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    1. STGD1 was determined according to initial symptoms of VA loss; fundus images showing orange-yellow flecks in the retina, a beaten-bronze appearance; and normal or cone-altered ffERG results

      Case#: MD-0242, onset at 18yo, 24yo at report

      DiseaseAssertion: STGD1

      FamilyInfo: Segregation noted, but no specific details provided

      CasePresentingHPOs:

      CaseHPOFreeText: VA loss, BCVA=0.1/0.1, "STGD1 was determined according to initial symptoms of VA loss; fundus images showing orange-yellow flecks in the retina, a beaten-bronze appearance; and normal or cone-altered ffERG results"

      CaseNotHPOs:

      CaseNotHPOFreeText: VF loss, abnormal ERG

      GenotypingMethod:

      PreviouslyPublished: n/a

      Variant: c.1715G>C p.(Arg572Pro); c.5242G>A p.(Gly1748Arg)

      ClinVar: 99073

      CAID: CA226919

      SupplementalData: Table S1

    1. Patients with RPE atrophy areas ≥0.05 mm2 secondary to STGD1 or AMD were included. RPE atrophy was defined as clearly demarcated definitely decreased fundus autofluorescence (FAF) under short-wavelength excitation light (488 nm) in combination with hypertransmission in optical coherence tomography (OCT).31,32 Insufficient pupil dilation, additional retinal pathology, previous retinal treatment, or other ocular comorbidities substantially affecting visual function or image quality (e.g., significant media opacity, amblyopia or optic nerve disease) led to exclusion from the study. The diagnosis of AMD was based on soft drusen and other retinal alterations consistent with the disease,9 while the diagnosis of STGD1 was based on (1) a compatible phenotype (yellow-white flecks that correlated with hyperautofluorescent flecks on FAF imaging) and (2) the presence of at least one mutated ABCA4 allele as well as the absence of mutations in peripherin-2 (PRPH2). To avoid potential confounding, patients exhibiting “diffuse-trickling geographic atrophy” were not included, as choroidal insufficiency has been previously implicated in the pathogenesis.33–37  Genetic testing was conducted at the Institute of Human Genetics, University of Regensburg (n = 7), and at the Center for Human Genetics Bioscientia, Ingelheim (n = 6). Analysis of all coding exons of the ABCA4 and PRPH2 genes was done by either direct chain-terminating dideoxynucleotide Sanger sequencing, a custom-designed GeneChip CustomSeq Resequencing Array (RetChip; Affymetrix, Santa Clara, CA, USA), or next-generation sequencing (Regensburg, n = 5; Bioscientia, n = 6). Two patients (#1 and #3) were screened for known mutations/polymorphisms using the Asper Ophthalmics ABCR400 microarray followed by Sanger sequencing to confirm selected variants.38 Only STGD1 patients with a minimum age of onset (first reported subjective symptoms) of 45 years were included as defined previously.38,39 Healthy subjects without retinal pathology served as controls.

      Case#: Patient #13

      DiseaseAssertion: STGD1

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: RPE atrophy (clearly demarcated definitely decreased fundus autofluorescence (FAF) under short-wavelength excitation light (488 nm) in combination with hypertransmission in optical coherence tomography (OCT)) areas ≥0.05 mm2 secondary to STGD1 or AMD. diagnosis of STGD1 was based on (1) a compatible phenotype (yellow-white flecks that correlated with hyperautofluorescent flecks on FAF imaging) and (2) the presence of at least one mutated ABCA4 allele as well as the absence of mutations in peripherin-2 (PRPH2). Minimum age of onset (first reported subjective symptoms) of 45 years.

      CaseNotHPOs:

      CaseNotHPOFreeText: Insufficient pupil dilation, additional retinal pathology, previous retinal treatment, or other ocular comorbidities substantially affecting visual function or image quality (e.g., significant media opacity, amblyopia or optic nerve disease) led to exclusion from the study. “diffuse-trickling geographic atrophy”

      GenotypingMethod: Analysis of all coding exons of the ABCA4 and PRPH2 genes was done by either direct chain-terminating dideoxynucleotide Sanger sequencing, a custom-designed GeneChip CustomSeq Resequencing Array, or NGS

      PreviouslyPublished: possible since the study was at the same university with the same first author as PMID: 33214501

      Variant: c.3468C>G/p.(Tyr1156*) and c.5059A>T/p.(Ile1687Phe)

      ClinVar: n/a

      CAID: CA341290648

      SupplementalData: supplement 1 has the genotype for probands

    1. STGD102 R572Q-2588G→C IVS35+2T→A Yes

      Case#: STGD102, 10-14yo at onset, German

      DiseaseAssertion: STGD

      FamilyInfo: segregation in family

      CasePresentingHPOs:

      CaseHPOFreeText: "The diagnosis of STGD was based on the demonstration of bilateral impairment of central vision and the appearance of perimacular and/or peripheral yellow-white flecks, with or without atrophy of the central retinal-pigment epithelium and a normal or only mildly abnormal flash electroretinogram when recorded in early stages of the disease."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: denaturing gradient gel electrophoresis, dHPLC, and SSCP analysis, PCR amplification of individual coding exons and flanking intron sequences, direct DNA sequencing

      PreviouslyPublished: n/a

      Variant: R572Q-2588G→C IVS35+2T→A in trans "Correct segregation of disease alleles was demonstrated in all 39 cases in which family samples were available for study"

      ClinVar: 7900

      CAID: CA226918

      SupplementalData: n/a

    2. STGD113 L541P-A1038V 2588G→C Yes

      Case#: STGD113, 20-24yo at onset, German

      DiseaseAssertion: STGD

      FamilyInfo: segregation in family

      CasePresentingHPOs:

      CaseHPOFreeText: "The diagnosis of STGD was based on the demonstration of bilateral impairment of central vision and the appearance of perimacular and/or peripheral yellow-white flecks, with or without atrophy of the central retinal-pigment epithelium and a normal or only mildly abnormal flash electroretinogram when recorded in early stages of the disease."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: denaturing gradient gel electrophoresis, dHPLC, and SSCP analysis, PCR amplification of individual coding exons and flanking intron sequences, direct DNA sequencing

      PreviouslyPublished: n/a

      Variant: L541P-A1038V; 2588G→C in trans "Correct segregation of disease alleles was demonstrated in all 39 cases in which family samples were available for study"

      ClinVar: 7879

      CAID: CA119128

      SupplementalData: n/a

    3. STGD138 IVS13+1GA 2588G→C Yes

      Case#: STGD138, 15-19yo at onset, German

      DiseaseAssertion: STGD

      FamilyInfo: segregation in family

      CasePresentingHPOs:

      CaseHPOFreeText: "The diagnosis of STGD was based on the demonstration of bilateral impairment of central vision and the appearance of perimacular and/or peripheral yellow-white flecks, with or without atrophy of the central retinal-pigment epithelium and a normal or only mildly abnormal flash electroretinogram when recorded in early stages of the disease."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: denaturing gradient gel electrophoresis, dHPLC, and SSCP analysis, PCR amplification of individual coding exons and flanking intron sequences, direct DNA sequencing

      PreviouslyPublished: n/a

      Variant: IVS13+1G→A; 2588G→C in trans "Correct segregation of disease alleles was demonstrated in all 39 cases in which family samples were available for study"

      ClinVar: 7879

      CAID: CA119128

      SupplementalData: n/a

    1. S2 File: This file contains the following sub-files: Figures A-C, Tables A-E and the references of the detected mutations in Tables A-E. Figure A shows the overall coverage of genes in the panel. Figures B and C show the genes that doesn’t reach 100% and 99%, respectively. Table A shows the variant numbers detected by NGS of 68 samples have previously tested by Sanger sequencing before. Table B shows the results of all 68 samples previously screened by Sanger sequencing. Table C shows the Z-score results for CNV detecting of family P041 and P048. Table D: Statistics of targeted NGS in 99 RP patients, shows the depth, coverage and variant numbers detected in 99 RP patients. Table E shows the mutations identified in 61 out of 99 RP patients.(RAR)pone.0185237.s002.rar (1.9M)GUID: D12AF020-8D31-4449-ACC9-879865E75832

      Unable to open this type of file, but according to LOVD this paper contains this variant and it is not in the main text.

    1. Mutation scanning and direct DNA sequencing of all 50 exons of ABCR were completed for 150 families segregating recessive Stargardt disease (STGD1). ABCR variations were identified in 173 (57%) disease chromosomes, the majority of which represent missense amino acid substitutions. These ABCR variants were not found in 220 unaffected control individuals (440 chromosomes) but do cosegregate with the disease in these families with STGD1, and many occur in conserved functional domains. Missense amino acid substitutions located in the amino terminal one-third of the protein appear to be associated with earlier onset of the disease and may represent misfolding alleles. The two most common mutant alleles, G1961E and A1038V, each identified in 16 of 173 disease chromosomes, composed 18.5% of mutations identified. G1961E has been associated previously, at a statistically significant level in the heterozygous state, with age-related macular degeneration (AMD). Clinical evaluation of these 150 families with STGD1 revealed a high frequency of AMD in first- and second-degree relatives. These findings support the hypothesis that compound heterozygous ABCR mutations are responsible for STGD1 and that some heterozygous ABCR mutations may enhance susceptibility to AMD.

      Annotating here since the full text is a PDF.

      Case#: Family AR263 proband, male, US, 9yo at onset

      DiseaseAssertion: Stargardt

      FamilyInfo: 3 generations, no other affected members in the pedigree

      CasePresentingHPOs:

      CaseHPOFreeText: The essential and defining features of STGD were (1) pedigrees with at least one living affected individual compatible with autosomal recessive inheritance; (2) an ophthalmoscopically characteristic retinal disorder in families with both parents living; (3) bilateral central visual loss with both “beaten metal” elliptical foveal dystrophy and temporal pallor of the optic discs, documented by retinal color photography, with or without yellow-pigment epithelial flecks in the macular and/or retinal “near periphery”; and (4) the characteristic fluorescein angiographic feature of a dark choroid (Blacharski 1988).

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: c.6445C>T (p.Arg2149Ter); c.6079C>T (p.Leu2027Phe). Heteroduplex and SSCP analyses were used to screen the 50 exons of ABCA4

      ClinVar: 99460

      CAID: CA227404

      SupplementalData: n/a

    1. The latter finding suggests that loss of significance is likely due to lack of statistical power caused by the reduced number of individuals in the subsequent analyses (from n = 335 to n = 247 to n = 197 patients, Supplementary Table S5).

      3 STGD patients have this variant but no specific clinical details (supplemental table s5).

      Patient 79: c.1654G>A p.(V552I); c.5196+1013A>G

      Patient 265: c.1654G>A p.(V552I) only

      Patient 320: c.1654G>A p.(V552I); c.4254-1G>C; c.6230G>A p.(R2077Q)

    1. Classification of noncanonical splice site variants according to the splice defects The percentage of correctly spliced ABCA4 RNA product for NCSS variants was calculated by using a capillary electrophoresis system (Fig. 4; Supplemental Table S3; Supplemental Fig. S5). Three variants, c.4634G>A, c.5196+3_5196+8del, and c.5585−10T>C, showed 100% correctly spliced ABCA4 mRNAs. We could rule out pathogenicity for the last two variants but not for c.4634G>A p.(Ser1545Asn), as this variant is significantly enriched in >3000 Caucasian STGD1 patients compared to the non-Finnish ExAC population (Cornelis et al. 2017). Sixteen variants showed between 4.3% and 79.6% normal RNA and were tentatively classified as severe, moderately severe, and mild, while the remaining 26 NCSS variants did not show any normal RNA and were thus deemed severe variants. For c.2382+5G>C and c.2588G>C, no quantification was performed as the wild-type BA12 clone also showed exon skipping. Based on the Sanger sequence validation, we were able to annotate all the variants at the RNA level and predict their effect at the protein level (Table 1). Figure 4. Open in a new tab Percentages of remaining normal ABCA4 transcripts due to noncanonical splice site variants based on capillary electrophoresis system analyses. The percentages of normal ABCA4 transcript for 45 noncanonical splice site variants are represented by black bars. Nineteen variants showed varying fractions (4.3%–100%) of correct ABCA4 mRNA. Four of them also result in missense changes as depicted, but only p.(Ser1545Asn) and p.(Lys2160Glu) are likely to have an effect on protein function, as significant amounts of ABCA4 protein will be produced. For the remaining 26 variants (in the square box), no residual RNA was observed. (#) For this variant, densitometric scanning was performed.Table 1. In vitro tested noncanonical splice site variants and their observed RNA and predicted protein effects Open in a new tabWe correlated the predicted effect of the NCSS variants with the phenotypes in reported cases and, when the variants were not present in a homozygous state, with the severity of the second allele. For 25 of 47 variants, sufficient clinical data were available, and in all these cases, our predicted effect of the NCSS variants correlated with the observed phenotypes (Supplemental Table S4).

      RT-PCR of midigenes demonstrated that this variant impacts splicing by causing a deletion (r.5461_5714del) which is predicted to result in a frameshift (p.Thr1821Aspfs*6). This variant showed 0% correctly spliced ABCA4 mRNA. This frameshift variant introduces a premature stop codon between codons 1-2255 (PVS1(RNA); 29162642). There do appear to be alternative splice products (supplemental figure s2), where exon 39 or 40, or both 39 and 40, are skipped, but in all cases, this leads to a frameshift.

    1. Among 161 patients with a Stargardt-related phenotype previously assessed with the commercial ABCA4 mutation microarray, we analyzed the ABCA4 gene with High-resolution melting (HRM) in patients in whom the array analysis identified either a heterozygous mutation (n = 50) or no mutation (n = 30).

      annotating here since the article is a PDF

      Case#: Duno Patient D015, Danish

      DiseaseAssertion: Stargardt flavimaculatus phenotype

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: The diagnosis was based on standard ophthalmological examinations including fundus photography, colour vision assessment, dark adaptometry, and full field ERG.

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: ABCA4 mutation microarray and High-resolution melting (HRM) in patients in whom the array analysis identified either a heterozygous mutation (n = 50) or no mutation (n = 30).

      PreviouslyPublished: n/a

      Variant: c.1654G>A p.V552I; c.6478A>G p.K2160E; c.3380G>A p.G1127E phase unknown

      CAID: CA239745

      SupplementalData:

    1. The study included index patients with ABCA4-related retinopathy and their parents. ABCA4-related retinopathy was diagnosed based on characteristic findings on indirect ophthalmoscopy, optical coherence tomography, and conventional fundus AF imaging. The clinical diagnosis was confirmed by the presence of biallelic mutations in ABCA4, and segregation analysis was carried out with samples of the parents. All index patients and their parents underwent a complete ophthalmologic examination including best-corrected visual acuity (BCVA), slit-lamp examination, and indirect ophthalmoscopy with dilated pupils. Axial length and corneal curvature were measured using the IOL-Master 500 (Carl Zeiss Meditec, Jena, Germany). Healthy subjects without ocular disease served as controls. To minimize an influence of factors known to alter qAF measurements,22 exclusion criteria were age ≥ 65 years, ethnicity other than Caucasian, significant lens opacities, dilated pupil diameter below 7 mm, unstable fixation, refractive error > ±6 diopters (spherical equivalent), and any other additional known ocular pathology or prior intraocular surgery.

      Case#: Muller Subject #8, 34yo, qAF=590

      DiseaseAssertion: ABCA4-related retinopathy

      FamilyInfo: mother was 59yo at report with qAF=399

      CasePresentingHPOs:

      CaseHPOFreeText: "ABCA4-related retinopathy was diagnosed based on characteristic findings on indirect ophthalmoscopy, optical coherence tomography, and conventional fundus AF imaging. The clinical diagnosis was confirmed by the presence of biallelic mutations in ABCA4, and segregation analysis was carried out with samples of the parents."

      CaseNotHPOs:

      CaseNotHPOFreeText: age ≥ 65 years, ethnicity other than Caucasian, significant lens opacities, dilated pupil diameter below 7 mm, unstable fixation, refractive error > ±6 diopters (spherical equivalent), and any other additional known ocular pathology or prior intraocular surgery.

      GenotypingMethod: ABCA4 sequence analysis of all coding exons and flanking splice junctions was performed either by Sanger chain-terminating dideoxynucleotide sequencing after PCR amplification, by multiplex ligation-dependent probe amplification (MLPA) analysis (performed when only a single mutation was detected), or by next-generation sequencing (NGS) including a quantitative readout to detect large structural rearrangements using a gene panel covering 120 genes associated with inherited retinal disease as described previously.23 Validation of identified putatively pathogenic variants and segregation analysis were carried out by conventional sequencing

      PreviouslyPublished: n/a

      Variant: maternal allele: [c.1622T>C (p.Leu541Pro); c.3113C>T (p.Ala1038Val)]; paternal allele: c.1654G>A (p.Val552Ile); c.4771G>A (p.Gly1591Arg)

      CAID: CA239745

      SupplementalData:

    1. The proband of thisfamily (Patient #4

      Case#: Male, Family #2, patient #4, onset at 48y.o

      DiseaseAssertion: STGD

      FamilyInfo: proband sister(#3) identical ABCA4 allele to proband, developed central vision issues. Proband son has complex allele w/ early onset cone-rod dystrophy. Proband daughter(#6) has complex allele mutation, central vision issues developed at 17. retinal exam showed atrophic macular lesions. Proband second daughter(patient #5, asymptomatic)

      CasePresentingHPOs: HP:0012508, HP:0030500

      CaseHPOFreeText:Proband presented with bull's eye macular lesions with no fundus flecks. Normal rod-mediated amplitudes, normal single-flash response, reduces 32-Hz flicker amplitude.

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: maintained foveal sparing in both eyes 20/25+2 R.E, 20/25+1 L.E.

      Genotyping Method: Genotyping performed at Columbia University, sequencing technology used is not disclosed.

