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Ayash J, Woods RL, Akula JD, Rajabi F, Alwattar BK, Altschwager P, Fulton AB. Characteristics of Eyes With CRB1-Associated EOSRD/LCA: Age-Related Changes. Am J Ophthalmol 2024; 263:168-178. [PMID: 38461945 DOI: 10.1016/j.ajo.2024.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/09/2024] [Accepted: 02/18/2024] [Indexed: 03/12/2024]
Abstract
PURPOSE To evaluate ocular and retinal features of CRB1-associated early onset severe retinal dystrophy/Leber congenital amaurosis (EOSRD/LCA) for age-related changes. DESIGN Retrospective cohort study. METHODS Sixteen pediatric patients with biallelic CRB1 EOSRD/LCA who had been followed for up to 18 years were reviewed. Results of comprehensive ophthalmic examinations-including visual acuity, refractive error, dark-adapted visual threshold, Goldmann perimetry, and macular optical coherence tomography (OCT)-were analyzed for significant age-related changes using mixed-effects models. RESULTS Visual acuity dark-adapted visual sensitivity, and area of seeing visual field (all subnormal from the earliest ages recorded) declined with increasing age. Hyperopia was stable through childhood and adolescence. In CRB1 EOSRD/LCA, OCT extrafoveal inner and outer laminar thicknesses exceeded those in controls but varied little with age, and foveal metrics (depth, breadth, thickness at rim) differed significantly from those in controls, but variations in foveal metrics were not associated with declines in acuity. CONCLUSIONS From the youngest ages, retinal and visual function is significantly subnormal and becomes progressively compromized. A goal of future therapies should be intervention at young ages, when there is more function to be rescued.
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Affiliation(s)
- Jad Ayash
- From the Department of Ophthalmology (J.A., R.L.W., J.D.A., F.R., B.K.A., P.A., A.B.F.), Boston Children's Hospital, Boston, Massachusetts, USA
| | - Russell L Woods
- From the Department of Ophthalmology (J.A., R.L.W., J.D.A., F.R., B.K.A., P.A., A.B.F.), Boston Children's Hospital, Boston, Massachusetts, USA; Department of Ophthalmology (R.L.W., J.D.A., F.R., B.K.A., P.A., A.B.F.), Harvard Medical School, Boston, Massachusetts, USA
| | - James D Akula
- From the Department of Ophthalmology (J.A., R.L.W., J.D.A., F.R., B.K.A., P.A., A.B.F.), Boston Children's Hospital, Boston, Massachusetts, USA; Department of Ophthalmology (R.L.W., J.D.A., F.R., B.K.A., P.A., A.B.F.), Harvard Medical School, Boston, Massachusetts, USA
| | - Farrah Rajabi
- From the Department of Ophthalmology (J.A., R.L.W., J.D.A., F.R., B.K.A., P.A., A.B.F.), Boston Children's Hospital, Boston, Massachusetts, USA; Department of Ophthalmology (R.L.W., J.D.A., F.R., B.K.A., P.A., A.B.F.), Harvard Medical School, Boston, Massachusetts, USA
| | - Bilal K Alwattar
- From the Department of Ophthalmology (J.A., R.L.W., J.D.A., F.R., B.K.A., P.A., A.B.F.), Boston Children's Hospital, Boston, Massachusetts, USA; Department of Ophthalmology (R.L.W., J.D.A., F.R., B.K.A., P.A., A.B.F.), Harvard Medical School, Boston, Massachusetts, USA
| | - Pablo Altschwager
- From the Department of Ophthalmology (J.A., R.L.W., J.D.A., F.R., B.K.A., P.A., A.B.F.), Boston Children's Hospital, Boston, Massachusetts, USA; Department of Ophthalmology (R.L.W., J.D.A., F.R., B.K.A., P.A., A.B.F.), Harvard Medical School, Boston, Massachusetts, USA
| | - Anne B Fulton
- From the Department of Ophthalmology (J.A., R.L.W., J.D.A., F.R., B.K.A., P.A., A.B.F.), Boston Children's Hospital, Boston, Massachusetts, USA; Department of Ophthalmology (R.L.W., J.D.A., F.R., B.K.A., P.A., A.B.F.), Harvard Medical School, Boston, Massachusetts, USA.
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2
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Daich Varela M, Georgiou M, Alswaiti Y, Kabbani J, Fujinami K, Fujinami-Yokokawa Y, Khoda S, Mahroo OA, Robson AG, Webster AR, AlTalbishi A, Michaelides M. CRB1-Associated Retinal Dystrophies: Genetics, Clinical Characteristics, and Natural History. Am J Ophthalmol 2023; 246:107-121. [PMID: 36099972 PMCID: PMC10555856 DOI: 10.1016/j.ajo.2022.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE To analyze the clinical characteristics, natural history, and genetics of CRB1-associated retinal dystrophies. DESIGN Multicenter international retrospective cohort study. METHODS Review of clinical notes, ophthalmic images, and genetic testing results of 104 patients (91 probands) with disease-causing CRB1 variants. Macular optical coherence tomography (OCT) parameters, visual function, fundus characteristics, and associations between variables were the main outcome measures. RESULTS The mean age of the cohort at the first visit was 19.8 ± 16.1 (median 15) years, with a mean follow-up of 9.6 ± 10 years. Based on history, imaging, and clinical examination, 26 individuals were diagnosed with retinitis pigmentosa (RP; 25%), 54 with early-onset severe retinal dystrophy / Leber congenital amaurosis (EOSRD/LCA; 52%), and 24 with macular dystrophy (MD; 23%). Severe visual impairment was most frequent after 40 years of age for patients with RP and after 20 years of age for EOSRD/LCA. Longitudinal analysis revealed a significant difference between baseline and follow-up best-corrected visual acuity in the 3 subcohorts. Macular thickness decreased in most patients with EOSRD/LCA and MD, whereas the majority of patients with RP had increased perifoveal thickness. CONCLUSIONS A subset of individuals with CRB1 variants present with mild, adult-onset RP. EOSRD/LCA phenotype was significantly associated with null variants, and 167_169 deletion was exclusively present in the MD cohort. The poor OCT lamination may have a degenerative component, as well as being congenital. Disease symmetry and reasonable window for intervention highlight CRB1 retinal dystrophies as a promising target for trials of novel therapeutics.
