Electron microscopic studies of human retinitis pigmentosa. I. Two cases of advanced retinitis pigmentosa.
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OBJECTIVE: To detect mutations of the retinitis pigmentosa GTPase regulator (RPGR) gene in two Chinese X-linked retinitis pigmentosa families. METHODS: Fragments of exons 1-19 of the RPGR gene were amplified with intronic primers, using genomic DNA as template. The polymerase chain reaction (PCR) products were analysed by single-strand conformation polymorphism (SSCP) and direct sequencing. Mutations were identified by comparing DNA sequences of the patients with those of the normal controls. RESULTS: Two novel mutations, c1536delC and E332X, were identified in exons 12 and 9 of the RPGR gene in both families. Each mutation was the first mutation found in their respective exons. Both mutations were predicted to cause premature termination, which resulted in truncated proteins without normal functions of the RPGR products. CONCLUSIONS: Both mutations are the genetic basis of the pathogenesis in the respective families. Our data might be helpful in analysing the function of the RPGR protein.
A 54-year-old woman with retinitis pigmentosa and hearing loss developed white skin patches that were subsequently diagnosed as vitiligo. A review of the literature reveals that, although the association of vitiligo with various tapedoretinal degenerations has been reported on several occasions, the association with typical retinitis pigmentosa is quite rare. This combination of disorders associated with pigment loss is of interest as immunologic disturbances have been implicated on both.
PURPOSE: Retinitis pigmentosa (RP) is a genetically heterogeneous group of retinal degenerative disorders characterized by the loss of rod and cone photoreceptors, leading to visual impairment and blindness. To date, to our knowledge, X-linked RP has been associated with variants in 3 genes (RPGR, RP2, and OFD1), whereas genetic defects at 3 loci (RP6, RP24, and RP34) are yet unidentified. The aim of this study was to identify a novel candidate gene underlying X-linked RP. METHODS: Participants were identified from cohorts of genetically unsolved male individuals affected by RP, who underwent genome sequencing, exome sequencing, or candidate gene screening via direct Sanger sequencing at 3 referral centers. Specifically, 2 probands were identified at the National Reference Centre for Rare Retinal Diseases (Paris, France), 2 at the Massachusetts Eye and Ear Hospital (Boston, MA), and 1 at the National Reference Centre for Inherited Sensory Diseases (Montpellier, France). The pathogenicity of the identified variants was assessed using bioinformatic predictions, protein expression analyses, and mitochondrial function assays. RESULTS: We identified 4 rare single-nucleotide variants in IDH3G (HGNC:5386), located at the RP34 locus on the X chromosome, and a complete gene deletion, in 5 unrelated male individuals affected with nonsyndromic RP. The variants segregated with the phenotype in all available family members. In all cases, the disease severity was intermediate. None had high myopia. IDH3G encodes the γ subunit of mitochondrial isocitrate dehydrogenase (IDH3), an enzyme involved in the citric acid cycle, which is expressed in the inner segments of photoreceptors. Variants in IDH3A and IDH3B, encoding the other subunits of IDH3, have already been associated with nonsyndromic autosomal recessive RP. Bioinformatic predictions and functional assays support a pathogenic role for the variants identified in this study, possibly through partial loss of enzymatic activity and mitochondrial function. CONCLUSION: Our findings suggest that variants in IDH3G are a novel cause of X-linked RP.
Autosomal recessive retinitis pigmentosa (ARRP) is a degenerative disorder of photoreceptors. Mutations in several genes encoding different proteins of the visual cascade are described. The inheritance of two intragenic markers within the interstitial retinol binding protein (IRBP) gene was established in 45 Spanish families with a history of ARRP. Homozygosity mapping and cosegregation analyses were positive in 19 families. Only one heterozygous T-C transition at position 3024 (exon 1) was detected in one consanguineous family. This variant was identified as a rare polymorphism and was present in 5% of the chromosomes analyzed.
