Purpose: Detailed genetic characterization of three individuals from two families with macular dystrophy caused by exon 2 duplication of the PRPH2 gene.Methods: Two of the affected members (P1, P2) from one family were treated in the Helsinki University Hospital, Finland and one (P3) at Loma Linda University Eye Institute, CA, USA. The patients underwent comprehensive ophthalmic examination, and their genomic DNA was subjected to macular (P2) and retinal dystrophy (P3) gene panels or targeted genetic testing (P1). Additionally, Oxford nanopore adaptive sequencing was used for characterizing and mapping the breakpoints of the identified partial duplication of the PRPH2 gene.Results: Based on the ophthalmic examination, the mother (P1) of the Finnish family was diagnosed with butterfly‐shaped pattern dystrophy (BPD) and the daughter (P2) with vitelliform macular dystrophy. P3 (male) from the USA was diagnosed with BPD in the right eye and central areolar choroidal dystrophy in the left eye. Exome‐based genetic testing indicated that all patients are heterozygous for the same 482 bp duplication c.(581+1_582‐1)_(828+1_829‐1)dup between introns 1 and 2 of the PRPH2 gene, duplicating exon 2 (NM_000322.5). In‐depth analysis of the patients DNA samples by long‐read adaptive nanopore sequencing revealed the duplication to be ∼4kb in size. For all patients the 3’ breakpoint (BP) is located directly upstream from an intronic alu‐element (AluYM1). In the Finnish family the 5’BP resides in a novel alu‐element (AluYa5) lacking from the hg38 reference genome. The P3 lacks the novel‐alu element found in the Finnish family and instead the 5’BP resides in a known alu‐element (AluSq), located some 300bp upstream.Conclusions: We report here that the macular dystrophy in the two families is caused by duplication involving exon 2 of the PRPH2 gene. The alu‐elements at the breakpoints indicate non‐allelic homologous recombination as a possible mechanism for the duplication event.
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