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Affiliation(s)
- Malena Daich Varela
- Moorfields Eye Hospital (M.D.V., M.G., K.F., S.K., O.A.M., A.G.R., A.R.W., M.M.), London, United Kingdom; UCL Institute of Ophthalmology, University College London (M.D.V., M.G., K.F., Y.F.-Y., O.A.M., A.G.R., A.R.W., M.M.), London, United Kingdom
| | - Michalis Georgiou
- Moorfields Eye Hospital (M.D.V., M.G., K.F., S.K., O.A.M., A.G.R., A.R.W., M.M.), London, United Kingdom; UCL Institute of Ophthalmology, University College London (M.D.V., M.G., K.F., Y.F.-Y., O.A.M., A.G.R., A.R.W., M.M.), London, United Kingdom; Jones Eye Institute (M.G.), University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Yahya Alswaiti
- St John of Jerusalem Eye Hospital group, Jerusalem, Palestine (Y.A., A.A.)
| | - Jamil Kabbani
- Imperial College London (J.K.), London, United Kingdom
| | - Kaoru Fujinami
- Moorfields Eye Hospital (M.D.V., M.G., K.F., S.K., O.A.M., A.G.R., A.R.W., M.M.), London, United Kingdom; UCL Institute of Ophthalmology, University College London (M.D.V., M.G., K.F., Y.F.-Y., O.A.M., A.G.R., A.R.W., M.M.), London, United Kingdom; Laboratory of Visual Physiology, Division of Vision Research, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center (Y.F.-Y.), Tokyo, Japan
| | - Yu Fujinami-Yokokawa
- UCL Institute of Ophthalmology, University College London (M.D.V., M.G., K.F., Y.F.-Y., O.A.M., A.G.R., A.R.W., M.M.), London, United Kingdom; Laboratory of Visual Physiology, Division of Vision Research, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center (Y.F.-Y.), Tokyo, Japan; Department of Health Policy and Management, School of Medicine, Keio University(Y.F.-Y.), Tokyo, Japan
| | - Shaheeni Khoda
- Moorfields Eye Hospital (M.D.V., M.G., K.F., S.K., O.A.M., A.G.R., A.R.W., M.M.), London, United Kingdom
| | - Omar A Mahroo
- Moorfields Eye Hospital (M.D.V., M.G., K.F., S.K., O.A.M., A.G.R., A.R.W., M.M.), London, United Kingdom; UCL Institute of Ophthalmology, University College London (M.D.V., M.G., K.F., Y.F.-Y., O.A.M., A.G.R., A.R.W., M.M.), London, United Kingdom
| | - Anthony G Robson
- Moorfields Eye Hospital (M.D.V., M.G., K.F., S.K., O.A.M., A.G.R., A.R.W., M.M.), London, United Kingdom; UCL Institute of Ophthalmology, University College London (M.D.V., M.G., K.F., Y.F.-Y., O.A.M., A.G.R., A.R.W., M.M.), London, United Kingdom
| | - Andrew R Webster
- Moorfields Eye Hospital (M.D.V., M.G., K.F., S.K., O.A.M., A.G.R., A.R.W., M.M.), London, United Kingdom; UCL Institute of Ophthalmology, University College London (M.D.V., M.G., K.F., Y.F.-Y., O.A.M., A.G.R., A.R.W., M.M.), London, United Kingdom
| | - Alaa AlTalbishi
- St John of Jerusalem Eye Hospital group, Jerusalem, Palestine (Y.A., A.A.)
| | - Michel Michaelides
- Moorfields Eye Hospital (M.D.V., M.G., K.F., S.K., O.A.M., A.G.R., A.R.W., M.M.), London, United Kingdom; UCL Institute of Ophthalmology, University College London (M.D.V., M.G., K.F., Y.F.-Y., O.A.M., A.G.R., A.R.W., M.M.), London, United Kingdom.
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Non-vasogenic cystoid maculopathies. Prog Retin Eye Res 2022; 91:101092. [PMID: 35927124 DOI: 10.1016/j.preteyeres.2022.101092] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 11/23/2022]
Abstract
Besides cystoid macular edema due to a blood-retinal barrier breakdown, another type of macular cystoid spaces referred to as non-vasogenic cystoid maculopathies (NVCM) may be detected on optical coherence tomography but not on fluorescein angiography. Various causes may disrupt retinal cell cohesion or impair retinal pigment epithelium (RPE) and Müller cell functions in the maintenance of retinal dehydration, resulting in cystoid spaces formation. Tractional causes include vitreomacular traction, epiretinal membranes and myopic foveoschisis. Surgical treatment does not always allow cystoid space resorption. In inherited retinal dystrophies, cystoid spaces may be part of the disease as in X-linked retinoschisis or enhanced S-cone syndrome, or occur occasionally as in bestrophinopathies, retinitis pigmentosa and allied diseases, congenital microphthalmia, choroideremia, gyrate atrophy and Bietti crystalline dystrophy. In macular telangiectasia type 2, cystoid spaces and cavitations do not depend on the fluid leakage from telangiectasia. Various causes affecting RPE function may result in NVCM such as chronic central serous chorioretinopathy and paraneoplastic syndromes. Non-exudative age macular degeneration may also be complicated by intraretinal cystoid spaces in the absence of fluorescein leakage. In these diseases, cystoid spaces occur in a context of retinal cell loss. Various causes of optic atrophy, including open-angle glaucoma, result in microcystoid spaces in the inner nuclear layer due to a retrograde transsynaptic degeneration. Lastly, drug toxicity may also induce cystoid maculopathy. Identifying NVCM on multimodal imaging, including fluorescein angiography if needed, allows guiding the diagnosis of the causative disease and choosing adequate treatment when available.
