ARMS2

gene
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Also known as LOC387715ARMD8

Summary

ARMS2 (age-related maculopathy susceptibility 2, HGNC:32685) is a protein-coding gene on chromosome 10q26.13, encoding Age-related maculopathy susceptibility protein 2 (P0C7Q2).

This gene encodes a small secreted protein specific to primates. This protein is a component of the choroidal extracellular matrix of the eye. Mutations in this gene are associated with age-related macular degeneration.

Source: NCBI Gene 387715 — RefSeq curated summary.

At a glance

  • GWAS associations: 24
  • Clinical variants (ClinVar): 33 total — 1 pathogenic
  • MANE Select transcript: NM_001099667

Identifiers

Gene identifiers

FieldValue
HGNC IDHGNC:32685
Approved symbolARMS2
Nameage-related maculopathy susceptibility 2
Location10q26.13
Locus typegene with protein product
StatusApproved
AliasesLOC387715, ARMD8
Ensembl geneENSG00000254636
Ensembl biotypeprotein_coding
OMIM611313
Entrez387715

Gene structure

Transcript identifiers

Ensembl transcripts: 1 — 1 protein_coding

ENST00000528446

RefSeq mRNA: 1 — MANE Select: NM_001099667 NM_001099667

CCDS: CCDS53585

Canonical transcript exons

ENST00000528446 — 2 exons

ExonStartEnd
ENSE00002173356122456907122457352
ENSE00002182701122454653122455024

Expression profiles

Bgee: expression breadth broad, 99 present calls, max score 61.46.

FANTOM5 (CAGE): breadth tissue_specific, TPM avg 0.0136 / max 8.4927, expressed in 5 samples.

FANTOM5 promoters (1 alternative TSS)

Promoter IDTPM avgSamples expressed
1074470.01365

Top tissues by expression

122 total, by Bgee expression score (0-100, higher = more expressed):

TissueAnatomy IDExpression scoreQuality
primordial germ cell in gonadCL:0000670 ∩ UBERON:000099161.46gold quality
placentaUBERON:000198760.32gold quality
left ovaryUBERON:000211957.55gold quality
left testisUBERON:000453357.27gold quality
ovaryUBERON:000099256.37gold quality
testisUBERON:000047356.21gold quality
right testisUBERON:000453456.16gold quality
right ovaryUBERON:000211854.57gold quality
pituitary glandUBERON:000000750.18gold quality
smooth muscle tissueUBERON:000113548.17gold quality
adenohypophysisUBERON:000219647.62gold quality
right lobe of liverUBERON:000111447.49gold quality
left uterine tubeUBERON:000130347.31gold quality
body of uterusUBERON:000985346.58gold quality
myometriumUBERON:000129646.11gold quality
muscle layer of sigmoid colonUBERON:003580545.56gold quality
lower esophagusUBERON:001347345.01gold quality
lower esophagus muscularis layerUBERON:003583345.01gold quality
omental fat padUBERON:001041444.89gold quality
anterior cingulate cortexUBERON:000983544.64gold quality
esophagogastric junction muscularis propriaUBERON:003584144.43gold quality
ascending aortaUBERON:000149644.26gold quality
popliteal arteryUBERON:000225044.14gold quality
tibial arteryUBERON:000761044.10gold quality
liverUBERON:000210743.94gold quality
thoracic aortaUBERON:000151543.92gold quality
adipose tissueUBERON:000101343.72gold quality
descending thoracic aortaUBERON:000234543.23gold quality
subcutaneous adipose tissueUBERON:000219043.15gold quality
saliva-secreting glandUBERON:000104442.46gold quality

Single-cell (SCXA)

Detected in 1 experiment(s), a significant marker in 0.

