Genetic association at the 9p21 glaucoma locus contributes to sex bias in normal-tension glaucoma

Soo Khai Ng, Kathryn P. Burdon*, Jude T. Fitzgerald, Tiger Zhou, Rhys Fogarty, Emmanuelle Souzeau, John Landers, Richard A. Mills, Robert J. Casson, Bronwyn Ridge, Stuart L. Graham, Alex W. Hewitt, David A. Mackey, Paul R. Healey, Jie Jin Wang, Paul Mitchell, Stuart Macgregor, Jamie E. Craig

*Corresponding author for this work

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    Abstract

    PURPOSE. Many genome-wide association studies have identified common single nucleotide polymorphisms (SNPs) at the 9p21 glaucoma locus (CDKN2B/CDKN2B-AS1) to be significantly associated with primary open-angle glaucoma (POAG), with association being stronger in normal tension glaucoma (NTG) and advanced glaucoma. We aimed to determine whether any observed differences in genetic association at the 9p21 locus are influenced by sex. METHODS. Sex was assessed as a risk factor for POAG for 2241 glaucoma participants from the Australian and New Zealand Registry of Advanced Glaucoma, the Glaucoma Inheritance Study in Tasmania, and the Flinders Medical Centre. A total of 3176 controls were drawn from the Blue Mountains Eye Study and South Australia: 1523 advanced POAG and 718 nonadvanced POAG cases were genotyped along with 3176 controls. We selected 13 SNPs at the 9p21 locus, and association results were subanalyszd by sex for high-tension glaucoma (HTG) and NTG. Odds ratios (ORs) between sexes were compared. RESULTS. A sex bias was present within advanced NTG cases (57.1% female versus 42.9% male, P = 0.0026). In all POAG cases, the strongest associated SNP at 9p21 was rs1063192 (OR, 1.43; P = 4 × 10-18). This association was stronger in females (OR, 1.5; P = 5 × 10-13) than inmales (OR, 1.35; P = 7 × 10-7), with a statistically significant difference in female to male OR comparison (P = 1.0 × 10-2). An NTG to HTG subanalysis yielded statistically significant results only in females (OR, 1.63; P = 1.5 × 10-4) but not in males (OR, 1.15; P = 2.8 × 10-1), with a statistically significant difference in female to male OR comparison (P = 1.4 × 10-4). CONCLUSIONS. This study demonstrated that female sex is a risk factor for developing advanced NTG. The stronger genetic signals at the 9p21 locus among females may contribute at least in part to the observed sex bias for NTG.

    Original languageEnglish
    Pages (from-to)3416-3421
    Number of pages6
    JournalInvestigative Ophthalmology and Visual Science
    Volume57
    Issue number7
    DOIs
    Publication statusPublished - 1 Jun 2016

    Bibliographical note

    Copyright the Author(s) 2016. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

    Keywords

    • 9p21
    • primary open-angle glaucoma
    • normal-tension glaucoma
    • sex specific
    • sex bias

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