ABCA4 disease progression and a proposed strategy for gene therapy
Open accessAbstract
Autosomal recessive retinal diseases caused by mutations in the ABCA4 gene are being considered for gene replacement therapy. All individuals with ABCA4-disease show macular degeneration, but only some are thought to progress to retina-wide blindness. It is currently not predictable if or when specific ABCA4 genotypes will show extramacular disease, and how fast it will progress thereafter. Early clinical trials of focal subretinal gene therapy will aim to arrest disease progression in the extramacular retina. In 66 individuals with known disease-causing ABCA4 alleles, we defined retina-wide disease expression by measuring rod- and cone-photoreceptor-mediated vision. Serial measurements over a mean period of 8.7 years were consistent with a model wherein a normal plateau phase of variable length was followed by initiation of retina-wide disease that progressed exponentially. Once initiated, the mean rate of disease progression was 1.1 log/decade for rods and 0.45 log/decade for cones. Spatio-temporal progression of disease could be described as the sum of two components, one with a central-to-peripheral gradient and the other with a uniform retina-wide pattern. Estimates of the age of disease initiation were used as a severity metric and contributions made by each ABCA4 allele were predicted. One-third of the non-truncating alleles were found to cause more severe disease than premature truncations supporting the existence of a pathogenic component beyond simple loss of function. Genotype-based inclusion/exclusion criteria and prediction of the age of retina-wide disease initiation will be invaluable for selecting appropriate candidates for clinical trials in ABCA4 disease.
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Lack of a functional ABCA4 transporter causes Stargardt disease, a juvenile form of macular degeneration, whereas some other changes are associated with AMD.
“Here, lack of a functional transporter causes Stargardt disease,545,558,559 a juvenial form of macular degeneration, whereas some other changes were demonstrated to be associated with AMD.560,561”
From Chemistry of the Retinoid (Visual) Cycle (2014) · cites this paper as [558]
The Discussion links ABCA4 mutations to Stargardt disease (STGD), but describes a spectrum of disease rather than saying that complete loss of transporter function specifically causes STGD. It associates likely complete loss of function with some of the more severe retinal disease and notes that STGD can progress beyond the macula. The AMD clause has separate citations in the citing sentence, so it is not attributed to this source. (LLM, conf=0.84)
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Non-exomic and synonymous variants in ABCA4 are an important cause of Stargardt disease
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“In some instances Stargardt disease can progress to cone-rod dystrophy [53,58].”
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Stargardt disease and progress in therapeutic strategies
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Self-citationNew Editing Tools for Gene Therapy in Inherited Retinal Dystrophies
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- Authors
- Cideciyan, A. V., Swider, M., Aleman, T. S., Tsybovsky, Y., Schwartz, S. B., Windsor, E. A. M., Roman, A. J., Sumaroka, A., Steinberg, J. D., Jacobson, S. G., Stone, E. M., & Palczewski, K.
- Affiliations
- University of Pennsylvania (US)
- Case Western Reserve University (US)
- Howard Hughes Medical Institute (US)
- Corresponding author
- Cideciyan, Artur V.
- ORCID
- Venue
- Human Molecular Genetics
- Publisher
- Oxford University Press (OUP)
- Published
- 2008-12-12
- Volume
- 18
- Issue
- 5
- Pages
- 931-941
- ISSN
- 0964-6906 (ISSN-L)
- 1460-2083
- PMC
- PMC2640207
- OpenAlex
- W2164929411
- Cited by
- 186
- References
- 87
- Citations by year
- 2026: 5 · 2025: 11 · 2024: 6 · 2023: 11 · 2022: 8 · 2021: 13 · 2020: 9 · 2019: 8 · 2018: 18 · 2017: 14 · 2016: 9 · 2015: 11 · 2014: 13 · 2013: 13 · 2012: 9
- FWCI
- 3.84
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Human Molecular Genetics (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Research to Prevent Blindness
- Macula Vision Research Foundation
- Hope For Vision
- National Institutes of Health (EY09339)
- National Eye Institute (EY-13203, EY 09339, R01EY013203, R01EY009339)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Retinal Development and Disorders
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Physiology › Lysosomal Storage Disorders Research
- Keywords
- ABCA4, autosomal recessive retinal degeneration, macular degeneration, disease progression, gene replacement therapy, subretinal gene therapy, photoreceptors, rod photoreceptors, cone photoreceptors, genotype severity
- MeSH terms
- Adolescent, Adult, Aged, Child, Female, Genotype, Humans, Male, Middle Aged, Mutation, Pedigree, Retinal Diseases, Genetic Therapy, Cohort Studies, Age of Onset, Disease Progression, ATP-Binding Cassette Transporters, Young Adult
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