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Ku CA, Wei LW, Sieving PA. X-Linked Retinoschisis. Cold Spring Harb Perspect Med 2023; 13:a041288. [PMID: 36690462 PMCID: PMC10513161 DOI: 10.1101/cshperspect.a041288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
X-linked retinoschisis (XLRS) is an inherited vitreoretinal dystrophy causing visual impairment in males starting at a young age with an estimated prevalence of 1:5000 to 1:25,000. The condition was first observed in two affected brothers by Josef Haas in 1898 and is clinically diagnosed by characteristic intraretinal cysts arranged in a petaloid "spoke-wheel" pattern centered in the macula. When clinical electroretinogram (ERG) testing began in the 1960s, XLRS was noted to have a characteristic reduction of the dark-adapted b-wave amplitude despite normal or usually nearly normal a-wave amplitudes, which became known as the "electronegative ERG response" of XLRS disease. The causative gene, RS1, was identified on the X-chromosome in 1997 and led to understanding the molecular and cellular basis of the condition, discerning the structure and function of the retinoschisin protein, and generating XLRS murine models. Along with parallel development of gene delivery vectors suitable for targeting retinal diseases, successful gene augmentation therapy was demonstrated by rescuing the XLRS phenotype in mouse. Two human phase I/II therapeutic XLRS gene augmentation studies were initiated; and although these did not yield definitive improvement in visual function, they gave significant new knowledge and experience, which positions the field for further near-term clinical testing with enhanced, next-generation gene therapy for XLRS patients.
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Affiliation(s)
- Cristy A Ku
- Department of Ophthalmology & Vision Science, University of California Davis, Sacramento, California 95817, USA
| | - Lisa W Wei
- National Institutes of Health, National Institute of Allergy and Infectious Diseases, NIH Office of Biodefense, Research Resources and Translational Research/Vaccine Section, Bethesda, Maryland 20892, USA
| | - Paul A Sieving
- Department of Ophthalmology & Vision Science, University of California Davis, Sacramento, California 95817, USA
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Pennesi ME, Yang P, Birch DG, Weng CY, Moore AT, Iannaccone A, Comander JI, Jayasundera T, Chulay J. Intravitreal Delivery of rAAV2tYF-CB-hRS1 Vector for Gene Augmentation Therapy in Patients with X-Linked Retinoschisis: 1-Year Clinical Results. Ophthalmol Retina 2022; 6:1130-1144. [PMID: 35781068 DOI: 10.1016/j.oret.2022.06.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of rAAV2tYF-CB-hRS1, a recombinant adeno-associated virus vector expressing retinoschisin (RS1), in individuals with retinal disease caused by mutations in the RS1 gene. DESIGN Open-label, phase I/II dose-escalation clinical trial. SUBJECTS Twenty-two adults and 5 children with X-linked retinoschisis (XLRS), aged 10 to 79 years, were enrolled. METHODS The participants received an intravitreal (IVT) injection of rAAV2tYF-CB-hRS1, at 1 of 3 dose levels, in the poorer-seeing eye and were followed up for a minimum of 1 year after treatment. MAIN OUTCOME MEASURES The primary safety measures were local (ocular) or systemic (nonocular) adverse events (AEs) during the 12-month period after study agent administration. Efficacy was assessed based on measures of best-corrected visual acuity (BCVA), schisis cavity volume, static perimetry visual field testing, and electroretinography (ERG). RESULTS The IVT administration of rAAV2tYF-CB-hRS1 was generally safe at each of the dose levels. There were no AEs resulting in early termination, and no dose-limiting toxicities were reported. The most common ocular AEs observed were related to ocular inflammation (blurred vision, visual impairment, and the presence of vitreous cells, keratic precipitates, vitreous floaters, anterior chamber cells, and vitreous haze). Ocular inflammation was generally either mild or moderate in severity and responsive to standard immunosuppressive therapy, except in 3 participants (all in the highest-dose group) who developed chronic uveitis, which required prolonged therapy. Two patients experienced retinal detachments. There was no overall improvement in BCVA, visual fields, or ERG in the study eye compared with that in the fellow eye for any dose group. Variable changes in the cystic cavity volume over time were similar in the study and fellow eyes. CONCLUSIONS Gene augmentation therapy with rAAV2tYF-CB-hRS1 for XLRS was generally safe and well tolerated but failed to demonstrate a measurable treatment effect. The clinical trial is ongoing through 5 years of follow-up to assess its long-term safety.
