Antje Bernd

TRPM1 is mutated in patients with autosomal-recessive complete congenital stationary night blindness.

Night vision requires signaling from rod photoreceptors to adjacent bipolar cells in the retina. Mutations in the genes NYX and GRM6, expressed in ON bipolar cells, lead to a disruption of the ON bipolar cell response. This dysfunction is present in patients with complete X-linked and autosomal-recessive congenital stationary night blindness (CSNB) and can be assessed by standard full-field electroretinography (ERG), showing severely reduced rod b-wave amplitude and slightly altered cone responses. Although many cases of complete CSNB (cCSNB) are caused by mutations in NYX and GRM6, in approximately 60% of the patients the gene defect remains unknown. Animal models of human diseases are a good source for candidate genes, and we noted that a cCSNB phenotype present in homozygous Appaloosa horses is associated with downregulation of TRPM1. TRPM1, belonging to the family of transient receptor potential channels, is expressed in ON bipolar cells and therefore qualifies as an excellent candidate. Indeed, mutation analysis of 38 patients with CSNB identified ten unrelated cCSNB patients with 14 different mutations in this gene. The mutation spectrum comprises missense, splice-site, deletion, and nonsense mutations. We propose that the cCSNB phenotype in these patients is due to the absence of functional TRPM1 in retinal ON bipolar cells.

PDZD7 is a modifier of retinal disease and a contributor to digenic Usher syndrome

Usher syndrome is a genetically heterogeneous recessive disease characterized by hearing loss and retinitis pigmentosa (RP). It frequently presents with unexplained, often intrafamilial, variability of the visual phenotype. Although 9 genes have been linked with Usher syndrome, many patients do not have mutations in any of these genes, suggesting that there are still unidentified genes involved in the syndrome. Here, we have determined that mutations in PDZ domain-containing 7 (PDZD7), which encodes a homolog of proteins mutated in Usher syndrome subtype 1C (USH1C) and USH2D, contribute to Usher syndrome. Mutations in PDZD7 were identified only in patients with mutations in other known Usher genes. In a set of sisters, each with a homozygous mutation in USH2A, a frame-shift mutation in PDZD7 was present in the sister with more severe RP and earlier disease onset. Further, heterozygous PDZD7 mutations were present in patients with truncating mutations in USH2A, G protein-coupled receptor 98 (GPR98; also known as USH2C), and an unidentified locus. We validated the human genotypes using zebrafish, and our findings were consistent with digenic inheritance of PDZD7 and GPR98, and with PDZD7 as a retinal disease modifier in patients with USH2A. Pdzd7 knockdown produced an Usher-like phenotype in zebrafish, exacerbated retinal cell death in combination with ush2a or gpr98, and reduced Gpr98 localization in the region of the photoreceptor connecting cilium. Our data challenge the view of Usher syndrome as a traditional Mendelian disorder and support the reclassification of Usher syndrome as an oligogenic disease.

Panel-based next generation sequencing as a reliable and efficient technique to detect mutations in unselected patients with retinal dystrophies.

Hereditary retinal dystrophies (RD) constitute a group of blinding diseases that are characterized by clinical variability and pronounced genetic heterogeneity. The different forms of RD can be caused by mutations in >100 genes, including >1600 exons. Consequently, next generation sequencing (NGS) technologies are among the most promising approaches to identify mutations in RD. So far, NGS is not routinely used in gene diagnostics. We developed a diagnostic NGS pipeline to identify mutations in 170 genetically and clinically unselected RD patients. NGS was applied to 105 RD-associated genes. Underrepresented regions were examined by Sanger sequencing. The NGS approach was successfully established using cases with known sequence alterations. Depending on the initial clinical diagnosis, we identified likely causative mutations in 55% of retinitis pigmentosa and 80% of Bardet–Biedl or Usher syndrome cases. Seventy-one novel mutations in 40 genes were newly associated with RD. The genes USH2A, EYS, ABCA4, and RHO were more frequently affected than others. Occasionally, cases carried mutations in more than one RD-associated gene. In addition, we found possible dominant de-novo mutations in cases with sporadic RD, which implies consequences for counseling of patients and families. NGS-based mutation analyses are reliable and cost-efficient approaches in gene diagnostics of genetically heterogeneous diseases like RD.

