Date of Award

16-12-2024

Document Type

Thesis

School

School of Chemical & Biotechnology

Programme

Ph.D.-Doctoral of Philosophy

First Advisor

Dr.S.Sripriya

Second Advisor

Dr.Suma Mohan

Keywords

Next Generation Sequencing, Genetic Etiology, Syndromic Blindness, Retinitis Pigmentosa, Human Genetics

Abstract

India is one of the largest populations in the world and is estimated to have a high prevalence of Retinitis Pigmentosa (RP). RP is clinically and genetically heterogenous, characterized initially as night blindness, leading to complete vision loss due to retinal degeneration. RP can occur in non-syndromic or syndromic forms, affecting other organs as observed in Bardet Biedl Syndrome (BBS) and Usher syndrome (USH).

BBS is characterized by RP, polydactyly, obesity, renal anomalies and learning difficulties. USH is characterized by RP and sensorineural hearing loss (SNHL), with variable presence of vestibular dysfunction. Nextgeneration sequencing (NGS) has become a cost-effective technology for rapid and accurate data generation and analysis in genetic studies.

In this study, NGS was used to screen patients clinically diagnosed with syndromic RP and Leber Congenital Amaurosis (LCA)/Severe Early Congenital Onset Retinal Degeneration (SECORD)) after detailed ophthalmic examinations and documentation of extraocular features through a proforma and questionnaire.

A total of 207 (N=108 BBS, N=90 USH and N=9 retrospective SECORD) patients were analysed for genetic etiology; pathogenic variations were identified in 85% of BBS and 84% of USH in known genes; N= 48 in BBS and N=36 in USH were novel variations. Eleven patients showed variations in other IRD and ciliary genes (3 BBS and 8 USH); noncandidate gene variations were identified in 5 BBS and 3 USH patients through whole exome sequencing; however, the disease causal role of these variations deems further clinical evaluation and correlation.

Genetic alterations were not identified in 9% and 6% of BBS and USH patients respectively. The study also revealed the potential of NGS in re-diagnosis of syndromic forms of LCA/SECORD in patients who were initially diagnosed as isolated RP cases. The study has expanded the knowledge on genetic spectrum of BBS and USH patients from India and is the only available report from the country.

This study gains momentum in the context of emerging gene based therapeutic interventions and also validates the need for early molecular diagnosis, which will aid in the (i) management of syndromic conditions (ii) confirmation of disease pathogenesis through differential diagnosis based on the genes identified.

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Graphical Abstract