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Affiliation(s)
- Mark Edward Pennesi
- Casey Eye Institute, Oregon Health & Sciences University, Portland, Oregon; Retina Foundation of the Southwest, Dallas, Texas; Cullen Eye Institute, Baylor College of Medicine, Houston, Texas; University of California San Francisco, San Francisco, California; Duke Eye Center, Duke Medical Center, Durham, North Carolina; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan; Applied Genetic Technologies Corporation, Alachua, Florida.
| | - Paul Yang
- Casey Eye Institute, Oregon Health & Sciences University, Portland, Oregon; Retina Foundation of the Southwest, Dallas, Texas; Cullen Eye Institute, Baylor College of Medicine, Houston, Texas; University of California San Francisco, San Francisco, California; Duke Eye Center, Duke Medical Center, Durham, North Carolina; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan; Applied Genetic Technologies Corporation, Alachua, Florida
| | - David G Birch
- Casey Eye Institute, Oregon Health & Sciences University, Portland, Oregon; Retina Foundation of the Southwest, Dallas, Texas; Cullen Eye Institute, Baylor College of Medicine, Houston, Texas; University of California San Francisco, San Francisco, California; Duke Eye Center, Duke Medical Center, Durham, North Carolina; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan; Applied Genetic Technologies Corporation, Alachua, Florida
| | - Christina Y Weng
- Casey Eye Institute, Oregon Health & Sciences University, Portland, Oregon; Retina Foundation of the Southwest, Dallas, Texas; Cullen Eye Institute, Baylor College of Medicine, Houston, Texas; University of California San Francisco, San Francisco, California; Duke Eye Center, Duke Medical Center, Durham, North Carolina; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan; Applied Genetic Technologies Corporation, Alachua, Florida
| | - Anthony T Moore
- Casey Eye Institute, Oregon Health & Sciences University, Portland, Oregon; Retina Foundation of the Southwest, Dallas, Texas; Cullen Eye Institute, Baylor College of Medicine, Houston, Texas; University of California San Francisco, San Francisco, California; Duke Eye Center, Duke Medical Center, Durham, North Carolina; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan; Applied Genetic Technologies Corporation, Alachua, Florida
| | - Alessandro Iannaccone
- Casey Eye Institute, Oregon Health & Sciences University, Portland, Oregon; Retina Foundation of the Southwest, Dallas, Texas; Cullen Eye Institute, Baylor College of Medicine, Houston, Texas; University of California San Francisco, San Francisco, California; Duke Eye Center, Duke Medical Center, Durham, North Carolina; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan; Applied Genetic Technologies Corporation, Alachua, Florida
| | - Jason I Comander
- Casey Eye Institute, Oregon Health & Sciences University, Portland, Oregon; Retina Foundation of the Southwest, Dallas, Texas; Cullen Eye Institute, Baylor College of Medicine, Houston, Texas; University of California San Francisco, San Francisco, California; Duke Eye Center, Duke Medical Center, Durham, North Carolina; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan; Applied Genetic Technologies Corporation, Alachua, Florida
| | - Thiran Jayasundera
- Casey Eye Institute, Oregon Health & Sciences University, Portland, Oregon; Retina Foundation of the Southwest, Dallas, Texas; Cullen Eye Institute, Baylor College of Medicine, Houston, Texas; University of California San Francisco, San Francisco, California; Duke Eye Center, Duke Medical Center, Durham, North Carolina; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan; Applied Genetic Technologies Corporation, Alachua, Florida
| | - Jeffrey Chulay
- Casey Eye Institute, Oregon Health & Sciences University, Portland, Oregon; Retina Foundation of the Southwest, Dallas, Texas; Cullen Eye Institute, Baylor College of Medicine, Houston, Texas; University of California San Francisco, San Francisco, California; Duke Eye Center, Duke Medical Center, Durham, North Carolina; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan; Applied Genetic Technologies Corporation, Alachua, Florida
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- Casey Eye Institute, Oregon Health & Sciences University, Portland, Oregon; Retina Foundation of the Southwest, Dallas, Texas; Cullen Eye Institute, Baylor College of Medicine, Houston, Texas; University of California San Francisco, San Francisco, California; Duke Eye Center, Duke Medical Center, Durham, North Carolina; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan; Applied Genetic Technologies Corporation, Alachua, Florida
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Abstract
In 2001, the first large animal was successfully treated with a gene therapy that restored its vision. Lancelot, the Briard dog that was treated, suffered from a human childhood blindness called Leber's congenital amaurosis type 2. Sixteen years later, the gene therapy was approved by the U.S. Food and Drug Administration. The success of this gene therapy in dogs led to a fast expansion of the ocular gene therapy field. By now every class of inherited retinal dystrophy has been treated in at least one animal model and many clinical trials have been initiated in humans. In this study, we review the status of viral gene therapies for the retina, with a focus on ongoing human clinical trials. It is likely that in the next decade we will see several new viral gene therapies approved.
