Identification of a CRYAB mutation associated with autosomal dominant posterior polar cataract in a Chinese family

PURPOSE: A four-generation Chinese family with 13 members affected with autosomal dominant congenital posterior polar cataract was studied. The purpose of this study was to identify the disease-causing gene in the family and to validate that mutations in CRYAB, the alphaB-crystallin gene, cause the congenital cataract. METHODS: Linkage analysis was performed with a panel of microsatellite markers flanking candidate genetic loci for cataracts, including 14 known autosomal dominant congenital cataract (ADCC) genes. For mutation analysis, the complete coding region and exon-intron boundaries of CRYAB were sequenced with DNA from the proband. Single-strand conformation polymorphism (SSCP) analysis for exon 1 of CRYAB was performed in all family members and 200 normal control subjects. RESULTS: The disease gene in the Chinese family was mapped to chromosome 11 in region q22-22.3 with a maximum lod score of 4.52. Direct DNA sequence of CRYAB revealed a heterozygous C-->T transition at nucleotide 58, resulting in a novel 58 C-->T (Pro20Ser) mutation. The Pro20Ser mutation cosegregated with all affected individuals and was not present in unaffected members in the family or in 200 normal control subjects. The mutation occurs at the evolutionarily conserved residue Pro20 in the N-terminal region of alphaB-crystallin. CONCLUSIONS: To date, only one CRYAB mutation has been associated with congenital isolated cataract. This study identified a second novel mutation in CRYAB in a large Chinese cataract family. Together, these results provide strong evidence that CRYAB is a pathogenic gene for congenital cataract.     

常染色体显性遗传性白内障一家系致病基因的研究

目的:对一个4代常染色体显性遗传先天性白内障家系进行致病基因研究。方法:对15例家系成员(8例患者,7例非患者)进行眼部检查,采集静脉血,提取基因组DNA,选取已报道的与常染色体显性遗传性白内障相关的19个位点附近的微卫星标记,PCR扩增后进行基因型分析,用连锁分析进行定位;对提示连锁的标记计算Lod值,并构建单体型;对定位区域内已知候选基因测序。结果:该家系患者表型为绕核性白内障;患者在17q11-12有共享基因型,该位点微卫星标记与致病基因间的两点连锁最大Lod值为2.71,证实该位点与该家系的致病基因连锁;测序未发现CRYBA1/BA3突变。结论:该家系的致病突变不是由于CRYBA1/A3外显子和调控区突变,可能是未被发现基因突变或机制参与该家系的发病。     

先天性粉尘状白内障一家系基因突变定位

目的 探讨先天性粉尘状白内障一家系的基因突变定位.方法 回顾性研究.对一先天性白内障家系成员(共32人,其巾患者15人)散瞳后采用裂隙灯显微镜观察晶状体,并取外周血提取DNA样品.选取常染色体上微卫星标记物,通过聚合酶链反应(PCR)进行扩增后,进行基因扫描.利用GeneMapper软件进行PCR扩增产物片段大小和单体型分析.分别通过Linkage 5.1和GeneHunter软件进行两点法和多点法对数优势记分(LOD)值计算.对候选基因通过测序进行基因序列分析.结果 家系成员中的白内障患者晶状体环胎儿核可见散在的类似于蚁卵的短棒状混浊.在不同患者间以及同一患者的不同眼别存在晶状体混浊程度和形态的差异.两点法计算LOD值,在重组率(θ)为0时,微卫星位点D20S186、D230S163、D20S915、D20S152、D20S98、D20S904、D20S875、D20S112、D20S1140、D20S432均获得正值,其中在D20S904获得最大LOD值6.02.通过单体型构建,发现微卫星位点D20S163在Ⅳ7患者发生交换,而D20S912在Ⅱ3患者发生交换.基因序列分析未发现BFSP1、PLCB4基因突变.结论 该家系突变基因位于常染色体20p12.1-p11.23上微卫星位点D20S186和D20S912间5.47厘摩范围内.     

