Molecular genetics of inherited retinal degenerations

Variants in UBAP1L lead to autosomal recessive rod-cone and cone-rod dystrophy

PURPOSE

Progressive inherited retinal degenerations (IRDs) affecting rods and cones are clinically and genetically heterogeneous and can lead to blindness with limited therapeutic options. The major gene defects have been identified in subjects of European and Asian descent with only few reports of North African descent.

METHODS

Genome, targeted next-generation, and Sanger sequencing was applied to cohort of ∼4000 IRDs cases. Expression analyses were performed including Chip-seq database analyses, on human-derived retinal organoids (ROs), retinal pigment epithelium cells, and zebrafish. Variants' pathogenicity was accessed using 3D-modeling and/or ROs.

RESULTS

Here, we identified a novel gene defect with three distinct pathogenic variants in UBAP1L in 4 independent autosomal recessive IRD cases from Tunisia. UBAP1L is expressed in the retinal pigment epithelium and retina, specifically in rods and cones, in line with the phenotype. It encodes Ubiquitin-associated protein 1-like, containing a solenoid of overlapping ubiquitin-associated domain, predicted to interact with ubiquitin. In silico and in vitro studies, including 3D-modeling and ROs revealed that the solenoid of overlapping ubiquitin-associated domain is truncated and thus ubiquitin binding most likely abolished secondary to all variants identified herein.

CONCLUSION

Biallelic UBAP1L variants are a novel cause of IRDs, most likely enriched in the North African population.

G106R rhodopsin mutation is also present in Spanish ADRP patients

A large family affected with autosomal dominant retinitis pigmentosa (ADRP) with a sectorial phenotype showed a previously described (G to A) mutation in the rhodopsin gene resulting in the substitution of a glycine residue by an arginine in codon 106 of rhodopsin. This mutation shows some unusual characteristics, such as initial pathology of the inferior retina, superior visual field with normal disc and retinal vessels, and ERG findings that show a modest reduction in both cone and rod amplitudes with normal implicit times. The Gly 106 Arg mutation has been previously reported in American and British patients. Its presence in a Spanish ADRP family confirms that it and its homogeneous associated phenotype are geographically widespread.

Serum retinoids in retinitis pigmentosa patients treated with vitamin A

BACKGROUND

Patients with retinitis pigmentosa have been suggested to benefit from treatment with moderate doses of retinyl palmitate. Retinyl palmitate is not an active retinoid in itself but is metabolised to active components in the body. To find out which metabolites of retinyl palmitate were formed and at which concentrations, we measured the concentrations of retinol, retinyl palmitate, retinoic acids and tocopherol in serum of patients treated with oral retinyl palmitate for retinitis pigmentosa.

METHODS

Nine male patients and one female diagnosed as having retinitis pigmentosa after a complete ophthalmological examination including a full-field electroretinogram were given vitamin A at their own request as one daily morning dose of 16600 IU vitamin A. Blood samples were obtained before and after > 2 weeks of treatment. The concentrations of retinoids and tocopherol were measured with established methods.

RESULTS

The patients were not deficient in vitamin A or vitamin E as judged from the serum vitamin concentrations. Treatment with retinyl palmitate significantly increased the serum concentration of retinyl palmitate and of 13-cis-retinoic acid but not of retinol, tocopherol or all-trans-retinoic acid.

CONCLUSIONS

Neither retinyl palmitate nor 13-cis-retinoic acid, are known to be biologically active. However, 13-cis-retinoic acid can isomerise to the active vitamin A derivative, all-trans-retinoic acid. It is suggested that patients may be treated with a small dose of 13-cis-retinoic acid instead, to avoid the relatively long metabolic detour from retinyl palmitate.

On the inheritance of intracranial aneurysms

BACKGROUND AND PURPOSE

The familial occurrence of intracranial aneurysms suggests the presence of a genetically determined underlying arteriopathy. The pattern of inheritance in these families usually is not known.

