1
|
Khatib TZ, Safi A, Nixon TRW, Georgoulas S, Montesano G, Martin H, Richards AJ, McNinch A, Poulson AV, Alexander P, Snead MP. Peripapillary Hyperreflective Ovoid Mass-Like Structures in Stickler Syndrome. Ophthalmol Retina 2024; 8:1013-1020. [PMID: 38750936 DOI: 10.1016/j.oret.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/07/2024] [Accepted: 05/07/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE To report a previously undescribed finding of peripapillary hyperreflective ovoid mass-like structures (PHOMS) in Stickler syndrome. DESIGN Noncomparative case series. SUBJECTS Twenty-two eyes with anomalous optic disc from 11 Stickler syndrome patients were identified and imaged. METHODS Peripapillary hyperreflective ovoid mass-like structures were graded using enhanced-depth imaging OCT (EDI-OCT) according to the consensus recommendations of the Optic Disc Drusen Studies Consortium. All EDI-OCT scans were obtained using the Heidelberg Spectralis (Heidelberg Engineering) with a dense horizontal raster (15 × 10°, 97 sections) centered on the optic nerve head and graded by 2 independent assessors. In case of disagreement, the image was graded by a third assessor. The presence of any coexisting optic disc drusen was also assessed using EDI-OCT and autofluorescence. MAIN OUTCOME MEASURES The presence of PHOMS, clinical characteristics and genetic mutations. RESULTS A pilot sample of 22 eyes with phenotypic optic disc abnormalities from 11 Stickler syndrome patients were identified and imaged. Eight patients were female and 3 were male. The mean age was 31 years (13-58 years). Peripapillary hyperreflective ovoid mass-like structures were present in 91% (n = 20) of imaged eyes. Seventy percent (n = 14) were type 1 Stickler syndrome and 30% (n = 6) were type 2 Stickler syndrome. All eyes were myopic and the degree of myopia did not seem to affect whether or not PHOMS was present in this cohort. One eye with PHOMS had retinal detachment, and 77.3% (n = 17) of eyes had undergone 360o prophylactic retinopexy. Thirty-two percent (n = 7) of eyes with PHOMS were present in patients with coexisting hearing loss and 22.7% (n = 5) had orofacial manifestation of Stickler syndrome in the form of a cleft palate. Seventy-seven percent (n = 15) of eyes with PHOMS were present in patients who reported joint laxity or symptoms of arthritis. No coexisting optic disc drusen were identified and raised intracranial pressure was also excluded after neurological investigation. CONCLUSIONS These data suggest that PHOMS are a novel finding in Stickler syndrome patients and should be considered when evaluating the optic nerves of these patients. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Collapse
Affiliation(s)
- Tasneem Z Khatib
- Department of Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Department of Clinical Neurosciences, Centre for Brain Repair, University of Cambridge, Cambridge, United Kingdom; Vitreoretinal Research Group, Centre for Brain Repair, University of Cambridge, Cambridge, United Kingdom
| | - Antoine Safi
- Department of Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Thomas Ralph William Nixon
- Department of Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Vitreoretinal Research Group, Centre for Brain Repair, University of Cambridge, Cambridge, United Kingdom
| | - Stylianos Georgoulas
- Department of Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Giovanni Montesano
- Optometry and Visual Sciences, City University of London, London, London, United Kingdom; NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, London, United Kingdom
| | - Howard Martin
- Department of Clinical Neurosciences, Centre for Brain Repair, University of Cambridge, Cambridge, United Kingdom; Vitreoretinal Research Group, Centre for Brain Repair, University of Cambridge, Cambridge, United Kingdom
| | - Allan J Richards
- Department of Clinical Neurosciences, Centre for Brain Repair, University of Cambridge, Cambridge, United Kingdom; Vitreoretinal Research Group, Centre for Brain Repair, University of Cambridge, Cambridge, United Kingdom
| | - Annie McNinch
- Department of Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Department of Clinical Neurosciences, Centre for Brain Repair, University of Cambridge, Cambridge, United Kingdom; Vitreoretinal Research Group, Centre for Brain Repair, University of Cambridge, Cambridge, United Kingdom
| | - Arabella V Poulson
- Department of Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Philip Alexander
- Department of Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Martin P Snead
- Department of Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Department of Clinical Neurosciences, Centre for Brain Repair, University of Cambridge, Cambridge, United Kingdom; Vitreoretinal Research Group, Centre for Brain Repair, University of Cambridge, Cambridge, United Kingdom.
| |
Collapse
|
2
|
Snead MP, Lovicu FJ, Nixon TR, Richards AJ, Martin H. Pathobiology of the crystalline lens in Stickler syndrome. Prog Retin Eye Res 2024:101304. [PMID: 39349161 DOI: 10.1016/j.preteyeres.2024.101304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 09/21/2024] [Accepted: 09/23/2024] [Indexed: 10/02/2024]
Abstract
PURPOSE The Stickler syndromes are a group of connective tissue disorders characterised by congenital myopia, giant retinal tear and retinal detachment, cleft palate, hearing loss and premature arthropathy. Patients with Stickler syndrome are also susceptible to abnormalities of the crystalline lens. Since neither type II or type XI collagen (those typically affected in the vast majority of Stickler patients) are highly expressed in the lens, this observational cohort study explores potential alternative mechanisms to explain why patients frequently exhibit such unusual but characteristic types of cataract. METHODS Author observations drawn from a cohort of over 1,800 patients with genetically confirmed Stickler syndrome. RESULTS 3 distinct lens pathologies were identified. Firstly, a congenital quadrantic lamellar opacity. This can be present in both type 1 (COL2A1) and type 2 (COL11A1) Stickler syndrome. Secondly, early onset Pantone 557 C blue-green nuclear cataract. Thirdly, congenital lens coloboma associated with localised zonule deficiency. CONCLUSIONS The characteristic quadrantic lamellar lens opacity can be helpful in alerting to the possible diagnosis, particularly in sub-groups with an ocular-only phenotype. Temporal and spatial signalling pathways shared embryologically by both the developing vitreous body and crystalline lens suggest an ancillary role of the fibrillar collagens in cell signalling beyond their basic structural function. A common pathway of TGFb/BMP super-family dysregulation may be shared with allied disorders associated with both retinal detachment and cataract as well as the pathobiology linking retinal detachment and cataract in the population at large. Congenital lens coloboma associated with localised zonule deficiency can increase the difficulty and risks of cataract surgery. Strategies to mitigate such risks are presented.
Collapse
Affiliation(s)
- Martin P Snead
- Vitreoretinal Research Group, John van Geest Centre for Brain Repair, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0PY, United Kingdom.
| | - Frank J Lovicu
- Save Sight Institute and Molecular and Cellular Biomedicine, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Thomas Rw Nixon
- Vitreoretinal Research Group, John van Geest Centre for Brain Repair, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0PY, United Kingdom
| | - Allan J Richards
- Vitreoretinal Research Group, John van Geest Centre for Brain Repair, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0PY, United Kingdom
| | - Howard Martin
- Vitreoretinal Research Group, John van Geest Centre for Brain Repair, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0PY, United Kingdom
| |
Collapse
|
3
|
McElhinney K, McGrath R, Holohan R, Idrees Z. Twelve-month analysis of emergency argon laser retinopexy in an Irish tertiary hospital. Ir J Med Sci 2024; 193:1653-1657. [PMID: 37874504 DOI: 10.1007/s11845-023-03549-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Retinal tears occur as a result of traction at sites of retinal and vitreous adhesion-this allows retrohyaloid fluid into the subretinal space. Prompt management is required to prevent progression to rhegmatogenous retinal detachment (RRD). AIMS To identify the post-procedural outcomes following treatment of retinal tears with laser retinopexy in an emergency setting. METHODS Retrospective review of all patients who underwent emergency slit-lamp laser retinopexy between January and December 2021 in Cork University Hospital, an Irish tertiary referral centre. RESULTS A total of 87 patients were identified-mean age of 60 ± 12 years and 54% female. Follow-up ranged from 1 week to 11 months. Pre-disposing risk factors were identified-myopia (37%), recent trauma (2%), and RRD family history (5%). All patients had slit-lamp mounted laser-retinopexy performed in the eye-casualty. 63 patients (72%) had a superior break, 66 patients (76%) had a horse-shoe retinal tear, and 21 patients (24%) had a retinal hole. Associated findings included lattice degeneration (26%), sub-retinal fluid (55%), and vitreous haemorrhage (33%). Fourteen patients (16%) required multiple slit-lamp laser retinopexies while 18 patients (21%) required intervention by a vitreo-retinal surgeon including indirect-laser retinopexy (3%), cryotherapy (11%), and pars-plana vitrectomy (6%). At the most recent follow-up, all the patients had anatomically attached retinas. CONCLUSION A notable proportion of patients (21%) undergoing emergency laser retinopexy required further intervention. Patients with anteriorly located retinal tears would benefit from an early discussion with a vitreo-retinal surgeon. Departmental training in laser retinopexy and retinal tear management is recommended as part of ongoing quality improvement.