The X-linked form of retinitis pigmentosa (XLRP) is a severe disease of the retina, characterised by night blindness and visual field constriction in a degenerative process, culminating with complete loss of sight within the third decade of life. Genetic mapping studies have identified two major loci for XLRP: RP3 (70%-75% of XLRP) and RP2 (20%-25% of XLRP). The RPGR (retinitis pigmentosa GTPase regulator) gene has been cloned within the RP3 genomic interval and it has been shown that 10%-20% of XLRP families have mutations in this gene. Here, we describe a single-strand conformational polymorphism-based mutation screening of RPGR in a pool of 29 XLRP families for which the disease segregates with the RP3 locus, in order to investigate the proportion of RP3 families with RPGR mutations and to relate the results to previous reports. Five different new mutations have been identified: two splice site mutations for exon 1 and three frameshift mutations in exons 7, 10 and 11. The percentage of RPGR mutations identified is 17% (5/29) in our genetically well-defined population. This figure is comparable to the percentage of RP2 gene mutations that we have detected in our entire XLRP patient pool (10%-15%). A correlation of RPGR mutations with phenotype in the families described in this study and the biochemical characterisation of reported mutations may provide insights into the function of the protein.
Reports have appeared of abnormal copper metabolism in retinitis pigmentosa, and of a family with vitelliform retinal degeneration in which other members suffered from hepatolenticular degeneration. In the present study 15 patients with retinitis pigmentosa, 4 with various other retinal degenerations, and 1 with a family disposition to retinitis pigmentosa were examined. The copper concentration in serum and the coeruloplasmin concentration in plasma were found to be within normal limits. In 9 of the patients with retinitis pigmentosa the urinary excretion of copper per 24 hours was determined and was found to be normal. The results of the present study lend no support to the hypothesis of abnormal copper metabolism in retinitis pigmentosa.
Inherited retinal degenerations (IRDs) are a leading cause of blindness among the population of young people in the developed world. Approximately half of IRDs initially manifest as gradual loss of night vision and visual fields, characteristic of retinitis pigmentosa (RP). Due to challenges in genetic testing, and the large heterogeneity of mutations underlying RP, targeted gene therapies are an impractical largescale solution in the foreseeable future. For this reason, identifying key pathophysiological pathways in IRDs that could be targets for mutation-agnostic and disease-modifying therapies (DMTs) is warranted. In this study, we investigated the retinal proteome of three distinct IRD mouse models, in comparison to sex- and age-matched wild-type mice. Specifically, we used the Pde6βRd10 (rd10) and RhoP23H/WT (P23H) mouse models of autosomal recessive and autosomal dominant RP, respectively, as well as the Rpe65-/- mouse model of Leber's congenital amaurosis type 2 (LCA2). The mice were housed at two distinct institutions and analyzed using LC-MS in three separate facilities/instruments following data-dependent and data-independent acquisition modes. This cross-institutional and multi-methodological approach signifies the reliability and reproducibility of the results. The large-scale profiling of the retinal proteome, coupled with in vivo electroretinography recordings, provided us with a reliable basis for comparing the disease phenotypes and severity. Despite evident inflammation, cellular stress, and downscaled phototransduction observed consistently across all three models, the underlying pathologies of RP and LCA2 displayed many differences, sharing only four general KEGG pathways. The opposite is true for the two RP models in which we identify remarkable convergence in proteomic phenotype even though the mechanism of primary rod death in rd10 and P23H mice is different. Our data highlights the cAMP and cGMP second-messenger signaling pathways as potential targets for therapeutic intervention. The proteomic data is curated and made publicly available, facilitating the discovery of universal therapeutic targets for RP.
INTRODUCTION: Retinitis pigmentosa (RP) is a group of hereditary retinal diseases in which photoreceptor cells degenerate. It is both clinically and genetically heterogenous. Using a two-stage approach by combining linkage analysis with mutation detection, we have rapidly identified the gene locus and the mutation site of a Chinese Singaporean family with autosomal dominant RP. MATERIALS AND METHODS: Three Chinese Singaporean families were tested. One family showed autosomal dominant inheritance pattern, while the other two could be recessive or sporadic. Twelve di-nucleotide markers tightly linked to 6 genes known to be responsible for either autosomal dominant or recessive RP were selected for linkage analysis. Cosegregation of marker and disease inheritance pattern permits identification of the target candidate gene. RFLP (restriction fragment length polymorphism) markers were added to confirm the linkage result prior to the detailed mutation detection study. RESULTS: With this two-stage strategy, the autosomal dominant RP family showed the rhodopsin locus segregating concordantly with the disease. Mutation screening later identified a nonsense mutation 5261C>T in the last exon of rhodopsin gene. It predicted a Q344X changes at the C-terminus of the gene product, truncating it by 5 amino acids. CONCLUSION: This systematic approach facilitates molecular diagnosis of a genetically heterogenous disease like RP. This is the first report of an RP mutation in Singapore. This 5261C>T mutation has been reported in the Caucasian, but not the Chinese population. The relatively milder phenotype in this family showed similarity to the reported US family, indicating the correlation of mutation site to severity of disease regardless of ethnicity.
