1
|
Liu S, Ren Y, Wang D, Xiao D, Li Z, Xu D, Sun Y, Wang Z, Pang J. Case report: Familial foveal retinoschisis caused by CRB1 gene mutation in a family with recessive inheritance. Front Med (Lausanne) 2023; 10:1220075. [PMID: 37636578 PMCID: PMC10451074 DOI: 10.3389/fmed.2023.1220075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/17/2023] [Indexed: 08/29/2023] Open
Abstract
X-linked retinoschisis is more common in male children and rare in females. Clinically, male patients mainly present with early onset visual impairment or vision loss, and retinal retinoschisis due to division of the inner retina. We report a long-term observation of a female patient with familial foveal retinoschisis (FFR) caused by CRB1 gene with complex heterozygotic mutation. The initial symptoms of the female patient reported in this study were very similar to some early manifestations of X-linked retinoschisis (XLRS) caused by RS1 mutations involving macular fovea. However, as time going on, the splitting height at retinal fovea of FFR gradually decreased, and the splitting extent at retinal fovea of FFR gradually decreased.
Collapse
Affiliation(s)
- Shu Liu
- Shenyang He Eye Specialist Hospital, Shenyang, China
- Liaoning Provincial Innovation Center of Ophthalmology, Shenyang, China
| | - Yue Ren
- Shenyang He Eye Specialist Hospital, Shenyang, China
| | - Di Wang
- Shenyang He Eye Specialist Hospital, Shenyang, China
| | - Dan Xiao
- Shenyang He Eye Specialist Hospital, Shenyang, China
| | - Zhuang Li
- Shenyang He Eye Specialist Hospital, Shenyang, China
| | - Dan Xu
- Shenyang Weijing Biotechnology Co., Ltd., Shenyang, China
| | - Yan Sun
- Shenyang He Eye Specialist Hospital, Shenyang, China
| | - Zhuoshi Wang
- Shenyang He Eye Specialist Hospital, Shenyang, China
| | - Jijing Pang
- Shenyang He Eye Specialist Hospital, Shenyang, China
- Shenyang Weijing Biotechnology Co., Ltd., Shenyang, China
- Institute of Innovation Research for Precision Medical Treatment, He University, Shenyang, China
| |
Collapse
|
2
|
Manley A, Meshkat BI, Jablonski MM, Hollingsworth TJ. Cellular and Molecular Mechanisms of Pathogenesis Underlying Inherited Retinal Dystrophies. Biomolecules 2023; 13. [PMID: 36830640 DOI: 10.3390/biom13020271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023] Open
Abstract
Inherited retinal dystrophies (IRDs) are congenital retinal degenerative diseases that have various inheritance patterns, including dominant, recessive, X-linked, and mitochondrial. These diseases are most often the result of defects in rod and/or cone photoreceptor and retinal pigment epithelium function, development, or both. The genes associated with these diseases, when mutated, produce altered protein products that have downstream effects in pathways critical to vision, including phototransduction, the visual cycle, photoreceptor development, cellular respiration, and retinal homeostasis. The aim of this manuscript is to provide a comprehensive review of the underlying molecular mechanisms of pathogenesis of IRDs by delving into many of the genes associated with IRD development, their protein products, and the pathways interrupted by genetic mutation.
Collapse
|
3
|
Wu J, Chen J, Zhao R, Zeng L, Li T, Wang W, Jia H, Wang F, Zhu H, Tan W, Sun X. Status of Visual Impairment among Children with Special Needs in Rural China. Ophthalmic Res 2022; 66:99-107. [PMID: 35970143 DOI: 10.1159/000526494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/09/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Previous studies have reported a high prevalence of visual defects in children with special needs. However, routine ocular examinations for these children in rural areas of China are lacking. This study aimed to evaluate the status of visual impairment (VI) in children at special education schools in rural China. METHODS A total of 316 students from two special schools in Zunyi city, Guizhou province, were enrolled. Full ophthalmic examinations were performed, and gene-sequencing services were offered to potential patients. RESULTS The mean age of the 316 participants was 12.27 ± 3.49 years and 75 showed abnormal ophthalmic manifestations on slit-lamp examination. Visual acuity (VA) was assessed in 232 eyes, and the mean VA (logarithm of the minimum angle of resolution, logMAR) was 0.27 ± 0.34. Whole-exome sequencing identified 19 mutations in these children, which might explain their visual complaints. Children with Down syndrome had a significantly higher prevalence of ocular disorders than those without. CONCLUSION VI is common among children at special education schools in rural areas; however, routine screening and effective interventions have not been consistently implemented. Efforts should be made to address this issue in these already disadvantaged children.