      PreviouslyPublished: n/a

      Variant: c.4139C>T (p.P1380L), BoldM1: c.5603A>T(p.N18681)[NM_000350.3(ABCA4):c.5603A>T (p.Asn1868Ile) - Variation ID 99390], M2: c.[1622T>C; 3113C>T] (p.[L541P; A1308V])

      ClinVar: M1) 99390 M2) 99067

      CAID: n/a

      SupplementalData: Fig 1: Pedigree illustrating ABCA4 variants and the associated Stargardt phenotype for 5 families. Proband Labeled w/ white arrow for each family. Fig 2: retinal scan measuring melanin in 4 patients of family 2. Panel shows bull's-eye ring of RPE atropy. Fig 3: Macular SD-OCT line profile from b-scans. Reflectivity plotted against function of retinal depth. Table 1: table shows patients with p.N18681 variant, type of mutation, and pathogenicity class. Table 2: Patients, age on-set and first symptom

    2. The proband of Family #4

      Case#: Female, Family #4, patient #8

      DiseaseAssertion: STGD

      FamilyInfo: Proband's daughter shares ABCA4 variant and struggled with difficulty focusing at age 19. BVCA 20/200 R.E and 20/80 in L.E.

      CasePresentingHPOs: HP:0030500, HP:0007663, HP:0000608

      CaseHPOFreeText: Proband's first symptom was difficulty with night vision occurring at 45 y.o, BVCA at 50 y.o in both eyes was 20/20. atrophy in macula and Stage 2 fundus flecks identified.

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a

      Genotyping Method: Genotyping performed at Columbia University, sequencing technology used is not disclosed.

      PreviouslyPublished: n/a

      Variant: NM_000350.3(ABCA4):c.1622T>C (p.Leu541Pro), NM_000350.3(ABCA4):c.1957C>T (p.Arg653Cys)

      ClinVar: M2) 99067, M5) 99108

      CAID: n/a

      SupplementalData: Fig 1: Pedigree illustrating ABCA4 variants and the associated Stargardt phenotype for 5 families. Proband Labeled w/ white arrow for each family. Fig 2: retinal scan measuring melanin in 4 patients of family 2. Panel shows bull's-eye ring of RPE atropy. Fig 3: Macular SD-OCT line profile from b-scans. Reflectivity plotted against function of retinal depth. Table 1: table shows patients with p.N18681 variant, type of mutation, and pathogenicity class. Table 2: Patients, age on-set and first symptom

    1. Case 4

      Case#: Case 4, Sex: Female, Age:34

      DiseaseAssertion: STGD

      FamilyInfo: n/a

      CasePresentingHPOs: n/a

      CaseHPOFreeText: Text mentions BCVA 20/100 in both eyes later became 20/240. Bilateral atrophic-appearing foveal lesions associated with yellowish-white fundus flecks at the posterior pole. Subnormal scotopic and photopic responses. Subretinal fibrosis in left eye. Hypofluorescence due to hyperplasia of RPE in left eye.

      CaseNotHPOs:n/a

      CaseNotHPOFreeText: No ocular trauma.

      Genotyping Method: genetic analysis

      PreviouslyPublished: n/a

      Variant: Variant is a heterozygous mutation given as NM_000350.3(ABCA4):c.3113C>T (p.Ala1038Val)

      ClinVar: Variation ID: 7894

      CAID: CA119135

      SupplementalData: n/a

    2. Case 2

      Case#: Case 2, Sex: Male, Age:20

      DiseaseAssertion: STGD

      FamilyInfo: n/a

      CasePresentingHPOs: HP:0007663, HP:0007401

      CaseHPOFreeText: Text mentions visual acuity of 20/32 in right eye and 20/50 in left eye but later degrades to 20/200 in both eyes. pigmented changes in macula associated with flecks. Area of subretinal fibrosis in right eye. Subnormal scotopic and photopic responses. Instable fixation in both eyes with low retinal mean sensitivity. Hypofluorescent central area corresponding to macular atrophy and corresponding to flecks. Atrophic areas, some with pigment, localized in the temporal sector of the left eye which have become areas of subretinal fibrosis.

      CaseNotHPOs:n/a

      CaseNotHPOFreeText: Anterior segment showed a healthy ocular adnexa, and specular, transparent and 'in situ' lens, absence of any ocular trauma.

      Genotyping Method: genetic analysis

      PreviouslyPublished: n/a

      Variant: Variant is a homozygous mutation given as NM_000350.3(ABCA4):c.571-2A>T

      ClinVar: Variation ID: 1048133

      CAID: CA958800

      SupplementalData: n/a

    1. Patient 3

      Case#: 25 year old Female, Sikh, India, Punjab

      DiseaseAssertion: EORSD

      FamilyInfo: Family history for other disease were negative

      CasePresentingHPOs: HP:0007401, HP:0007913

      CaseHPOFreeText: Macular atrophy, scar and pigment OU, plus midperipheral pigmentation OU

      CaseNotHPOs: N/a

      CaseNotHPOFreeText: N/a

      Genotyping Method: BGISeq-500 2 x 100-bp paired-end module, Burrows-Wheeler Aligner and Genome Analysis Tooklit HaploptypeCaller

      PreviouslyPublished: N/a

      Variant: NM_000350.3(ABCA4):c.6729+5_6729+19del

      ClinVar: 283573

      CAID: CA501163

      SupplementalData: Family reported never saw well and had poor vision and nystagmus before the age of one.

    2. Patient 1

      Case#: German/British, 76

      DiseaseAssertion: EOSRD

      FamilyInfo: Grandparents from Germany and the United Kingdom

      CasePresentingHPOs: HP:0007401, HP:0007913

      CaseHPOFreeText: Macular atrophy and pigmentation, peripheral pigmentation, early-onset severe retinal dystrophy

      CaseNotHPOs: N/a

      CaseNotHPOFreeText: N/a

      Genotyping Method: BGISeq-500 2 x 100-bp paired-end module, Burrows-Wheeler Aligner and Genome Analysis Tooklit HaploptypeCaller

      PreviouslyPublished: n/a

      Variant: c.1622T>C, c.4326C>A, and c.3113C>T

      ClinVar: 99067, 417991, 7894

      CAID: CA226911, CA957653, CA119135

      SupplementalData: The c.1622T>C variants and c.3133C>T are thought to be same gene copy

    1. Among the 390 probands and 16 pseudodominant relatives in the cohort, 736 instances of 241 different alleles of the ABCA4 gene were observed (Table S2, available at www.aaojournal.org). A total of 10% of these alleles harbored terminating variants, 22% harbored splice-altering variants, and 61% harbored missense variants. No disease-causing variants could be found on 7% of the probands' alleles.

      Case#: Proband P399, Family F345, male, 8yo at onset, US

      DiseaseAssertion:

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: phenotypically focused tiered testing strategy beginning with allele-specific testing of the most common disease alleles and progressing through Sanger sequencing of candidate genes and, in many cases, to next generation sequencing of whole exomes and whole genomes

      PreviouslyPublished: n/a

      Variant: Pro1380Leu (c.4139C>T); Glu2031Lys (c.6091G>A) phase unconfirmed

      ClinVar: 866538

      CAID: CA341279017

      SupplementalData: table s2 (listed as table 1 when you open it)

    1. Seven hundred and fifty-six patients (98%) had inherited retinal diseases (IRD), and the remaining 17 (2%) had other etiologies, such as optic atrophy (6) and coloboma (4). Four hundred and eighty-three patients (62%) had a diagnosis of non-syndromic retinitis pigmentosa (RP), 41 (5%) of early-onset severe retinal dystrophy (EOSRD), 40 (5%) of Stargardt disease, 39 (5%) of Usher syndrome, 38 (5%) of macular dystrophy (MD), 19 (2%) of cone-rod dystrophy (CORD), 19 (2%) of choroideremia (CHM), and the remaining patients had less frequent conditions (Fig. ​(Fig.22 and Supplementary Table 1).

      Case#: Patient 339, Argentinian

      DiseaseAssertion: macular dystrophy

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: c.6383A>G (p.His2128Arg); c.4457C>T (p.Pro1486Leu) NGS

      ClinVar: 99455

      CAID: CA227399

      SupplementalData: supplemental table 1 contains phenotype info

    1. STGD-01

      Case#: Case1, Sex:Male, Age:19

      DiseaseAssertion: STGD

      FamilyInfo: n/a

      CasePresentingHPOs: n/a

      CaseHPOFreeText: Clinical Notes: Peripapillary sparing, discrete flecks; nummular atrophy. General notes: Panretinal cone dysfunction with preserved rod function was documented by ERG

      CaseNotHPOs:n/a

      CaseNotHPOFreeText: n/a

      Genotyping Method: Whole exome sequencing data generation. Additional sequencing targeted amplification fo PRPH2 and ELOVL4 using PCR.

      PreviouslyPublished: n/a

      Variant: Variant 1 given as p.N965S; NM_000350.3(ABCA4):c.2894A>G (p.Asn965Ser). Variant 2 given as p.R2038W; NM_000350.3(ABCA4):c.6112C>T (p.Arg2038Trp)

      ClinVar: Variation ID: 236096; Variation ID: 99430

      CAID: CA958124; CA227368

      SupplementalData: Proband variant information given in Table 1.

    1. Thirty-Three Truncated and 98 Amino Acid–Changing Variants in the ABCA4 Gene

      This variant was found on one allele of a Stargardt patient, but no additional details are provided about the patient or the other allele. A combination of single-strand conformation polymorphism (SSCP) and automated DNA sequencing was used to evaluate the entire exonic and flanking intron sequence of the ABCA4 gene

    2. Thirty-Three Truncated and 98 Amino Acid–Changing Variants in the ABCA4 Gene

      c.1989G>CA (p.Trp663Ter) variant was found on one allele of a Stargardt patient, but no additional details are provided about the patient or the other allele. A combination of single-strand conformation polymorphism (SSCP) and automated DNA sequencing was used to evaluate the entire exonic and flanking intron sequence of the ABCA4 gene

    3. Thirty-Three Truncated and 98 Amino Acid–Changing Variants in the ABCA4 Gene

      This variant was found on one allele of a Stargardt patient, but no additional details are provided about the patient or the other allele. A combination of single-strand conformation polymorphism (SSCP) and automated DNA sequencing was used to evaluate the entire exonic and flanking intron sequence of the ABCA4 gene

    1. Patient 1, a 40-year-old Caucasian woman, presented in July 1998 with a history of progressive decline in visual acuity since the age of 15.

      PMID: 10612508

      Gene: ABCA4

      Case#: Patient 1, 40-year-old female

      DiseaseAssertion: STGD1

      FamilyInfo: One of four affected siblings in a family of eight. Segregation consistent with autosomal recessive inheritance.

      CasePresentingHPOs: HP:0000545 — Decreased visual acuity HP:0000612 — Central scotoma HP:0007754 — Macular atrophy HP:0030638 — Retinal flecks HP:0000512 — Abnormal fundus morphology

      CaseHPOFreeText: Progressive decline in visual acuity since age 15. Best-corrected visual acuity RE 20/400, LE 20/150. Central scotomas reported. Fundus exam showed bilateral central macular atrophy (worse in right eye), pigment deposits at the level of the retinal pigment epithelium, and numerous yellow flecks in the midperiphery. Fluorescein angiography demonstrated central hypofluorescence corresponding to atrophy with surrounding hyperfluorescence and peripheral dark choroid.

      CaseNotHPOs: HP:0000662 — Night blindness (absent)

      CaseNotHPOFreeText: Patient denied nyctalopia.

      GenotypingMethod: PCR amplification and direct sequencing of all 50 exons of ABCA4 following SSCP screening.

      PreviouslyPublished: Yes

      Variant: NM_000350.2:c.2588G>C (p.Gly863Ala) NM_000350.2:c.161G>A (p.Cys54Tyr)

      ClinVar: Not reported

      CAID: Not reported

      SupplementalData: Segregation demonstrated in pedigree (Figure 1); mutation confirmation by sequencing (Figure 4)

    1. -year-old girl without any detectable fundus abnormalities.

      Case#: Patient 8 yo, F, Turkiye, onset at 8yo (early onset)

      DiseaseAssertion:STGD1

      FamilyInfo: no consanguinity between parents, neither parents are affected or show symptoms

      CasePresentingHPOs: HP:0008035, HP:0011504

      CaseHPOFreeText: vision of 6/10

      CaseNotHPOs: HP:0000007, HP:0000608

      CaseNotHPOFreeText: normal movements and mobility, unremarkable slit-lamp, no fundoscopy changes, unremarkable OCT

      Genotyping Method: N/A

      PreviouslyPublished: N/A

      Variant: NM_000350.3a: c.3322C>T,p.(Arg1108Cys)rs61750120

      CAID: CA220683

      SupplementalData: N/A

    1. Case 3: RP3.03

      Case:RP3,03, male proband with first symptoms as 18 years old. DiseaseAssertion:RP19 FamilyInfo:Proband was born in a consangiuineous family of Moroccan origin. Parents were unaffected. InheritancePattern:AutosomalRecessive CasePresentingHPOs:HP:0007994,HP:0000510,HP:0100014 CaseHPOFreeText:Difficulty with dark adaptation, Fig 4B severe impairment of the entire visual field. Fig 4A Scotopic and photopic ERG traces were altered indicating rod and cone photoreceptor dysfunctions. Macular OCT showed relative preservation of the foveal structure. Epiretinal membrane formation was observed. CaseNOTHPOs:HP:0007667 CaseNOTHPOFreeText:absence of cystic spaces CasePreviousTesting: GenotypingMethod:Whole exome sequencing MultipleGeneVariants: compound heterozygous GeneName:ABCA4 Variant:NM_000350.3(ABCA4):c.5908C>T (p.Leu1970Phe) ClinVarID :7892 gnomAD:0.00362 GeneName:ABCA4 Variant:NM_000350.3(ABCA4):c.6148G>C (p.Val2050Leu) ClinVarID :7884 gnomAD:0.00308

    1. 413; 19c.1804C>T; c.2828G>Ap.R602W (D); p.R943Q (U)16c.2453G>Ap.G818E (D)Compound heterozygous

      Case#: Sporadic Case #4, Mexican

      DiseaseAssertion: Stargardt

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: STGD diagnosis based on: "onset of symptoms in childhood or early adulthood (before 20 years of age), bilateral central vision loss (central and peripheral visual field computerized testing), a retinal “beaten-bronze” foveal appearance and/or yellow-whitish flecks from the posterior pole to the mid periphery, normal caliber of the retinal vessels, no pigmented bone spicules in the retinal periphery, a normal to subnormal electroretinogram, and a typical dark choroid in fluorescein angiography."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: allele 1: c.1804C>T (p.R602W) and c.2828G>A (p.R943Q) allele 2: c.2453G>A (p. G818E); direct sequencing of exons of ABCA4

      ClinVar: 99135

      CAID: CA227000

      SupplementalData: n/a

    2. 816c.2453G>Ap.G818E (D)28c.4249_4251 delTTCp.F1417del (D; N)Compound heterozygous

      Case#: Familial Case #8, Mexican

      DiseaseAssertion: Stargardt

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: STGD diagnosis based on: "onset of symptoms in childhood or early adulthood (before 20 years of age), bilateral central vision loss (central and peripheral visual field computerized testing), a retinal “beaten-bronze” foveal appearance and/or yellow-whitish flecks from the posterior pole to the mid periphery, normal caliber of the retinal vessels, no pigmented bone spicules in the retinal periphery, a normal to subnormal electroretinogram, and a typical dark choroid in fluorescein angiography."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: allele 1: c.2453G>A (p. G818E) allele 2: c.4249_4251 delTTC (p.F1417del); direct sequencing of exons of ABCA4

      ClinVar: 99135

      CAID: CA227000

      SupplementalData: n/a

    3. 1016c.2453G>Ap.G818E (D)16c.2453G>Ap.G818E (D)Homozygous

      Case#: Sporadic Case #10, Mexican

      DiseaseAssertion: Stargardt

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: STGD diagnosis based on: "onset of symptoms in childhood or early adulthood (before 20 years of age), bilateral central vision loss (central and peripheral visual field computerized testing), a retinal “beaten-bronze” foveal appearance and/or yellow-whitish flecks from the posterior pole to the mid periphery, normal caliber of the retinal vessels, no pigmented bone spicules in the retinal periphery, a normal to subnormal electroretinogram, and a typical dark choroid in fluorescein angiography."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: c.2453G>A (p. G818E) homozygous; direct sequencing of exons of ABCA4

      ClinVar: 99135

      CAID: CA227000

      SupplementalData: n/a

    1. A 10-year-old female patient

      Case#: Patient 10, female, Lithuanian, onset at 6yo

      DiseaseAssertion: STGD

      FamilyInfo:Both parents and older brother healthy; no clinical signs in grandparents or extended family; inheritance most likely autosomal recessive

      CasePresentingHPOs: HP:0000505, HP:0012508, HP:0001105, HP:0025148, HP:0000662

      CaseHPOFreeText: progressive central vision loss from age 6; visual acuity dropped from OD=0.3, OS=0.3 to OD=0.08, OS=0.1 over 4 years; fundus examination: yellow pisciform flecks at the maculae; OCT: thin atrophic neurosensory retina in foveal region, altered photoreceptor reflectivity, thinner RPE; ERG: loss of scotopic b-waves, attenuated scotopic a-wave, missing oscillatory potentials, loss of photopic a- and b-waves; “bull’s eye” maculopathy noted

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a

      Genotyping Method: RetChip v1.0 STGD-module array and confirmation by Sanger sequencing

      PreviouslyPublished: n/a

      Variant: ABCA4 NM_000350.2 c.1622T>C p.(L541P), NM_000350.2 c.3113C>T p.(A1038V)

      CAID: CA226911, CA119135

      SupplementalData: clinical images, OCT, ERG, and pedigree information included in supplemental data (Figs. 1–5)

    1. MD-0560ABCA423c.3386G>Tp.Arg1129Leu47c.6410G>Ap.Cys2137Tyr16NPABCR400

      Case#: Family MD-0560 Proband, 16yo at onset

      DiseaseAssertion: AR Stargardt

      FamilyInfo:

      CasePresentingHPOs:

