Association of Steroid 5α-Reductase Type 3 Congenital Disorder of Glycosylation With Early-Onset Retinal Dystrophy
| Autor: | Carmel Toomes, Gavin Arno, Anthony T. Moore, Martin McKibbin, Andrew R. Webster, Manir Ali, Nikolas Pontikos, Katherine R. Smith, Jill Clayton-Smith, James A. Poulter, Jiten Morarji, Alison J. Hardcastle, Rachel L. Taylor, Chris F. Inglehearn, Michel Michaelides, Graeme C.M. Black, Sarah Hull, Stephanie Grunewald, Antonio Rueda Martin, Kamron N. Khan |
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| Rok vydání: | 2017 |
| Předmět: |
Male
0301 basic medicine Pathology medicine.medical_specialty Visual acuity Adolescent Genetic counseling DNA Mutational Analysis Vision Disorders Visual Acuity Disease Nyctalopia Young Adult 03 medical and health sciences chemistry.chemical_compound Congenital Disorders of Glycosylation 3-Oxo-5-alpha-Steroid 4-Dehydrogenase Ophthalmology Retinal Dystrophies Electroretinography medicine Humans Exome Fluorescein Angiography Exome sequencing Genome business.industry Membrane Proteins Retinal Sequence Analysis DNA medicine.disease Pedigree Phenotype 030104 developmental biology chemistry Mutation Visual Field Tests Female Visual Fields medicine.symptom business Congenital disorder of glycosylation |
| Zdroj: | JAMA Ophthalmology. 135:339 |
| ISSN: | 2168-6165 |
| Popis: | Importance: Steroid 5α-reductase type 3 congenital disorder of glycosylation (SRD5A3-CDG) is a rare disorder of N-linked glycosylation. Its retinal phenotype is not well described but could be important for disease recognition because it appears to be a consistent primary presenting feature. Objective: To investigate a series of patients with the same mutation in the SRD5A3 gene and thereby characterize its retinal manifestations and other associated features. Design, Setting and Participants: Seven affected individuals from 4 unrelated families with early-onset retinal dystrophy as a primary manifestation underwent comprehensive ophthalmic assessment, including retinal imaging and electrodiagnostic testing. Developmental and systemic findings were also recorded. Molecular genetic approaches, including targeted next-generation sequencing, autozygosity mapping, and apex microarray, were tried to reach a diagnosis; all participants were mutation negative. Whole-exome sequencing or whole-genome sequencing was used to identify the causative variant. Biochemical profiling was conducted to confirm a CDG type I defect. Patient phenotype data were collected over the course of ophthalmic follow-up, spanning a period of 20 years, beginning March 20, 1997, through September 15, 2016. Main Outcomes and Measures: Detailed clinical phenotypes as well as genetic and biochemical results. Results: The cohort consisted of 7 participants (5 females and 2 males) whose mean (SD) age at the most recent examination was 17.1 (3.9) years and who were all of South Asian ethnicity. Whole-exome sequencing and whole-genome sequencing identified the same homozygous SRD5A3 c.57G>A, p.(Trp19Ter) variant as the underlying cause of early-onset retinal dystrophy in each family. Detailed ocular phenotyping identified early-onset (aged ≤3 years) visual loss (mean [SD] best-corrected visual acuity, +0.95 [0.34] logMAR [20/180 Snellen]), childhood-onset nyctalopia, myopia (mean [SD] refractive error, -6.71 [-4.22]), and nystagmus. Six of the 7 patients had learning difficulties and psychomotor delay. Fundus autofluorescence imaging and optical coherence tomographic scans were abnormal in all patients, and electrodiagnostic testing revealed rod and cone dysfunction in the 5 patients tested. Conclusions and Relevance: Mutations in the SRD5A3 gene may cause early-onset retinal dystrophy, a previously underdescribed feature of the SRD5A3-CDG disorder that is progressive and may lead to serious visual impairment. SRD5A3 and other glycosylation disorder genes should be considered as a cause of retinal dystrophy even when systemic features are mild. Further delineation of SRD5A3-associated eye phenotypes can help inform genetic counseling for prognostic estimation of visual loss and disease progression. |
| Databáze: | OpenAIRE |
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