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Retinitis pigmentosa (RP) is the general term given to a group of genetically determined, degenerative retinal diseases which afflict some 1.5 million humans worldwide. Molecular genetic studies in recent years have shown that RP cannot be explained by a single genetic defect but rather that the hereditary aberration responsible for triggering the onset of the disease is localized in different genes and at different sites within these genes. A fuller understanding of these processes is possible only if the pathogenesis of the diseases can be followed as they develop. Animal models are an indispensable requirement for this. Only in the animal model is it possible to observe progressive degenerations in "time-lapse photography" as it were and to examine the biochemical, functional and morphological changes which appear at specific times in the retina. This article gives an overview of the animal models presently used in RP research, with a short description of genetic backgrounds and the progression of the disease in individual animals. In addition, a look at the future is provided of new molecular techniques which make it possible to create specific animal models with gene mutations identical to those appearing in human RP. Since hereditary human retinal degenerations can be brought about by numerous different genetic defects, comparative studies using animals with clearly defined genetic defects are essential. Only in this way is it possible to arrive at conclusions concerning this specialized syndrome and to clarify the mechanisms which are common to all retinal degenerations.
BACKGROUND: Retinitis pigmentosa (RP) is associated with the development of posterior subcapsular cataract (PSC). Due to their retinal pathology, RP patients need optimal contrast conditions to attain good visual acuity. Lens opacities like PSC, therefore, decrease central visual acuity in RP patients earlier and more markedly than in patients without retinal problems. PATIENTS AND METHODS: We examined 39 patients aged 52.2 +/- 15.4 years who had underwent 61 cataract operations with intraocular lens implantation 1-4 years previously. Patients with autosomal dominant (n = 7), autosomal recessive (n = 1), X chromosomal recessive (n = 2), and simplex RP (n = 21), as well as eight patients with Usher's syndrome (RP and sensoneurinal deafness), were evaluated. RESULTS: Visual acuity (VA) of all patients increased from 0.17 +/- 0.13 preoperatively to 0.33 +/- 0.22 postoperatively. The mean age of the patients at the onset of RP was 28.8 +/- 19.6 years. The average time between subjective onset of RP and cataract operation was 20 years. Patients with early manifestation of RP, before the age of 20 years, had significantly lower postoperative VA (P = 0.0005) than patients with late manifestation. A short duration of RP, less than 20 years, was associated with significantly better postoperative VA (P = 0.016). The surgical trauma of the cataract operation did not influence the course of RP. Visual field testing did not show statistically significant differences between preoperative and postoperative (1-4 years) results. The development of clinically significant posterior capsule opacification was observed in 70.7% of all RP patients. CONCLUSIONS: Patients with RP and cataract should be operated early to provide, for as long as possible, an optimal optical image to compensate and support the inferior retinal function. Early onset of RP symptoms and longer duration of the disease have an negative impact on postoperative visual outcome in cataract surgery.
The X-linked RP3 locus codes for retinitis pigmentosa GTPase regulator (RPGR), a protein of unknown function with sequence homology to the guanine nucleotide exchange factor for Ran GTPase. We created an RPGR-deficient murine model by gene knockout. In the mutant mice, cone photoreceptors exhibit ectopic localization of cone opsins in the cell body and synapses and rod photoreceptors have a reduced level of rhodopsin. Subsequently, both cone and rod photoreceptors degenerate. RPGR was found normally localized to the connecting cilia of rod and cone photoreceptors. These data point to a role for RPGR in maintaining the polarized protein distribution across the connecting cilium by facilitating directional transport or restricting redistribution. The function of RPGR is essential for the long-term maintenance of photoreceptor viability.