一个常染色体显性遗传先天性白内障家系致病基因筛查

目的: 对中国一个常染色体显性遗传先天性白内障家系(ADCC)的已知候选基因进行筛查以寻找致病位点。方法: 收集一个ADCC家系的临床资料并采集静脉血。在24个已知与ADCC相关基因附近选择微卫星标记,利用Linkage软件Mlink软件包进行连锁分析计算Lod值。结果: 此家系白内障类型为核性白内障,24个候选基因附近50个微卫星Lod值均小于0,微卫星所在区域与此家系致病基因无连锁关系。结论: 此ADCC家系致病基因不是已知的与ADCC相关基因,可能是一个新的致病基因突变导致此家系疾病发生。     

Approaches to a posterior polar cataract

Posterior polar cataracts present special challenges to the cataract surgeon. These are often associated with weakness/dehiscence of the posterior capsule and thus have a higher rate of intraoperative posterior capsule rupture. The surgeon needs to adhere to special surgical strategies to minimize the risk of a posterior capsule rupture. These include, adhering to the principles of closed chamber technique, avoiding hydrodissection – instead performing ‘inside-out’ hydrodelineation and using modest to low phaco parameters and reducing these stepwise. This article provides important pearls on how to approach a posterior polar cataract.     

晶状体蛋白基因在一先天性白内障家系中的突变筛查

目的研究晶状体蛋白基因与先天性白内障的关系。方法收集1个先天性白内障家系,制备外周血白细胞基因组DNA。除对CRYGD基因直接测序外,在距离已知晶状体蛋白基因5个厘摩范围内选取微卫星标记进行连锁分析,计算微卫星位点与致病基因之间的最大优势对数值(LOD SCORE),来确定晶状体蛋白基因与此家系致病基因的关系。结果当重组分数分别为0.1、0.2、0.3、0.4时,所选取的位于晶状体蛋白基因附近的14个微卫星位点与该家系致病基因之间连锁的LOD值均为负值,故排除连锁。CRYGD基因测序后在基因编码区及启动子、内含子与外显子连接处的剪切位点均未见任何碱基改变。结论晶状体蛋白基因非此家系的致病基因,为进一步定位与克隆该家系的致病基因,需进行全基因组扫描,以探求先天性白内障的分子发病机制。     

先天性白内障一家系的致病基因初步筛查

目的：对常染色体显性遗传先天性白内障一家系的致病基因进行初步筛查。方法收集常染色显性遗传的白内障一家系23名成员的外周静脉血,提取基因组DNA,选取与已知常染色体显性遗传的先天性白内障的候选基因CRYGD、GJA3,采用软件Linkage对该家系2个基因附近共10个STR位点进行两点法连锁分析,筛查这2个基因是否为此家系的致病基因。结果对该家系的基因连锁分析表明,基因CRYGD、JGA3所有编码区及外显子与内含子交界处均未发现基因序列的突变。结论基因CRYGD、GJA3不是该家系的遗传致病基因,对该家系需进一步做全基因组扫描,以发现致病基因在染色体上的可疑区间。     

常染色体显性先天性白内障一家系致病基因的连锁分析

背景先天性白内障约1／3的病例是由遗传所致,已发现遗传性白内障有着极为明显的遗传异质性,了解先天性白内障的致病基因对其基因治疗极为重要。目的分析一个具有常染色体显性遗传特点的先天性白内障家系的临床表型特征,进行已知致病基因的筛查定位。方法对遗传性先天性白内障一家系共16名成员眼部进行详细的临床检查,包括6例患者,确定为本家系白内障患者的临床表型。收集其中11名家系成员的血液样本提取DNA,包括3名正常家系成员及其配偶、5例患者。利用连锁分析进行排除定位,并采用Schuelke报道的新方法,只合成普通引物及一种荧光标记的通用引物M13,进行聚合酶链反应（PCR）,对连锁区域内的候选基因进行基因序列分析。结果本家系的白内障遗传方式符合常染色体显性遗传特征。基因连锁分析表明,在D22S315得到最高LOD值为1．20,在D16S3068得到LOD值为0．6。CRYBB2基因所有编码区及外显子与内含子交界处未发现基因序列突变。结论本家系初步排除了CRYBB2基因与此家系先天性白内障的相关性。对这个家系的基因定位需要更进一步的全基因组扫描,以发现致病基因在染色体上的可疑区间。连锁分析中进行微卫星位点的PCR扩增时,利用合成荧光标记的通用引物M13,可以显著降低成本,并取得同样的实验结果。     

