The clinical features of all affected individuals with diagnosed RP are listed in
Table 2. The diagnosis of RP was made by electroretinography (ERG) and visual field testing for progressive loss in photoreceptor function. The average age at onset was 7 to 8 years, although some individuals were affected slightly later, at 10 to 11 years of age. Affected individuals have narrowing of the visual fields and night blindness accompanied by loss of visual acuity. Fundus photographs of affected individuals show changes typical of RP, including a waxy, pale optic disc, attenuation of retinal arteries, and bone spicule pigment deposits in the mid periphery of the retina, as shown in individual 21, a 14-year-old affected girl (
Fig. 1A), and individual 19, a 45-year-old affected man (
Fig. 1B). The visual fields of the affected individuals progressively narrowed with age, eventually leading to loss of peripheral vision with relative preservation of central vision, even in the 14-year-old girl (
Figs. 1C,
1D). Affected individuals had typical RP changes on ERG including loss of both the rod and, in more advanced cases, cone responses (
Fig. 2). Results from individual 19 (45 years old and severely affected) showed little detectable activity under either photopic or scotopic conditions. However, the photopic ERG and 30-MHz flicker response from individual 21 (14 years old and more mildly affected) showed preservation of cone cell function, whereas the rod response decreased under scotopic conditions, consistent with a predominantly rod pathology. A multifocal ERG in individual 21 also showed functional preservation in the central macular area and decreased signal in the peripheral macular area (
Fig. 1D).
A candidate gene screen was performed using a set of 34 polymorphic markers adjacent to or flanking known candidate genes for RP. In the candidate screen, all markers showed negative lod scores except that RP cosegregated with alleles of microsatellite marker
D2S160, yielding a maximum lod score of 1.4 at θ = 0 (
Table 3). For fine mapping additional markers,
D2S233 and
D2S2216 were analyzed as shown in
Table 3 and
Figure 3A. Two-point linkage analyses gave further evidence for linkage to markers on chromosome 2, region q11.2, with maximum lod scores of 3.5 with
D2S2333 at θ = 0 and 3.47 with
D2S2216 at θ = 0.
Visual inspection of the haplotypes in this region support the linkage analysis (
Fig. 3A), localizing the disease to a region of 2q11.2 flanked by
D2S286 and
D2S347. Recombination events at
D2S286, either in affected individuals 5 and 8 (indicated on haplotype bars) or possibly in affected individual 3 (not indicated in haplotype bars) set the centromeric boundary. Similarly, recombination events at
D2S347 in affected individual 21 and individuals 5 and 8 set the telomeric boundary of the linked interval. Once more, this recombination could have taken place either in affected individuals 5 and 8 (indicated on haplotype bars) or possibly in affected individual 3 and unaffected individual 11. In either event, the linked interval extends from
D2S286 proximally to
D2S347 distally.
The linked region on 2q11.2 harbors
ASCC3L1 (NM_014014), a known component of the tri-snRNP component of the spliceosome. The
ASCC3L1 gene contains 45 exons and encodes a 2136 amino acid protein (NP_054733). Sequencing of
ASCC3L1 showed a single base transversion in exon 25: c.3269G→T, predicted to result in a nonconservative change in the protein amino acid sequence: p.R1090L (
Fig. 4). Sequencing of
ASCC3L1 in 100 unaffected control individuals of matched (Han Chinese) ethnicity (200 chromosomes) did not reveal this sequence change. This mutation resulted in loss of a
HpaII site that cosegregated with the disease in all affected individuals (
Fig. 3B).
R1090 is conserved among
Homo sapiens,
Pongo abelii,
Mus musculus,
Equus caballus,
Bos taurus,
Danio rerio, and
Dictyostelium discoideum (
Fig. 4C). ASCC3L1 protein sequences for
Pongo abelii,
Mus musculus,
Gallus gallus,
Culex quinquefasciatus, and
Strongylocentotus purpuratus, available from NCBI, did not align in this region of the protein and are not shown. However, R1090 was conserved when sequences predicted from the corresponding mRNAs of
Pongo abelii,
Mus musculus, and
Gallus gallus were aligned (
Fig. 4C). The average percent identity for these sequences is approximately 85%, with the sequence of
Dictyostelium discoideum being most divergent at 52%. The R1090L amino acid change scores a −4 on a blosum80 matrix
34 and a PSIC profile score of 3.2, calculated by the POLYPHEN program.
35 Both of these values indicate that this amino acid substitution is likely to have a deleterious effect on the protein.