ExperimentMarker?Max mean expression
E-ANND-3no2.13

Regulation

Is transcription factor: no

miRNA regulators (miRDB)

37 targeting ARMS2, top 30 by miRDB confidence (max_score; target_count = how many genes the miRNA targets in total — lower means more specific):

miRNAMax scoreAvg scoremiRNA target_count
HSA-MIR-12118100.0065.881270
HSA-MIR-477599.9875.006394
HSA-MIR-6891-5P99.9866.531372
HSA-MIR-3173-3P99.9866.491217
HSA-MIR-807599.9767.20962
HSA-MIR-590-3P99.9674.346478
HSA-MIR-311999.9271.342390
HSA-MIR-477999.8666.501583
HSA-MIR-7856-5P99.7569.992901
HSA-MIR-92A-2-5P99.7567.012164
HSA-MIR-442899.7366.411733
HSA-MIR-182799.6368.573265
HSA-MIR-1249-5P99.6166.552049
HSA-MIR-6797-5P99.6166.552084
HSA-MIR-451699.6167.783390
HSA-MIR-94099.3766.142064
HSA-MIR-542-3P99.3467.581270
HSA-MIR-6808-5P99.3166.232150
HSA-MIR-6893-5P99.3166.252119
HSA-MIR-4477B99.2370.491733
HSA-MIR-296-3P99.2166.56474
HSA-MIR-491-5P99.1365.981468
HSA-MIR-125399.1267.081688
HSA-MIR-443499.1067.011984
HSA-MIR-570399.1067.092053
HSA-MIR-6829-5P98.8665.121480
HSA-MIR-4680-3P98.6468.602093
HSA-MIR-31-5P98.5868.351239
HSA-MIR-426698.5367.291035
HSA-MIR-313898.4167.53744

Literature-anchored findings (GeneRIF, showing 40)

