@article {863, title = {Genome-wide association meta-analysis for early age-related macular degeneration highlights novel loci and insights for advanced disease.}, journal = {BMC Med Genomics}, volume = {13}, year = {2020}, month = {2020 08 26}, pages = {120}, abstract = {

BACKGROUND: Advanced age-related macular degeneration (AMD) is a leading cause of blindness. While around half of the genetic contribution to advanced AMD has been uncovered, little is known about the genetic architecture of early AMD.

METHODS: To identify genetic factors for early AMD, we conducted a genome-wide association study (GWAS) meta-analysis (14,034 cases, 91,214 controls, 11 sources of data including the International AMD Genomics Consortium, IAMDGC, and UK Biobank, UKBB). We ascertained early AMD via color fundus photographs by manual grading for 10 sources and via an automated machine learning approach for > 170,000 photographs from UKBB. We searched for early AMD loci via GWAS and via a candidate approach based on 14 previously suggested early AMD variants.

RESULTS: Altogether, we identified 10 independent loci with statistical significance for early AMD: (i) 8 from our GWAS with genome-wide significance (P~< 5 {\texttimes} 10), (ii) one previously suggested locus with experiment-wise significance (P~< 0.05/14) in our non-overlapping data and with genome-wide significance when combining the reported and our non-overlapping data (together 17,539 cases, 105,395 controls), and (iii) one further previously suggested locus with experiment-wise significance in our non-overlapping data. Of these 10 identified loci, 8 were novel and 2 known for early AMD. Most of the 10 loci overlapped with known advanced AMD loci (near ARMS2/HTRA1, CFH, C2, C3, CETP, TNFRSF10A, VEGFA, APOE), except two that have not yet been identified with statistical significance for any AMD. Among the 17 genes within these two loci, in-silico functional annotation suggested CD46 and TYR as the most likely responsible genes. Presence or absence of an early AMD effect distinguished the known pathways of advanced AMD genetics (complement/lipid pathways versus extracellular matrix metabolism).

CONCLUSIONS: Our GWAS on early AMD identified novel loci, highlighted shared and distinct genetics between early and advanced AMD and provides insights into AMD etiology. Our data provide a resource comparable in size to the existing IAMDGC data on advanced AMD genetics enabling a joint view. The biological relevance of this joint view is underscored by the ability of early AMD effects to differentiate the major pathways for advanced AMD.

}, keywords = {Case-Control Studies, Genetic Loci, Genetic Markers, Genetic Predisposition to Disease, Genome-Wide Association Study, Humans, Macular Degeneration, Polymorphism, Single Nucleotide}, issn = {1755-8794}, doi = {10.1186/s12920-020-00760-7}, author = {Winkler, Thomas W and Grassmann, Felix and Brandl, Caroline and Kiel, Christina and G{\"u}nther, Felix and Strunz, Tobias and Weidner, Lorraine and Zimmermann, Martina E and Korb, Christina A and Poplawski, Alicia and Schuster, Alexander K and M{\"u}ller-Nurasyid, Martina and Peters, Annette and Rauscher, Franziska G and Elze, Tobias and Horn, Katrin and Scholz, Markus and Ca{\~n}adas-Garre, Marisa and McKnight, Amy Jayne and Quinn, Nicola and Hogg, Ruth E and K{\"u}chenhoff, Helmut and Heid, Iris M and Stark, Klaus J and Weber, Bernhard H F} } @article {735, title = {Detailed genetic characteristics of an international large cohort of patients with Stargardt disease: ProgStar study report 8.}, journal = {Br J Ophthalmol}, volume = {103}, year = {2019}, month = {2019 03}, pages = {390-397}, abstract = {

BACKGROUND/AIMS: To describe the genetic characteristics of the cohort enrolled in the international multicentre progression of Stargardt disease~1 (STGD1) studies (ProgStar) and to~determine geographic differences based on the allele frequency.

METHODS: 345 participants with a clinical diagnosis of STGD1 and harbouring at least one disease-causing ABCA4 variant were enrolled from 9 centres in the USA and Europe. All variants were reviewed and analysis was performed including allele frequency in public databases and pathogenicity predictions. Participants with multiple likely pathogenic variants were classified into four national subgroups (USA, UK, France, Germany), with subsequent comparison analysis of the allele frequency for each prevalent allele.