Collapse
Affiliation(s)
- Kealan McElhinney
- Department of Ophthalmology, Cork University Hospital, Cork, Ireland.
| | - Robert McGrath
- Department of Ophthalmology, Cork University Hospital, Cork, Ireland
| | - Rory Holohan
- Department of Ophthalmology, Cork University Hospital, Cork, Ireland
| | - Zubair Idrees
- Department of Ophthalmology, Cork University Hospital, Cork, Ireland
| |
Collapse
|
4
|
Soh Z, Martin H, Richards AJ, Suri M, Snead MP. Ophthalmic manifestations of Czech dysplasia. Am J Med Genet A 2024; 194:e63480. [PMID: 37982325 DOI: 10.1002/ajmg.a.63480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/21/2023] [Accepted: 11/10/2023] [Indexed: 11/21/2023]
Abstract
Czech dysplasia is an autosomal dominant type 2 collagenopathy that is caused by heterozygosity for the recurrent p.(Arg275Cys) COL2A1 variant. Affected individuals usually present with skeletal abnormalities such as metatarsal hypoplasia of the third and fourth toes and early-onset arthropathy, as well as hearing loss. To date, no ophthalmic findings have been reported in patients with Czech dysplasia even though COL2A1 has been implicated in other ocular conditions such as type 1 Stickler syndrome. For the first time, we report the ocular findings in four families with Czech dysplasia, including type 1 vitreous anomaly, hypoplastic vitreous, retinal tears, and significant refractive error. These novel ocular findings expand the phenotype associated with Czech dysplasia and may aid clinicians as an additional diagnostic feature. Patients with congenital abnormalities of vitreous gel architecture have an increased risk of retinal detachment, and as such, patients may benefit from prophylaxis. Considering that many of the patients did not report any ocular symptoms, vitreous phenotyping is of key importance in identifying the need for counseling with regard to prophylaxis.
Collapse
Affiliation(s)
- Zack Soh
- Vitreoretinal Research Group, John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK
| | - Howard Martin
- Vitreoretinal Research Group, John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK
| | - Allan J Richards
- Vitreoretinal Research Group, John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK
| | - Mohnish Suri
- Nottingham Clinical Genetics Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Martin P Snead
- Vitreoretinal Research Group, John van Geest Centre for Brain Repair, University of Cambridge, Cambridge, UK
| |
Collapse
|
5
|
Soh Z, Richards AJ, McNinch A, Alexander P, Martin H, Snead MP. Dominant Stickler Syndrome. Genes (Basel) 2022; 13:1089. [PMID: 35741851 PMCID: PMC9222743 DOI: 10.3390/genes13061089] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 02/04/2023] Open
Abstract
The Stickler syndromes are a group of genetic connective tissue disorders associated with an increased risk of rhegmatogenous retinal detachment, deafness, cleft palate, and premature arthritis. This review article focuses on the molecular genetics of the autosomal dominant forms of the disease. Pathogenic variants in COL2A1 causing Stickler syndrome usually result in haploinsufficiency of the protein, whereas pathogenic variants of type XI collagen more usually exert dominant negative effects. The severity of the disease phenotype is thus dependent on the location and nature of the mutation, as well as the normal developmental role of the respective protein.
Collapse
Affiliation(s)
- Zack Soh
- John van Geest Centre for Brain Repair, Vitreoretinal Research Group, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0PY, UK; (Z.S.); (A.J.R.); (A.M.); (H.M.)
| | - Allan J. Richards
- John van Geest Centre for Brain Repair, Vitreoretinal Research Group, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0PY, UK; (Z.S.); (A.J.R.); (A.M.); (H.M.)
- NHS England Highly Specialised Stickler Syndrome Diagnostic Service, Cambridge University, NHS Foundation Trust, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK;
| | - Annie McNinch
- John van Geest Centre for Brain Repair, Vitreoretinal Research Group, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0PY, UK; (Z.S.); (A.J.R.); (A.M.); (H.M.)
- NHS England Highly Specialised Stickler Syndrome Diagnostic Service, Cambridge University, NHS Foundation Trust, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK;
| | - Philip Alexander
- NHS England Highly Specialised Stickler Syndrome Diagnostic Service, Cambridge University, NHS Foundation Trust, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK;
| | - Howard Martin
- John van Geest Centre for Brain Repair, Vitreoretinal Research Group, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0PY, UK; (Z.S.); (A.J.R.); (A.M.); (H.M.)
- NHS England Highly Specialised Stickler Syndrome Diagnostic Service, Cambridge University, NHS Foundation Trust, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK;
| | - Martin P. Snead
- John van Geest Centre for Brain Repair, Vitreoretinal Research Group, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0PY, UK; (Z.S.); (A.J.R.); (A.M.); (H.M.)
- NHS England Highly Specialised Stickler Syndrome Diagnostic Service, Cambridge University, NHS Foundation Trust, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK;
| |
Collapse
|
6
|
Dong Z, Ma Q, Zheng C, Huang Y, Dong X, Yang K, Tan Y, Hu H, Ren Z, Yan Y, Zhang D, Lin L. Identification of novel heterozygous missense variant in the COL11A1 causing fetal craniofacial anomalies. ALL LIFE 2022. [DOI: 10.1080/26895293.2022.2039784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Zhe Dong
- Department of Obstetrics and Gynecology, Peking University International Hospital, Beijing, People’s Republic of China
| | - Qiang Ma
- Department of Obstetrics and Gynecology, Peking University International Hospital, Beijing, People’s Republic of China
| | - Chunyan Zheng
- Department of Orthodontics, Capital Medical University School of Stomatology, Beijing, People’s Republic of China
| | - Yanxia Huang
- Department of Orthodontics, Capital Medical University School of Stomatology, Beijing, People’s Republic of China
| | - Xingyue Dong
- Department of Orthodontics, Capital Medical University School of Stomatology, Beijing, People’s Republic of China
| | - Kai Yang
- Department of Obstetrics and Gynecology, Peking University International Hospital, Beijing, People’s Republic of China
| | - Ya Tan
- Department of Obstetrics and Gynecology, Peking University International Hospital, Beijing, People’s Republic of China
| | - Huaying Hu
- School of Medicine, Xiamen University, Xiamen, People’s Republic of China
- Jiaen Genetics Laboratory, Beijing Jiaen Hospital, Beijing, People’s Republic of China
| | - Zhuo Ren
- Department of Obstetrics and Gynecology, Peking University International Hospital, Beijing, People’s Republic of China
| | - Yousheng Yan
- Department of Obstetrics and Gynecology, Peking University International Hospital, Beijing, People’s Republic of China
| | - Dongliang Zhang
- Department of Orthodontics, Capital Medical University School of Stomatology, Beijing, People’s Republic of China
| | - Li Lin
- Department of Obstetrics and Gynecology, Peking University International Hospital, Beijing, People’s Republic of China
| |
Collapse
|
7
|
Boothe M, Morris R, Robin N. Stickler Syndrome: A Review of Clinical Manifestations and the Genetics Evaluation. J Pers Med 2020; 10:jpm10030105. [PMID: 32867104 PMCID: PMC7564399 DOI: 10.3390/jpm10030105] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/05/2020] [Accepted: 08/07/2020] [Indexed: 01/17/2023] Open
Abstract
Stickler Syndrome (SS) is a multisystem collagenopathy frequently encountered by ophthalmologists due to the high rate of ocular complications. Affected individuals are at significantly increased risk for retinal detachment and blindness, and early detection and diagnosis are critical in improving visual outcomes for these patients. Systemic findings are also common, with craniofacial, skeletal, and auditory systems often involved. SS is genotypically and phenotypically heterogenous, which can make recognizing and correctly diagnosing individuals difficult. Molecular genetic testing should be considered in all individuals with suspected SS, as diagnosis not only assists in treatment and management of the patient but may also help identify other at-risk family members. Here we review common clinical manifestation of SS and genetic tests frequently ordered as part of the SS evaluation.
Collapse
Affiliation(s)
- Megan Boothe
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL 35233, USA;
| | - Robert Morris
- Retina Specialists of Alabama, Birmingham, AL 35233, USA;
| | - Nathaniel Robin
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL 35233, USA;
- Correspondence:
| |
Collapse
|
8
|
Boysen KB, La Cour M, Kessel L. Ocular complications and prophylactic strategies in Stickler syndrome: a systematic literature review. Ophthalmic Genet 2020; 41:223-234. [PMID: 32316871 DOI: 10.1080/13816810.2020.1747092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Stickler syndrome is a collagenopathy caused by mutations in the genes COL2A1 (STL1) or COL11A1 (STL2). Affected patients manifest ocular, auditory, articular, and craniofacial manifestations in varying degrees. Ocular symptoms include myopia, retinal detachment, cataract, and glaucoma. The aim of this systematic review was to evaluate the prevalence of ocular manifestations and the outcome of prophylactic treatment on reducing the risk of retinal detachment. METHOD A systematic literature search was performed in the PubMed database. Information on the cross-study prevalence of myopia, retinal detachment, cataract, glaucoma, visual impairment, severity and age of onset of myopia and retinal detachments. Studies that reported on the outcome of prophylactic treatment against a control group were explored. RESULTS 37 articles with 2324 individual patients were included. Myopia was found in 83% of patients, mostly of a moderate to severe degree. Retinal detachments occurred in 45% of patients. Generally, the first detachment occurred in the second decade of life in STL1 patients and later in STL2. Cataracts were more common in STL2 patients, 59% versus 36% in STL1. Glaucoma (10%) and visual impairment (blind: 6%; vision loss in one eye: 10%) were rare. Three studies reported on the effect of prophylactic treatment being protective. CONCLUSION Ocular manifestations are common in Stickler patients, but the comparison between studies was difficult because of inconsistencies in diagnostic and inclusion criteria by different studies. Sight-threatening complications such as retinal detachments are common but although prophylactic therapy is reported to be effective in retrospective studies, evidence from randomized trials is missing.
