Abstract
Age-related macular degeneration (AMD) is a devastating retinal disease that results in irreversible vision loss in the aged population. The complex genetic nature and degree of genetic penetrance require a redefinition of the current therapeutic strategy for AMD. We aimed to investigate the role of modifiers for current anti-VEGF therapy especially for non-responder AMD patients. We recruited 78 wet AMD cases (out of 278 AMD patients) with their socio-demographic and treatment regimen. Serum protein levels were estimated by ELISA in AMD patients. Data pertaining to the number of anti-VEGF injections given (in 1 year) along with clinical images (FFA and OCT) of AMD patients were also included. Visual acuity data (logMAR) for 46 wet AMD cases out of a total of 78 patients were also retrieved to examine the response of anti-VEGF injections in wet AMD cases. Lipid metabolizing genes (LIPC and APOE) have been identified as chief biomarkers for anti-VEGF response in AMD patients. Both genotypes ‘CC’ and ‘GC’ of LIPC have found to be associated with a number of anti-VEGF injections in AMD patients which could influence the expression of B3GALTL,HTRA1, IER3, LIPC and SLC16A8 proteins in patients bearing both genotypes as compared to reference genotype. Elevated levels of APOE were also observed in group 2 wet AMD patients as compared to group 1 suggesting the significance of APOE levels in anti-VEGF response. The genotype of B3GALTL has also been shown to have a significant association with the number of anti-VEGF injections. Moreover, visual acuity of group 1 (≤ 4 anti-VEGF injections/year) AMD patients was found significantly improved after 3 doses of anti-VEGF injections and maintained longitudinally as compared to groups 2 and 3. Lipid metabolising genes may impact the outcome of anti-VEGF AMD treatment.
Highlights
Age-related macular degeneration (AMD) is a devastating retinal disease that results in irreversible vision loss in the aged population
We have shown the outcome of anti-VEGF associated with both environmental and genetic factors
Our results have revealed the association of genetic variants of B3GALTL and LIPC with the number of anti-VEGF injections in Indian AMD patients
Summary
Age-related macular degeneration (AMD) is a devastating retinal disease that results in irreversible vision loss in the aged population. Lipid metabolizing genes (LIPC and APOE) have been identified as chief biomarkers for anti-VEGF response in AMD patients Both genotypes ‘CC’ and ‘GC’ of LIPC have found to be associated with a number of anti-VEGF injections in AMD patients which could influence the expression of B3GALTL,HTRA1, IER3, LIPC and SLC16A8 proteins in patients bearing both genotypes as compared to reference genotype. Exploring the genetic penetrance of rare and common genetic variants and their pathological implication under the influence of confounders can determine the genetic complexity and susceptibility of A MD17 which can influence the disease phenotype and treatment outcome This is suggestive of possible association of genetic variation and the influence of environmental factors (with or without interactions) which may modulate the outcome and number of anti-VEGF treatment in AMD patients which can contribute in AMD management. This study describes the genetic susceptibility towards the response of Anti-VEGF treatment in Indian AMD patients
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