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Heath Jeffery RC, Thompson JA, Lamey TM, McLaren TL, McAllister IL, Constable IJ, Mackey DA, De Roach JN, Chen FK. CLASSIFYING ABCA4 MUTATION SEVERITY USING AGE-DEPENDENT ULTRA-WIDEFIELD FUNDUS AUTOFLUORESCENCE-DERIVED TOTAL LESION SIZE. Retina 2021; 41:2578-2588. [PMID: 34125082 DOI: 10.1097/iae.0000000000003227] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To establish a mutation-specific age-dependent ultra-widefield fundus autofluorescence (UWF-FAF) trajectory in a large Stargardt disease (STGD1) cohort using total lesion size (TLS) and to develop a clinical method for variant classification. METHODS A retrospective study of patients with biallelic ABCA4 mutations that were evaluated with UWF-FAF. Boundaries of TLS, defined by stippled hyper/hypoautofluorescence, were outlined manually. Pathogenicity was assessed according to ACMG/AMP criteria, and mutation severities were classified based on the current literature. Age-dependent trajectories in TLS were examined in patients with nullizygous, mild, and intermediate mutations. Mutations of uncertain severities were classified using a clinical criterion based on age of symptom onset and TLS. RESULTS Eighty-one patients with STGD1 (mean age = 42 ± 20 years and mean visual acuity = 20/200) were recruited from 65 unrelated families. Patients with biallelic null/severe variants (n = 6) demonstrated an increase in TLS during their second decade reaching a mean ± SD of 796 ± 29 mm2 by age 40. Those harboring mild mutations c.5882G>A or c.5603A>T had lesions confined to the posterior pole with a mean ± SD TLS of 30 ± 39 mm2. Intermediate mutations c.6079C>T or c.[2588G>C;5603A>T] in trans with a null/severe mutation had a mean ± SD TLS of 397 ± 29 mm2. Thirty-two mutations were predicted to cause severe (n = 22), intermediate (n = 6), and mild (n = 5) impairment of ABCA4 function based on age of symptom onset and TLS. CONCLUSION Age-dependent TLS showed unique ABCA4 mutation-specific trajectories. Our novel clinical criterion using age of symptom onset and TLS to segregate ABCA4 mutations into three severity groups requires further molecular studies to confirm its validity.
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Affiliation(s)
- Rachael C Heath Jeffery
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Australia
- Department of Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Jennifer A Thompson
- Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; and
| | - Tina M Lamey
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Australia
- Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; and
| | - Terri L McLaren
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Australia
- Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; and
| | - Ian L McAllister
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Australia
| | - Ian J Constable
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Australia
| | - David A Mackey
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Australia
| | - John N De Roach
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Australia
- Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; and
| | - Fred K Chen
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Australia
- Department of Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia
- Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; and
- Department of Ophthalmology, Perth Children's Hospital, Nedlands, Western Australia, Australia
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Sung YC, Yang CH, Yang CM, Lin CW, Huang DS, Huang YS, Hu FR, Chen PL, Chen TC. Genotypes Predispose Phenotypes-Clinical Features and Genetic Spectrum of ABCA4-Associated Retinal Dystrophies. Genes (Basel) 2020; 11:genes11121421. [PMID: 33261146 PMCID: PMC7759801 DOI: 10.3390/genes11121421] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/12/2020] [Accepted: 11/25/2020] [Indexed: 12/31/2022] Open
Abstract
The ABCA4 gene is one of the most common disease-causing genes of inherited retinal degeneration. In this study, we report different phenotypes of ABCA4-associated retinal dystrophies in the Taiwanese population, its clinical progression, and its relationship with genetic characteristics. Thirty-seven subjects were recruited and all patients underwent serial ophthalmic examinations at a single medical center. Fundus autofluorescence (FAF) images were quantified for clinical evaluation, and panel-based next-generation sequencing testing was performed for genetic diagnosis. Visual preservation, disease progression, and genotype–phenotype correlation were analyzed. In this cohort, ABCA4-associated retinal degeneration presented as Stargardt disease 1 (STGD1, 62.16%), retinitis pigmentosa (32.43%), and cone-rod dystrophy (5.41%). STGD1 could be further divided into central and dispersed types. In each phenotype, the lesion areas quantified by FAF increased with age (p < 0.01) and correlated with poorer visual acuity. However, three patients had the foveal sparing phenotype and had relatively preserved visual acuity. Forty-two ABCA4 variants were identified as disease-causing, with c.1804C>T (p.Arg602Trp) the most frequent (37.84%). Patients with a combination of severe/null variants could have more extensive phenotypes, such as arRP and dispersed STGD1. This is the first cohort study of ABCA4-associated retinal degeneration in Taiwan with wide spectrums of both genotypic and phenotypic characteristics. An extremely high prevalence of c.1804C>T, which has not been reported in East Asia before, was noted. The extensiveness of retinal involvement might be regarded as a spectrum of ABCA4-associated retinal dystrophies. Different types of genetic variations could lead to distinctive phenotypes, according to the coding impact of variants.
