The molecular genetics of anterior segment dysgenesis

Double Iris, A case report

The formation of the iris involves interactions between the neural ectoderm, neural crest-derived cells, and the mesoderm. This report describes the occurrence of double iris in a patient and describes the clinical profile for him. The study presents a case of 31-year-old male with a history of blurred vision in the left eye since childhood. His left eye (OS) was amblyopic with a VA of 6/60. There was hypermetropia in the left eye and intraocular pressure (IOP) was within the normal range. Anterior chamber (AC) showed no signs of inflammation, and the vitreous was clear. The slit lamp examination revealed double iris bilaterally that was confirmed using an optical coherence tomography.

Exome sequencing identifies existing and novel variants in a South African cohort presenting with anterior segment dysgenesis

Anterior segment dysgenesis (ASD) defines a collection of congenital eye disorders that affect structures within the anterior segment of the eye. Mutations in genes that initiate and regulate the complex pathways involved in eye development can cause a spectrum of disorders such as ASD, congenital cataracts and corneal opacity. In South Africa, causes of ASD are poorly understood with few studies looking at the possible genetic basis for these disorders. In this study, we performed exome sequencing on a cohort of South African patients with ASD, focusing on a panel of genes known to regulate eye development pathways, including the PXDN gene which has recently been associated with ASD. We identified novel as well as established variants: specifically, we found a disease-causing variant in PAX6; variants that are likely to be pathogenic in GJA8, BCOR and EPHA2, as well as variants of uncertain significance in PXDN and LTBP2. In conclusion, this study is the first to show disease-causing variants in South African patients presenting with ASD, including the identification of novel variants and highlights the need to expand upon such studies in understudied populations.

Identification of lens-regulated genes driving anterior eye development

Signals from the lens regulate multiple aspects of eye development, including establishment of eye size, patterning of the presumptive iris and ciliary body in the anterior optic cup and migration and differentiation of neural crest cells. To advance understanding of the molecular mechanism by which the lens regulates eye development, we performed transcriptome profiling of embryonic chicken retinas after lens removal. Genes associated with nervous system development were upregulated in lens-removed eyes, but the presumptive ciliary body and iris region did not adopt a neural retina identity following lens removal. Lens-regulated genes implicated in periocular mesenchyme, cornea and anterior optic cup development were identified, including factors not previously implicated in eye development. Unexpectedly, transcriptomic differences were identified in retinas from male versus female chicken embryos, suggesting sexual dimorphism from early stages. In situ hybridisation of embryonic chicken eyes and analyses of datasets from embryonic mouse and adult human eyes confirmed expression of candidate genes, including multiple WNT genes, in tissues important for anterior eye development and function. Remarkably, pharmacological activation of canonical WNT signalling restored eye development and size in the absence of the lens. These analyses have identified candidate genes and biological pathways involved in eye development, providing avenues for new research in this area.

Primary Cilium in Neural Crest Cells Crucial for Anterior Segment Development and Corneal Avascularity

Purpose

Intraflagellar transport 46 (IFT46) is an integral subunit of the IFT-B complex, playing a key role in the assembly and maintenance of primary cilia responsible for transducing signaling pathways. Despite its predominant expression in the basal body of cilia, the precise role of Ift46 in ocular development remains undetermined. This study aimed to elucidate the impact of neural crest (NC)-specific deletion of Ift46 on ocular development.

Methods

NC-specific conditional knockout mice for Ift46 (NC-Ift46F/F) were generated by crossing Ift46F mice with Wnt1-Cre2 mice, enabling the specific deletion of Ift46 in NC-derived cells (NCCs). Sonic Hedgehog (Shh) and Notch signaling activities in NC-Ift46F/F mice were evaluated using Gli1lacZ and CBF:H2B-Venus reporter mice, respectively. Cell fate mapping was conducted using ROSAmTmG reporter mice.

Results

The deletion of Ift46 in NCCs resulted in a spectrum of ocular abnormalities, including thickened corneal stroma, hypoplasia of the anterior chamber, irregular iris morphology, and corneal neovascularization. Notably, this deletion led to reduced Shh signal activity in the periocular mesenchyme, sustained expression of key transcription factors Foxc1, Foxc2 and Pitx2, along with persistent cell proliferation. Additionally, it induced increased Notch signaling activity and the development of ectopic neovascularization within the corneal stroma.

Conclusions

The absence of primary cilia due to Ift46 deficiency in NCCs is associated with anterior segment dysgenesis (ASD) and corneal neovascularization, suggesting a potential link to Axenfeld-Rieger syndrome, a disorder characterized by ASD. This underscores the pivotal role of primary cilia in ensuring proper anterior segment development and maintaining an avascular cornea.