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Congenital or childhood cataract is a clinically and genetically highly heterogeneous lens disorder, with autosomal dominant inheritance being most common. Non-syndromic congenital cataracts have an estimated frequency of 1–6 per 10 000 live births,1 with one third of cases familial. Underlying mutations have identified 14 genes involved in the pathogenesis of isolated inherited cataract, including seven genes coding for crystallins (CRYAA, CRYAB, CRYBA1/A3, CRYBB1, CRYBB2, CRYGC, CRYGD), two for gap junctional channel protein (GJA3 and GJA8), two for lens membrane protein (LIM2 and MIP), one for beaded filament structural protein 2 (BFSP2), and one for glucosaminyl (N-acetyl) transferase 2 (GCNT2), one for heat shock transcription factor (HSF4). Here we report two novel heterozygous mutations in the GJA8 and GJA3 genes, in two Chinese families affected by autosomal dominant congenital nuclear cataracts.
We studied two Chinese three generation nuclear cataract families with a dominant pattern of inheritance. Clinical information and blood specimens were obtained from 16 members of family A (seven affected and nine unaffected), and 13 members of family B (nine affected and four unaffected). All participants had a full ocular assessment to document the phenotype. The phenotype of two families was characterised by bilateral nuclear cataract that was present at birth or developed during infancy. There was no evidence of other systemic or ocular defects.
After obtaining informed consent, we used a panel of 46 microsatellite markers to study 13 loci for known candidate genes of autosomal dominant congenital cataract susceptibility. The markers’ order and position were obtained from the Marshfield Genetic Database (www.marshfield.org/genetics/maps). Genotyping and data collection were conducted by ABI Prism GeneMapper v 3.0 software. We carried out two point linkage analysis using the MLINK program from the Linkage v.5.10 software package. It suggested positive linkage on chromosome 1q21.1 (lod score was 2.44 for marker D1S1167) in family A and chromosome 13q11–12 (lod score was 1.63 for marker D13S1326) in family B (tables 1 and 2).
There are two strong candidate genes in these regions, GJA8 encoding connexin 50 (Cx50) and GJA3 encoding connexin 46 (Cx46). We screened the mutation of candidate genes by bidirectional sequencing polymerase chain reaction products (300–700 bp). Sequence analysis of the entire coding region and immediate flanking regions detected a heterozygous 191 T → G (AF217524) transition in exon 2 of GJA8, resulting in a Val → Gly substitution at codon 64 (fig 1B). Sequence analysis of GJA3 detected a heterozygous 134 G → C (AF075290) transition, resulting in a Trp(TGG) →Ser (TCG) substitution at codon 45 (fig 2B). We examined all unaffected members of two families and 200 unrelated normal controls for GJA3 and GJA8 gene mutations but failed to detect these sequence variations.
Three connexins are expressed in the lens: connexin 43, connexin 46, and connexin 50. Gap junction intercellular communication is an essential part of the cell–cell communication system, which facilitates the exchange of ions, metabolites, signalling molecules, and other molecules with a molecular weight up to 1 kDa.2
Each gap junction channel is composed of two hemi-channels, or connexons, which dock in the extracellular space between adjacent cells, and each connexon comprised six integral transmembrane protein subunits known as connexins. All connexins have four transmembrane domains and two extracellular loops with cytoplasmic N and C termini.
To date, four heterozygous missense Cx50 mutations (P88S, E48K, R23T, and I247M) have been described, causing a nuclear or zonular nuclear pulverulent cataract.3–6 Six mutations of Cx46 have been associated with ADCC, including five missense mutations (F32L, P59L, N63S, P187L, and N188T) and one insertion mutation (1137 insC), which resulted in a frame shift at codon 380 (S380fs).7,8,9,10,11,12
Currently, two mutations occurred: Cx50 (G22R and D47A) results in cataracts in the mouse,13,14 but no dominant spontaneous or mutagen induced cataracts have been associated with the murine gene for GJA3 (Gja3).
V64G and W45S substitutions in two Chinese families occurred within evolutionarily conserved residues across species for Cx50 and Cx46 (figs 1E and 2E). These two mutant amino acid residue locate at the phylogenetically conserved extracellular loop 1 (E1). The two extracellular loops mediate docking between connexons and the E1 loop has also been shown to be important for determinant of the transjunctional voltage required for closure of gap junction pores.15 The mutant proteins may disrupt normal interactions between the two connexons, which may reduce resistance of the intercellular channel to the leakage of small ions.
In conclusion, two novel heterozygous mutations, V64G in Cx50 and W45S in Cx46, were identified in two Chinese families. These further expand the genetic and phenotypic heterogeneity of cataract.
Competing interests: none declared
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