Mutationsabhängige Mechanismen und deren Bedeutung für zielgerichtete Behandlungsstrategien am Beispiel von Bestrophin 1 und den Bestrophinopathien

Zusammenfassung

Das Bestrophin-1-Gen (BEST1) codiert für ein integrales Membranprotein und findet sich im basolateralen Aspekt des retinalen Pigmentepithels. Mutationen im BEST1 sind mit einer heterogenen Gruppe von erblichen Netzhautdystrophien assoziiert, den sog. Bestrophinopathien, die schon in jüngerem Alter zu einer Beeinträchtigung des Sehvermögens führen können. Die einzelnen Krankheitsbilder sind anhand ihrer phänotypischen Merkmale und Erbgänge abgrenzbar. Während die meisten BEST1-Mutationen einem autosomal-dominanten Erbgang folgen, bei dem bereits eine defekte Genkopie zur Erkrankung führt, sind bei der autosomal-rezessiven Bestrophinopathie heterozygote Mutationsträger i. d. R. symptomfrei. In diesem Übersichtsartikel soll am Beispiel der Bestrophinopathien die Bedeutung der Kenntnis von mutationsabhängigen Mechanismen für das Verständnis der Pathogenese, aber auch für die Entwicklung von zukünftigen Therapieansätzen, hervorgehoben werden.

Abstract

Bestrophin 1 (BEST1) encodes an integral membrane protein localized in the basolateral aspect of the retinal pigment epithelium. Mutations in BEST1 are associated with distinct retinal dystrophies, the so-called “bestrophinopathies”, often causing visual impairment, even in early childhood. The clinical entities of the bestrophinopathies can be distinguished by phenotypic characteristics and mode of inheritance of the respective gene defect. While the autosomal dominant inheritance pattern with one altered copy of BEST1 is common, heterozygous carriers of the autosomal recessive bestrophinopathy are generally but not consistently symptom-free. This review highlights the significance of understanding the underlying molecular mechanisms that contribute to disease pathogenesis of autosomal dominant and autosomal recessive bestrophinopathies. This knowledge is deemed crucial and needs to be considered in future planning of treatment strategies.

Schlüsselwörter

Bestrophin 1 - vitelliforme Makuladystrophie - ER- und post-ER-assoziierte Proteindegradation - induzierte pluripotente Stammzellen - Gentherapie

Key words

Bestrophin 1 - vitelliform macular dystrophy - ER- and post-ER associated protein degradation - induced pluripotent stem cells - gene therapy

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