD) in a cohort of 222 children and adults. DESIGN Single-center retrospective, consecutive, observational study. PARTICIPANTS Patients with a clinical diagnosis of BVMD from pedigrees with a likely disease-causing monoallelic sequence variant in the BEST1 gene. METHODS Data were extracted from electronic and physical case notes. Electrophysiologic assessment and molecular genetic testing were analyzed. MAIN OUTCOME MEASURES Molecular genetic test findings and clinical findings including best-corrected visual acuity (BCVA), choroidal neovascularization (CNV) rates, and electrophysiologic parameters. RESULTS Two hundred twenty-two patients from 141 families were identified harboring 69 BEST1 variants. Mean age at presentation was 26.8 years (range, 1.3-84.8 years) and most patients (61.5%) demonstrated deterioration of central vision. Major funduscopic findings included 128 eyes (30.6%) with yellow vitelliform lesions, 78 eyes (18.7%) with atrophic changes, 49 eyes (11.7%) with fibrotic changes, 48 eyes (11.5%) with mild pigmentary changes, and 43 eyes (10.3%) showing a vitelliruptive appearance. Mean BCVA was 0.37 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, 20/47) for the right eye and 0.33 logMAR (Snellen equivalent, 20/43) for the left eye at presentation, with a mean annual loss rate of 0.013 logMAR and 0.009 logMAR, respectively, over a mean follow-up of 9.7 years. Thirty-seven patients (17.3%) received a diagnosis of CNV over a mean follow-up of 8.0 years. Eyes with CNV that received treatment with an anti-vascular endothelial growth factor (VEGF) agent showed better mean BCVA compared with eyes that were not treated with an anti-VEGF agent (0.28 logMAR [Snellen equivalent, 20/38] vs. 0.62 logMAR [Snellen equivalent, 20/83]). Most eyes exhibited a hyperopic refractive error (78.7%), and 13 patients (6.1%) received a diagnosis of amblyopia. Among the 3 most common variants, p.(Ala243Val) was associated with a later age of onset, better age-adjusted BCVA, and less advanced Gass stages compared with p.(Arg218Cys) and p.(Arg218His). CONCLUSIONS BVMD shows a wide spectrum of phenotypic variability. The disease is very slowly progressive, and the observed phenotype-genotype correlations allow for more accurate prognostication and counselling. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Yannik Laich
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom; Eye Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michalis Georgiou
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom; Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Kaoru Fujinami
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom; Laboratory of Visual Physiology, Division of Vision Research, National Institute of Sensory Organs, NHO Tokyo Medical Center, Tokyo, Japan
| | - Malena Daich Varela
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Yu Fujinami-Yokokawa
- UCL Institute of Ophthalmology, University College London, London, United Kingdom; Laboratory of Visual Physiology, Division of Vision Research, National Institute of Sensory Organs, NHO Tokyo Medical Center, Tokyo, Japan; Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan
| | - Shaima Awadh Hashem
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | | | - Omar A Mahroo
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Andrew R Webster
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Michel Michaelides
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom.
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Daich Varela M, Laich Y, Hashem SA, Mahroo OA, Webster AR, Michaelides M. Prognostication in Stargardt Disease Using Fundus Autofluorescence: Improving Patient Care. Ophthalmology 2023; 130:1182-1190. [PMID: 37331482 DOI: 10.1016/j.ophtha.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/22/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023] Open
Abstract
PURPOSE To explore fundus autofluorescence (FAF) imaging as an alternative to electroretinography as a noninvasive, quick, and readily interpretable method to predict disease progression in Stargardt disease (STGD). DESIGN Retrospective case series of patients who attended Moorfields Eye Hospital (London, United Kingdom). PARTICIPANTS Patients with STGD who met the following criteria were included: (1) biallelic disease-causing variants in ABCA4, (2) electroretinography testing performed in house with an unequivocal electroretinography group classification, and (3) ultrawidefield (UWF) FAF imaging performed up to 2 years before or after the electroretinography. METHODS Patients were divided into 3 electroretinography groups based on retinal function and 3 FAF groups according to the extent of hypoautofluorescence and retinal background appearance. Fundus autofluorescence images of 30° and 55° were reviewed subsequently. MAIN OUTCOME MEASURES Electroretinography and FAF concordance and its association with baseline visual acuity (VA) and genetics. RESULTS Two hundred thirty-four patients were included in the cohort. One hundred seventy patients (73%) were in electroretinography and FAF groups of the same severity, 33 (14%) were in a milder FAF than electroretinography group, and 31 (13%) were in a more severe FAF than electroretinography group. Children < 10 years of age (n = 23) showed the lowest electroretinography and FAF concordance at 57% (9 of the 10 with discordant electroretinography and FAF showed milder FAF than electroretinography), and adults with adult onset showed the highest (80%). In 97% and 98% of patients, 30° and 55° FAF imaging, respectively, matched with the group defined by UWF FAF. CONCLUSIONS We demonstrated that FAF imaging is an effective method to determine the extent of retinal involvement and thereby inform prognostication by comparing FAF with the current gold standard of electroretinography. In 80% of patients in our large molecularly proven cohort, we were able to predict if the disease was confined to the macula or also affected the peripheral retina. Children assessed at a young age, with at least 1 null variant, early disease onset, poor initial VA, or a combination thereof may have wider retinal involvement than predicted by FAF alone, may progress to a more severe FAF phenotype over time, or both. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Malena Daich Varela
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Yannik Laich
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom; Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Shaima Awadh Hashem
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Omar A Mahroo
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Andrew R Webster
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Michel Michaelides
- Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom.
