title: Severe retinal degeneration in women with a c.2543del mutation in ORF15 of the RPGR gene.
abstract: OBJECTIVE
  To describe the genotype-phenotype correlation and serial observations in a five-generation Czech family with X-linked retinitis pigmentosa (XLRP) associated with severe visual impairment in women.
  
  
  METHODS
  Comprehensive ophthalmological examination including spectral domain optical coherence tomography (SD-OCT) was performed. Based on the pedigree structure and women being severely affected, autosomal dominant inheritance was suspected, and screening for known mutations by genotyping microarray was performed. Subsequently, direct sequencing of ORF15 RPGR was undertaken.
  
  
  RESULTS
  Eighteen family members (nine women and nine men) were examined. A pathogenic variant, c.2543del in ORF15 of RPGR, was found to segregate with disease. The oldest woman and her two sisters had no perception of light in their sixth decade. Four women and five men had signs and symptoms of typical XLRP, including moderate to high myopia. Three other women also had moderate to high myopia and myopic astigmatism but without the presence of bone spicule-like formation. Severe disruption of macular architecture on SD-OCT was equally common in both sexes. Only one 32-year-old female carrier had clinically normal findings. Subfoveal choroidal thickness was decreased in all affected men and in all female carriers, except the only carrier with a normal fundus examination.
  
  
  CONCLUSIONS
  The c.2543del mutation in ORF15 of RPGR is associated with a severe phenotype in the women in this family. The presence of a significant myopic refractive error, in the absence of male-to-male transmission, may be indicative of X-linked inheritance. Measurements of choroidal thickness may help in clinically identifying carrier status.
authors.affiliation: Department of Ophthalmology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic ; Laboratory of the Biology and Pathology of the Eye, Institute of Inherited Metabolic Disorders; First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.
authors.forename: Bohdan
authors.initials: B
authors.lastname: Kousal
authors.affiliation: Department of Ophthalmology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.
authors.forename: Pavlina
authors.initials: P
authors.lastname: Skalicka
authors.affiliation: Department of Ophthalmology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.
authors.forename: Lucie
authors.initials: L
authors.lastname: Valesova
authors.affiliation: Regional Molecular Genetics Service, St Mary's Hospital, Manchester, United Kingdom.
authors.forename: Tracy
authors.initials: T
authors.lastname: Fletcher
authors.affiliation: Regional Molecular Genetics Service, St Mary's Hospital, Manchester, United Kingdom.
authors.forename: Niki
authors.initials: N
authors.lastname: Hart-Holden
authors.affiliation: Regional Molecular Genetics Service, St Mary's Hospital, Manchester, United Kingdom.
authors.forename: Anna
authors.initials: A
authors.lastname: O'Grady
authors.affiliation: UCL Institute of Ophthalmology, London, United Kingdom.
authors.forename: Christina F
authors.initials: CF
authors.lastname: Chakarova
authors.affiliation: UCL Institute of Ophthalmology, London, United Kingdom ; Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Michel
authors.initials: M
authors.lastname: Michaelides
authors.affiliation: UCL Institute of Ophthalmology, London, United Kingdom.
authors.forename: Alison J
authors.initials: AJ
authors.lastname: Hardcastle
authors.affiliation: Department of Ophthalmology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic ; Laboratory of the Biology and Pathology of the Eye, Institute of Inherited Metabolic Disorders; First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic ; UCL Institute of Ophthalmology, London, United Kingdom.
authors.forename: Petra
authors.initials: P
authors.lastname: Liskova
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001483:Base Sequence; D002648:Child; D002829:Choroid / Q000378:metabolism / Q000473:pathology; D005136:Eye Proteins / Q000235:genetics*; D005260:Female; D005799:Genes, Dominant; D050172:Genes, X-Linked; D006579:Heterozygote; D006801:Humans; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D016366:Open Reading Frames; D010375:Pedigree; D012160:Retina / Q000378:metabolism* / Q000473:pathology; D012174:Retinitis Pigmentosa / Q000235:genetics* / Q000473:pathology; D017384:Sequence Deletion; D012720:Severity of Illness Index; D012737:Sex Factors; D041623:Tomography, Optical Coherence
chemical_list: D005136:Eye Proteins; C099929:RPGR protein, human