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Affiliation(s)
- Shun-Yun Cheng
- University of Massachusetts Medical School, Ophthalmology, Worcester, Massachusetts, United States;
| | - Claudio Punzo
- University of Massachusetts Medical School, Ophthalmology, 368 Plantation Street, Albert Sherman Center, AS6-2041, Worcester, Massachusetts, United States, 01605;
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Bender C, Woo EG, Guan B, Ullah E, Feng E, Turriff A, Tumminia SJ, Sieving PA, Cukras CA, Hufnagel RB. Predominant Founder Effect among Recurrent Pathogenic Variants for an X-Linked Disorder. Genes (Basel) 2022; 13:genes13040675. [PMID: 35456481 PMCID: PMC9029724 DOI: 10.3390/genes13040675] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/06/2022] [Accepted: 04/06/2022] [Indexed: 02/05/2023] Open
Abstract
For disorders with X-linked inheritance, variants may be transmitted through multiple generations of carrier females before an affected male is ascertained. Pathogenic RS1 variants exclusively cause X-linked retinoschisis (XLRS). While RS1 is constrained to variation, recurrent variants are frequently observed in unrelated probands. Here, we investigate recurrent pathogenic variants to determine the relative burden of mutational hotspot and founder allele events to this phenomenon. A cohort RS1 variant analysis and standardized classification, including variant enrichment in the XLRS cohort and in RS1 functional domains, were performed on 332 unrelated XLRS probands. A total of 108 unique RS1 variants were identified. A subset of 19 recurrently observed RS1 variants were evaluated in 190 probands by a haplotype analysis, using microsatellite and single nucleotide polymorphisms. Fourteen variants had at least two probands with common variant-specific haplotypes over ~1.95 centimorgans (cM) flanking RS1. Overall, 99/190 of reportedly unrelated probands had 25 distinct shared haplotypes. Examination of this XLRS cohort for common RS1 haplotypes indicates that the founder effect plays a significant role in this disorder, including variants in mutational hotspots. This improves the accuracy of clinical variant classification and may be generalizable to other X-linked disorders.
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Affiliation(s)
- Chelsea Bender
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA; (C.B.); (E.G.W.); (B.G.); (E.U.); (E.F.); (A.T.); (S.J.T.); (P.A.S.); (C.A.C.)
| | - Elizabeth Geena Woo
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA; (C.B.); (E.G.W.); (B.G.); (E.U.); (E.F.); (A.T.); (S.J.T.); (P.A.S.); (C.A.C.)
| | - Bin Guan
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA; (C.B.); (E.G.W.); (B.G.); (E.U.); (E.F.); (A.T.); (S.J.T.); (P.A.S.); (C.A.C.)
| | - Ehsan Ullah
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA; (C.B.); (E.G.W.); (B.G.); (E.U.); (E.F.); (A.T.); (S.J.T.); (P.A.S.); (C.A.C.)
| | - Eric Feng
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA; (C.B.); (E.G.W.); (B.G.); (E.U.); (E.F.); (A.T.); (S.J.T.); (P.A.S.); (C.A.C.)
| | - Amy Turriff
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA; (C.B.); (E.G.W.); (B.G.); (E.U.); (E.F.); (A.T.); (S.J.T.); (P.A.S.); (C.A.C.)
| | - Santa J. Tumminia
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA; (C.B.); (E.G.W.); (B.G.); (E.U.); (E.F.); (A.T.); (S.J.T.); (P.A.S.); (C.A.C.)
| | - Paul A. Sieving
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA; (C.B.); (E.G.W.); (B.G.); (E.U.); (E.F.); (A.T.); (S.J.T.); (P.A.S.); (C.A.C.)
- UC Davis Medical Center, Ophthalmology & Vision Sciences, University of California, Davis, CA 95817, USA
| | - Catherine A. Cukras
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA; (C.B.); (E.G.W.); (B.G.); (E.U.); (E.F.); (A.T.); (S.J.T.); (P.A.S.); (C.A.C.)
| | - Robert B. Hufnagel
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA; (C.B.); (E.G.W.); (B.G.); (E.U.); (E.F.); (A.T.); (S.J.T.); (P.A.S.); (C.A.C.)