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Weatherly SM, Collin GB, Charette JR, Stone L, Damkham N, Hyde LF, Peterson JG, Hicks W, Carter GW, Naggert JK, Krebs MP, Nishina PM. Identification of Arhgef12 and Prkci as genetic modifiers of retinal dysplasia in the Crb1rd8 mouse model. PLoS Genet 2022; 18:e1009798. [PMID: 35675330 PMCID: PMC9212170 DOI: 10.1371/journal.pgen.1009798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 06/21/2022] [Accepted: 05/03/2022] [Indexed: 12/03/2022] Open
Abstract
Mutations in the apicobasal polarity gene CRB1 lead to diverse retinal diseases, such as Leber congenital amaurosis, cone-rod dystrophy, retinitis pigmentosa (with and without Coats-like vasculopathy), foveal retinoschisis, macular dystrophy, and pigmented paravenous chorioretinal atrophy. Limited correlation between disease phenotypes and CRB1 alleles, and evidence that patients sharing the same alleles often present with different disease features, suggest that genetic modifiers contribute to clinical variation. Similarly, the retinal phenotype of mice bearing the Crb1 retinal degeneration 8 (rd8) allele varies with genetic background. Here, we initiated a sensitized chemical mutagenesis screen in B6.Cg-Crb1rd8/Pjn, a strain with a mild clinical presentation, to identify genetic modifiers that cause a more severe disease phenotype. Two models from this screen, Tvrm266 and Tvrm323, exhibited increased retinal dysplasia. Genetic mapping with high-throughput exome and candidate-gene sequencing identified causative mutations in Arhgef12 and Prkci, respectively. Epistasis analysis of both strains indicated that the increased dysplastic phenotype required homozygosity of the Crb1rd8 allele. Retinal dysplastic lesions in Tvrm266 mice were smaller and caused less photoreceptor degeneration than those in Tvrm323 mice, which developed an early, large diffuse lesion phenotype. At one month of age, Müller glia and microglia mislocalization at dysplastic lesions in both modifier strains was similar to that in B6.Cg-Crb1rd8/Pjn mice but photoreceptor cell mislocalization was more extensive. External limiting membrane disruption was comparable in Tvrm266 and B6.Cg-Crb1rd8/Pjn mice but milder in Tvrm323 mice. Immunohistological analysis of mice at postnatal day 0 indicated a normal distribution of mitotic cells in Tvrm266 and Tvrm323 mice, suggesting normal early development. Aberrant electroretinography responses were observed in both models but functional decline was significant only in Tvrm323 mice. These results identify Arhgef12 and Prkci as modifier genes that differentially shape Crb1-associated retinal disease, which may be relevant to understanding clinical variability and underlying disease mechanisms in humans. Inherited eye diseases affect roughly 1:1,000 individuals worldwide. Although these diseases are often linked to variants of a single gene, it is increasingly recognized that a second variant in other genes may modify disease characteristics, including age of onset, severity, and lesion appearance. Identifying such modifier genes in humans is difficult. In this study, two modifiers of a gene associated with retinal damage leading to childhood blindness in humans (CRB1) were identified in mice. Retinal damage caused by Crb1 mutation alone was less severe than in the presence of Arhgef12 or Prkci mutations. Furthermore, the modifier gene mutations caused retinal damage only in the presence of the Crb1 mutation. Our results point to a role of mouse Crb1 and the modifying effects of Arhgef12 and Prkci in a biological network that controls adhesive interactions between cells. The variation in disease severity, lesion appearance, and visual responses in these mice provide a dramatic example of modifier gene influence. This work may lead to an improved understanding of the molecular basis of CRB1-associated retinal disease, with possible relevance to diagnostic and therapeutic intervention in humans.
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Affiliation(s)
| | - Gayle B. Collin
- The Jackson Laboratory, Bar Harbor, Maine, United States of America
| | | | - Lisa Stone
- The Jackson Laboratory, Bar Harbor, Maine, United States of America
| | - Nattaya Damkham
- The Jackson Laboratory, Bar Harbor, Maine, United States of America
- Graduate Program in Immunology, Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Siriraj Center of Excellence for Stem Cell Research, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Lillian F. Hyde
- The Jackson Laboratory, Bar Harbor, Maine, United States of America
| | | | - Wanda Hicks
- The Jackson Laboratory, Bar Harbor, Maine, United States of America
| | | | | | - Mark P. Krebs
- The Jackson Laboratory, Bar Harbor, Maine, United States of America
- * E-mail: (MPK); (PMN)
| | - Patsy M. Nishina
- The Jackson Laboratory, Bar Harbor, Maine, United States of America
- * E-mail: (MPK); (PMN)
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5
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Cheng Z, Hagan R, Yeo DCM. Identification of a novel CRB1 variant in a compound heterozygous state in a patient with CRB1-associated maculopathy and foveal retinoschisis. Ophthalmic Genet 2021; 43:253-257. [PMID: 34783605 DOI: 10.1080/13816810.2021.1998551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To report a novel CRB1 variant responsible for autosomal recessive foveal retinoschisis and its associated clinical and electrophysiological data. METHODS A case report. RESULTS A 15-year-old boy has foveal retinoschisis similar to those seen in X-linked retinoschisis (XLRS). During follow-up, we observed the co-existence of foveoschitic changes and parafoveal macular atrophy. Molecular genetic testing identified compound heterozygous variants in the CRB1 gene, including a novel variant, c.3878 G > A, predicted to disrupt the normal translation of CRB1 and a previously reported likely pathogenic mutation, c.498_506del. Full-field electroretinograms (ERG) were normal but multifocal ERG showed focal reduced waveform amplitude corresponding to the area of atrophy. CONCLUSIONS A novel missense variant existing in a compound heterozygous state was identified. Biallelic CRB1 mutations can cause anatomical fovea disruption similar to XLRS but have very different electroretinogram findings. This case report enhances our understanding of the spectrum of biallelic CRB1 mutations.
