Study of the effect of RS1800629 TNF polymorphism on the course of age-related macular degeneration through the prism of ANTI-VEGF therapy

Abstract

Annotation. Age-related macular degeneration (AMD) includes pathological changes in the deep layers of the retina, macula, and surrounding blood vessels, leading to loss of central vision. The wet form of nosology is the leading cause of irreversible blindness in developed countries among people over 60, where more than 30 million people suffer from the disease. The number of patients in the United States is expected to increase from 9.1 million in 2010 to 17.8 million in 2050. New therapeutic strategies and the development of new practical methods for identifying patients at high risk of treatment resistance are needed to reduce the prevalence of the disease. That is why the aim of the study was to shed light on the role of the rs1800629 polymorphism of the TNF gene as one of the prognostic factors in the effectiveness of treatment of the wet form of AMD. The study group consisted of 162 people diagnosed with a wet form of pathology, while the comparison group consisted of 105 people without a history of ophthalmic pathology. Optical coherence tomography of certain areas of the eye, including the retina, was used to confirm or rule out the diagnosis. To detect the polymorphism status of the TNF gene, the real-time polymerase chain reaction method was used on the BioRad CFX 96 thermocycler-amplifier, using “Litekh” (RF) reagent kits. Statistical processing of the results was performed by determining the Hardy-Weinberg equilibrium, Student’s and Wilcoxon’s criteria, logistic regression using OR values and 95% CI, and by subtracting RR and χ². The study found that the frequency of genotype distribution with mutant allele A was predominant among patients in the study group, and the G allele was determined predominantly in the control group and was associated with better results of anti-VEGF therapy. The results of OCT confirmed this information, because among carriers of genotypes GG and GA (p<0.05) visual acuity improved even after the first injection of the drug in most areas, while among carriers of homozygous genotype AA was not sufficient probability of biological effects, efficiency in the presence of this genotype was reduced (p<0,05). The results of treatment were most representative in the areas of OCT 4, OCT 8 and macula (OCT 3) – among carriers of allele A in the OCT 4 zone, the chance of resistance to treatment was 3.1 times (OR=3.1; 95% SI 1,686 - 5.7) higher than in carriers of the G allele, and in the zone of OCT 8 in patients from the study group the risk of ineffectiveness of therapy was 2.81 times (OR=2.81; 95% CI 1.56 - 5.059) higher than in the corresponding zone of the G allele carriers. This suggests a lack of clinical efficacy in individuals carrying the mutant A allele, and the need to identify the status of polymorphisms for prognostic assessment of treatment efficacy.