title: VSX1 (RINX) mutation with craniofacial anomalies, empty sella, corneal endothelial changes, and abnormal retinal and auditory bipolar cells.
abstract: OBJECTIVE
  To present a previously unreported African American family with 1 variation and 1 mutation of the homeobox transcription factor gene, VSX1 (RINX), and to describe the clinical features of family members.
  
  
  METHODS
  Family genotype and clinical studies.
  
  
  METHODS
  A 3-generation family with 7 available family members.
  
  
  METHODS
  Blood was drawn from all available family members, and the VSX1 (RINX) gene was sequenced. Craniofacial abnormalities, central nervous system defects, anterior segment features, and retinal and auditory function were assessed.
  
  
  METHODS
  Main outcome measures included identification and molecular characterization of 1 variation and 1 mutation in VSX1 (RINX) of 4 affected family members (3 adults and 1 child). Craniofacial features were documented. Central neuroimaging was performed. Ophthalmologic findings were described. Retinal and auditory functions were quantified.
  
  
  RESULTS
  Two changes in VSX1 (RINX) were identified: a variation (R131S) not in a critical region and in few controls, and a mutation (A256S) in the critical CVC-domain and not in any controls. Both were present on 1 chromosome at 20p11.2 and were segregated with the 4 affected patients. Clinical features demonstrated extremely variable expressivity. Craniofacial features, including wide interpupillary distance and unusual pinnae, occurred in the 4 affected patients. Neuroimaging demonstrated that the propositus had an empty sella turcica, a posterior fossa cyst, an anterior encephalocele, hypertelorism, and severe hydrocephalus; her mother had a partially empty sella turcica, a small pituitary gland without any subarachnoid extension of fluid, and hypertelorism; and her older sister had hypertelorism but otherwise normal neuroimaging results. Anterior segment anomalies of the corneal endothelium were a constant finding in all affected family members. Electrophysiologic examination provided evidence for abnormal cone bipolar cells (visual evoked response and electroretinogram) in the adult affected patients and for abnormal auditory bipolar cells (audiogram and audio-evoked brainstem response) in the propositus.
  
  
  CONCLUSIONS
  The new mutation in the VSX1 (RINX) gene described in this report results in abnormal craniofacial features, absence of the roof of the sella turcica, and anomalous development of the corneal endothelium. This mutation also impacts on the maintenance of cone bipolar cells of the visual system and of bipolar cells of the auditory system.
authors.affiliation: Department of Ophthalmology and Visual Science, University of Texas-Houston Medical School, 6410 Fannin, Suite 920, Houston, TX 77030-5204, USA. Helen.A.Mintz-Hittner@uth.tmc.edu
authors.forename: Helen A
authors.initials: HA
authors.lastname: Mintz-Hittner
authors.forename: Elena V
authors.initials: EV
authors.lastname: Semina
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Frishman
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Prager
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Murray
mesh_terms: D000015:Abnormalities, Multiple; D000328:Adult; D000595:Amino Acid Sequence; D001308:Auditory Perceptual Disorders / Q000175:diagnosis / Q000235:genetics*; D019465:Craniofacial Abnormalities / Q000235:genetics; D004596:Electroretinography; D004652:Empty Sella Syndrome / Q000235:genetics*; D004728:Endothelium, Corneal / Q000002:abnormalities* / Q000473:pathology; D016057:Evoked Potentials, Auditory, Brain Stem; D005074:Evoked Potentials, Visual; D005124:Eye Abnormalities / Q000175:diagnosis / Q000235:genetics; D005136:Eye Proteins / Q000235:genetics*; D005260:Female; D014644:Genetic Variation; D018398:Homeodomain Proteins / Q000235:genetics*; D006801:Humans; D007395:Interneurons / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008969:Molecular Sequence Data; D009154:Mutation; D010375:Pedigree; D012164:Retinal Diseases / Q000175:diagnosis / Q000235:genetics*
chemical_list: D005136:Eye Proteins; D018398:Homeodomain Proteins; C491583:VSX1 protein, human