PURPOSE-To evaluate the clinical features associated with the RP10 form of autosomaldominant retinitis pigmentosa in 11 affected members of various ages from one family with a defined IMPDH1 mutation (Asp226Asn).
DESIGN-Prospective, observational case series.METHODS-Visual function assessment included visual acuity, color vision, visual field, dark adaptometry, full-field electroretinography (ffERG), and multifocal electroretinography (mfERG). Ophthalmologic examinations, fundus photography, and optical coherence tomographic scans were also performed. Blood samples were obtained to screen for basic immune function.RESULTS-Visual acuity was slightly reduced in the teenage years and substantially reduced in association with cystoid macular edema (CME) at all ages. Color defects were observed in three patients (one teen, two adults). Dark-adapted thresholds were elevated. Visual fields were markedly constricted by age 40 (≤20 degrees). Rod and cone a-wave and b-wave ffERG responses were small or nondetectable by age 20, with greater rod than cone loss at all ages. The normal to significantly delayed ffERG cone b-wave implicit times in different patients were explained by their mfERG implicit times from the central retina. The amplification factors (log S) and recovery kinetics derived from the full-field rod a-waves were normal. Optical coherence tomography revealed subretinal fluid accumulation in the majority of eyes. Cystoid macular edema was diagnosed in four patients. No unusual immunologic findings were noted.
CONCLUSIONS-TheAsp226Asn mutation is associated with a severe, early-onset form of retinal degeneration in members of this family.Autosomal-dominant retinitis pigmentosa (adRP) is a clinically and genetically heterogenous group of degenerative retinal disorders. To date, 14 genes have been identified in individuals with adRP accounting for approximately 50% of all cases (http://www.sph.uth.tmc.edu/RetNet/). The RP10 form has been reported in individuals of American and European (Spanish, Scottish, Irish, and Polish) origin, maps to the long arm of human chromosome 7 (q32.1), [1][2][3][4][5][6][7][8]
NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript associates 10 reduced the linkage interval to 3.4 Mb in two unrelated American families and identified a G-to-A transition at codon 226 of the IMPDH1 (inosine-5′-monophosphate dehydrogenase type 1) gene. The resulting Asp226Asn mutation is the most common in the IMPDH1 gene and occurs at a site that is evolutionarily highly conserved, consistent with a highly deleterious consequence of a missense mutation in this region. 10 IMPDH is an enzyme which functions as a homotetramer. IMPDH catalyzes the conversion of inosine monophosphate to xanthine monophosphate, a rate-limiting step in the de novo synthesis of guanine and adenine nucleotides. Xanthine monophosphate is subsequently converted into guanosine di-and triphosphate. There are two vertebrate forms of the enzyme, IMPDH1 and IMPDH2. IMPDH1 expression is believed to be uncha...