  • Hypothetical LOC387715 is a second major susceptibility gene for age-related macular degeneration, contributing independently of complement factor H to disease risk. (PMID:16174643)
  • Our results strongly implicate a coding change (Ala69Ser) in the LOC387715 gene as the second major identified AMD-susceptibility allele, confirming earlier suggestions. This variant’s effect on AMD is statistically independent of CFH . (PMID:16642439)
  • Results further support the notion that CFH (complement factor H) and LOC387715 genes are the major risk factors for ARMD. (PMID:16954704)
  • study provides additional support for the CFH and LOC387715 genes in age-related maculopathy (ARM) susceptibility via the evaluation of cohorts that had different ascertainment schemes regarding ARM status and through the meta-analyses (PMID:17000705)
  • A polymorphism of LOC387715 gene is associated with age-related macular degeneration in the Japanese population. (PMID:17194541)
  • findings suggest that the combined effect of variants in the CFH and LOC 387715 genes may contribute to the age-related macular degeneration phenotype in this family (PMID:17285240)
  • AMD (age-related macular degeneration) genetic risk marker harbored within LOC387715, the nested case-control data from the population-based BMES samples showed lower estimates than from the clinic-based samples. (PMID:17325155)
  • The number of risk alleles at the LOC387715 SNP was associated with advanced Age-related macular degeneration (PMID:17347568)
  • Combined effects for the LOC387715 genotypes with 3 inflammatory markers and PAI-1 on the risk of early or late age-related macular degeneration(AMD), and with current smoking on the risk of late AMD. (PMID:17675241)
  • The LOC387715/HTRA1 variants are associated with polypoidal choroidal vasculopathy (PCV) and wet age-related macular degeneration (AMD) in the Japanese population. (PMID:17692272)
  • Both ARMS2 polymorphism and complement factor H polymorphism are independently associated with progression of age-related macular degeneration. (PMID:17846368)
  • SNP rs10490924 represents a major susceptibility variant for age-related macular degeneration. A likely biological mechanism is that the A69S change in the LOC387715/ARMS2 protein affects its presumptive function in mitochondria. (PMID:17884985)
  • The Age-related macular degeneration associated complement factor H Y402H and LOC387715 A69S variants were associated with differences in choroidal neovascular lesion size in this study. (PMID:18054635)
  • Although a role for PLEKHA1 could not be totally excluded, there was a four times higher age-related macular degeneration risk was associated with haplotype “A-T-A” involving “PLEKHA1-LOC387715-HTRA1” risk alleles. (PMID:18079691)
  • CFH and ARMS2 haplotypes and smoking exerted large effects on AMD risk. CFH haplotypes conferred ORs from 1 to 4.17. Homozygotes for ARMS2 were at very high risk for AMD. Risk of wet AMD rose to 15.5% in 1/10 of the population with highest predicted risk. (PMID:18162041)
  • Polymorphisms in the complement factor H gene, LOC387715, and the HTRA1 promoter are strongly associated with age-related macular degeneration. (PMID:18162041)
  • The LOC387715 polymorphism is associated with polypoidal choroidal vasculopathy (PCV)and clinical severity in the subgroups of PCV in the Japanese population. (PMID:18400199)
  • The findings of this study indicate that an individual’s response to age-related eye disease supplements may be related to complement factor H genotype. (PMID:18423869)
  • The present data provided an independent validation of the association of LOC387715 and HTRA1 SNPs, along with their risk estimates among Indian patients with AMD. (PMID:18436811)
  • our results showed that in Spanish patients with AMD the associations of both polymorphisms are not equal: Y402H is associated with early and wet AMD, whereas A69S is associated only with wet AMD. (PMID:18452766)
  • Age-related macular degeneration is associated with an unstable ARMS2 (LOC387715) mRNA. (PMID:18511946)
  • a deletion-insertion polymorphism in ARMS2 is strongly associated with AMD, directly affecting the transcript by removing the polyadenylation signal and inserting a 54-bp element known to mediate rapid mRNA turnover. (PMID:18511946)
  • Both the HTRA1 and LOC387715/ARMS2 single nucleotide polymorphysms appear to contribute equally to disease risk (both geographic atrophy and choroidal neovascularization) with no evidence of interaction with CFH. (PMID:18682806)
  • The purpose of this study was to investigate the association of reported common single-nucleotide polymorphisms (SNPs) in CFH, LOC387715, and HTRA1 with exudative age-related macular degeneration in a northern Chinese population. (PMID:18682812)
  • The LOC387715/ARMS2 gene is expressed in the human brain, and it may concur to the individual risk for Alzheimer’s disease (PMID:18688167)
  • We did not find a positive association in high myopia. Based on these results, neither the Y402H nor the A69S single nucleotide polymorphisms seem to be involved in the choroid neovascularization process in high myopia patients. (PMID:18762075)
  • A tentative gene-gene interaction between the two major age-related macular degeneration-associated loci, LOC387715 and complement factor H, was found in this study. (PMID:19048105)
  • The rs10490924 Single nucleotide polymorphisms (SNP) in LOC387715/ARMS2 and the rs11200638 SNP in HTRA1 are strongly associated with neovascular age-related macular degeneration in this Israeli population. (PMID:19065273)
  • ARMS2 was mainly distributed in the cytosol, not in the mitochondrial outer membrane as previously reported (PMID:19255159)
  • Data show that SNP rs10490924 on chromosome 10 in exon 1 of the ARMS2 gene has highly significant association with an odds ratio of 3.2 for the risk allele with AMD cases. (PMID:19259132)
  • Both HTRA1 SNPs are significantly associated with exudative age-related macular degeneration(AMD) in Chinese cohort and seem to contribute equally to disease status. (PMID:19491722)
  • The replication of the reported associations of CFH T1277C polymorphism with age-related macular degeneration (AMD) suggest that the 1277C allele could serve as a high-risk genetic marker for the disease. (PMID:19568762)
  • three AMD-associated SNPs (rs10490924 (A69S) of ARMS2/LOC387715, rs11200638 of HTRA1, and rs1061170 (Y402H) of CFH)do not contribute significantly to the development of choroidal neovascularization in highly myopic eyes of the elderly Japanese. (PMID:19680273)
  • Several polymorphisms examined in the LOC387715/ARMS2/HTRA1 locus, but none in the CFH region, correlated with specific phenotypic attributes of AMD. (PMID:19796758)
  • The findings indicate that age-related maculopathy (AMD) progression is differentially affected by genotypic variants. (PMID:19797206)
  • To our knowledge, this is the first confirmation of the association of del443ins54 in Italian patients with age-related macular degeneration, and we also confirmed the association of Tyr402His with CFH. (PMID:19822855)
  • variants at CFH, C3, and ARMS2 confer significant risks for geographic atrophy due to age-related macular degeneration (PMID:19823576)
  • The CFH, LOC387715 and HTRA1 polymorphisms are strongly associated with the development of age-related macular degeneration in the Hungarian population (PMID:19845562)
  • The LOC387715 A69S genotype is not associated with lesion composition or size on indocyanine green angiography but with lesion size on fluorescein angiography in patients with subfoveal polypoidal choroidal vasculopathy. (PMID:19898184)
  • These findings provide the first evidence suggesting that ARMS2 interacts with hormone replacement therapy to modulate age-related macular degeneration (AMD) risk and are consistent with previous reports. (PMID:19933179)

Cross-species orthologs

0 orthologs

Protein

Protein identifiers

Age-related maculopathy susceptibility protein 2P0C7Q2 (reviewed: P0C7Q2)

All UniProt accessions (1): P0C7Q2

UniProt curated annotations — full annotation on UniProt →

Subcellular location. Cytoplasm.

