■青光眼是全球不可逆失明的主要原因。正常眼压性青光眼(NTG)是一种独特的亚型,其特征在于眼内压(IOP)在正常范围(<21mmHg)内。由于其发病隐匿和视神经损伤,患者在诊断时通常会出现晚期疾病。NTG带来了额外的挑战,因为它很难与正常眼压鉴别,使其预测复杂化,预防,和治疗。观察性研究表明,NTG与异常脂质代谢之间存在潜在关联,然而,缺乏建立直接因果关系的确凿证据。本研究旨在探讨血脂与NTG之间的因果关系,同时确定与脂质相关的治疗靶标。从预测的角度来看,预防性,和个性化医疗(PPPM),阐明血脂异常在NTG发生发展中的作用,可以为初步预测,有针对性的预防,和个性化的疾病治疗。
■在我们的研究中,我们假设,由于视神经乳头微血管调节异常,血脂异常患者可能更容易患NTG.为了验证工作假设,单变量孟德尔随机化(UVMR)和多变量孟德尔随机化(MVMR)用于评估脂质性状对NTG的因果影响。药物靶MR用于探索NTG治疗的可能靶基因。从全球脂质遗传学联盟全基因组关联研究(GWAS)中提取了与脂质性状相关的遗传变异和编码七个脂质相关药物靶标的基因的变异。NTG的GWAS数据,原发性开角型青光眼(POAG),和疑似青光眼(GLAUSP)从FinnGen财团获得。对于载脂蛋白,我们使用了Kettunen等人的GWAS研究的汇总统计数据。2016年。对于代谢综合征,摘要统计数据来自英国生物银行参与者.最后,这些发现可以通过筛查血脂异常来帮助识别有NTG风险的个体,可能导致新的有针对性的预防和个性化的治疗方法。
■遗传评估的高密度胆固醇(HDL)与NTG风险呈负相关(逆方差加权[IVW]模型:HDL水平的每SD变化OR=0.64;95%CI,0.49-0.85;P=1.84×10-3),并且因果效应与载脂蛋白和代谢综合征无关(IVW模型:OR=0.29;95%CI,0.14-0.60;经ApoB和ApoA1调整P=0.001;OR=0.70;95%CI,0.52-0.95;经BMI调整P=0.023,HTN,和T2DM)。甘油三酯(TG)与NTG风险呈正相关(IVW模型:OR=1.62;95%CI,1.15-2.29;P=6.31×10-3),且因果效应与代谢综合征无关(IVW模型:OR=1.66;95%CI,1.18-2.34;经BMI调整,P=0.003,HTN,和T2DM),但不是载脂蛋白(IVW模型:OR=1.71;95%CI,0.99-2.95;经ApoB和ApoA1调整后P=0.050)。载脂蛋白B(APOB)增强的遗传模仿与较低的NTG风险相关(IVW模型:OR=0.09;95%CI,0.03-0.26;P=9.32×10-6)。
■我们的研究结果支持血脂异常是NTG的预测原因,独立于其他因素,如代谢合并症。在七个与脂质相关的药物靶标中,APOB是预防NTG的潜在候选药物靶标。通过将脂质代谢与生活方式相结合,可以开发个性化的健康档案,视觉生活质量,如阅读,驾驶,和走路。这种全面的方法将有助于在NTG管理中从被动医疗服务转变为PPPM。
■在线版本包含补充材料,可在10.1007/s13167-024-00373-5获得。
UNASSIGNED: Glaucoma is the leading cause of irreversible blindness worldwide. Normal tension glaucoma (NTG) is a distinct subtype characterized by intraocular pressures (IOP) within the normal range (< 21 mm Hg). Due to its insidious onset and optic nerve damage, patients often present with advanced conditions upon diagnosis. NTG poses an additional challenge as it is difficult to identify with normal IOP, complicating its prediction, prevention, and treatment. Observational studies suggest a potential association between NTG and abnormal lipid metabolism, yet conclusive evidence establishing a direct causal relationship is lacking. This study aims to explore the causal link between serum lipids and NTG, while identifying lipid-related therapeutic targets. From the perspective of predictive, preventive, and personalized medicine (PPPM), clarifying the role of dyslipidemia in the development of NTG could provide a new strategy for primary prediction, targeted prevention, and personalized treatment of the disease.
UNASSIGNED: In our study, we hypothesized that individuals with dyslipidemia may be more susceptible to NTG due to a dysregulation of microvasculature in optic nerve head. To verify the working hypothesis, univariable Mendelian randomization (UVMR) and multivariable Mendelian randomization (MVMR) were utilized to estimate the causal effects of lipid traits on NTG. Drug target MR was used to explore possible target genes for NTG treatment. Genetic variants associated with lipid traits and variants of genes encoding seven lipid-related drug targets were extracted from the Global Lipids Genetics Consortium genome-wide association study (GWAS). GWAS data for NTG, primary open angle glaucoma (POAG), and suspected glaucoma (GLAUSUSP) were obtained from FinnGen Consortium. For apolipoproteins, we used summary statistics from a GWAS study by Kettunen et al. in 2016. For metabolic syndrome, summary statistics were extracted from UK Biobank participants. In the end, these findings could help identify individuals at risk of NTG by screening for lipid dyslipidemia, potentially leading to new targeted prevention and personalized treatment approaches.
UNASSIGNED: Genetically assessed high-density cholesterol (HDL) was negatively associated with NTG risk (inverse-variance weighted [IVW] model: OR per SD change of HDL level = 0.64; 95% CI, 0.49-0.85; P = 1.84 × 10-3), and the causal effect was independent of apolipoproteins and metabolic syndrome (IVW model: OR = 0.29; 95% CI, 0.14-0.60; P = 0.001 adjusted by ApoB and ApoA1; OR = 0.70; 95% CI, 0.52-0.95; P = 0.023 adjusted by BMI, HTN, and T2DM). Triglyceride (TG) was positively associated with NTG risk (IVW model: OR = 1.62; 95% CI, 1.15-2.29; P = 6.31 × 10-3), and the causal effect was independent of metabolic syndrome (IVW model: OR = 1.66; 95% CI, 1.18-2.34; P = 0.003 adjusted by BMI, HTN, and T2DM), but not apolipoproteins (IVW model: OR = 1.71; 95% CI, 0.99-2.95; P = 0.050 adjusted by ApoB and ApoA1). Genetic mimicry of apolipoprotein B (APOB) enhancement was associated with lower NTG risks (IVW model: OR = 0.09; 95% CI, 0.03-0.26; P = 9.32 × 10-6).
UNASSIGNED: Our findings supported dyslipidemia as a predictive causal factor for NTG, independent of other factors such as metabolic comorbidities. Among seven lipid-related drug targets, APOB is a potential candidate drug target for preventing NTG. Personalized health profiles can be developed by integrating lipid metabolism with life styles, visual quality of life such as reading, driving, and walking. This comprehensive approach will aid in shifting from reactive medical services to PPPM in the management of NTG.
UNASSIGNED: The online version contains supplementary material available at 10.1007/s13167-024-00373-5.