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Affiliation(s)
- Zhihang Cheng
- Alder Hey Children's Nhs Foundation Trust, Department of Ophthalmology, Alder Hey Children's Hospital, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Richard Hagan
- Alder Hey Children's Nhs Foundation Trust, Department of Ophthalmology, Alder Hey Children's Hospital, Liverpool, United Kingdom of Great Britain and Northern Ireland.,Clinical Engineering Department, Royal Liverpool University Hospital, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Damien C M Yeo
- Alder Hey Children's Nhs Foundation Trust, Department of Ophthalmology, Alder Hey Children's Hospital, Liverpool, United Kingdom of Great Britain and Northern Ireland
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6
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Roshandel D, Thompson JA, Heath Jeffery RC, Sampson DM, Chelva E, McLaren TL, Lamey TM, De Roach JN, Durkin SR, Chen FK. Multimodal Retinal Imaging and Microperimetry Reveal a Novel Phenotype and Potential Trial End Points in CRB1-Associated Retinopathies. Transl Vis Sci Technol 2021; 10:38. [PMID: 34003923 PMCID: PMC7910635 DOI: 10.1167/tvst.10.2.38] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose Biallelic crumbs cell polarity complex component 1 (CRB1) mutations can present as Leber congenital amaurosis (LCA), retinitis pigmentosa (RP), or cystic maculopathy. This study reports a novel phenotype of asymptomatic fenestrated slit maculopathy (AFSM) and examines macular volume profile and microperimetry as clinical trial end points in CRB1-associated retinopathies. Methods Twelve patients from nine families with CRB1 mutation were recruited. Ultra-widefield (UWF) color fundus photography and autofluorescence (AF), spectral-domain optical coherence tomography (SD-OCT), microperimetry, and adaptive optics (AO) imaging were performed. Macular volume profiles were compared with age-matched healthy controls. Genotyping was performed using APEX genotyping microarrays, targeted next-generation sequencing, and Sanger sequencing. Results We identified one patient with LCA, five patients with RP, and four patients with macular dystrophy (MD) with biallelic CRB1 mutations. Two siblings with compound heterozygote genotype (c.[2843G>A]; [498_506del]) had AFSM characterized by localized outer retinal disruption on SD-OCT and parafoveal cone loss on AO imaging despite normal fundus appearance, visual acuity, and foveal sensitivity. UWF AF demonstrated preserved para-arteriolar retinal pigment epithelium (PPRPE) in all patients with RP. Microperimetry documented preserved central retinal function in six patients. The ratio of perifoveal-to-foveal retinal volume was greater than controls in 89% (8/9) of patients with RP or MD, whereas central subfield and total macular volume were outside normal limits in 67% (6/9). Conclusions AO imaging was helpful in detecting parafoveal cone loss in asymptomatic patients. Macular volume profile and microperimetry parameters may have utility as CRB1 trials end points. Translational Relevance Macular volume and sensitivity can be used as structural and functional end points for trials on CRB1-associated RP and MD.
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Affiliation(s)
- Danial Roshandel
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Australia
| | - Jennifer A Thompson
- Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Rachael C Heath Jeffery
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Australia.,Department of Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Danuta M Sampson
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Australia.,Surrey Biophotonics, Centre for Vision, Speech and Signal Processing and School of Biosciences and Medicine, The University of Surrey, Guildford, UK
| | - Enid Chelva
- Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Terri L McLaren
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Australia.,Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Tina M Lamey
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Australia.,Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - John N De Roach
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Australia.,Australian Inherited Retinal Disease Registry and DNA Bank, Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Shane R Durkin
- Discipline of Ophthalmology and Visual Science, The University of Adelaide, South Australia, Australia.,Department of Ophthalmology, The Royal Adelaide and Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Fred K Chen
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Australia.,Department of Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia.,Department of Ophthalmology, Perth Children's Hospital, Nedlands, Western Australia, Australia
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7
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Talib M, Schooneveld MJ, Wijnholds J, Genderen MM, Schalij‐Delfos NE, Talsma HE, Florijn RJ, Brink JB, Cremers FP, Thiadens AA, Born LI, Hoyng CB, Meester‐Smoor MA, Bergen AA, Boon CJ. Defining inclusion criteria and endpoints for clinical trials: a prospective cross-sectional study in CRB1-associated retinal dystrophies. Acta Ophthalmol 2021; 99:e402-e414. [PMID: 33528094 PMCID: PMC8248330 DOI: 10.1111/aos.14597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 11/29/2022]
Abstract
Purpose To investigate the retinal structure and function in patients with CRB1‐associated retinal dystrophies (RD) and to explore potential clinical endpoints. Methods In this prospective cross‐sectional study, 22 patients with genetically confirmed CRB1‐RD (aged 6–74 years), and who had a decimal best‐corrected visual acuity (BCVA) ≥ 0.05 at the last visit, were studied clinically with ETDRS BCVA, corneal topography, spectral‐domain optical coherence tomography (SD‐OCT), fundus autofluorescence, Goldmann visual field (VF), microperimetry, full‐field electroretinography (ERG) and full‐field stimulus testing (FST). Ten patients were from a genetic isolate (GI). Results Patients had retinitis pigmentosa (n = 19; GI and non‐GI), cone‐rod dystrophy (n = 2; GI) or macular dystrophy (n = 1; non‐GI). Median age at first symptom onset was 3 years (range 0.8–49). Median decimal BCVA in the better and worse‐seeing eye was 0.18 (range 0.05–0.83) and 0.08 (range light perception‐0.72), respectively. Spectral‐domain optical coherence tomography (SD‐OCT) showed cystoid maculopathy in 8 subjects; inner retinal thickening (n = 20), a well‐preserved (para)foveal outer retina (n = 7) or severe (para)foveal outer retinal atrophy (n = 14). All retinal layers were discernible in 13/21 patients (62%), with mild to moderate laminar disorganization in the others. Nanophthalmos was observed in 8 patients (36%). Full‐field stimulus testing (FST) provided a subjective outcome measure for retinal sensitivity in eyes with (nearly) extinguished ERG amplitudes. Conclusions Despite the generally severe course of CRB1‐RDs, symptom onset and central visual function are variable, even at advanced ages. Phenotypes may vary within the same family. Imaging and functional studies in a prospective longitudinal setting should clarify which endpoints may be most appropriate in a clinical trial.
