Juvenile Retinoschisis Research Articles

Functional implications of the spectrum of mutations found in 234 cases with X-linked juvenile retinoschisis. The Retinoschisis Consortium.

X-linked retinoschisis (XLRS) is the most common cause of juvenile macular degeneration in males, resulting in vision loss early in life. The gene involved in XLRS was identified recently. It encodes a protein with a disoidin domain, suggested to be involved in cell-cell interactions. We have screened the gene for mutations in 234 familial and sporadic retinoschisis cases and identified 82 different mutations in 214 (91%). Thirty one mutations were found more than once, i.e. 2-10 times, with the exception of the 214G-->A mutation which was found in 34 apparently unrelated cases. The origin of the patients, the linkage data and the site of the mutations (mainly CG dinucleotides) indicate that most recurrent mutations had independent origins and thus suggest the existence of a significant new mutation rate in XLRS1. The mutations identified cover the entire spectrum, from small intra-genic deletions (7%), to nonsense (6%), missense (75%), small frameshifting insertions/deletions (6%) and splice site mutations (6%). Since, regardless of the mutation type, no females with a typical RS phenotype were identified, RS seems to be caused by loss-of-function mutations only. Mutations occurred non-randomly, with hotspots at several CG dinucleotides and a C6stretch. Exons 1-3 contained few, mainly translation-truncating mutations, arguing against an important functional role for this segment of the protein. Exons 4-6, encoding the discoidin domain, contained most, mainly missense mutations. An alignment of 32 discoidin domain proteins was constructed to reveal the consensus sequence and to deduce the functional importance of the missense mutations identified. The mutation analysis revealed a high preponderance of mutations involving or creating cysteine residues, pointing to sites important for the tertiary folding and/or protein function, and highlights several amino acids which may be involved in XLRS1-specific protein-protein interactions. Despite the enormous mutation heterogeneity, patients have relatively uniform clinical manifestations although with great intra-familial variation in age at onset and progression.

Japanese juvenile retinoschisis is caused by mutations of the

Japanese juvenile retinoschisis is caused by mutations of the

Exclusion of PPEF as the gene causing X-linked juvenile retinoschisis

X-linked juvenile retinoschisis (RS) is a progressive vitreoretinal degeneration localised in Xp22.1-p22.2. A human homologue of the retinal degeneration gene C (rdgC), a gene that in Drosophila melanogaster prevents light-induced retinal degeneration, was localised in the RS obligate gene region. We have tested the gene, designated PPEF in humans, as a candidate gene in RS patients using RT-PCR and the protein truncation test on RNA and SSCP on DNA. No mutations were identified, making it highly unlikely that PPEF is the gene implicated in RS. The data presented facilitate mutation analysis of the PPEF gene in other diseases which have been or will be localised to this region.

Positional cloning of the gene associated with X-linked juvenile retinoschisis.

X-linked juvenile retinoschisis(RS) is a recessively inherited vitreo-retinal degeneration characterized by macular pathology and intraretinal splitting of the retina. The RS gene has been localized to Xp22.2 to an approximately 1 Mb interval between DXS418 and DXS999/DXS7161. Mapping and expression analysis of expressed sequence tags have identified a novel transcript, designated XLRS1, within the centromeric RS locus that is exclusively expressed in retina. The predicted XLRS1 protein contains a highly conserved motif implicated in cell-cell interaction and thus may be active in cell adhesion processes during retinal development. Mutational analyses of XLRS1 in affected individuals from nine unrelated RS families revealed one nonsense, one frameshift, one splice acceptor and six missense mutations segregating with the disease phenotype in the respective families. These data provide strong evidence that the XLRS1 gene, when mutated, causes RS.

Surgical management of retinoschisis.

Most cases of X-linked juvenile retinoschisis and degenerative retinoschisis never require any type of surgical intervention. However, on rare occasions, associated problems such as retinal detachment come about and threaten the visual prognosis. Both conditions have in common the adherence of cortical vitreous to the inner layer of peripheral schisis cavities, which can make the secondary complications technically difficult to manage. Although good surgical results can often be obtained, it is not unusual to require relatively advanced vitreoretinal techniques to achieve long-term surgical success.

