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Li B, Goss D, Miller JW, Lin JB, Vavvas DG. Systemic Dyslipidemia in Age-related Macular Degeneration: An Updated Systematic Review and Meta-analysis. OPHTHALMOLOGY SCIENCE 2024; 4:100341. [PMID: 37869027 PMCID: PMC10587641 DOI: 10.1016/j.xops.2023.100341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/09/2023] [Accepted: 05/24/2023] [Indexed: 10/24/2023]
Abstract
Topic Though lipid and cholesterol dyshomeostasis is thought to contribute to the pathogenesis of age-related macular degeneration (AMD), there is no consensus regarding which elements of systemic lipid homeostasis are perturbed in AMD. In this systematic review and meta-analysis, an update to that performed by Wang et al in 2016, we characterized serum lipoprotein profiles in patients with AMD and its various stages. Clinical Relevance These findings may identify novel therapeutic approaches for AMD, a leading cause of blindness among older adults in the industrialized world. Methods We used MEDLINE, Embase, and Web of Science to identify articles from database inception to May 2022 that reported blood/serum levels of lipid subspecies (triglycerides [TGs], total cholesterol [TC], low-density lipoprotein [LDL], and high-density lipoprotein [HDL]) in patients with AMD compared with controls. We meta-analyzed the data by generating multilevel random-effects models using restricted maximum likelihood estimation. Results Our updated meta-analysis included 56 studies, almost 3 times as many studies as the 2016 meta-analysis with a total of 308 188 participants. There were no significant differences in serum TG, TC, LDL, or HDL between patients with AMD and non-AMD controls. Given significant heterogeneity, we performed subanalyses specifically in patients with early to intermediate nonexudative AMD, advanced nonexudative AMD, and advanced exudative AMD. Compared with non-AMD controls, patients with early to intermediate nonexudative AMD had significantly lower serum TG (standardized mean difference [SMD]: -0.03; 95% confidence interval [95% CI]: -0.06 to -0.01) and higher serum HDL (SMD: 0.07; 95% CI: 0.04-0.11). Patients with advanced exudative AMD had significantly higher serum LDL (SMD: 0.33; 95% CI: 0.04-0.62) compared with non-AMD controls. There were no other significant differences identified. Conclusion We found that there is significant heterogeneity in systemic lipoproteins in patients with AMD compared with non-AMD controls. The specific pattern of lipid dyshomeostasis appeared to be distinct based on AMD stage. These findings highlight both the underlying heterogeneity of AMD as well as the presence of distinct pathophysiological mechanisms involved at different stages or subtypes of AMD and may inform the development of novel therapeutic approaches. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Brandon Li
- Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Deborah Goss
- Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts
| | - Joan W. Miller
- Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts
| | - Jonathan B. Lin
- Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts
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Ioakeimidis N, Gourgouli I, Terentes-Printzios D, Gourgouli DM, Georgakopoulos C, Aznaouridis K, Spai S, Tousoulis D, Tsioufis K, Vlachopoulos C. Aortic stiffness and systemic inflammation changes predict clinical response to intravitreal anti-vascular endothelial growth factor therapy in patients with age-related macular degeneration. J Hum Hypertens 2023; 37:273-278. [PMID: 35474138 DOI: 10.1038/s41371-022-00689-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 08/06/2021] [Accepted: 03/30/2022] [Indexed: 11/09/2022]
Abstract
Aortic stiffness and systemic inflammation are predictors of cardiovascular risk. Anti-vascular endothelial growth factor agents (anti-VEGF), injected intravitreally, can reverse the course of exudate age-related macular degeneration (AMD). We sought to investigate the association of changes in aortic stiffness and systemic inflammation with response to anti-VEGF therapy. 54 patients (mean age: 76 ± 10 years) with AMD received two consecutive monthly intravitreal injections of ranibizumab (0.5 mg). The primary outcome measure was change in carotid-femoral pulse wave velocity (PWV) from baseline to 1 month after the second injection. Secondary endpoint was the change in serum high sensitivity interleukin-6 (hsIL-6) levels. Ranibizumab caused a decrease of PWV after the first (by 0.36 ± 1.4 m/s) and the second injection (by 0.31 ± 1.4 m/s) and remained decreased 1 month after the second injection (overall P < 0.05). PWV decreased significantly in good responders (according to clinical criteria and fundus findings, P = 0.004), whereas it increased numerically in poor responders (P = 0.21) over the study period. In responders, hsIL-6 decreased after the first injection and remained decreased 1 month after the second injection (by 0.63 ± 0.35 pg/ml, overall P = 0.02). PWV (P = 0.005) and hsIL-6 (P = 0.042) were independent predictors of improvement after adjusting for age and presence of hypertension and diabetes. The decrease in PWV through the whole study period was positively correlated with the reduction in hsIL-6 (r = 0.36, P < 0.01). Intravitreal ranibizumab injections lead to a decrease in PWV and hsIL-6. Both parameters predict clinical improvement and may aid to improving treatment targeting and hence therapeutic outcome in patients with AMD.