常染色体显性遗传核性白内障合并小角膜的CRYAA基因突变研究

Objective To identify the gene mutation in a four-generation Chinese family with autosomal dominant congenital cataract associated with microcornea. Methods Experimental research.Twelve members in this family (including six affected and six unaffected individuals) were enrolled into this study. They underwent full ophthalmological and clinical examinations to rule out any concomitant disorders.Blood samples were collected and genomic DNA was extracted. Microsatellite markers near the reported loci,which are associated with congenital cataract and microcornea were selected and amplified from DNA samples using polymerase chain reaction. Linkage analysis was performed. The exons and exon/intron junction of candidate gene in the related chromosome were sequenced. The product of the first exon was digested by ApaL Ⅰ restriction enzyme to certify the mutation. Results The phenotype studied in this family was nuclear cataract accompanied with microcornea. At markers D21S1885 and D21S1890 near the locus 21q22. 3, the affected members had the same allele, but the unaffected did not. The Lod scores were 2. 11in both markers, indicating that this locus were linked to the congenital cataract in this family. DNA sequencing of candidate gene CRYAA showed a heterozygous mutation c. 34C ＞ T in exon 1, which led to condon 12 in peptide chain encoding arginine substituted by cysteine. ApaL Ⅰ enzyme digestion certified that all of the affected members had the same mutation c. 34C ＞T, but the unaffected and normal individuals did not. Conclusion Mutation (p. R12C) of CRYAA is the genetic change that causes the occurrence of congenital cataract with microcornea in this family.     

A novel mutation of LIM2 causes autosomal dominant membranous cataract in a Chinese family

AIM: To determine the prevalence and associations of non-retinopathy ocular conditions among older Australian adults with diabetes. METHODS: Multistage random-cluster sampling was used to select 3098 non-indigenous Australians aged 50y or older (46.4% male) and 1738 indigenous Australians aged 40y or older (41.1% male) from all levels of geographic remoteness in Australia. Participants underwent a standardised questionnaire to ascertain diabetes history, and a clinical examination to identify eye disease. We determined the prevalence of uncorrected refractive error, visually significant cataract, cataract surgery, age-related macular degeneration, glaucoma, ocular hypertension, retinal vein occlusion and epiretinal membrane among those with and without self-reported diabetes. RESULTS: Participants with self-reported diabetes had a higher prevalence of cataract surgery than those without diabetes (28.8% vs 16.9%, OR 1.78, 95%CI: 1.35-2.34 among non-indigenous Australians, and 11.3% vs 5.2%, OR 1.62, 95%CI: 1.22-2.14 among indigenous Australians). Diabetic retinopathy (DR) increased the odds of cataract surgery among self-reported diabetic indigenous and non-indigenous Australians (OR 1.89, P=0.004 and OR 2.33, P<0.001 respectively). Having diabetes for ≥20y and having vision-threatening DR increased the odds of cataract surgery among indigenous Australians with diabetes (OR 3.73, P=0.001 and 7.58, P<0.001, respectively). CONCLUSION: Most non-retinopathy ocular conditions are not associated with self-reported diabetes. However, to account for Australia’s worsening diabetes epidemic, interventions to reduce the impact of diabetes-related blindness should include increased cataract surgery services.     

常染色体显性遗传核性白内障合并小角膜的CRYAA基因突变研究

Objective To identify the gene mutation in a four-generation Chinese family with autosomal dominant congenital cataract associated with microcornea. Methods Experimental research.Twelve members in this family (including six affected and six unaffected individuals) were enrolled into this study. They underwent full ophthalmological and clinical examinations to rule out any concomitant disorders.Blood samples were collected and genomic DNA was extracted. Microsatellite markers near the reported loci,which are associated with congenital cataract and microcornea were selected and amplified from DNA samples using polymerase chain reaction. Linkage analysis was performed. The exons and exon/intron junction of candidate gene in the related chromosome were sequenced. The product of the first exon was digested by ApaL Ⅰ restriction enzyme to certify the mutation. Results The phenotype studied in this family was nuclear cataract accompanied with microcornea. At markers D21S1885 and D21S1890 near the locus 21q22. 3, the affected members had the same allele, but the unaffected did not. The Lod scores were 2. 11in both markers, indicating that this locus were linked to the congenital cataract in this family. DNA sequencing of candidate gene CRYAA showed a heterozygous mutation c. 34C ＞ T in exon 1, which led to condon 12 in peptide chain encoding arginine substituted by cysteine. ApaL Ⅰ enzyme digestion certified that all of the affected members had the same mutation c. 34C ＞T, but the unaffected and normal individuals did not. Conclusion Mutation (p. R12C) of CRYAA is the genetic change that causes the occurrence of congenital cataract with microcornea in this family.     

