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      Prevalence and genetic–phenotypic characteristics of patients with USH2A mutations in a large cohort of Chinese patients with inherited retinal disease

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          Abstract

          Aims

          To investigate the frequency of USH2A mutation and the clinical and genetic differences between Usher syndrome type II (USH2) and retinitis pigmentosa (RP) in a large cohort of Chinese patients.

          Methods

          A total of 1381 patients with inherited retinal disease (IRD) were recruited. The phenotypic and genotypic information of patients with USH2A mutations was evaluated.

          Results

          The prevalence of patients with USH2A mutations was 15.75%, which was the most frequently detected gene in this cohort of patients. Hotspot of USH2A mutations was c.8559-2A >G and c.2802T >G. Patients with USH2 had an earlier and more serious decline of visual function and damage to retina structure than did patients with RP in the first 10 years (p<0.05), but there was no difference in the visual prognosis between the two groups when the course of disease exceeded 10 years (p>0.05). Missense variants had less severe consequences and were found more commonly in RP, whereas more deleterious genotypes were associated with an earlier onset of disease and were found more commonly in USH2.

          Conclusions

          This study provides detailed clinical–genetic assessment of patients with USH2A mutations of Chinese origin, enabling precise genetic diagnoses, better management of these patients and putative therapeutic approaches.

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          Most cited references13

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          Usherin, the defective protein in Usher syndrome type IIA, is likely to be a component of interstereocilia ankle links in the inner ear sensory cells.

          Usher syndrome type IIa (USH2A) combines moderate to severe congenital hearing impairment and retinitis pigmentosa. It is the most common genetic form of USH. USH2A encodes usherin, which was previously defined as a basement membrane protein. A much larger USH2A transcript predicted to encode a transmembrane (TM) isoform was recently reported. Here, we address the role of TM usherin in the inner ear. Analysis of the usherin alternative transcripts in the murine inner ear revealed the existence of several predicted TM usherin isoforms with modular ectodomains of different lengths. In addition, we identified in the usherin cytoplasmic region a predicted 24 amino acid peptide, derived from a newly defined exon that is predominantly expressed in the inner ear but not in the retina. In mouse and rat inner ears, we show that TM usherin is present at the base of the differentiating stereocilia, which make up the mechanosensitive hair bundles receptive to sound. The usherin immunolabeling is transient in the hair bundles of cochlear hair cells (HCs), but persists in mature hair bundles of vestibular HCs. Several lines of evidence support the involvement of TM usherin in the composition of the ankle links, a subset of filamentous lateral links connecting stereocilia at the base. By co-immunoprecipitation and in vitro binding assays, we establish that the usherin cytodomain can bind to whirlin and harmonin, two PDZ domain-containing proteins that are defective in genetic forms of isolated deafness and USH type I, respectively. These PDZ proteins are suitable to provide the anchoring of interstereocilia lateral links to the F-actin core of stereocilia. Our results strongly suggest that congenital deafness in USH type I and type II shares similar pathogenic mechanisms, i.e. the disruption of hair bundle links-mediated adhesion forces that are essential for the proper organization of growing hair bundles.
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            A detailed clinical and molecular survey of subjects with nonsyndromic USH2A retinopathy reveals an allelic hierarchy of disease-causing variants

            Defects in USH2A cause both isolated retinal disease and Usher syndrome (ie, retinal disease and deafness). To gain insights into isolated/nonsyndromic USH2A retinopathy, we screened USH2A in 186 probands with recessive retinal disease and no hearing complaint in childhood (discovery cohort) and in 84 probands with recessive retinal disease (replication cohort). Detailed phenotyping, including retinal imaging and audiological assessment, was performed in individuals with two likely disease-causing USH2A variants. Further genetic testing, including screening for a deep-intronic disease-causing variant and large deletions/duplications, was performed in those with one likely disease-causing change. Overall, 23 of 186 probands (discovery cohort) were found to harbour two likely disease-causing variants in USH2A. Some of these variants were predominantly associated with nonsyndromic retinal degeneration (‘retinal disease-specific'); these included the common c.2276 G>T, p.(Cys759Phe) mutation and five additional variants: c.2802 T>G, p.(Cys934Trp); c.10073 G>A, p.(Cys3358Tyr); c.11156 G>A, p.(Arg3719His); c.12295-3 T>A; and c.12575 G>A, p.(Arg4192His). An allelic hierarchy was observed in the discovery cohort and confirmed in the replication cohort. In nonsyndromic USH2A disease, retinopathy was consistent with retinitis pigmentosa and the audiological phenotype was variable. USH2A retinopathy is a common cause of nonsyndromic recessive retinal degeneration and has a different mutational spectrum to that observed in Usher syndrome. The following model is proposed: the presence of at least one ‘retinal disease-specific' USH2A allele in a patient with USH2A-related disease results in the preservation of normal hearing. Careful genotype–phenotype studies such as this will become increasingly important, especially now that high-throughput sequencing is widely used in the clinical setting.
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              Genetic and clinical findings in a large cohort of Chinese patients with suspected retinitis pigmentosa

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                Author and article information

                Journal
                Br J Ophthalmol
                Br J Ophthalmol
                bjophthalmol
                bjo
                The British Journal of Ophthalmology
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                0007-1161
                1468-2079
                January 2021
                18 March 2020
                : 105
                : 1
                : 87-92
                Affiliations
                [1 ] departmentEye Institute , Eye and ENT Hospital, College of Medicine, Fudan University , Shang Hai, China
                [2 ] departmentShanghai Key Laboratory of Visual Impairment and Restoration , Science and Technology Commission of Shanghai Municipality , Shang Hai, China
                [3 ] departmentKey Laboratory of Myopia (Fudan University) , Chinese Academy of Medical Sciences, National Health Commission , Shang Hai, China
                [4 ] departmentLaboratory of Genomics and Molecular Biomedicine, Department of Biology , University of Copenhagen , Copenhagen, Denmark
                [5 ] departmentShenzhen Engineering Laboratory for Birth Defects Screening , BGI-Shenzhen , Shenzhen, China
                [6 ] BGI-Shenzhen , Shenzhen, China
                [7 ] Sonoma Academy , Santa Rosa, CA
                [8 ] departmentDept of Computer Science , City University of Hong Kong , Hong Kong, China
                [9 ] departmentBGI Education Center , University of Chinese Academy of Sciences , Shenzhen, China
                Author notes
                [Correspondence to ] Professor Ji-Hong Wu, Ophthalmology, Shanghai, China; jihongwu@ 123456fudan.edu.cn

                F-JG, D-DW and FC are joint first authors.

                Author information
                http://orcid.org/0000-0002-2799-3554
                http://orcid.org/0000-0002-6861-5752
                http://orcid.org/0000-0003-4288-9736
                Article
                bjophthalmol-2020-315878
                10.1136/bjophthalmol-2020-315878
                7788223
                32188678
                9af38949-684c-4ada-a384-6c4b2da1bf8c
                © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 15 January 2020
                : 27 February 2020
                : 29 February 2020
                Funding
                Funded by: Shanghai municipal science and technology major projects;
                Award ID: 2018SHZDZX05
                Funded by: Study on comprehensive prevention and control of common eye diseases in xuhui district;
                Award ID: XHLHGG201807
                Funded by: the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences;
                Award ID: 2018PT32019
                Funded by: the National Natural Science Foundation of China;
                Award ID: 81770925
                Award ID: 81790641
                Categories
                Clinical Science
                1506
                Custom metadata
                unlocked

                Ophthalmology & Optometry
                retina,genetics
                Ophthalmology & Optometry
                retina, genetics

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