Autosomal Dominant Macular Degeneration Associated with 208Delg Mutation in the FSCN2 Gene
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OPHTHALMIC MOLECULAR GENETICS SECTION EDITOR: EDWIN M. STONE, MD, PhD Autosomal Dominant Macular Degeneration Associated With 208delG Mutation in the FSCN2 Gene Yuko Wada, MD; Toshiaki Abe, MD; Toshitaka Itabashi, MD; Hajime Sato, MD; Miyuki Kawamura, MD; Makoto Tamai, MD Objective: To assess the clinical and genetic character- different phenotypes, autosomal dominant retinitis pig- istics of 2 Japanese families with autosomal dominant mentosa and ADMD. macular degeneration (ADMD) associated with a 208delG mutation in the retinal fascin (FSCN2) gene. Conclusions: The 208delG mutation in the FSCN2 gene produces not only autosomal dominant retinitis pigmen- Design: Case reports with clinical findings and results tosa but also ADMD in the Japanese population. This mu- of fluorescein angiography, electroretinography, ki- tation is relatively common in Japanese patients with au- netic visual field testing, and DNA analysis. tosomal dominant retinal degeneration and showed clinical variability. Setting: University medical center. Clinical Relevance: Autosomal dominant retinitis pig- Results: The 208delG mutation in the FSCN2 gene was mentosa and ADMD can be caused by the same 208delG identified in 14 members of 4 Japanese families with au- mutation. We suggest that mutations in the FSCN2 gene tosomal dominant retinitis pigmentosa and in 5 mem- can lead to a spectrum of phenotypes. bers of 2 Japanese families with ADMD. The character- istic features associated with this mutation led to 2 Arch Ophthalmol. 2003;121:1613-1620 ACULAR DEGENERATION patients with ADRP (14 patients from 4 un- (MD) can have a domi- related families) have the identical 208delG nant or recessive in- mutation in the FSCN2 gene. FSCN2, a can- heritance pattern and didate gene for ADRP, is located on chro- shows clinical and ge- mosome 17q25 and plays an important role Mnetic heterogeneity. To date, 4 loci and 6 in photoreceptor disc formation. The clini- candidate genes for MD have been re- cal characteristics of the 14 patients from ported, and 10 loci and 28 candidate genes 4 families with the 208delG mutation were for retinitis pigmentosa (RP) have been those of typical RP.14 identified.1 Among these candidate genes, However, 1 patient had an atrophic the peripherin/RDS gene causes autoso- MD in addition to the pigmentary retinal de- mal dominant retinitis pigmentosa (ADRP) generation. This finding suggested the pos- and autosomal dominant macular degen- sibility that mutations in the FSCN2 gene eration (ADMD). Therefore, it was re- were related to not only ADRP but also ported that the Arg172Trp,2-4 Tyr258Stop,5 ADMD. Thereafter, 148 patients from un- and Gly167Asp6 mutations cause ADMD related families with ADRP and 54 pa- and that the Trp179Arg,7 Cys165Thr,8 tients from unrelated families with cone- Phe211Leu,8 and Asn244Lys9 mutations rod dystrophy or MD were screened to cause ADRP. These reports suggested that search for mutations in the FSCN2 gene. other candidate genes for RP caused other Fourteen patients from 4 unrelated fami- phenotypes, such as MD. lies with ADRP and 5 patients from 2 un- From the Department of In 2001, it was first reported that the related families with ADMD had the iden- Ophthalmology, Tohoku 12 University School of Medicine, human retinal fascin gene (FSCN2) was one tical 208delG mutation in the FSCN2 gene. Sendai, Japan. The authors of the causative genes for Japanese We describe herein the ocular findings as- have no relevant financial patients with ADRP. This and other sociated with the 208delG mutation in 2 of interest in this article. studies10-14 disclosed that about 3.0% of the these Japanese families with ADMD. (REPRINTED) ARCH OPHTHALMOL / VOL 121, NOV 2003 WWW.ARCHOPHTHALMOL.COM 1613 ©2003 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/29/2021 Family 1 Family 2 T A CCT G A C A G C T G A 12 I 1 2 I Normal Allele 12 1 X X II 2 II +/+ M/+ 12 34XX5 XXX III 1 23 M/+ +/+ III M/+ +/+ M/+ 12XX 3 IV Deletion G M/+ +/+ 1 V T A CCT– A C A G C T G A Figure 1. Pedigrees of 2 Japanese families with macular degeneration Mutant Allele associated with the 208delG mutation in the FSCN2 gene showing affected (solid symbols) and unaffected (open symbols) members. Squares indicate male; circles, female; X, individuals examined in this study; slash, deceased; arrow, proband; M, mutant allele; and plus sign, normal allele. METHODS Figure 2. Results of nucleotide sequencing analysis of exon 1 in patient III:4 of family 1 showing the heterozygous 208delG mutation. The arrow indicates Genomic DNA samples isolated from 148 patients from unre- the position of the mutation. lated families with ADRP and from 54 patients from unrelated