Use of Perfluorocarbon Liquid in the Repair of Retinoschisis Retinal Detachments

To determine the effectiveness of perfluorocarbon liquid in the repair of retinoschisis-associated retinal detachments. Four patients with either degenerative or juvenile X-linked retinoschisis had rhegmatogenous retinal detachments that were repaired with the use of perfluorocarbon liquid during vitrectomy. The patients' ages ranged from 17 to 78 years and the postoperative follow-up was at least 6 months. All of the patients had complete anatomic repair of the retinoschisis-associated retinal detachments. The postoperative visual acuity was 20/200 or better in all of the patients and 20/40 or better in half of the patients. The use of perfluorocarbon liquid is an effective adjunct in the management of rhegmatogenous retinal detachments associated with degenerative and juvenile X-linked retinoschisis.

X-linked juvenile retinoschisis: localization between (DXS1195, DXS418) and AFM291wf5 on a single YAC.

We studied 17 pedigrees with 108 affected males with X-linked juvenile retinoschisis (RS; McKusick No. 31270) and have analyzed all of the known polymorphic markers in the RS region of Xp22.1-p22.2 between DXS987 and DXS41. By haplotype analyses we found 7 individuals who showed crossovers in this interval surrounding RS. We previously reported AFM291wf5 as the centromeric boundary, and this remains unchanged in the present study. A new recombination was identified on the telomeric side at (DXS1195, DXS418). Our data support the locus order Xpter--(DXS987, DXS207, DXS1053, DXS43)--(DXS1195, DXS418)--(RS, DXS257, DXS999)--(AFM291wf5, DXS443)--DXS1052--(DXS1226, DXS274, DXS41)--Xcen; loci grouped in parentheses could not be mutually ordered by our genetic data. Physical mapping has indicated a distance of at most 900-1,000 kb between (DXS1195, DXS418) and AFM291wf5. No recombination was observed between RS and DXS257 which lies in our new interval of interest, but one critical individual was not informative with this marker. Our data now define the smallest RS inclusion interval. This interval is contained on a single YAC from which we have identified expressed sequences as candidate genes for RS.

The role of inner wall retinectomy in the management of juvenile retinoschisis.

The purpose of this paper is to describe the technique and application of relief of vitreous traction and inner wall retinectomy in the management of juvenile retinoschisis (JRS). In addition, during the course of this study a previously undescribed form of tractional retinal detachment associated with retinal schisis was observed. Six eyes of four children with visual field and/or central vision loss underwent vitrectomy (in five of the six eyes the lenses were preserved), inner wall retinectomy and photocoagulation for rhegmatogenous/schisis retinal detachment, tractional retinal detachment and reduced central vision secondary to intraschisis hemorrhage overhanging the macula. The children were followed up for 1 to 4 years. All eyes showed anatomic reattachment. Three of the four eyes that could be tested for vision showed improved visual function postoperatively. One eye showed marked enlargement of visual field and central visual acuity improvement from 20/200 preoperatively to 20/50 postoperatively. Inner wall retinectomy can be a useful ajunct in the management of the retinal complication of JRS. Appropriate case selection of eyes with associated central traction retinal detachment can result in improved visual field and central visual acuity. The success of this technique suggests that the mechanical and/or pharmacological relief of vitreous traction may be able to alter the clinical course of JRS.

Efficient DNA carrier detection in X linked juvenile retinoschisis.

Juvenile retinoschisis is a rare, X linked hereditary vitroretinal degeneration. Female carriers of the disease do not develop any ocular abnormalities. Therefore, carrier detection by DNA analysis is extremely useful for these females. In order to evaluate the usefulness of a new class of DNA markers for carrier detection in X linked juvenile retinoschisis, DNA carrier detection or carrier exclusion was carried out in four possible carriers for X linked juvenile retinoschisis. The use of these highly polymorphic CA repeats, closely linked to the RS gene, greatly enhances both the reliability and feasibility of carrier detection in X linked juvenile retinoschisis.