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Affiliation(s)
- Mays Talib
- Department of Ophthalmology Leiden University Medical Center Leiden The Netherlands
| | - Mary J. Schooneveld
- Department of Ophthalmology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
- Bartiméus Diagnostic Centre for complex visual disorders Zeist The Netherlands
| | - Jan Wijnholds
- Department of Ophthalmology Leiden University Medical Center Leiden The Netherlands
| | - Maria M. Genderen
- Bartiméus Diagnostic Centre for complex visual disorders Zeist The Netherlands
| | | | - Herman E. Talsma
- Department of Ophthalmology Leiden University Medical Center Leiden The Netherlands
- Bartiméus Diagnostic Centre for complex visual disorders Zeist The Netherlands
| | - Ralph J. Florijn
- Department of Clinical Genetics Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Jacoline B. Brink
- Department of Clinical Genetics Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Frans P.M. Cremers
- Department of Human Genetics and Donders Institute for Brain Cognition and Behaviour Radboud University Medical Center Nijmegen The Netherlands
| | | | | | - Carel B. Hoyng
- Department of Ophthalmology Radboud University Medical Center Nijmegen The Netherlands
| | | | - Arthur A. Bergen
- Department of Clinical Genetics Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
- The Netherlands Institute for Neuroscience (NIN‐KNAW) Amsterdam The Netherlands
| | - Camiel J.F. Boon
- Department of Ophthalmology Leiden University Medical Center Leiden The Netherlands
- Department of Ophthalmology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
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8
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CRB1 maculopathy presenting as fenestrated sheen macular dystrophy with 15-year follow-up. Doc Ophthalmol 2021; 142:381-388. [PMID: 33387055 DOI: 10.1007/s10633-020-09810-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION We present two patients, the proband and the affected sibling, with biallelic CRB1 mutations leading to a macular dystrophy. CASE PRESENTATION We present two patients, the proband and the affected sibling, with biallelic CRB1 mutations leading to a macular dystrophy. With 15 years of follow-up for the proband, we illustrate the natural history of CRB1 maculopathy based on clinical examination, multimodal imaging, and electrophysiology. In addition, we demonstrate the wide phenotypic spectrum of the condition with the affected sister harboring the same variants but with much milder phenotypic manifestations. CONCLUSION In addition to a previously described pathogenic variant, Ile167_Gly169del, one pathogenic missense variant in CRB1, Lys801Ter, not previously associated with macular dystrophy, is reported here. While CRB1 mutations have been more commonly described in retinitis pigmentosa (RP) and Leber congenital amaurosis (LCA), we demonstrate that mutations in CRB1 can cause a maculopathy with initial features similar to fenestrated sheen macular dystrophy (FSMD) that later evolves into severe macular atrophy.
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9
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Oh DJ, Sheth V, Fishman GA, Grassi MA. Simplex Crumbs Homologue 1 Maculopathy Masquerading as Juvenile X-Linked Retinoschisis in Male Patients. JOURNAL OF VITREORETINAL DISEASES 2020; 4:437-440. [PMID: 33029571 PMCID: PMC7537420 DOI: 10.1177/2474126420916079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: We demonstrate that Crumbs homologue 1 ( CRB1) maculopathy should be considered in the differential of petaloid pigmentary changes in the macula of young children with good vision who may be asymptomatic. Methods: We report on 2 unrelated male patients presenting at a young age with decreased vision from a macular dystrophy due to biallelic CRB1 mutations. Results: In addition to a previously described pathogenic variant, Ile167Gly169del, 2 new pathogenic missense variants in CRB1, Thr745Met and Cys948Tyr, are reported here. Conclusions: Although CRB1 mutations have been more commonly described in retinitis pigmentosa and Leber congenital amaurosis, we demonstrate that mutations in CRB1 can cause a maculopathy in which initial features can resemble juvenile X-linked retinoschisis. We show that the accompanying macular edema is responsive to carbonic anhydrase inhibitors. With long-term follow-up for each case, we illustrate the natural history of CRB1 maculopathy based on clinical examination and diagnostic imaging.
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Affiliation(s)
- Daniel J. Oh
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Gerald A. Fishman
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
- The Chicago Lighthouse, Chicago, IL, USA
| | - Michael A. Grassi
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
- Grassi Retina, Naperville, IL, USA
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10
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Grudzinska Pechhacker MK, Di Scipio M, Vig A, Tumber A, Roslin N, Tavares E, Vincent A, Hèon E. CRB1-related retinopathy overlapping the ocular phenotype of S-adenosylhomocysteine hydrolase deficiency. Ophthalmic Genet 2020; 41:457-464. [PMID: 32689861 DOI: 10.1080/13816810.2020.1790013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND S-adenosylhomocysteine hydrolase deficiency due to pathologic variants in AHCY gene is a rare neurometabolic disease for which no eye phenotype has been documented. Pathologic variants in CRB1 gene are known to cause a wide spectrum of autosomal recessive retinal diseases with Leber's congenital amaurosis as a most common. The aim of this study is to report co-inheritance of neurometabolic disease and eye disease in a pedigree. MATERIALS AND METHODS Comprehensive eye examination was performed in available family members together with color vision test, visual fields, fundus images, OCT, electroretinogram and visual evoked potentials. Genetic testing included whole-exome sequencing (WES), retinal dystrophy gene panel and segregation analysis. RESULTS Two children from a family not known to be consanguineous were affected with neurometabolic disease and one of them presented with reduced vision due to maculopathy. The mother had symptoms of retinal degeneration of unspecified cause. Clinical WES revealed homozygous missense pathologic variants in AHCY gene c.148G>A, p.(Ala50Thr) as a cause of S-adenosylhomocysteine hydrolase deficiency. Retinal dystrophy gene panel sequencing revealed two heterozygous missense pathologic variants in CRB1 gene c.1831T>C, p.(Ser611Pro) and c.3955T>C, p.(Phe1319Leu) in the proband and her mother. These variants segregated with disease phenotype in family members. CONCLUSIONS Establishing an ocular genetic diagnosis may be challenging with the co-existence of a rare systemic genetic disease with previously unknown eye involvement. Extensive phenotyping and genotyping of available family members showed that the proband and her mother shared a CRB1-related retinopathy at different stages while the brother did not.