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Liu J, He Y, Lwin C, Han M, Guan B, Naik A, Bender C, Moore N, Huryn LA, Sergeev Y, Qian H, Zeng Y, Dong L, Liu P, Lei J, Haugen CJ, Prasov L, Shi R, Dollfus H, Aristodemou P, Laich Y, Németh AH, Taylor J, Downes S, Krawczynski M, Meunier I, Strassberg M, Tenney J, Gao J, Shear MA, Moore AT, Duncan JL, Menendez B, Hull S, Vincent A, Siskind CE, Traboulsi EI, Blackstone C, Sisk R, Utz V, Webster AR, Michaelides M, Arno G, Synofzik M, Hufnagel RB. Neuropathy target esterase activity predicts retinopathy among PNPLA6 disorders. bioRxiv 2023:2023.06.09.544373. [PMID: 37333224 PMCID: PMC10274907 DOI: 10.1101/2023.06.09.544373] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Biallelic pathogenic variants in the PNPLA6 gene cause a broad spectrum of disorders leading to gait disturbance, visual impairment, anterior hypopituitarism, and hair anomalies. PNPLA6 encodes Neuropathy target esterase (NTE), yet the role of NTE dysfunction on affected tissues in the large spectrum of associated disease remains unclear. We present a clinical meta-analysis of a novel cohort of 23 new patients along with 95 reported individuals with PNPLA6 variants that implicate missense variants as a driver of disease pathogenesis. Measuring esterase activity of 46 disease-associated and 20 common variants observed across PNPLA6 -associated clinical diagnoses unambiguously reclassified 10 variants as likely pathogenic and 36 variants as pathogenic, establishing a robust functional assay for classifying PNPLA6 variants of unknown significance. Estimating the overall NTE activity of affected individuals revealed a striking inverse relationship between NTE activity and the presence of retinopathy and endocrinopathy. This phenomenon was recaptured in vivo in an allelic mouse series, where a similar NTE threshold for retinopathy exists. Thus, PNPLA6 disorders, previously considered allelic, are a continuous spectrum of pleiotropic phenotypes defined by an NTE genotype:activity:phenotype relationship. This relationship and the generation of a preclinical animal model pave the way for therapeutic trials, using NTE as a biomarker.
