The Familial Dementia Gene Revisited: a Missense Mutation Revealed By

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The Familial Dementia Gene Revisited: a Missense Mutation Revealed By Human Molecular Genetics, 2014, Vol. 23, No. 2 491–501 doi:10.1093/hmg/ddt439 Advance Access published on September 10, 2013 The familial dementia gene revisited: a missense mutation revealed by whole-exome sequencing identifies ITM2B as a candidate gene underlying a novel autosomal dominant retinal dystrophy in a large family Isabelle Audo1,2,3,4,5,∗, Kinga Bujakowska1,2,3, Elise Orhan1,2,3, Said El Shamieh1,2,3, Florian Downloaded from https://academic.oup.com/hmg/article/23/2/491/663466 by guest on 01 October 2021 Sennlaub1,2,3, Xavier Guillonneau1,2,3, Aline Antonio1,2,3, Christelle Michiels1,2,3, Marie-Elise Lancelot1,2,3, Melanie Letexier6, Jean-Paul Saraiva6, Hoan Nguyen7, Tien D. Luu7, Thierry Le´veillard1,2,3, Olivier Poch7,He´le`ne Dollfus8,9, Michel Paques1,2,3,4, Olivier Goureau1,2,3, Saddek Mohand-Saı¨d1,2,3,4, Shomi S. Bhattacharya1,2,3,5,10, Jose´-Alain Sahel1,2,3,4,11,12 and Christina Zeitz1,2,3 1INSERM, U968, Paris F-75012, France, 2CNRS, UMR_7210, Paris F-75012, France, 3Department of Genetics, Institut de la Vision, UPMC Univ Paris 06, UMR_S 968, Paris F-75012, France, 4Centre Hospitalier National d’Ophtalmologie des Quinze-Vingts, INSERM-DHOS CIC 503, Paris F-75012, France, 5Department of Genetics, UCL-Institute of Ophthalmology, 11–43 Bath Street, London EC1V 9EL, UK, 6IntegraGen SA, Genopole CAMPUS 1 bat G8, Evry FR- 91030, France, 7Institut de Ge´ne´tique et de Biologie Mole´culaire et Cellulaire, Illkirch Cedex 67404, France, 8Centre de Re´fe´rence pour les Affections Rares en Ge´ne´tique Ophtalmologique, Hoˆpitaux Universitaires de Strasbourg, Strasbourg, France, 9Laboratoire de ge´ne´tique me´dicale, Universite´ de Strasbourg, UMR-S INSERM U1112, Strasbourg, France, 10Andalusian Centre for Molecular Biology and Regenerative Medicine (CABIMER), Isla de Cartuja, Seville, Spain, 11Fondation Ophtalmologique Adolphe de Rothschild, Paris, France and 12Acade´mie des Sciences–Institut de France, Paris 75006, France Received July 18, 2013; Revised and Accepted September 4, 2013 Inherited retinal diseases are a group of clinically and genetically heterogeneous disorders for which a signifi- cant number of cases remain genetically unresolved. Increasing knowledge on underlying pathogenic mechan- isms with precise phenotype–genotype correlation is, however, critical for establishing novel therapeutic interventions for these yet incurable neurodegenerative conditions. We report phenotypic and genetic charac- terization of a large family presenting an unusual autosomal dominant retinal dystrophy. Phenotypic character- ization revealed a retinopathy dominated by inner retinal dysfunction and ganglion cell abnormalities. Whole- exome sequencing identified a missense variant (c.782A>C, p.Glu261Ala) in ITM2B coding for Integral Membrane Protein 2B, which co-segregates with the disease in this large family and lies within the 24.6 Mb inter- val identified by microsatellite haplotyping. The physiological role of ITM2B remains unclear and has never been investigated in the retina. RNA in situ hybridization reveals Itm2b mRNA in inner nuclear and ganglion cell layers within the retina, with immunostaining demonstrating the presence of the corresponding protein in the same layers. Furthermore, ITM2B in the retina co-localizes with its known interacting partner in cerebral tissue, the ∗To whom correspondence should be addressed at: Department of Genetics, Institut de la Vision, 17, Rue Moreau, Paris 75012, France. Tel: +33 153462542; Fax: +33 153462602; Email: [email protected] # The Author 2013. Published by Oxford University Press. All rights reserved. For Permissions, please email: [email protected] 492 Human Molecular Genetics, 2014, Vol. 23, No. 2 amyloid b precursor protein, critical in Alzheimer disease physiopathology. Interestingly, two distinct ITM2B mutations, both resulting in a longer protein product, had already been reported in two large autosomal domin- ant families with Alzheimer-like dementia but never in subjects with isolated retinal diseases. These findings should better define pathogenic mechanism(s) associated with ITM2B mutations underlying dementia or retinal disease and add a new candidate to the list of genes involved in inherited retinal dystrophies. INTRODUCTION RESULTS Inherited retinal dystrophies are a heterogeneous group of Clinical characterization disorders including stationary conditions such as congenital The reported family includes at least 14 affected family members stationary night blindness (CSNB) characterized by post- spanning three generations, with two deceased, suffering Downloaded from https://academic.oup.com/hmg/article/23/2/491/663466 by guest on 01 October 2021 phototransduction dysfunction or