IQCB1 Mutations in Patients with Leber Congenital Amaurosis

PURPOSE Leber congenital amaurosis (LCA) is genetically heterogeneous, with 15 genes identified thus far, accounting for ∼70% of LCA patients. The aim of the present study was to identify new genetic causes of LCA. METHODS Homozygosity mapping in >150 LCA patients of worldwide origin was performed with high-density SNP microarrays to identify new disease-causing genes. RESULTS In three isolated LCA patients, the authors identified large homozygous regions on chromosome 3 encompassing the IQCB1 gene, which has been associated with Senior-Loken syndrome (SLSN), characterized by nephronophthisis and retinal degeneration. Mutation analysis of IQCB1 in these three patients and a subsequent cohort of 222 additional LCA patients identified frameshift and nonsense mutations in 11 patients diagnosed with LCA. On re-inspection of the patients disease status, seven were found to have developed SLSN, but four maintained the diagnosis of LCA as the kidney function remained normal. CONCLUSIONS Results show that the onset of renal failure in patients with IQCB1 mutations is highly variable, and that mutations are also found in LCA patients without nephronophthisis, rendering IQCB1 a new gene for LCA. However, these patients are at high risk for developing renal failure, which in early stages is often not recognized and can cause sudden death from fluid and electrolyte imbalance. It is therefore recommended that all LCA patients be screened for IQCB1 mutations, to follow them more closely for kidney disease.

ABCA4 gene analysis in patients with autosomal recessive cone and cone rod dystrophies.

The ATP-binding cassette (ABC) transporters constitute a family of large membrane proteins, which transport a variety of substrates across membranes. The ABCA4 protein is expressed in photoreceptors and possibly functions as a transporter for N-retinylidene-phosphatidylethanolamine (N-retinylidene-PE), the Schiff base adduct of all-trans-retinal with PE. Mutations in the ABCA4 gene have been initially associated with autosomal recessive Stargardt disease. Subsequent studies have shown that mutations in ABCA4 can also cause a variety of other retinal dystrophies including cone rod dystrophy and retinitis pigmentosa. To determine the prevalence and mutation spectrum of ABCA4 gene mutations in non-Stargardt phenotypes, we have screened 64 unrelated patients with autosomal recessive cone (arCD) and cone rod dystrophy (arCRD) applying the Asper Ophthalmics ABCR400 microarray followed by DNA sequencing of all coding exons of the ABCA4 gene in subjects with single heterozygous mutations. Disease-associated ABCA4 alleles were identified in 20 of 64 patients with arCD or arCRD. In four of 64 patients (6%) only one mutant ABCA4 allele was detected and in 16 patients (25%), mutations on both ABCA4 alleles were identified. Based on these data we estimate a prevalence of 31% for ABCA4 mutations in arCD and arCRD, supporting the concept that the ABCA4 gene is a major locus for various types of degenerative retinal diseases with abnormalities in cone or both cone and rod function.

Mutation Detection in Patients with Retinal Dystrophies Using Targeted Next Generation Sequencing.

Retinal dystrophies (RD) constitute a group of blinding diseases that are characterized by clinical variability and pronounced genetic heterogeneity. The different nonsyndromic and syndromic forms of RD can be attributed to mutations in more than 200 genes. Consequently, next generation sequencing (NGS) technologies are among the most promising approaches to identify mutations in RD. We screened a large cohort of patients comprising 89 independent cases and families with various subforms of RD applying different NGS platforms. While mutation screening in 50 cases was performed using a RD gene capture panel, 47 cases were analyzed using whole exome sequencing. One family was analyzed using whole genome sequencing. A detection rate of 61% was achieved including mutations in 34 known and two novel RD genes. A total of 69 distinct mutations were identified, including 39 novel mutations. Notably, genetic findings in several families were not consistent with the initial clinical diagnosis. Clinical reassessment resulted in refinement of the clinical diagnosis in some of these families and confirmed the broad clinical spectrum associated with mutations in RD genes.