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Affiliation(s)
- Yu-Chi Sung
- Department of Medical Education, National Taiwan University Hospital, Taipei 100, Taiwan;
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 100, Taiwan; (C.-H.Y.); (C.-M.Y.); (C.-W.L.); (D.-S.H.); (Y.-S.H.); (F.-R.H.)
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 100, Taiwan; (C.-H.Y.); (C.-M.Y.); (C.-W.L.); (D.-S.H.); (Y.-S.H.); (F.-R.H.)
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Chao-Wen Lin
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 100, Taiwan; (C.-H.Y.); (C.-M.Y.); (C.-W.L.); (D.-S.H.); (Y.-S.H.); (F.-R.H.)
| | - Ding-Siang Huang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 100, Taiwan; (C.-H.Y.); (C.-M.Y.); (C.-W.L.); (D.-S.H.); (Y.-S.H.); (F.-R.H.)
| | - Yu-Shu Huang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 100, Taiwan; (C.-H.Y.); (C.-M.Y.); (C.-W.L.); (D.-S.H.); (Y.-S.H.); (F.-R.H.)
| | - Fung-Rong Hu
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 100, Taiwan; (C.-H.Y.); (C.-M.Y.); (C.-W.L.); (D.-S.H.); (Y.-S.H.); (F.-R.H.)
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Pei-Lung Chen
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Graduate Institute of Medical Genomics and Proteomics, College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Department of Medical Genetics, National Taiwan University Hospital, Taipei 100, Taiwan
- Correspondence: (P.-L.C.); (T.-C.C.); Tel.: +886-2-23123456 (ext. 71942) (P.-L.C.); +886-2-23123456 (ext. 63783) (T.-C.C.); Fax: +886-2-23934420 (T.-C.C.)
| | - Ta-Ching Chen
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 100, Taiwan; (C.-H.Y.); (C.-M.Y.); (C.-W.L.); (D.-S.H.); (Y.-S.H.); (F.-R.H.)
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Correspondence: (P.-L.C.); (T.-C.C.); Tel.: +886-2-23123456 (ext. 71942) (P.-L.C.); +886-2-23123456 (ext. 63783) (T.-C.C.); Fax: +886-2-23934420 (T.-C.C.)
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Oh JK, Ryu J, Lima de Carvalho JR, Levi SR, Lee W, Tsamis E, Greenstein VC, Mahajan VB, Allikmets R, Tsang SH. Optical Gap Biomarker in Cone-Dominant Retinal Dystrophy. Am J Ophthalmol 2020; 218:40-53. [PMID: 32445700 PMCID: PMC8291221 DOI: 10.1016/j.ajo.2020.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/01/2020] [Accepted: 05/13/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To characterize the progression of optical gaps and expand the known etiologies of this phenotype. DESIGN Retrospective cohort study. METHODS Thirty-six patients were selected based on the identification of an optical gap on spectral-domain optical coherence tomography (OCT) from a large cohort of patients (N = 746) with confirmed diagnoses of inherited retinal dystrophy. The width and height of the gaps in 70 eyes of 36 patients were measured by 2 independent graders using the caliper tool on Heidelberg Explorer. Measurements of outer and central retinal thickness were also evaluated and correlated with gap dimensions. RESULTS Longitudinal analysis confirmed the progressive nature of optical gaps in patients with Stargardt disease, achromatopsia, occult macular dystrophy, and cone dystrophies (P < .003). Larger changes in gap width were noted in patients with Stargardt disease (78.1 μm/year) and cone dystrophies (31.9 μm/year) compared with patients with achromatopsia (16.2 μm/year) and occult macular dystrophy (15.4 μm/year). Gap height decreased in patients with Stargardt disease (6.5 μm/year; P = .02) but increased in patients with achromatopsia (3.3 μm/year) and occult macular dystrophy (1.2 μm/year). Gap height correlated with measurements of central retinal thickness at the fovea (r = 0.782, P = .00012). Interocular discordance of the gap was observed in 7 patients. Finally, a review of all currently described etiologies of optical gap was summarized. CONCLUSION The optical gap is a progressive phenotype seen in an increasing number of etiologies. This progressive nature suggests a use as a biomarker in the understanding of disease progression. Interocular discordance of the phenotype may be a feature of Stargardt disease and cone dystrophies.