      CaseHPOFreeText: STGD diagnosed based on "bilateral central vision loss; fundus presenting with a beaten-bronze appearance and/or the presence of orange-yellow flecks in the retina from the posterior pole to the mid-periphery; fluorescein angiography showing typical dark choroid; and normal electroretinogram (ERGs)." VA loss, VF loss, BCVA=0.1/0.1

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: c.6410G>A (p.Cys2137Tyr); c.3386G>T (p.Arg1129Leu) found by ABCR400

      ClinVar: 2202779; 99224

      CAID: CA341277358; CA227116

      SupplementalData:

    2. MD-0170ABCA430c.4457C>Tp.Pro1486Leu9c.1222C>Tp.Arg408*14YesABCR400

      Case#: MD-0170 Proband, 14yo at onset

      DiseaseAssertion: STGD

      FamilyInfo: Family MD-0170

      CasePresentingHPOs:

      CaseHPOFreeText: STGD diagnosed based on "bilateral central vision loss; fundus presenting with a beaten-bronze appearance and/or the presence of orange-yellow flecks in the retina from the posterior pole to the mid-periphery; fluorescein angiography showing typical dark choroid; and normal to subnormal electroretinogram (ERGs)."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: Haplotype analysis, ABCR400

      PreviouslyPublished: unclear

      Variant: c.4457C>T (p.Pro1486Leu); c.1222C>T (p.Arg408*)

      ClinVar: 99283

      CAID: CA227192

      SupplementalData: n/a

    3. MD-0084ABCA447c.6410G>Ap.Cys2137Tyr47c.6410G>Ap.Cys2137Tyr7YesABCR400 + dHPLC + HRM + MLPAValverde et al. 2006 (6); Aguirre-Lamban et al. 2010 (16)

      Case#: Family MD-0084 Proband, 7yo at onset

      DiseaseAssertion: AR Stargardt

      FamilyInfo:

      CasePresentingHPOs:

      CaseHPOFreeText: STGD diagnosed based on "bilateral central vision loss; fundus presenting with a beaten-bronze appearance and/or the presence of orange-yellow flecks in the retina from the posterior pole to the mid-periphery; fluorescein angiography showing typical dark choroid; and normal to subnormal electroretinogram (ERGs)." VA loss, VF loss, BCVA=<0.05/<0.05

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: PMID: 16917483 (variant not found in this paper); PMID: 19959634

      Variant: c.6410G>A (p.Cys2137Tyr) homozygous, found by ABCR400 + dHPLC + HRM + MLPA

      ClinVar: 2202779

      CAID: CA341277358

      SupplementalData:

    1. In 20 patients (19 STGD and 1 CRD), 18 different genotypes were identified (Table 1). Except p.Arg187His and p.Tyr954Ser variants, the rest of changes were previously reported as disease-associated allele. 14 The p.Arg187His and p.Tyr954Ser variants were not found in 100 ethnically matched control chromosomes. All the mutations identified in the 20 patients except one were detected by HRM for sensitivity of 95%; however, only 16 variants were identified by dHPLC for sensitivity of 80%.  Table 1. View Table Mutations AnalyzedTable 1. Mutations Analyzed Family Exon Genotype Mutation Detected by dHPLC Mutation Detected by HRM Nucleotide Change Amino Acid Change ARDM-167 5 c.560G>A p.Arg187His No Yes ARDM-257 5 c.560G>A p.Arg187His No Yes ARDM-164 6 c.700C>T p.Gln234X Yes Yes ARDM-135 8 c.1029_1030insT p.Asn344fsX Yes No ARDM-240 15 c.2285C>A p.Ala762Glu Yes Yes ARDM-248 19 c.2861A>C p.Tyr954Ser Yes Yes ARDM-90 — IVS21-2A>T — Yes Yes ARDM-40 27 c.3943C>T p.Gln1315X Yes Yes ARDM-158 30 c.4537delC p.Gln1513fsX1525 Yes Yes ARDM-38 33 c.4739delT p.Leu1580fs Yes Yes ARDM-163 36 c.5172G>T p.Trp1724Cys Not Yes ARDM-197 36 c.5172G>T p.Trp1724Cys Yes Yes ARDM-181 — IVS38+5G>A — Yes Yes ARDM-125 40 — p.KNLFA1876dup Yes Yes ARDM-183 43 c.5929G>A(False −) p.Gly1977Ser(False −) Yes Yes ARDM-146 44 c.6140T>A p.lle2047Asn Yes Yes ARDM-174 — IVS44+2T>A — Yes Yes ARDM-247 47 c.6410G>A p.Cys2137Tyr* Yes Yes ARDM-84 47 c.6410G>A p.Cys2137Tyr† No Yes ARDM-225 48 c.6559C>T p.Gln2187X Yes Yes  Previously unreported mutations are shown in bold. *  Mutation in heterozygous. †  Mutation in homozygous. Homozygous sequence alteration (p.Cys2137Tyr) could be identified from wild-type by HRM analyses (Fig. 1). In contrast, dHPLC did not distinguish any homozygous mutation, except when we mixed it, in a 1:1 proportion, with a previously sequenced wild-type sample at the end of each PCR session and before heteroduplex formation.

      Case#: Family MD-0084/ARDM-84 Proband, 7yo at onset

      DiseaseAssertion: AR Stargardt

      FamilyInfo:

      CasePresentingHPOs:

      CaseHPOFreeText: STGD diagnosed based on "bilateral central vision loss; fundus presenting with a beaten-bronze appearance and/or the presence of orange-yellow flecks in the retina from the posterior pole to the mid-periphery; fluorescein angiography showing typical dark choroid; and normal to subnormal electroretinogram (ERGs)." VA loss, VF loss, BCVA=<0.05/<0.05

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: c.6410G>A (p.Cys2137Tyr) homozygous, found by ABCR400 + dHPLC + HRM + MLPA

      ClinVar: 2202779

      CAID: CA341277358

      SupplementalData: n/a

    1. Sixty-six individuals representing 54 families were studied (Supplementary Material, Table S1). All individuals were found to harbor two ABCA4 variants likely to cause the retinal disease (18,20–26). In 40 families (74%), independent segregation of the two alleles was demonstrated. The ages at the time of their first visit ranged from 9 to 74 years (mean = 35.9, median = 35.2 years); in the majority of individuals (36/66=55%), data were available from a second visit that occurred on average 8.7 years (range=2–20 years, median = 6.9 years) after the first visit.

      This variant was found in 6 different families (F32, F33, F40, F41, F42, and F43).

      PP4: F32: Patient #37 is a 31yo male, ADI=4yo, dx of CRD F33: Patient #38 is a 32yo female, ADI=>32yo, dx of STGD, segregation in the family but no further details F40: Patient #45 is a 65yo male, ADI=26yo, dx of CRD, segregation of homozygous alleles with disease was demonstrated in 2 affected siblings in Family 40. F41: Patient #46 is a 38yo female, ADI=>38yo, dx of STGD F42: Patient #47 is a 45yo female, ADI=>53yo, dx of STGD F43: Patient #48 is a 55yo female, ADI=46yo, dx of STGD

      PM3: In family 40, the proband was homozygous. In the other families, the variant was in compound heterozygosity with p.A1038V;p.L541P (F32); p.A1038V (F33); p.V1686M (F41); p.G1961E (F42); p.K2172R (F43).

    1. proband

      Case#: Two affected sisters/Female siblings/Progressive onset initially presenting as Stargardt disease

      DiseaseAssertion: ABCA4

      FamilyInfo: Large American family pedigree with two affected sisters. Both sisters were compound heterozygous for two novel ABCA4 variants. Unaffected relatives carried one variant or neither variant, supporting autosomal recessive inheritance.

      CasePresentingHPOs: HP:0000556, HP:0000572, HP:0007754, HP:0000648, HP:0000510, HP:0001133, HP:0000610

      CaseHPOFreeText: Proband initially showed phenotype compatible with Stargardt disease with progressive central vision loss. Over several years disease advanced into severe cone-rod dystrophy with worsening retinal degeneration, abnormal visual fields, and reduced electroretinography responses.

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: Unaffected family members with only one mutation had no retinal disease phenotype.

      Genotyping Method: Genome-wide linkage analysis using 408 microsatellite markers followed by direct Sanger DNA sequencing of all ABCA4 exons and exon-intron boundaries. Segregation analysis performed in family members.

      PreviouslyPublished: No, both variants were novel at time of publication.

      Variant: ABCA4 (RefSeq: NM_000350.3): c.655A>T ; ABCA4 (RefSeq: NM_000350.3): c.5312+3A>T

      ClinVar: 632118

      CAID: n/a

      SupplementalData: Variants absent in 200 unrelated controls. Clinical testing included visual acuity, fundus examination, fluorescein angiography, visual field testing, and electroretinography. Compound heterozygous state associated with severe progressive phenotype.

    1. 54-year-old female patient

      Case#: Female, 54 yo

      FamilyInfo: No family members were available

      CasePresentingHPOs: HP:0007924, HP:0000519,HP:0001105, HP:0030825,

      CaseHPOFreeText: diagnosed with HIV 15 years ago. She was initially diagnosed with HIV following recurrent respiratory infections and an unintentional weight loss of 12 kg over six months. The diagnosis was confirmed via a positive HIV antibody test, followed by a Western blot confirmation and a CD4 count of 400 cells/mm³ at the time of diagnosis. Antiretroviral therapy (ART) was initiated shortly after confirmation of the diagnosis. Her condition has since progressed to AIDS, with a recent CD4 count of 80 cells/mm³. She was on ART, including tenofovir, emtricitabine, and efavirenz.

      CaseNotHPOs: n/a

      GenotypeMethod: NGS, Sanger Sequencing

      Variant: c.2588G>C in exon 13, c.5461-10T>C in intron 39

      ClinVar: Not reported in ClinVar

      **SupplementalData: ** indicative of significant loss of central retinal structure (Figure 4).

    1. Figure 3: Protein yield and ATP-binding capacity of 37 naturally occurring ABCR variants produced in transiently transfected 293 cells.Membranes were analysed by immunoblotting with affinity-purified anti-ABCR antibodies (top) and photoaffinity labelling with α-32P azido-ATP (bottom). We loaded 1 μg (immunoblotting) or 2.5 μg (azido-ATP labelling) of total membrane protein, as determined by Bradford assay, per track. The mutations that reside in NBD-1 and NBD-2 are indicated above the corresponding lanes. The relative levels of the different variant proteins and the extent of azido-ATP labelling were observed to be highly reproducible in multiple independent experiments. ABCR (large arrowhead); an endogenous 55-kD protein (small arrowhead) serves as an internal control for azido-ATP labelling. Molecular mass standards are shown on the left in kD.Full size imageThe combination of immunoblotting and azido-ATP labelling revealed defects in more than 75% of the variants tested. Among the variants with reduced yield and/or ATP binding are G863A and delG863, the two protein products of a guanosine2588→cytosine mutation that both generates a glycine-to-alanine substitution at codon 863 and activates a cryptic splice acceptor site in exon 17 that results in the removal of codon 863 from approximately 50% of the transcripts10. This is the most common allele among STGD patients in Northern Europe, representing roughly 20% of disease-associated alleles. It is also present at a frequency of approximately 3% in the general population in Northern Europe and approximately 1% in the United States population7,9,10. Genotype-phenotype correlations suggest that it is a mild allele and that it leads to STGD only when paired with a more severe allele10. Relative to wild type, the G863A variant is subtantially impaired and the delG863 variant is mildly impaired (Fig. 3).

      This variant was transfected into HEK 293 cells and appears to show reduced expression and ATP-binding capacity, but no quantities were provided

    2. The two codon 863 variants, G863A and delG863, show a decrease in both basal and retinal-stimulated ATPase, with G863A showing the greater decrease (Fig. 4d).

      In HEK293 cells, G863A was purified, reconstituted into membranes, and tested for basal and retinal-stimulated ATPase activities. G863A was shown to have reduced basal and retinal-stimulated ATPase (Fig 4d)

    3. Over 200 ABCA4 sequence variants have been reported so far in patients with STGD and other retinopathies1,5,6,7,8,9,10,11,12,13,14,15,16,17. We have examined 33 missense mutations, 3 small in-frame deletions and 1 frameshift near the carboxy terminus (Table 1 and Fig. 2), including those mutations most commonly encountered in STGD patients1,5,6,7,8,9,10,11 and several that were reported in AMD patients15. As an initial step in assessing protein folding and stability, we analysed each ABCR variant by immunoblotting and azido-ATP labelling (Fig. 3). Mutations that cause small deletions (delVVAIC1681 and delPAL1761) or introduce charged amino acids into predicted transmembrane domains (G851D and G1886E) produce greatly reduced amounts of protein. Among the ABCR variants that are expressed with normal or nearly normal yield, azido-ATP labelling revealed a subset that is defective in ATP binding. A variety of mutations that lie outside of the nucleotide-binding domains (NBDs) can impair azido-ATP labelling, including L541P, predicted to reside adjacent to a transmembrane domain, and W1408R, which resides between the homologous halves of ABCR (Fig. 2). These data suggest that ATP binding to the NBDs is allosterically coupled to conformational changes in or near the transmembrane regions. Moreover, some mutations within either of the two NBDs abolish or nearly abolish all azido-ATP labelling, as seen, for example, with variants T971N, L1971R, G1977S and E2096K, implying allosteric coupling between the two NBDs, as described for P-glycoprotein22,23.Table 1 Naturally occurring ABCR variants produced in transfected 293 cellsFull size tableFigure 2: Locations of 37 naturally occurring ABCR sequence variants and 4 synthetic mutations.The predicted transmembrane topography and domain structure of ABCR is based on the hydropathy profile and sequence alignment with other ABC transporters. The cytosolic face of the membrane is downward. NBD, nucleotide binding domain; HH, highly hydrophobic domain shared with other members of the ABC1/ABCR subfamily of ABC transporters. A, B and C indicate the sequence motifs characteristic of nucleotide binding folds. Asterisks denote the four synthetic mutations.Full size imageFigure 3: Protein yield and ATP-binding capacity of 37 naturally occurring ABCR variants produced in transiently transfected 293 cells.Membranes were analysed by immunoblotting with affinity-purified anti-ABCR antibodies (top) and photoaffinity labelling with α-32P azido-ATP (bottom). We loaded 1 μg (immunoblotting) or 2.5 μg (azido-ATP labelling) of total membrane protein, as determined by Bradford assay, per track. The mutations that reside in NBD-1 and NBD-2 are indicated above the corresponding lanes. The relative levels of the different variant proteins and the extent of azido-ATP labelling were observed to be highly reproducible in multiple independent experiments. ABCR (large arrowhead); an endogenous 55-kD protein (small arrowhead) serves as an internal control for azido-ATP labelling. Molecular mass standards are shown on the left in kD.Full size imageThe combination of immunoblotting and azido-ATP labelling revealed defects in more than 75% of the variants tested. Among the variants with reduced yield and/or ATP binding are G863A and delG863, the two protein products of a guanosine2588→cytosine mutation that both generates a glycine-to-alanine substitution at codon 863 and activates a cryptic splice acceptor site in exon 17 that results in the removal of codon 863 from approximately 50% of the transcripts10. This is the most common allele among STGD patients in Northern Europe, representing roughly 20% of disease-associated alleles. It is also present at a frequency of approximately 3% in the general population in Northern Europe and approximately 1% in the United States population7,9,10. Genotype-phenotype correlations suggest that it is a mild allele and that it leads to STGD only when paired with a more severe allele10. Relative to wild type, the G863A variant is subtantially impaired and the delG863 variant is mildly impaired (Fig. 3).

      This variant was transfected into HEK 293 cells and appears to show reduced expression and ATP-binding capacity, but no quantities were provided

    1. 2 F 62 c.1222 C>T ND

      Case Annotation Template

      Case#: Patient 2, female, age 62

      DiseaseAssertion: STGD

      FamilyInfo: diagnosis of autosomal recessive STGD based on the pedigree and clinical phenotype of fleck deposits with or without genetic testing

      CasePresentingHPOs: HP:0000608, HP:0000007, HP:0030610, HP:0030500

      CaseHPOFreeText: Macular degeneration. autosomal recessive, Photoreceptor outer segment loss on macular OCT, Yellow/white lesions of the macula

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a

      Genotyping Method: n/a

      PreviouslyPublished: n/a

      Variant: ENST00000370225.4:c.1222C>T

      ClinVar: NM_000350.3(ABCA4):c.1222C>T (p.Arg408Ter)

      CAID: CA179692

      SupplementalData: composite mask analysis shown in figure 3 for patient 2, "Both patient 2 and 14 show foveal preservation of IS/OS and RPE," "Patients 2, 19, and 11 show large areas of matched degeneration and isolated IS/OS loss, "

    2. 10 F 19 c.2588G>C c.1222C>T

      Case#: Patient 10, female, age 19

      DiseaseAssertion: STGD

      FamilyInfo: diagnosis of autosomal recessive STGD based on the pedigree and clinical phenotype of fleck deposits with or without genetic testing

      CasePresentingHPOs: HP:0000608, HP:0000007, HP:0030610, HP:0030500

      CaseHPOFreeText: Macular degeneration. autosomal recessive, Photoreceptor outer segment loss on macular OCT, Yellow/white lesions of the macula

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a

      Genotyping Method: n/a

      PreviouslyPublished: n/a

      Variant: Allele 1: NM_000350.3:c.2588G>C Allele 2: NM_000350.3:c.1222C>T

      ClinVar: Allele 1: NM_000350.3(ABCA4):c.2588G>C (p.Gly863Ala) Allele 2: NM_000350.3(ABCA4):c.1222C>T (p.Arg408Ter)

      CAID: Allele 1: CA119128 Allele 2: CA179692

      SupplementalData: composite mask analysis shown in figure 3 for patient 10

    1. RP-0298 CRD 8 c.950del p.(Gly317Alafs*57) 33 c.4720G>T p.(Glu1574*) yes 10 10 8 36y - HM/HM This stud

      This variant is found in compound heterozygosity with c.950del p.(Gly317Alafs*57) in family RP-0298 in this study. Proband is 10yo at onset of VA loss and VF loss, 8yo at night blindness, and 36yo at opthalmological exam. BCVA=HM/HM.