RESULTS: 211 likely pathogenic variants were identified in the total cohort, including missense (63\%), splice site alteration (18\%), stop (9\%) and others. 50 variants were novel. Exclusively missense variants were detected in 139 (50\%) of 279 patients with multiple pathogenic variants. The three most prevalent variants of these patients with multiple pathogenic variants were p.G1961E (15\%), p.G863A (7\%)~and~c.5461-10 T>C (5\%). Subgroup analysis revealed a statistically significant difference between the four recruiting nations in the allele frequency of nine variants.

CONCLUSIONS: There is a large spectrum of ABCA4 sequence variants, including 50 novel variants, in a well-characterised cohort thereby further adding to the unique allelic heterogeneity in STGD1. Approximately half of the cohort harbours missense variants only, indicating a relatively mild phenotype of the ProgStar cohort. There are significant differences in allele frequencies between nations, although the three most prevalent variants are shared as frequent variants.

}, keywords = {Adolescent, Adult, Age of Onset, Aged, ATP-Binding Cassette Transporters, Child, Child, Preschool, Cohort Studies, Databases, Factual, DNA Mutational Analysis, Female, Gene Frequency, Genotyping Techniques, Geography, Humans, Internationality, Macular Degeneration, Male, Middle Aged, Mutation, Polymerase Chain Reaction}, issn = {1468-2079}, doi = {10.1136/bjophthalmol-2018-312064}, author = {Fujinami, Kaoru and Strauss, Rupert W and Chiang, John Pei-Wen and Audo, Isabelle S and Bernstein, Paul S and Birch, David G and Bomotti, Samantha M and Cideciyan, Artur V and Ervin, Ann-Margret and Marino, Meghan J and Sahel, Jos{\'e}-Alain and Mohand-Said, Saddek and Sunness, Janet S and Traboulsi, Elias I and West, Sheila and Wojciechowski, Robert and Zrenner, Eberhart and Michaelides, Michel and Scholl, Hendrik P N} } @article {118, title = {Assessment of estimated retinal atrophy progression in Stargardt macular dystrophy using spectral-domain optical coherence tomography.}, journal = {Br J Ophthalmol}, volume = {100}, year = {2016}, month = {2016 Jul}, pages = {956-962}, abstract = {

AIMS: To estimate disease progression based on analysis of macular volume measured by spectral-domain optical coherence tomography (SD-OCT) in patients affected by Stargardt macular dystrophy (STGD1) and to evaluate the influence of software errors on these measurements.

METHODS: 58 eyes of 29 STGD1 patients were included. Numbers and types of algorithm errors were recorded and manually corrected. In a subgroup of 36 eyes of 18 patients with at least two examinations over time, total macular volume (TMV) and volumes of all nine Early Treatment of Diabetic Retinopathy Study (ETDRS) subfields were obtained. Random effects models were used to estimate the rate of change per year for the population, and empirical Bayes slopes were used to estimate yearly decline in TMV for individual eyes.

RESULTS: 6958 single B-scans from 190 macular cube scans were analysed. 2360 (33.9\%) showed algorithm errors. Mean observation period for follow-up data was 15 months (range 3-40). The median (IQR) change in TMV using the empirical Bayes estimates for the individual eyes was -0.103 (-0.145, -0.059) mm per year. The mean ({\textpm}SD) TMV was 6.321{\textpm}1.000 mm at baseline, and rate of decline was -0.118 mm per year (p=0.003). Yearly mean volume change was -0.004 mm in the central subfield (mean baseline=0.128 mm), -0.032 mm in the inner (mean baseline=1.484 mm) and -0.079 mm in the outer ETDRS subfields (mean baseline=5.206 mm).

CONCLUSIONS: SD-OCT measurements allow monitoring the decline in retinal volume in STGD1; however, they require significant manual correction of software errors.