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Affiliation(s)
- Jin Kyun Oh
- Jonas Children's Vision Care, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York, USA; Department of Psychology, Columbia University, New York, New York, USA; State University of New York at Downstate Medical Center, Brooklyn, New York, USA
| | - Joseph Ryu
- Jonas Children's Vision Care, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York, USA
| | - Jose Ronaldo Lima de Carvalho
- Jonas Children's Vision Care, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York, USA; Department of Ophthalmology, Empresa Brasileira de Servicos Hospitalares, Hospital das Clinicas de Pernambuco, Federal University of Pernambuco, Recife, Pernambuco, Brazil; Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Sarah R Levi
- Jonas Children's Vision Care, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York, USA
| | - Winston Lee
- Jonas Children's Vision Care, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York, USA
| | - Emmanouil Tsamis
- Department of Psychology, Columbia University, New York, New York, USA
| | - Vivienne C Greenstein
- Jonas Children's Vision Care, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York, USA
| | - Vinit B Mahajan
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Rando Allikmets
- Jonas Children's Vision Care, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York, USA; Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Stephen H Tsang
- Jonas Children's Vision Care, Department of Ophthalmology, Columbia University Irving Medical Center, New York, New York, USA; Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA.
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Affiliation(s)
- Jin K Oh
- Columbia University Irving Medical Center, New York, NY
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Sunness JS, Ifrah A, Wolf R, Applegate CA, Sparrow JR. Abnormal Visual Function Outside the Area of Atrophy Defined by Short-Wavelength Fundus Autofluorescence in Stargardt Disease. Invest Ophthalmol Vis Sci 2020; 61:36. [PMID: 32334431 PMCID: PMC7401975 DOI: 10.1167/iovs.61.4.36] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 02/03/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose To examine the extent of visual function abnormality outside the dark lesion on short-wavelength fundus autofluorescence (SW-AF), and its correlation with background SW-AF features and optical coherence tomography (OCT) in recessive Stargardt disease (STGD1). Methods Forty-nine eyes of 25 participants in the ProgStar (the Natural History of the Progression of Atrophy Secondary to Stargardt Disease) study at our center were included. Patients underwent microperimetry (both threshold and dense scotoma mapping), OCT, SW-AF, and visual acuity testing. The Fisher's exact test, the χ2 test, and unpaired t-tests were used to analyze the data. Results Of 40 eyes without central fixation, 33 (82%) placed fixation remote (most ≥5°) from the dense scotoma edge, despite good intervening retinal sensitivity. OCT findings accounted for the remote fixation in 75%. Eighteen (37%) of all 49 eyes had dense scotoma extending past the dark lesion border. OCT was not adequate to define the edge of the scotoma. Of the 49 eyes, 28 (57%) had the mottled background pattern, 10 (20%) had the uniform pattern, and 11 (22%) had the other pattern, with >75% of eyes in each pattern having remote fixation. The dense scotoma exceeded the dark lesion primarily in the mottled pattern. The two eyes of each patient were concordant in all features. Conclusions Functional abnormalities in STGD1 extend past the SW-AF dark lesion. The disruption of the ellipsoid zone shows that photoreceptor abnormality extends peripheral to the dark lesion, and it explains in part the remote fixation pattern and the dense scotoma exceeding the dark lesion. This has implications for clinical trials for STGD1.
