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Updated: Mar 17, 2026
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Published on: July 28, 2023
Martinique Crinkled Retinal Pigment Epitheliopathy: Clinical Stages and Pathophysiologic Insights
Albert Jean-Charles1, Harold Merle1, Isabelle Audo2
1Department of Ophthalmology, University Hospital of Fort de France, Martinique (FWI), France.
Purpose:
To reappraise the autosomal dominant Martinique crinkled retinal pigment epitheliopathy (MCRPE) in light of the knowledge of its associated mutated gene mitogen-activated protein kinase-activated protein kinase 3 (MAPKAPK3), an actor in the p38 mitogen-activated protein kinase pathway.
Design:
Clinical and molecular study.
Participants:
A total of 45 patients from 3 generations belonging to a family originating from Martinique with an autosomal dominant MCRPE were examined.
Methods:
Best-corrected visual acuity, fundus photographs, and spectral-domain optical coherence tomography (SD OCT) of all clinically affected patients and carriers for the causal mutation were reviewed at the initial visit and 4 years later for 10 of them. Histologic retinal lesions of Mapkapk3(-/-) mice were compared with those of the human disease.
Main Outcome Measures:
The MCRPE natural history in view of MAPKAPK3 function and Mapkapk3(-/-) mouse retinal lesions.
Results:
Eighteen patients had the c.518T>C mutation. One heterozygous woman aged 20 years was asymptomatic with normal fundus and SD OCT (stage 0). All c.518T>C heterozygous patients older than 30 years of age had the characteristic dried-out soil fundus pattern (stages 1 and 2). Complications (stage 3) were observed in 7 cases, including polypoidal choroidal vasculopathy (PCV) and macular fibrosis or atrophy. One patient was homozygous and had a form with severe Bruch's membrane (BM) thickening and macular exudation with a dried-out soil pattern in the peripheral retina. The oldest heterozygous patient, who was legally blind, had peripheral nummular pigmentary changes (stage 4). After 4 years, visual acuity was unchanged in 6 of 10 patients. The dried-out soil elementary lesions radically enlarged in patients with a preferential macular extension and confluence. These findings are in line with the progressive thickening of BM noted with age in the mouse model. During follow-up, there was no occurrence of PCV.
Conclusions:
MCRPE is an autosomal dominant, fully penetrant retinal dystrophy with a preclinical stage, an onset after the age of 30 years, and a preserved visual acuity until occurrence of macular complications. The natural history of MCRPE is in relation to the role of MAPKAPK3 in BM modeling, vascular endothelial growth factor activity, retinal pigment epithelial responses to aging, and oxidative stress.
Insights
Martinique crinkled retinal pigment epitheliopathy (MCRPE) is a genetic disorder that develops after age 30. The study links MCRPE to the MAPKAPK3 gene, showing its progression and relation to Bruch's membrane changes.
Area of Science:
- Ophthalmology
- Genetics
- Molecular Biology
Background:
- Martinique crinkled retinal pigment epitheliopathy (MCRPE) is an autosomal dominant condition.
- The gene mitogen-activated protein kinase-activated protein kinase 3 (MAPKAPK3) has been associated with MCRPE.
Purpose of the Study:
- To re-evaluate MCRPE in light of the known role of the MAPKAPK3 gene.
- To understand the natural history and molecular basis of MCRPE.
Main Methods:
- Clinical and molecular study of 45 patients from 3 generations.
- Review of visual acuity, fundus photography, and SD OCT over 4 years.
- Comparison of human MCRPE with Mapkapk3(-/-) mouse retinal lesions.
Main Results:
- The c.518T>C mutation in MAPKAPK3 was identified in 18 patients.
- MCRPE onset occurs after age 30, with a characteristic 'dried-out soil' fundus pattern.
- Macular complications, including fibrosis and atrophy, developed in some patients; homozygous mutation caused severe Bruch's membrane thickening.
Conclusions:
- MCRPE is a fully penetrant autosomal dominant retinal dystrophy with a preclinical stage.
- The natural history is linked to MAPKAPK3's role in Bruch's membrane modeling and cellular stress responses.
- Visual acuity is preserved until macular complications arise, typically after age 30.
