Überblick über die kongenitale stationäre Nachtblindheit mit überwiegend normalem Fundus

Zusammenfassung

Kongenitale stationäre Nachtblindheit (Englisch: congenital stationary night blindness, CSNB) bezeichnet eine klinisch und genetisch unterscheidbare Gruppe von nicht progressiven Netzhauterkrankungen, die kaum Fundusauffälligkeiten zeigt. Die Vererbung kann autosomal-dominant (adCSNB), autosomal-rezessiv (arCSNB) oder X-chromosomal (XLCSNB) sein. Weitere klinische Merkmale können Myopie, Hyperopie, Strabismus, Nystagmus und reduzierter Visus sein. Mittels Elektroretinografie kann eine Riggs- und eine Schubert-Bornschein-Form unterschieden werden. Während die Riggs-Form eine Fehlfunktion der Stäbchen selbst aufweist, zeigen Patienten mit der weitaus häufigeren Schubert-Bornschein-Form eine Signalübertragungsstörung zwischen den Photorezeptoren und nachgeschalteten Bipolarzellen. Die Schubert-Bornschein-Form der CSNB lässt sich anhand des Elektroretinogramms (ERG) noch weiter in eine inkomplette (Englisch: incomplete, icCSNB) und komplette Form (Englisch: complete, cCSNB) einteilen. Während es sich bei der cCSNB um eine Fehlfunktion des ON-Signalwegs handelt, sind bei der icCSNB sowohl der ON- als auch der OFF-Signalweg und damit meist auch die Sehschärfe betroffen. Mittels klassischer Kopplungsanalyse, Kandidatengenanalyse und seit Neuerem Hochdurchsatzsequenzierung konnten bisher Mutationen in 13 verschiedenen Genen mit dieser Erkrankung assoziiert werden. Durch Studien an Zelllinien oder Tiermodellen konnte gezeigt werden, dass der Phänotyp der Patienten mit der Expression, Proteinlokalisation und Funktion der entsprechenden Moleküle korreliert: Gene, die bei Patienten mit der Riggs-Form der CSNB mutiert sind, haben eine bedeutende Rolle in der Phototransduktionskaskade der Stäbchen. Gene, die bei Patienten mit der icCSNB mutiert sind, kodieren für Proteine, die für die Freisetzung des Neurotransmitters Glutamat am synaptischen Spalt der Photorezeptoren verantwortlich sind. Gene, die bei Patienten mit der cCSNB mutiert sind, kodieren für Proteine, die für die Aufnahme des Glutamats und Weiterleitung des Signals an den ON-Bipolarzellen verantwortlich sind. Erste Therapieversuche im Tiermodell zeigen, dass die CSNB mittels eines gentherapeutischen Ansatzes geheilt werden könnte. Die CSNB betreffende Studien sind einerseits wichtig für eine genaue Diagnose für den Patienten, andererseits helfen sie bei der Entschlüsselung der Moleküle, die für die Signalübertragung zwischen Photorezeptoren und Bipolarzellen eine Rolle spielen, ein bislang wenig erforschtes Gebiet.

Abstract

Congenital stationary night blindness (CSNB) is a clinically and genetically heterogeneous group of non-progressive retinal disorder with largely normal fundus appearance. The mode of inheritance can be autosomal dominant (adCSNB), autosomal recessive (arCSNB) or X-chromosomal (XLCSNB). Additional ocular signs can be myopia, hyperopia, strabismus, nystagmus and reduced visual acuity. The Riggs and Schubert-Bornschein form of CSNB can be discriminated by electroretinography. While the Riggs form represents a dysfunction of the rods, a signal transmission defect from photoreceptors to bipolar cell is described in patients with the more frequently occurring Schubert-Bornschein form. The Schubert-Bornschein form can be further divided into incomplete (icCSNB) and complete (cCSNB) showing different electroretinograms (ERGs). While patients with cCSNB show a dysfunction of the ON-signaling pathway, patients with icCSNB show a dysfunction of the ON- and OFF-signaling pathways, affecting visual acuity as well. Using classical linkage, candidate gene analyses and more recent next-generation sequencing approaches, to date, mutations in 13 different genes have been associated with this disease. In vitro and in vivo models showed a correlation of the phenotype of patients with the expression, protein localization and function of the respective molecules: genes, mutated in patients with the Riggs form of CSNB have an important role in the rod phototransduction cascade. Genes mutated in patients with icCSNB, code for proteins important for glutamate neurotransmitter release at the synaptic cleft of the photoreceptors. Genes mutated in patients with cCSNB, code for proteins important for glutamate uptake and further signal transmission to the ON-bipolar cells. Preliminary in vivo studies showed that CSNB may be cured by gene therapy. These studies concerning CSNB are important for the precise diagnosis of patients with this disease, but are also helpful in deciphering key molecules essential for signal transmission from photoreceptors to bipolar cells. So far, it is a poorly understood field.

Schlüsselwörter

Retina - Elektrophysiologie - Genetik - Biochemie

Key words

retina - electrophysiology - genetics - biochemistry

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