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Laich Y, Wolf J, Hajdu RI, Schlecht A, Bucher F, Pauleikhoff L, Busch M, Martin G, Faatz H, Killmer S, Bengsch B, Stahl A, Lommatzsch A, Schlunck G, Agostini H, Boneva S, Lange C. Single-Cell Protein and Transcriptional Characterization of Epiretinal Membranes From Patients With Proliferative Vitreoretinopathy. Invest Ophthalmol Vis Sci 2022; 63:17. [PMID: 35579905 PMCID: PMC9123517 DOI: 10.1167/iovs.63.5.17] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose Proliferative vitreoretinopathy (PVR) remains an unresolved clinical challenge and can lead to frequent revision surgery and blindness vision loss. The aim of this study was to characterize the microenvironment of epiretinal PVR tissue, in order to shed more light on the complex pathophysiology and to unravel new treatment options. Methods A total of 44 tissue samples were analyzed in this study, including 19 epiretinal PVRs, 13 epiretinal membranes (ERMs) from patients with macular pucker, as well as 12 internal limiting membranes (ILMs). The cellular and molecular microenvironment was assessed by cell type deconvolution analysis (xCell), RNA sequencing data and single-cell imaging mass cytometry. Candidate drugs for PVR treatment were identified in silico via a transcriptome-based drug-repurposing approach. Results RNA sequencing of tissue samples demonstrated distinct transcriptional profiles of PVR, ERM, and ILM samples. Differential gene expression analysis revealed 3194 upregulated genes in PVR compared with ILM, including FN1 and SPARC, which contribute to biological processes, such as extracellular matrix (ECM) organization. The xCell and IMC analyses showed that PVR membranes were composed of macrophages, retinal pigment epithelium, and α-SMA-positive myofibroblasts, the latter predominantly characterized by the co-expression of immune cell signature markers. Finally, 13 drugs were identified as potential therapeutics for PVR, including aminocaproic acid and various topoisomerase-2A inhibitors. Conclusions Epiretinal PVR membranes exhibit a unique and complex transcriptional and cellular profile dominated by immune cells and myofibroblasts, as well as a variety of ECM components. Our findings provide new insights into the pathophysiology of PVR and suggest potential targeted therapeutic options.
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Affiliation(s)
- Yannik Laich
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julian Wolf
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Rozina Ida Hajdu
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Anja Schlecht
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Institute of Anatomy and Cell Biology, Julius Maximilian University Wuerzburg, Wuerzburg, Germany
| | - Felicitas Bucher
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Laurenz Pauleikhoff
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Busch
- Department of Ophthalmology, University Medical Center Greifswald, Greifswald, Germany
| | - Gottfried Martin
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Henrik Faatz
- Achim Wessing Institute for Imaging in Ophthalmology, University Hospital Essen, Essen, Germany.,Ophtha-Lab, Department of Ophthalmology at St. Franziskus Hospital, Muenster, Germany
| | - Saskia Killmer
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology, and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bertram Bengsch
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology, and Infectious Diseases), Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Signaling Research Centres BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
| | - Andreas Stahl
- Department of Ophthalmology, University Medical Center Greifswald, Greifswald, Germany
| | - Albrecht Lommatzsch
- Achim Wessing Institute for Imaging in Ophthalmology, University Hospital Essen, Essen, Germany.,Ophtha-Lab, Department of Ophthalmology at St. Franziskus Hospital, Muenster, Germany
| | - Günther Schlunck
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hansjürgen Agostini
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stefaniya Boneva
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Clemens Lange
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Ophtha-Lab, Department of Ophthalmology at St. Franziskus Hospital, Muenster, Germany
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8
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Boneva SK, Wolf J, Hajdú RI, Prinz G, Salié H, Schlecht A, Killmer S, Laich Y, Faatz H, Lommatzsch A, Busch M, Bucher F, Stahl A, Böhringer D, Bengsch B, Schlunck G, Agostini H, Lange CAK. In-Depth Molecular Characterization of Neovascular Membranes Suggests a Role for Hyalocyte-to-Myofibroblast Transdifferentiation in Proliferative Diabetic Retinopathy. Front Immunol 2021; 12:757607. [PMID: 34795670 PMCID: PMC8593213 DOI: 10.3389/fimmu.2021.757607] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/18/2021] [Indexed: 12/31/2022] Open
Abstract
Background Retinal neovascularization (RNV) membranes can lead to a tractional retinal detachment, the primary reason for severe vision loss in end-stage disease proliferative diabetic retinopathy (PDR). The aim of this study was to characterize the molecular, cellular and immunological features of RNV in order to unravel potential novel drug treatments for PDR. Methods A total of 43 patients undergoing vitrectomy for PDR, macular pucker or macular hole (control patients) were included in this study. The surgically removed RNV and epiretinal membranes were analyzed by RNA sequencing, single-cell based Imaging Mass Cytometry and conventional immunohistochemistry. Immune cells of the vitreous body, also known as hyalocytes, were isolated from patients with PDR by flow cytometry, cultivated and characterized by immunohistochemistry. A bioinformatical drug repurposing approach was applied in order to identify novel potential drug options for end-stage diabetic retinopathy disease. Results The in-depth transcriptional and single-cell protein analysis of diabetic RNV tissue samples revealed an accumulation of endothelial cells, macrophages and myofibroblasts as well as an abundance of secreted ECM proteins such as SPARC, FN1 and several types of collagen in RNV tissue. The immunohistochemical staining of cultivated vitreal hyalocytes from patients with PDR showed that hyalocytes express α-SMA (alpha-smooth muscle actin), a classic myofibroblast marker. According to our drug repurposing analysis, imatinib emerged as a potential immunomodulatory drug option for future treatment of PDR. Conclusion This study delivers the first in-depth transcriptional and single-cell proteomic characterization of RNV tissue samples. Our data suggest an important role of hyalocyte-to-myofibroblast transdifferentiation in the pathogenesis of diabetic vitreoretinal disease and their modulation as a novel possible clinical approach.
