An Investigation Into LOXL1 Variants in Black South African Individuals with Exfoliation Syndrome
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OPHTHALMIC MOLECULAR GENETICS SECTION EDITOR: JANEY L. WIGGS, MD, PhD An Investigation Into LOXL1 Variants in Black South African Individuals With Exfoliation Syndrome Robyn M. Rautenbach, MBChB, DipOphth(SA); Soraya Bardien, PhD; Justin Harvey, MCom(Mathematical Statistics); Ari Ziskind, MBChB, FCSOphth(SA), MSc, BSc Objective: To investigate the association between 2 ly- ing majority of cases with XFS (PϽ.00001; odds ra- syl oxidase–like 1 (LOXL1) polymorphisms, rs1048661 tio,17.10; 95% confidence interval, 4.91-59.56), con- (R141L) and rs3825942 (G153D), and exfoliation syn- trary to all previous articles in which the GG genotype was drome (XFS) in black South African individuals. strongly associated with the disease phenotype. Methods: A total of 43 black patients with XFS and 47 Conclusion: The LOXL1 SNPs R141L and G153D are ethnically matched controls were recruited for genetic significantly associated with XFS in this black South Afri- analysis. Samples were analyzed for presence of the can population. The AA genotype of G153D confers XFS LOXL1–R141L and G153D variants using restriction frag- risk in this population, as opposed to the GG genotype ment length polymorphism analysis. A case-control as- described in all other populations, suggesting that un- sociation study was performed. identified genetic or environmental factors indepen- dent of these LOXL1 SNPs may influence phenotypic ex- Results: The R141L and G153D single-nucleotide poly- pression of the syndrome. morphisms (SNPs) were both significantly associated with XFS (P=.00582 and PϽ.00001, respectively). Consis- Clinical Relevance: Elucidation of the role of genetic tent with findings in white populations but not in Asian factors, including the LOXL1 gene, in XFS will facilitate cohorts, the GG genotype of the R141L SNP was present identification of individuals predisposed to developing in significantly more XFS cases than controls (P=.00582). this condition. However, in this black South African study population, the AA genotype of G153D was present in an overwhelm- Arch Ophthalmol. 2011;129(2):206-210 XFOLIATION SYNDROME angle glaucoma, accounting for approxi- (XFS) is a generalized dis- mately 25% of cases worldwide.5 order of the extracellular The prevalence of XFS increases with matrix characterized by the age, and a number of studies have re- pathological deposition and ported geographical clustering of this con- Eaccumulation of fibrillar material through- dition based on race and ethnicity.6 Fa- out the eye. The origin of this fibrillar ma- milial aggregation studies have suggested terial is unknown but believed to be de- a significant genetic contribution to XFS.7 rived from abnormal basement membranes Despite these findings, a simple inherit- Author Affiliations: Division of of aging epithelial cells in ocular struc- ance model is not evident, suggesting that 1 Ophthalmology, Stellenbosch tures. In addition to its occurrence within XFS is the result of a complex inherit- University and Tygerberg the eye, exfoliative fibrillopathy has been ance pattern with multiple contributing ge- Hospital (Drs Rautenbach and reported in the skin, blood vessels, and vis- netic and/or environmental factors. Ziskind); and Division of ceral organs, suggesting that XFS may in A landmark genome-wide association Molecular Biology and Human fact be an ocular manifestation of a sys- study by Thorleifsson et al8 identified 3 Genetics, Faculty of Health temic disorder.2-4 common single-nucleotide polymor- Sciences (Dr Bardien) and This condition is associated with an ar- phisms (SNPs) in the lysyl oxidase–like Centre for Statistical Consultation, Department of ray of ocular manifestations, most fre- 1(LOXL1) gene on chromosome 15q24.1 Statistics and Actuarial Science, quently a severe and progressive form of that were strongly associated with XFS and Stellenbosch University chronic open-angle glaucoma. Exfolia- exfoliation glaucoma in Scandinavian (Dr Harvey), Cape Town, tion syndrome is acknowledged as the populations. The LOXL family of pro- South Africa. most common identifiable cause of open- teins play a vital role in the homeostasis (REPRINTED) ARCH OPHTHALMOL / VOL 129 (NO. 2), FEB 2011 WWW.ARCHOPHTHALMOL.COM 206 ©2011 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/29/2021 of elastic tissues, acting as cross-linking enzymes and to detect a clinically significant association between the pres- thereby ensuring spatially defined deposition of elastin ence or absence of a specific polymorphism and XFS. Data was fibrils.9,10 The identification of the LOXL1 protein in pseu- analyzed using SAS version 9.1 (SAS Institute Inc, Cary, North doexfoliation deposits verifies its involvement in abnor- Carolina). Descriptive statistics were computed for patient age, mal fibrinogenesis in pseudoexfoliative tissues.11,12 and comparison between the mean ages of cases and controls was performed by t test for 2 