METHODS

A family with seven members with intracranial aneurysms is described and, from the literature before 1994, a total of 238 families with 560 affected members (56% female and 44% male) with intracranial aneurysms not associated with a known heritable disease are reviewed. A segregation analysis was performed on 73 of these families.

RESULTS

Two members were affected in the great majority of families (79%); five or more members were reported in only eight families (3%). The most common affected kinship was among siblings. Angiographic screening in 12 families detected an intracranial aneurysm in 29% of 51 asymptomatic relatives. Segregation analysis revealed several patterns of inheritance that were consistent with the compiled pedigrees, but no single mendelian model was the overall best fitting, suggesting that genetic heterogeneity may be important. Twenty-two percent of siblings of male probands had an intracranial aneurysm compared with 9% of siblings of female probands (P = .003).

CONCLUSIONS

Genetic heterogeneity may be important in the genetics of intracranial aneurysms. In families with intracranial aneurysms, siblings of an affected male proband may be at a higher risk of developing an aneurysm than siblings of an affected female proband. Screening for intracranial aneurysms in asymptomatic relatives should be considered in families with two or more affected members. In most families, the nature of the underlying arteriopathy remains obscure.

Ocular manifestations in autosomal dominant retinitis pigmentosa with a Lys-296-Glu rhodopsin mutation at the retinal binding site

A lysine to glutamic acid substitution at codon 296 in the rhodopsin gene has been reported in a family with autosomal dominant retinitis pigmentosa. This mutation is of particular functional interest as this lysine molecule is the binding site of 11-cis-retinal. The clinical features of a family with this mutation have not been reported previously. We examined 14 patients with autosomal dominant retinitis pigmentosa and a lysine-296-glutamic acid rhodopsin mutation. Four had detailed psychophysical and electrophysiological testing. Most affected subjects had severe disease with poor night vision from early life, and marked reduction of visual acuity and visual field by their early forties. Psychophysical testing showed no demonstrable rod function and severely reduced cone function in all patients tested.

Structure and function in rhodopsin: the role of asparagine-linked glycosylation

Rhodopsin, the dim light photoreceptor of the rod cell, is an integral membrane protein that is glycosylated at Asn-2 and Asn-15. Here we report experiments on the role of the glycosylation in rhodopsin folding and function. Nonglycosylated opsin was prepared by expression of a wild-type bovine opsin gene in COS-1 cells in the presence of tunicamycin, an inhibitor of asparagine-linked glycosylation. The non-glycosylated opsin folded correctly as shown by its normal palmitoylation, transport to the cell surface, and the formation of the characteristic rhodopsin chromophore (lambda max, 500 nm) with 11-cis-retinal. However, the nonglycosylated rhodopsin showed strikingly low light-dependent activation of GT at concentration levels comparable with those of glycosylated rhodopsin. Amino acid replacements at positions 2 and 15 and the cognate tripeptide consensus sequence [Asn-2-->Gln, Gly-3-->Cys(Pro), Thr-4-->Lys, Asn-15-->Ala(Cys, Glu, Lys, Gln, Arg), Lys-16-->Cys(Arg), Thr-17-->Met(Val)] showed that the substitutions at Asn-2, Gly-3, and Thr-4 had no significant effect on the folding, cellular transport, and/or function of rhodopsin, whereas those at Asn-15 and Lys-16 caused poor folding and were defective in transport to the cell surface. Further, mutant pigments with amino acid replacements at Asn-15 and Thr-17 activated GT very poorly. We conclude that Asn-15 glycosylation is important in signal transduction.

Strategies for rescue of retinal photoreceptor cells

A variety of genetic and environmental factors cause degeneration of retinal photoreceptors. This review focuses on current strategies to rescue defective, but still viable, rods and cones, including transplantation of normal retinal pigment epithelium cells, corrective gene therapy, administration of survival/growth factors, protection from the damaging effects of light, and dietary supplementation of vitamin A.