}, keywords = {Adolescent, Adult, Aged, Child, Disease Progression, Female, Humans, Macula Lutea, Macular Degeneration, Male, Middle Aged, Reproducibility of Results, Retrospective Studies, Tomography, Optical Coherence, Visual Acuity, Young Adult}, issn = {1468-2079}, doi = {10.1136/bjophthalmol-2015-307035}, author = {Strauss, Rupert W and Mu{\~n}oz, Beatriz and Wolfson, Yulia and Sophie, Raafay and Fletcher, Emily and Bittencourt, Millena G and Scholl, Hendrik P N} } @article {48, title = {Comparison of Short-Wavelength Reduced-Illuminance and Conventional Autofluorescence Imaging in Stargardt Macular Dystrophy.}, journal = {Am J Ophthalmol}, volume = {168}, year = {2016}, month = {2016 Aug}, pages = {269-278}, abstract = {

PURPOSE: To compare grading results between short-wavelength reduced-illuminance and conventional autofluorescence imaging in Stargardt macular dystrophy.

DESIGN: Reliability study.

METHODS: setting: Moorfields Eye Hospital, London (United Kingdom).

PATIENTS: Eighteen patients (18 eyes) with Stargardt macular dystrophy.

OBSERVATION PROCEDURES: A series of 3 fundus autofluorescence images using 3 different acquisition parameters on a custom-patched device were obtained: (1) 25\% laser power and total sensitivity 87; (2) 25\% laser power and freely adjusted sensitivity; and (3) 100\% laser power and freely adjusted total sensitivity (conventional). The total area of 2 hypoautofluorescent lesion types (definitely decreased autofluorescence and poorly demarcated questionably decreased autofluorescence) was measured.

MAIN OUTCOME MEASURES: Agreement in grading between the 3 imaging methods was assessed by kappa coefficients (κ) and intraclass correlation coefficients.

RESULTS: The mean {\textpm} standard deviation area for images acquired with 25\% laser power and freely adjusted total sensitivity was 2.04 {\textpm} 1.87~mm(2) for definitely decreased autofluorescence (n~= 15) and 1.86 {\textpm} 2.14~mm(2) for poorly demarcated questionably decreased autofluorescence (n~= 12). The intraclass correlation coefficient (95\% confidence interval) was 0.964 (0.929, 0.999) for definitely decreased autofluorescence and 0.268 (0.000, 0.730) for poorly demarcated questionably decreased autofluorescence.

CONCLUSIONS: Short-wavelength reduced-illuminance and conventional fundus autofluorescence imaging showed good concordance in assessing areas of definitely decreased autofluorescence. However, there was significantly higher variability between imaging modalities for assessing areas~of poorly demarcated questionably decreased autofluorescence.

}, keywords = {Adult, Female, Fluorescein Angiography, Fundus Oculi, Humans, Macula Lutea, Macular Degeneration, Male, Middle Aged, Ophthalmoscopy, Optical Imaging, Reproducibility of Results, Stargardt Disease}, issn = {1879-1891}, doi = {10.1016/j.ajo.2016.06.003}, author = {Strauss, Rupert W and Mu{\~n}oz, Beatriz and Jha, Anamika and Ho, Alexander and Cideciyan, Artur V and Kasilian, Melissa L and Wolfson, Yulia and Sadda, SriniVas and West, Sheila and Scholl, Hendrik P N and Michaelides, Michel} } @article {344, title = {Complex inheritance of ABCA4 disease: four mutations in a family with multiple macular phenotypes.}, journal = {Hum Genet}, volume = {135}, year = {2016}, month = {2016 Jan}, pages = {9-19}, abstract = {