Collapse
Affiliation(s)
- Jiali Wu
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China,
- Department of Ophthalmology, School of Medicine, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University, Shanghai, China,
- National Clinical Research Center for Eye Diseases, Shanghai, China,
- Shanghai Key Laboratory of Fundus Diseases, Shanghai, China,
| | - Jieqiong Chen
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China
- Department of Ophthalmology, School of Medicine, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Fundus Diseases, Shanghai, China
| | - Ruyi Zhao
- Graduate School of Zunyi Medical University, Zunyi, China
- Department of Ophthalmology, The Third Affiliated Hospital of Zunyi, Medical University (The First People's Hospital of Zunyi), Zunyi, China
| | - Lan Zeng
- Graduate School of Zunyi Medical University, Zunyi, China
- Department of Ophthalmology, The Third Affiliated Hospital of Zunyi, Medical University (The First People's Hospital of Zunyi), Zunyi, China
| | - Tong Li
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China
- Department of Ophthalmology, School of Medicine, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Fundus Diseases, Shanghai, China
| | - Wenqiu Wang
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China
- Department of Ophthalmology, School of Medicine, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Fundus Diseases, Shanghai, China
| | - Huixun Jia
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China
- Department of Ophthalmology, School of Medicine, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Fundus Diseases, Shanghai, China
| | - Fenghua Wang
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China
- Department of Ophthalmology, School of Medicine, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Hong Zhu
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China
- Department of Ophthalmology, School of Medicine, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Fundus Diseases, Shanghai, China
| | - Wei Tan
- Graduate School of Zunyi Medical University, Zunyi, China
- Department of Ophthalmology, The Third Affiliated Hospital of Zunyi, Medical University (The First People's Hospital of Zunyi), Zunyi, China
| | - Xiaodong Sun
- National Clinical Research Center for Ophthalmic Diseases, Shanghai, China
- Department of Ophthalmology, School of Medicine, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- Shanghai Key Laboratory of Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| |
Collapse
|
4
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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)
| |
Collapse
|
5
|
Pauleikhoff D, Pauleikhoff L, Chew EY. Imaging endpoints for clinical trials in MacTel type 2. Eye (Lond) 2022; 36:284-93. [PMID: 34389818 DOI: 10.1038/s41433-021-01723-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/15/2021] [Accepted: 07/26/2021] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Macular Telangiectasia type 2 (MacTel) is a bilateral neurodegenerative disease associated with dysfunction in the serine and lipid metabolism resulting in loss of Muller cells and photoreceptors. Typical structural changes include vascular abnormalities, loss of retinal transparency, redistribution of macular pigment and thinning of the central retina with photoreceptor loss. The presence and extent of photoreceptor loss, as visible on Optical Coherence Tomography (OCT) ("disease severity scale"), correlate with functional loss and the limitation of photoreceptor loss appears to be the most promising therapeutic approach. Ongoing clinical trials of ciliary neurotrophic factor (CNTF) implants for the treatment of MacTel are using this outcome to evaluate efficacy. An ideal outcome measure provides the ability to quantify the extent of the disease progression with precision and reproducibility. METHODS This review describes the changes and findings on different imaging techniques including fluorescein- and OCT angiography, blue light reflectance, 1- and 2-wavelength autofluorescence and OCT. RESULTS The possibilities of objective quantification of the severity of MacTel and correlation with functional characteristics such as best-corrected visual acuity (BCVA) and microperimetry and their applications as quantitative imaging endpoints for clinical treatment trials are discussed. OCT and especially en face OCT could be demonstrated as precise and reproducible methods to quantify the area of photoreceptor loss, which correlated highly significantly with functional loss in microperimetry. CONCLUSION The analysis of the area of photoreceptor loss on en face OCT is the most reliable imaging endpoint for treatment trials in MacTel. This method is already being used in ongoing randomized trials.