    2. MD-1146 STGD1 14 c.2023G>A p.(Val675Ile) 47 c.6410G>A p.(Cys2137Tyr) Yes 46 - - 46y Normal 1/1 This study

      This variant is found in compound heterozygosity with c.2023G>A p.(Val675Ile) in family MD-1146 in this study. Proband is 46yo at onset of VA loss. 46yo at opthalmological exam. Normal ERG. BCVA=1/1. Not eligible for PP4 due to age of onset.

    3. MD-0740 STGD1 47 c.6410G>A p.(Cys2137Tyr) IVS28 c.4253+43G>A p.[=, Ile1377Hisfs*3] - 61 No - 62y - 0.8/0.16 This study

      This variant is found in compound heterozygosity with c.4253+43G>A p.[=, Ile1377Hisfs*3] in family MD-0740 in this study. Proband is 61yo at onset of VA loss with no VF loss. 62yo at opthalmological exam. Cone pattern on ERG. BCVA=0.8/0.16. Not eligible for PP4 due to age of onset.

    1. ARDM-133 32T→C L11P 2888delG Frameshift Cosegregates

      Case#: Family ARDM-133 Proband, Spanish Retinal Dystrophy Investigation Network (EsRetNet), 8yo at onset, 42yo at report

      DiseaseAssertion: arCRD

      FamilyInfo: cosegregates

      CasePresentingHPOs: HP:0007663, HP:0000575, HP:0007641, HP:0000613

      CaseHPOFreeText: "The diagnosis of CRD was based on the following criteria: initial complaints of blurred central vision without a history of night blindness, poor visual acuity (typically 20/100 or worse, with progressive decline from an early age), impairment of color vision, funduscopic evidence of atrophic macular degeneration, peripheral disturbances including pigment clumping and/or pigment epithelial thinning, and greater or earlier loss of cone than rod ERG amplitude."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: ABCR400 microarray, PCR amplification

      PreviouslyPublished: n/a

      Variant: 32T→C, L11P; 2888delG

      ClinVar: 99217

      CAID: CA227106

      SupplementalData:

    1. The patients’ demographic and genetic characteristics are provided in eTable 1 in Supplement 1.

      Proband can genotype and some phenotype information can be found in eTable 1.

      Case#: Patient 601691#46, male, Italian, 32yo

      DiseaseAssertion: ABCA4-Associated Retinopathy

      GenotypingMethod: sequencing with Illumina NexSeq500 platform, confirmation with Sanger sequencing

      PreviouslyPublished: n/a

      Variant: c.5018+2T>C; c.6415C>T (p.Arg2139Trp)

      CAID: CA227402

      SupplementalData: eTable 1

    1. Table 1shows the age, sex, vision at the most recent visit, fluorescein angiographic findings, and clinical phenotype for 29 patients with a possible disease-causing mutation in the ABCRgene. Each of the 29 patients were from different pedigrees. However, the mother of patient 12 and the father of patient 29 were also found to have compound heterozygous sequence variations in the ABCRgene.

      Case#: Fishman Patient #22, male, 28yo

      DiseaseAssertion: Stargardt dystrophy or fundus flavimaculatus

      FamilyInfo:

      CasePresentingHPOs:

      CaseHPOFreeText: dark choroid, diffuse yellowish white flecks in the fundus, 20/400 OU, central scotoma

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: only one variant found: c.6383A>G (p.His2128Arg) Single-strand conformation polymorphism analysis and DNA sequencing were used to identify variations in coding sequences of the ABCRgene.

      ClinVar: 99455

      CAID: CA227399

      SupplementalData:

    1. Data from 244 and 645 individuals with ABCA4-AR from scanning and exon-sequencing techniques, respectively, from Lille University Hospital were included in the study, as well as data from 800 individuals from Moorfields Eye Hospital London and 271 individuals described by Corradi et al.13 In total, these data included 18 individuals with 2 mild_rp noncomplex variants. Individuals with c.2588G>C without c.5603A>T were mainly reported in the scanning dataset from Lille University Hospital and the Moorfields Eye Hospital London dataset. These datasets likely reported only a few cases with c.5603A>T in cis because the latter variant was long considered benign because of its high frequency. An overview of the data are given in the Table.

      Looked through supplemental files and was unable to locate the patient from the LOVD entry for this variant for more phenotype details.

    1. Our case-control association study included 116 patients with atrophic AMD, 77 with RP, 86 with STGD, and 100 healthy controls. All the patients were evaluated by a standard ophthalmologic examination and OCT. ERG was performed on STGD and RP patients. All the subjects underwent a blood drawing for genetic testing and the CFHY402H polymorphism was genotyped with the TaqMan real-time polymerase chain reaction single nucleotide polymorphism assay.

      annotating here since unable to annotate on PDF.

      Case#: Stargardt patient 22, Italian

      DiseaseAssertion: STGD

      FamilyInfo:

      CasePresentingHPOs:

      CaseHPOFreeText: STGD criteria: "(1) juvenile to adult onset of symptoms; (2) bilateral central vision loss; (3) macular dystrophy and/or atrophy (beaten bronze appearance or large patch of atrophy); (4) normal caliber of retinal vessels; (5) absence of pigmented bone spicules. The presence of yellow-white flecks was not considered obligatory inclusion criteria, even though they could be found in most of the patients of our series. Similarly, the possible presence of the “dark choroid” phenomenon could be identified in the fluorescein angiography examinations carried out on some patients in previous clinical settings, but it was not considered significant for the recruitment."

      CaseNotHPOs:

      CaseNotHPOFreeText: "myopia >6 diopters, hyperopia and astigmatism >3 diopters, ocular disorders other than RP, STGD, or AMD, significant systemic diseases, a history of inflammation-associated diseases and media opacities preventing fundus examination"

      GenotypingMethod: all coding exons, including intron-exon boundaries of the ABCA4 gene (NM 000350) were sequenced. PCR

      PreviouslyPublished: n/a

      Variant: c.5882G>A (p.Gly1961Glu); c.4450C>T (p.Pro1484Ser); c.203C>T (p.Pro68Leu)

      ClinVar: 99113

      CAID: CA226972

      SupplementalData: Table S2

    1. Family: SG-04

      MonDO: MONDO:0019353

      Case: Family SG-04 Patient II:1. Indian Male, 26 years old diagnosed with Stargardt's disease DiseaseAssertion: Stargardt disease

      FamilyInfo: Only child of nonconsanguineous parents. Proband's unaffected mother (I:1) harbored only one heterozygous variant (p.Gly1961Glu) in ABCA4. His father (I:2) was clinically normal and was not included for genetic testing.

      CasePresentingHPOs: HP:0001129, HP:0007401 (Large central visual field defect, Macular atrophy)

      CaseHPOFreeText: atrophic macular lesions

      CaseNOTHPOs: HP:0011507 (macular flecks)

      CasePreviousTesting: Five clinically confirmed unrelated patients with Stargardt disease and their available family members were enrolled for genetic analysis. Study subjects underwent a complete ophthalmic examination including measurement of visual acuity, intraocular pressure, slit lamp biomicroscopy, detailed fundus examination, fundus photography, fundus autofluorescence (FAF), spectral domain optical coherence tomography (SD-OCT), and full field electroretinography (ERG). Fifty normal controls without any history of eye diseases were included.

      GenotypingMethod: NGS panel testing targeting 184 genes with previously known pathogenic variations associated with multiple eye disorders. Peripheral blood samples were obtained from all subjects.

      MultipleGeneVariants:

      (1) GeneName: ABCA4

      (1) Variant: p.Gly1961Glu

      (1) CAID: CA119132

      (1) gnomAD: The total minor allele frequency in gnomAD v4.1.0 is 0.003406 (5498/1614012 alleles).

      (2) GeneName: ABCA4

      (2) Variant: p.Tyr872X

      (2) CAID: CA341276149

      (2) gnomAD: Not found in gnomad v. 4.1

    1. Finally, we examined whether the phenotype‐associated known/candidate pathogenic variants could explain the patient's disease, andif the MAF in population‐matched control data (8.3kJPN) was relatedto disease prevalence. Patients were classified as “Solved” if theirgenotype was consistent with their clinical phenotype. Patients wereclassified as “Partially solved” when a heterozygous known/candidatepathogenic variant was detected in a recessive allele, but without anadditional variant in trans. Patients were categorized as “Unsolved” iftheir genotypes exhibited either no candidate pathogenic variants ormultiple heterozygous pathogenic variants that did not explain thephenotype clearly. Variants annotated as causal for solved patients arelisted in Supporting Information: Table S2. Novel variants identified inthis study are listed in the second sheet of Table S2. SupportingInformation: Table S3 shows the phenotypes and genotypes of solvedpatients.2.4 | Statistical analysisBefore counting the allele frequency in our cohort, the list ofpatients was modified to contain only the proband to avoid theoverrepresentation of pedigrees with larger numbers of affectedindividuals. Inter‐pedigree comparisons of genetic diagnoses evaluat-ing proband only and proband with family members were performedby the chi‐square test. Enrichments of the pathogenic variants ingenetically solved and unsolved patients were compared by the one‐sided binominal test. Allele frequencies were compared with thehighest allele frequencies among the 8.3KJPN, HGVD, ExAC_EAS, andgnomAD_EAS databases. Statistical analyses were performed byR (ver. 4.0.3).2.5 | Detection of RP1:c.4052‐4053ins328(Alu insertion)Previously reported primers were used to amplify the expectedAlu‐inserted region (Nikopoulos et al., 2019). Genomic DNA wasamplified with Prime Star (TAKARA) following the manufacturer'sSUGA ET AL . | 310981004, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/humu.24492 by Mie University, Wiley Online Library on [07/11/2022]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

      This variant is listed in supplementary tables S2 and S3. Proband TM-319 is a "solved" patient, meaning the phenotype matches the genotype. Compound heterozygous (c.5318C>T p.A1773V) female with Stargardt disease- all that is provided.

    1. V1 H1 Exon 36.1–3 G>A chr1:94,484,001 c.5196+1137G>A 4 4 0 0

      Case#: Braun Family 6 Proband (from left to right, top to bottom of available pedigrees), male

      DiseaseAssertion: Stargardt

      FamilyInfo: Genotypes not provided for parents. No siblings

      CasePresentingHPOs:

      CaseHPOFreeText: "five or more of the following features of ABCA4-associated retinal disease: decreased visual acuity before age 20, decreased visual acuity as the first visual symptom, symmetrical fundus findings, pisciform flecks, beaten metal macular atrophy, bulls-eye maculopathy, peripapillary sparing, vermillion fundus, masked choroid on fluorescein angiography, nummular pigment overlying extensive macular atrophy, central outer retinal atrophy on optical coherence tomography and central scotomas on Goldmann perimetry."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: one plausible disease-causing mutation detected in ABCA4 after assessing the entire coding sequence and canonical retinal splice junctions with automated bidirectional Sanger sequencing using an ABI 3730 sequencer

      PreviouslyPublished: n/a

      Variant: c.5196+1137G>A; c.454C>T (p.R152X)

      ClinVar: 438100

      CAID: CA26843511

      SupplementalData: pedigree in fig s2

    1. 5 4514 S 12 1/10 / 1/10 c.32T>C(1) / c.[1A>G(1)]+[6089G>A(44)] p.Leu11Pro [12]/p.(Met1Val [6])+(Arg2030Gln [9])

      Case#: Maia-Lopes Family 5 Proband 4514, Portuguese, 12yo at onset

      DiseaseAssertion: STGD

      FamilyInfo: Family 5

      CasePresentingHPOs:

      CaseHPOFreeText: severe central fundus changes, vision: 1/10 / 1/10

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: ABCR400 microarray, dHPLC

      PreviouslyPublished: n/a

      Variant: c.32T>C(1) / c.[1A>G(1)]+[6089G>A(44)]; p.Leu11Pro/p.(Met1Val)+(Arg2030Gln)

      ClinVar: 99217

      CAID: CA227106

      SupplementalData: n/a

    2. 11 4613 S 9 FC / FC c.[4926C>G(35)]+[5041_5055del(36)] / c.32T>C(1) p.(Ser1642Arg [10])+(Val1681_Cys1685del [10])/p.Leu11Pro

      Case#: Maia-Lopes Family 11 Proband 4613, Portuguese, 9yo at onset

      DiseaseAssertion: STGD

      FamilyInfo: Family 11

      CasePresentingHPOs:

      CaseHPOFreeText: severe central fundus changes, vision: FC/FC

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: ABCR400 microarray, dHPLC

      PreviouslyPublished: n/a

      Variant: c.[4926C>G(35)]+[5041_5055del(36)] / c.32T>C(1); p.(Ser1642Arg [10])+(Val1681_Cys1685del [10])/p.Leu11Pro

      ClinVar: 99217

      CAID: CA227106

      SupplementalData: n/a

    1. Thirty-eight sporadic cases (60%) were resolved, of which 34 presented mutations in AR inheritance genes, three in AD inheritance genes, and one in XL inheritance. According to the genetic results, five initially AD retinitis pigmentosa (adRP) cases were reclassified to AR retinitis pigmentosa (arRP; fRPN-110) and to XL RP (fRPN-GB, fRPN-45, fRPN-97, fRPN-174), two arRP families to adRP (fRPN-AP, fRPN-168), one autosomal dominant MD family to late-onset retinal degeneration (LORD; fRPN-100), one Best MD case to CRD (fRPN-125), and one STGD case to Best MD (fRPN-39) (Supplemental Table S5).

      Case#: Proband RPN-290, Male, 43yo at genetic testing, 27yo at dx, onset in 30s, Spanish

      DiseaseAssertion: Nonsyndromic Inherited Retinal Dystrophies. Stargardt

      FamilyInfo: Family RPN-133

      CasePresentingHPOs:

      CaseHPOFreeText: decreased visual acuity, photophobia, BCVA (logMAR) 28y: 0,0/0,0 35y: 0,4/0,1 43y: 1,0/1,0, central scotoma (56/ 63), yellow-white deposits around the macula, central and peripheral neuroepithelium thinning; 43y: without significant changes, 27y: normal visual evoked potentials, normal : full field electroretinography, abnormal electrooculogram (Arden index); 36y: delayed latency right eye visual evoked potentials, decreased cone and rod ffERG.

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: NGS; MLPA and array CGH

      PreviouslyPublished: n/a

      Variant: c.4457C>T; p.(Pro1486Leu) homozygous

      ClinVar: 99283

      CAID: CA227192

      SupplementalData: supplemental table S2 has phenotype, S4 and S5 have genotype information

    1. Age of onset

      Case #: Eldest sister/Female/Onset at 3yo

      DiseaseAssertion: SLC26A2

      FamilyInfo: Family pedigree showing consanguinity of the proband's parents. The osteochondrodysplasia genotype, derived from a homozygous variant in the SLC26A2 gene and compound heterozygous variants in the ABCA4 gene, is responsible for the retinal phenotype

      CasePresentingHPOs: HP:0034345, HP:0000556, HP:0002098, HP:0001903, HP:0001385, HP:0007754, HP:0002650, HP:0000939, HP:0025388, HP:0007987, HP:0003124, HP:0007401

      CaseHPOFreeText: Visual acuity was 1/50 and 2/50 for both eyes, knee dysplasia, sticky platelet syndrome type II

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a

      GenotypyingMethod: genetic screening by next‐generation sequencing (NGS) was performed on a panel of genes involved in retinal dystrophy and macular degeneration

      PreviouslyPublished: n/a

      Variant: ABCA4 (RefSeq: NM_000350.3(ABCA4):c.203C>T (p.Pro68Leu))

      CAID: n/a

      SupplementalData: Comparison of phenotypes (table 1)

    1. 231

      Case#: Patient 231, Female, age of onset at 7 y.o, Poland

      DiseaseAssertion: STGD1

      FamilyInfo: Mother was a carrier, unaffected father.

      CasePresentingHPOs: HP:0007722, HP:0000608, HP:0025158

      CaseHPOFreeText: RPE atrophy, macular degeneration, central hyper-autofluorescence in fundus autofluorescence

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a, non-proband identified HPO's mentioned, but not assignable to individual proband.

      Genotyping Method: DNA isolated from peripheral blood from patients and relatives via MagNA Pure 24, samples screened with MIPs targeting 108 genes involved in pathogensis of IRD's. PCR completed on library, analysed with NGS fragment analysis kit.

      PreviouslyPublished: yes

      Variant: c.4234C>T , p.(Gln1412*)

      ClinVar: 99263

      gnomeAD 0.00001984 allelic frequency

      CAID: n/a

      SupplementalData: Fig1: List of families displaying pseudo-dominant inheritance. Fig2: Number of alleles for most common variants.

    2. c.634C>T

      Case#: Patient 225, Female, age of onset 7 y.o, Poland

      DiseaseAssertion: STGD-1

      FamilyInfo: no given family information.

      CasePresentingHPOs: HP:0007722, HP:0000608, HP:0025158

      CaseHPOFreeText: RPE atrophy, macular degeneration, central hyper-autofluorescence in fundus autofluorescence

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a, non-proband identified HPO's mentioned, but not assignable to individual proband.

      Genotyping Method: DNA isolated from peripheral blood from patients and relatives via MagNA Pure 24, samples screened with MIPs targeting 108 genes involved in pathogensis of IRD's. PCR completed on library, analysed with NGS fragment analysis kit.

      PreviouslyPublished: yes

      Variant: c.634C>T,p.(Arg212Cys)

      ClinVar: 7898

      CAID: n/a

      gnomeAD 0.0001177 allele frequency

      SupplementalData: Fig1: List of families displaying pseudo-dominant inheritance. Fig2: Number of alleles for most common variants.

    3. c.5882G>A

      Case#: Patient 231, Female, age of onset at 7 y.o, Poland

      DiseaseAssertion: STGD1

      FamilyInfo: Mother was a carrier, unaffected father.

