PRGR基因研究进展

视网膜色素变性（ｒｅｔｉｎｉｔｉｓ ｐｉｇｍ ｅｎｔｏｓａ,ＲＰ）是一组与多个基因相关而任一单基因突变可致病的视网膜退化疾病,是造成失明的常见病因之一。患者多初起夜盲,随之发现周边视野逐渐缩小,成为管状视野,最终至完全失明。它以视网膜进行性感光细胞和色素上皮功能丧失为共同表现。临床上以眼底色素沉着和视网膜电图异常或无波为特征。不同基因所致的ＲＰ病在临床上无特征性差异。全球约有４００ 万人患有此病,我国的发病率约是１／３５００。该病的遗传方式有：常染色体隐性（Ａｕｔｏｓｏｍ ａｌＲｅｃｅｓｓｉｖｅ,ＡＲ）;常染色体显性（Ａｕｔｏｓｏｍ ａｌＤｏｍ ｉｎａｎｔ,ＡＤ）;Ｘ连锁隐性（Ｘ－ｌｉｎｋｅｄＲｅｃｅｓｓｉｖｅ,ＸＲ）和Ｘ连锁显性（Ｘ－ｌｉｎｋｅｄ Ｄｏｍ ｉｎａｎｔ,ＸＤ）;Ｙ连锁ＲＰ家系也有报道。Ｘ连锁ＲＰ发病率较低,在我国约为７．７％ （美国为６％ ）,但它发病早,进展快,病情严重,３０－ ４５ 岁就有严重视力损伤甚至失明。临床上大部为隐性,散发病例可以认为属于隐性遗传,因为无先辈病史的患者可以认为是新突变,无后代患者的不会是显性遗传,而隐性纯合体患者的配偶若不携带同一突变基因,则后代无患者,本人于是表现为散发。未成年无家史患者则难以判断。照此计算,这部分约占患者总数的８１．３％ （美国为８４％ ）;其次为常染色体显性遗传,约占１１％ （美国为１０％ ）［１,２］。已发现的ＲＰ相关基因有２７个。位于Ｘ染色体上的ＲＰ基因有５ 个。ＲＰ３ 位于Ｘ染色体短臂Ｘｐ２１．１,是一种隐性遗传ＲＰ病。ＲＰＧＲ（ｒｅｔｉｎｉｔｉｓ ｐｉｇｍ ｅｎｔｏｓａ ＧＴＰａｓｅ ｒｅｇｕｌａｔｏｒ,视网膜色素变性ＧＴＰ酶调节物）基因是ＲＰ３的致病基因,已于１９９６ 年被克隆 。     

420～750 nm超连续谱光源和532 nm激光致兔视网膜损伤修复

超连续谱(SC)光源是一种宽光谱、高亮度、眼睛危害大的新光源,有关它致视网膜损伤研究却未见报道。为了观察SC光源致视网膜损伤特点和修复过程,试验将波长420～750 nm的SC光源与532 nm激光进行比较,采用两者平行光入射,在0. 1 s照射时间,3 mm角膜光斑直径条件下,用略高于视网膜损伤阈值的功率照射青紫蓝灰兔视网膜;通过检眼镜和HE染色观察视网膜照后4 h,1、3、7、14 d损伤修复过程。SC光源和532 nm激光致视网膜的损伤在检眼镜下为灰色小圆斑。照后4 h出现视网膜外核层固缩深染,感光细胞外节与视网膜色素上皮层(RPE)粘连;随后RPE层色素增生、损伤的外核层细胞丢失,损伤进行性加重; 3 d后色素细胞开始向外核层和内核层迁移,胶质细胞填充损伤区域。由此可见,波长420～750 nm的SC光源主要损伤视网膜外核层和RPE层,后期色素颗粒和胶质细胞填充损伤区域。其视网膜损伤特点和修复过程与532 nm激光类似。     

无脉络膜症的发病机制及诊疗进展

无脉络膜(CHM)是一种X染色体连锁的遗传性进行性视网膜色素上皮,光感受细胞和脉络膜血管逐渐退化,最终致盲的疾病。该病是由于位于Xq21上的REP-1缺失突变导致失活,导致CHM基因不能表达,从而出现脉络膜血管层发育障碍,进行性视网膜色素上皮和脉络膜营养不良,变性及进行性脉络膜萎缩消失。男性患者一般在十几岁至二十几岁时开始出现夜盲,周边视野逐渐丧失,形成管状视野,严重者仅剩5-10度的中央视野,最终失明。女性携带者大多无症状。     