Collapse
Affiliation(s)
| | - Morten La Cour
- Department of Ophtalmology, Rigshospitalet , Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen , Copenhagen, Denmark
| | - Line Kessel
- Department of Ophtalmology, Rigshospitalet , Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen , Copenhagen, Denmark
| |
Collapse
|
9
|
Flaxel CJ, Adelman RA, Bailey ST, Fawzi A, Lim JI, Vemulakonda GA, Ying GS. Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration Preferred Practice Pattern®. Ophthalmology 2019; 127:P146-P181. [PMID: 31757500 DOI: 10.1016/j.ophtha.2019.09.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 12/29/2022] Open
Affiliation(s)
| | | | - Steven T Bailey
- Casey Eye Institute, Oregon Health & Science University, Portland, OR
| | - Amani Fawzi
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - G Atma Vemulakonda
- Department of Ophthalmology, Palo Alto Medical Foundation, Palo Alto, CA
| | - Gui-Shuang Ying
- Center for Preventative Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
10
|
Osteoporosis in Stickler syndrome. A new family case with bone histology study. Morphologie 2017; 101:33-38. [PMID: 28159459 DOI: 10.1016/j.morpho.2016.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 10/12/2016] [Accepted: 10/20/2016] [Indexed: 11/20/2022]
Abstract
The Stickler syndrome (SS) has been described as a "hereditary progressive arthro-ophtalmopathy" by Stickler in 1965, due to mutations on the collagen genes. Currently about 40 different genes have been identified which encode for at least 27 different collagens. The majority of mutations occur in the COL2A1 gene on chromosome 12q13 (SS type I). Mutations in COL11A1 are less frequent (SS type II). More recently, mutations in COL11A2 and in the COL9A1 gene have been reported with particular phenotypes. The main features of this autosomal inherited disease are ocular, auditory with orofacial abnormalities and early-onset osteoarthritis. We report the clinical presentation of an adult and his son, with a particular focus on the bone status of the father, radiography, bone densitometry and transiliac bone biopsy showing that he was suffering from osteoporosis. The lumbar bone mineral density was low with a Z-score at -2.9. Transiliac bone biopsy showed a dramatic decrease of trabecular bone volume (8.6%; Nl: 19.5±4.9%), thin trabeculae and a disorganized trabecular network. A slight increase of osteoid parameters was observed. Bone resorption was markedly increased with an excessive number of active (TRAcP+) osteoclasts. The cortical width was normal, but a slight increase of cortical porosity was found. Osteoporosis has been rarely described in the SS. It might be useful to systematically perform a bone densitometry in all patients with SS and to discuss the indication of a transiliac bone biopsy in severe cases.
Collapse
|
11
|
Mehta NS, Yannuzzi NA, Young R, McClellan AJ, Read SP, Berrocal AM. Retinal Detachment in a Combined Case of Stickler Syndrome and X-Linked Retinoschisis. Ophthalmic Surg Lasers Imaging Retina 2017; 48:83-86. [PMID: 28060400 DOI: 10.3928/23258160-20161219-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 10/10/2016] [Indexed: 11/20/2022]
Abstract
A 12-year-old boy presented with a total rhegmatogenous retinal detachment and a giant retinal tear in the right eye. Clinical examination, optical coherence tomography, and fundus images showed an optically empty vitreous, lattice degeneration, and retinoschisis of the macula. Genetic testing revealed mutations in the COL2A1 and RS1 genes, confirming a dual diagnosis of Stickler syndrome and X-linked retinoschisis, respectively. This represents the first published account of a patient with both Stickler syndrome and X-linked retinoschisis. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:83-86.].
Collapse
|
12
|
Sergouniotis PI, Fincham GS, McNinch AM, Spickett C, Poulson AV, Richards AJ, Snead MP. Ophthalmic and molecular genetic findings in Kniest dysplasia. Eye (Lond) 2015; 29:475-82. [PMID: 25592122 DOI: 10.1038/eye.2014.334] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 12/09/2014] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To study the variability of the ophthalmic phenotype in Kniest dysplasia. Kniest dysplasia is an inherited disorder associated with defects in type II collagen and characterised by short-trunked dwarfism, kyphoscoliosis, and enlarged joints with restricted mobility. Other features include marked hand arthropathy, cleft palate, hearing loss, and ocular abnormalities (myopia, abnormal vitreous, and high risk of developing retinal detachment). METHODS Data from eight unrelated individuals with a clinical and molecular diagnosis of Kniest dysplasia are reported. Clinical assessment included an audiogram and ophthalmological examination in all but one patient who died in the immediate postnatal period. Sanger sequencing of the COL2A1 gene was performed. RESULTS Six of the seven patients tested were high myopes with one patient being an emmetrope. Bilateral quandratic cataracts and subluxed lenses were noted in one subject. Variable but abnormal vitreous architecture was observed in all seven individuals tested. Six of the seven patients had significant hearing impairment and five of the seven patients exhibited clefting abnormalities. One patient had bilateral retinal detachments in his twenties. Six dominant disease-causing COL2A1 variants were detected. In three cases, testing of parental samples revealed that the disease-causing variant was not present in either parent. CONCLUSION The ophthalmic features in Kniest dysplasia are very similar to those in other disorders of type II collagen such as Stickler syndrome. It is likely that different type II collagenopathies have a similar level of ocular morbidity and regular ophthalmologic examination is recommended. Kniest dysplasia is associated with heterozygous COL2A1 mutations that are frequently de novo.
Collapse
Affiliation(s)
- P I Sergouniotis
- Vitreoretinal Service, Addenbrooke's Hospital, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - G S Fincham
- Vitreoretinal Service, Addenbrooke's Hospital, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - A M McNinch
- 1] Vitreoretinal Service, Addenbrooke's Hospital, Cambridge University NHS Foundation Trust, Cambridge, UK [2] Department of Pathology, University of Cambridge, Cambridge, UK
| | - C Spickett
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - A V Poulson
- Vitreoretinal Service, Addenbrooke's Hospital, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - A J Richards
- 1] Vitreoretinal Service, Addenbrooke's Hospital, Cambridge University NHS Foundation Trust, Cambridge, UK [2] Department of Pathology, University of Cambridge, Cambridge, UK
| | - M P Snead
- Vitreoretinal Service, Addenbrooke's Hospital, Cambridge University NHS Foundation Trust, Cambridge, UK
| |
Collapse
|
13
|
Hufnagel SB, Weaver KN, Hufnagel RB, Bader PI, Schorry EK, Hopkin RJ. A novel dominant COL11A1 mutation resulting in a severe skeletal dysplasia. Am J Med Genet A 2014; 164A:2607-12. [PMID: 25091507 DOI: 10.1002/ajmg.a.36688] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 05/22/2014] [Indexed: 11/06/2022]
Abstract
Mutations in the type XI collagen alpha-1 chain gene (COL11A1) cause a change in protein structure that alters its interactions with collagens II and V, resulting in abnormalities in cartilage and ocular vitreous. The most common type XI collagenopathies are dominantly inherited Stickler or Marshall syndromes, while severe recessive skeletal dysplasias, such as fibrochondrogenesis, occur less frequently. We describe a family with a severe skeletal dysplasia caused by a novel dominantly inherited COL11A1 mutation. The siblings each presented with severe myopia, hearing loss, micromelia, metaphyseal widening of the long bones, micrognathia, and airway compromise requiring tracheostomy. The first child lived for over 2 years, while the second succumbed at 5 months of age. Their mother has mild rhizomelic shortening of the limbs, brachydactyly, and severe myopia. Sequencing of COL11A1 revealed a novel deleterious heterozygous mutation in COL11A1 involving the triple helical domain in both siblings, and a mosaic mutation in their mother, indicating germline mosaicism with subsequent dominant inheritance. These are the first reported individuals with a dominantly inherited mutation in COL11A1 associated with a severe skeletal dysplasia. The skeletal involvement is similar to, yet milder than fibrochondrogenesis and allowed for survival beyond the perinatal period. These cases highlight both a novel dominant COL11A1 mutation causing a significant skeletal dysplasia and the phenotypic heterogeneity of collagenopathies.