Retinitis pigmentosa (RP) point mutations in both the intradiscal (ID) and transmembrane domains of rhodopsin cause partial or complete misfolding of rhodopsin, resulting in loss of 11-cis-retinal binding. Previous work has shown that misfolding is caused by the formation of a disulfide bond in the ID domain different from the native Cys-110-Cys-187 disulfide bond in native rhodopsin. Here we report on direct identification of the abnormal disulfide bond in misfolded RP mutants in the transmembrane domain by mass spectrometric analysis. This disulfide bond is between Cys-185 and Cys-187, the same as previously identified in misfolded RP mutations in the ID domain. The strategy described here should be generally applicable to identification of disulfide bonds in other integral membrane proteins.
Retinitis pigmentosa (RP) comprises a clinically and genetically heterogeneous group of diseases that afflicts approximately 1.5 million people worldwide. Affected individuals suffer from a progressive degeneration of the photoreceptors, eventually resulting in severe visual impairment. To isolate candidate genes for chorioretinal diseases, we cloned cDNAs specifically or preferentially expressed in the human retina and the retinal pigment epithelium (RPE) through a novel suppression subtractive hybridization (SSH) method. One of these cDNAs (RET3C11) mapped to chromosome 1q31-q32.1, a region harbouring a gene involved in a severe form of autosomal recessive RP characterized by a typical preservation of the para-arteriolar RPE (RP12; ref. 3). The full-length cDNA encodes an extracellular protein with 19 EGF-like domains, 3 laminin A G-like domains and a C-type lectin domain. This protein is homologous to the Drosophila melanogaster protein crumbs (CRB), and denoted CRB1 (crumbs homologue 1). In ten unrelated RP patients with preserved para-arteriolar RPE, we identified a homozygous AluY insertion disrupting the ORF, five homozygous missense mutations and four compound heterozygous mutations in CRB1. The similarity to CRB suggests a role for CRB1 in cell-cell interaction and possibly in the maintenance of cell polarity in the retina. The distinct RPE abnormalities observed in RP12 patients suggest that CRB1 mutations trigger a novel mechanism of photoreceptor degeneration.
BACKGROUND: Retinitis pigmentosa(RP) is a human disease characterized by loss of photoreceptor cells, especially rods, leading to visual disturbance and eventually to blindness. Effective treatment for RP control is still unavailable. The establishment of reliable animal models is essential for a better understanding of this disease, and for the development of therapeutic intervention. Here we summarize the establishment of N-methyl-N-nitrosourea (MNU)-induced retinal degeneration in animals, and success in disease control using this model. RESULTS: Retinal damage induced by MNU was highly reproducible and involved photoreceptor cell loss. It was obvious in all animals at approximately 7 days following a single systemic administration of MNU to adult mice (60 mg/kg), rats (60-75 mg/kg), hamsters (90 mg/kg), shrews (65 mg/kg), and monkeys (40 mg/kg). Extensive investigation in the rats revealed that MNU-induced photoreceptor cell loss was due to apoptosis with a decrease of Bcl-2 protein, increase of Bax protein, and activation of caspase families. Therapeutic to control MNU-induced photoreceptor cell loss in rats was evaluated with caspase-3 inhibitor (Ac-DEVD-CHO), nicotinamide(NAM), and docosahexaenoic acid(DHA); 4,000ng Ac-DEVD-CHO injected intravitreally 0 and 10 h after MNU suppressed disease progression, 25-1,000 mg/kg NAM subcutaneously injected concurrently or subsequently to MNU reversed retinal damage, and dietary supplementation of 9.5% DHA counteracted photoreceptor cell loss. CONCLUSION: Although the mechanisms triggering pathogenesis and the apoptotic cascade may differ between animals and humans, MNU-induced retinal degeneration is caused by photoreceptor cell apoptosis. Thus, suppression of MNU-induced photoreceptor cell apoptosis in animals may provide therapeutic information for RP control in humans.
While retinal vascular attenuation is a typical finding in retinitis pigmentosa (RP), studies on changes in choroidal vasculature have yielded contradictory results. In 44 patients with RP the relative pulse blood volumes were measured, and perfusion pressure videoangiography (PVA) was performed in 7 of them. Follow-up examinations were performed in 14 of the patients between 1.5 and 6 years later. The results show that the choroidal circulation is considerably reduced in RP patients; it was found to be further reduced at the follow-up examinations. PVA shows atrophy of the choroid capillary network. Characteristic changes occur not only in the retinal but also in the choroidal circulation, depending on the form, duration (stage) and prognosis of the disease.