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Affiliation(s)
| | - Julian Wolf
- Eye Center, Medical Center, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Rozina Ida Hajdú
- Eye Center, Medical Center, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany.,Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Gabriele Prinz
- Eye Center, Medical Center, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Henrike Salié
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Disease, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Anja Schlecht
- Eye Center, Medical Center, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany.,Institute for Anatomy and Cell Biology, Julius-Maximilians-University Würzburg, Würzburg, Germany
| | - Saskia Killmer
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Disease, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Yannik Laich
- Eye Center, Medical Center, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | | | | | - Martin Busch
- Department of Ophthalmology, University Medical Center Greifswald, Greifswald, Germany
| | - Felicitas Bucher
- Eye Center, Medical Center, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Andreas Stahl
- Department of Ophthalmology, University Medical Center Greifswald, Greifswald, Germany
| | - Daniel Böhringer
- Eye Center, Medical Center, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Bertram Bengsch
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Disease, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Günther Schlunck
- Eye Center, Medical Center, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Hansjürgen Agostini
- Eye Center, Medical Center, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Clemens A K Lange
- Eye Center, Medical Center, Faculty of Medicine, University Medical Center Freiburg, Freiburg, Germany
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9
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Zhang P, Schlecht A, Wolf J, Boneva S, Laich Y, Koch J, Ludwig F, Boeck M, Thien A, Härdtner C, Kierdorf K, Agostini H, Schlunck G, Prinz M, Hilgendorf I, Wieghofer P, Lange C. The role of interferon regulatory factor 8 for retinal tissue homeostasis and development of choroidal neovascularisation. J Neuroinflammation 2021; 18:215. [PMID: 34544421 PMCID: PMC8454118 DOI: 10.1186/s12974-021-02230-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Microglia cells represent the resident innate immune cells of the retina and are important for retinal development and tissue homeostasis. However, dysfunctional microglia can have a negative impact on the structural and functional integrity of the retina under native and pathological conditions. METHODS In this study, we examined interferon-regulatory factor 8 (Irf8)-deficient mice to determine the transcriptional profile, morphology, and temporospatial distribution of microglia lacking Irf8 and to explore the effects on retinal development, tissue homeostasis, and formation of choroidal neovascularisation (CNV). RESULTS Our study shows that Irf8-deficient MG exhibit a considerable loss of microglial signature genes accompanied by a severely altered MG morphology. An in-depth characterisation by fundus photography, fluorescein angiography, optical coherence tomography and electroretinography revealed no major retinal abnormalities during steady state. However, in the laser-induced CNV model, Irf8-deficient microglia showed an increased activity of biological processes critical for inflammation and cell adhesion and a reduced MG cell density near the lesions, which was associated with significantly increased CNV lesion size. CONCLUSIONS Our results suggest that loss of Irf8 in microglia has negligible effects on retinal homeostasis in the steady state. However, under pathological conditions, Irf8 is crucial for the transformation of resident microglia into a reactive phenotype and thus for the suppression of retinal inflammation and CNV formation.
