Disease Progression in Age-Related Macular Degeneration Patients Carrying Rare Variants in the Complement Factor H or

Francesco Cinque1, Anita de Breuk1, Haras Mhmud1

  • 1Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.

Insights

Rare variants in Complement Factor I (CFI) or Complement Factor H (CFH) genes increase the incidence of late age-related macular degeneration (AMD). These findings suggest potential for gene-targeted therapies in AMD management.

Area of Science:

  • Ophthalmology
  • Genetics
  • Molecular Biology

Background:

  • Rare variants in Complement Factor I (CFI) and Complement Factor H (CFH) genes are linked to age-related macular degeneration (AMD).
  • Understanding the incidence and progression of AMD in carriers of these variants is crucial for developing targeted treatments.

Purpose of the Study:

  • To compare the incidence of late AMD in carriers of rare CFI/CFH variants against a reference cohort.
  • To evaluate short-term AMD progression, including geographic atrophy (GA) and visual function, in a cohort of variant carriers.

Main Methods:

  • A cohort study utilizing a long follow-up (LF) cohort (retrospective, >5 years) and a short follow-up (SF) cohort (prospective, 1 year).
  • Patients with rare CFH/CFI variants were identified from the European Genetic Database.
  • The LF-cohort assessed late AMD incidence per 100 person-years, compared to a matched reference cohort.
  • The SF-cohort measured annual GA growth, retinal sensitivity, and visual acuity.

Main Results:

  • The LF-cohort (28 patients) showed a significantly higher incidence of late AMD (6.2 per 100 person-years) compared to the reference cohort (1.8 per 100 person-years, P=0.01).
  • In the SF-cohort (44 patients), mean annual GA growth was 0.22 mm.
  • Retinal sensitivity decreased in late-staged eyes (P=0.03 for right eye), while visual acuity remained stable.

Conclusions:

  • Carriers of rare CFI or CFH variants exhibit an elevated incidence of late AMD.
  • These findings support the potential benefit of personalized gene therapy and complement inhibition strategies for AMD patients with these genetic variants in future clinical trials.
Abstract

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