Genetic Testing Fails to Predict Optimal Timing for Retinal Detachment Prophylaxis in Stickler Syndrome

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Genetic testing for Stickler syndrome does not reliably inform the optimal timing for providing prophylactic retinal treatment to reduce the risk of contralateral retinal detachment.

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The study presented at the American Society of Retina Specialists (ASRS) 2024 Annual Meeting examined the relationship between specific genetic mutations and the severity of Stickler syndrome. The researchers conducted genetic testing on 60 patients with retinal detachment and suspected Stickler syndrome, finding pathogenic variants in the COL2A1 or COL11A1 collagen genes in 93% of the patients.

However, the researchers did not find obvious differences in the onset and laterality of retinal detachment or the incidence of systemic disease between patients with the two variants. They did observe that patients with COL2A1 variants causing an aberration or reduction of the type 2 collagen alpha-1 chain tended to have an earlier onset and more severe detachment.

The study also confirmed that 50% of first-degree, at-risk relatives who were tested had the disease, with clinically significant signs, but none had retinal detachment. The researchers noted that there is no clear correlation between a specific gene mutation and the disease manifestation, and it remains challenging to determine the optimal timing for intervention to prevent vision loss in Stickler syndrome patients.

The study highlights the limitations of genetic testing in predicting the clinical course of Stickler syndrome and the need for a more comprehensive approach, including detailed family history and clinical assessments, to guide treatment decisions.

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The age of onset for the first retinal detachment in the 60 patients ranged from 3 to 46 years, with a median age of 10 years.
50% of first-degree, at-risk relatives (13 of 24) who were tested had the disease, with clinically significant signs of glaucoma, hearing loss, or skeletal dysplasia, but none had retinal detachment.

Citaten

"Patients with these particular variants tended to have the disease at an earlier stage and a more severe detachment."
"We still don't quite know exactly who to treat, when to treat, or even how."
"In this era of precision medicine, we should be able to answer these [questions]."
"There is no one gene, one effect" in patients with Stickler syndrome.

Belangrijkste Inzichten Gedestilleerd Uit

Retinal Detachment Still Sticky Issue for Stickler Syndrome

by Manuela Call... om www.medscape.com 07-19-2024

https://www.medscape.com/viewarticle/retinal-detachment-still-sticky-issue-stickler-syndrome-2024a1000dcu

Diepere vragen

What other factors, beyond genetic mutations, may contribute to the variable clinical presentation and severity of Stickler syndrome?

In addition to genetic mutations, several other factors may contribute to the variable clinical presentation and severity of Stickler syndrome. Environmental factors, such as exposure to certain toxins or infections during pregnancy, can influence the expression of the syndrome. Additionally, epigenetic modifications, which can alter gene expression without changing the underlying DNA sequence, may play a role in the variability of symptoms seen in Stickler syndrome patients. Furthermore, interactions between different genes and gene-environment interactions can also impact the severity of the disease. For example, modifier genes that affect the expression of COL2A1 and COL11A1 could contribute to the diverse clinical manifestations observed in individuals with Stickler syndrome.

How can clinicians best utilize a combination of genetic testing, family history, and clinical assessments to guide the timing and approach to prophylactic retinal treatment in Stickler syndrome patients?

Clinicians can effectively utilize a combination of genetic testing, family history, and clinical assessments to guide the timing and approach to prophylactic retinal treatment in Stickler syndrome patients by adopting a personalized medicine approach. Firstly, genetic testing can help identify specific mutations in genes like COL2A1 and COL11A1, providing insights into the underlying genetic basis of the syndrome in individual patients. Family history assessment is crucial in understanding the inheritance pattern of Stickler syndrome within a family and identifying at-risk relatives who may benefit from early intervention. Clinical assessments, including ophthalmic evaluations and systemic examinations, can help determine the severity of retinal detachment and other associated complications, guiding the decision-making process for prophylactic retinal treatment. By integrating these three components, clinicians can tailor treatment strategies based on the genetic profile, familial risk, and clinical presentation of each patient, optimizing the timing and approach to prophylactic retinal treatment in Stickler syndrome.

What novel diagnostic or prognostic tools could be developed to better predict the risk and timing of retinal detachment in Stickler syndrome patients, and how might these tools inform personalized treatment strategies?

To better predict the risk and timing of retinal detachment in Stickler syndrome patients and inform personalized treatment strategies, novel diagnostic and prognostic tools could be developed. One potential approach is the utilization of advanced imaging techniques, such as optical coherence tomography (OCT) and genetic expression profiling, to assess the structural integrity of the retina and identify early signs of detachment. Biomarker analysis, including the measurement of specific proteins or metabolites associated with retinal pathology, could offer insights into the disease progression and help predict the likelihood of detachment. Furthermore, the integration of artificial intelligence algorithms to analyze genetic data, clinical parameters, and imaging results may enable the development of predictive models for individualized risk assessment and treatment planning. By combining these innovative tools, clinicians can enhance their ability to predict the onset and progression of retinal detachment in Stickler syndrome patients, facilitating the implementation of personalized treatment strategies tailored to each patient's unique genetic and clinical profile.