Genetic analysis of new French X-linked juvenile retinoschisis kindreds using microsatellite markers closely linked to the RS locus: further narrowing of the RS candidate region.

The gene involved in juvenile retinoschisis (RS) has previously been localized, by genetic linkage analyses, to Xp22.1-p22.2, between DXS274 and DXS43/DXS207; it is closely linked to the latter markers. From our recent data, this interval represents a genetic distance of approximately 10 cM. In the present study, we have studied 14 French families with X-linked juvenile RS by using four CA polymorphisms that are closely linked to the RS locus and that have recently been included in an Xp22.1-p22.2 high-resolution map. Complete cosegregation with the disease locus was observed for three of them, DXS207, DXS418, and DXS999, which further confirms the locus homogeneity for RS and the close linkage to this region. One recombinant was found with the most proximal marker, AFM291wf5, thereby defining this marker as the new proximal boundary of the candidate region for RS. Under the assumption that DXS207 and DXS43 constitute the distal boundary, the present study further reduces the region containing the disease gene to a interval of 3-4 cM. The results reported here should facilitate the eventual cloning of the RS gene.

Refined genetic mapping of juvenile X-linked retinoschisis.

Juvenile X-linked retinoschisis (RS) is an eye disease that causes acuity reduction and peripheral visual field loss typically beginning early in life. In further work towards positional cloning of the RS gene, we restudied our previously reported seven large American families and one additional new family, with a total of 63 affected males. RS linkage analysis using microsatellite repeat markers gave the following results: DXS207 (Z = 24.89, theta = 0.01), DXS987 (Z = 24.04, theta 0.01) and DXS999 (Z = 14.70, theta = 0.00). Recombination events in four individuals were studied further with additional markers (AFM291wf5, DXS443, DXS1052, DXS274 and DXS1226), and a flanking interval was obtained (DXS43, DXS207, DXS987)-RS-(AFM291wf5, DXS443). This study moves the RS centromeric boundary to (AFM291wf5, DXS443), about 5.5 cM closer than the previously reported boundary at DXS274 and narrows the RS inclusion interval to about 3.7 cM (using distances from CEPH family data).

X-linked juvenile retinoschisis (RS) maps between DXS987 and DXS443.

X-linked juvenile retinoschisis (RS) has previously been localized to a 7-8 cM interval between markers at (DXS43, DXS207) and (DXS274, DXS41). Our analysis of more than 300 meioses in two multigeneration RS families identified eight recombinant RS chromosomes and narrowed the RS locus to an interval between DXS987 and DXS443. Our data suggest the following order of loci: Xpter-DXS207-DXS987-([DXS418-DXS999], RS)-DXS443-DXS365-DXS274-Xcen.

Refinement of the chromosomal position of the X linked juvenile retinoschisis gene.

Linkage analysis was carried out in seven X linked juvenile retinoschisis (XLRS) families using four DNA probes and four CA repeat polymorphisms from the Xp22 region. Close linkage was observed between the XLRS locus and DXS207 (theta max = 0.04, Zmax = 3.71), DXS999 (theta max = 0.00, Zmax = 4.59), DXS365 (theta max = 0.07, Zmax = 2.22), and DXS451 (theta max = 0.05, Zmax = 3.26). The analysis of recombination breakpoints and multipoint linkage analysis suggests the order Xpter-DXS16-(DXS43, DXS207)-RS-DXS365-(DXS451, DXS41)-Xcen, thereby refining the position of the XLRS locus to an interval of approximately 3-4 cM. These results improve the feasibility of diagnosis in XLRS considerably, since carriers of this disease cannot be identified clinically.

Construction of a high-resolution linkage map for Xp22.1-p22.2 and refinement of the genetic localization of the Coffin-Lowry syndrome gene.

