In this classic twin study, we obtained MP measurements in 76 MZ and 74 DZ twin pairs, enabling us to comment on the heritability of this dietary pigment at the macula.
In our study, the mean MP optical density of the entire study group was 0.43 ± 0.20 using HFP, comparable to other studies using the same Maculometer in healthy eyes (0.36 ± 0.15 in 64 normal, female eyes).
33 Beatty et al.
43 and Werner et al.
44 also recorded similar values in healthy subjects, where HFP with a similar stimulus size (0.95/1° respectively) was used, with mean MP optical densities of 0.496 and 0.39, respectively. Other studies have reported lower mean values, possibly attributable to differences in the HFP instrumentation and the population studied.
45 46
MP readings using AF (MP optical density measured at 1° eccentricity from the foveal center, 0.27 ± 0.10) are comparable with those of Wustemeyer et al.
39 (average MP optical density in the 2° diameter area, 0.22 ± 0.07), who used a very similar apparatus and MP density calculation program. Delori et al.
34 reported a higher mean MP optical density, averaged in a 2° diameter, of 0.37 ± 0.12, but AF images in that study were acquired with a modified fundus camera with different excitation wavelengths, possibly contributing to the higher readings.
There is a general consensus that MP measurements recorded with HFP, using a circular and central target, represents the optical density of this pigment at a retinal location 0.5 to 0.7 of the foveal test field diameter. Therefore, with a 1° foveal target, as was used in the present study, HFP readings reflect MP densities from retinal loci of approximately 0.3° eccentricity from the foveal center.
19 47 Because MP densities derived from AF reflect readings obtained at 1° eccentricity, and because MP optical density peaks at the fovea, it is not surprising that we found our AF readings to be lower than HFP readings.
It is important to note that the strength inherent in a classic twin study rests on the ability to compare a variable in MZ and DZ twin pairs and thus determine the relative contributions of genes and environment with respect to the variable in question. In other words, as long as a single and reproducible technique is used for all subjects, the relative nature of the readings will determine the conclusion. Therefore, despite the difficulties inherent in all methods of measuring MP in vivo, the heritability of MP levels can be studied in a meaningful way as a result of our findings.
Subjects’ MP optical densities covered a wide range, according to both HFP and AF, which is consistent with most studies that have reported considerable interindividual variability.
8 19 48 49
Both the AF and HFP results show that genetic factors and environmental risk factors not shared by twins are influential in MP optical density in this population. This classic twin study has enabled us to quantify the relative contributions of genetic and environmental effects in determining variability of MP optical density, with heritabilities of 0.85 and 0.67 for AF and HFP, respectively. Unique, individual environmental effects, which could include lifestyle and dietary factors, accounted for the remaining variance of MP levels. Our finding is in agreement with a study by Bone et al.
50 who measured MP optical density using HFP in 19 subjects and also assessed dietary intake and serum levels of L and Z, and estimated that 17% of the variability of MP optical density was attributable to dietary intake of L and Z. To our knowledge, there has been only one previous twin study of MP in which 10 pairs of MZ (but not DZ) twins were studied, thereby precluding comment on the heritability of MP.
51 In that study, significant differences in MP were found in five pairs of twins, moderately related to dietary differences, and thus confirming that MP was not entirely genetically determined.
As measurement error is included in the unique environmental variance, the higher heritability estimated by AF (0.85) compared with HFP (0.67) may be attributable to the greater measurement error and imprecision of HFP, as it is a psychophysical method. Further evidence of this is the lower interocular correlation of HFP readings (0.77) compared to AF measurements (0.96).
Genetic factors may play a role in every step of MP accumulation, from digestion and absorption of carotenoids in the diet, to the transport of these substances in the bloodstream and their capture by and stabilization within the retina. Many of the mechanisms involved in delivery of L and Z to tissues remain unstudied, including the precise way by which carotenoids are taken up by intestinal mucosal cells. Carotenoids are transported as chylomicrons from the gastrointestinal system to the lymphatic or portal circulation and lipoproteins transport L and Z from the liver to the retina.
