Variabilidade alélica e expressão do gene ABCA4 em sujeitos diagnosticados com a maculopatia de Stargardt: associação com a função e estrutura da retina e morfologia celular granulocítica

Abstract

The autosomal recessive Stargardt's maculopathy is characterized by symmetrical progressive loss of central vision in patients’ first and second decades of life. It is also part of the clinical diagnosis the presence of yellowish-white color specific macular lesions found in the parafoveal and foveal regions, besides lipofuscin deposition generating hypofluorescence and atrophy of choriocapillaris and retinal pigment epithelium. Visual acuity of the Stargardt’s degeneration carriers decreases with their progress and tend to stabilize between 20/200 (1.0 logMAR) to 20/400 (1.3 logMAR). This thesis aimed to investigate the occurrence of association between allelic variants (mutations) and ABCA4 gene expression levels with the peripheral granulocytes morphology and clinical phenotypes, electrophysiological and retinal structure in patients harboring Stargardt’s maculopathy. Four non-synonymous and three synonymous allelic variants were identified among eleven selected subjects. The allelic combination L1395P/D1817E was found in 64% of the 22 chromosomes analyzed suggesting the occurrence of founder effect. There were no association between genotypes and clinical phenotypes analyzed. The differential values obtained for ABCA4 gene expression between patients and controls, as well as the prevalence of banded neutrophils in the peripheral blood circulation suggest the possibility they could serve as biomarkers for Stargardt. The eye fundus and angiographic images were used for the classification in the stages I, II and III of retinal impairment in subjects investigated. The thickness values of the central region of the macula among patients were much lower than those obtained for the controls, indicating a loss of photoreceptor layer. Full-field electroretinographic findings of light adapted eyes during the course of time enabled the characterization of the functional losses in investigated subjects.