families with cone-rod dystrophy or MD were screened to search for mutations in the FSCN2 gene. One hundred control chro- quence. There was a deletion of nucleotide G at the mosomes from 50 normal subjects were further screened for complementary DNA position 208, and this was desig- mutations of this gene. Informed consent was obtained from nated as a 208delG mutation in the FSCN2 gene all patients before their entry into this study. (Figure 2). The nonaffected members did not have this The sequences from exon 1 to exon 5 of the FSCN2 gene mutation, and this mutation cosegregated with the phe- were amplified by polymerase chain reaction. Nine sets of oli- notype of MD (Figure 1). We further screened our pa- gonucleotide primer pairs were used to cover the extent of these tients for mutations in the peripherin/RDS, CRX, and sequences.12 Products of the polymerase chain reaction were GUCY2D genes, and no mutation was detected. We also directly sequenced in the forward and reverse directions on an confirmed that the 208delG mutation was not present in ABI sequencer (model 3100; Applied Biosystems, Foster City, 100 normal control chromosomes. Calif). The clinical features of the 4 Japanese families with ADRP associated with the 208delG mutation have already been re- ported.12 We present herein our findings on the 5 patients from REPORT OF CASES 2 Japanese families with ADMD. The heterozygous 208delG mu- tation in the FSCN2 gene was identified in all affected mem- FAMILY 1, PATIENT III:4 bers from the 2 families (Figure 1). Ophthalmic examinations included best-corrected visual The proband, a 62-year-old man, had a gradual progres- acuity, kinetic visual field examination, slitlamp biomicros- sion of visual impairment, photophobia, and constric- copy, fundus examination, fluorescein angiography, and elec- tion of the visual field during his 40s. In 1992, at age 52, troretinography. Ophthalmoscopic findings were recorded by he visited our clinic to have a detailed assessment of his color fundus photography. Kinetic visual field examinations were eyes. His visual acuity was corrected to 0.70 OD with a performed on the Goldmann perimetry with the V-4-e, I-4-e, I-3-e, and I-2-e targets. 2.0 diopter (D) sphere and to 0.06 OS with a 1.0 D sphere. Electroretinograms (ERGs) were recorded under con- Slitlamp biomicroscopic examination showed nor- trolled conditions that conformed to the standards of the In- mal-appearing cornea, anterior chamber, iris, lens, and ternational Society of Clinical Electrophysiology of Vision.15 vitreous in both eyes. Fundus examination showed the Briefly, photopic ERGs were elicited by a single flash or a 30-Hz mottled appearance of retinal pigment epithelium (RPE) flicker stimulus of red light under light-adapted conditions in the posterior pole bilaterally (Figure 3A). Fluores- (cone-isolated responses); a dim blue flash under dark- cein angiography disclosed diffuse hyperfluorescence adapted conditions (30 minutes) was used for the rod-isolated around the macula in the right eye and oval and round ERGs (rod-isolated responses); and a bright white flash (in- hyperfluorescent lesions in the posterior pole of the left tensity of 1.69 candelas/m2 per second) under dark-adapted con- eye (Figure 4A). ditions was used to elicit the mixed cone-rod responses. The means±SDs of the amplitudes of the ERGs of the normal sub- The rod-isolated, photopic, mixed cone-rod, and jects in our laboratory were: rod-isolated b-wave, 230.1±51.2 30-Hz flicker ERGs were within the normal range µV; photopic a-wave, 57.2±17.1 µV; photopic b-wave, (Figure 5). The patient could not identify the numbers 110.3±22.6 µV; mixed a-wave, 376.3±49.4 µV; mixed b- on the Ishihara plates. wave, 560.2±72.9 µV; and 30-Hz flicker, 127.5±24.1 µV. He experienced an accelerated deterioration of cen- tral visual acuity after his first visit in 1992 at age 52. In RESULTS 2001, his visual acuity had decreased to counting fin- gers in both eyes. Fundus examination at this time showed The 5 affected members from the 2 families with ADMD bilateral atrophic MD, a mottled appearance of the RPE, (Figure 1) had an identical abnormal nucleotide se- which appeared to have progressed since his first visit, (REPRINTED) ARCH OPHTHALMOL / VOL 121, NOV 2003 WWW.ARCHOPHTHALMOL.COM 1614 ©2003 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/29/2021 A B C D Figure 3. Fundus photographs of symptomatic patients. A, Patient III:4 of family 1 at age 52 years. The mottled appearance of retinal pigment epithelium in the posterior pole can be seen. B, Same patient at age 62. Atrophic macular degeneration has progressed during the 10 years. C, Patient III:1 of family 2 at age 13 years showing atrophic degeneration in the posterior pole without attenuation of the retinal vessels. D, Same patient at age 23.