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Affiliation(s)
- Nikolaos Ioakeimidis
- Hypertension and Cardiometabolic Syndrome Unit 1st Cardiology Department, Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Ioanna Gourgouli
- Ophthalmology Department, General Hospital of Athens "Sismanoglio-Amalia Fleming", Athens, Greece
| | - Dimitrios Terentes-Printzios
- Hypertension and Cardiometabolic Syndrome Unit 1st Cardiology Department, Athens Medical School, Hippokration Hospital, Athens, Greece
| | | | - Christos Georgakopoulos
- Hypertension and Cardiometabolic Syndrome Unit 1st Cardiology Department, Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Konstantinos Aznaouridis
- Hypertension and Cardiometabolic Syndrome Unit 1st Cardiology Department, Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Sofia Spai
- Ophthalmology Department, General Hospital of Athens "Sismanoglio-Amalia Fleming", Athens, Greece
| | - Dimitris Tousoulis
- Hypertension and Cardiometabolic Syndrome Unit 1st Cardiology Department, Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Konstantinos Tsioufis
- Hypertension and Cardiometabolic Syndrome Unit 1st Cardiology Department, Athens Medical School, Hippokration Hospital, Athens, Greece
| | - Charalambos Vlachopoulos
- Hypertension and Cardiometabolic Syndrome Unit 1st Cardiology Department, Athens Medical School, Hippokration Hospital, Athens, Greece.
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Baltu F, Sarici AM, Yildirim O, Mergen B, Bolat E. Investigation of vascular endothelial dysfunction in the patients with age-related macular degeneration. Cutan Ocul Toxicol 2018; 38:29-35. [PMID: 30037291 DOI: 10.1080/15569527.2018.1504056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE This study aims to evaluate the association between age-related macular degeneration (AMD) and cardiovascular disease by using the noninvasive flow-mediated dilation (FMD) test to show endothelial dysfunction as an indicator of subclinical atherosclerosis. METHOD Participants in this study included 30 dry AMD patients, 30 wet AMD patients, and 30 healthy controls without any systemic disease, including AMD. FMD and the intima media thickness (IMT) of the carotid artery were compared between the groups. RESULTS Comparison of FMD between the groups showed a 10.96% brachial artery dilation in the healthy controls, 3.99% in the dry AMD group, and 5.03% in the wet AMD group. While a significant difference was not observed between the wet and dry AMD groups, comparison of the control group to the wet and dry AMD groups yielded a significant difference. When brachial artery dilation below 7% was accepted as an abnormal FMD, 26.7% of the healthy controls, 66.7% of the dry AMD patients and 76.7% of the wet AMD patients were found to be abnormal. Similarly, while no significant difference was observed between the wet and dry AMD groups, comparison of the control group with the wet and dry AMD patients yielded a significant difference. When an IMT below 0.7 mm was accepted as abnormal, 26.7% of the healthy controls, 33.3% of the dry AMD, and 43.3% of the wet AMD were found to have an abnormal IMT. However, differences between the groups did not reach statistical significance. CONCLUSIONS In this study, use of the FMD test showed endothelial dysfunction among AMD patients. No significant differences were found between the dry and wet AMD patient groups.