52 53 Genetic factors have been shown to play an important role in determining plasma lipoprotein profile.
54 55 The high concentration of L and Z in the retina, to the exclusion of all other carotenoids found abundantly in the human plasma, suggests that there are specific mechanisms involved in the uptake and/or stabilization of MP. Highly specific membrane-associated xanthophyll-binding proteins (XBP), which are saturable, have now been identified in the retina.
56 57 However, the exact physiological roles of these XBPs have yet to be elucidated.
The results of this study suggest a greater role for genes than may have been expected, partly because environmental factors such as nutrition and cigarette smoking have been investigated more extensively than have genetic factors. There is growing interest in the effects of dietary modification and supplementation on MP optical density, primarily because of the protection that this pigment may confer against ARMD. Although most cross-sectional studies show some relationship between dietary intake of L (and Z) and MP optical density, there is considerable interindividual variability of MP optical density and its response to dietary intervention. For example, Hammond et al.
22 showed that MP levels did not increase in a substantial proportion of subjects (3/11; 27%) after dietary modification designed to augment intake of L and Z. Our results suggest that these differences, which may be due in part to other dietary factors (such as fat and iron),
48 may also be due to genetic differences between individuals. The recent evidence that a common variant in the complement factor H (
CFH) gene is strongly associated with ARMD highlights the complex integration of genetic and environmental factors.
28 58 Clearly, further work is needed, to determine whether there is any relationship between
CFH allelic status and MP optical density. In this study, the AF method allowed us to generate MP spatial profiles and we identified different shaped profiles, consistent with the findings of previous investigators.
37 We also noted that MP spatial profiles among MZ twins tended to correlate better than those of DZ twins, suggesting that genes may influence the spatial distribution as well as quantity of MP in the eye
(Fig 2) .
All the twins examined in this study were female because of the difficulty in recruiting enough male subjects to make any significant comment on gender differences. The TwinsUK adult registry database has a much higher proportion of women, partly because it was set up to study osteoporosis in women. Although several large studies have not shown any difference in MP optical density between males and females,
25 34 45 59 a few have found males to have significantly higher levels.
33 46 48 Because our MP readings were comparable to those in other studies and twins have been shown to be comparable to singletons in many complex traits,
60 we believe the results are generalizable but should be interpreted with caution in relation to men.
Ninety-six percent of our subjects were white and from the United Kingdom. At present, there are no substantial data that examine racial differences in MP optical density. Bone and Sparrock
49 performed a small study on 49 subjects to investigate differences between racial groups but found no systematic difference in peak MP density.
49 As there is no gold standard for the measurement of MP density, it is difficult to compare values obtained from studies of different populations due to differences in the instrumentation, methodology, and levels of analysis performed.
This study, examining 18- to 50-year-old subjects, did not reveal any significant association between age and MP, using HFP results. Although the AF values suggested a positive correlation between MP optical density and age, the intraclass correlation coefficient was very small (
r 2 = 0.03), and the spread of data points was large. Although we attempted to recruit subjects evenly distributed by age through the age range (16 to 50 years), there were more subjects at the older end of the spectrum (44% aged 41–50 years). So far, the results of previous studies investigating this relationship have also been inconsistent. Several studies agree with our HFP findings of no age-related change.
32 33 44 Some studies have shown an age-related decline
18 46 or increase in MP density,
34 but the data have generally had a large spread and the regression coefficients have been small (
r = −0.14,
46 −0.05 log units per decade calculated from the best-fit line
18 ). Large, prospective long-term studies have not yet been performed but given that age is the most important risk factor for ARMD, the relationship between MP levels and age warrants investigation in a longitudinal fashion.
In conclusion, this study reveals that genetic factors play an important role in determining the MP optical density in the healthy eye, with heritability estimates of 0.67 and 0.85 using HFP and AF methods of MP quantification. Given the genetic predisposition to ARMD and the protection MP may afford against development of that condition, the mechanisms whereby genes influence MP optical density and distribution warrants investigation.
The authors thank all the twin pairs who volunteered to participate in the study.