Collapse
Affiliation(s)
- Sophia B Hufnagel
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | | | | | | |
Collapse
|
14
|
Stickler syndrome, ocular-only variants and a key diagnostic role for the ophthalmologist. Eye (Lond) 2011; 25:1389-400. [PMID: 21921955 DOI: 10.1038/eye.2011.201] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The entity described by Gunnar Stickler, which included hereditary arthro-ophthalmopathy associated with retinal detachment, has recently been recognised to consist of a number of subgroups, which might now more correctly be referred to as the Stickler syndromes. They are the most common clinical manifestation of the type II/XI collagenopathies and are the most common cause of inherited rhegmatogenous retinal detachment. This review article is intended to provide the ophthalmologist with an update on current research, subgroups, and their diagnosis together with a brief overview of allied conditions to be considered in the clinical differential diagnosis. We highlight the recently identified subgroups with a high risk of retinal detachment but with minimal or absent systemic involvement--a particularly important group for the ophthalmologist to identify.
Collapse
|
15
|
|
16
|
Coffee RE, Westfall AC, Davis GH, Mieler WF, Holz ER. Symptomatic posterior vitreous detachment and the incidence of delayed retinal breaks: case series and meta-analysis. Am J Ophthalmol 2007; 144:409-413. [PMID: 17583667 DOI: 10.1016/j.ajo.2007.05.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2006] [Revised: 04/24/2007] [Accepted: 05/01/2007] [Indexed: 12/21/2022]
Abstract
PURPOSE To establish the necessity for an early follow-up examination after an initial funduscopic examination with negative results for patients with acute, symptomatic posterior vitreous detachment (PVD). DESIGN Retrospective case-control study and meta-analysis. METHODS Records were reviewed of patients seeking treatment over a 4.5-year period who were diagnosed with an acute, symptomatic PVD. A MEDLINE search to identify all published observational case studies reporting vitreoretinal pathologic features after acute, symptomatic PVD. RESULTS The incidence of retinal tears in eyes with a symptomatic PVD was 8.2%. The overall rate of retinal break in the meta-analysis portion of the study was 21.7%. In total, 1.8% of patients had retinal tears that were not seen on initial examination. Of the 29 patients with delayed-onset retinal breaks, 24 (82.8%) had at least one of the following: vitreous hemorrhage at initial examination, hemorrhage in the peripheral retina at initial examination, or new symptoms. CONCLUSIONS If the results of an initial examination of a patient with an acute, symptomatic PVD are negative for retinal tears, the necessity of early follow-up may be best determined by the presence of pigmented cells in the vitreous, vitreous hemorrhage, or retinal hemorrhage. Most patients with symptomatic PVD may not need an early follow-up examination.
Collapse
Affiliation(s)
- Robert E Coffee
- Cullen Eye Institute, Baylor College of Medicine, Houston, Texas 77030, USA
| | | | | | | | | |
Collapse
|
17
|
Meredith SP, Richards AJ, Bearcroft P, Pouson AV, Snead MP. Significant ocular findings are a feature of heritable bone dysplasias resulting from defects in type II collagen. Br J Ophthalmol 2007; 91:1148-51. [PMID: 17347327 PMCID: PMC1954906 DOI: 10.1136/bjo.2006.112482] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS The type II collagenopathies are a phenotypically diverse group of genetic skeletal disorders caused by a mutation in the gene coding for type II collagen. Reports published before the causative mutations were discovered suggest heritable bone dysplasias with skeletal malformations may be associated with a vitreoretinopathy. METHODS A retrospective notes search of patients with a molecularly characterised type II collagenopathy chondrodysplasia who had been examined in the ophthalmology clinic was conducted. RESULTS 13 of 14 patients had a highly abnormal vitreous appearance. One patient aged 11 presented with a total retinal detachment. Two other children aged 2 and 4 had bilateral flat multiple retinal tears on presentation. 10 of 12 patients refracted were myopic. Two patients had asymptomatic lens opacities: one associated with bilateral inferiorly subluxed lenses and the other with a zonule and lens coloboma. CONCLUSION Heritable skeletal disorders resulting from a mutation in the gene coding for type II collagen are associated with abnormal vitreous, myopia and peripheral cataract with lens subluxation. In bone dysplasias resulting from a defect of type II collagen there is likely to be a high risk of retinal detachment with a propensity to retinal tears at a young age.
Collapse
Affiliation(s)
- Sarah P Meredith
- Vitreoretinal Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | | | | |
Collapse
|
18
|
Van Camp G, Snoeckx RL, Hilgert N, van den Ende J, Fukuoka H, Wagatsuma M, Suzuki H, Smets RME, Vanhoenacker F, Declau F, Van de Heyning P, Usami SI. A new autosomal recessive form of Stickler syndrome is caused by a mutation in the COL9A1 gene. Am J Hum Genet 2006; 79:449-57. [PMID: 16909383 PMCID: PMC1559536 DOI: 10.1086/506478] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2006] [Accepted: 06/05/2006] [Indexed: 11/03/2022] Open
Abstract
Stickler syndrome is characterized by ophthalmic, articular, orofacial, and auditory manifestations. It has an autosomal dominant inheritance pattern and is caused by mutations in COL2A1, COL11A1, and COL11A2. We describe a family of Moroccan origin that consists of four children with Stickler syndrome, six unaffected children, and two unaffected parents who are distant relatives (fifth degree). All family members were clinically investigated for ear, nose, and throat; ophthalmologic; and radiological abnormalities. Four children showed symptoms characteristic of Stickler syndrome, including moderate-to-severe sensorineural hearing loss, moderate-to-high myopia with vitreoretinopathy, and epiphyseal dysplasia. We considered the COL9A1 gene, located on chromosome 6q13, to be a candidate gene on the basis of the structural association with collagen types II and XI and because of the high expression in the human inner ear indicated by cDNA microarray. Mutation analysis of the coding region of the COL9A1 gene showed a homozygous R295X mutation in the four affected children. The parents and four unaffected children were heterozygous carriers of the R295X mutation. Two unaffected children were homozygous for the wild-type allele. None of the family members except the homozygous R295X carriers had any signs of Stickler syndrome. Therefore, COL9A1 is the fourth identified gene that can cause Stickler syndrome. In contrast to the three previously reported Stickler syndrome-causing genes, this gene causes a form of Stickler syndrome with an autosomal recessive inheritance pattern. This finding will have a major impact on the genetic counseling of patients with Stickler syndrome and on the understanding of the pathophysiology of collagens. Mutation analysis of this gene is recommended in patients with Stickler syndrome with possible autosomal recessive inheritance.
Collapse
Affiliation(s)
- Guy Van Camp
- Department of Medical Genetics, University of Antwerp, Universiteitsplein 1, B-2610 Antwerp, Belgium.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Lincoln J, Lange AW, Yutzey KE. Hearts and bones: shared regulatory mechanisms in heart valve, cartilage, tendon, and bone development. Dev Biol 2006; 294:292-302. [PMID: 16643886 DOI: 10.1016/j.ydbio.2006.03.027] [Citation(s) in RCA: 166] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2006] [Revised: 03/06/2006] [Accepted: 03/19/2006] [Indexed: 10/24/2022]
Abstract
The mature heart valves are dynamic structures composed of highly organized cell lineages and extracellular matrices. The discrete architecture of connective tissue within valve leaflets and supporting structures allows the valve to withstand life-long functional demands and changes in hemodynamic forces and load. The dysregulation of ECM organization is a common feature of heart valve disease and can often be linked to genetic defects in matrix protein structure or developmental regulation. Recent studies have identified specific regulatory pathways that are active in the developing valve structures and also control cartilage, tendon, and bone development. This review will focus on the regulatory hierarchies that control normal and abnormal heart valve development in parallel with other connective tissue cell types.
Collapse
Affiliation(s)
- Joy Lincoln
- Division of Molecular Cardiovascular Biology, MLC 7020, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | | | | |
Collapse
|
20
|
Molecular Genetics of Retinal Disease. Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50022-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
|
21
|
|
22
|
Leung L, Hyland JC, Young A, Goldberg MF, Handa JT. A NOVEL MUTATION IN INTRON 11 OF THE COL2A1 GENE IN A PATIENT WITH TYPE 1 STICKLER SYNDROME. Retina 2006; 26:106-9. [PMID: 16395149 DOI: 10.1097/00006982-200601000-00019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- L Leung
- Wilmer Eye Institute, Johns Hopkins Medical Institutes, Baltimore, MD 21287, USA
| | | | | | | | | |
Collapse
|
23
|
MacRae ME, Patel DV, Richards AJ, Snead MP, Tolmie J, Lee WR. Type 1 Stickler syndrome: a histological and ultrastructural study of an untreated globe. Eye (Lond) 2005; 20:1061-7. [PMID: 16327798 DOI: 10.1038/sj.eye.6702129] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
AIMS To present a histological and ultrastructural study of an untreated globe in a patient with genetically confirmed type 1 Stickler syndrome. METHODS Histological and electron microscopic examinations were performed on the enucleated globe from the proband of a pedigree with type 1 Stickler syndrome. Linkage analysis was carried out using polymorphic markers flanking the COL2A1 gene and the mutation was identified by direct sequencing. RESULTS The significant retinal abnormality was incarceration of vitreous collagen within glial strands on the inner surface of an atrophic and gliotic detached retina. The incarcerated collagenous layers contained glial cells and extended from the retina to form strands, some of which contributed to a retrolental membrane. Mutation screening detected a C to T mutation in exon 47 that inserted a premature termination codon into the reading frame of the mRNA. Sequence analysis of three of the four affected children confirmed that they were also heterozygous for the base change. The youngest child's DNA was not analysed. CONCLUSIONS The study represents the first evidence of abnormal interactions between pathological vitreous collagen and the inner retina in a patient with type 1 Stickler syndrome with a confirmed mutation in the COL2A1 gene.
