Precision Medicine for ABCA4 Disease: Modifier Alleles

Genetic variation affecting the structure and function of the ABCA4 protein gives rise to a broad collection of genetically and clinically heterogeneous diseases, collectively known as ABCA4 disease, which are characterized by both phenotypic overlap and variable penetrance and expressivity. These include autosomal recessive Stargardt disease, cone-rod dystrophy, occult maculopathy, bull's eye macular dystrophy, retinitis pigmentosa-like retinal dystrophy, etc. Some phenotypic variation can be attributed to variability of highly penetrant ABCA4 mutations; however, much of the heterogeneity cannot be explained by ABCA4 mutations alone. The concept of Precision Medicine requires, by definition, identification of all genetic variation contributing to specific disease phenotypes. The main goal of this study is to identify all genetic variation resulting in phenotypes compatible with ABCA4 disease, which, in addition to biallelic disease-causing variants in the ABCA4 locus, include cis- and trans-acting modifiers and mutations in genes other than ABCA4.The study was carried out by performing whole exome sequencing (WES) of affected individuals to identify causal and modifying genetic variation for patients with macular dystrophies compatible with ABCA4 disease. All samples were sequenced with the IDT's Exome Research Panel Version 1 with SeqCap EZ Exome v2 and SeqCap EZ Exome v3 capture kits. Samples were sequenced on Illumina next-generation sequencing machines (San Diego, CA, USA) using DRAGEN Bio-IT Platform v. 2.5.1 (Illumina) to align reads to the Genome Reference Consortium Human Build 37, calling variants in accordance with the Genome Analysis Tool Kit (GATK, v.4.0.2.1) Best Practices Workflow, using ATAV (v.7.0.16) variant-calling pipeline. Variants for analysis were restricted to the consensus coding sequencing public transcripts (CCDS release 20) plus 2 base pair (bp) intronic extensions. Variants were annotated using ClinEff (DnaMiner) with Ensembl-HGRCh37.73 annotations.This set of WES data from unrelated patients of different racial and ethnic backgrounds can be stored and shared through dbGaP. These data provide information on frequencies of disease-causing variants in genes other than ABCA4 in patients with macular dystrophies. These also provide frequencies of selected pathogenic and none-pathogenic variants in different ethnicities.]]>
Study included patients whose phenotypes were compatible with those caused by pathogenic variants in the ABCA4 gene; i.e., Stargardt disease, Cone-Rod Dystrophy, Pattern Dystrophy, Bulls-Eye Maculopathy, Retinitis Pigmentosa-like. Patients with all other retinal disease phenotypes were excluded. All study-related procedures adhered to tenets set out in the Declaration of Helsinki. Patients presenting with ABCA4 disease were enrolled into Columbia University Medical Center–approved protocol #AAAI9906 after providing written consent at the conclusion of a complete ophthalmic exam by a retina specialist.]]>
Cases were recruited over 20-year period, 2000-2019. WES was performed in 2017-2019. Analysis of WES data was performed in 2018-2021. The first set of results was published in 2019 (PMID: 30926958). The other sets of data are not yet published.]]>