Tissue specificity. Detected in retina and placenta.

Disease relevance. Macular degeneration, age-related, 8 (ARMD8) [MIM:613778] A form of age-related macular degeneration, a multifactorial eye disease and the most common cause of irreversible vision loss in the developed world. In most patients, the disease is manifest as ophthalmoscopically visible yellowish accumulations of protein and lipid that lie beneath the retinal pigment epithelium and within an elastin-containing structure known as Bruch membrane. Disease susceptibility is associated with variants affecting the gene represented in this entry.

RefSeq proteins (1): NP_001093137* (*=MANE)

Domains & families (InterPro)

UniProt features (4 total): sequence variant 2, chain 1, region of interest 1

Structure

Experimental structures (PDB)

0 structures.

Predicted structure (AlphaFold)

ModelpLDDTFraction very-high
AF-P0C7Q2-F158.140.00

Function

Pathways and Gene Ontology

Reactome pathways

0 pathways

MSigDB gene sets: 14 (showing top): GOBP_MULTICELLULAR_ORGANISMAL_LEVEL_HOMEOSTASIS, GOBP_RETINA_HOMEOSTASIS, GOBP_HOMEOSTATIC_PROCESS, GOCC_PHOTORECEPTOR_INNER_SEGMENT, MIR7856_5P, MIR3119, MIR4680_3P, MIR4428, MIR8075, MIR6888_5P, GOBP_TISSUE_HOMEOSTASIS, KONIGORSKI_INCREASED_SUBCUTANEOUS_ADIPOSE_TISSUE_MASS_UP, chr10q26, GOCC_MITOCHONDRION

GO Biological Process (1): retina homeostasis (GO:0001895)

GO Molecular Function (1): protein binding (GO:0005515)

GO Cellular Component (3): photoreceptor inner segment (GO:0001917), mitochondrion (GO:0005739), cytoplasm (GO:0005737)

GO top-level categories

Rollup of top GO terms by namespace:

CategoryTerms
cellular anatomical structure2
tissue homeostasis1
binding1
cytoplasm1
intracellular membrane-bounded organelle1
intracellular anatomical structure1

Protein interactions and networks

STRING

424 interactions, top by confidence (×1000):

Protein AProtein BPartner UniProtScore
ARMS2CFHP08603953
ARMS2PLEKHA1Q9HB21915
ARMS2CFBP00751817
ARMS2HMCN1Q96RW7800
ARMS2HTRA1Q92743781
ARMS2C2P06681765
ARMS2LIPCP11150720
ARMS2CETPP11597697
ARMS2CFIP05156668
ARMS2SLC16A8O95907648
ARMS2CFHR1Q03591625
ARMS2CFHR3Q02985624
ARMS2C3P01024621
ARMS2B3GLCTQ6Y288620
ARMS2SKIC2Q15477601

IntAct

31 interactions, top by confidence:

ABTypeScore
CFPARMS2psi-mi:“MI:0407”(direct interaction)0.660
ARMS2CFPpsi-mi:“MI:0915”(physical association)0.660
CFPARMS2psi-mi:“MI:0403”(colocalization)0.660
CFPARMS2psi-mi:“MI:0915”(physical association)0.660
HMCN1ARMS2psi-mi:“MI:0915”(physical association)0.580
ARMS2HMCN1psi-mi:“MI:0915”(physical association)0.580
ARMS2psi-mi:“MI:0407”(direct interaction)0.540
ARMS2psi-mi:“MI:0915”(physical association)0.540
COL1A1ARMS2psi-mi:“MI:0915”(physical association)0.370
COL4A2ARMS2psi-mi:“MI:0915”(physical association)0.370
EMILIN2ARMS2psi-mi:“MI:0915”(physical association)0.370
FN1ARMS2psi-mi:“MI:0915”(physical association)0.370
FBLN1ARMS2psi-mi:“MI:0915”(physical association)0.370
PSG9ARMS2psi-mi:“MI:0915”(physical association)0.370
PSG11ARMS2psi-mi:“MI:0915”(physical association)0.370
METTL27ARMS2psi-mi:“MI:0915”(physical association)0.370
ARMS2PRKCApsi-mi:“MI:0914”(association)0.350

