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Peripheral Macular Endothelial Dystrophy: Clinical, Histopathologic, Genetic and Functional Characterization.

OBJECTIVE: To report a CHST6-associated corneal endothelial dystrophy. DESIGN: Prospective observational case series. PARTICIPANTS: Thirty-five individuals from seven families, including 13 affected individuals exhibiting corneal epithelial and stromal edema, peripheral posterior corneal macular opacities, and endothelial guttae, as well as 22 unaffected family members. METHODS: Whole-exome sequencing was performed in 3 families and Sanger sequencing of CHST6 was performed in all individuals. Histological examination of Descemet membrane (DM) excised at the time of endothelial keratoplasty was performed for three probands. Serum keratan sulfate (KS) levels were measured in members of six families. Functional analysis of identified mutations was performed using CHST6 promoter containing CHST6 expression vector in human keratocytes (HK) and corneal endothelial cells (HCEnC). MAIN OUTCOME MEASURES: Clinical phenotype; genetic analysis; functional analysis of identified CHST6 mutations; serum KS levels; histologic examinations of DM. RESULTS: All affected individuals demonstrated peripheral macular opacities at the level of DM. Visually significant corneal edema in affected individuals was successfully managed by endothelial keratoplasty. Genetic analysis demonstrated a rare CHST6 promoter mutation (c.-690G>C) in the homozygous state in affected individuals from three families and in the compound heterozygous state with a CHST6 coding mutation (p.R211Q, p.Y268C or p.P280L) in affected individuals from the other four families. In silico analysis predicted c.-690G>C to be a regulatory variant, located at the RNA polymerase II binding site. Functional analysis in vitro demonstrated that c.-690G>C leads to increased KS sulfation in the corneal endothelium and DM, with no change of KS sulfation in keratocytes. Histologic examination of DM from affected individuals revealed elevated levels of sulfated and non-sulfated KS in DM and endothelium, consistent with the functional analysis. Minimum changes in serum sulfated KS levels were observed in affected individuals. CONCLUSIONS: We suggest the name Peripheral macular endothelial dystrophy (PMED) to describe this dystrophy that is characterized by peripheral posterior corneal macular opacities and endothelial dysfunction without stromal haze or opacities. Given that both PMED and macular corneal dystrophy are associated with promoter and coding region mutations in CHST6, we propose that they be categorized as CHST6-associated corneal dystrophies.

Humans

CHST5 gene mutations contribute to high myopia by disrupting collagen fiber organization.

High myopia (HM) is a leading cause of irreversible vision loss in working-age adults. Its pathogenesis is characterized by alterations in the microstructure and composition of collagen fibers, and genetic factors make a substantial contribution. In this study, we identify carbohydrate sulfotransferase 5 (CHST5) as a candidate gene for HM in humans and mice, with its mutations disrupting collagen fiber organization. The c.444C>A (p.S148R) variant in CHST5, a gene critical for sulfating corneal keratan sulfate (KS), completely co-segregates with HM in a Chinese family. Screening of CHST5 variants in 320 HM patients identifies two additional ones. We further find that Chst5 is expressed primarily in the cornea and sclera of mouse ocular tissues, and that the mutant protein CHST5S148R loses its Golgi localization. Homozygous mutant Chst5S126R mice exhibit HM phenotypes, including myopic refractive error (RE), significantly thinner sclera and cornea, notable microstructural changes in scleral and corneal collagen fibers, and shorter corneal KS chains. Our findings suggest that CHST5 NM_024533.5 c.444C>A (p.S148R) causes loss of proper protein localization, likely impairing its sulfotransferase function. This defect disrupts the organization of corneal and scleral collagen fibers and ultimately contributes to the development and progression of HM.

CHST5

Dual role of glucuronyl- and sulfotransferases converting xenobiotics into reactive or biologically inactive and easily excretable compounds.

Glucuronyl- and sulfotransferases inactivate a wide variety of hazardous compounds, for example, phenols and dihydrodiols generated during the metabolism of polycyclic hydrocarbons. Our understanding of the firmly membrane-bound glucuronyltransferase is complicated because of their marked activation by membrane perturbants in vitro. Membrane perturbation also occurs in vivo, for example in liver injury caused by CCl4. Moreover, glucuronyltransferases are inducible by xenobiotics. Phenobarbital and 3-methylcholanthrene probably stimulate separate glucuronyltransferases. Sulfotransferases, located in the cytoplasm, often compete with glucuronyltransferases for the same substrates. The generation of 'active sulfate' (PAPS) from cysteine is more likely to be depleted in vivo than the formation of UDP-glucuronic acid generated from carbohydrates. Hence the proportion of sulfate ester/glucuronide may fall with increasing dose of the substrate. Sulfate esters and glucuronides of certain N-hydroxy-arylamines (N-hydroxy-N-acetylaminofluorene, N-hydroxy-phenacetin) are more reactive than the parent compound and bind covalently to cell constituents. Of the two conjugates, sulfate esters are more reactive and thereby more toxic than the corresponding glucuronides. Glucuronides may become toxic in the kidney and bladder where they are highly concentrated.

Animals