We have identified a GRAP variant (c.311A>T; p.Gln104Leu) cosegregating with autosomal recessive nonsyndromic deafness in two unrelated families. GRAP encodes a member of the highly conserved growth factor receptor-bound protein 2 (GRB2)/Sem-5/drk family of proteins, which are involved in Ras signaling; however, the function of the growth factor receptor-bound protein 2 (GRB2)-related adaptor protein (GRAP) in the auditory system is not known. Here, we show that, in mouse, Grap is expressed in the inner ear and the protein localizes to the neuronal fibers innervating cochlear and utricular auditory hair cells. Downstream of receptor kinase (drk), the Drosophila homolog of human GRAP, is expressed in Johnston's organ (JO), the fly hearing organ, and the loss of drk in JO causes scolopidium abnormalities. drk mutant flies present deficits in negative geotaxis behavior, which can be suppressed by human wild-type but not mutant GRAP. Furthermore, drk specifically colocalizes with synapsin at synapses, suggesting a potential role of such adaptor proteins in regulating actin cytoskeleton dynamics in the nervous system. Our findings establish a causative link between GRAP mutation and nonsyndromic deafness and suggest a function of GRAP/drk in hearing.adaptor proteins | drk | Drosophila | GRAP | nonsyndromic hearing loss H earing loss (HL) is the most common sensory disorder with an incidence of 1-3 in 1,000 births (1). Genetic factors show high heterogeneity and are responsible for more than half of the cases with congenital HL (2). It is estimated that 70% of genetic HL is nonsyndromic sensorineural HL and mostly shows an autosomal recessive inheritance pattern (1, 3). The identification of DNA variants causing HL is rapidly advancing due to technological developments in genome sequencing. However, delineating causality for a novel rare variant in a gene not previously associated with HL is difficult and often requires functional studies in model organisms.The mouse has been shown to be an excellent model organism to study human deafness due to the anatomic and physiologic similarities of their auditory systems with those of humans (4). Recent studies of Drosophila's hearing organ, Johnston's organ (JO), highlight the molecular and genetic conservations of the mechanosensory transduction in flies and vertebrates (5, 6).Several key genes first identified in Drosophila, such as atonal, crinkled, and nanchung, that are required for the specification or function of auditory cell types in the JO are also important for the normal development or function of the vertebrate ear (5). In addition, 20% of Drosophila auditory-associated genes have human homologs and are implicated in hearing disorders (7).In this paper, via exome and genome sequencing of over 60 consanguineous multiplex families with autosomal recessive nonsyndromic HL, which are negative for variants in known deafness genes (details of families are given in SI Appendix, Table S1), we have identified a GRAP variant in two unrelated Turkish families. We show that G...