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Affiliation(s)
- Janet S. Sunness
- Richard E. Hoover Low Vision Rehabilitation Services and Department of Ophthalmology, GreaterBaltimore Medical Center, Baltimore, Maryland, United States
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, United States
| | - Abraham Ifrah
- Richard E. Hoover Low Vision Rehabilitation Services and Department of Ophthalmology, GreaterBaltimore Medical Center, Baltimore, Maryland, United States
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
| | - Robert Wolf
- Richard E. Hoover Low Vision Rehabilitation Services and Department of Ophthalmology, GreaterBaltimore Medical Center, Baltimore, Maryland, United States
- Boston University School of Medicine, Boston, Massachusetts, United States
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts, United States
| | - Carol A. Applegate
- Richard E. Hoover Low Vision Rehabilitation Services and Department of Ophthalmology, GreaterBaltimore Medical Center, Baltimore, Maryland, United States
| | - Janet R. Sparrow
- Department of Ophthalmology, Harkness Eye Institute, Columbia University Medical Center, New York,New York,United States
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Fang Y, Tschulakow A, Taubitz T, Illing B, Biesemeier A, Julien-Schraermeyer S, Radu RA, Jiang Z, Schraermeyer U. Fundus autofluorescence, spectral-domain optical coherence tomography, and histology correlations in a Stargardt disease mouse model. FASEB J 2020; 34:3693-3714. [PMID: 31989709 DOI: 10.1096/fj.201901784rr] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 07/16/2019] [Revised: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 01/09/2023]
Abstract
Stargardt disease (STGD1), known as inherited retinal dystrophy, is caused by ABCA4 mutations. The pigmented Abca4-/- mouse strain only reflects the early stage of STGD1 since it is devoid of retinal degeneration. This blue light-illuminated pigmented Abca4-/- mouse model presented retinal pigment epithelium (RPE) and photoreceptor degeneration which was similar to the advanced STGD1 phenotype. In contrast, wild-type mice showed no RPE degeneration after blue light illumination. In Abca4-/- mice, the acute blue light diminished the mean autofluorescence (AF) intensity in both fundus short-wavelength autofluorescence (SW-AF) and near-infrared autofluorescence (NIR-AF) modalities correlating with reduced levels of bisretinoid-fluorophores. Blue light-induced RPE cellular damage preceded the photoreceptors loss. In late-stage STGD1-like patient and blue light-illuminated Abca4-/- mice, lipofuscin and melanolipofuscin granules were found to contribute to NIR-AF, indicated by the colocalization of lipofuscin-AF and NIR-AF under the fluorescence microscope. In this mouse model, the correlation between in vivo and ex vivo assessments revealed histological characteristics of fundus AF abnormalities. The flecks which are hyper AF in both SW-AF and NIR-AF corresponded to the subretinal macrophages fully packed with pigment granules (lipofuscin, melanin, and melanolipofuscin). This mouse model, which has the phenotype of advanced STGD1, is important to understand the histopathology of Stargardt disease.
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Affiliation(s)
- Yuan Fang
- Division of Experimental Vitreoretinal Surgery, Center for Ophthalmology, Institute of Ophthalmic Research, University of Tuebingen, Tuebingen, Germany
| | - Alexander Tschulakow
- Division of Experimental Vitreoretinal Surgery, Center for Ophthalmology, Institute of Ophthalmic Research, University of Tuebingen, Tuebingen, Germany
- Preclinical Drug Assessment, STZ Ocutox, Hechingen, Germany
| | - Tatjana Taubitz
- Division of Experimental Vitreoretinal Surgery, Center for Ophthalmology, Institute of Ophthalmic Research, University of Tuebingen, Tuebingen, Germany
| | - Barbara Illing
- Division of Experimental Vitreoretinal Surgery, Center for Ophthalmology, Institute of Ophthalmic Research, University of Tuebingen, Tuebingen, Germany
| | - Antje Biesemeier
- Division of Experimental Vitreoretinal Surgery, Center for Ophthalmology, Institute of Ophthalmic Research, University of Tuebingen, Tuebingen, Germany
| | - Sylvie Julien-Schraermeyer
- Division of Experimental Vitreoretinal Surgery, Center for Ophthalmology, Institute of Ophthalmic Research, University of Tuebingen, Tuebingen, Germany
- Preclinical Drug Assessment, STZ Ocutox, Hechingen, Germany
| | - Roxana A Radu
- UCLA Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Zhichun Jiang
- UCLA Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Ulrich Schraermeyer
- Division of Experimental Vitreoretinal Surgery, Center for Ophthalmology, Institute of Ophthalmic Research, University of Tuebingen, Tuebingen, Germany
- Preclinical Drug Assessment, STZ Ocutox, Hechingen, Germany
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