常染色体显性遗传性白内障一家系的临床遗传学及基因定位研究

目的 鉴定导致一个4代遗传性核性白内障大家系的遗传学缺陷.方法 详细收集家族史及临床资料.提取所有家系成员外周血DNA,应用微卫星标记进行基因型建立,并应用连锁分析软件包进行连锁分析.结果 在微卫星标记D1S1 156(LOD score[z]=2.36,recombination fraction[θ]=0.00)和D1S514(LOD score[z]=2.12,recombination frac-tion[θ]=0.00)得到有意义的连锁结果 .单倍体图形的建立显示致病基因位于D1S2 888和D1S3 466之间40 Mb的区域内.该区段内含有位于1q21-25编码缝隙连接蛋白50的GJA8.结论 本研究家系的遗传性核性白内障发生符合常染色体显性遗传规律,并将导致这个大家系发生常染色体显性遗传性白内障的致病基因定位在1q21-25的40 Mb范围内.     

常染色体显性遗传核性白内障合并小角膜的CRYAA基因突变研究

目的 研究一个4代常染色体显性遗传先天性核性白内障伴小角膜家系的致病基因.方法 实验研究.对12例家系成员(6例患者,6例非患者)进行眼部检查并采集静脉血,提取基因组DNA.在已知的与先天性白内障伴小角膜相关致病基因附近选择微卫星标记,进行聚合酶链反应扩增-变性聚丙烯酰胺凝胶电泳,并进行基因型分析和连锁分析.对连锁区域内候选基因的外显子、外显子和内含子交界区进行测序.限制性内切酶ApaL Ⅰ法在全部家系成员和正常人群中验证突变.结果 该家系患者表型为先天性核性白内障伴小角膜;在染色体21q22.3区域的D21S1885和D21S1890两个标记,家系患者均有共享基因型,并且两点连锁分析Lod值为2.11,提示该位点与家系致病基因连锁;对此区域内候选基因CRYAA测序发现cDNA序列第34位碱基存在C＞T杂合突变(c.34C＞T),导致其编码肽链第12位精氨酸变为半胱氨酸(p.R12C).ApaL Ⅰ酶切验证家系患者均携带c.34C＞T突变,家系中及对照正常个体均不携带此突变.结论 CRYAA的p.R12C突变可能是该先天性白内障伴小角膜家系发病的遗传基础.

Abstract：

Objective To identify the gene mutation in a four-generation Chinese family with autosomal dominant congenital cataract associated with microcornea. Methods Experimental research.Twelve members in this family (including six affected and six unaffected individuals) were enrolled into this study. They underwent full ophthalmological and clinical examinations to rule out any concomitant disorders.Blood samples were collected and genomic DNA was extracted. Microsatellite markers near the reported loci,which are associated with congenital cataract and microcornea were selected and amplified from DNA samples using polymerase chain reaction. Linkage analysis was performed. The exons and exon/intron junction of candidate gene in the related chromosome were sequenced. The product of the first exon was digested by ApaL Ⅰ restriction enzyme to certify the mutation. Results The phenotype studied in this family was nuclear cataract accompanied with microcornea. At markers D21S1885 and D21S1890 near the locus 21q22. 3, the affected members had the same allele, but the unaffected did not. The Lod scores were 2. 11in both markers, indicating that this locus were linked to the congenital cataract in this family. DNA sequencing of candidate gene CRYAA showed a heterozygous mutation c. 34C ＞ T in exon 1, which led to condon 12 in peptide chain encoding arginine substituted by cysteine. ApaL Ⅰ enzyme digestion certified that all of the affected members had the same mutation c. 34C ＞T, but the unaffected and normal individuals did not. Conclusion Mutation (p. R12C) of CRYAA is the genetic change that causes the occurrence of congenital cataract with microcornea in this family.     