- Correspondence:
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Ren X, Gao Y, Lin Y, Fu X, Xiao L, Wang X, Zeng Z, Bao L, Yan N, Zhang M, Tang L. A Novel Mutation in the Membrane Frizzled-Related Protein Gene for Posterior Microphthalmia, Non-pigmented Retinitis Pigmentosa, Optic Nerve Drusen, and Retinoschisis in a Consanguineous Family. Front Med (Lausanne) 2022; 9:835621. [PMID: 35402469 PMCID: PMC8987310 DOI: 10.3389/fmed.2022.835621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Microphthalmos (MCO) is a rare developmental defect characterized by small malformed eyes. Our study aimed to describe the clinical characteristics of posterior microphthalmos syndrome caused by a novel variant in MFRP gene in a Chinese patient. Methods Complete ophthalmologic examinations were performed for the proband and proband's family members. Whole exon sequencing (WES) and Sanger sequencing were used to identify the mutated genes, and bioinformatic analysis was undertaken to predict the effect of this variant. Results Clinical analysis showed that the proband had reduced axial length (17.95 and 17.98 mm) with normal-size corneas and shallow anterior chamber depth. Fundus photography showed scattered yellowish-white spots in the whole retina with cup-to-disc ratios of 0.95 in both eyes. Retinoschisis in the inner nuclear layer and reduced outer retina thickness were apparent on OCT examination, and optic nerve drusen demonstrated increased autofluorescence in fundus autofluorescence (FAF). Perimeter examination revealed a tubular visual field for the right eye, and electroretinography (ERG) revealed a moderately reduced rod response combined with compromised cone response. Ocular examinations of the patient's family members were unremarkable. WES revealed that the proband had homozygous mutations in c.55-1 (IVS1) G>A in intron 1 for the MFRP gene. Both the proband's parents and offspring were confirmed to be heterozygous by Sanger sequencing. Bioinformatic analysis showed this mutation was deleterious. Conclusion We reported autosomal recessive posterior microphthalmia, atypical retinitis pigmentosa, and retinoschisis caused by a novel mutation in the MFRP gene in this consanguineous marriage family. Our study further broadens the mutation and phenotype spectrum of the MFRP gene in microphthalmia.
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Affiliation(s)
- Xiang Ren
- Ophthalmic Laboratory, Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Yunxia Gao
- Ophthalmic Laboratory, Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Lin
- Ophthalmic Laboratory, Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangyu Fu
- Ophthalmic Laboratory, Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Lirong Xiao
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyue Wang
- Ophthalmic Laboratory, Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhibing Zeng
- Ophthalmic Laboratory, Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Li Bao
- Ophthalmic Laboratory, Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Naihong Yan
- Research Laboratory of Ophthalmology and Vision Sciences, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Zhang
- Ophthalmic Laboratory, Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Ming Zhang
| | - Li Tang
- Ophthalmic Laboratory, Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Li Tang
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7
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Lembo A, Bacci GM, Serafino M, Lucentini S, Caputo R, Bargiacchi S, Passerini I, Barca F, Nucci P. Unusual presentation of early-onset X-linked retinoschisis: Report after 1 year of multimodal follow-up. Eur J Ophthalmol 2020; 31:NP60-NP64. [PMID: 32306756 DOI: 10.1177/1120672120916722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To describe the unusual presentation, diagnosis, and clinical course of an early-onset X-linked infantile retinoschisis. CASE REPORT A 6-month-old infant presented with strabismus and poor fixation. After the detection of bilateral intraretinal hemorrhage and diffuse dystrophic retinal pattern at indirect ophthalmoscopy, the patient received a complete evaluation under anesthesia. Retinal wide-field imaging, spectral domain optical coherence tomography, and electroretinogram were performed and revealed a retinoschisis involving the posterior pole and the inferior periphery in the right eye. In the left eye, an inferior retinal detachment extending to the macula was detected. Blood sample and genetic counseling were required in the strong suspicion of an inherited retinal dystrophy. Genetic tests confirmed the diagnosis of X-linked retinoschisis (RS1 gene mutation). After consultation with a pediatric vitreoretinal surgeon, a wait and see strategy was chosen. The follow up visits showed a surprisingly good natural course of the disease. CONCLUSION X-linked retinoschisis is a well-known inherited retinal disease potentially affecting young children as early as 3 months old. In this case, the stunning presentation (diffuse retinal pigment epithelium dystrophic changes resembling a macular dystrophy) and the positive course of the disease (resolution of macular retinal detachment in the left eye and stability of schisis in the right eye) arise some interesting considerations about the necessity of an early surgical treatment.