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Affiliation(s)
- Fatih Baltu
- a Cerrahpasa Medical Faculty, Department of Ophthalmology , Istanbul University , Istanbul , Turkey
| | - Ahmet Murat Sarici
- a Cerrahpasa Medical Faculty, Department of Ophthalmology , Istanbul University , Istanbul , Turkey
| | - Onur Yildirim
- b Cerrahpasa Medical Faculty, Department of Radiology , Istanbul University , Istanbul , Turkey
| | - Burak Mergen
- a Cerrahpasa Medical Faculty, Department of Ophthalmology , Istanbul University , Istanbul , Turkey
| | - Erkut Bolat
- c Cerrahpasa Medical Faculty, Department of Biostatistics and Medical Informatics , Istanbul University , Istanbul , Turkey
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Abstract
PURPOSE To investigate the relationship between metabolic syndrome (MetS) and its components with the risk of early- and late-stage age-related macular degeneration (AMD). METHODS A prospective cohort of individuals aged older than or equal to 49 years were followed up over a period of 10 years in the Blue Mountains Eye Study, Australia. MetS components were measured at baseline (1992-1994), 5-year (1997-1999), and 10-year (2002-2004) follow-ups. Incident cases of early and late AMD were diagnosed using standard photographic grading of retinal images of 2,218 participants at risk. Mixed-effect logistic regression was conducted to explore the relationship between MetS (and its components) with subsequent development of early/late AMD. RESULTS Over the 10-year follow-up, early AMD developed in 12% and late AMD in 3% of participants at risk. Amongst subjects aged younger than or equal to 70 years, MetS was associated with the incidence of late AMD. Of the five MetS components, obesity, high glucose, and high triglyceride were associated with the increased incidence of late AMD during the 10-year follow-up. There was no evidence of effect of MetS and its components on the risk of early AMD. CONCLUSION Metabolic syndrome, obesity, high glucose, and high triglycerides were predictors of progression to late AMD. These data provide additional insights into the pathogenesis of AMD.
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Lyck Hansen M, Beck HC, Irmukhamedov A, Jensen PS, Olsen MH, Rasmussen LM. Proteome analysis of human arterial tissue discloses associations between the vascular content of small leucine-rich repeat proteoglycans and pulse wave velocity. Arterioscler Thromb Vasc Biol 2015; 35:1896-903. [PMID: 26069235 DOI: 10.1161/atvbaha.114.304706] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 05/26/2015] [Indexed: 01/23/2023]
Abstract
OBJECTIVES We hypothesized that arterial stiffness is associated with changes in the arterial protein profile, particularly of extracellular matrix components. We aimed at determining differentially expressed proteins by quantitative proteome analysis in arterial tissue from patients with different degrees of arterial stiffness. APPROACH AND RESULTS Arterial stiffness, assessed by carotid-femoral pulse wave velocity (PWV), central blood pressure and augmentation index by pulse wave analysis were measured the day before surgery in a group of patients undergoing coronary artery bypass grafting. Protein extracts of well-defined, homogenous, nonatherosclerotic individual samples of the left mammary artery from 10 of these patients with high PWV and 9 with low PWV were compared by quantitative proteome analysis, using tandem mass tag labeling and nano-liquid chromatography mass spectrometry/mass spectrometry. Of 418 quantified proteins, 28 were differentially expressed between the groups with high and low PWV (P<0.05). Three of 7 members of the extracellular matrix family of small leucine-rich repeat proteoglycans displayed significant differences between the 2 groups (P=0.0079; Fisher exact test). Three other ECM proteins were differentially regulated, that is, collagen, type VIII, α-1 and α-2 and collagen, type IV, α-1. Several proteins related to smooth muscle cell function and structure were also found in different amounts between the 2 groups. CONCLUSIONS Changes in the arterial amounts of small leucine-rich proteoglycans, known to be involved in collagen fibrillogenesis, and of some nonfibrillar collagens in combination with alterations in proteins related to functions of the human arterial smooth muscle are associated with arterial stiffness, as determined by PWV.
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Affiliation(s)
- Maria Lyck Hansen
- From the Department of Clinical Biochemistry and Pharmacology (M.L.H., H.C.B., P.S.J., L.M.R.), Centre of Individualized Medicine In Arterial Diseases (CIMA) (M.L.H., H.C.B., P.S.J., M.H.O., L.M.R.), Department of Cardiothoracic and Vascular Surgery (A.I.), Centre for Clinical Proteomics (H.C.B.), and The Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology Denmark (M.H.O.), Odense University Hospital, Odense, Denmark.
