原发性开角型青光眼遗传学的当前概念:对疾病病理生理学和未来治疗的贡献。
Current concepts on primary open-angle glaucoma genetics: a contribution to disease pathophysiology and future treatment.
机构信息
Southampton Eye Unit, Southampton General Hospital, Southampton, UK.
出版信息
Eye (Lond). 2012 Mar;26(3):355-69. doi: 10.1038/eye.2011.309. Epub 2011 Dec 16.
Glaucoma is a common, complex, heterogenous disease and it constitutes the major cause of irreversible blindness worldwide. Primary open-angle glaucoma (POAG) is the most common type of glaucoma in all populations. Most of the molecular mechanisms leading to POAG development are still unknown. Gene mutations in various populations have been identified by genetic studies and a genetic basis for glaucoma pathogenesis has been established. Linkage analysis and association studies are genetic approaches in the investigation of the genetic basis of POAG. Genome-wide association studies (GWAS) are more powerful compared with linkage analysis in discovering genes of small effect that might contribute to the development of the disease. POAG links to at least 20 genetic loci, but only 2 genes identified in these loci, myocilin and optineurin, are considered as well-established glaucoma-causing genes, whereas the role of other loci, genes, and variants implicated in the development of POAG remains controversial. Gene mutations associated with POAG result in retinal ganglion cell death, which is the common outcome of pathogenetic mechanisms in glaucoma. In future, if the sensitivity and specificity of genotyping increases, it may be possible to screen individuals routinely for disease susceptibility. This review is an update on the latest progress of genetic studies associated with POAG. It emphasizes the correlation of recent achievements in genetics with glaucoma pathophysiology, glaucoma treatment perspectives, and the possibility of future prevention of irreversible visual loss caused by the disease.
青光眼是一种常见的、复杂的、异质性疾病,是全球范围内导致不可逆性失明的主要原因。原发性开角型青光眼(POAG)是所有人群中最常见的青光眼类型。导致 POAG 发展的大多数分子机制仍不清楚。通过遗传研究已经在不同人群中发现了基因突变,并确定了青光眼发病机制的遗传基础。连锁分析和关联研究是研究 POAG 遗传基础的遗传方法。与连锁分析相比,全基因组关联研究(GWAS)在发现可能导致疾病发展的小效应基因方面更具优势。POAG 与至少 20 个遗传位点相关,但在这些位点中仅确定了 2 个基因,即肌球蛋白和视神经病变,被认为是明确的青光眼致病基因,而其他位点、基因和变异体在 POAG 发展中的作用仍存在争议。与 POAG 相关的基因突变导致视网膜神经节细胞死亡,这是青光眼发病机制的共同结果。如果未来基因分型的敏感性和特异性提高,可能会定期对个体进行疾病易感性筛查。本综述更新了与 POAG 相关的遗传研究的最新进展。它强调了遗传学的最新成就与青光眼病理生理学、青光眼治疗前景以及未来预防该疾病引起的不可逆转视力丧失的相关性。