Collapse
Affiliation(s)
- M E MacRae
- Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh, UK.
| | | | | | | | | | | |
Collapse
|
24
|
Rose PS, Levy HP, Liberfarb RM, Davis J, Szymko-Bennett Y, Rubin BI, Tsilou E, Griffith AJ, Francomano CA. Stickler syndrome: Clinical characteristics and diagnostic criteria. Am J Med Genet A 2005; 138A:199-207. [PMID: 16152640 DOI: 10.1002/ajmg.a.30955] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The purpose of this study was to establish diagnostic criteria for Stickler syndrome. Ninety patients from 38 families had complete evaluations for possible Stickler syndrome. Molecular confirmation of COL2A1 mutation status (type I Stickler syndrome) was available on 25 patients from six families. In the remaining 65 patients, 47 from 25 families were affected with Stickler syndrome and 18 from seven families were unaffected with Stickler syndrome. A diagnostic nosology based on type I Stickler patients with known COL2A1 mutations was applied to clinically affected and unaffected patients. A diagnostic scale of 9 points evaluated molecular data or family history data and characteristic ocular, orofacial, auditory, and musculoskeletal findings. A score of > or =5 was diagnostic of Stickler syndrome. These criteria demonstrate 100% sensitivity when applied to type I Stickler syndrome patients with known COL2A1 mutations, 98% sensitivity when applied to clinically affected Stickler patients, and 86% specificity when applied to patients unaffected based on clinical and/or molecular analysis. We conclude that diagnostic criteria based on type I Stickler patients with molecularly confirmed COL2A1 mutations appear to be sensitive and specific for the diagnosis of this syndrome and should be helpful to clinicians when making the diagnosis.
Collapse
Affiliation(s)
- Peter S Rose
- Warren Magnuson Grant Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Abstract
PURPOSE The ocular findings, systemic features, and genetic loci distinguishing known genetic causes of vitreoretinal degenerations were studied in the original Snowflake family. DESIGN Prospective, comparative study and molecular genetic investigation. PARTICIPANTS Members of the original snowflake vitreoretinal degeneration family. METHODS Clinical data were collected on 26 family members by history and examination. Thirteen of the 26 total family members underwent prospective examination. Linkage to known vitreoretinal degeneration loci (COL2A1, COL11A1, and the Wagner disease locus) was evaluated with short tandem repeat markers. MAIN OUTCOME MEASURES Ocular and systemic features of known vitreoretinal degenerations. RESULTS Six of the 13 prospectively examined subjects had snowflake vitreoretinal degeneration. Corneal guttae (4/5; 80%), early onset cataract (5/6; 83%), fibrillar vitreous degeneration (6/6; 100%), and peripheral retinal abnormalities (5/6; 83%), including minute crystallinelike deposits called snowflakes (4/6; 67%), were common. Retinal detachment was seen in 1 of 6 of these prospectively examined subjects (17%). A total of 14 affected subjects were identified within the family, and in 3 (21%), retinal detachment developed. Orofacial features, early-onset hearing loss, and arthritis typical of Stickler syndrome were absent. Linkage to known vitreoretinal degeneration loci was excluded. CONCLUSIONS The absence of vitreous gel in the retrolental space and presence of fibrillar vitreous degeneration were consistent with the vitreous structure reported for collagen 11A1 (COL11A1) but not collagen 2A1 (COL2A1) mutations. The absence of systemic features was characteristic of the vitreoretinopathies linked to chromosome 5q13 (Wagner disease and erosive vitreoretinopathy) and mutations in exon 2 of the COL2A1 gene. Snowflakes in the peripheral retina and the absence of nyctalopia, posterior chorioretinal atrophy, and tractional retinal detachment were inconsistent with the chromosome 5q13 vitreoretinopathies. The association of Fuchs' corneal endothelial dystrophy found in this family has not been reported previously in other vitreoretinal degenerations. These findings and the exclusion of known genetic loci suggest snowflake is a distinct vitreoretinal degeneration.
Collapse
Affiliation(s)
- Mike M Lee
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | | | | |
Collapse
|
26
|
Donoso LA, Edwards AO, Frost AT, Ritter R, Ahmad N, Vrabec T, Rogers J, Meyer D, Parma S. Clinical variability of Stickler syndrome: role of exon 2 of the collagen COL2A1 gene. Surv Ophthalmol 2003; 48:191-203. [PMID: 12686304 DOI: 10.1016/s0039-6257(02)00460-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Stickler syndrome (progressive arthro-ophthalmopathy) is a genetically heterogeneous disorder resulting from mutations in at least three collagen genes. The most common disease-causing gene is COL2A1, a 54-exon-containing gene coding for type II collagen. At least 17 different mutations causing Stickler syndrome have been reported in this gene. Phenotypically, it is also a variably expressed disorder in which most patients present with a wide range of eye and extraocular manifestations including auditory, skeletal, and orofacial manifestations. Some patients, however, present without clinically apparent systemic findings. This observation has led to difficulty distinguishing this Stickler phenotype from other hereditary vitreoretinal degenerations, such as Wagner syndrome and Snowflake vitreoretinal degeneration. In this regard, review of the literature indicates type II collagen exists in two forms resulting from alternative splicing of exon 2 of the COL2A1 gene. One form, designated as type IIB (short form), is preferentially expressed in adult cartilage tissue. The other form, designated as type IIA (long form), is preferentially expressed in the vitreous body of the eye. Because of this selective tissue expression, mutations in exon 2 of the COL2A1 gene have been hypothesized to produce this Stickler syndrome phenotype with minimal or absent extraocular findings. We review the evidence for families with exon 2 mutations of the collagen COL2A1 gene presenting in a distinct manner from families with mutations in the remaining 53 exons, as well as other hereditary vitreoretinal degenerations without significant systemic manifestations.
Collapse
Affiliation(s)
- Larry A Donoso
- Henry and Corinne Bower Laboratory, Eye Research Institute, Wills Eye Hospital, 900 Walnut Street, Philadelphia, PA 19107, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Ahmad N, Richards AJ, Murfett HC, Shapiro L, Scott JD, Yates JRW, Norton J, Snead MP. Prevalence of mitral valve prolapse in Stickler syndrome. Am J Med Genet A 2003; 116A:234-7. [PMID: 12503098 DOI: 10.1002/ajmg.a.10619] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The prevalence of mitral valve prolapse in Stickler syndrome has been reported to be much higher than in the general population. As a result, it has been recommended that all patients with Stickler syndrome undergo routine echocardiography and have antibiotic prophylaxis prior to surgery. The purpose of this study was to evaluate the prevalence of mitral valve prolapse in a large cohort of UK patients with Stickler syndrome in whom the clinical diagnosis has been confirmed by molecular genetic analysis. Probands and pedigrees were identified from the Vitreoretinal Service database according to previously published criteria. Ophthalmic, skeletal, audiometric, and orofacial features were assessed. Affected individuals underwent a full cardiological examination including auscultation and two-dimensional echocardiography. Mutation analysis of the COL2A1 and COL11A1 genes was carried out. Seventy-eight patients from 25 pedigrees were studied. Mutation analysis confirmed the clinical diagnosis in every pedigree. No patient was found to have clinical evidence of cardiovascular disease and no patient had significant mitral or other valvular prolapse on echocardiography. These data from a large cohort of UK patients with proven Stickler syndrome do not suggest an increased incidence of mitral valve prolapse over and above that found in the general population. Routine echocardiography screening and use of preoperative antibiotics are unnecessary and should be reserved for those individual cases where there is clear clinical indication.
Collapse
Affiliation(s)
- Nadeem Ahmad
- Department of Ophthalmology, Vitreoretinal Service, Addenbrooke's Hospital, Cambridge, UK
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Donoso LA, Edwards AO, Frost AT, Ritter R, Ahmad NN, Vrabec T, Rogers J, Meyer D. Identification of a stop codon mutation in exon 2 of the collagen 2A1 gene in a large stickler syndrome family. Am J Ophthalmol 2002; 134:720-7. [PMID: 12429249 DOI: 10.1016/s0002-9394(02)01638-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To describe the clinical features and identify the mutation responsible for an autosomal dominant vitreoretinal degeneration occurring in a previously unreported large family. DESIGN Cohort study. METHODS Family members were evaluated clinically over a 30-year period. Genealogical investigation, genetic linkage to known vitreoretinal degenerations, and mutation screening of the COL2A1 gene were performed. RESULTS We identified a single large family (2,384 total family members) with vitreoretinal degeneration spanning 12 generations. We reviewed the clinical records of 165 family members (95 affected and 70 unaffected). The common clinical findings in affected individuals included early-onset posterior perivascular retinal degeneration, vitreous degeneration, and retinal detachment. The incidence of retinal detachment was 57% (95/165) and the mean age of onset was 15.2 years. Orofacial, skeletal, and auditory abnormalities were seen in 0%, 5%, and 7.5%, respectively, in a subset of 28 affected subjects. Linkage to the collagen COL2A1 locus was demonstrated and a cytosine to adenosine transition identified within exon 2, leading to the creation of a stop codon at position 86 (Cys86Stop). CONCLUSIONS Identification of the mutation in this family enables diagnosis of individuals at risk for potentially blinding complications in this condition at an early age. Given the variability of the Stickler phenotype, mutation detection allows for more comprehensive genetic counseling and directs clinical monitoring to family members inheriting the disease gene.