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Affiliation(s)
- Andrea Lembo
- Department of Clinical Sciences and Community Health, Eye Clinic San Giuseppe Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multimedica, University of Milan, Milan, Italy
| | - Giacomo Maria Bacci
- Pediatric Ophthalmology Unit, Children's Hospital A. Meyer, University of Florence, Florence, Italy
| | - Massimiliano Serafino
- Department of Clinical Sciences and Community Health, Eye Clinic San Giuseppe Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multimedica, University of Milan, Milan, Italy
| | - Stefano Lucentini
- Department of Clinical Sciences and Community Health, Eye Clinic San Giuseppe Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multimedica, University of Milan, Milan, Italy
| | - Roberto Caputo
- Pediatric Ophthalmology Unit, Children's Hospital A. Meyer, University of Florence, Florence, Italy
| | - Sara Bargiacchi
- Medical Genetics Unit, Children's Hospital A. Meyer, University of Florence, Florence, Italy
| | - Ilaria Passerini
- Department of Genetic Diagnosis, Careggi Teaching Hospital, University of Florence, Florence, Italy
| | - Francesco Barca
- Department of Neuroscience, Ophthalmology Unit, Careggi Teaching Hospital, Florence, Italy
| | - Paolo Nucci
- Department of Clinical Sciences and Community Health, Eye Clinic San Giuseppe Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multimedica, University of Milan, Milan, Italy
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8
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Liu Y, Kinoshita J, Ivanova E, Sun D, Li H, Liao T, Cao J, Bell BA, Wang JM, Tang Y, Brydges S, Peachey NS, Sagdullaev BT, Romano C. Mouse models of X-linked juvenile retinoschisis have an early onset phenotype, the severity of which varies with genotype. Hum Mol Genet 2020; 28:3072-3090. [PMID: 31174210 DOI: 10.1093/hmg/ddz122] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/04/2019] [Accepted: 06/03/2019] [Indexed: 12/17/2022] Open
Abstract
X-linked juvenile retinoschisis (XLRS) is an early-onset inherited condition that affects primarily males and is characterized by cystic lesions of the inner retina, decreased visual acuity and contrast sensitivity and a selective reduction of the electroretinogram (ERG) b-wave. Although XLRS is genetically heterogeneous, all mouse models developed to date involve engineered or spontaneous null mutations. In the present study, we have studied three new Rs1 mutant mouse models: (1) a knockout with inserted lacZ reporter gene; (2) a C59S point mutant substitution and (3) an R141C point mutant substitution. Mice were studied from postnatal day (P15) to 28 weeks by spectral domain optical coherence tomography and ERG. Retinas of P21-22 mice were examined using biochemistry, single cell electrophysiology of retinal ganglion cells (RGCs) and by immunohistochemistry. Each model developed intraretinal schisis and reductions in the ERG that were greater for the b-wave than the a-wave. The phenotype of the C59S mutant appeared less severe than the other mutants by ERG at adult ages. RGC electrophysiology demonstrated elevated activity in the absence of a visual stimulus and reduced signal-to-noise ratios in response to light stimuli. Immunohistochemical analysis documented early abnormalities in all cells of the outer retina. Together, these results provide significant insight into the early events of XLRS pathophysiology, from phenotype differences between disease-causing variants to common mechanistic events that may play critical roles in disease presentation and progression.
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Affiliation(s)
- Yang Liu
- Regeneron Pharmaceuticals, Tarrytown, NY 10591, USA
| | - Junzo Kinoshita
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Elena Ivanova
- Burke Neurological Institute at Weill Cornell Medicine, White Plains, NY 10605, USA
| | - Duo Sun
- Regeneron Pharmaceuticals, Tarrytown, NY 10591, USA
| | - Hong Li
- Regeneron Pharmaceuticals, Tarrytown, NY 10591, USA
| | - Tara Liao
- Regeneron Pharmaceuticals, Tarrytown, NY 10591, USA
| | - Jingtai Cao
- Regeneron Pharmaceuticals, Tarrytown, NY 10591, USA
| | - Brent A Bell
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Jacob M Wang
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Yajun Tang
- Regeneron Pharmaceuticals, Tarrytown, NY 10591, USA
| | | | - Neal S Peachey
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA.,Louis Stokes Cleveland VA Medical Center, Cleveland, OH 44106, USA.,Department of Ophthalmology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH 44195, USA
| | - Botir T Sagdullaev
- Burke Neurological Institute at Weill Cornell Medicine, White Plains, NY 10605, USA
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9
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Rubinstein Y, Weiner C, Chetrit N, Newman H, Hecht I, Shoshany N, Pras E. Effect of light and diurnal variation on macular thickness in X-linked retinoschisis: a case series. Graefes Arch Clin Exp Ophthalmol 2020; 258:529-536. [PMID: 31897705 DOI: 10.1007/s00417-019-04578-7] [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: 09/26/2019] [Revised: 12/07/2019] [Accepted: 12/18/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Diurnal variations in foveal thickness have been reported in several ocular pathologies including X-linked retinoschisis (XLRS), but its underlying mechanism is poorly understood. Rods are active under scotopic conditions with high metabolic demand, and its decrease may have positive effect on metabolic activity and macular thickness. The purpose of this study is to evaluate whether exposure to light and diurnal variation influence macular thickness in XLRS patients. METHODS Five patients with clinical suspicion of XLRS underwent RS1 gene sequencing and optical coherence tomography measurements at three consecutive times: morning following sleep in a dark room, morning following sleep in an illuminated room, and late afternoon following sleep in an illuminated room. Central macular thickness (CMT) was compared between measurements, and molecular analysis was performed. RESULTS Five RS1 mutations were identified: p.Gly140Arg, p.Arg141Cys, p.Gly109Glu, p.Pro193Leu, and p.Arg200His in patients 1-5, respectively. Two patients (4-5) had atrophied macula and were excluded from macular thickness variation analysis. A significant decrease in CMT between morning and afternoon measurements was observed in all patients (1-3: mean: 455.0 ± 32 μm to 342.17 ± 39 μm, 25%). Morning measurements following sleep in an illuminated room show a CMT reduction in all eyes of all patients with a mean reduction of 113 μm (mean: 547.17 ± 105 μm to 455.0 ± 32 μm, 17%). CONCLUSIONS Among XLRS patients, CMT decreased at the afternoon compared to the morning of the same day and may be reduced following sleep in an illuminated room. These results help shed light on the pathophysiologic process underlying intraretinal fluid accumulation involved with the disease.