BioGRID (6): MICAL1 (Affinity Capture-MS), ANXA13 (Affinity Capture-MS), PRKCA (Affinity Capture-MS), OGDHL (Affinity Capture-MS), EEF1A2 (Affinity Capture-MS), EFR3A (Affinity Capture-MS)

ESM2 similar proteins: A0A096LPI5, A0A0A0MT76, A4D1N5, A6NM66, A8MUN3, B1ANH7, F5HDA4, O76042, P03414, P04219, P06831, P0C092, P0C5K7, P0C7Q2, P15099, P37125, P37200, P49671, Q1W209, Q21QM3, Q2M3A8, Q4G0G2, Q5T0J3, Q5T6R2, Q5T742, Q5TEZ4, Q5VSD8, Q5W150, Q6UXP9, Q6W349, Q6ZP68, Q6ZS52, Q6ZSR6, Q6ZV60, Q6ZVU0, Q8IWL8, Q8N6C7, Q8N814, Q8TCH9, Q8TEV8

SIGNOR signaling

0 interactions.

Disease & clinical

Clinical variants and AI predictions

ClinVar

33 variants total. Per-class counts are floors (≥ shown; pagination cap):

ClassificationCount (floor)
Pathogenic1
Likely pathogenic0
Uncertain significance19
Likely benign5
Benign2

Top pathogenic / likely-pathogenic (1)

Variant IDHGVSClassification
1801372NM_002775.5(HTRA1):c.175_178del (p.Arg59fs)Pathogenic

SpliceAI

98 predictions. Top by Δscore:

VariantEffectΔscore
10:122456905:A:AGacceptor_gain1.0000
10:122456906:G:GGacceptor_gain1.0000
10:122456906:GT:Gacceptor_gain0.9900
10:122456906:GTC:Gacceptor_gain0.9900
10:122456906:GTCT:Gacceptor_gain0.9900
10:122455022:CTGG:Cdonor_loss0.9800
10:122455023:TGGTA:Tdonor_loss0.9800
10:122455024:GGTAA:Gdonor_loss0.9800
10:122455025:GTAA:Gdonor_loss0.9800
10:122455026:T:Gdonor_loss0.9800
10:122456906:GTCTA:Gacceptor_gain0.9800
10:122454991:G:GTdonor_gain0.9700
10:122455025:G:GGdonor_gain0.9600
10:122456905:AGTCT:Aacceptor_loss0.9600
10:122456906:G:GTacceptor_loss0.9600
10:122455022:CTG:Cdonor_gain0.9200
10:122456901:TTTCA:Tacceptor_gain0.9200
10:122456902:TTCAG:Tacceptor_gain0.9200
10:122456903:TCAGT:Tacceptor_gain0.9200
10:122456904:CAGTC:Cacceptor_gain0.9200
10:122456905:A:Tacceptor_gain0.9200
10:122456906:G:Tacceptor_gain0.9100
10:122455020:CACTG:Cdonor_gain0.8600
10:122456911:T:Gacceptor_gain0.8500
10:122454759:C:Gdonor_gain0.8400
10:122455021:ACTG:Adonor_gain0.8300
10:122455027:AA:Adonor_loss0.8200
10:122455023:TG:Tdonor_gain0.8000
10:122455024:GG:Gdonor_gain0.8000
10:122455959:A:Tdonor_gain0.7600

AlphaMissense

677 scored. Top likely-pathogenic:

