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在一个患有遗传性视网膜营养不良的家族中,突变作为各种临床表现的病因。

mutation as the cause of various clinical manifestations in a family affected with inherited retinal dystrophy.

作者信息

Daftarian Narsis, Mirrahimi Mehraban, Sabbaghi Hamideh, Moghadasi Afrooz, Zal Niloufar, Dehghan Banadaki Hossein, Ahmadieh Hamid, Suri Fatemeh

机构信息

Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

出版信息

Ophthalmic Genet. 2019 Oct;40(5):436-442. doi: 10.1080/13816810.2019.1678178. Epub 2019 Oct 16.

Abstract

: To reveal the underlying genetic defect in a complex family affected with different clinical features of inherited retinal dystrophy, we carried out whole exome sequencing followed by confirmatory molecular tests.: Complete ophthalmic examinations were performed for available affected family members. Whole exome sequencing, bioinformatics analysis, Sanger sequencing confirmation, and segregation analysis were done to identify the causative mutation.: Clinical findings suggested fundus flavimaculatus as an early clinical feature progressing to an extensive chorioretinal atrophy involving the macula and mid-periphery of the fundus in one parent and central areolar chorioretinal dystrophy (CACD) as the most probable clinical diagnosis in another parent. Macular pattern dystrophy for one of their daughters and a Leber congenital amaurosis (LCA) like phenotype for the daughter with an early onset retinal dystrophy (EORD) phenotype was suggested. We found a known pathogenic nonsense variation in the gene (NM_000322: p.Gln239Ter). The parents with end stage fundus flavimaculatus and CACD diagnosis and their daughter with macular pattern dystrophy were heterozygous for the identified variant. The daughter affected with EORD/LCA like retinal dystrophy was homozygous for the same variation.: In this family, the same pathogenic variant in gene showed a wide range of clinical features of extensive chorioretinal macular atrophy with flecks as fundus falvimaculatus to CACD and macular pattern dystrophy in the heterozygous inheritance pattern and early onset/LCA like retinal dystrophy in the patient who was homozygous for the causative variant.

摘要

为了揭示一个患有遗传性视网膜营养不良不同临床特征的复杂家系潜在的基因缺陷,我们进行了全外显子组测序,随后进行了验证性分子检测。

对所有可用的患病家庭成员进行了全面的眼科检查。进行了全外显子组测序、生物信息学分析、桑格测序验证和分离分析以确定致病突变。

临床检查结果表明,在一位家长中,早期临床特征为黄斑黄白色斑点状眼底病变,进展为累及黄斑和眼底中周边部的广泛脉络膜视网膜萎缩;在另一位家长中,最可能的临床诊断为中心性晕轮状脉络膜视网膜营养不良(CACD)。他们的一个女儿被诊断为黄斑图案营养不良,另一个患有早发性视网膜营养不良(EORD)表型的女儿表现出类似莱伯先天性黑矇(LCA)的表型。我们在该基因(NM_000322:p.Gln239Ter)中发现了一个已知的致病性无义变异。被诊断为晚期黄斑黄白色斑点状眼底病变和CACD的家长以及患有黄斑图案营养不良的女儿对此变异呈杂合状态。患有EORD/LCA样视网膜营养不良的女儿对此相同变异呈纯合状态。

在这个家系中,该基因中的相同致病性变异在杂合遗传模式下表现出广泛的临床特征,从伴有斑点的广泛脉络膜视网膜黄斑萎缩(如黄斑黄白色斑点状眼底病变)到CACD和黄斑图案营养不良,而在致病变异纯合的患者中表现出早发性/LCA样视网膜营养不良。

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