      CasePresentingHPOs: HP:0007722, HP:0000608, HP:0025158

      CaseHPOFreeText: RPE atrophy, macular degeneration, central hyper-autofluorescence in fundus autofluorescence

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a, non-proband identified HPO's mentioned, but not assignable to individual proband.

      Genotyping Method: DNA isolated from peripheral blood from patients and relatives via MagNA Pure 24, samples screened with MIPs targeting 108 genes involved in pathogensis of IRD's. PCR completed on library, analysed with NGS fragment analysis kit.

      PreviouslyPublished: yes

      Variant: c.5882G>A

      ClinVar:7888

      gnomeAD: 0.00310 allelic freq.

      CAID: n/a

      SupplementalData: Fig1: List of families displaying pseudo-dominant inheritance. Fig2: Number of alleles for most common variants.

    1. Patient 2 is the 47-year-old sister of patient 1.

      Case#: 47-year-old female, sibling of patient 1.

      DiseaseAssertion: Discordant STGD phenotype

      FamilyInfo: The mother was found to harbour p.L541V/p.A1038V, and the father carried the p.R811C mutation; both of whom were asymptomatic with normal retinal examination (Fig. 1). ABCA4 screening detected three variants: two variants p.L541V and p.A1038V – commonly co-inherited in a complex allele in STGD (Maugeri et al. 2000) – and a third novel variant p.R881C (Fig. 1). Patient 1 had all three variants

      CasePresentingHPOs: HP:0007401, HP:0025010, HP:0011507

      CasePhenotypeFreeText: Patient 2 is the 47-year-old sister of patient 1. At initial examination in 1994, she reported a central scotoma. VA was 6/9 in both eyes with bilateral subtle foveal atrophy and perifoveal yellowish-white flecks (Fig. 1). By 2003, foveal atrophy had progressed with more perifoveal flecks (Fig. 1). In 2012, her VA was 6/12 bilaterally, but fundus findings remained stable (Fig. 1). AF imaging demonstrated a mottled signal within the central macula, optical coherence tomography showed outer retinal disruption confined to the central macula

      CaseNotHPOs: N/A

      CaseNotPhenotypeFreeText: N/A

      CasePreviousTesting: The article mentions ABCA4 screen but does not go into detail. However, it does say,”(patient 2) harboured the complex allele (p.L541V/p.A1038V)”

      GenotypingMethod: Again only mentioned ABCA4 screening without going into detail.

      Variant: NM_000350.3:c.1621C>G and NM_000350.3(ABCA4):c.3113C>T

      LegacyVariant: c.1621C>G (p.Leu541Val) and c.3113C>T(p.Ala1038Val)

      CAID: CA341280463 and CA119135

      gnomeAD: chr1-94063251-G-C and chr1-94043413-G-A

      PreviouslyPublished: N/A

      AdditionalInfo: Figure 1 provides information about the imaging of patients’ eyes that helps determine phenotype.

    1. The patient was an 80-year-old man

      Case#: 80 yo M, siagonosed at 18 yo

      DiseaseAssertion: Stargardt

      FamilyInfo: one of his 2 sisters had same mutation to ABCA4

      CasePresentingHPOs:,HP:0007663, HP:0008002

      CaseHPOFreeText: RPE hyperplasia, atrophy of the inner and outer photoreceptor segments, the outer nuclear layer, and the outer plexiform layer, with scanty RPE cells in the macular area

      CaseNotHPOs: NA

      CaseNotHPOFreeText: NA

      Genotyping Method: N/A

      PreviouslyPublished: none

      Variant: G1961E

      ClinVar: 7888

      SupplementalData: See supplemental Material for further look at the probands Human Embryonic Stem Cell-derived Retinal Pigment Epithelium Transplantation

    1. Through a meta-analysis of published literature38,39, we also found that individuals with inherited retinal disease caused by recessive ABCA4 deficiency (Stargardt disease or cone rod dystrophy) are likely to have ASO-amenable variants in similar proportions (Supplementary Note 7 and Supplementary Tables 15 and 16), leading us to suggest that around 15% is a reasonable first estimate for other recessive genetic conditions.

      This variant is found in supplemental table 16, but is referencing the cases from PMID 32619608

    1. Flow of individuals. A schematic representation showing the outcome of the 677 individuals with IRD participating in the study. *Supplementary Table 4. Indiv: individuals.

      Case#: Patient #330

      DiseaseAssertion: Stargardt

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: "Patients clinically suspected of having a retinal dystrophy were selected for the targeted analysis based on evaluation of available clinical records (clinical diagnosis, clinical history, fundus changes, OCT imaging, ERG, visual acuity, visual fields, family history)."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: NGS panel of 125 genes known to be associated with: retinitis pigmentosa, Bardet-Biedl syndrome, cone-rod dystrophy, Leber congenital amaurosis, Usher syndrome and congenital stationary night blindness (some genes cause more than one eye disorder).

      PreviouslyPublished: n/a

      Variant: 2453G>A (p.Gly818Glu)

      ClinVar: 99135

      CAID: CA227000

      SupplementalData: supplemental table s4

    1. Genetic testing by target enrichment and next-generation sequencing was performed (Molecular Vision Laboratory, Hillsboro, Oregon) and revealed two pathogenic variations in the ABCA4 gene, c.5461-10T>C4 and c.5603A>T,5 confirming the diagnosis of late-onset SD.

      Case#: Male, 60

      DiseaseAssertion: Stargardt disease

      FamilyInfo: Possible macular degeneration in father

      CasePresentingHPOs: HP:0007401, HP:0025010

      CaseHPOFreeText: Vision was 20/40 in the right eye and 20/20 in the left eye. Dilated examination revealed scattered subretinal yellow flecks and macular atrophy bilaterally. The flecks were hyperautofluorescent. Fluorescein angiography showed obscuration of background choroidal fluorescence and window defects associated with the atrophy. Optical coherence tomography showed foveal atrophy and hyperreflective deposits at the level of the retinal pigment epithelium.

      CaseNotHPOs: N/A

      CaseNotHPOFreeText: Anterior segment examination was unremarkable. Normal cone and rod responses.

      CasePreviousTesting: Target enrichment and next-generation sequencing were performed.

      GenotypingMethod: N/A

      PreviouslyPublished: N/A

      Variant: Variant 1: NM_000350.3:c.5461-10T>C Variant 2: NM_000350.3:c.5603A>T

      ClinVar: Variant 1: 92870 Variant 2: 99390

      gnomAD: N/A

      SupplementalData: Figure 1 shows fundus photographs (A and B), fundus autofluorescence (C and D), fluorescein angiography (E and F), near-infrared reflectance imaging (G), and an optical coherence tomography scan (H).

    2. A 60-year-old man presented with right eye blurry vision for two years.

      Case #: Male, 60 years old

      DiseaseAssertion: He was diagnosed with late-onset Stargardts disease.

      FamilyInfo: Has a family history with his father possibly having macular degeneration.

      CasePresentingHPOs: HP:0007401, HP:0025010, HP:0012045 (sub-retinal/yellow), HP:0030602

      CaseHPOFreeText: Proband presents with blurry vision (right eye) from over the past two years, with the right eye having 20/40 vision, while the left was 20/20. In addition to this, through dilation scattered subretinal yellow flecks and macular atrophy bilaterally, were revealed. The flecks were hyperautofluorescent. Obscuration of background choroidal fluorescence and window defects were also found. As well as foveal atrophy and hyperreflective deposits (RPE).

      CaseNotHPOs: None found

      CaseNotHPOFreeText: No abnormalities in the anterior segment examination. Through a full-field electroretinogram, normal rod and cone responses were found.

      Genotyping Method: The genotyping was done through the use of target enrichment and next-generation sequencing.

      PreviouslyPublished: N/a

      Variant: 1) NM_000350.3(ABCA4):c.5461-10T>C 2) NM_000350.3(ABCA4):c.5603A>T (p.Asn1868Ile)

      ClinVar: 1) 92870 2) 99390

      CAID: N/a

      gnomAD: 1) Highest minor allele frequency was 0.00031 (https://www.ncbi.nlm.nih.gov/clinvar/variation/92870/) 2) Highest minor allele frequency was 0.05787 (https://www.ncbi.nlm.nih.gov/clinvar/variation/99390/)

      SupplementalData: I was able to find a variant (NM_000350.3(ABCA4):c.[5461-10T>C;5603A>T]) that addresses both of the variants. Also, Fig.1 shows the phenotype of the proband through tests.

    1. A 69-year-old female patient complained of progressive vision loss. Her parents were first cousins. She had been diagnosed with retinitis pigmentosa 27 years previously.

      Case#: Female, 69yo, Puerto Rican

      DiseaseAssertion: STDG1

      FamilyInfo: Parents were first cousins (consanguinity), no other family history reported

      CasePresentingHPOs: HP:0030603, HP:0007754, HP:0000512, HP:0008020, HP:0000603

      CaseHPOFreeText: progressive vision loss, severe reduction in visual acuity (counting fingers at 5’ and 3’), bilateral central scotoma, extensive central macular atrophy, retinal pigment epithelium atrophy and pigment hyperplasia, multifocal retinal atrophy, central hypoautofluorescence with peripheral expansion, reduced macular thickness and volume on OCT, abnormal visual field (marked mean deviation)

      CaseNotHPOs: HP:0000510

      CaseNotHPOFreeText: normal rod response on full-field electroretinogram

      Genotyping Method: Next-generation sequencing (Invitae Corporation, San Francisco, California)

      PreviouslyPublished: N/A

      Variant: NM_000350.3(ABCA4):c.5714+5G>A

      ClinVar: ClinVarID:99403

      CAID: N/A

      SupplementalData: N/A

    1. The 1,000 probands in this study came to our clinic from 40 different states, the District of Columbia and seven foreign countries (Supplemental Figure 1). Four hundred eighty-nine were female and 511 were male. The average age at entry into the study was 37.3 years (36.3 years for males and 38.5 years for females); the range was 8 months to 88 years. Plausible disease-causing genotypes were identified in 760 of these probands, 393 males and 367 females (Supplemental Table 1). The average age at entry into the study was very slightly younger for those in whom a disease-causing genotype was identified (34.9 years for males and 37.7 years for females).

      Case#: Patient 817, female, 33yo at entry

      DiseaseAssertion: Stargardt disease

      FamilyInfo:

      CasePresentingHPOs:

      CaseHPOFreeText: category IIA (autosomal recessive stargardt disease)

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: one or more of the following approaches: automated Sanger sequencing with an ABI 3730xl sequencer, allele-specific genotyping with a Fluidigm EP1, amplification refractory mutation system (ARMS 17), chromosomal microarray analysis, and/or plasmid cloning of PCR products followed by Sanger sequencing. WES, WGS

      PreviouslyPublished: n/a

      Variant: c.1654G>A (p.Val552Ile); second variant not identified

      CAID: CA239745

      SupplementalData: supplemental table 1

    2. Four hundred eighty-nine were female and 511 were male. The average age at entry into the study was 37.3 years (36.3 years for males and 38.5 years for females); the range was 8 months to 88 years. Plausible disease-causing genotypes were identified in 760 of these probands, 393 males and 367 females (Supplemental Table 1). The average age at entry into the study was very slightly younger for those in whom a disease-causing genotype was identified (34.9 years for males and 37.7 years for females).

      Case#: Patient 721, male, 41yo at entry

      DiseaseAssertion: Stargardt disease

      FamilyInfo:

      CasePresentingHPOs:

      CaseHPOFreeText: category IIA (autosomal recessive stargardt disease)

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: one or more of the following approaches: automated Sanger sequencing with an ABI 3730xl sequencer, allele-specific genotyping with a Fluidigm EP1, amplification refractory mutation system (ARMS 17), chromosomal microarray analysis, and/or plasmid cloning of PCR products followed by Sanger sequencing. WES, WGS

      PreviouslyPublished: n/a

      Variant: c.6416G>C p.Arg2139Pro; c.2588G>C p.Gly863Ala. confirmed in trans

      CAID: CA10611614

      SupplementalData: supplemental table 1

    1. Filename Description aos14218-sup-0001-TableS1.xlsxMS Excel, 27.1 KB Table S1. List of genetic variants found in IRD patients, Norway, 2018. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

      This variant is supposed to be listed in this paper per the LOVD entry; however, the protein change actually says it is Glu1228* instead

    1. ABCR Gene Analysis in Familial Exudative Age-Related Macular Degeneration

      PMID: 10634626 Gene: ABCA4 HGNCID: HGNC:34

      Fifty-two unrelated French patients referred to the Eye University Clinic of Creteil for unilateral or bilateral exudative AMD due to any type of choroidal neovascularization (well-defined, occult, or vascularized pigment epithelium detachment) were included in this study.

      SSCP analysis in a control population, obtained from 90 unrelated French individuals without any complaint of visual impairment. Our control group was not age- or sex-matched, and no ophthalmological examination was performed for these individuals.

      MonDO:

      Case: DiseaseAssertion: Age-related macular degeneration FamilyInfo: CasePresentingHPOs: CaseHPOFreeText: CaseNOTHPOs: CaseNOTHPOFreeText: CasePreviousTesting:

      GenotypingMethod: entire coding sequence of the ABCR gene using a combination of single-strand conformation polymorphism (SSCP) and direct sequence analysis of each exon

      Variant: "ABCR" (ABCA4), p.Ser2255ile

    1. In the German cohort of 46 patients with single heterozygous ABCA4 variants, none of the known or any novel variant was found in the regions analyzed (Supp. Table S3).

      Case#: Bauwens Case ID #20864, German

      DiseaseAssertion: Simplex Retinitis Pigmentosa

      FamilyInfo:

      CasePresentingHPOs:

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: Screening for V1-V7 (deep intronic variants) negative, sequencing of the coding exons and intron–exon boundaries of ABCA4, Sanger sequencing

      PreviouslyPublished:

      Variant: c.1654G>A p.(Val552Ile), no second allele

      CAID: CA239745

      SupplementalData: supplemental table s3

    1. We performed diagnostic NGS testing for 537 patients (287 males and 250 females) referred with clinical indications of IRD. All of the 537 individuals were initially referred on a singleton basis.Phenotype classification IRDs have a diverse spectrum of overlapping clinical presentation, which can vary by age of onset, extent of visual impairment, nature of disease progression and involvement of additional clinical features. We grouped all referred patients into 10 distinct clinical classifications (see online supplementary table S3). The most common referral was non-syndromic RCD/RP (n=250). The most common referral of syndromic disease was Usher syndrome (n=38), a disorder characterised by neurosensory hearing loss and visual impairment. There were eight cases of suspected syndromic ciliopathies referred, including seven cases of BBS.

      Case#: Case #82863

      DiseaseAssertion: CRD

      FamilyInfo: n/a

      CasePresentingHPOs: n/a

      CaseHPOFreeText: n/a

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a

      CasePreviousTesting: n/a

      GenotypingMethod: NGS panel of 105 genes

      PreviouslyPublished: possible since this is an international cohort

      Variant: c.3098delA; c.4139C>T p.(Pro1380Leu)

      ClinVar: 236516

      CAID: CA10581650

      SupplementalData: supplemental table S3 has genotype info and phenotype

    1. Case 3A 15-year-old female presented with complaints of difficulty reading materials held greater than 6 inches from her eyes. She was clinically diagnosed with STGD 4 years prior and noted decreased visual acuity since age seven, which stabilized over the past few years. Family history was not significant for ocular disease. Best-corrected visual acuity was 20/150 OU. Anterior segment exam was unremarkable with applanation tonometry measuring 16 mmHg OU. Posterior segment exam and autofluorescence was significant for bilateral central atrophy and pisciform fleck atrophy involving the peripapillary, macular, and peripheral regions OU (Figure 3, A and B). Genotyping was significant for ABCA4 mutations P1380L and R2030Q.Open in a separate windowFig. 3A and B, Case 3. STGD mutations P1380L and R2030Q. Autofluorescence OD and OS demonstrate atrophic fleck lesions involving the macula and periphery with an area of confluent atrophy superotemporal to the fovea OD. Hyperautofluorescent flecks are also present in the periphery OU. The peripapillary regions reveal atrophic flecks OU without areas of confluent atrophy.

      Case#: Hwang Case 3, female, 15yo at report, 7yo at onset

      DiseaseAssertion: Stargardt

      FamilyInfo: Family history was not significant for ocular disease.

      CasePresentingHPOs: HP:0500087, HP:0011507

      CaseHPOFreeText: difficulty reading materials held greater than 6 inches from her eyes, decreased visual acuity since age seven. BCVA was 20/150 OU. Posterior segment exam and autofluorescence was significant for bilateral central atrophy and pisciform fleck atrophy involving the peripapillary, macular, and peripheral regions OU (Figure 3, A and B).

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: Genotyping was performed by the ABCR400 microarray followed by direct sequencing to confirm identified variants.

      PreviouslyPublished: n/a

      Variant: P1380L and R2030Q

      ClinVar: 7904

      CAID: CA129033

      SupplementalData: n/a

    2. Case 1

      Case#: 55 year old female

      DiseaseAssertion: Stargardt

      FamilyInfo: no significant ocular disease shown.

      CasePresentingHPOs: difficulty reading materials 6 inches from her eyes, decreased visual acuity from age seven. BCVA was 20/150 OU. Posterior segment exam and autofluorescence was significant for bilateral central atrophy and pisciform fleck atrophy involving the peripapillary, macular, and peripheral regions.