RCS大鼠和Wistar大鼠视网膜酸性磷酸酶活性的动态观察

本实验观察了不同年龄组ＲＣＳ大鼠和Ｗｉｓｔａｒ大鼠视网膜中酸性磷酸酶的动态变化及其与ＲＰＥ细胞消化功能的关系。运用偶氮偶联法显示１２ｄ、２１ｄ、２ｍ的ＲＣＳ大鼠和７ｄ、２ｍ的Ｗｉｓｔａｒ大鼠视网膜中的酸性磷酸酶;通过图像分析仪测定ＲＰＥ细胞层和光感受器外节部分的酸性磷酸酶含量,并进行统计学分析。结果：酸性磷酸酶阳性反应呈暗红色,主要位于ＲＰＥ细胞层,视网膜外核层、内核层,节细胞层亦有少量阳性反应颗粒。２ｍ的ＲＣＳ大鼠视细胞内、外节的酸性磷酸酶含量则明显高于其它组（Ｐ＜０．０１）,其余结构的酸性酶各组间无显著性差异（Ｐ＞０．０５）。结论：ＲＣＳ大鼠和Ｗｉｓｔａｒ大鼠的视网膜色素上皮细胞可能具有相同的消化功能。     

大鼠视网膜变性相关组织形态及功能研究

目的　探讨视网膜变性RCS (RoyalCollegeSurgeon)大鼠的视网膜形态及功能特点。 方法　应用HE染色、免疫组化染色和眼电生理技术 ,对比研究正常和变性两组大鼠视网膜特点。结果　 1 RCS大鼠在 3月龄时 ,视网膜外核层和感光细胞内外节完全消失 ;突触素免疫组化染色显示外丛状层不着色 ;视紫红质免疫组化染色显示原视网膜外层部位有阳性反应 ;胶质纤维酸性蛋白染色显示原视网膜外层部位有强阳性反应。 2 RCS大鼠的闪光视网膜电图 (flashelectronicretinogram ,FERG)a、b波振幅较正常Wistar大鼠明显降低 (P <0 0 1)。结论　在形态和功能上 ,3月龄RCS大鼠视网膜与人类晚期视网膜色素变性极为相似 ,因此可用于视网膜联合移植研究。     

视网膜干细胞的研究进展

干细胞研究是近年生命科学研究的热点之一,近来在干细胞研究领域的进步已经给治疗甚至是治愈某些变性疾病和不能治疗的人类疾病带来了希望.在体外,睫状缘色素上皮细胞来源的视网膜干细胞能增殖形成克隆球,并能分化成视网膜各种细胞类型,包括光感受器细胞,双极细胞及神经胶质细胞等等.视网膜干细胞的移植可以作为治疗一些致盲性眼病潜在治疗方式.因此,视网膜干细胞的研究对于视网膜变性疾病,如遗传性视网膜变性、青光眼、年龄相关性黄斑变性等,提供了新的治疗途径.现就视网膜干细胞的培养与鉴定,增殖、分化、移植以及信号机制方面的研究进展作一综述.     

Wistar大鼠和RCS大鼠视网膜色素上皮细胞和视杆细胞外节表面Con－A受体

为探讨正常大鼠与吞噬功能缺陷大鼠视网膜色素上皮（ＲＰＥ）和视杆细胞外节（ＲＯＳ）膜表面的甘露糖受体的存在和分布,本实验用胶体金标记物对１２只Ｗｉｓｔａｒ大鼠和１２只ＲＣＳ大鼠的ＲＰＥ细胞及临近其顶部的ＲＯＳ表面的Ｃｏｎ－Ａ受体进行标记．结果表明。两种大鼠ＲＰＥ细胞及ＲＯＳ膜表面均有胶体金标记物．胶体金标记物在两种ＲＰＥ细胞微绒毛上分布密度较低,而在两种大鼠ＲＯＳ膜表面分布密度则高。说明两种大鼠ＲＰＥ细胞和ＲＯＳ膜表面均有Ｃｏｎ－Ａ受体分布。在两种大鼠ＲＯＳ被ＲＰＥ细胞吞入后,均无胶体金标记物。     

