Understanding the molecular basis and pathogenesis of hereditary optic neuropathies: towards improved diagnosis and management.

Hereditary optic neuropathies result from defects in the human genome, both nuclear and mitochondrial. The two main and most recognised phenotypes are dominant optic atrophy and Leber hereditary optic neuropathy. Advances in modern molecular diagnosis have expanded our knowledge of genotypes and phenotypes of inherited disorders that affect the optic nerve, either alone or in combination, with various forms of neurological and systemic degeneration. A unifying feature in the pathophysiology of these disorders appears to involve mitochondrial dysfunction, suggesting that the retinal ganglion cells and their axons are especially susceptible to perturbations in mitochondrial homoeostasis. As we better understand the pathogenesis behind these genetic diseases, aetiologically targeted therapies are emerging and entering into clinical trials, including treatments aimed at halting the cascade of neurodegeneration, replacing or editing the defective genes or their protein products, and potentially regenerating damaged optic nerves, as well as preventing generational disease transmission.
Competing Interests: Declaration of interests NJN is a consultant for GenSight Biologics, Santhera/Chiesi, Stealth Biotherapeutics, and Neurophoenix; receives research support from GenSight Biologics and Santhera/Chiesi; is a participant in educational webinars sponsored by WebMD-Global Medscape and First Class; and is a medical-legal consultant in matters not related to this work. PY-W-M is a consultant for GenSight Biologics, Santhera/Chiesi, and PYC Therapeutics; receives research support from GenSight Biologics and Santhera/Chiesi; and is a participant in educational webinars sponsored by WebMD-Global Medscape and First Class. VB is a consultant for GenSight Biologics and Neurophoenix, and receives research support from GenSight Biologics and Santhera/Chiesi. VC is a consultant for GenSight Biologics, Santhera/Chiesi, and Stealth Biotherapeutics; receives research support from GenSight Biologics and Santhera/Chiesi; and is a participant in educational webinars sponsored by WebMD-Global Medscape and First Class.
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