Collapse
Affiliation(s)
- Larry A Donoso
- Henry and Corinne Bower Laboratory, Wills Eye Hospital, Philadelphia, Pennsylvania 19107, USA.
| | | | | | | | | | | | | | | |
Collapse
|
29
|
|
30
|
Abstract
Rhegmatogenous retinal detachment (RRD) most commonly occurs as a spontaneous event resulting from posterior vitreous detachment, typically between the ages of 40-70 yrs. It is also a feature in some inherited disorders, most commonly Stickler syndrome. The relationship between these inherited disorders and the spontaneous cases is unclear. Here in particular we review Stickler syndrome, and discuss the differential diagnosis of Stickler, Wagner and Marshall syndromes. Other rare inherited disorders associated with RRD are also briefly reviewed.
Collapse
Affiliation(s)
- A J Richards
- Department of Pathology University of Cambridge Cambridge, UK.
| | | | | |
Collapse
|
31
|
Abstract
The objective was to study the expressivity of Stickler syndrome in affected children and adults in the UK and to highlight issues for improving early diagnosis, treatment and counselling. A postal questionnaire survey of the 216 members of the Stickler Syndrome Support Group was carried out. Of the 153 (71%) who responded to the questionnaire, 48 (61%) of adults and 15 (20%) of children had experienced retinal detachment; 36 (49%) of the children and 18 (23%) of the adults were born with a cleft palate. Only 5 (7%) of the children and none of the adults had been diagnosed by a cleft surgeon, although 23 (31%) of the children had been diagnosed originally as having Pierre-Robin sequence. Only a third of the adults had been given any genetic counselling. Stickler syndrome is an under-diagnosed condition with profound consequences, particularly with respect to vision. Earlier diagnosis by the cleft team may help to reduce suffering and increase awareness of the condition.
Collapse
Affiliation(s)
- A C Webb
- Department of Oral and Maxillofacial Surgery, Poole Hospital NHS Trust, Poole, Dorset, UK
| | | |
Collapse
|
32
|
McLeod D, Black GCM, Bishop PN. Vitreous phenotype: genotype correlation in Stickler syndrome. Graefes Arch Clin Exp Ophthalmol 2002; 240:63-5; author reply 66. [PMID: 11954783 DOI: 10.1007/s00417-001-0380-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
33
|
Richards AJ, Baguley DM, Yates JRW, Lane C, Nicol M, Harper PS, Scott JD, Snead MP. Variation in the vitreous phenotype of Stickler syndrome can be caused by different amino acid substitutions in the X position of the type II collagen Gly-X-Y triple helix. Am J Hum Genet 2000; 67:1083-94. [PMID: 11007540 PMCID: PMC1288550 DOI: 10.1016/s0002-9297(07)62938-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2000] [Accepted: 08/24/2000] [Indexed: 11/23/2022] Open
Abstract
Stickler syndrome is a dominantly inherited disorder characterized by arthropathy, midline clefting, hearing loss, midfacial hypoplasia, myopia, and retinal detachment. These features are highly variable both between and within families. Mutations causing the disorder have been found in the COL2A1 and COL11A1 genes. Premature termination codons in COL2A1 that result in haploinsufficiency of type II collagen are a common finding. These produce a characteristic congenital "membranous" anomaly of the vitreous of all affected individuals. Experience has shown that vitreous slit-lamp biomicroscopy can distinguish between patients with COL2A1 mutations and those with dominant negative mutations in COL11A1, who produce a different "beaded" vitreous phenotype. Here we characterize novel dominant negative mutations in COL2A1 that result in Stickler syndrome. Both alter amino acids in the X position of the Gly-X-Y triple-helical region. A recurrent R365C mutation occurred in two unrelated sporadic cases and resulted in the membranous vitreous anomaly associated with haploinsufficiency. In a large family with linkage to COL2A1, with a LOD score of 2.8, a unique L467F mutation produced a novel "afibrillar" vitreous gel devoid of all normal lamella structure. These data extend the mutation spectrum of the COL2A1 gene and help explain the basis for the different vitreous phenotypes seen in Stickler syndrome.
Collapse
Affiliation(s)
- Allan J. Richards
- Department of Pathology, University of Cambridge, and Departments of Audiology, Medical Genetics, and Vitreoretinal Service, Addenbrooke’s Hospital, Cambridge; and Cardiff Eye Unit, University Hospital of Wales, and Institute of Medical Genetics, University of Wales College of Medicine, Cardiff
| | - David M. Baguley
- Department of Pathology, University of Cambridge, and Departments of Audiology, Medical Genetics, and Vitreoretinal Service, Addenbrooke’s Hospital, Cambridge; and Cardiff Eye Unit, University Hospital of Wales, and Institute of Medical Genetics, University of Wales College of Medicine, Cardiff
| | - John R. W. Yates
- Department of Pathology, University of Cambridge, and Departments of Audiology, Medical Genetics, and Vitreoretinal Service, Addenbrooke’s Hospital, Cambridge; and Cardiff Eye Unit, University Hospital of Wales, and Institute of Medical Genetics, University of Wales College of Medicine, Cardiff
| | - Carol Lane
- Department of Pathology, University of Cambridge, and Departments of Audiology, Medical Genetics, and Vitreoretinal Service, Addenbrooke’s Hospital, Cambridge; and Cardiff Eye Unit, University Hospital of Wales, and Institute of Medical Genetics, University of Wales College of Medicine, Cardiff
| | - Mary Nicol
- Department of Pathology, University of Cambridge, and Departments of Audiology, Medical Genetics, and Vitreoretinal Service, Addenbrooke’s Hospital, Cambridge; and Cardiff Eye Unit, University Hospital of Wales, and Institute of Medical Genetics, University of Wales College of Medicine, Cardiff
| | - Peter S. Harper
- Department of Pathology, University of Cambridge, and Departments of Audiology, Medical Genetics, and Vitreoretinal Service, Addenbrooke’s Hospital, Cambridge; and Cardiff Eye Unit, University Hospital of Wales, and Institute of Medical Genetics, University of Wales College of Medicine, Cardiff
| | - John D. Scott
- Department of Pathology, University of Cambridge, and Departments of Audiology, Medical Genetics, and Vitreoretinal Service, Addenbrooke’s Hospital, Cambridge; and Cardiff Eye Unit, University Hospital of Wales, and Institute of Medical Genetics, University of Wales College of Medicine, Cardiff
| | - Martin P. Snead
- Department of Pathology, University of Cambridge, and Departments of Audiology, Medical Genetics, and Vitreoretinal Service, Addenbrooke’s Hospital, Cambridge; and Cardiff Eye Unit, University Hospital of Wales, and Institute of Medical Genetics, University of Wales College of Medicine, Cardiff
| |
Collapse
|
34
|
Richards AJ, Baguley DM, Yates JRW, Lane C, Nicol M, Harper PS, Scott JD, Snead MP. Variation in the Vitreous Phenotype of Stickler Syndrome Can Be Caused by Different Amino Acid Substitutions in the X Position of the Type II Collagen Gly‐X‐Y Triple Helix. Am J Hum Genet 2000. [DOI: 10.1086/321189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
35
|
Wilkin DJ, Liberfarb R, Davis J, Levy HP, Cole WG, Francomano CA, Cohn DH. Rapid determination of COL2A1 mutations in individuals with Stickler syndrome: analysis of potential premature termination codons. AMERICAN JOURNAL OF MEDICAL GENETICS 2000; 94:141-8. [PMID: 10982970 DOI: 10.1002/1096-8628(20000911)94:2<141::aid-ajmg6>3.0.co;2-a] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Stickler syndrome is one of the milder phenotypes resulting from mutations in the gene that encodes type-II collagen, COL2A1. All COL2A1 mutations known to cause Stickler syndrome result in the formation of a premature termination codon within the type-II collagen gene. COL2A1 has 10 in-frame CGA codons, which can mutate to TGA STOP codons via a methylation-deamination mechanism. We have analyzed these sites in genomic DNA from a panel of 40 Stickler syndrome patients to test the hypothesis that mutations that cause Stickler syndrome preferentially occur at these bases. Polymerase chain reaction (PCR) amplification of genomic DNA containing each of the in-frame CGA codons was done by one of two methods: either using primers that amplify DNA that includes the CGA codon, or using allele-specific primers that either amplify normal sequence containing a CGA codon or amplify a mutant sequence containing a TGA codon. Analysis of PCR products by restriction endonuclease digestion or sequencing demonstrated the presence of a normal or mutated codon. TGA mutations were identified in eight patients, at five of the 10 in-frame CGA codons. The identification of these mutations in eight of 40 patients demonstrates that these sites are common sites for mutations in individuals with Stickler syndrome and, we propose, should be analyzed as a first step in the search for mutations that result in this disorder.