Collapse
|
6
|
Daich Varela M, Cabral de Guimaraes TA, Georgiou M, Michaelides M. Leber congenital amaurosis/early-onset severe retinal dystrophy: current management and clinical trials. Br J Ophthalmol 2021; 106:445-451. [PMID: 33712480 PMCID: PMC8961750 DOI: 10.1136/bjophthalmol-2020-318483] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/18/2021] [Accepted: 02/23/2021] [Indexed: 12/26/2022]
Abstract
Leber congenital amaurosis (LCA) is a severe congenital/early-onset retinal dystrophy. Given its monogenic nature and the immunological and anatomical privileges of the eye, LCA has been particularly targeted by cutting-edge research. In this review, we describe the current management of LCA, and highlight the clinical trials that are on-going and planned. RPE65-related LCA pivotal trials, which culminated in the first Food and Drug Administration-approved and European Medicines Agency-approved ocular gene therapy, have paved the way for a new era of genetic treatments in ophthalmology. At present, multiple clinical trials are available worldwide applying different techniques, aiming to achieve better outcomes and include more genes and variants. Genetic therapy is not only implementing gene supplementation by the use of adeno-associated viral vectors, but also clustered regularly interspaced short palindromic repeats (CRISPR)-mediated gene editing and post-transcriptional regulation through antisense oligonucleotides. Pharmacological approaches intending to decrease photoreceptor degeneration by supplementing 11-cis-retinal and cell therapy’s aim to replace the retinal pigment epithelium, providing a trophic and metabolic retinal structure, are also under investigation. Furthermore, optoelectric devices and optogenetics are also an option for patients with residual visual pathway. After more than 10 years since the first patient with LCA received gene therapy, we also discuss future challenges, such as the overlap between different techniques and the long-term durability of efficacy. The next 5 years are likely to be key to whether genetic therapies will achieve their full promise, and whether stem cell/cellular therapies will break through into clinical trial evaluation.
Collapse
Affiliation(s)
- Malena Daich Varela
- UCL Institute of Ophthalmology, University College London, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
| | | | - Michalis Georgiou
- UCL Institute of Ophthalmology, University College London, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
| | - Michel Michaelides
- UCL Institute of Ophthalmology, University College London, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
| |
Collapse
|
7
|
Mueller S, Gunnemann F, Rothaus K, Book M, Faatz H, Bird A, Pauleikhoff D. Incidence and phenotypical variation of outer retina-associated hyperreflectivity in macular telangiectasia type 2. Br J Ophthalmol 2021; 105:573-576. [PMID: 33414243 DOI: 10.1136/bjophthalmol-2020-317997] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/23/2020] [Accepted: 12/16/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Macular telangiectasia type 2 (MacTel) is a neurodegenerative disease resulting in photoreceptor loss. Optical coherence tomography (OCT) reveals outer retina-associated hyperreflectivity (ORaH) as part of this process. The purpose of this study was to describe the incidence and phenotypical variation of ORaH. METHODS Different parameters of ORaH were analysed: OCT characteristics (Spectralis SD-OCT), correlation with vascular changes (OCT angiography; OCTA 3×3 mm Optovue) and correlation with hyperpigmentation (autofluorescence/fundus images). ORaH was also evaluated regarding the grade of severity of photoreceptor loss (Disease Severity Scale). RESULTS Of 220 eyes with MacTel type 2, 106 demonstrated ORaH. On OCT, the size, the extension into the inner retina and the contact with retinal pigment epithelium (RPE) of the ORaH were variable. On OCTA neovascularisation (NV) in the outer retina (OR) was present at the location of the ORaH in 97.6%. Increasing size of NV correlated with progressive photoreceptor loss. In 86.6% with NV, the flow signals were visible between the OR and the choriocapillaris. In 85.7%, the ORaH was associated with hyperpigmentation on autofluorescence and fundus colour images. CONCLUSIONS The presence of ORaH is associated with increasing photoreceptor loss and disease severity. In these more advanced cases of the present study, a variable presentation of ORaH in respect to size and form was seen, but in most cases, ORaH was in contact to the RPE. Additionally, ORaH was associated with hyperpigmentation and OR NV on OCTA. These results are consistent with the concept of ORaH representing fibrovascular OR-NV with RPE proliferation after contact with the RPE.
Collapse
Affiliation(s)
- Stefanie Mueller
- Department of Ophthalmology, St. Franziskus Hospital, Münster, Germany
| | - Frederic Gunnemann
- Department of Ophthalmology, St. Franziskus Hospital, Münster, Germany.,Retinal Disorders and Ophthalmic Genetics, Jules Stein Eye Institute, Los Angeles, California, USA
| | - Kai Rothaus
- Department of Ophthalmology, St. Franziskus Hospital, Münster, Germany
| | - Marius Book
- Department of Ophthalmology, St. Franziskus Hospital, Münster, Germany
| | - Henrik Faatz
- Department of Ophthalmology, St. Franziskus Hospital, Münster, Germany
| | - Alan Bird
- Genetics, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Daniel Pauleikhoff
- Department of Ophthalmology, St. Franziskus Hospital, Münster, Germany .,Department of Ophthalmology, University of Duisburg-Essen Faculty of Medicine, Essen, Nordrhein-Westfalen, Germany
| |
Collapse
|