degenerative processes such from visual symptoms segregating as a dominant trait (Fig. 1, as rod–cone and cone–rod dystrophies. This clinical heterogen- proband with a single arrow). Eleven affected and eight unaf- eity is mirrored by genetic heterogeneity (https://sph.uth.edu/ fected subjects were available for genetic testing. Detailed clin- Retnet/, last accessed date on September 16, 2013). Despite ical examination was performed on affected family members the increasing number of identified genes recognized for their ranging in age from 46 to 73 years (average 54) (Table 1). role in retinal physiology and pathology, the underlying Onset of symptoms appeared between 25 and 40 years genetic defect(s) remains unknown in a number of cases. Increas- (average 36). Light sensitivity was the first sign, reported by ing knowledge in pathogenic mechanisms and their associated all subjects, followed by progressive loss of central vision. phenotype–genotype correlation is de facto critical for a better Visual acuity varied from 20/25 to 20/400 (average 20/50). understanding of these heterogeneous disorders, even for rare Visual fields showed decreased central retinal sensitivity with subgroups. It may not only provide important insights into the preservation of peripheral visual field. Fundus examination, complexity of retinal physiology or neurophysiology in general fundus autofluorescence imaging and spectral domain optical but also help for accurate counselling and, moreover, for the es- coherence tomography (SD-OCT) revealed macular changes tablishment of innovative therapeutic interventions in these yet associated with optic disc pallor, hyper-reflectivity of ganglion incurable conditions. Recently, techniques of next-generation se- cell and nerve fibre layers (Fig. 2A) with loss of optic nerve quencing (NGS) have proved their efficiency to increase chances fibres (Fig. 2B). Full-field electroretinogram (Fig. 2C) showed of deciphering unknown genetic defect in this context (1). inner retinal dysfunction in all cases: all affected subjects dis- We applied these techniques to decipher the underlying gene played an absent or very reduced b-wave in response to a dim defect in a large dominant pedigree with 14 members affected by flash of 0.01 cd s m22 under dark-adapted (scotopic) conditions; a clinically novel retinal dystrophy dominated by inner retinal stimulation with a bright flash (3 and 12 0.01 cd s m22) under dysfunction and ganglion cell abnormalities. Applying whole- scotopic conditions revealed a normal a-wave, reflecting exome sequencing and subsequent haplotype analysis, we iden- normal photoreceptor function, dominated under dark adapta- tified a missense mutation in ITM2B, encoding Integral Mem- tion by rod function, but a severely reduced b-wave, reflecting brane Protein 2B, which co-segregates with the disease, and post-receptoral dysfunction with the typical electronegative further investigated expression of this gene in the retina. waveform. Oscillatory potentials, originating at the inner retinal Figure 1. Family pedigree revealing autosomal dominant segregation of the disease. Affected individuals are presented with filled symbols, unaffected with white symbols;squaresymbolsrepresentmaleandroundsymbols,female;deceasedindividualsare presentedwitha slash;subjectswho underwent ophthalmicevaluationin our centre are marked with an asterisk; mutation segregation is shown on the pedigree as ‘[¼];[¼]’ carrying both normal allele and ‘[M];[¼]’ heterozygous for the mutant change; the proband IV.27 is marked with a double black arrow and his DNA sample was included in whole-exome sequencing; other subjects includedin whole-exome sequencing are marked with arrows (i.e. IV.1 and IV.12). Table 1. Clinical characteristics of affected family members Patient Age at Age of onset Sex Symptoms BCVA Colour vision Kinetic visual field Fundus examination FAF SD-OCT the time OD/OS of testing refraction III.13 73 Around 40 F Mild photophobia 20/100; 20/250 OD normal Relative central scotoma Temporal optic disc Hyper-autofluorescent ring Hyper-reflectivity within Decreased vision 21.75 (21.75) OS mild tritanopia within 10 central pallor; mild around the macular region; the foveal ONL; small Downloaded fromhttps://academic.oup.com/hmg/article/23/2/491/663466bygueston01October2021 958 degrees with normal retinal vessel hypo-autofluorescence drusenoid changes in 23.75 (20.5) 708 peripheral isopter narrowing; foveal within the ring with subtle the foveal region; changes foveal hyper-reflectivity of hyper-autofluorescence the inner retina III.15 72 Around 40 F Mild photophobia 20/250; 20/400 OD and OS mild Relative central scotoma Pale optic disc; mild Hyper-autofluorescent ring Hyper-reflectivity within Decreased vision +1.25 (21.75) deuteranopia within 20 central retinal vessel around the macular region;
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