| | - Hans Christian Beck
- From the Department of Clinical Biochemistry and Pharmacology (M.L.H., H.C.B., P.S.J., L.M.R.), Centre of Individualized Medicine In Arterial Diseases (CIMA) (M.L.H., H.C.B., P.S.J., M.H.O., L.M.R.), Department of Cardiothoracic and Vascular Surgery (A.I.), Centre for Clinical Proteomics (H.C.B.), and The Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology Denmark (M.H.O.), Odense University Hospital, Odense, Denmark
| | - Akhmadjon Irmukhamedov
- From the Department of Clinical Biochemistry and Pharmacology (M.L.H., H.C.B., P.S.J., L.M.R.), Centre of Individualized Medicine In Arterial Diseases (CIMA) (M.L.H., H.C.B., P.S.J., M.H.O., L.M.R.), Department of Cardiothoracic and Vascular Surgery (A.I.), Centre for Clinical Proteomics (H.C.B.), and The Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology Denmark (M.H.O.), Odense University Hospital, Odense, Denmark
| | - Pia Søndergaard Jensen
- From the Department of Clinical Biochemistry and Pharmacology (M.L.H., H.C.B., P.S.J., L.M.R.), Centre of Individualized Medicine In Arterial Diseases (CIMA) (M.L.H., H.C.B., P.S.J., M.H.O., L.M.R.), Department of Cardiothoracic and Vascular Surgery (A.I.), Centre for Clinical Proteomics (H.C.B.), and The Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology Denmark (M.H.O.), Odense University Hospital, Odense, Denmark
| | - Michael Hecht Olsen
- From the Department of Clinical Biochemistry and Pharmacology (M.L.H., H.C.B., P.S.J., L.M.R.), Centre of Individualized Medicine In Arterial Diseases (CIMA) (M.L.H., H.C.B., P.S.J., M.H.O., L.M.R.), Department of Cardiothoracic and Vascular Surgery (A.I.), Centre for Clinical Proteomics (H.C.B.), and The Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology Denmark (M.H.O.), Odense University Hospital, Odense, Denmark
| | - Lars Melholt Rasmussen
- From the Department of Clinical Biochemistry and Pharmacology (M.L.H., H.C.B., P.S.J., L.M.R.), Centre of Individualized Medicine In Arterial Diseases (CIMA) (M.L.H., H.C.B., P.S.J., M.H.O., L.M.R.), Department of Cardiothoracic and Vascular Surgery (A.I.), Centre for Clinical Proteomics (H.C.B.), and The Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology Denmark (M.H.O.), Odense University Hospital, Odense, Denmark
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Effects of co-administration of candesartan with pioglitazone on inflammatory parameters in hypertensive patients with type 2 diabetes mellitus: a preliminary report. Cardiovasc Diabetol 2013; 12:71. [PMID: 23635096 PMCID: PMC3663745 DOI: 10.1186/1475-2840-12-71] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 04/19/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Angiotensin receptor blockers (ARBs) are reported to provide direct protection to many organs by controlling inflammation and decreasing oxidant stress. Pioglitazone, an anti-diabetic agent that improves insulin resistance, was also reported to decrease inflammation and protect against atherosclerosis. This study aimed to evaluate the utility of combination therapy with both medicines from the viewpoint of anti-inflammatory effects. METHODS We administered candesartan (12 mg daily) and pioglitazone (15 mg daily) simultaneously for 6 months to hypertensive patients with type 2 diabetes mellitus (T2DM) and evaluated whether there were improvements in the serum inflammatory parameters of high-molecular-weight adiponectin (HMW-ADN), plasminogen activator inhibitor-1 (PAI-1), highly sensitive C-reactive protein (Hs-CRP), vascular cell adhesion molecule-1 (VCAM-1), and urinary-8-hydroxydeoxyguanosine (U-8-OHdG). We then analyzed the relationship between the degree of reductions in blood pressure and HbA1c values and improvements in inflammatory factors. Furthermore, we analyzed the relationship between pulse pressure and the degree of lowering of HbA1c and improvements in inflammatory factors. Finally, we examined predictive factors in patients who received benefits from the co-administration of candesartan with pioglitazone from the viewpoint of inflammatory factors. RESULTS After 6 months of treatment, in all patients significant improvements from baseline values were observed in HMW-ADN and PAI-1 but not in VCAM-1, Hs-CRP, and U-8-OHdG. Changes in HbA1c were significantly correlated with changes in HMW-ADN and PAI-1 in all patients, but changes in blood pressure were not correlated with any of the parameters examined. Correlation and multilinear regression analyses were performed to determine which factors could best predict changes in HbA1c. Interestingly, we found a significant positive correlation of pulse pressure values at baseline with changes in HbA1c. CONCLUSIONS Our data suggest that the pulse pressure value at baseline is a key predictive factor of changes in HbA1c. Co-administration of candesartan with pioglitazone, which have anti-inflammatory (changes in HMW-ADN and PAI-1) effects and protective effects on organs, could be an effective therapeutic strategy for treating hypertensive patients with type 2 diabetes mellitus. TRIAL REGISTRATION UMIN-CTR: UMIN000010142.