Collapse
Affiliation(s)
- D J Wilkin
- Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, the National Institutes of Health, Bethesda, Maryland, USA.
| | | | | | | | | | | | | |
Collapse
|
36
|
Richards AJ, Martin S, Yates JR, Scott JD, Baguley DM, Pope FM, Snead MP. COL2A1 exon 2 mutations: relevance to the Stickler and Wagner syndromes. Br J Ophthalmol 2000; 84:364-71. [PMID: 10729292 PMCID: PMC1723423 DOI: 10.1136/bjo.84.4.364] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To compare the clinical and molecular genetic features of two phenotypically distinct subgroups of families with type 1 Stickler syndrome. BACKGROUND Stickler syndrome (hereditary arthro-ophthalmopathy, McKusick Nos 108300 and 184840) is a dominantly inherited disorder of collagen connective tissue, resulting in an abnormal vitreous, myopia, and a variable degree of orofacial abnormality, deafness, and arthropathy. Stickler syndrome is the commonest inherited cause of rhegmatogenous retinal detachment in childhood with a risk of giant retinal tear (GRT) which is commonly bilateral and a frequent cause of blindness. METHOD Pedigrees were identified from the vitreoretinal service database and subclassified according to vitreoretinal phenotype. Ophthalmic, skeletal, auditory, and orofacial features were assessed. Linkage analysis was carried out with markers for the candidate genes COL2A1, COL11A1, and COL11A2. The COL2A1 gene was amplified as five overlapping PCR products. Direct sequencing of individual exons identified mutations. RESULTS Eight families exhibiting the type 1 vitreous phenotype were studied. Seven were consistent for linkage to COL2A1, with lod scores ranging from 2.1 to 0.3. In most instances linkage to COL11A1 and COL11A2 could be excluded. One family was analysed without prior linkage analysis. Three of the families exhibited a predominantly ocular phenotype with minimal or absent systemic involvement and were found to have mutations in exon 2 of COL2A1. Five other pedigrees with an identical ocular phenotype plus orofacial, auditory, and articular involvement had mutations in others regions of the COL2A1 gene. None of the pedigrees exhibited the characteristic lenticular, retinal pigment epithelial, or choroidal changes seen in Wagner syndrome. CONCLUSIONS These data confirm that type 1 Stickler syndrome is caused by mutations in the gene encoding type II collagen (COL2A1). In addition, data are submitted showing that mutations involving exon 2 of COL2A1 are characterised by a predominantly ocular variant of this disorder, consistent with the major form of type II procollagen in non-ocular tissues having exon 2 spliced out. Such patients are all at high risk of retinal detachment. This has important implications for counselling patients with regard to the development of systemic complications. It also emphasises the importance and reliability of the ophthalmic examination in the differential diagnosis of this predominantly ocular form of Stickler syndrome from Wagner's vitreoretinopathy.
Collapse
Affiliation(s)
- A J Richards
- MRC Connective Tissue Genetics Group, University of Cambridge, Department of Pathology, Cambridge CB2 1QP, UK
| | | | | | | | | | | | | |
Collapse
|
37
|
Freddi S, Savarirayan R, Bateman JF. Molecular diagnosis of Stickler syndrome: ACOL2A1 stop codon mutation screening strategy that is not compromised by mutant mRNA instability. ACTA ACUST UNITED AC 2000. [DOI: 10.1002/(sici)1096-8628(20000228)90:5<398::aid-ajmg10>3.0.co;2-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
38
|
Abstract
Stickler syndrome is an autosomal dominant disorder with characteristic ophthalmological and orofacial features, deafness, and arthritis. Abnormalities of vitreous gel architecture are a pathognomonic feature, usually associated with high myopia which is congenital and non-progressive. There is a substantial risk of retinal detachment. Less common ophthalmological features include paravascular pigmented lattice degeneration and cataracts. Non-ocular features show great variation in expression. Children with Stickler syndrome typically have a flat midface with depressed nasal bridge, short nose, anteverted nares, and micrognathia. These features can become less pronounced with age. Midline clefting, if present, ranges in severity from a cleft of the soft palate to Pierre-Robin sequence. There is joint hypermobility which declines with age. Osteoarthritis develops typically in the third or fourth decade. Mild spondyloepiphyseal dysplasia is often apparent radiologically. Sensorineural deafness with high tone loss may be asymptomatic or mild. Occasional findings include slender extremities and long fingers. Stature and intellect are usually normal. Mitral valve prolapse was reported to be a common finding in one series but not in our experience. The majority of families with Stickler syndrome have mutations in the COL2A1 gene and show the characteristic type 1 vitreous phenotype. The remainder with the type 2 vitreous phenotype have mutations in COL11A1 or other loci yet to be identified. Mutations in COL11A2 can give rise to a syndrome with the systemic features of Stickler syndrome but no ophthalmological abnormality.
Collapse
|
39
|
Perveen R, Hart-Holden N, Dixon MJ, Wiszniewski W, Fryer AE, Brunner HG, Pinkners AJ, van Beersum SE, Black GC. Refined genetic and physical localization of the Wagner disease (WGN1) locus and the genes CRTL1 and CSPG2 to a 2- to 2.5-cM region of chromosome 5q14.3. Genomics 1999; 57:219-26. [PMID: 10198161 DOI: 10.1006/geno.1999.5766] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Wagner syndrome (WGN1; MIM 143200), an autosomal dominant vitreoretinopathy characterized by chorioretinal atrophy, cataract, and retinal detachment, is linked to 5q14.3. Other vitreoretinopathies without systemic stigmata, including erosive vitreoretinopathy, are also linked to this region and are likely to be allelic. Within the critical region lie genes encoding two extracellular macromolecules, link protein (CRTL1) and versican (CSPG2), which are important in binding hyaluronan, a significant component of the mammalian vitreous gel, and which therefore represent excellent candidates for Wagner syndrome. Genetic mapping presented here in two further families reduces the critical region to approximately 2 cM. Subsequent refinement of the physical map allows ordering of known polymorphic microsatellites and excludes CRTL1 as a likely candidate for the disorder. CSPG2 is shown to lie within the critical region; however, analysis of the complete coding region of the mature peptide reveals no clear evidence that it is the gene underlying WGN1.
Collapse
Affiliation(s)
- R Perveen
- University Department of Medical Genetics and Regional Genetic Service, St. Mary's Hospital, Hathersage Road, Manchester, M13 OJH, United Kingdom
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Wilkin DJ, Mortier GR, Johnson CL, Jones MC, De Paepe A, Shohat M, Wildin RS, Falk RE, Cohn DH. Correlation of linkage data with phenotype in eight families with Stickler syndrome. ACTA ACUST UNITED AC 1998. [DOI: 10.1002/(sici)1096-8628(19981102)80:2<121::aid-ajmg6>3.0.co;2-m] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
41
|
Ballo R, Beighton PH, Ramesar RS. Stickler-like syndrome due to a dominant negative mutation in the COL2A1 gene. AMERICAN JOURNAL OF MEDICAL GENETICS 1998; 80:6-11. [PMID: 9800905 DOI: 10.1002/(sici)1096-8628(19981102)80:1<6::aid-ajmg2>3.0.co;2-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The type II collagenopathies include a wide spectrum of phenotypes ranging from mild spondylo epiphyseal dysplasia (SED) to severe achondrogenesis/hypochondrogenesis. Several attempts have been made at providing phenotype-genotype correlations in this group of disorders. In this report we discuss a South African family in which four members have a phenotype resembling Stickler syndrome type 1. Ocular problems and conductive deafness predominate, while skeletal changes resemble those of a mild form of multiple epiphyseal dysplasia (MED). In distinction to the classical form of Stickler syndrome, the affected persons have stubby digits. DNA analysis of the exons of the COL2A1 gene documented a C-T transversion in exon 39, resulting in an Arg704Cys substitution in the triple helical domain of the type II collagen peptide; this nontermination mutation may be indicative of further heterogeneity in the Stickler group of disorders or of a new syndrome amongst the type II collagenopathies.
Collapse
Affiliation(s)
- R Ballo
- MRC Research Unit for Medical Genetics and Department of Human Genetics, University of Cape Town Medical School, South Africa
| | | | | |
Collapse
|
42
|
Nowak CB. Genetics and hearing loss: a review of Stickler syndrome. JOURNAL OF COMMUNICATION DISORDERS 1998; 31:437-454. [PMID: 9777489 DOI: 10.1016/s0021-9924(98)00015-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Stickler syndrome is an autosomal dominant multisystem disease. The four most affected systems are craniofacial, skeletal, ocular, and auditory. The manifestations of Stickler syndrome vary considerably among affected individuals. Audiologists and speech-language pathologists should be familiar with the characteristics associated with Stickler syndrome to facilitate early identification and appropriate management.