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Affiliation(s)
- Peipei Zhang
- Medical Faculty, Eye Center, University Hospital, University of Freiburg, Freiburg im Breisgau, Germany
| | - Anja Schlecht
- Medical Faculty, Eye Center, University Hospital, University of Freiburg, Freiburg im Breisgau, Germany.,Institute of Anatomy, Wuerzburg University, Wuerzburg, Germany
| | - Julian Wolf
- Medical Faculty, Eye Center, University Hospital, University of Freiburg, Freiburg im Breisgau, Germany
| | - Stefaniya Boneva
- Medical Faculty, Eye Center, University Hospital, University of Freiburg, Freiburg im Breisgau, Germany
| | - Yannik Laich
- Medical Faculty, Eye Center, University Hospital, University of Freiburg, Freiburg im Breisgau, Germany
| | - Jana Koch
- Medical Faculty, Eye Center, University Hospital, University of Freiburg, Freiburg im Breisgau, Germany
| | - Franziska Ludwig
- Medical Faculty, Eye Center, University Hospital, University of Freiburg, Freiburg im Breisgau, Germany
| | - Myriam Boeck
- Medical Faculty, Eye Center, University Hospital, University of Freiburg, Freiburg im Breisgau, Germany
| | - Adrian Thien
- Medical Faculty, Eye Center, University Hospital, University of Freiburg, Freiburg im Breisgau, Germany
| | - Carmen Härdtner
- Cardiology and Angiology, University Heart Center, University of Freiburg, Freiburg im Breisgau, Germany.,Medical Center and Faculty of Medicine, Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg Bad Krozingen, University of Freiburg, Freiburg, Germany
| | - Katrin Kierdorf
- Medical Faculty, Institute of Neuropathology, University Hospital, University of Freiburg, Freiburg im Breisgau, Germany.,CIBSS-Centre for Integrative Biological Signalling Studies, University of Freiburg, Freiburg, Germany.,Medical Faculty, Center for Basics in NeuroModulation (NeuroModulBasics), University of Freiburg, Freiburg im Breisgau, Germany
| | - Hansjürgen Agostini
- Medical Faculty, Eye Center, University Hospital, University of Freiburg, Freiburg im Breisgau, Germany
| | - Günther Schlunck
- Medical Faculty, Eye Center, University Hospital, University of Freiburg, Freiburg im Breisgau, Germany
| | - Marco Prinz
- Medical Faculty, Institute of Neuropathology, University Hospital, University of Freiburg, Freiburg im Breisgau, Germany.,Medical Faculty, Center for Basics in NeuroModulation (NeuroModulBasics), University of Freiburg, Freiburg im Breisgau, Germany.,Signalling Research Centres BIOSS and CIBSS, University of Freiburg, Freiburg im Breisgau, Germany
| | - Ingo Hilgendorf
- Cardiology and Angiology, University Heart Center, University of Freiburg, Freiburg im Breisgau, Germany.,Medical Center and Faculty of Medicine, Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg Bad Krozingen, University of Freiburg, Freiburg, Germany
| | - Peter Wieghofer
- Medical Faculty, Institute of Neuropathology, University Hospital, University of Freiburg, Freiburg im Breisgau, Germany. .,Institute of Anatomy, Leipzig University, Leipzig, Germany.
| | - Clemens Lange
- Medical Faculty, Eye Center, University Hospital, University of Freiburg, Freiburg im Breisgau, Germany.
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10
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Boneva SK, Wolf J, Rosmus DD, Schlecht A, Prinz G, Laich Y, Boeck M, Zhang P, Hilgendorf I, Stahl A, Reinhard T, Bainbridge J, Schlunck G, Agostini H, Wieghofer P, Lange CAK. Transcriptional Profiling Uncovers Human Hyalocytes as a Unique Innate Immune Cell Population. Front Immunol 2020; 11:567274. [PMID: 33042148 PMCID: PMC7517040 DOI: 10.3389/fimmu.2020.567274] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/20/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose To decipher the transcriptional signature of macrophages of the human vitreous, also known as hyalocytes, and compare it to the profiles of other myeloid cell populations including human blood-derived monocytes, macrophages, and brain microglia. Methods This study involves a total of 13 patients of advanced age with disorders of the vitreoretinal interface undergoing vitrectomy at the University Eye Hospital Freiburg between 2018 and 2019. Vitreal hyalocytes were analyzed by fluorescence-activated cell sorting (FACS) and isolated as CD45+CD11b+CX3CR1+Mat-Mac+ cells using a FACS-based sorting protocol. RNA extraction, library preparation and RNA sequencing were performed and the sequencing data was analyzed using the Galaxy web platform. The transcriptome of human hyalocytes was compared to the transcriptional profile of human blood-derived monocytes, macrophages and brain microglia obtained from public databases. Protein validation for selected factors was performed by immunohistochemistry on paraffin sections from three human donor eyes. Results On average, 383 ± 233 hyalocytes were isolated per patient, resulting in 128 pg/μl ± 76 pg/μl total RNA per sample. RNA sequencing revealed that SPP1, FTL, CD74, and HLA-DRA are among the most abundantly expressed genes in hyalocytes, which was confirmed by immunofluorescence for CD74, FTL, and HLA-DRA. Gene ontology (GO) enrichment analysis showed that biological processes such as “humoral immune response,” “leukocyte migration,” and “antigen processing and presentation of peptide antigen” (adjusted p < 0.001) are dominating in vitreal hyalocytes. While the comparison of the gene expression profiles of hyalocytes and other myeloid cell populations showed an overall strong similarity (R2 > 0.637, p < 0.001), hyalocytes demonstrated significant differences with respect to common leukocyte-associated factors. In particular, transcripts involved in the immune privilege of the eye, such as POMC, CD46, and CD86, were significantly increased in hyalocytes compared to other myeloid cell subsets. Conclusion Human hyalocytes represent a unique and distinct innate immune cell population specialized and adapted for the tissue-specific needs in the human vitreous. Vitreal hyalocytes are characterized by a strong expression of genes related to antigen processing and presentation as well as immune modulation. Thus, hyalocytes may represent an underestimated mediator in vitreoretinal disease and for the immune privilege of the eye.
