■基于基因的遗传性视网膜营养不良(IRD)疗法即将推出。在实质性视力丧失之前的治疗将优化结果。确定儿童的常见表型和致病基因至关重要。这项研究调查了这些在儿科IRD中的频率,目的是突出未来治疗的相关群体。
■诊断,遗传,和人口统计数据,从20岁以下IRD患者的医疗图表中收集(n=624,男性占63%),在荷兰RD5000数据库中注册,进行了分析,以确定表型和遗传原因的频率。表型分为非综合征型(进行性和静止型IRD)和综合征型IRD。遗传原因,主要通过全外显子组测序(WES)确定,进行了检查。此外,我们调查了在遗传未解决的病例中定期重新分析WES数据的实用性.
■注册时的中位年龄为13岁(四分位数范围,9-16).色素性视网膜炎(RP;n=123,20%),Leber先天性黑蒙(LCA;n=97,16%),X-连锁视网膜裂(n=64,10%),色盲(n=63,10%)是最常见的表型。在76%的基因检查患者中确定了遗传原因(n=473)。最常见的致病基因是RS1(n=32,9%),CEP290(n=28,8%),CNGB3(n=21,6%),和CRB1(n=17,5%)。重新分析遗传数据后的诊断产量增加了7%。
■与大多数国家一样,RP和LCA是荷兰最著名的儿科IRD,RS1和CEP290中的变异体是最突出的IRD基因型。我们的发现可以指导治疗开发针对年轻患者需求最大的疾病和基因。
Gene-based therapies for inherited retinal dystrophies (IRDs) are upcoming. Treatment before substantial vision loss will optimize outcomes. It is crucial to identify common phenotypes and causative genes in children. This study investigated the frequency of these in pediatric IRD with the aim of highlighting relevant groups for future therapy.
Diagnostic, genetic, and demographic data, collected from medical charts of patients with IRD aged up to 20 years (n = 624, 63% male), registered in the Dutch RD5000 database, were analyzed to determine frequencies of phenotypes and genetic causes. Phenotypes were categorized as nonsyndromic (progressive and stationary IRD) and syndromic IRD. Genetic causes, mostly determined by whole-exome sequencing (WES), were examined. Additionally, we investigated the utility of periodic reanalysis of WES data in genetically unresolved cases.
Median age at registration was 13 years (interquartile range, 9-16). Retinitis pigmentosa (RP; n = 123, 20%), Leber congenital amaurosis (LCA; n = 97, 16%), X-linked retinoschisis (n = 64, 10%), and achromatopsia (n = 63, 10%) were the most frequent phenotypes. The genetic cause was identified in 76% of the genetically examined patients (n = 473). The most frequently disease-causing genes were RS1 (n = 32, 9%), CEP290 (n = 28, 8%), CNGB3 (n = 21, 6%), and CRB1 (n = 17, 5%). Diagnostic yield after reanalysis of genetic data increased by 7%.
As in most countries, RP and LCA are the most prominent pediatric IRDs in the Netherlands, and variants in RS1 and CEP290 were the most prominent IRD genotypes. Our findings can guide therapy development to target the diseases and genes with the greatest needs in young patients.