Cataracts are a significant public health problem. Here, we describe the genetic alteration responsible for a progressive form of cataract, segregating as an autosomal dominant trait in a three-generation pedigree. Unlike most autosomal dominant cataracts, these are not clinically apparent at birth but are initially observed in the first year or two of life. The opacification evolves relatively slowly, generally necessitating removal of the lens in childhood or early adolescence. A genome-wide search in our kindred revealed linkage at 2q33-35 where the ␥-crystallin gene cluster resides. A single base alteration resulting in an Arg-14 3 Cys (R14C) substitution in ␥D-crystallin was subsequently identified. Protein modeling suggests that the effect of this mutation is a subtle one, affecting the surface properties of the crystallin molecule rather than its tertiary structure, consistent with the fact that the patients' lenses are normal at birth. This is the first gene defect shown to be responsible for a noncongenital progressive cataract, and studying the defective protein should teach us more about the mechanisms underlying cataract formation.A number of inherited cataracts are known in both humans and animals (1-3). These cataracts are present at birth and generally static, suggesting a structural defect affecting lens development. Some, like the human cerulean (3) and Coppocklike (4) cataracts involve synthesis of grossly misfolded lens crystallins. Others, like the human zonular pulverulent (5) and autosomal dominant congenital cataract (2) cataracts, involve more subtle mutations in other lens proteins that cause congenital opacities. All of the nonsyndromal human cataracts known to be linked to a genetic locus or caused by a specific genetic mutation are congenital. We have identified a threegeneration family with hereditary progressive cataracts transmitted as a fully penetrant autosomal dominant trait (Fig. 1). The lenses of affected individuals appear clear at birth, but with time focal opacities develop, suggesting some progressive alteration in protein structure or interaction. The cataract is always detectable by age 2.5 and consists of grayish-white punctate opacities in the nucleus and surrounding deep cortex, with intervening and peripheral clear lens (Fig. 1 A). The cataracts are 5 to 6 mm in diameter, and the opacities become more dense over time such that lens extraction is ultimately required because of decreased vision. Once the opaque lens is removed and a synthetic lens inserted, vision returns to 20͞20 and the eye functions normally.To find the trait locus in the family, we performed a genome-wide search for linkage, obtained evidence for linkage at 2q33-q35 where the ␥-crystallin genes are located, and looked for mutations in the two ␥-crystallins that are expressed at high levels in the developing lens-␥-crystallins C and D. We discovered a mutation in the ␥D-crystallin (␥D) gene that may alter its interaction with other proteins.
MATERIALS AND METHODSThese studies were performed ...