The calcium-binding epidermal growth factor-like (cbEGF) domain is a widely occurring module in proteins of diverse function. Amino acid substitutions that disrupt its structure or calcium affinity have been associated with various disorders. The extracellular portion of CRB1, the human homologue of Drosophila Crumbs, exhibits a modular domain organization that includes EGF and cbEGF domains. The N1317H substitution in the 19th cbEGF domain of CRB1 is associated with the serious visual disorder Leber congenital amaurosis. We have investigated the structure and Ca 2؉ binding of recombinant wild-type and N1317H CRB1 fragments (EGF18-cbEGF19) using NMR and find that Ca 2؉ binding is altered, resulting in disruption of long range interactions between adjacent EGF domains in CRB1. From these observations, we propose that this substitution affects the structural integrity of CRB1 in the inter-photoreceptor matrix of the retina, where it is expressed. Furthermore, we identify disease-causing substitutions in other cbEGF-containing proteins that are likely to result in similar disruption of interdomain packing, supporting the hypothesis that the tandem cbEGF domain linkages are critical for the structure and function of proteins containing cbEGF domains.CRB1 is the human homologue of Drosophila Crumbs, a well conserved gene with homologues across multiple phyla (1). In Drosophila, the Crumbs protein is expressed in all ectodermally derived epithelial cells, which includes photoreceptors, and its disruption results in a discontinuous cuticle and extensive cell death (2, 3). In higher organisms, the orthologues CRB2 and CRB3 have a similarly broad expression profile (4, 5), but CRB1 is restricted to brain and retina (6). The expression of CRB1 in retina has been localized to the subapical region adjacent to the outer limiting membrane, a region analogous to the zonula adherens in Drosophila where a similar localization of the protein is observed (7-9).Unsurprisingly from its localization in humans, mutations in CRB1 have been associated with a number of visual disorders including retinitis pigmentosa with (10, 11) or without (11, 12) preserved para-arteriolar retinal pigment epithelium, paravenous pigmented chorioretinal atrophy (13), and Leber congenital amaurosis (LCA) 3 (14, 15). Of these disorders, LCA is the most severe form of inherited retinal dystrophy and is characterized by severe visual impairment from birth or very early life and a decreased or absent electroretinogram response (16). LCA is generally inherited in an autosomal recessive manner (16). Mutations in CRB1 represent a significant cause (10 -13%) of LCA among the identified LCA loci; missense, nonsense, and splice site mutations together with insertions and deletions have been identified (17, 18). The majority of disease-associated missense mutations in CRB1 have been localized to the extracellular region of the protein, and substitutions associated with the various disorders are approximately evenly distributed along its length, with no unambiguous g...