Management of posterior polar cataract

In this technique for managing posterior polar cataract, extreme care is taken not to overpressurize the anterior chamber or capsular bag to prevent posterior capsule rupture. Minimal hydrodissection and hydrodelineation are performed. The nucleus is extracted using minimal ultrasound energy. Viscodissection is used as a primary technique to mobilize the epinucleus and cortex. A protective layer is preserved over the posterior polar region until the conclusion of the extraction procedure to minimize the risk of loss of lens material into the vitreous cavity in the case of a capsule defect.     

一特殊表型的常染色体显性遗传先天性白内障家系致病基因的筛选与鉴定

背景遗传因素是先天性白内障的主要致病因素之一,致病基因的筛查是研究先天性白内障发病分子机制的重要步骤。目的明确一结晶样晶状体混浊的先天性常染色体显性遗传白内障（ADCC）家系的致病基因。方法收集山西省榆社县一个四代先天性结晶样混浊白内障家系22名成员,其中患者10例。在获得知情同意后,该家系成员进行家系调查以确定遗传方式。经裂隙灯显微镜检查和常规眼科临床检查确定表型。采集其中17例家系成员的外周静脉血5ml并提取DNA,ADCC的17个已知致病基因周围选取22个荧光标记的微卫星,通过对微卫星标志物的扩增和基因型分析对该家系进行基因两点连锁分析,并计算对数优势评分（LOD）值。对筛选的候选基因进行直接测序分析。结果该家系患者晶状体混浊表型非常类似,家系分析表明为四代垂直遗传,符合单基因ADCC的特点。基因连锁分析提示,该家系与微卫星D2S325位点和D2S2358位点连锁,最大LOD值分别为1．20（0=0）和0．22（0=0）,位于此区域内的CRYGD基因测序后发现一个已经报道的错义突变c．C70A（p．P23T）。结论CRYGD基因P23T突变是该家系结晶样晶状体混浊的致病原因。     

Phacoemulsification in eyeswith posterior polar cataract

Purpose:To evaluate the results of phacoemulsification in eyes with posterior polar developmental cataract and to appraise the strategy for surgical management.Setting:Iladev Cataract & IOL Research Centre, Raghudeep Eye Clinic, Ahmedabad, India.Method:This prospective study comprised 25 consecutive patients. All surgerieswere performed by 1 surgeon. Endophacoernulsification was carried out after hydrodelineation. Hydrodissection or rotation was not attempted. A 2-port vitrectomy was performed when necessary.Results:Mean follow-up was 13.72 months (range 1 to 22 months). Nine patients (36%) developed posterior capsule rupture and 8 (32%) revealed plagues. An intraocular lens (IOL) was implanted in all 25 eyes. In of 9 cases with rupture, the haptics were placed, in the sulcus; in 1 case, the IOL was placed in the bag. One patient in the capsular rupture group developed macular edema 3 weeks postoperatively that responded to conservative treatment. Among 25 patients, 18 had a visual: acuity of 20/20 to 20/30 and 6, 20/80 to 20/120. These 6 patients had residual posterior capsule plaque. All except 2 patients with plaque, required a neodymium YAG capsulotomy. In these patients, visual acuity improved to 20/30. In 1 patient, with microcornea, acuity did not improve to beyond 20/120.Conclusion:This study confirms the predisposition to posterior capsule rupture in eyes with posterior polar cataracts. Careful surgical planning produces satisfactory technical and visual outcomes.     

后极性白内障的超声乳化吸出术

目的探讨后极性白内障的超声乳化吸出术特殊手术方法。方法设计了不作水分离，只作水分层，囊袋上劈核，保护后极部后囊等特殊手术方法完成后极性白内障的超声乳化吸出术，避免后囊破裂导致的晶状体核下沉、玻璃体脱失等手术并发症。结果明显降低了后极性白内障术中并发症。结论作者设计的特殊手术方法减少了后极性白内障超声乳化吸出术手术风险，具有一定优越性。