VariantProtein changeam_pathogenicity
10:122454824:T:CF33L0.901
10:122454826:C:AF33L0.901
10:122454826:C:GF33L0.901
10:122454924:T:CI66T0.832
10:122454965:T:CF80L0.782
10:122454967:C:AF80L0.782
10:122454967:C:GF80L0.782
10:122456930:G:CR107S0.764
10:122456930:G:TR107S0.764
10:122454968:T:CF81L0.744
10:122454970:C:AF81L0.744
10:122454970:C:GF81L0.744
10:122454924:T:GI66S0.700
10:122456929:G:TR107M0.673
10:122456911:T:CI101T0.657
10:122456911:T:GI101S0.616
10:122454825:T:CF33S0.611
10:122456911:T:AI101N0.599
10:122456929:G:CR107T0.583
10:122456920:C:TT104I0.568

dbSNP variants (sampled 300 via entrez): RS1001665931 (10:122453300 C>T), RS1001846246 (10:122456811 T>A), RS1001905146 (10:122457059 T>C,G), RS1001941084 (10:122456487 T>G), RS1002517059 (10:122453885 G>C), RS1003106300 (10:122456081 CTAAAT>C), RS1003135799 (10:122456391 C>T), RS1004225872 (10:122452654 T>C,G), RS1006352162 (10:122457124 A>G), RS1006832981 (10:122457474 G>T), RS1007018610 (10:122454520 C>T), RS1008533830 (10:122452822 A>G), RS1008662762 (10:122452834 G>T), RS1008693824 (10:122453174 G>A,T), RS1009266628 (10:122456458 C>A,T)

Disease associations

OMIM: gene MIM:611313 | disease phenotypes: MIM:616779, MIM:613778

GenCC curated gene-disease

Mondo (2): cerebral arteriopathy, autosomal dominant, with subcortical infarcts and leukoencephalopathy, type 2 (MONDO:0014768), age related macular degeneration 8 (MONDO:0013416)

Orphanet (0):

HPO phenotypes

0 total (0 of 0 shown, HPO-id order):

GWAS associations

24 associations (top):

StudyTraitp-value
GCST000652_7Age-related macular degeneration4.000000e-60
GCST000653_9Age-related macular degeneration5.000000e-119
GCST000806_2Age-related macular degeneration1.000000e-60
GCST001571_1Age-related macular degeneration3.000000e-72
GCST001577_1Age-related macular degeneration (CNV vs. GA)7.000000e-14
GCST001578_6Age-related macular degeneration (geographic atrophy)7.000000e-47
GCST001579_6Age-related macular degeneration (choroidal neovascularisation)2.000000e-138
GCST001814_1Age-related macular degeneration4.000000e-24
GCST001814_29Age-related macular degeneration1.000000e-25
GCST001884_11Age-related macular degeneration0.000000e+00
GCST001899_2Age-related macular degeneration1.000000e-16
GCST001986_3Age-related macular degeneration8.000000e-27
GCST001987_1Age-related macular degeneration (extreme sampling)3.000000e-29
GCST002766_5Exudative age-related macular degeneration1.000000e-103
GCST003219_4Advanced age-related macular degeneration0.000000e+00
GCST003720_10Migraine3.000000e-08
GCST004737_2Neovascular age-related macular degeneration7.000000e-17
GCST004813_2Laterality in neovascular age-related macular degeneration2.000000e-09
GCST005358_4Disease progression to choroidal neovascularization form in age-related macular degeneration1.000000e-25
GCST005359_1Disease progression in age-related macular degeneration8.000000e-43
GCST005360_2Disease progression to geographic atrophy form in age-related macular degeneration1.000000e-25
GCST010002_227Refractive error6.000000e-23
GCST010723_8Early age-related macular degeneration1.000000e-116
GCST011317_2Age-related macular degeneration2.000000e-20

EFO canonical traits (3, from GWAS)

EFO IDTrait name
EFO:1001492atrophic macular degeneration
EFO:0008372laterality measurement
EFO:0008336disease progression measurement

Drugs & pharmacology

Drug and pharmacology data

Is drug target: no

PharmGKB: 1 entry (VIP=true, CPIC=false)

PharmGKB clinical annotations

1 annotations.

VariantTypeLevelDrugsPhenotypes
rs10490924Efficacy3bevacizumabMacular Degeneration

PharmGKB variants

1 variants.

VariantGenesLevelScore#Clin annotsDrugs
rs10490924ARMS234.251bevacizumab

CTD chemical–gene interactions

5 total (human), top 5 by PubMed support.

ChemicalActions (top 5)PubMed papers
aristolochic acid Iincreases expression1
Grape Seed Proanthocyanidinsaffects cotreatment, decreases expression1
Benzo(a)pyreneincreases methylation1
Catechinaffects cotreatment, decreases expression1
Rotenoneincreases expression1

Clinical trials (associated diseases)

0 trials via MONDO — disease-level, not drug-specific.