Unraveling the genetics of exfoliation glaucoma

Abstract

Abstract Purpose To give an account of our recent discovery (2007) of the association of lysyl oxidase like 1 (LOXL1) sequence variants and exfoliation glaucoma (XFG) as well as later replications in other populations. Methods We did a genome‐wide association study on open angle glaucoma cases and controls using the Illumina 300 chip. This chip includes probes for 317.000 single – nucleotide polymorphisms (SNPs), that tag, as highly correlated surrogates about 80% of the 2.1 million known common SNPs in the Caucasian genome. For diagnosis of exfoliation syndrome a peripheral band or central shield of exfoliative material on the anterior lens capsule was required. Results When we had done 195 open angle glaucoma cases high genome wide significance was achieved on chromosome 15q24.1 an association later found to be confined to XFG only. This SNP (rs2165241T) was located in the first intron of the LOXL1 gene. We then added 11 correlated SNPs that are not on the Illumina chip and found that two non‐synonymous variants in the first exon of LOXL1 can jointly account for all the observed association (R141L, OR 2.5; G153D, OR 20.1). Combined the variants explained 99% of the population attributable risk for exfoliation glaucoma. Conclusion These findings have now largely been confirmed in numerous American, Asian, Australian and European studies, and in all instances do these polymorphisms in the LOXL1 gene confer risk to XFG. LOXL1 is cross linking enzyme responsible for elastin polymer deposition in ocular tissue. The LOXL1 discovery is the first big hit in the search for genetic background for exfoliation glaucoma. These findings may soon influence monitoring of glaucoma suspects in the clinic targeting persons with the high risk haplotypes.