      CaseHPOFreeText: NR

      CaseNotHPOs: NR

      CaseNotHPOFreeText: NR

      Genotyping Method: ABCR400 microarray

      PreviouslyPublished: NR

      Variant: NM_000350.3:c.4139C>T, NM_000350.3(ABCA4):c.6089G>A

      ClinVar: 7904, 99428

      CAID: CA129033

      SupplementalData: NR

    3. Case 2A 19-year-old female referred for consultation for difficulty reading, particularly in dim light. She was clinically diagnosed with STGD 3 month prior, after complaining of gradual difficulty in focusing. Family history was not significant for ocular disease. Visual acuity measured 20/40 OD and 20/150 OS. Slit-lamp examination was unremarkable with normal anterior segments and applanation tensions of 14 mmHg OU. Funduscopic exam revealed bilateral central atrophy, multiple fleck lesions, multiple clumps of yellowish deposits at the level of the retinal pigment epithelium in the posterior pole surrounded with some pigment clumping, and no evidence of atrophy of the retinal pigment epithelium. Autofluorescence imaging revealed multifocal atrophic lesions involving the central macula and peripheral hyperautofluorescent flecks OU. The peripapillary regions demonstrated atrophic flecks OU without confluent atrophy (Figure 2, A and B). Genotyping revealed homozygous ABCA4 mutations, P1380L and P1380L.Open in a separate windowFig. 2Case 2. STGD mutations P1380L and P1380L. A, Autofluorescence OD. B, Autofluorescence OS show multifocal hypoautofluorescent (atrophic) lesions involving the central macula OU and peripheral hyperautofluorescent flecks OU. The peripapillary regions have atrophic flecks OU but there is not confluent peripapillary atrophy.

      Case#: Hwang Case 2, female, 19yo at report, 18yo at onset

      DiseaseAssertion: Stargardt

      FamilyInfo: Family history was not significant for ocular disease

      CasePresentingHPOs: HP:0007663, HP:0500087, HP:0011507

      CaseHPOFreeText: difficulty reading, particularly in dim light; gradual difficulty in focusing. Visual acuity measured 20/40 OD and 20/150 OS. bilateral central atrophy, multiple fleck lesions, multiple clumps of yellowish deposits at the level of the retinal pigment epithelium in the posterior pole surrounded with some pigment clumping, and no evidence of atrophy of the retinal pigment epithelium. Autofluorescence imaging revealed multifocal atrophic lesions involving the central macula and peripheral hyperautofluorescent flecks OU. The peripapillary regions demonstrated atrophic flecks OU without confluent atrophy (Figure 2, A and B).

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: Genotyping was performed by the ABCR400 microarray followed by direct sequencing to confirm identified variants.

      PreviouslyPublished: n/a

      Variant: P1380L homozygous

      ClinVar: 7904

      CAID: CA129033

      SupplementalData: n/a

    1. STGD in 48 patients (55%) was explained by recessive ABCA4 mutations (supplemental table S2). Only 22 patients could be solved using previously known STGD causing mutations. However, we identified 35 novel mutations in ABCA4 contributing to the diagnosis of 25 STGD patients. This contained 10 novel mutations leading to amino acid substitutions already known to cause disease and mutations known to cause diseases other than STGD. In addition, we identified 13 novel nonsense mutations. The remaining 12 novel mutations are well justified, and novel mutations were either completely absent or extremely rare in controls.

      Case#: Patient #126, Chinese

      DiseaseAssertion: Stargardt

      FamilyInfo: n/a

      CasePresentingHPOs: "Clinical diagnosis of STGD was made when the patient, usually a child, developed central visual acuity loss with an atrophic maculopathy with or without flecks." No individual details

      CaseHPOFreeText: n/a

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a

      GenotypingMethod: shotgun sequencing; Sanger sequencing; CNV analysis using CGH microarray

      PreviouslyPublished: n/a

      Variant: c.6119G>A p.(R2040Q); c.5776C>T p.(Q1926X)

      CAID: CA232815

      SupplementalData: info found in table S2

    1. p.Cys2137Tyr (c.6410G>A)0.63±0.090.45±0.03 0.32±0.120Severe 17(Riveiro-Alvarez et al., 2013)

      The relative expression level (0.63) and relative substrate-stimulated ATPase activity (0.45-0.32) as compared to WT were assessed in transfected HEK293T cells. F-Index= 0, which is said to be "indicative of a severe phenotype" or categorized as Class 1 (F-index <0.05). Three or more independent experiments were carried out and unpaired T-test was used to analyze differences between WT and several variants

    1. Screening of reported pathogenic variants in ABCA4 for Stargardt (STGD) The disease prevalence of STGD is estimated as 1 in 10000 individuals4. It has been estimated that about 70% of STGD patients carry variants in ABCA45. Therefore, this represents the scenario of a recessive disease with a relatively homogeneous genetic cause. We screened 945 reported pathogenic variants in ABCA4 genes collected in HGMD. Among them, 11 variants are likely benign, as their population AF in is higher than 0.7% (1/20000‾‾‾‾‾‾‾‾√)<math xmlns:mml="http://www.w3.org/1998/Math/MathML" display="inline" id="M11"><mrow><mrow><mo>(</mo><mrow><msqrt><mrow><mn>1</mn><mo>/</mo><mn>20000</mn></mrow></msqrt></mrow><mo>)</mo></mrow></mrow></math>, the cutoff based on STGD disease prevalence, therefore were excluded from further analysis. The remaining 934 variants were subjected to our test model. As a result, 26 variants with the AF in the range of 0.46% to 0.03% were identified as likely benign (Binomial test1, Bonferroni correction p-value ≤ 0.05/934 and test2 Bonferroni correction p-value > 0.05/934) (Figure 3A).

      This variant is reported in Table S6, but only location, predictions, frequencies, etc are reported for it, not cases.

    2. Screening of reported pathogenic variants in ABCA4 for Stargardt (STGD) The disease prevalence of STGD is estimated as 1 in 10000 individuals4. It has been estimated that about 70% of STGD patients carry variants in ABCA45. Therefore, this represents the scenario of a recessive disease with a relatively homogeneous genetic cause. We screened 945 reported pathogenic variants in ABCA4 genes collected in HGMD. Among them, 11 variants are likely benign, as their population AF in is higher than 0.7% (1/20000‾‾‾‾‾‾‾‾√)<math xmlns:mml="http://www.w3.org/1998/Math/MathML" display="inline" id="M11"><mrow><mrow><mo>(</mo><mrow><msqrt><mrow><mn>1</mn><mo>/</mo><mn>20000</mn></mrow></msqrt></mrow><mo>)</mo></mrow></mrow></math>, the cutoff based on STGD disease prevalence, therefore were excluded from further analysis. The remaining 934 variants were subjected to our test model. As a result, 26 variants with the AF in the range of 0.46% to 0.03% were identified as likely benign (Binomial test1, Bonferroni correction p-value ≤ 0.05/934 and test2 Bonferroni correction p-value > 0.05/934) (Figure 3A).

      This variant is reported in Table S6, but only location, predictions, frequencies, etc are reported for it, not cases.

    3. Screening of reported pathogenic variants in ABCA4 for Stargardt (STGD) The disease prevalence of STGD is estimated as 1 in 10000 individuals4. It has been estimated that about 70% of STGD patients carry variants in ABCA45. Therefore, this represents the scenario of a recessive disease with a relatively homogeneous genetic cause. We screened 945 reported pathogenic variants in ABCA4 genes collected in HGMD. Among them, 11 variants are likely benign, as their population AF in is higher than 0.7% (1/20000‾‾‾‾‾‾‾‾√)<math xmlns:mml="http://www.w3.org/1998/Math/MathML" display="inline" id="M11"><mrow><mrow><mo>(</mo><mrow><msqrt><mrow><mn>1</mn><mo>/</mo><mn>20000</mn></mrow></msqrt></mrow><mo>)</mo></mrow></mrow></math>, the cutoff based on STGD disease prevalence, therefore were excluded from further analysis. The remaining 934 variants were subjected to our test model. As a result, 26 variants with the AF in the range of 0.46% to 0.03% were identified as likely benign (Binomial test1, Bonferroni correction p-value ≤ 0.05/934 and test2 Bonferroni correction p-value > 0.05/934) (Figure 3A).

      This variant is reported in Table S6, but only location, predictions, frequencies, etc are reported for it, not cases.

    1. TABLE S2 Description and classification of variants observed to change classifications over time or between laboratories depicted in Figure 4. Separate tabs are present for different types of variant classifications changes: (a) changes from uncertain to pathogenic or benign, (b) changes from pathogenic to uncertain or benign, (c) changes from benign to pathogenic, (d) changes without clear trend.

      This variant is listed in table S2 to show the change in classification over time, but no additional details are provided.

    1. Table.

      MonDO: MONDO_0800406

      GenotypingMethod: combined SSCP and heteroduplex analyses of all 50 exons of ABCA4, Sanger sequencing

      For PP4: Patients harbored heterozygous or homozygous ABCA4 variants in addition to G1961E.

      Case 7-1: Male, Jordanian, born to consanguineous parents, disease onset at 4 years (PP4 +0.5 pts), Stage 3 STGD, Compound Hmz G1961E and H1838D. PP4: 2.5 points.

      Phenotype: central macular atrophy (PP4 +0.5 pts) with parafoveal or perifoveal flecks, severe fundus abnormalities, complete resorption of flecks with choriocapillaris atrophy also within the macula

      Patient was previously reported in review article by Iannaccone A. The genetics of hereditary retinopathies and optic neuropathies. Compr. Ophthalmol Update. 2005;6:39–62. (No PMID). Fig 1C: "View of the right macula of a 10-year-old Jordanian male with autosomal recessive cone-rod dystrophy. There are atrophic changes, a beaten-bronze appearance (PP4 +0.5pts), and abnormal vitreoretinal interface reflexes. The central lesion is surrounded by a halo of coarse deep mottling (PP4 +0.5pts) and there were pigmentary deposits in the retinal midperiphery (not shown). Electroretinogram testing revealed a cone-rod pattern of severe retinal dysfunction. This patient was homozygous for a previously reported ABCA4 mutation resulting in a glycine-to-glutamate amino acid substitution at codon 1961 (G1961E), as well as a previously unreported change at codon 1838, predicting a histidine-to-aspartate amino acid change (H1838D) and seven additional polymorphisms. (PP4 +0.5pts)"

      CasePresentingHPOs: HP:0007401, HP:0011507, HP:0001098, HP:0000548, HP:0025147, HP:0007793, HP:0001098 (Macular atrophy, Macular flecks, Abnormal fundus morphology, Cone/cone-rod dystrophy, Beaten bronze macular sheen, Granular macular appearance, Abnormal fundus morphology)

      CaseHPOFreeText: abnormal vitreoretinal interface reflexes, chroiocapillaris atrophy

      Case 7-2: Female, sibling of 7-1, Jordanian, born to consanguineous parents, disease onset at 7 years (PP4 +0.5 pts), Stage 4 STGD, Compound Hmz G1961E and H1838D (PP4 +0.5pts)

      Phenotype: severe central macular atrophy (PP4 +0.5 pts), peripheral intraretinal pigmentation on fundus photography, extensive atrophy of the RPE, Central scotomata (PP4 +0.5pts) with reduced visual sensitivity more peripherally, severe fundus abnormalities, central macular atrophy with parafoveal or perifoveal flecks (PP4 +0.5pts), Widespread RPE and chorioretinal atrophy throughout the fundus

      Case 8-1: Female, Italian, disease onset at 7 years (PP4 +0.5pts), Stage 3 STGD, Compound G1961E Hmz and N96K Het (PP4 +0.5 pts); PP4 = 3.5 pts

      Phenotype: severe central macular atrophy (PP4 +0.5pts), peripheral intraretinal pigmentation on fundus photography, extensive atrophy of the RPE, Central scotomata (PP4 +0.5pts) with reduced visual sensitivity more peripherally, severe fundus abnormalities, central macular atrophy with parafoveal or perifoveal flecks (+PP4 0.5pts), complete resorption of flecks with choriocapillaris atrophy also within the macula, Decreased central acuity (VA score of 20/2000 in both eyes) (PP4 +1 pts)

      CasePresentingHPOs: HP:0007401, HP:0000603, HP:0001098, HP:0011507, HP:0001141, HP:0030491 (Macular atrophy, Central scotoma, Abnormal fundus morphology, Macular flecks, Severely reduced visual acuity, chroiocapillaris atrophy)

      CaseHPOFreeText: peripheral intraretinal pigmentation on fundus photography, atrophy of RPE

      Case 8-2: Male, Italian, sibling of 8-1, disease onset at 10 years, Stage 4 STGD, N96K Het Central scotomata with reduced visual sensitivity more peripherally, severe fundus abnormalities, central macular atrophy with parafoveal or perifoveal flecks, Widespread RPE and chorioretinal atrophy throughout the fundus

      Case 9: Female, Italian, disease onset set 12 years (PP4 +0.5pts), Stage 4 STGD, G1961E Hmz and N96K Hmz (PP4 +0.5pts); PP4 = 3 points history of early central vision loss (PP4 +1 pts), severe fundus abnormalities, central macular atrophy (PP4 +0.5pts) with parafoveal or perifoveal flecks (PP4 +0.5 pts), Widespread RPE and chorioretinal atrophy throughout the fundus.

      Family members (parents and siblings) were available in all cases except for patients 6 and 10. The phase and true homozygosity of the G1961E mutation were determined by segregation analyses. Hemizygosity, that is the homozygous appearance due to the deletion on the other chromosome, was ruled out in all cases.

    1. Patient 2 (P2), previously described in a large IRD cohort study [1], is also of Somali origin and was seen in the retina clinic at the University of Iowa at age 11

      Case#: patient, 11, Somali, onset 8yo

      DiseaseAssertion: STGD

      FamilyInfo: parents and four siblings did not report visual issues

      CasePresentingHPOs: HP:0000007, HP:0011504, HP:0000608

      CaseHPOFreeText: BCVA 20/70 OD, 20/80 OS. Bull's eye maculopathy. Outer retinal and RPE atrophy. Slight opacity at level of RPE; loss of outer retinal structures in central area. Normal peripheral retina.

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a

      Genotyping Method: whole genome

      PreviouslyPublished: PMID:28559085

      Variant: NM_000350.3:c.5882G>A p.(Gly1961Glu) ; NM_000350.3:c.634C>T p.(Arg212Cys)

      ClinVar:7888; 7898

      CAID:n/a

      SupplementalData:n/a

    2. Patient 1 (P1

      Case#: 12, Somali, onset 5 years old

      DiseaseAssertion: STGD

      FamilyInfo: Parents were heterozygous for Arg212Cys, no family history of IRD

      CasePresentingHPOs: HP:0011504, ORPHA:827, HP:0000608

      CaseHPOFreeText: Bull's eye maculopathy, macular degredation, red-green color defecit, reduced cone function

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a

      Genotyping Method: Whole exome sequencing

      PreviouslyPublished: N/a

      Variant:

      ClinVar: NM_000350.3:c.5882G>A p.(Gly1961Glu) ; NM_000350.3:c.634C>T p.(Arg212Cys)

      ClinVar: 7888; 7898

      CAID: CA119132, CA203216

      SupplementalData: N/a

    1. Table S9. List of unique causative variants detected in 858 STGD probands mmc8.xlsx (19.3KB, xlsx) Table S11. STGD1 cases with at least two (likely) causal ABCA4 variants mmc9.xlsx (39.6KB, xlsx)

      Case#: DNAID 071549/Pat23, male

      DiseaseAssertion: STGD1

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: "In classic STGD1, loss of central vision starts around the second decade of life, but both early- and late-onset subtypes have been extensively described." No patient-specific details provided

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: smMIPs sequencing of the complete ABCA4 locus

      PreviouslyPublished: n/a

      Variant: c.6416G>C (p.Arg2139Pro); c.1648G>A (p.Gly550Arg)

      CAID: CA10611614

      SupplementalData: tables s9 and s11

    1. A 43-year-old white female

      Case#: 43 year old woman II:2

      DiseaseAssertion: Stargardt disease (STGD1)

      FamilyInfo: none of family had co-existing systemic disorders, father carried variant, probands affected suster did not

      CasePresentingHPOs:HP:0000007

      CaseHPOFreeText: loss of ellipsoid zone, mascular dystrophy with features of bull's eye maculopathy,

      CaseNotHPOs: na

      CaseNotHPOFreeText: na

      Genotyping Method: sanger sequencing

      PreviouslyPublished: n/a

      Variant: c.4685 T > C, p.(I1562T)

      ClinVar: not found

      CAID: not found

      SupplementalData: probands affected sister did not carry the ABAA4 variant, indicating ABCA4 was not relevant to mascular dystrophy in family, CRX variant was also found

    1. Eighty-four unrelated STGD1 patients were found to carry two or more disease-causing ABCA4 mutations, and cosegregation analyses were performed in 54 (64.3%). (See Supplementary Table S3 for a summary of clinical phenotype of STGD1 patients). The mean disease onset age of the patients was 13.1 years (range, 2–44 years), and half of these patients experienced their symptoms of visual impairment in their first decade. We classified the patients into three groups by their disease onset age. For the patients in the first group, whose disease onset ages were between 1 and 10 years, the fraction (45.3%, 19/42) of patients carrying compound heterozygous or homozygous deleterious mutations (nonsense, frameshift insertion or deletion, or splicing mutations) or complex alleles was much higher than those observed for the patients in the group 2 (24.1%, 7/29) and group 3 (15.4%, 2/13), whose disease onset ages were from 11 to 20 years or older than 20 years, respectively. In contrast, the percentage of patients carrying compound heterozygous or homozygous missense mutations was higher in group 3 than in group 1 or group 2 (Table 2). The most common mutation (p.Y808X) was detected in 12 patients, and all were heterozygous compound with missense (6 patients), splicing (1 patient), and insertion or deletion (5 patients) mutations. The two most frequent missense mutations (p.F2188S and p.N965S) were identified as heterozygous. In 84 patients, 9 patients carried complex mutations, and 4 of those 9 patients carried a common complex allele p.E328V/p.E1036K. All these patients had early onset age and relatively severe visual acuity defects. One patient (010222) also carried three heterozygous mutations (p.E328, p.E1036K, and p.R1843W); however, he did not harbor the common complex allele p.E328V/p.E1036K, as only p.E1036K was detected in his son in the subsequent cosegregation analysis. Compared to the four patients carrying the common complex alleles (p.E328V/p.E1036K), patient 010221 had a late onset age (44 years old).