Collapse
Affiliation(s)
- C B Nowak
- National Birth Defects Center, Waltham, Massachusetts 02154, USA.
| |
Collapse
|
43
|
Griffith AJ, Sprunger LK, Sirko-Osadsa DA, Tiller GE, Meisler MH, Warman ML. Marshall syndrome associated with a splicing defect at the COL11A1 locus. Am J Hum Genet 1998; 62:816-23. [PMID: 9529347 PMCID: PMC1377029 DOI: 10.1086/301789] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Marshall syndrome is a rare, autosomal dominant skeletal dysplasia that is phenotypically similar to the more common disorder Stickler syndrome. For a large kindred with Marshall syndrome, we demonstrate a splice-donor-site mutation in the COL11A1 gene that cosegregates with the phenotype. The G+1-->A transition causes in-frame skipping of a 54-bp exon and deletes amino acids 726-743 from the major triple-helical domain of the alpha1(XI) collagen polypeptide. The data support the hypothesis that the alpha1(XI) collagen polypeptide has an important role in skeletal morphogenesis that extends beyond its contribution to structural integrity of the cartilage extracellular matrix. Our results also demonstrate allelism of Marshall syndrome with the subset of Stickler syndrome families associated with COL11A1 mutations.
Collapse
Affiliation(s)
- A J Griffith
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA.
| | | | | | | | | | | |
Collapse
|
44
|
Sirko-Osadsa DA, Murray MA, Scott JA, Lavery MA, Warman ML, Robin NH. Stickler syndrome without eye involvement is caused by mutations in COL11A2, the gene encoding the alpha2(XI) chain of type XI collagen. J Pediatr 1998; 132:368-71. [PMID: 9506662 DOI: 10.1016/s0022-3476(98)70466-4] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Eye involvement has been considered a principal component feature in Stickler syndrome. However, families lacking eye involvement have been reported. We describe such a family and show that their phenotype is due to a heterozygous 27 basepair deletion in the gene COL11A2, which encodes the alpha2(XI) chain of type XI collagen. This is the second family in whom a COL11A2 mutation has been found to cause Stickler syndrome without eye involvement. This result confirms the role of COL11A2 in the etiopathogenesis of this disorder.
Collapse
Affiliation(s)
- D A Sirko-Osadsa
- Department of Genetics, Case Western Reserve University School of Medicine and the Center for Human Genetics, University Hospitals of Cleveland, USA
| | | | | | | | | | | |
Collapse
|
45
|
Svoboda KK, Gong H, Trinkaus-Randall V. Collagen expression and orientation in ocular tissues. Prog Polym Sci 1998. [DOI: 10.1016/s0079-6700(97)00038-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
46
|
Watanabe Y, Ueda M, Adachi-Usami E. Retinal detachment in identical twins with Stickler syndrome type 1. Br J Ophthalmol 1996; 80:976-81. [PMID: 8976725 PMCID: PMC505675 DOI: 10.1136/bjo.80.11.976] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The high incidence of retinal detachment and its poor surgical prognosis in patients with Stickler syndrome are well known. However, the vitreoretinal relation to retinal detachment in this syndrome is uncertain. METHODS Vitreoretinal examination with a binocular indirect ophthalmoscope and a Goldmann three mirror contact lens was performed on identical twin boys with Stickler syndrome. Each had retinal detachment in the left eye, and many aspects of their fundus findings were similar. The vitreous showed distinct abnormalities consistent with congenital vitreous anomaly of type 1 Stickler syndrome. The twins were followed up for 4 years after undergoing a successful operation to reattach their left retinas. RESULTS Rhegmatogenous detachment with multiple tears occurred in the right eye of only one twin during the follow up period, despite the similar condition of their fundi. Although vitreous body was not present in most parts, slightly opaque vitreous cortex was attached to the retina near the ora serrata, and neither twin had posterior vitreous detachment during the follow up period. CONCLUSION Multiple retinal tears appeared simultaneously in the right eye of one twin, indicating some tractional force had acted on the retina. It is believed that this force was caused by very thin vestigial vitreous cortex attached to the retina. Although these observations have been limited, vitreoretinal findings of the twins and their father were consistent and suggested presence of thin vitreous cortex attached to the retina without posterior vitreous detachment.
Collapse
Affiliation(s)
- Y Watanabe
- Department of Ophthalmology, Chiba University School of Medicine, Japan
| | | | | |
Collapse
|
47
|
Ahmad NN, McDonald-McGinn DM, Dixon P, Zackai EH, Tasman WS. PCR assay confirms diagnosis in syndrome with variably expressed phenotype: mutation detection in Stickler syndrome. J Med Genet 1996; 33:678-81. [PMID: 8863161 PMCID: PMC1050703 DOI: 10.1136/jmg.33.8.678] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Stickler syndrome is an autosomal dominant disease with ocular (severe myopia, vitreal degeneration, and retinal detachment) and other systemic manifestations (hearing loss, cleft palate, epiphyseal dysplasia, and premature osteoarthritis). As with other dominantly inherited conditions, the clinical phenotype of Stickler syndrome varies considerably. To date, all mutations have been located in the type II procollagen (COL2A1) gene. Analysis of a C-->T mutation we had identified previously, in COL2A1 gene in exon 40, in a three generation pedigree showed the loss of a cleavage site for the TaqI restriction enzyme. We designed a rapid PCR based restriction enzyme assay to detect this mutation and used it to establish the diagnosis in a neonate from the same pedigree, presenting with the first occurrence of the Pierre-Robin sequence in the family and minimal ocular findings. These results underline the potential diagnostic value of many as yet undetected DNA mutations in families affected with Stickler syndrome, since the variability of the phenotype can impede accurate diagnosis, appropriate genetic counselling, and effective intervention and prophylactic treatment for affected people.
Collapse
Affiliation(s)
- N N Ahmad
- Research Division, Wills Eye Hospital, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107-5598, USA
| | | | | | | | | |
Collapse
|
48
|
Snead MP, Yates JR, Williams R, Payne SJ, Pope FM, Scott JD. Stickler syndrome type 2 and linkage to the COL11A1 gene. Ann N Y Acad Sci 1996; 785:331-2. [PMID: 8702171 DOI: 10.1111/j.1749-6632.1996.tb56300.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- M P Snead
- Department of Ophthalmology, Addenbrooke's Hospital, Cambridge, UK
| | | | | | | | | | | |
Collapse
|
49
|
Abstract
The recent explosion in the number of identified genes involved in the human skeletal dysplasias has dramatically advanced this particular field. While linkage efforts are mapping hereditary disorders of the skeleton at an ever accelerating pace, progress in the Human Genome Project is providing tools for rapid gene discovery after the map location is known. Emerging themes in the molecular analysis of the skeletal dysplasias include the identification of allelic series of disorders and the existence of mutational and genetic heterogeneity in many of these conditions. Allelic series include those conditions caused by mutations in the genes encoding type II collagen (COL2A1), cartilage oligomeric matrix protein (COMP), fibroblast growth factor receptor 3 (FGFR3) and the diastrophic dysplasia sulfate transporter (DTDST). The recognition of these phenomena has initiated the analysis of the relationship between disease phenotype and gene.
Collapse
Affiliation(s)
- C A Francomano
- Medical Genetics Branch, National Center for Human Genome Research, National Institutes of Health, Bethesda, Maryland 20892, USA.
| | | | | |
Collapse
|
50
|
Schievink WI, Meyer FB, Atkinson JL, Mokri B. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. J Neurosurg 1996; 84:598-605. [PMID: 8613851 DOI: 10.3171/jns.1996.84.4.0598] [Citation(s) in RCA: 255] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Spinal cerebrospinal fluid (CSF) leaks are often implicated as the cause of the syndrome of spontaneous intracranial hypotension, but they have rarely been demonstrated radiographically or surgically. The authors reviewed their experience with documented cases of spinal CSF leaks of spontaneous onset in 11 patients including their surgical observations in four of the patients. The mean age of the six women and five men included in the study was 38 years (range 22-51 years). All patients presented with a postural headache; however, most had additional symptoms, including nausea, emesis, sixth cranial-nerve paresis, or local back pain at the level of the CSF leak. All patients underwent indium-111 radionucleotide cisternography or computerized tomographic (CT) myelography. The location of the spontaneous CSF leak was in the cervical spine in two patients, the cervicothoracic junction in three patients, the thoracic spine in five patients, and the lumbar spine in one patient. The false negative rate for radionucleotide cisternography was high (30%). Subdural fluid collections, meningeal enhancement, and downward displacement of the cerebellum, resembling a Chiari I malformation, were commonly found on cranial imaging studies. In most patients, the symptoms resolved in response to supportive measures or an epidural blood patch. Leaking meningeal diverticula were found to be the cause of the CSF leak in four patients who underwent surgery. In three patients these diverticula could be ligated with good result but in one patient an extensive complex of meningeal diverticula was found to be inoperable. Two patients had an unusual body habitus and joint hypermobility, and two other patients had suffered a spontaneous retinal detachment at a young age. In conclusion, spontaneous spinal CSF leaks are uncommon, but they are increasingly recognized as a cause of spontaneous intracranial hypotension. Most spinal CSF leaks are located at the cervicothoracic junction or in the thoracic spine, and they may be associated with meningeal diverticula. The radiographic study of choice is CT myelography. The disease is usually self-limiting, but in selected cases our experience with surgical ligation of leaking meningeal diverticula has been satisfactory. An underlying connective tissue disorder may be present in some patients with a spontaneous spinal CSF leak.
Collapse
Affiliation(s)
- W I Schievink
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA
| | | | | | | |
Collapse
|