视紫红质及RPE65蛋白在光致视网膜变性疾病中的作用机制

视紫红质是感光细胞中的一种视色素,在光线的接收和视觉电位的产生方面具有重要的生理作用,由视紫红质介导的过度光信号传导是光性视网膜变性的主要原因。近年的研究表明,视网膜色素上皮细胞中的RPE65蛋白作为影响视紫红质再生的关键因素,与视网膜光损伤的易感性密切相关。就视紫红质和RPE65蛋白在光致视网膜变性中的作用机理作一探讨。     

RCS大鼠视网膜变性过程中二级神经元形态学变化的研究

用免疫组织化学方法研究RCS大鼠(Royal College of Surgeon's rat,RCS rat)视网膜变性过程中早、中、晚期二级神经元形态的变化。结果发现,P1MRCS大鼠各二级神经元未见明显的形态改变。P2M RCS大鼠视网膜外核层萎缩约85%,视杆双极细胞顶端树突萎缩;水平细胞的树突与轴突在外网状层的分层未见改变。P3M RCS大鼠视网膜外核层萎缩近95%,RCS大鼠视杆双极细胞顶端萌生新的神经突起;水平细胞的树突分支明显丢失,轴突在外网状层的分层发生改变,出现新生神经突起;无长突细胞的树突在内网状层的分层至变性晚期也未见改变。该研究表明RCS大鼠视网膜二级神经元形态的改变是继发性改变,是感光细胞变性后对传入缺失的一种反应,即重构反应。在进行视网膜功能救治时需要考虑重构反应带来的影响。     

视网膜神经网络的信息传递

可见光作用于脊椎动物视网膜时,感光细胞外段的视色素吸收光量子,经过一系列瞬时光化学反应,迅速将光能转换成电信息,并向视网膜内核层细胞(水平、双极和无足细胞)及视神经节细胞传递,后者以峰电位形式将信息传向中枢。最近十几年来,对视觉系统外周部分的信息转换和传递过程的研究十分活跃,尤其是Tomita用微电极记录视网膜细胞内反应技术的发展,以及Kaneko用荧光黄染色单个     

Therapeutic challenges to retinitis pigmentosa: from neuroprotection to gene therapy

Syndromic retinitis pigmentosa (RP) is the result of several mutations expressed in rod photoreceptors, over 40 of which have so far been identified. Enormous efforts are being made to relate the advances in unraveling the patho-physiological mechanisms to therapeutic approaches in animal models, and eventually in clinical trials on humans. This review summarizes briefly the current clinical management of RP and focuses on the new exciting treatment possibilities. To date, there is no approved therapy able to stop the evolution of RP or restore vision. The current management includes an attempt at slowing down the degenerative process by vitamin supplementation, trying to treat ocular complications and to provide psychological support to blind patients. Novel therapeutic may be tailored dependant on the stage of the disease and can be divided in three groups. In the early stages, when there are surviving photoreceptors, the first approach would be to try to halt the degeneration by correction of the underlying biochemical abnormality in the visual cycle using gene therapy or pharmacological treatment. A second approach aims to cope with photoreceptor cell death using neurotrophic growth factors or anti-apoptotic factors, reducing the production of retino-toxic molecules, and limiting oxidative damage. In advanced stages, when there are few or no functional photoreceptors, strategies that may benefit include retinal transplantation, electronic retinal implants or a newly described optogenetic technique using a light-activated channel to genetically resensitize remnant cone-photoreceptor cells.     

Retinitis pigmentosa: genes and disease mechanisms

Retinitis pigmentosa (RP) is a group of inherited disorders affecting 1 in 3000-7000 people and characterized by abnormalities of the photoreceptors (rods and cones) or the retinal pigment epithelium of the retina which lead to progressive visual loss. RP can be inherited in an autosomal dominant, autosomal recessive or X-linked manner. While usually limited to the eye, RP may also occur as part of a syndrome as in the Usher syndrome and Bardet-Biedl syndrome. Over 40 genes have been associated with RP so far, with the majority of them expressed in either the photoreceptors or the retinal pigment epithelium. The tremendous heterogeneity of the disease makes the genetics of RP complicated, thus rendering genotype-phenotype correlations not fully applicable yet. In addition to the multiplicity of mutations, in fact, different mutations in the same gene may cause different diseases. We will here review which genes are involved in the genesis of RP and how mutations can lead to retinal degeneration. In the future, a more thorough analysis of genetic and clinical data together with a better understanding of the genotype-phenotype correlation might allow to reveal important information with respect to the likelihood of disease development and choices of therapy.     