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Klein R, Cruickshanks KJ, Myers CE, Sivakumaran TA, Iyengar SK, Meuer SM, Schubert CR, Gangnon RE, Klein BEK. The relationship of atherosclerosis to the 10-year cumulative incidence of age-related macular degeneration: the Beaver Dam studies. Ophthalmology 2013; 120:1012-9. [PMID: 23399375 DOI: 10.1016/j.ophtha.2012.11.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 10/30/2012] [Accepted: 11/02/2012] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To describe the relationships of intima-media thickness (IMT), plaque in the carotid artery, angina, myocardial infarction (MI), and stroke to the 10-year cumulative incidence of early and late age-related macular degeneration (AMD) and progression of AMD. DESIGN Cohort study. PARTICIPANTS A total of 1700 persons aged 53 to 96 years who participated in both the Epidemiology of Hearing Loss Study and the Beaver Dam Eye Study in 1998-2000, with photographs gradable for AMD at 5-year (2003-2005) and 10-year (2008-2010) follow-up examinations. METHODS The IMT and presence of plaque were assessed using B-mode ultrasonography of the carotid artery. Presence of angina, MI, and stroke were defined on the basis of a self-reported history of physician diagnosis. The presence and severity of AMD were determined by systematic grading of stereoscopic color fundus photographs. MAIN OUTCOME MEASURES Age-related macular degeneration. RESULTS The 10-year cumulative incidence of early AMD was 15.7%, and the 10-year cumulative incidence of late AMD was 4.0%. After adjusting for age, sex, body mass index, smoking status, age-related maculopathy susceptibility 2 (ARMS2) and complement factor H (CFH) genotypes, and other factors, mean IMT was associated with the 10-year incidence of early AMD (odds ratio [OR] per 0.1 mm IMT, 1.11; 95% confidence interval [CI], 1.00-1.21; P = 0.03) and late AMD (OR per 0.1 mm IMT, 1.27; CI, 1.10-1.47; P = 0.001). Mean IMT was associated with the 10-year incidence of pure geographic atrophy (OR per 0.1 mm IMT, 1.31; CI, 1.05-1.64; P = 0.02) but not exudative AMD (OR per 0.1 mm IMT, 1.14; CI, 0.97-1.34; P = 0.11). Similar associations were found for maximum IMT. The number of sites with plaque was related to the incidence of late AMD (OR per 0.1 mm IMT, 2.79 for 4-6 sites vs. none; CI, 1.06-7.37; P = 0.04) but not to early AMD. A history of angina, MI, or stroke was not related to any incident AMD outcome. CONCLUSIONS In these population-based data, carotid artery IMT and carotid plaques had a weak relationship to the incidence of late AMD that was independent of systemic and genetic risk factors. Angina, MI, and stroke were not related to AMD. It is unclear whether the carotid IMT is a risk indicator of processes affecting Bruch's membrane and the retinal pigment epithelium, or a measure of atherosclerosis affecting susceptibility to AMD. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Ronald Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53726, USA.
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Yin L, Shi Y, Liu X, Zhang H, Gong Y, Gu Q, Wu X, Xu X. A Rat Model for Studying the Biological Effects of Circulating LDL in the Choriocapillaris-BrM-RPE Complex. THE AMERICAN JOURNAL OF PATHOLOGY 2012; 180:541-9. [DOI: 10.1016/j.ajpath.2011.10.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 10/11/2011] [Accepted: 10/13/2011] [Indexed: 10/15/2022]
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Feehan M, Hartman J, Durante R, Morrison MA, Miller JW, Kim IK, DeAngelis MM. Identifying subtypes of patients with neovascular age-related macular degeneration by genotypic and cardiovascular risk characteristics. BMC MEDICAL GENETICS 2011; 12:83. [PMID: 21682878 PMCID: PMC3141628 DOI: 10.1186/1471-2350-12-83] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 06/17/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND One of the challenges in the interpretation of studies showing associations between environmental and genotypic data with disease outcomes such as neovascular age-related macular degeneration (AMD) is understanding the phenotypic heterogeneity within a patient population with regard to any risk factor associated with the condition. This is critical when considering the potential therapeutic response of patients to any drug developed to treat the condition. In the present study, we identify patient subtypes or clusters which could represent several different targets for treatment development, based on genetic pathways in AMD and cardiovascular pathology. METHODS We identified a sample of patients with neovascular AMD, that in previous studies had been shown to be at elevated risk for the disease through environmental factors such as cigarette smoking and genetic variants including the complement factor H gene (CFH) on chromosome 1q25 and variants in the ARMS2/HtrA serine peptidase 1 (HTRA1) gene(s) on chromosome 10q26. We conducted a multivariate segmentation analysis of 253 of these patients utilizing available epidemiologic and genetic data. RESULTS In a multivariate model, cigarette smoking failed to differentiate subtypes of patients. However, four meaningfully distinct clusters of patients were identified that were most strongly differentiated by their cardiovascular health status (histories of hypercholesterolemia and hypertension), and the alleles of ARMS2/HTRA1 rs1049331. CONCLUSIONS These results have significant personalized medicine implications for drug developers attempting to determine the effective size of the treatable neovascular AMD population. Patient subtypes or clusters may represent different targets for therapeutic development based on genetic pathways in AMD and cardiovascular pathology, and treatments developed that may elevate CV risk, may be ill advised for certain of the clusters identified.
