The Common ABCA4 Variant p.Asn1868Ile Shows Nonpenetrance and Variable Expression of Stargardt Disease When Present in trans With Severe Variants

Esmee H Runhart, Riccardo Sangermano, Stéphanie S Cornelis, Joke B G M Verheij, Astrid S Plomp, Camiel J F Boon, Dorien Lugtenberg, Susanne Roosing, Nathalie M Bax, Ellen A W Blokland, Marlie H M Jacobs-Camps, Saskia D van der Velde-Visser, Jan-Willem R Pott, Klaus Rohrschneider, Alberta A H J Thiadens, Caroline C W Klaver, L Ingeborgh van den Born, Carel B Hoyng, Frans P M Cremers

Research output: Contribution to journalArticleResearchpeer-review


Purpose: To assess the occurrence and the disease expression of the common p.Asn1868Ile variant in patients with Stargardt disease (STGD1) harboring known, monoallelic causal ABCA4 variants.

Methods: The coding and noncoding regions of ABCA4 were sequenced in 67 and 63 STGD1 probands respectively, harboring monoallelic ABCA4 variants. In case p.Asn1868Ile was detected, segregation analysis was performed whenever possible. Probands and affected siblings harboring p.Asn1868Ile without additional variants in cis were clinically evaluated retrospectively. Two asymptomatic siblings carrying the same ABCA4 variants as their probands were clinically examined. The penetrance of p.Asn1868Ile was calculated using allele frequency data of ABCA4 variants in non-Finnish European individuals.

Results: The p.Asn1868Ile variant was found in cis with known variants in 14/67 probands. In 27/67 probands, we identified p.Asn1868Ile without additional variants in cis, in combination with known, mainly severe ABCA4 variants. In 23/27 probands, the trans configuration was established. Among 27 probands and 6/7 STGD1 siblings carrying p.Asn1868Ile, 42% manifested late-onset disease (>44 years). We additionally identified four asymptomatic relatives carrying a combination of a severe variant and p.Asn1868Ile; ophthalmologic examination in two persons did not reveal STGD1. Based on ABCA4 allele frequency data, we conservatively estimated the penetrance of p.Asn1868Ile, when present in trans with a severe variant, to be below 5%.

Conclusions: A significant fraction of genetically unexplained STGD1 cases carries p.Asn1868Ile as a second variant. Our findings suggest exceptional differences in disease expression or even nonpenetrance of this ABCA4 variant, pointing toward an important role for genetic or environmental modifiers in STGD1.

Original languageEnglish
Pages (from-to)3220-3231
Number of pages12
JournalInvestigative ophthalmology & visual science
Issue number8
Publication statusPublished - 2 Jul 2018


  • ATP-Binding Cassette Transporters/genetics
  • Adult
  • Age of Onset
  • Aged
  • Electroretinography
  • Female
  • Fluorescein Angiography
  • Gene Frequency
  • Genetic Complementation Test
  • Humans
  • Macular Degeneration/congenital
  • Male
  • Middle Aged
  • Mutation
  • Pedigree
  • Penetrance
  • Polymorphism, Single Nucleotide
  • Retrospective Studies
  • Sequence Analysis, DNA
  • Siblings
  • Stargardt Disease
  • Tomography, Optical Coherence
  • Visual Acuity/physiology


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