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Affiliation(s)
- Yair Rubinstein
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel.,Matlow's Ophthalmogenetic Laboratory, Department of Ophthalmology, Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel
| | - Chen Weiner
- Matlow's Ophthalmogenetic Laboratory, Department of Ophthalmology, Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel.,Sackler faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Chetrit
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel
| | - Hadas Newman
- Sackler faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Idan Hecht
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel. .,Sackler faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Nadav Shoshany
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel.,Matlow's Ophthalmogenetic Laboratory, Department of Ophthalmology, Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel
| | - Eran Pras
- Department of Ophthalmology, Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel.,Matlow's Ophthalmogenetic Laboratory, Department of Ophthalmology, Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel.,Sackler faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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10
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Léveillard T, Klipfel L. Mechanisms Underlying the Visual Benefit of Cell Transplantation for the Treatment of Retinal Degenerations. Int J Mol Sci 2019; 20:ijms20030557. [PMID: 30696106 PMCID: PMC6387096 DOI: 10.3390/ijms20030557] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/23/2019] [Accepted: 01/24/2019] [Indexed: 12/13/2022] Open
Abstract
The transplantation of retinal cells has been studied in animals to establish proof of its potential benefit for the treatment of blinding diseases. Photoreceptor precursors have been grafted in animal models of Mendelian-inherited retinal degenerations, and retinal pigmented epithelial cells have been used to restore visual function in animal models of age-related macular degeneration (AMD) and recently in patients. Cell therapy over corrective gene therapy in inherited retinal degeneration can overcome the genetic heterogeneity by providing one treatment for all genetic forms of the diseases. In AMD, the existence of multiple risk alleles precludes a priori the use of corrective gene therapy. Mechanistically, the experiments of photoreceptor precursor transplantation reveal the importance of cytoplasmic material exchange between the grafted cells and the host cells for functional rescue, an unsuspected mechanism and novel concept. For transplantation of retinal pigmented epithelial cells, the mechanisms behind the therapeutic benefit are only partially understood, and clinical trials are ongoing. The fascinating studies that describe the development of methodologies to produce cells to be grafted and demonstrate the functional benefit for vision are reviewed.
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Affiliation(s)
- Thierry Léveillard
- Department of Genetics, Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012 Paris, France.
| | - Laurence Klipfel
- Department of Genetics, Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, F-75012 Paris, France.
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11
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Heymann JB, Vijayasarathy C, Huang RK, Dearborn AD, Sieving PA, Steven AC. Cryo-EM of retinoschisin branched networks suggests an intercellular adhesive scaffold in the retina. J Cell Biol 2019; 218:1027-1038. [PMID: 30630865 PMCID: PMC6400569 DOI: 10.1083/jcb.201806148] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 11/06/2018] [Accepted: 12/07/2018] [Indexed: 12/26/2022] Open
Abstract
Mutations in the essential retinal protein retinoschisin (RS1) cause a form of macular degeneration. Heymann et al. use cryo-EM to show that RS1 assembles into branched networks that may play a stabilizing role in maintaining the integrity of the retina. Mutations in the retinal protein retinoschisin (RS1) cause progressive loss of vision in young males, a form of macular degeneration called X-linked retinoschisis (XLRS). We previously solved the structure of RS1, a 16-mer composed of paired back-to-back octameric rings. Here, we show by cryo–electron microscopy that RS1 16-mers can assemble into extensive branched networks. We classified the different configurations, finding four types of interaction between the RS1 molecules. The predominant configuration is a linear strand with a wavy appearance. Three less frequent types constitute the branch points of the network. In all cases, the “spikes” around the periphery of the double rings are involved in these interactions. In the linear strand, a loop (usually referred to as spike 1) occurs on both sides of the interface between neighboring molecules. Mutations in this loop suppress secretion, indicating the possibility of intracellular higher-order assembly. These observations suggest that branched networks of RS1 may play a stabilizing role in maintaining the integrity of the retina.
