title: Neovascular age-related macular degeneration risk based on CFH, LOC387715/HTRA1, and smoking.
abstract: BACKGROUND
  Age-related macular degeneration (AMD) is the major cause of blindness in the elderly. Those with the neovascular end-stage of disease have irreversible loss of central vision. AMD is a complex disorder in which genetic and environmental factors play a role. Polymorphisms in the complement factor H (CFH) gene, LOC387715, and the HTRA1 promoter are strongly associated with AMD. Smoking also contributes to the etiology. We aimed to provide a model of disease risk based on these factors.
  
  
  RESULTS
  We genotyped polymorphisms in CFH and LOC387715/HTRA1 in a case-control study of 401 patients with neovascular AMD and 266 controls without signs of disease, and used the data to produce genetic risk scores for the European-descent population based on haplotypes at these loci and smoking history. CFH and LOC387715/HTRA1 haplotypes and smoking status exerted large effects on AMD susceptibility, enabling risk scores to be generated with appropriate weighting of these three factors. Five common haplotypes of CFH conferred a range of odds ratios (ORs) per copy from 1 to 4.17. Most of the effect of LOC387715/HTRA1 was mediated through one detrimental haplotype (carriage of one copy: OR 2.83; 95% confidence interval [CI] 1.91-4.20), with homozygotes being at particularly high risk (OR 32.83; 95% CI 12.53-86.07). Patients with neovascular macular degeneration had considerably higher scores than those without disease, and risk of blinding AMD rose to 15.5% in the tenth of the population with highest predicted risk.
  
  
  CONCLUSIONS
  An individual's risk of developing AMD in old age can be predicted by combining haplotype data with smoking status. Until there is effective treatment for AMD, encouragement to avoid smoking in those at high genetic risk may be the best option. We estimate that total absence of smoking would have reduced the prevalence of severe AMD by 33%. Unless smoking habits change or preventative treatment becomes available, the prevalence of AMD will rise as a consequence of the increasing longevity of the population.
authors.affiliation: Department of Medical Genetics, Queen's University Belfast, Belfast, United Kingdom. A.Hughes@qub.ac.uk
authors.forename: Anne E
authors.initials: AE
authors.lastname: Hughes
authors.forename: Nick
authors.initials: N
authors.lastname: Orr
authors.forename: Chris
authors.initials: C
authors.lastname: Patterson
authors.forename: Hossein
authors.initials: H
authors.lastname: Esfandiary
authors.forename: Ruth
authors.initials: R
authors.lastname: Hogg
authors.forename: Vivienne
authors.initials: V
authors.lastname: McConnell
authors.forename: Giuliana
authors.initials: G
authors.lastname: Silvestri
authors.forename: Usha
authors.initials: U
authors.lastname: Chakravarthy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001766:Blindness / Q000209:etiology* / Q000235:genetics; D016022:Case-Control Studies; D020256:Choroidal Neovascularization / Q000150:complications / Q000209:etiology* / Q000235:genetics; D017242:Complement Factor H / Q000235:genetics; D005260:Female; D020022:Genetic Predisposition to Disease; D006239:Haplotypes; D000074289:High-Temperature Requirement A Serine Peptidase 1; D006720:Homozygote; D006801:Humans; D016015:Logistic Models; D008268:Macular Degeneration / Q000150:complications / Q000209:etiology* / Q000235:genetics; D008297:Male; D008875:Middle Aged; D008957:Models, Genetic; D016017:Odds Ratio; D010641:Phenotype; D011110:Polymorphism, Genetic; D011401:Promoter Regions, Genetic; D011506:Proteins / Q000235:genetics*; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D012697:Serine Endopeptidases / Q000235:genetics*; D012907:Smoking / Q000009:adverse effects*
chemical_list: C514392:ARMS2 protein, human; C493495:CFH protein, human; D011506:Proteins; D017242:Complement Factor H; D000074289:High-Temperature Requirement A Serine Peptidase 1; C474012:HTRA1 protein, human; D012697:Serine Endopeptidases