Genotyping affected and unaffected dogs of various breeds proved to be an effective method for testing the hypothesis that the Gly661Arg variant of ADAMTS10 is the cause of inherited disease in the POAG beagle colony. The candidate disease allele had to satisfy the criterion that unaffected dogs could not be homozygous for the disease allele, since the disease is inherited as an autosomal recessive trait in the beagle POAG colony. The candidate disease allele also had to satisfy the criterion that its frequency in beagles was lower than the upper threshold of 10%, based on Hardy-Weinberg equilibrium, disease prevalence of 1% and autosomal recessive inheritance. The upper threshold is conservatively high because it assumes that a single genetic variant accounts for all beagle primary glaucoma, which is unlikely. Failure to satisfy the two criteria was strong evidence against a variant as being causative.
In addition to the
ADAMTS10 variant, some of the nonsynonymous SNPs were functionally compelling but could not previously be ruled out on the basis of allele frequency. For example, complement factor
C3 is functionally plausible, since there is evidence that complement could play a role in glaucoma.
20 DENND1C is a GDP-GTP exchange factor for rab13,
21 which coordinates assembly of tight junctions,
22 which may play a role in aqueous humor outflow resistance.
23 However, in the current study, complement factor
C3,
DENND1C and the other nonsynonymous SNPs other than that found in
ADAMTS10 were ruled out because control beagles were found homozygous for the alternative alleles. Identification of control dogs of various breeds homozygous for nonsynonymous SNPs further argues against these variants as glaucoma-causing, though it is possible that breed-specific differences could result in variable penetrance of a disease allele. The Gly661Arg variant of
ADAMTS10 was the only SNP that satisfied the criterion that no control dogs were found homozygous for the variant allele.
ADAMTS10 was also the only variant with a minor allele frequency below the upper limit of 10% in beagles and therefore the only plausible candidate among the eight nonsynonymous SNPs. The criteria of no homozygosity in controls and sufficiently low allele frequency were effective at eliminating the presumably false-positive candidate SNPs and support the Gly661Arg variant of
ADAMTS10 as causative for disease in the beagle POAG colony.
For breeds other than beagle, no evidence was found for involvement of ADAMTS10 in primary glaucoma. The ADAMTS10 variant was not found in a total of 43 affected dogs of breeds other than beagle, including 26 American Cocker Spaniels, seven Basset Hounds and 10 dogs of several other breeds. While the sample sizes are too small to rule out ADAMTS10 as causative, these data suggest that primary glaucoma in dogs is likely to be genetically complex, involving other loci in addition to ADAMTS10.
While a genetic basis for canine primary glaucoma is likely because of the high prevalence in many breeds, differences in age of onset, sex ratios, and inheritance patterns suggest distinct disease processes and involvement of multiple genes. Clinically, primary glaucoma in dogs most often presents with narrowed or closed angles, marked by dysplasia of the pectinate ligament structures, with complete angle closure and collapse of ciliary cleft typically seen after prolonged elevation of IOP. However, studies of POAG in the beagle have documented angle closure secondary to prolonged ocular hypertension, likely related to enlargement of the globe. Some dogs presenting to clinics at late stages of the disease, as is common with canine patients, may previously have had open angles with elevated IOP.
A colony of Basset Hounds with inherited glaucoma has been reported recently with the disease well-characterized as primary angle-closure glaucoma.
24 Absence of the
ADAMTS10 variant in the basset hounds affected with primary glaucoma would be consistent with a disease process different from POAG in beagles, a notion corroborated by the invariably dysgenic iridocorneal angles in these dogs. Although most American cocker spaniels present with severely dysgenic iridocorneal angles, primary glaucoma with open angles was reported in 1968 in this breed.
25 In this study, three Cocker Spaniels bred from glaucomatous dogs were investigated. These Cocker Spaniels had POAG, with elevated IOP and reduced outflow facility, but normal-appearing and open angles by gonioscopy and postmortem histology. Lack of the Gly661Arg variant of
ADAMTS10 in affected American cocker spaniels in the present study is consistent with either multiple genes involved in canine POAG or in most cases a distinct disease process.
A limitation of this study is that although seven of the eight variants have been effectively ruled out, it does not provide definitive evidence that the Gly661Arg variant is causal. Future studies either preventing glaucoma in dogs from the POAG beagle colony by expression of the normal form of the gene, or by inducing glaucoma by ablation of ADAMTS10 in mice would provide more conclusive data that the Gly661Arg variant of ADAMTS10 is causative.
The strongest evidence supporting the hypothesis that Gly661Arg variant of
ADAMTS10 causes glaucoma is the identification of an affected beagle homozygous for the variant. At 5 years of age, this dog was carefully examined by a veterinary ophthalmologist (CEP) and found to have open iridocorneal angles and elevated IOP in both eyes. A total of 63 control beagles were sequenced, which is a relatively large number for dog breeds which are isolated populations with very limited genetic diversity relative to humans.
26 A single control beagle was identified heterozygous for Gly661Arg, giving a MAF of 0.78%. By Hardy-Weinberg equilibrium, fewer than 1 in 1600 beagles would be homozygous for Gly661Arg. Though additional cases would strengthen our conclusions, our identification of a beagle that is both homozygous for this rare allele and affected by a disease with low prevalence supports the
ADAMTS10 variant as causative. This support for the Gly661Arg variant of
ADAMTS10 in beagle POAG is consistent with our more general hypothesis that disruption of microfibril structure or function may be an underlying mechanism of increased resistance to aqueous humor outflow in POAG.