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Affiliation(s)
- J Bernard Heymann
- Laboratory for Structural Biology Research, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
| | - Camasamudram Vijayasarathy
- Section on Translational Research for Retinal and Macular Degeneration, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD
| | - Rick K Huang
- Cryo-Electron Microscopy Facility, Janelia Research Campus, Howard Hughes Medical Institute, Ashburn, VA
| | - Altaira D Dearborn
- Laboratory for Structural Biology Research, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
| | - Paul A Sieving
- Section on Translational Research for Retinal and Macular Degeneration, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD.,National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Alasdair C Steven
- Laboratory for Structural Biology Research, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
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12
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Tochitsky I, Kienzler MA, Isacoff E, Kramer RH. Restoring Vision to the Blind with Chemical Photoswitches. Chem Rev 2018; 118:10748-10773. [PMID: 29874052 DOI: 10.1021/acs.chemrev.7b00723] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Degenerative retinal diseases such as retinitis pigmentosa (RP) and age-related macular degeneration (AMD) affect millions of people around the world and lead to irreversible vision loss if left untreated. A number of therapeutic strategies have been developed over the years to treat these diseases or restore vision to already blind patients. In this Review, we describe the development and translational application of light-sensitive chemical photoswitches to restore visual function to the blind retina and compare the translational potential of photoswitches with other vision-restoring therapies. This therapeutic strategy is enabled by an efficient fusion of chemical synthesis, chemical biology, and molecular biology and is broadly applicable to other biological systems. We hope this Review will be of interest to chemists as well as neuroscientists and clinicians.
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Affiliation(s)
- Ivan Tochitsky
- F.M. Kirby Neurobiology Center , Boston Children's Hospital , Boston , Massachusetts 02115 , United States.,Department of Neurobiology , Harvard Medical School , Boston , Massachusetts 02115 , United States
| | - Michael A Kienzler
- Department of Chemistry , University of Maine , Orono , Maine 04469 , United States
| | - Ehud Isacoff
- Department of Molecular and Cell Biology , University of California , Berkeley , California 94720 , United States.,Helen Wills Neuroscience Institute , University of California , Berkeley , California 94720 , United States.,Bioscience Division , Lawrence Berkeley National Laboratory , Berkeley , California 94720 , United States
| | - Richard H Kramer
- Department of Molecular and Cell Biology , University of California , Berkeley , California 94720 , United States.,Helen Wills Neuroscience Institute , University of California , Berkeley , California 94720 , United States
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13
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Plössl K, Weber BHF, Friedrich U. The X-linked juvenile retinoschisis protein retinoschisin is a novel regulator of mitogen-activated protein kinase signalling and apoptosis in the retina. J Cell Mol Med 2016; 21:768-780. [PMID: 27995734 PMCID: PMC5345684 DOI: 10.1111/jcmm.13019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 09/26/2016] [Indexed: 02/01/2023] Open
Abstract
X-linked juvenile retinoschisis (XLRS) is a hereditary retinal dystrophy in young males, caused by mutations in the RS1 gene. The function of the encoded protein, termed retinoschisin, and the molecular mechanisms underlying XLRS pathogenesis are still unresolved, although a direct interaction partner of the secreted retinoschisin, the retinal Na/K-ATPase, was recently identified. Earlier gene expression studies in retinoschisin-deficient (Rs1h-/Y ) mice provided a first indication of pathological up-regulation of mitogen-activated protein (MAP) kinase signalling in disease pathogenesis. To further investigate the role for retinoschisin in MAP kinase regulation, we exposed Y-79 cells and murine Rs1h-/Y retinae to recombinant retinoschisin and the XLRS-associated mutant RS1-C59S. Although normal retinoschisin stably bound to retinal cells, RS1-C59S exhibited a strongly reduced binding affinity. Simultaneously, exposure to normal retinoschisin significantly reduced phosphorylation of C-RAF and MAP kinases ERK1/2 in Y-79 cells and murine Rs1h-/Y retinae. Expression of MAP kinase target genes C-FOS and EGR1 was also down-regulated in both model systems. Finally, retinoschisin treatment decreased pro-apoptotic BAX-2 transcript levels in Y-79 cells and Rs1h-/Y retinae. Upon retinoschisin treatment, these cells showed increased resistance against apoptosis, reflected by decreased caspase-3 activity (in Y-79 cells) and increased photoreceptor survival (in Rs1h-/Y retinal explants). RS1-C59S did not influence C-RAF or ERK1/2 activation, C-FOS or EGR1 expression, or apoptosis. Our data imply that retinoschisin is a novel regulator of MAP kinase signalling and exerts an anti-apoptotic effect on retinal cells. We therefore discuss that disturbances of MAP kinase signalling by retinoschisin deficiency could be an initial step in XLRS pathogenesis.