Next generation sequencing-based molecular diagnosis of retinitis pigmentosa: identification of a novel genotype-phenotype correlation and clinical refinements

Retinitis pigmentosa (RP) is a devastating form of retinal degeneration, with significant social and professional consequences. Molecular genetic information is invaluable for an accurate clinical diagnosis of RP due to its high genetic and clinical heterogeneity. Using a gene capture panel that covers 163 of the currently known retinal disease genes, including 48 RP genes, we performed a comprehensive molecular screening in a collection of 123 RP unsettled probands from a wide variety of ethnic backgrounds, including 113 unrelated simplex and 10 autosomal recessive RP (arRP) cases. As a result, 61 mutations were identified in 45 probands, including 38 novel pathogenic alleles. Interestingly, we observed that phenotype and genotype were not in full agreement in 21 probands. Among them, eight probands were clinically reassessed, resulting in refinement of clinical diagnoses for six of these patients. Finally, recessive mutations in CLN3 were identified in five retinal degeneration patients, including four RP probands and one cone-rod dystrophy patient, suggesting that CLN3 is a novel non-syndromic retinal disease gene. Collectively, our results underscore that, due to the high molecular and clinical heterogeneity of RP, comprehensive screening of all retinal disease genes is effective in identifying novel pathogenic mutations and provides an opportunity to discover new genotype-phenotype correlations. Information gained from this genetic screening will directly aid in patient diagnosis, prognosis, and treatment, as well as allowing appropriate family planning and counseling.     

Stem‐cell‐based therapies for retinal degenerative diseases: Current challenges in the establishment of new treatment strategies

Various advances have been made in the treatment of retinal diseases, including new treatment strategies and innovations in surgical devices. However, the treatment of degenerative retinal diseases, such as retinitis pigmentosa (RP) and age‐related macular degeneration (AMD), continues to pose a significant challenge. In this review, we focus on the use of embryonic stem cells (ESCs) and induced pluripotent stem cells (iPSCs) to treat retinal diseases by harnessing the ability of stem cells to differentiate into different body tissues. The retina is a tissue specialized for light sensing, and its degradation leads to vision loss. As part of the central nervous system, the retina has very low regenerative capability, and therefore, treatment options are limited once it degenerates. Nevertheless, innovations in methods to induce the generation of retinal cells and tissues from ESCs/iPSCs enable the development of novel approaches for these irreversible diseases. Here we review some historical background and current clinical trials involving the use of stem‐cell‐derived retinal pigment epithelial cells for AMD treatment and stem cell‐derived retinal cells/tissues for RP therapy. Finally, we discuss our future vision of regenerative treatment for retinal diseases with a partial focus on our studies and introduce other interesting approaches for restoring vision.     

The nature of dominant mutations of rhodopsin and implications for gene therapy

Mutations in the rhodopsin gene are the most common cause of retinitis pigmentosa (RP) among human patients. The nature of the rhodopsin mutations has critical implications for the design of strategies for gene therapy. Nearly all rhodopsin mutations are dominant. Although dominance does not arise because of haploinsufficiency, it is unclear whether it is caused by gain-of-function or dominant-negative mutations. Current strategies for gene therapy have been devised to deal with toxic, gain-of-function mutations. However, analysis of results of transgenic and targeted expression of various rhodopsin genes in mice suggests that dominance may arise as a result of dominant-negative mutations. This has important consequences for gene therapy. The effects of dominant-negative mutations can be alleviated, in principle, by supplementation with additional wild-type rhodopsin. If added wild-type rhodopsin could slow retinal degeneration in human patients, as it does in mice, it would represent a valuable new strategy for gene therapy of RP caused by dominant rhodopsin mutations.     