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Affiliation(s)
- Monika K Grudzinska Pechhacker
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children , Toronto, Canada.,Department of Ophthalmology and Vision Sciences, University of Toronto , Toronto, Canada
| | - Matteo Di Scipio
- Genetics and Genome Biology, The Hospital for Sick Children , Toronto, Canada
| | - Anjali Vig
- Genetics and Genome Biology, The Hospital for Sick Children , Toronto, Canada
| | - Anupreet Tumber
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children , Toronto, Canada
| | - Nicole Roslin
- Genetics and Genome Biology, The Hospital for Sick Children , Toronto, Canada
| | - Erika Tavares
- Genetics and Genome Biology, The Hospital for Sick Children , Toronto, Canada
| | - Ajoy Vincent
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children , Toronto, Canada.,Department of Ophthalmology and Vision Sciences, University of Toronto , Toronto, Canada.,Genetics and Genome Biology, The Hospital for Sick Children , Toronto, Canada
| | - Elise Hèon
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children , Toronto, Canada.,Department of Ophthalmology and Vision Sciences, University of Toronto , Toronto, Canada.,Genetics and Genome Biology, The Hospital for Sick Children , Toronto, Canada
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11
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Talib M, Boon CJF. Retinal Dystrophies and the Road to Treatment: Clinical Requirements and Considerations. Asia Pac J Ophthalmol (Phila) 2020; 9:159-179. [PMID: 32511120 PMCID: PMC7299224 DOI: 10.1097/apo.0000000000000290] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/01/2020] [Indexed: 12/15/2022] Open
Abstract
: Retinal dystrophies (RDs) comprise relatively rare but devastating causes of progressive vision loss. They represent a spectrum of diseases with marked genetic and clinical heterogeneity. Mutations in the same gene may lead to different diagnoses, for example, retinitis pigmentosa or cone dystrophy. Conversely, mutations in different genes may lead to the same phenotype. The age at symptom onset, and the rate and characteristics of peripheral and central vision decline, may vary widely per disease group and even within families. For most RD cases, no effective treatment is currently available. However, preclinical studies and phase I/II/III gene therapy trials are ongoing for several RD subtypes, and recently the first retinal gene therapy has been approved by the US Food and Drug Administration for RPE65-associated RDs: voretigene neparvovec-rzyl (Luxturna). With the rapid advances in gene therapy studies, insight into the phenotypic spectrum and long-term disease course is crucial information for several RD types. The vast clinical heterogeneity presents another important challenge in the evaluation of potential efficacy in future treatment trials, and in establishing treatment candidacy criteria. This perspective describes these challenges, providing detailed clinical descriptions of several forms of RD that are caused by genes of interest for ongoing and future gene or cell-based therapy trials. Several ongoing and future treatment options will be described.
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Affiliation(s)
- Mays Talib
- Department of Ophthalmology, Leiden, The Netherlands
| | - Camiel J F Boon
- Department of Ophthalmology, Leiden, The Netherlands
- Department of Ophthalmology, Amsterdam UMC, Academic Medical Center, University of Amsterdam. Amsterdam, The Netherlands
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12
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Paolacci S, Iarossi G, Gusson E, Maltese PE, Dallavilla T, Fanelli F, Zulian A, Cerra D, Unfer V, Marchini G, Bertelli M. CRB1-Related Cystic Maculopathy in Twins Conceived Through Heterologous Fertilization With Variant-Carrying Oocytes. J Pediatr Ophthalmol Strabismus 2020; 57:e19-e24. [PMID: 32176805 DOI: 10.3928/01913913-20200204-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/16/2019] [Indexed: 11/20/2022]
Abstract
Cystic maculopathy has been associated with genetic disorders such as retinitis pigmentosa, X-linked retinoschisis, cone dystrophy, and foveal retinoschisis. Familial foveal retinoschisis was recently described as a rare disease caused by CRB1 variants. The authors report the phenotype-genotype pattern of a pair of dizygotic twins with early-onset cystic maculopathy due to CRB1 pathogenic variants. The twins were conceived by heterologous fertilization with variant-carrying oocytes. The probands were monitored for a period of 4 years. Next generation sequencing of a panel of genes responsible for retinal dystrophies was performed. Both children carried three pathogenic variants in CRB1: a novel heterozygous truncating variant p.(Val855*) inherited from the father and two known heterozygous missense variants, p.[(Phe144Val; Thr745Met)], inherited from the oocyte donor. The findings confirm that CRB1 variants can be responsible for foveal retinoschisis with variable clinical expressivity ranging from schitic macular alteration to early-onset forms of cystic maculopathy. The authors highlight the importance of exome analysis of gamete donors to assess the likelihood of recessively inherited disorders by means of a prediction algorithm able to combine parent and donor exome data. [J Pediatr Ophthalmol Strabismus. 2020;57:e19-e24.].
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13
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Mucciolo DP, Murro V, Giorgio D, Passerini I, Sodi A, Virgili G, Rizzo S. Long-term follow-up of a CRB1-associated maculopathy. Ophthalmic Genet 2018; 39:522-525. [PMID: 29869924 DOI: 10.1080/13816810.2018.1479431] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
PURPOSE To report a long-term follow-up of a CRB1-associated maculopathy. METHODS A case report. RESULTS A 47-year-old man was diagnosed with bilateral maculopathy. The clinical picture and the foveoschisis abnormalities present in the right eye were consistent with X-linked retinoschisis. During the follow-up we observed the spontaneous passage from a foveal schitic shape to a cystic profile and then to atrophic maculopathy. Two pathogenic CRB1 mutations were detected and he was subsequently diagnosed with CRB1-associated maculopathy. CONCLUSIONS Our clinical case allowed us to observe three different stages in the natural history of this particular CRB1-associated macular phenotype: a foveoschisis phenotype, cystoid macular abnormalities involving outer and inner retinal layers and macular atrophy. CRB1 mutations may be a rare cause of foveal schisis which progressively evolves in atrophic maculopathy and the clinician should be aware of this unusual macular phenotype.