Over 800 mutations in the ABCA4 gene cause autosomal recessive Stargardt disease. Due to extensive genetic heterogeneity, observed variant-associated phenotypes can manifest tremendous variability of expression. Furthermore, the high carrier frequency of pathogenic ABCA4 alleles in the general population (~1:20) often results in pseudo-dominant inheritance patterns further complicating the diagnosis and characterization of affected individuals. This study describes a genotype/phenotype analysis of an unusual family with multiple macular disease phenotypes spanning across two generations and segregating four distinct ABCA4 mutant alleles. Complete sequencing of ABCA4 discovered two known missense mutations, p.C54Y and p.G1961E. Array comparative genomic hybridization revealed a large novel deletion combined with a small insertion, c.6148-698_c.6670del/insTGTGCACCTCCCTAG, and complete sequencing of the entire ABCA4 genomic locus uncovered a new deep intronic variant, c.302+68C>T. Patients with the p.G1961E mutation had the mildest, confined maculopathy phenotype with peripheral flecks while those with all other mutant allele combinations exhibited a more advanced stage of generalized retinal and choriocapillaris atrophy. This family epitomizes the clinical and genetic complexity of ABCA4-associated diseases. It contained variants from all classes of mutations, in the coding region, deep intronic, both single nucleotide variants and copy number variants that accounted for varying phenotypes segregating in an apparent dominant fashion. Unequivocally defining disease-associated alleles in the ABCA4 locus requires a multifaceted approach that includes advanced mutation detection methods and a thorough analysis of clinical phenotypes.

}, keywords = {Adult, Aged, ATP-Binding Cassette Transporters, Comparative Genomic Hybridization, DNA Copy Number Variations, Electroretinography, Female, High-Throughput Nucleotide Sequencing, Humans, Macula Lutea, Macular Degeneration, Male, Middle Aged, Mutation, Pedigree, Phenotype}, issn = {1432-1203}, doi = {10.1007/s00439-015-1605-y}, author = {Lee, Winston and Xie, Yajing and Zernant, Jana and Yuan, Bo and Bearelly, Srilaxmi and Tsang, Stephen H and Lupski, James R and Allikmets, Rando} } @article {192, title = {Whole Exome Sequencing Identifies an Adult-Onset Case of Methylmalonic Aciduria and Homocystinuria Type C (cblC) with Non-Syndromic Bull{\textquoteright}s Eye Maculopathy.}, journal = {Ophthalmic Genet}, volume = {36}, year = {2015}, month = {2015}, pages = {270-5}, abstract = {

BACKGROUND: Methylmalonic aciduria and homocystinuria type C (cblC), a disorder of vitamin B12 (cobalamin) metabolism caused by mutations in the MMACHC gene, presents with many systemic symptoms, including neurological, cognitive, psychiatric, and thromboembolic events. Retinal phenotypes, including maculopathy, pigmentary retinopathy, and optic atrophy are common in early onset form of the disease but are rare in adult onset forms.

MATERIALS AND METHODS: An adult Hispanic female presented with decreased central vision, bilateral pericentral ring scotomas and bull{\textquoteright}s eye-appearing macular lesions at 28 years of age. Her medical history was otherwise unremarkable except for iron deficiency anemia and both urinary tract and kidney infections. Screening of the ABCA4 gene, mutations in which frequently cause bull{\textquoteright}s eye maculopathy, was negative. Subsequently, analysis with whole exome sequencing was performed.

RESULTS: Whole exome sequencing discovered compound heterozygous mutations in MMACHC, c.G482A:p.Arg161Gln and c.270_271insA:p.Arg91Lysfs*14, which segregated with the disease in the family. The genetic diagnosis was confirmed by biochemical laboratory testing, showing highly elevated urine methylmalonic acid/creatinine and homocysteine levels, and suggesting disease management with hydroxycobalamin injections and carnitine supplementation.

CONCLUSIONS: In summary, a unique case of an adult patient with bull{\textquoteright}s eye macular lesions and no clinically relevant systemic symptoms was diagnosed with cblC by genetic screening and follow-up biochemical laboratory tests.

}, keywords = {Adult, Carrier Proteins, Electroretinography, Exome, Female, Genetic Testing, Heterozygote, Homocystinuria, Humans, Macular Degeneration, Mutation, Pedigree, Scotoma, Sequence Analysis, DNA, Tomography, Optical Coherence, Visual Acuity, Visual Fields, Vitamin B 12, Vitamin B 12 Deficiency, Vitamin B Complex}, issn = {1744-5094}, doi = {10.3109/13816810.2015.1010736}, author = {Collison, Frederick T and Xie, Yajing Angela and Gambin, Tomasz and Jhangiani, Shalini and Muzny, Donna and Gibbs, Richard and Lupski, James R and Fishman, Gerald A and Allikmets, Rando} }