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Affiliation(s)
- Karolina Plössl
- Institute of Human Genetics, University of Regensburg, Regensburg, Germany
| | - Bernhard H F Weber
- Institute of Human Genetics, University of Regensburg, Regensburg, Germany
| | - Ulrike Friedrich
- Institute of Human Genetics, University of Regensburg, Regensburg, Germany
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14
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The pivotal role of CCN2 in mammalian palatogenesis. J Cell Commun Signal 2016; 11:25-37. [PMID: 27761803 DOI: 10.1007/s12079-016-0360-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 10/15/2016] [Indexed: 01/25/2023] Open
Abstract
Mammalian palatogenesis is a complex process involving a temporally and spatially regulated myriad of factors. Together these factors control the 3 vital processes of proliferation, elevation and fusion of the developing palate. In this study, we show for the first time the unequivocally vital role of CCN2 in development of the mammalian palate. We utilized CCN2 knockout (KO) mice and cranial neural crest derived mesenchymal cells from these CCN2 KO mice to investigate the 3 processes crucial to normal palatogenesis. Similar to previously published reports, the absence of CCN2 inhibits proliferation of cells in the palate specifically at the G1/S transition. Absence of CCN2 also inhibited palatal shelf elevation from the vertical to horizontal position. CCN2 KO mesenchymal cells demonstrated deficiencies in adhesion and spreading owing to an inability to activate Rac1 and RhoA. On the contrary, CCN2 KO mesenchymal cells exhibited increased rates of migration compared to WT cells. The addition of exogenous CCN2 to KO mesenchymal cells restored their ability to spread normally on fibronectin. Finally, utilizing an organ culture model we show that the palatal shelves of the CCN2 KO mice demonstrate an inability to fuse when apposed. Together, these data signify that CCN2 plays an indispensible role in normal development of the mammalian palate and warrants additional studies to determine the precise mechanism(s) responsible for these effects.
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15
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Apaolaza PS, Del Pozo-Rodríguez A, Solinís MA, Rodríguez JM, Friedrich U, Torrecilla J, Weber BHF, Rodríguez-Gascón A. Structural recovery of the retina in a retinoschisin-deficient mouse after gene replacement therapy by solid lipid nanoparticles. Biomaterials 2016; 90:40-9. [PMID: 26986855 DOI: 10.1016/j.biomaterials.2016.03.004] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 02/29/2016] [Accepted: 03/02/2016] [Indexed: 11/26/2022]
Abstract
X-linked juvenile retinoschisis (XLRS) is a retinal degenerative disorder caused by mutations in the RS1 gene encoding a protein termed retinoschisin. The disease is an excellent candidate for gene replacement therapy as the majority of mutations have been shown to lead to a complete deficiency of the secreted protein in the retinal structures. In this work, we have studied the ability of non-viral vectors based on solid lipid nanoparticles (SLN) to induce the expression of retinoschisin in photoreceptors (PR) after intravitreal administration to Rs1h-deficient mice. We designed two vectors prepared with SLN, protamine, and dextran (DX) or hyaluronic acid (HA), bearing a plasmid containing the human RS1 gene under the control of the murin opsin promoter (mOPS). In vitro, the nanocarriers were able to induce the expression of retinoschisin in a PR cell line. After injection into the murine vitreous, the formulation prepared with HA induced a higher transfection level in PR than the formulation prepared with DX. Moreover, the level of retinoschisin in the inner nuclear layer (INL), where bipolar cells are located, was also higher. Two weeks after vitreal administration into Rs1h-deficient mice, both formulations showed significant improvement of the retinal structure by inducing a decrease of cavities and PR loss, and an increase of retinal and outer nuclear layer (ONL) thickness. HA-SLN resulted in a significant higher increase in the thickness of both retina and ONL, which can be explained by the higher transfection level of PR. In conclusion, we have shown the structural improvement of the retina of Rs1h-deficient mice with PR specific expression of the RS1 gene driven by the specific promoter mOPS, after successful delivery via SLN-based non-viral vectors.
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Affiliation(s)
- P S Apaolaza
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Paseo de la Universidad, 7, 01006 Vitoria-Gasteiz, Spain
| | - A Del Pozo-Rodríguez
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Paseo de la Universidad, 7, 01006 Vitoria-Gasteiz, Spain
| | - M A Solinís
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Paseo de la Universidad, 7, 01006 Vitoria-Gasteiz, Spain
| | - J M Rodríguez
- Physiology Laboratory, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad, 7, 01006 Vitoria-Gasteiz, Spain
| | - U Friedrich
- Institute of Human Genetics, University of Regensburg, Franz-Josef-Strauß-Allee 11, D-93053 Regensburg, Germany
| | - J Torrecilla
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Paseo de la Universidad, 7, 01006 Vitoria-Gasteiz, Spain
| | - B H F Weber
- Institute of Human Genetics, University of Regensburg, Franz-Josef-Strauß-Allee 11, D-93053 Regensburg, Germany
| | - A Rodríguez-Gascón
- Pharmacokinetic, Nanotechnology and Gene Therapy Group (PharmaNanoGene), Faculty of Pharmacy, Centro de investigación Lascaray ikergunea, University of the Basque Country UPV/EHU, Paseo de la Universidad, 7, 01006 Vitoria-Gasteiz, Spain.
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