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Affiliation(s)
- Dario Pasquale Mucciolo
- a Department of Surgery and Translational Medicine , University of Florence , Florence , Italy
| | - Vittoria Murro
- a Department of Surgery and Translational Medicine , University of Florence , Florence , Italy
| | - Dario Giorgio
- a Department of Surgery and Translational Medicine , University of Florence , Florence , Italy
| | - Ilaria Passerini
- b Department of Genetic Diagnosis , Careggi Teaching Hospital , Florence , Italy
| | - Andrea Sodi
- a Department of Surgery and Translational Medicine , University of Florence , Florence , Italy
| | - Gianni Virgili
- a Department of Surgery and Translational Medicine , University of Florence , Florence , Italy
| | - Stanislao Rizzo
- a Department of Surgery and Translational Medicine , University of Florence , Florence , Italy
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14
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Khan KN, Robson A, Mahroo OAR, Arno G, Inglehearn CF, Armengol M, Waseem N, Holder GE, Carss KJ, Raymond LF, Webster AR, Moore AT, McKibbin M, van Genderen MM, Poulter JA, Michaelides M. A clinical and molecular characterisation of CRB1-associated maculopathy. Eur J Hum Genet 2018; 26:687-694. [PMID: 29391521 PMCID: PMC5945653 DOI: 10.1038/s41431-017-0082-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/14/2017] [Accepted: 12/05/2017] [Indexed: 12/22/2022] Open
Abstract
To date, over 150 disease-associated variants in CRB1 have been described, resulting in a range of retinal disease phenotypes including Leber congenital amaurosis and retinitis pigmentosa. Despite this, no genotype–phenotype correlations are currently recognised. We performed a retrospective review of electronic patient records to identify patients with macular dystrophy due to bi-allelic variants in CRB1. In total, seven unrelated individuals were identified. The median age at presentation was 21 years, with a median acuity of 0.55 decimalised Snellen units (IQR = 0.43). The follow-up period ranged from 0 to 19 years (median = 2.0 years), with a median final decimalised Snellen acuity of 0.65 (IQR = 0.70). Fundoscopy revealed only a subtly altered foveal reflex, which evolved into a bull’s-eye pattern of outer retinal atrophy. Optical coherence tomography identified structural changes—intraretinal cysts in the early stages of disease, and later outer retinal atrophy. Genetic testing revealed that one rare allele (c.498_506del, p.(Ile167_Gly169del)) was present in all patients, with one patient being homozygous for the variant and six being heterozygous. In trans with this, one variant recurred twice (p.(Cys896Ter)), while the four remaining alleles were each observed once (p.(Pro1381Thr), p.(Ser478ProfsTer24), p.(Cys195Phe) and p.(Arg764Cys)). These findings show that the rare CRB1 variant, c.498_506del, is strongly associated with localised retinal dysfunction. The clinical findings are much milder than those observed with bi-allelic, loss-of-function variants in CRB1, suggesting this in-frame deletion acts as a hypomorphic allele. This is the most prevalent disease-causing CRB1 variant identified in the non-Asian population to date.
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Affiliation(s)
- Kamron N Khan
- University College London Institute of Ophthalmology, University College London, London, UK. .,Inherited Eye Disease Service, Moorfields Eye Hospital, London, UK. .,Section of Ophthalmology and Neuroscience, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK. .,Department of Ophthalmology, St. James's University Teaching Hospital, Leeds, UK.
| | - Anthony Robson
- Department of Electrophysiology, Moorfields Eye Hospital, London, UK
| | - Omar A R Mahroo
- University College London Institute of Ophthalmology, University College London, London, UK.,Inherited Eye Disease Service, Moorfields Eye Hospital, London, UK
| | - Gavin Arno
- University College London Institute of Ophthalmology, University College London, London, UK
| | - Chris F Inglehearn
- Section of Ophthalmology and Neuroscience, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Monica Armengol
- Inherited Eye Disease Service, Moorfields Eye Hospital, London, UK
| | - Naushin Waseem
- Section of Ophthalmology and Neuroscience, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Graham E Holder
- Department of Electrophysiology, Moorfields Eye Hospital, London, UK
| | - Keren J Carss
- NIHR BioResource - Rare Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK.,Department of Haematology, NHS Blood and Transplant Centre, University of Cambridge, Cambridge, CB2 0PT, UK.,Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Cambridge, CB2 0XY, UK
| | - Lucy F Raymond
- NIHR BioResource - Rare Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK.,Department of Haematology, NHS Blood and Transplant Centre, University of Cambridge, Cambridge, CB2 0PT, UK.,Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Cambridge, CB2 0XY, UK
| | - Andrew R Webster
- University College London Institute of Ophthalmology, University College London, London, UK.,Inherited Eye Disease Service, Moorfields Eye Hospital, London, UK
| | - Anthony T Moore
- University College London Institute of Ophthalmology, University College London, London, UK.,Inherited Eye Disease Service, Moorfields Eye Hospital, London, UK.,Ophthalmology Department, University of California San Francisco Medical School, San Francisco, CA, USA
| | - Martin McKibbin
- Section of Ophthalmology and Neuroscience, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.,Department of Ophthalmology, St. James's University Teaching Hospital, Leeds, UK
| | - Maria M van Genderen
- Bartiméus Diagnostic Centre for Complex Visual Disorders, Zeist, The Netherlands.,Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - James A Poulter
- Section of Ophthalmology and Neuroscience, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Michel Michaelides
- University College London Institute of Ophthalmology, University College London, London, UK.,Inherited Eye Disease Service, Moorfields Eye Hospital, London, UK
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15
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Kumaran N, Moore AT, Weleber RG, Michaelides M. Leber congenital amaurosis/early-onset severe retinal dystrophy: clinical features, molecular genetics and therapeutic interventions. Br J Ophthalmol 2017; 101:1147-1154. [PMID: 28689169 PMCID: PMC5574398 DOI: 10.1136/bjophthalmol-2016-309975] [Citation(s) in RCA: 191] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 04/26/2017] [Accepted: 04/30/2017] [Indexed: 12/29/2022]
Abstract
Leber congenital amaurosis (LCA) and early-onset severe retinal dystrophy (EOSRD) are both genetically and phenotypically heterogeneous, and characterised clinically by severe congenital/early infancy visual loss, nystagmus, amaurotic pupils and markedly reduced/absent full-field electroretinograms. The vast genetic heterogeneity of inherited retinal disease has been established over the last 10 - 20 years, with disease-causing variants identified in 25 genes to date associated with LCA/EOSRD, accounting for 70–80% of cases, with thereby more genes yet to be identified. There is now far greater understanding of the structural and functional associations seen in the various LCA/EOSRD genotypes. Subsequent development/characterisation of LCA/EOSRD animal models has shed light on the underlying pathogenesis and allowed the demonstration of successful rescue with gene replacement therapy and pharmacological intervention in multiple models. These advancements have culminated in more than 12 completed, ongoing and anticipated phase I/II and phase III gene therapy and pharmacological human clinical trials. This review describes the clinical and genetic characteristics of LCA/EOSRD and the differential diagnoses to be considered. We discuss in further detail the diagnostic clinical features, pathophysiology, animal models and human treatment studies and trials, in the more common genetic subtypes and/or those closest to intervention.