The genes responsible for two X-linked diseases, the Coffin-Lowry syndrome (CLS) and juvenile retinoschisis (RS), have been previously mapped, through linkage studies, to an 8-cM region, in Xp22.1-p22.2, flanked distally by two tightly linked markers, DXS207 and DXS43, and proximally by DXS274. In the present study, five Genethon markers have been assigned to the (DXS207, DXS43)-DXS274 interval using somatic cell hybrids and a meiotic breakpoint panel and ordered together with three markers previously mapped to this region. A genetic map, which includes 13 loci and spans a distance of approximately 13 cM, was derived from linkage analysis using the CEPH families. The most likely locus order and map distances (in centimorgans) are Xpter-DXS16-(3.4)-(DXS207, DXS43, DXS1053)-(2.0)-(DXS999, DXS257)-(1.7)-AFM291 wf5-(1.4) - DXS443 - (2.0) - (DXS1229, DXS365) - (2.1) - (DXS1052, DXS274, DXS41)-Xcen. Analysis of multiply informative crossovers established AFM291 wf5 and DXS1052 as new flanking markers for CLS, which significantly reduces the candidate region for this disease gene to a 4- to 5-cM interval. Three markers, DXS443, DXS1229, and DXS365, mapping within this interval showed complete cosegregation with the disease phenotype, giving a multipoint lod score of 14.2. The present map provides the framework for constructing a YAC contig for the CLS and RS region and should be useful for refining the localization of other disease genes mapping to this region. The panel of somatic cell hybrids characterized for the present study has also allowed us to refine the localization of five genes (CALB3, GRPR, PDHA1, GLRA2, and PHKA2) and two expressed sequence tags (DXS1118E and DXS1006E) previously assigned to the Xp22 region.

Visual impairment in Nordic children. V. X-linked juvenile retinoschisis.

In a study on 2,527 visually impaired children from four Nordic countries X-linked juvenile retinoschisis was diagnosed in 35 male children. Striking differences in frequency between the four countries were found, with 26 cases reported from Finland, 5 cases from Denmark, and 4 cases from Norway. None was reported from Iceland. The corresponding age and sex-specific prevalence rates of X-linked juvenile retinoschisis (N:1,000,000) were 44.5 in Finland, 8.8 in Denmark, and 7.9 in Norway. The uneven geographical distribution is possibly attributed to a 'founder effect' due to the settlements in Finland by European immigrants in the 17th century. The visual impairment of the registered cases was usually mild with 91.4% falling into WHO category 1. However, one child was totally blind, demonstrating large phenotypic heterogeneity. None of our cases had additional impairments. The majority were more than five years old, indicating a progressive course during childhood. Nevertheless, two children were diagnosed at the age of one. The most common age at registration was seven years, coinciding with the beginning of school attendance.

Characterisation of a highly polymorphic microsatellite at the DXS207 locus: confirmation of very close linkage to the retinoschisis disease gene.

Juvenile retinoschisis (RS) is an X linked recessive vitreoretinal disorder for which the basic molecular defect is unknown. The gene for RS has been previously localised by linkage analysis to Xp22.1-p22.2 and the locus order Xpter-DXS16-(DXS43, DXS207)-RS-DXS274-DXS41-Xcen established. To improve the resolution of the genetic map in the RS region, we have isolated a highly polymorphic microsatellite at DXS207, which displays at least nine alleles with a heterozygosity of 0.83. Using this microsatellite and four other Xp22.1-p22.2 marker loci, DXS16, DXS43, DXS274, and DXS41, we performed pairwise and multilocus linkage analysis in 14 kindreds with RS. The microsatellite was also typed in the CEPH (Centre d'Etude du Polymorphisme Humain) reference families. Tight linkage was found between RS and DXS207 (Z(theta) = 14.32 at theta = 0.0), RS and DXS43 (Z(theta) = 8.10 at theta = 0.0), and DXS207 and DXS43 (Z(theta) = 40.31 at theta = 0.0). Our linkage results combined with data previously reported suggest that the DXS207-DXS43 cluster is located less than 2 cM telomeric to the RS locus. The microsatellite reported here will be a very useful marker for further linkage studies with retinoschisis as well as with other diseases in this region of the X chromosome.

Multipoint linkage analysis in X-linked juvenile retinoschisis.