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Affiliation(s)
| | - Julian Wolf
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Anja Schlecht
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gabriele Prinz
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Yannik Laich
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Myriam Boeck
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peipei Zhang
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ingo Hilgendorf
- Heart Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Andreas Stahl
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Ophthalmology, University Medical Center Greifswald, Greifswald, Germany
| | - Thomas Reinhard
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - James Bainbridge
- National Institute for Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, United Kingdom
| | - Günther Schlunck
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hansjürgen Agostini
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Clemens A K Lange
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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11
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Boeck M, Thien A, Wolf J, Hagemeyer N, Laich Y, Yusuf D, Backofen R, Zhang P, Boneva S, Stahl A, Hilgendorf I, Agostini H, Prinz M, Wieghofer P, Schlunck G, Schlecht A, Lange C. Temporospatial distribution and transcriptional profile of retinal microglia in the oxygen‐induced retinopathy mouse model. Glia 2020; 68:1859-1873. [DOI: 10.1002/glia.23810] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 02/12/2020] [Accepted: 02/19/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Myriam Boeck
- Eye Center, Medical Center, Faculty of MedicineUniversity of Freiburg Freiburg im Breisgau Germany
| | - Adrian Thien
- Eye Center, Medical Center, Faculty of MedicineUniversity of Freiburg Freiburg im Breisgau Germany
| | - Julian Wolf
- Eye Center, Medical Center, Faculty of MedicineUniversity of Freiburg Freiburg im Breisgau Germany
| | - Nora Hagemeyer
- Institute of Neuropathology, Faculty of MedicineUniversity of Freiburg Freiburg im Breisgau Germany
| | - Yannik Laich
- Eye Center, Medical Center, Faculty of MedicineUniversity of Freiburg Freiburg im Breisgau Germany
| | - Dilmurat Yusuf
- Department of BioinformaticsUniversity of Freiburg Freiburg im Breisgau Germany
| | - Rolf Backofen
- Department of BioinformaticsUniversity of Freiburg Freiburg im Breisgau Germany
| | - Peipei Zhang
- Eye Center, Medical Center, Faculty of MedicineUniversity of Freiburg Freiburg im Breisgau Germany
| | - Stefaniya Boneva
- Eye Center, Medical Center, Faculty of MedicineUniversity of Freiburg Freiburg im Breisgau Germany
| | - Andreas Stahl
- Department of OphthalmologyUniversity Medical Center Greifswald Greifswald Germany
| | - Ingo Hilgendorf
- Cardiology and AngiologyUniversity Heart Center, University of Freiburg Freiburg im Breisgau Germany
| | - Hansjürgen Agostini
- Eye Center, Medical Center, Faculty of MedicineUniversity of Freiburg Freiburg im Breisgau Germany
| | - Marco Prinz
- Institute of Neuropathology, Faculty of MedicineUniversity of Freiburg Freiburg im Breisgau Germany
- Signalling Research Centres BIOSS and CIBSSUniversity of Freiburg Freiburg im Breisgau Germany
- Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of MedicineUniversity of Freiburg Freiburg im Breisgau Germany
| | - Peter Wieghofer
- Institute of AnatomyUniversity of Leipzig Freiburg im Breisgau Germany
| | - Günther Schlunck
- Eye Center, Medical Center, Faculty of MedicineUniversity of Freiburg Freiburg im Breisgau Germany
| | - Anja Schlecht
- Eye Center, Medical Center, Faculty of MedicineUniversity of Freiburg Freiburg im Breisgau Germany
| | - Clemens Lange
- Eye Center, Medical Center, Faculty of MedicineUniversity of Freiburg Freiburg im Breisgau Germany
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