Prediagnostic Plasma Metabolomics and the Risk of Exfoliation Glaucoma

Author(s): Jae H Kang (1), Oana Zeleznik (1), Lisa Frueh (1), Jessica Lasky-Su (1), A Heather Eliassen (1,2), Clary Clish (3), Bernard A Rosner (1,4), Louis R Pasquale (5), Janey L Wiggs (6)

1 Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States.
2 Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States.
3 Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts, United States.
4 Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States.
5 Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
6 Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States.

PURPOSE: The etiology of exfoliation glaucoma (XFG) is poorly understood. We aimed to identify a prediagnostic plasma metabolomic signature associated with XFG.

METHODS: We conducted a 1:1 matched case-control study nested within the Nurses' Health Study and Health Professionals Follow-up Study. We collected blood samples in 1989-1990 (Nurses' Health Study) and 1993-1995 (Health Professionals Follow-up Study). We identified 205 incident XFG cases through 2016 (average time to diagnosis from blood draw = 11.8 years) who self-reported glaucoma and were confirmed as XFG cases with medical records. We profiled plasma metabolites using liquid chromatography-mass spectrometry. We evaluated 379 known metabolites (transformed for normality using probit scores) using multiple conditional logistic models. Metabolite set enrichment analysis was used to identify metabolite classes associated with XFG. To adjust for multiple comparisons, we used number of effective tests (NEF) and the false discovery rate (FDR).

RESULTS: Mean age of cases (n = 205) at diagnosis was 71 years; 85% were women and more than 99% were Caucasian; controls (n = 205) reported eye examinations as of the matched cases' index date. Thirty-three metabolites were nominally significantly associated with XFG (P < 0.05), and 4 metabolite classes were FDR-significantly associated. We observed positive associations for lysophosphatidylcholines (FDR = 0.02) and phosphatidylethanolamine plasmalogens (FDR = 0.004) and inverse associations for triacylglycerols (FDR < 0.0001) and steroids (FDR = 0.03). In particular, the multivariable-adjusted odds ratio with each 1 standard deviation higher plasma cortisone levels was 0.49 (95% confidence interval, 0.32-0.74; NEF = 0.05).

CONCLUSIONS: In plasma from a decade before diagnosis, lysophosphatidylcholines and phosphatidylethanolamine plasmalogens were positively associated and triacylglycerols and steroids (e.g., cortisone) were inversely associated with XFG risk.

Invest Ophthalmol Vis Sci. 2022 Aug 2;63(9):15. doi: 10.1167/iovs.63.9.15.

PMID: 35951322 PMCID: PMC9386645 DOI: 10.1167/iovs.63.9.15

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