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Affiliation(s)
- Neruban Kumaran
- UCL Institute of Ophthalmology, University College London, London, UK.,Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Anthony T Moore
- UCL Institute of Ophthalmology, University College London, London, UK.,Moorfields Eye Hospital NHS Foundation Trust, London, UK.,University of California San Francisco, San Francisco CA, California, USA
| | - Richard G Weleber
- Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Michel Michaelides
- UCL Institute of Ophthalmology, University College London, London, UK.,Moorfields Eye Hospital NHS Foundation Trust, London, UK
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16
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Murro V, Mucciolo DP, Sodi A, Vannozzi L, De Libero C, Simonini G, Rizzo S. Retinal capillaritis in a CRB1-associated retinal dystrophy. Ophthalmic Genet 2017; 38:555-558. [DOI: 10.1080/13816810.2017.1281966] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Vittoria Murro
- Department of Translational Surgery and Medicine, Eye Clinic, University of Florence, Florence, Italy
| | - Dario Pasquale Mucciolo
- Department of Translational Surgery and Medicine, Eye Clinic, University of Florence, Florence, Italy
| | - Andrea Sodi
- Department of Translational Surgery and Medicine, Eye Clinic, University of Florence, Florence, Italy
| | - Lorenzo Vannozzi
- Department of Translational Surgery and Medicine, Eye Clinic, University of Florence, Florence, Italy
| | - Cinzia De Libero
- Ophthalmology Unit, Department of Pediatrics, Anna Meyer Children’s University Hospital, Florence, Italy
| | - Gabriele Simonini
- Rheumatology Unit, NEUROFARBA Department—Pediatric Section, Anna Meyer Children’s Hospital, Florence, Italy
| | - Stanislao Rizzo
- Department of Translational Surgery and Medicine, Eye Clinic, University of Florence, Florence, Italy
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17
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Hettinga YM, van Genderen MM, Wieringa W, Ossewaarde-van Norel J, de Boer JH. Retinal Dystrophy in 6 Young Patients Who Presented with Intermediate Uveitis. Ophthalmology 2016; 123:2043-6. [DOI: 10.1016/j.ophtha.2016.03.046] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 03/29/2016] [Accepted: 03/29/2016] [Indexed: 10/21/2022] Open
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18
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Slavotinek AM. The Family of Crumbs Genes and Human Disease. Mol Syndromol 2016; 7:274-281. [PMID: 27867342 DOI: 10.1159/000448109] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2016] [Indexed: 11/19/2022] Open
Abstract
The family of vertebrate Crumbs proteins, homologous to Drosophila Crumbs (Crb), share large extracellular domains with epidermal growth factor-like repeats and laminin-globular domains, a single transmembrane domain, and a short intracellular C-terminus containing a single membrane proximal 4.1/ezrin/radixin/moesin-binding domain and PSD-95/Discs large/ZO-1-binding motifs. There are 3 Crb genes in humans - Crumbs homolog-1 (CRB1), Crumbs homolog-2 (CRB2), and Crumbs homolog-3 (CRB3). Bilallelic loss-of-function mutations in CRB1 cause visual impairment, with Leber's congenital amaurosis and retinitis pigmentosa, whereas CRB2 mutations are associated with raised maternal serum and amniotic fluid alpha feto-protein levels, ventriculomegaly/hydrocephalus, and renal disease, ranging from focal segmental glomerulosclerosis to congenital Finnish nephrosis. CRB3 has not yet been associated with human disease. In this review, we summarize the phenotypic findings associated with deleterious sequence variants in CRB1 and CRB2. We discuss the mutational spectrum, animal models of loss of function for both genes and speculate on the likely mechanisms of disease.
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Affiliation(s)
- Anne M Slavotinek
- Department of Pediatrics, UCSF School of Medicine, University of California San Francisco, San Francisco, Calif., USA
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19
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Shah N, Damani MR, Zhu XS, Bedoukian EC, Bennett J, Maguire AM, Leroy BP. Isolated maculopathy associated with biallelic CRB1 mutations. Ophthalmic Genet 2016; 38:190-193. [PMID: 27096895 DOI: 10.3109/13816810.2016.1155225] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Neepa Shah
- a Division of Ophthalmology , Children's Hospital of Philadelphia , Philadelphia , Pennsylvania , USA.,b Scheie Eye Institute, University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Mausam R Damani
- a Division of Ophthalmology , Children's Hospital of Philadelphia , Philadelphia , Pennsylvania , USA.,b Scheie Eye Institute, University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Xiaosong Sonia Zhu
- a Division of Ophthalmology , Children's Hospital of Philadelphia , Philadelphia , Pennsylvania , USA
| | - Emma C Bedoukian
- c Individualized Medical Genetics Center, Children's Hospital of Philadelphia , Philadelphia , Pennsylvania , USA
| | - Jean Bennett
- b Scheie Eye Institute, University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Albert M Maguire
- a Division of Ophthalmology , Children's Hospital of Philadelphia , Philadelphia , Pennsylvania , USA.,b Scheie Eye Institute, University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Bart P Leroy
- a Division of Ophthalmology , Children's Hospital of Philadelphia , Philadelphia , Pennsylvania , USA.,d Department of Ophthalmology & Center for Medical Genetics , Ghent University Hospital & Ghent University , Ghent , Belgium
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