Rescue from Photoreceptor Degeneration in the rd Mouse by Human Immunodeficiency Virus Vector-Mediated Gene Transfer

Retinitis pigmentosa (RP) is the most common inherited retinal disease, in which photoreceptor cells degenerate, leading to blindness. Mutations in the rod photoreceptor cGMP phosphodiesterase beta subunit (PDEbeta) gene are found in patients with autosomal recessive RP as well as in the rd mouse. We have recently shown that lentivirus vectors based on human immunodeficiency virus (HIV) type 1 achieve stable and efficient gene transfer into retinal cells. In this study, we evaluated the potential of HIV vector-mediated gene therapy for RP in the rd mouse. HIV vectors containing a gene encoding a hemagglutinin (HA)-tagged PDEbeta were injected into the subretinal spaces of newborn rd mouse eyes. One to three rows of photoreceptor nuclei were observed in the eyes for at least 24 weeks postinjection, whereas no photoreceptor cells remained in the eyes of control animals at 6 weeks postinjection. Expression of HA-tagged PDEbeta in the rescued photoreceptor cells was confirmed by two-color confocal immunofluorescence analysis using anti-HA and anti-opsin antibodies. HIV vector-mediated gene therapy appears to be a promising means for the treatment of recessive forms of inherited retinal degeneration.     

Diagnostic challenges in retinitis pigmentosa: genotypic multiplicity and phenotypic variability

Retinitis pigmentosa (RP) is a heterogeneous group of inherited retinal disorders. Diagnosis can be challenging as more than 40 genes are known to cause non-syndromic RP and phenotypic expression can differ significantly resulting in variations in disease severity, age of onset, rate of progression, and clinical findings. We describe the clinical manifestations of RP, the more commonly known causative gene mutations, and the genotypic-phenotypic correlation of RP.     

Inherited retinal degenerations: therapeutic prospects

Retinitis pigmentosa (RP) is a heterogeneous group of inherited retinal degenerative diseases, characterized by the progressive death of rod and cone photoreceptors. A tremendous genetic heterogeneity is associated with the RP phenotype. Most mutations affect rods selectively and, through an unknown pathway, cause the rod cells to die by apoptosis. Cones, on the other hand, are seldom directly affected by the identified mutations, and yet, in many cases, they degenerate secondarily to rods, which accounts for loss of central vision and complete blindness. Many animal models of RP are available and have led to a better understanding of the disease and to the development of therapeutic strategies aimed at curing the specific genetic disorder (gene therapy), slowing down or even stopping the process of photoreceptor degeneration (growth factors or calcium blockers applications, vitamin supplementation), preserving the cones implicated in the central visual function (identification of endogenous cone viability factors) or even replacing the lost cells (transplantation, use of stem or precursor cells). Still, many obstacles will need to be overcome before most of these strategies can be applied to humans. In this review, we describe the different therapeutic strategies being studied worldwide and report the latest results in this field.     

Small molecules targeting glycogen synthase kinase 3 as potential drug candidates for the treatment of retinitis pigmentosa

Retinitis pigmentosa (RP) is an inherited retinal dystrophy that courses with progressive degeneration of retinal tissue and loss of vision. Currently, RP is an unpreventable, incurable condition. We propose glycogen synthase kinase 3 (GSK-3) inhibitors as potential leads for retinal cell neuroprotection, since the retina is also a part of the central nervous system and GSK-3 inhibitors are potent neuroprotectant agents. Using a chemical genetic approach, diverse small molecules with different potency and binding mode to GSK-3 have been used to validate and confirm GSK-3 as a pharmacological target for RP. Moreover, this medicinal chemistry approach has provided new leads for the future disease-modifying treatment of RP.     

Dependable and Efficient Clinical Molecular Diagnosis of Chinese RP Patient with Targeted Exon Sequencing

Retinitis pigmentosa (RP) is the most common inherited retinal disease. It is a clinically and genetically heterogeneous disorder, which is why it is particularly challenging to diagnose. The aim of this study was to establish a targeted next-generation sequencing (NGS) approach for the comprehensive, rapid, and cost-effective clinical molecular diagnosis of RP. A specific hereditary eye disease enrichment panel (HEDEP) based on exome capture technology was used to collect the protein coding regions of 371 targeted hereditary eye disease genes, followed by high-throughput sequencing on the Illumina HiSeq2000 platform. From a cohort of 34 Chinese RP families, 13 families were successfully diagnosed; thus, the method achieves a diagnostic rate of approximately 40%. Of 16 pathogenic mutations identified, 11 were novel. Our study demonstrates that targeted capture sequencing offers a rapid and effective method for the molecular diagnosis of RP, which helps to provide a more accurate clinical diagnosis and paves the way for genetic counseling, family planning, and future gene-targeted treatment.