Large deletions of the KCNV2 gene are common in patients with cone dystrophy with supernormal rod response

Cone dystrophy with supernormal rod response (CDSRR) is considered to be a very rare autosomal recessive retinal disorder. CDSRR is associated with mutations in KCNV2, a gene that encodes a modulatory subunit (Kv8.2) of a voltage‐gated potassium channel. In this study, we found that KCNV2 mutations are present in a substantial fraction (2.2–4.3%) of a sample of 367 independent patients with a variety of initial clinical diagnoses of cone malfunction, indicating that CDSRR is underdiagnosed and more common than previously thought. In total, we identified 20 different KCNV2 mutations; 15 of them are novel. A new finding of this study is the substantial proportion of large deletions at the KCNV2 locus that accounts for 15.5% of the mutant alleles in our sample. We determined the breakpoints and size of all five different deletions, which ranged between 10.9 and 236.8 kb. Two deletions encompass the entire KCNV2 gene and one also includes the adjacent VLDLR gene. Furthermore, we investigated N‐terminal amino acid substitution mutations for its effect on interaction with Kv2.1 using yeast two‐hybrid technology. We found that these mutations dramatically reduce or abolish this interaction suggesting a lack of assembly of heteromeric Kv channels as one underlying pathomechanism of CDSRR. 32:1398–1406, 2011. ©2011 Wiley Periodicals, Inc.

Visual acuity changes in cone and cone-rod dystrophies

Citation information: Prokofyeva E, Troeger E, Bernd A & Zrenner E. Visual acuity changes in cone and cone‐rod dystrophies. Ophthalmic Physiol Opt 2011. doi: 10.1111/j.1475‐1313.2011.00883.x

Correlation Between Spectral Domain OCT Retinal Nerve Fibre Layer Thickness and Multifocal Pattern Electroretinogram in Advanced Retinitis Pigmentosa

Our aim is to assess the correlation between retinal nerve fibre layer thickness and ganglion cell function by electrophysiological means in advanced retinitis pigmentosa (RP) patients. A prospective observational case–control study enrolled 12 RP patients (age average 44 ± 14 years) with concentric visual field loss (≤10o) and 12 healthy age-matched control for testing. The peripapillary retinal nerve fibre layer (RNFL) thickness was assessed by spectral domain optical coherence tomography. The VERIS system was used to record multifocal pattern electroretinograms (mfPERG), a measure of inner retinal functional output. Amplitudes of P1N2 component were 42 ± 14, 53 ± 25 and 42 ± 17 nV within temporal superior, temporal, and temporal inferior region in RP, and 174 ± 52, 171 ± 46 and 144 ± 15 nV respectively in the control group (p 0.05). The diminution of photoreceptors sensory inputs in advanced RP patients corresponds with reduced amplitudes in mulitifocal pattern electroretinogram, although RNFL measurements indicate no detectable loss of RGC.

Erbliche Ionenkanalerkrankungen der Netzhaut

ZusammenfassungRetinale Ionenkanalerkrankungen sind klinisch und genetisch sehr heterogen. Die bisher identifizierten krankheitsassoziierten Ionenkanäle umfassen zyklisch nukleotidgesteuerte (CNG-)Kanäle, spannungsgesteuerte Kalium- und Kalziumkanäle, einen einwärtsrektifizierenden Kaliumkanal, einen kalziumaktivierten Chloridkanal und den transienten Rezeptorpotenzialionenkanal TRPM1. Dieses breite Spektrum spiegelt sich auch in der resultierenden Pathophysiologie wieder. Mutationen in retinalen Ionenkanälen können die Detektion von Lichtreizen bzw. deren Umwandlung in ein elektrisches Signal oder die Weiterleitung des Signals von den Fotorezeptoren zu nachgeschalteten Neuronen beeinträchtigen. Einige Erkrankungen werden auch durch Mutationen in Ionenkanälen, die im retinalen Pigmentepithel lokalisiert sind, hervorgerufen. Dieses ist mit seinen unterstützenden Aufgaben für eine normale Netzhautfunktion essenziell.AbstractRetinal channelopathies are clinically and genetically heterogeneous, and are caused by mutations in genes for a variety of ion channels such as cyclic nucleotide-gated channels, voltage-gated potassium and calcium channels, an inwardly rectifying potassium channel, a calcium-dependent chloride channel and the TRPM1 channel. This broad spectrum of disease-associated ion channels is also reflected in the diversity of pathophysiological consequences. Mutations in retinal ion channels may affect phototransduction, thereby impairing the detection of light or interfere with the transmission of the stimulus from the photoreceptor to second-order neurons. Ion channels located in the retinal pigment epithelium, which supports normal retina function, can also be affected in some diseases.