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Affiliation(s)
- Michael Feehan
- Observant LLC, 1601 Trapelo Road, Waltham, MA, 02451, USA
| | - John Hartman
- Observant LLC, 1601 Trapelo Road, Waltham, MA, 02451, USA
| | | | - Margaux A Morrison
- Ocular Molecular Genetics Institute and the Retina Service, Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA
- 3 Ophthalmology and Visual Sciences, University of Utah, Moran Eye Center, 65 Mario Capecchi Drive, Salt Lake City, UT, 84132, USA
| | - Joan W Miller
- Ocular Molecular Genetics Institute and the Retina Service, Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA
| | - Ivana K Kim
- Ocular Molecular Genetics Institute and the Retina Service, Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA
| | - Margaret M DeAngelis
- Ocular Molecular Genetics Institute and the Retina Service, Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA
- 3 Ophthalmology and Visual Sciences, University of Utah, Moran Eye Center, 65 Mario Capecchi Drive, Salt Lake City, UT, 84132, USA
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C-reactive protein levels and complement factor H polymorphism interaction in age-related macular degeneration and its progression. Ophthalmology 2010; 117:1982-8. [PMID: 20605213 DOI: 10.1016/j.ophtha.2010.02.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 12/28/2009] [Accepted: 02/02/2010] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To determine the effect of elevated level of C-reactive protein (CRP) and its joint effect with the complement factor H (CFH) polymorphism on prevalent age-related macular degeneration (AMD) and its progression. DESIGN Two-arm case-control study: (a) Study on prevalent AMD cases and population-based controls; (b) longitudinal study on AMD progression, comparing those in whom AMD progressed with those with no progression. PARTICIPANTS (a) A cross-sectional sample of 544 participants, of whom 312 had features of early or late AMD and 232 were controls; (b) a sample of 254 early AMD cases, followed for 7 years. METHODS The study was conducted in Melbourne, Australia. Macular stereo photographs were graded for AMD according to the International Classification and Grading System. High-sensitivity CRP was measured in fresh serum, and genotyping was performed through the Australian Genome Research Facility. The association of CRP with outcomes was tested using multivariate logistic regression analysis adjusted for age, smoking, anti-inflammatory medications, and the CC genotype of the CFH gene. Risk factor interaction was explored using an additive model. MAIN OUTCOME MEASURES Prevalent early AMD, prevalent late AMD, progressed AMD, and measures of risk factor interaction. RESULTS Elevated CRP levels were associated with late AMD: odds ratio (OR), 3.12; 95% confidence interval (CI), 1.38-7.07. An association of elevated CRP with AMD progression was weaker: OR, 1.90 (95% CI, 0.88-4.10). A combination of elevated CRP and the CC (Y402H) genotype resulted in a super-additivity of the risks, with odds ratios of 19.3 (95% CI, 2.8-134) for late AMD, and 6.8 (95% CI, 1.2-38.8) for AMD progression, with the attributable proportion of risk owing to CRP-CFH interaction calculated at 26% for prevalent late AMD and 22% for AMD progression. CONCLUSIONS Synergistic influence of CRP levels and the at risk genotype of the CFH gene resulted in a super-additive risk for prevalent late AMD and AMD progression. Testing for the combination of these 2 risk factors to predict a high risk of AMD and its progression would allow for targeted trials of new intervention strategies.
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