groups. Furthermore, the pri- Two of these SNPs, rs1048661 (R141L) and rs3825942 mary outcome variables were analyzed by contingency tables. (G153D), are located within exon 1 of LOXL1 and cause Associations between the cases and controls and the different amino acid missense changes in the protein. This exon allele, genotype, and haplotype frequencies was examined using codes for the N-terminal portion of the protein, which Pearson 2 test. Odds ratios and relative risk estimates were also may have a role in directing the LOXL1 protein to sites produced to examine further interactions between the disease of elastogenesis. The third LOXL1 SNP, rs2165241, is lo- and specific alleles and genotypes. Confidence intervals (CIs) cated in the first intron of the gene and is presumed not for these estimates were also produced. A PϽ.05 represented to have any biological consequence. All 3 of these SNPs statistical significance in hypothesis testing and 95% confi- were in significant linkage disequilibrium in the studied dence intervals were used to describe the estimation of un- population.8 These genetic findings have been repli- known parameters. Hardy-Weinberg equilibrium of the allele and genotype fre- cated to a large extent, with some important variations, 13-17 quencies of cases and control subjects was examined, both sepa- in numerous studies throughout North America, Aus- rately and in combination, using 2 and Fisher exact tests. tralia,18 Europe,19 and Asia.20-26 This study investigates the association of these LOXL1 gene polymorphisms with XFS among black South Af- RESULTS ricans, a geographical cluster with a high prevalence of XFS and exfoliation glaucoma.27,28 Of the 43 patients with XFS, 15 had exfoliation glau- coma. Of the 47 controls; 13 had primary open-angle glau- METHODS coma but no evidence of exfoliation. The cases and con- trols were age-matched with a mean (SD) age of 72.37 (9.57) in XFS cases and 71.81(7.56) in controls without PATIENT POPULATION XFS, with no significant difference found between the means of these 2 groups (P=.75621). An ethnically matched cohort of 43 elderly black patients with exfoliation syndrome and 47 control individuals were identi- The G allele of SNP rs1048661 (R141L) was detected fied from the outpatient ophthalmology service at the East Lon- in a statistically higher frequency in patients with XFS don Hospital Complex (Eastern Cape, South Africa) for this than controls (P=.00106). The relative risk of having no study. The study was approved by the Stellenbosch University disease given the presence of the G allele vs the T allele Committee for Human Research (N08/08/208), and all pa- for this SNP was 0.49 (95% CI. 0.42-0.57). The A allele tients and controls were recruited after informed consent. All of SNP rs3825942 (G153D) was strongly associated with cases and controls underwent an anterior segment evaluation exfoliation syndrome (PϽ.00001) in this sample, with after pupillary dilatation to confirm the presence or absence of patients being 9.94 times more likely to have an A allele the characteristic fibrillar material diagnostic of XFS. Venous than a G allele (odds ratio,9.94; 95% CI, 4.75-20.79) blood samples were collected from all study participants. (Table 1). The genotype frequencies for the rs1048661 (R141L) GENOTYPING SNP and the rs3825942 (G153D) SNP confirmed statis- tically significant differences between the XFS cases and DNA was extracted from the peripheral venous blood samples controls. The GG genotype of R141L was present in sig- according to established methods. Polymerase chain reaction primers were designed to amplify the region containing the nificantly more XFS cases than controls (P=.00582), with LOXL1 R141L and G153D variants (forward: 5Ј-GCA GGT GTA a relative risk of having no disease (GG vs GT/TT) CAG CTT GCT CA-3Ј and reverse: 5Ј-GGC CGG TAG TAC of0.46 (95% CI, 0.37-0.59). In this study population, we ACG AAA CC-3Ј), which produced a product of 474 base pairs. found that the AA genotype of G153D was present in an Restriction fragment–length polymorphism analysis was used overwhelming majority of cases with XFS (PϽ.00001), to genotype the 2 SNPs. The Smal (fermentas) and Eco24I (fer- with an odds ratio (AA vs GG) of 17.10 (95% CI, 4.91- mentas) restriction endonuclease enzymes were used for R141L 59.56) (Table 1). and G153D, respectively. Following digestion, the polymer- The haplotypes composed of the 2 LOXL1 SNPs ase chain reaction products were resolved on 12% polyacryl- rs1048661 and rs3825942 were determined, with the fre- amide gels and the bands visualized using silver staining. The quencies of the 2-SNP haplotypes differing significantly genotyping method was verified by sequencing randomly se- between the patients with XFS and the controls lected samples using the BigDye Terminator Sequence Ready Ͻ Reaction kit version 3.1 (Applied Biosystems, Foster City, Cali- (P .00001). The GA haplotype was associated with the fornia) and analyzed on a 3130xl Genetic Analyzer (Applied highest risk of XFS in which a patient is 9.94 times more Biosystems).