Thirteen families with X-linked juvenile retinoschisis (XLRS) were studied in order to evaluate the linkage relationship between the XLRS locus (RS) and seven X-chromosomal DNA markers. Linkage was found between RS and DXS9 (theta max = 0.11, Zmax = 4.17), DXS16 (theta max = 0.06, Zmax = 7.72), DXS41 (theta max = 0.06, Zmax = 8.13) and DXS43 (theta max = 0.03, Zmax = 6.11). Recombinants were found between RS and all loci studied. Multipoint linkage analysis and recombination analysis significantly favour the order of Xpter-(DXS9, (DXS16-DXS43))-RS-DXS41-Xcen.

Electroretinographic Findings In Juvenile X-Linked Retinoschisis

Three generations of one family (ten males and five females) with two young boys (cousins) and grandfather showing signs of retinoschisis were examined clinically and electrophys-iologically. The inheritance of the retinoschisis was determined to be X-linked. The aim of this study was to detect the typical ERG findings in juvenile retinoschisis and to find out any possible ERG changes in female carriers.No clinical findings or ERG abnormalities were detected in obligate or possible carriers of the disease. ERG recordings of the three subjects who had X-linked retinoschisis showed reduced b-wave amplitudes in all rod-mediated and mixed responses. Also most cone-mediated b-waves were subnormal. The b-wave implicit times were increased in some mixed and cone-mediated responses. They showed also some abnormalities in the a-waves.

Refined localization of the gene causing X-linked juvenile retinoschisis

Previous linkage studies in X-linked juvenile retinoschisis (RS) placed the gene between the loci DXS43 and DXS41 in the region Xp22.2–p22.1. Here we have extended our earlier studies by analyzing 31 RS families with the markers DXS16 (pSE3.2-L), DXS274, DXS92, and ZFX. Pairwise linkage analysis revealed significant linkage of the RS gene to all markers used; locus DXS274 (probe CRI-L1391) was tightly linked to the disorder, with a lod score of 9.02 at a recombination fraction of 0.05. The genetic map around the RS locus was refined by multilocus linkage studies in an expanded database including a large set of normal families (40 CEPH families). The results indicated that the RS gene locus lies between (DXS207, DXS43) and DXS274 with odds of 1.8 × 10 4: 1 favoring this most likely location over the second most likely location, i.e., distal to DXS43. Analysis by LINKMAP gave a maximum location score of 136.4 with the order Xpter-DXS16 - (DXS207, DXS43) - RS - DXS274 - (DXS41, DXS92)-Xcen. To assess the diagnostic value of the markers in Finnish patients, a total of 12 markers were tested for allele frequencies in 126 Finnish unrelated blood donors. With the exception of the markers DXS207, DXS43, and DXS92, allele frequencies did not show any significant deviation from the data published elsewhere. Haplotype analysis was performed with five DNA markers flanking the RS locus. Patients from southwest Finland had a haplotype association that differed from the haplotype association found in the patients from north central Finland, favoring the hypothesis that the mutations in the two groups arose independently.

Local ERG for clinical examination of eye diseases

We used a suction electrode with a frosted front window to record a full-field (general) ERG, and a suction electrode with a short-focus lens and a red-green light diode to record a local ERG. As the suction electrode moved with the eye, the stimulus struck the macula in all positions of gaze. Our data showed that only mildly intense stimuli with an angular size of 10 to 15 degrees induced a retinal response, with a macular contribution of 70%. Patients with various dystrophic changes of the retina, such as Stargardt's dystrophy, vitelliform dystrophy of the Best type, X-linked juvenile retinoschisis, and age-related macular dystrophy of different stages, were examined. In patients with retinitis pigmentosa, the cones were involved in the pathologic process to varying degrees; the behavior of the local ERGs helped determine the final visual acuity. We also observed a reduction in the local ERG in patients with Stargardt's dystrophy that disappeared as the disease progressed. In age-related macular dystrophy, a disturbance of the electrogenesis mainly occurred in the central retina in advanced stages of the disease.