      Case#: Patient#010046, Chinese, 28yo at onset

      DiseaseAssertion: stargardt

      FamilyInfo: n/a

      CasePresentingHPOs: STGD1 diagnosis based on the following criteria: "a bilateral central vision defect; fundus displaying a beaten-bronze appearance and/or orange-yellow flecks in the retina from the macula to the midperiphery; fluorescein angiography presenting with a typical dark choroid; and normal to subnormal ERG results." stage 2( numerous yellow-whitish flecks throughout the posterior pole) BCVA=0.05/ 0.05

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: p.P2097S; p.A1773V phase unknown

      ClinVar: 2202780

      CAID: CA341277622

      SupplementalData: supplementary table S3 has phenotype information

    1. In this molecular study, we identified a 40-year-old woman diagnosed with STGD in childhood, who had an apparently homozygous pattern for the missense p.Arg1129Leu (c.3386G>T) mutation

      Case Annotation Template

      Case#: Patient 40, female, Caucasian, onset at 2-3yo, Spain

      DiseaseAssertion: STGD

      FamilyInfo: Brother and Sister not affected showed heterozygous patterns of (p.His423Arg (c.1268A>G), IVS33+48 C>T) mutations. R1129L mutation heterozygous in the unaffected father; mutation not found in the unaffected mother. Patient has 4yo asymptomatic female child

      CasePresentingHPOs: HP:0000505, HP: 0011463, HP:0030786, HP:0007641, HP:0007663, HP: 0000610, HP: 0007814, HP:0000007

      CaseHPOFreeText: Macular yellow flecks, macular dystrophy

      CaseNotHPOs: N/A

      CaseNotHPOFreeText: Normal biomicroscopy

      Genotyping Method: Conventional mutational screening on 77 STGD families and screened on the ABCR400 Microarray. Haplotype analyses, HR karyotypes, and MLPA were also performed.

      PreviouslyPublished: N/A

      Variant: p.Arg1129Leu (c.3386G>T)

      CAID: CA227116

      SupplementalData:N/A

    1. Functional studies of the arRP-associated complex allele [L541P; A1038V] also showed abnormal localization to rod IS although the IF studies revealed a different staining pattern than R602W, because the mutant protein forms fine aggregates in the IS (Fig. 2E and F). The aggregate formation suggests a mechanism distinct from that observed for R602W may be responsible for the retention of [L541P; A1038V] in the IS. To determine which mutation prevents translocation of [L541P; A1038V] to ROS, we examined functionally the L541P and A1038V mutants independently. We observed retention of L541P in the IS (Fig. 2G and H) and correct localization of A1038V to ROS (Fig. 2I and J). These results suggest that L541P is a disease-causing mutation that affects ABCA4 processing.

      ABCA4 localization in transgenic tadpoles showed retention of L541P in the IS (Fig. 2G and H). However, this assay does not meet the requirements for use of PS3 by the ClinGen ABCA4 VCEP.

    1. 93RECRDrecessive ABCA4 c.3988G>Tp.E1330XHet[a]c.6410G>Ap.C2137YHet[a]

      Case#: 93RE proband, Spanish

      DiseaseAssertion: cone rod dystrophy

      FamilyInfo: 1 affected sibling with the same genotype. het, carrier parents

      CasePresentingHPOs: n/a

      CaseHPOFreeText:

      CaseNotHPOs: n/a

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: c.6410G>A (p.C2137Y); c.3988G>T (p.E1330X) found on WES. Cosegregation with GNAT2, ZNF513, OPA1, RP1L1

      ClinVar: 2202779

      CAID: CA341277358

      SupplementalData: pedigree with genotype in supplemental file

    1. 46-year-old male

      Case#: a 46-year-old male

      DiseaseAssertion: Pseudoxanthoma elasticum (PXE)

      FamilyInfo: NR

      CasePresentingHPOs: HP:0200034, HP:0011506, HP:0001102, HP:0025533, HP:0007401, HP:0200056, HP:0007754, HP:0031526, HP:0007663

      CaseHPOFreeText: skin papules, CNV in right eye, angioid steaks, peau d'orange, peripheral comet lesions and macular atrophy at the poseterior pole (more severe in left eye). Juxtafoveal pigmented scar in right eye and fibrotic tissue at the interpapillomacular region in left eye. Pattern dystrophy-like changes were evident at posterior pole. OCT scan showed subretinal fluid with ellipsoid zone abnormalities at the fovea with juxtafoveal hyperreflective alteration corresponding to the fundus scar in the right eye. At the interpapillomacular region, the atrophy of the outer retinal layer and RPE was evident (hypertransmission phenomenon). In left eye, OCT scan showed widespread RPE atrophy with atrophy of the outer retinal layers. 6/10 visual acuity in right eye and 1/20 in left eye.

      CaseNotHPOs: NR

      CaseNotHPOFreeText: NR

      Genotyping Method: Whole exome sequencing analysis focusing on 340 genes associated with the calcification process or inherited retinal diseases

      PreviouslyPublished: NR

      Variant: c.6647C>T, p.Ala2216Val, NM_000350.3

      ClinVar: 236149

      CAID: CA10602405

      SupplementalData: NR

    1. Patient 8, a 13-year-old individual carrying two mutations, the p.Leu541Pro and p.Ala1038Val, most likely as a complex allele, had an early disease onset with 20/200 VA and stage 4 FC (Table 1). Previous reports have documented the severity and early age of onset associated with the p.[Leu541Pro;Ala1038Val] complex variant.36,38 Our screening studies failed to detect an additional mutation in ABCA4 in patients 6, 8, or 12.

      Case#: Patient 8, 13yo at report, British Columbia, Canada

      DiseaseAssertion: Stargardt disease

      FamilyInfo:

      CasePresentingHPOs:

      CaseHPOFreeText: stage 4 Fishman classification (extensive choroid and RPE atrophy throughout the fundus, decreased ERG cone and rod amplitudes, and moderate to severe peripheral field restriction). Visual acuity= 20/200

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: exons and exon-intron boundaries of ABCA4, CNGB3, and ELOVL4 were sequenced

      PreviouslyPublished: n/a

      Variant: L541P; A1038V phase unknown, but likely a complex allele

      ClinVar:

      CAID: CA226911

      SupplementalData: n/a

    2. Patient 4 with an early frameshift mutation in one allele and a downstream p.Val552Ile mutation in the second allele has a mild form of STGD1. Because the frameshift mutation is likely to result in a null allele, any residual functional activity of ABCA4 would arise from ABCA4 harboring the p.Val552Ile missense mutation. Our in vitro studies showing that the p.Val552Ile variant expresses at close to WT levels, exhibits normal N-Ret-PE binding properties, and has only a modest reduction in ATPase activity (Table 2) are consistent with the mild disease phenotype of patient 4. Another study has also reported that the p.Val552Ile mutation is associated with a STGD1 disease phenotype.50 However, in silico predictions on the pathological relevance of this mutation have been variable.20,13 On the basis of allele frequencies in controls versus patients, it has been argued that the p.Val552Ile is most likely benign.20 At a protein level, a hydrophobic amino acid residue valine is replaced with another hydrophobic residue isoleucine. Accordingly, this substitution would be predicted to have only a marginal impact on ABCA4 protein structure and function. However, valine at position 552 of ABCA4 is invariable among vertebrate species, including other mammals, chicken, Xenopus, and Japanese puffer fish (Takifugu rubripes), attesting to the likely importance of valine at this position. Collectively, these studies suggest that the p.Val552Ile is a mild mutation in which the pathogenicity may only be displayed in selected cases. More specifically, the p.Val522Ile would display a mild STGD1 phenotype when combined with a null allele as in the case of patient 4 or a missense mutation with little or no activity such as the p.Asn965Ser mutation,37,51 but would not display a disease phenotype in a patient homozygous for this mutation or patients in which this mutation is combined with a mutation that shows significant ABCA4 function because under these circumstances sufficient ABCA4 activity would be realized to prevent the accumulation of toxic retinoids.

      In HEK293T cells, p.Val552Ile expresses at close to WT levels, exhibits normal N-Ret-PE binding properties, and has only a modest reduction in ATPase activity. Consistent with mild disease phenotype

    1. Precision medicine integrating whole-genome sequencing, comprehensive metabolomics, and advanced imaging

      PMID: 31980526

      Gene: ABCA4

      Disease: adults ≥18 y old without acute illness, activity-limiting unexplained illness or symptoms, or known active cancer

      prospective cohort study: 3-y precision medicine study with a goal to integrate whole-genome sequencing with deep phenotyping.

    1. 5-year-old girl

      Case#:5-year-old girl

      DiseaseAssertion: Asymptomatic

      FamilyInfo: Mother was diagnosed with STGD1 and She was homozygous for a (severe) splice site mutation, IVS 35+2 T>C, Maternal uncle was diagnosed with STGD1. Father passed down the G1961E variant.

      CasePresentingHPOs: HP:0030630, HP:0011504

      CaseHPOFreeText: The ELM in the central macula appeared thickened with indistinct borders, particularly along its inner border (Fig. 2C), horizontal diameter for the region of thickened ELM was 1113 μm, FAF revealed Bull’s Eye Maculopathy (BEM) (Fig. 2B),

      CaseNotHPOs:

      CaseNotHPOFreeText: No retinal, vasculature, pigmentary or optic nerve head abnormalities were detected on clinical examination, no focal abnormality observed in the outer nuclear layer (ONL) or RPE (Fig. 2C), There was no FAF evidence of flecks or GA

      Genotyping Method:

      PreviouslyPublished: No

      Variant:NM_000350.3:c.5882G>,

      ClinVar:7888

      CAID:CA119132

      SupplementalData:

    1. 6Mc.4720G>Tp.Glu1574*not detected 20/15020/2006/38/32

      Case#: Patient #16, male, 6yo at onset, Brazilian

      DiseaseAssertion: stargardt

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: type II (an area of foveal hypofluorescence surrounded by an area with a heterogeneous appearance and hyperautofluorescent and hypoautofluorescent points that extend to the temporal arcades, giving the retina a reticulate appearance). visual acuity: OD=20/150, OS=20/200

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: c.4720G>T p.(Glu1574*), no second variant. NGS and conclusive molecular testing regarding other Stargardt genes were excluded

      ClinVar: 1460063

      CAID: CA341283936

      SupplementalData: n/a

    1. We identified 255 patients (87.9 %) harboring biallelic ABCA4 variants, 27 probands (9.3 %) with two or three variants but lacking familial segregation analysis, and eight patients (2.8 %) with monoallelic ABCA4 variants (Supplemental Table S4). We detected 268 distinct ABCA4 variants, consisting of 114 missense, 35 nonsense, 34 frameshift deletion or insertion, 31 canonical splice variants, 13 noncanonical splice site variants, 9 in-frame deletion or insertion, 9 DIVs, 4 structural variations, and 19 complex variants (Fig. 2).

      Case#: Patient#010477, Chinese, male, 18yo at onset

      DiseaseAssertion: stargardt

      FamilyInfo: n/a

      CasePresentingHPOs: STGD1 diagnosis based on the following criteria: "a bilateral central vision defect; fundus displaying a beaten-bronze appearance and/or orange-yellow flecks in the retina from the macula to the midperiphery; fluorescein angiography presenting with a typical dark choroid; and normal to subnormal ERG results." BCVA=0.4/ 0.5

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: p.P2097S; c.2255G>T p.(Ser752Ile) phase unknown

      ClinVar: 2202780;

      CAID: CA341277622;

      SupplementalData: supplementary table S4 has phenotype information

    1. Of the 266 arSTGD chromosomes studied, mutations were identified in 161, resulting in a detection rate for the genotyping microarray of 60.5%: two mutant alleles were found in 64/133 patients (48.1%), whereas in 33/133 cases (24.8%) only one allele could be identified. A total of 56 different sequence variants related to the disease were identified, including missense (42), nonsense (four) frameshift (five) and splicing (five) mutations. Furthermore, combinations of variants acting in cis (complex alleles; six double alleles, one triple allele) were also found. Of this spectrum of substitutions, the p.Arg1129Leu (c.3386G>T) allele accounted for 26% of the disease-associated alleles (fig 2). Considering the percentage represented by this variant in patients (26%) and the obtained mutation detection rate (60.5%), this change would represent the 15.7% of all the potential arSTGD associated alleles.

      This variant is in Figure 2 as an ABCA4 disease-associated allele identified in Spanish Stargardt disease (STGD) patients with a frequency below 5%. No additional information about phenotype or genotype is provided and a future paper focusing on those details, by the same first author (PMID: 23755871), so they are likely the same patient in the same cohort

    1. 56-year-old female

      Case#: a 56-year-old female

      DiseaseAssertion: Pseudoxanthoma elasticum (PXE)

      FamilyInfo: NR

      CasePresentingHPOs: HP:0200034, HP:0001102, HP:0025533, HP:0011506, HP:0500087

      CaseHPOFreeText: Papules on neck and axillae, marked skin laxity and redundance in neck, axillae, periumbilican area, groyne, and inner thighs, angioid streaks, peau d'orange. In right eye, a CNV, a large peripapillary atrophy, a small iuxafoveal scar, and RPE-Bruch's membrane complex normalities nasally to the fovea.

      CaseNotHPOs: NR

      CaseNotHPOFreeText: NR

      Genotyping Method: Next generation sequencing focusing on 362 genes associated with calcification-related diseases and inherited retinal diseases

      PreviouslyPublished: NR

      Variant: c.1928T>G, p.Val643Gly, NM_000350.3

      ClinVar: 99102

      CAID: CA226958

      SupplementalData: This variant has been reported likely pathogenic in VarSome and literature.

    1. Molecular analysis of ABCA4 and CRB1 genes in a Spanish family segregating both Stargardt disease and autosomal recessive retinitis pigmentosa

      PMID: 18334942

      Gene: ABCA4

      HGNC ID: 34

      Case#: patient 33, male, Spanish

      DiseaseAssertion: STGD

      FamilyInfo: Figure 1. Both parents and two siblings of the proband were heterozygous for ABCA4 c.5413A>G allele. Sister affected despite heterozygosity.

      CasePresentingHPOs: HP:0007663, HP:0030786, HP:0007722

      CaseHPOFreeText: myopia, astigmatism, opafication of posterior pole of lens, hyperpigmentation, a few central yellowish flecks, shallow peripheral scotomas in both eyes, full-field ERG response showed slightly reduced—but still within the normal range—amplitudes for rod, mixed cone-rod, cone single flash, and cone flicker, respectively.

      CasePreviousTesting: n/a

      GenotypingMethod: microarray

      PreviouslyPublished: 11385708, 12442277

      Variant: ABCA4 p.Asn1805Asp (c.5413A>G)

      ClinVar: 99373 https://www.ncbi.nlm.nih.gov/clinvar/variation/99373/?term=%22ABCA4%22%5BGENE%5D+AND+%22p.Asn1805Asp%22%5BVARNAME%5D+AND+%22(c.5413A%3EG)%22%5BVARNAME%5D

      gnomAD: 0.000009292 https://gnomad.broadinstitute.org/variant/1-94014590-T-C?dataset=gnomad_r4

    2. Molecular analysis of ABCA4 and CRB1 genes in a Spanish family segregating both Stargardt disease and autosomal recessive retinitis pigmentosa

      PMID: 18334942

      Gene: ABCA4

      HGNCID: 34

      Case#: patient 26, female, Spanish

      DiseaseAssertion: early onset RP

      FamilyInfo: Figure 1. One brother homozygous for ABCA4 c.5413A.G allele, parents and one brother heterozygous for ABCA4 c.5413A>G allele. All three brothers and father carriers of p.Cys948Tyr allele on the CRB1 gene. Mother heterozygous for p. Trp822ter (c.2465G>A)

      CasePresentingHPOs: HP:0000662, HP:0001133, HP:0007663,

      CaseHPOFreeText: hyperopia, astigmatism, nystagmus, roundish pigments distributed across entire retina including peripheral retina, posterior pole, and macular region, filiform constriction on retinal vessels.

      CasePreviousTesting: N/A

      GenotypingMethod: Microarray

      PreviouslyPublished: 11385708, 12442277

      Variant: ABCA4 p.Asn1805Asp (c.5413A>G)

      ClinVar: 99373 https://www.ncbi.nlm.nih.gov/clinvar/variation/99373/?term=%22ABCA4%22%5BGENE%5D+AND+%22p.Asn1805Asp%22%5BVARNAME%5D+AND+%22(c.5413A%3EG)%22%5BVARNAME%5D

      gnomAD: 0.000009292 https://gnomad.broadinstitute.org/variant/1-94014590-T-C?dataset=gnomad_r4

    1. 16P36M198426217–50.300.10 P37F198913817–40.22

      Case#: Family 16, P37, female, Netherlands 13yo at onset

      DiseaseAssertion: Stargardt

      FamilyInfo: 1 affected sibling with same genotype

      CasePresentingHPOs:

      CaseHPOFreeText: visual acuity: OD=0.22, FAF images consistent with STGD1

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: Sanger

      PreviouslyPublished: n/a

      Variant: c.5196+1137G>A; c.859-506G>C

      ClinVar: 438100

      CAID: CA26843511

      SupplementalData:

    1. WDR19-associated retinopathy presenting with adult-onset Stargardt-like phenotype

      PMID:39967245

      Gene: ABCA4

      HGNC ID: 34

      Case#:39-year-old man

      DiseaseAssertion:

      FamilyInfo:

      CasePresentingHPOs:omplained of visual impairment with night blindness

      CaseHPOFreeText:NA

      CaseNotHPOs:NA

      CaseNotHPOFreeText:NA

      Genotyping Method:SAnger Seqencing

      PreviouslyPublished:

      Variant:WDR19 variants: the novel deletion at c.1777 + 1 within the donor splicing site (class 4) and the rare c.1430 G>T variant causing the amino-acid substitution p.(Arg477Leu) (class 3) in the putative protein. Additionally, a heterozygous c.1793A>G (class 3) variant in the CDH23 gene was found, though it was deemed as not contributive to the patient’s clinical phenotype. All reported variants were confirmed through Sanger sequencing.

      ClinVar:NA

      CAID:Na

      SupplementalData:NA

    1. To overcome these limitations, we designed a genotyping microarray (gene chip) for ABCR that includes all approximately 400 disease-associated and other variants currently described, enabling simultaneous detection of all known ABCR variants.

