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(Investigative Ophthalmology and Visual Science. 2004;45:3683-3689.)
© 2004 by The Association for Research in Vision and Ophthalmology, Inc.
DOI:  10.1167/iovs.04-0550
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Mutations of VMD2 Splicing Regulators Cause Nanophthalmos and Autosomal Dominant Vitreoretinochoroidopathy (ADVIRC)

Jill Yardley,1,2 Bart P. Leroy,2,3,4 Niki Hart-Holden,1,2 Bart A. Lafaut,5 Bart Loeys,4 Ludwine M. Messiaen,4 Rahat Perveen,1 M. Ashwin Reddy,6 Shomi S. Bhattacharya,6 Elias Traboulsi,7 Diana Baralle,8 Jean-Jacques De Laey,3 Bernard Puech,9 Philippe Kestelyn,3 Anthony T. Moore,6 Forbes D. C. Manson,1,10,11 and Graeme C. M. Black1,2,10,11

1From the Academic Unit of Medical Genetics and Regional Genetics Service, St. Mary’s Hospital, Manchester, United Kingdom; 3Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium; 4Centre for Medical Genetics, Ghent University Hospital, Ghent, Belgium; 5Department of Ophthalmology, St-Jan General Hospital, Bruges, Belgium; 6Institute of Ophthalmology, London, United Kingdom; 7Department of Ophthalmic Research, Cole Eye Institute, Cleveland, Ohio; 8Department of Medical Genetics, Addenbrookes Hospital, Cambridge, United Kingdom; 9Exploration Fonctionelle de la Vision, Centre Hospitalier Régional Universitaire, Hôpital Roger Salengro, Lille Cedex, France; 10Academic Department of Ophthalmology, Manchester Royal Eye Hospital, Manchester, United Kingdom; 11Centre for Molecular Medicine, University of Manchester, Manchester, United Kingdom.

PURPOSE. To investigate the genetic basis of autosomal dominant vitreoretinochoroidopathy (ADVIRC), a rare, inherited retinal dystrophy that may be associated with defects of ocular development, including nanophthalmos.

METHODS. A combination of linkage analysis and DNA sequencing in five families was used to identify disease-causing mutations in VMD2. The effect of these mutations on splicing was assessed using a minigene system.

RESULTS. Three pathogenic sequence alterations in VMD2 were identified in five families with nanophthalmos associated with ADVIRC. All sequences showed simultaneous missense substitutions and exon skipping.

CONCLUSIONS. VMD2 encodes bestrophin, a transmembrane protein located at the basolateral membrane of the RPE, that is also mutated in Best macular dystrophy. We support that each heterozygous affected individual produces three bestrophin isoforms consisting of the wild type and two abnormal forms: one containing a missense substitution and the other an in-frame deletion. The data showed that VMD2 mutations caused defects of ocular patterning, supporting the hypothesized role for the RPE, and specifically VMD2, in the normal growth and development of the eye.




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