      Article is a PDF, so annotating here. In the supplemental file (table S1), this variant was listed as being included on the microarray, but that is all the information provided.

    1. 92 RHO c.180C>A p.Tyr60* – [a] ROM1: f 31 RP ad no Ger c.178C>A p.Pro60Thr; – [42], [43] c.323C>T p.Thr108Met rs146358003 [42], [43] ABCA4: c.1654G>A p.Val552Ile rs145525174 [44] c.5714+5G>A RP2: splice rs61751407 [45] c.844C>T RPGRIP1: c.2510C>G p.Arg282Trp rs1805147 [17], [18] p.Ala837Gly – [22]

      Case#: Eisenberger Patient 92, female, 31yo, German

      DiseaseAssertion: Autosomal dominant RP

      FamilyInfo: non-consanguineous

      CasePresentingHPOs:

      CaseHPOFreeText: "The diagnoses of all patients were established by medical history, family history and detailed clinical evaluation of vision. Ophthalmological examination included stereoscopic funduscopy, standard ERG, perimetry, measurement of dark adaptation, and determination of best-corrected visual acuity in most patients."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: NGS for the exons of 55 RP and LCA genes, Sanger for confirmation

      PreviouslyPublished: n/a

      Variant: Allele 1: RHO c.180C>A p.Tyr60; Allele 2*: ROM1: c.178C>A p.Pro60Thr; c.323C>T p.Thr108Met;

      ABCA4: c.1654G>A p.Val552Ile; c.5714+5G>A; <br /> RP2: c.844C>T p.Arg282Trp; <br /> RPGRIP1: c.2510C>G p.Ala837Gly

      ClinVar:

      CAID: CA239745

      SupplementalData: n/a

    1. Case 3 showed a p.Ala643Gly variant in the PROM1 gene and a single variation in the ABCA4 gene, but molecular testing results were inconclusive.

      Annotating here since unable on the PDF.

      Case 3 is a 6yo male. VA: OD: 20/150, OS: 20/200. Proband had macular atrophy and flecks at the posterior pole. In the autofluorescence exam, there was peripapillary sparing of the hyper-autofluorescent flecks. On OCT images the atrophic areas at the macula correlated to disruption of the elipsoid layer and decrease in the foveal thickness. OCT showed loss of the photoreceptor layer and EPR layer. Proband has only 1 ABCA4 variant, so not eligible for PP4. Also has a variant in PROM1 (p.Ala643Gly). ABCA4, PROM1, and ELOVL4 genes sequenced by next-generation sequencing (NGS) test.

    1. ABCA4 whole-gene sequencing, subsequent WGS, and segregation analysis identified a complex deep-intronic allele (NM_000350.2(ABCA4):c.[1555-5882C>A;1555-5784C>G]) in trans to the missense variant.

      PMID: 39421326 (PMCID: PMC11675205)

      Gene: ABCA4

      HGNC ID: 34

      Case#: Patient 24 (male)

      DiseaseAssertion: STGD (Stargardt disease)

      FamilyInfo: Caucasian family from Germany. Patient has two siblings carrying the variant but they are not clinically affected according to pedigree information.

      CasePresentingHPOs: Decreased central visual acuity (HP:0000545) Macular atrophy (HP:0007754) Retinal flecks (HP:0030638) Abnormal fundus autofluorescence (HP:0030647) Macular degeneration (HP:0007754) Abnormal electroretinogram (HP:0000763)

      CaseHPOFreeText: Male patient diagnosed before age 50 with Stargardt disease. Best corrected visual acuity (BCVA) approximately 0.05–0.2. Fundus imaging shows paracentral scotoma, macular atrophy, and hyperfluorescent flecks with sparing of the fovea. Autofluorescence demonstrates hyperreflective spots and patchy lesions with parafoveal involvement.

      CaseNotHPOs: None explicitly reported.

      CaseNotHPOFreeText: Pattern-like distribution of lesions noted on clinical examination.

      Genotyping Method: Whole-exome sequencing (WES) with an in-house RD-associated gene panel including 619 candidate and disease-associated genes.

      PreviouslyPublished: No (novel complex deep-intronic allele described in this study).

      Variant: c.[1555-5882C>A;1555-5784C>G]

      ClinVar: Not reported in ClinVar in the provided information.

      CAID: CA272741; CA227172

      SupplementalData: Segregation data and functional splicing analysis available in the supplemental data (Table S1, Figure S1) of the article.

    1. D023{"type":"entrez-protein","attrs":{"text":"STG00205","term_id":"1440289030"}}STG00205FPlano9January 21, 1985May 5, 201328.3

      Case#: Bertelsen Patient D023, female, 9yo at onset

      DiseaseAssertion: generalized choriocapillaris dystrophy

      FamilyInfo:

      CasePresentingHPOs:

      CaseHPOFreeText: end-stage generalized choriocapillaris dystrophy characterized by semiconfluent multifocal areolar outer retinal atrophy, the severity of which decreases with increasing eccentricity. Central patches of visible sclera are surrounded by coarse confluent hyperpigmentation. The periphery shows isolated or clustered hyperpigmentation. In and around the fovea there is pronounced atrophy of the retinal pigment epithelium, the photoreceptor layer, and the outer nuclear layer and intraretinal hyperreflective material corresponding to the hyperpigmentation

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: microarray

      PreviouslyPublished: n/a

      Variant: c.203C>T p.P68L; c.3329-2A>G

      ClinVar: 99113

      CAID: CA226972

      SupplementalData: n/a

    1. Disease-causing or likely disease-causing mutations were identified in 185 out of 251 patients (74%) with MD/CCRD (Supplementary Table 1).

      Case#: Patient #43, male, 9yo at onset, 16yo at report, German

      DiseaseAssertion: macular dystrophy or cone-rod dystrophy

      FamilyInfo: inheritance= sporadic. phase not confirmed, but no other affected family members and no parental consanguinity

      CasePresentingHPOs:

      CaseHPOFreeText: reduced visual acuity, erg scotopic= reduced, erg-photopic=reduced

      CaseNotHPOs:

      CaseNotHPOFreeText: syndromic retinal disease, age-related macular degeneration, central serous retinopathy, autoimmune retinopathy, retinal vascular disease, achromatopsia, X-linked retinoschisis, North Carolina macular dystrophy

      CasePreviousTesting: n/a

      GenotypingMethod: Sanger sequencing of ABCA4

      PreviouslyPublished: n/a

      Variant: c.3098del (p.Lys1033Serfs*51); c.3243G>T (p.Lys1081Asn)

      ClinVar: 236516

      CAID: CA10581650

      SupplementalData: Supplementary table 1

    1. A six-year-old girl with vision loss and prominent behavioral changes and overlooking was presumptively diagnosed as having the Batten disease form of neuronal ceroid lipofuscinosis.

      MonDO: MOND:08000406

      Case: Female, onset 6 years VA 20/200 OU identify 1 ouf 15 Ishiara cards and overlooking symptom. Presumably diagnosed with Batten disease but found to harbor genetic variant for Stargardt disease.

      DiseaseAssertion: Stargardt disease

      FamilyInfo: No family history of visual loss in childhood.

      "CasePresentingHPOs: HP:0007663, HP:0007988, HP:0030584, HP:0008043, HP:0008001, HP:0030609 (Reduced visual acuity, Macular hypopigmentation, Color vision test abnormality, Retinal arteriolar constriction, Foveal hyperpigmentation, Photoreceptor layer loss on macular OCT"

      CaseHPOFreeText: bull's eye lesions, prominent overlooking, hyperreflective granular deposits

      CaseNOTHPOFreeText: HP:0001336, HP:0001250, HP:0000648, HP:0000707

      CasePreviousTesting: (Myoclonus, Seizure, Optic atrophy, Abnormality of the nervous system

      GenotypingMethod: Genetic testing was negative for all mutations known to cause neuronal ceroid lipofuscinosis, but whole exome sequencing showed compound heterozygosity for 2 pathogenic variants in the ABCA4 gene

      MultipleGeneVariants:

      (1) GeneName: ABCA4

      (1) Variant: c.3007C>T, p.Q1003X

      (1) ClinVarID or CAID: CA119132

      (1) gnomAD: 0.003406 total AF in gnomAD v4.1 (https://gnomad.broadinstitute.org/variant/1-94008251-C-T?dataset=gnomad_r4)

      (2) GeneName: ABCA4

      (2) Variant: c.768G>T

      (2) ClinVarID or CAID: CA227458

      (2) gnomAD: 0.00007930 total AF in gnomAD v4.1 (https://gnomad.broadinstitute.org/variant/1-94098794-C-A?dataset=gnomad_r4)

    1. We found two variants or more in ABCA4 in 69/95 (73%) probands (Supplementary Tables 2, 3); a single ABCA4 variant was found in 9/95 (9.5%) probands with STGD1 phenotype. A second variant could be found in four of these nine patients by Khan et al. (2020) (Figure 1 and Supplementary Tables 2, 4). Therefore, a total of 73/95 (77%) probands of our cohort ended up having two or more ABCA4 variants. In 17/95 (18%) probands, no variant was found in any of the sequenced genes.

      Case#: Patient STG-16, 13yo at onset, Argentina

      DiseaseAssertion: STGD1

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: BCVA=0.7/0.7, FA=3B, AF pattern=2, OCT showed decreased retinal thickness with disruption of external layers

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: NGS of ABCA4 (NM_000350.2), ELOVL4 (NM_022726.3), PROM1 (NM_006017.2), and CNGB3 (NM_019098.4)

      PreviouslyPublished: n/a

      Variant: c.4457C>T (p.Pro1486Leu); c.1804C>T (p.Arg602Trp)

      ClinVar: 99283

      CAID: CA227192

      SupplementalData: supplementary table 2 has genotype/phenotype info

    1. RP-029895-0103 ABCA4 c.4720G>Tp.E1574*known [44]

      Case#: Proband 95-0103, Spanish, onset at 8yo

      DiseaseAssertion: cone-rod dystrophy

      FamilyInfo: Family RP-0298. Affected sister, 95-0101, with same genotype

      CasePresentingHPOs: HP:0001133, HP:0000529, HP:0000662, HP:0000512, HP:0000543, HP:0007737, HP:0007641, HP:0007787

      CaseHPOFreeText: BCVA=0.1/0.1; ERG: scotopic-Low amplitude, normal latency, photopic-abolished, mixed-diminished a and b waves; dense pigment accumulation at macular region;, bilateral posterior subcapsular cataract.

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: 19365591

      Variant: c.4720G>T p.E1574; c.950delG p.G317Afs57. WES, All patients were previously tested and all resulted to be negative for known autosomal recessive retinitis pigmentosa (ARRP) or Leber Congenital Amaurosis (LCA) mutations by microarray screening

      ClinVar: 1460063

      CAID: 341283936

      SupplementalData: Table S2 has phenotype details

    1. A 25‐year‐old male presented to our hospital with a chief complaint of blurred vision in the right eye and significant night vision difficulties (nyctalopia) for 5 years.

      Case#:patient, 25, male

      DiseaseAssertion:Retinitis Pigmentosa

      FamilyInfo:Unaffected brother with no variants, parents each heterozygous for one pathogenic variant in ABCA4

      CasePresentingHPOs: HP:0000007, HP:0011462, HP:0007703, HP:0000662, HP:0007641

      CaseHPOFreeText: Onset 20 year old. Gradual onset of blurred vision OD, dyschromatopsia. BCVA 1/20 OD 20/20 OS. Optic disc pale, retinal arteries and foveal reflex attenuated. Yellow deposits in perofoveal area and mid-peripheral retina, which showed mottled appearance OU. OCT - thinning of outer nuclear layer and disruption of ellipsoid zone with hyper-reflective flecks. Severe bilateral constriction in visual field. Hypofluorescence of optic disc OU

      CaseNotHPOs: n/a

      CaseNotHPOFreeText: n/a

      Genotyping Method: whole exome (Sanger segregation test)

      PreviouslyPublished: n/a

      Variant: NM_000350.3:c.4793C>A; NM_000350.3:c.1769A>G

      ClinVar: 99321

      CAID: CA341279788

      SupplementalData: n/a

    1. Case 1

      Case#:1, 44-year-old man

      DiseaseAssertion: Stargardt disease

      FamilyInfo: no known family history of an ocular disease

      CasePresentingHPOs: HP:0007663, HP:0007793, HP:0012045, HP:0000603

      CaseHPOFreeText: gradual, relatively recent decreased visual acuity in the right eye, some pigment mottling in both maculae and ‘fish-tail'-like retinal flecks, central relative scotoma

      CaseNotHPOs:

      CaseNotHPOFreeText:

      Genotyping Method: “Analysis of the entire coding region of the ABCA4 gene”

      PreviouslyPublished: NR

      Variant: NM_000350.3:c.191C>T

      ClinVar:2733951

      CAID:CA341285580

      SupplementalData:

    1. 534-05STGD2461 T→AW821RMissense4139 C→TP1380LMissense5682 G→CNoneSilent5814 A→GNoneSilent

      Case#: Family AR534 Proband 05

      DiseaseAssertion: Stargardt

      FamilyInfo: Three paternal cousins are affected with STGD, with onset between the ages of 8 and 10 (unaffected het parents). The proband’s parents reported no visual impairment (father has P1380L/wt, mother has W821R/wt), but the paternal grandmother had been diagnosed previously with age-related macular degeneration at age 68 (het for P1380L). Subsequently, she developed hemorrhagic detachment of the macula, and a diagnosis of exudative AMD was made at age 74

      CasePresentingHPOs:

      CaseHPOFreeText: central visual impairment at age 11, retinal atrophy of the macula and a few peripheral flecks, A dark choroid was observed on fluorescein angiography,

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: Direct DNA sequencing of the 50 exons and flanking intronic regions of ABCR. Heteroduplex analysis

      PreviouslyPublished: n/a

      Variant: c.2461T>A (p.W821R); c.4139C>T (p.P1380L). Phase confirmed. Also has 2 synonymous variants (c.5682G>C and c.5814A>G)

      ClinVar: 7904

      CAID: CA129033

      SupplementalData: n//a

    1. P023 ABCA4 20 c.3035_3037delACA p.Asn1012Ile ATP-binding domain novel deletion – DCABCA4 24 c.3547G>T p.Gly1183Cys – reported – – –ABCA4 46 c.6289C>T p.Pro2097Ser ATP-binding domain novel missense probablydamagingDC

      Case#: Patient #P023, Korean

      DiseaseAssertion: stargardt

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: no individual phenotype information, group only

      CaseNotHPOs:

      CaseNotHPOFreeText:

      PreviouslyPublished: n/a

      Variant: exome sequencing: c.6289C>T p.Pro2097Ser; c.3547G>T p.Gly1183Cys; c.3035_3037delACA p.Asn1012Ile

      ClinVar: CA341277622

      CAID: 2202780

      SupplementalData: n/a

    1. In this study, we summarized the phenotypic and genotypic characteristics of 129 Chinese patients with ABCA4-RD.

      paper not publicly available, but is said to contain this variant based on LOVD entry. requested from library.

      Update: Received paper from library. 1 proband in Figure 1 has this variant, but cannot access the supplementary info to see the individual phenotype information. Affected maternal aunt with homozygous c.4605_4606ins-non-segregation.

    1. In case 71674, diagnosed with arRD, along with a recurrent nonsense mutation (p.Trp663*, HGMD Accession = {"type":"entrez-nucleotide","attrs":{"text":"CM003370","term_id":"909078994","term_text":"CM003370"}}CM003370), a novel splice-site variant was identified (c.2160 + 1 G > T) (Fig. 3a). This variant is predicted to lead to skipping of exon 14 in the ABCA4 transcript. The patient inherited one mutant allele from each parent.

      Patient 71674: Female, Swiss, 13 years old. bi-allelic variants in ABCA4, diagnosed with Retinal dystrophy DD: Retinitis pigmentosa

      Figure 3: Segregation analysis performed on family samples GenotypingMethod: Whole exome sequencing performed on HiSeq2000 and NextSeq500 (252 genes)

      Multiple Variants: VPS13B NM_017890.4:c.897 8A>G:p.Asn2993Ser Heterozygous CM041280

      PCDH15 NM_001142763.1:c. 4329_4337del:p.Pro 1446_Pro1448del Heterozygous

      DHX38 NM_014003.3:c.366 2C>T:p.Thr1221Met Heterozygous

      USH1G NM_173477.4:c.310 A>G:p.Met104Val Heterozygous

    1. Additionally, one novel change in exon 12 (p.Val552Ile) was found in one STGD patient by means of the dHPLC technique. This variant was detected in two alleles out of 200, suggesting a polymorphism.

      Case#: Aguirre-Lamban Unlabeled Proband, Spanish

      DiseaseAssertion: STGD

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: "Diagnosis of STGD was determined according to a bilateral central vision loss with a beaten-bronze appearance and/or the presence of orange-yellow flecks in the retina from the posterior pole to the mid-periphery; typical dark choroid observed by fluorescein angiography; and normal to subnormal electroretinograms (ERGs)."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: ABCR400 microarray, direct sequencing, dHPLC, haplotype analysis

      PreviouslyPublished: n/a

      Variant: c.1654G>A p.Val552Ile, interpreted as non-pathogenic, suggested to be a polymorphism

      CAID: CA239745

      SupplementalData: n/a

    1. Souradip C

      PMID:35973334

      Gene: ABCA4

      HGNC ID: 34

      Case#: 18-year-old sister II.3

      Variant splice-site variant NC_000003.11(NM_016247.3):c.1239 + 1G > T [Chr3:100972539C > A

      FammilyInfo two-generation north Indian family with three members affected with Stargardt-like macular dys trophy

      CasePresentingHPOs:ow vision and difficulty in night vision, with symptoms starting in the early second decade of life, which progressed slowly over time

      PedrigreeIn the results section is mentioned

      CaseHPOFreeText:NA

      CaseNotHPOs:Na

      CaseNotHPOFreeText:NA

      Genotyping Method:2.3. Validation of identified variant by Sanger sequencing

      PreviouslyPublished:NA