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1 From the Departments of Molecular Genetics and 4 Pathology, Institute of Ophthalmology, London, United Kingdom; the 2 Department of Ophthalmology, Tanta University Hospitals, Tanta, Egypt; and 3 Moorfields Eye Hospital, London, United Kingdom.
| Abstract |
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METHODS. DNA was extracted from venous blood obtained from all participants, and the coding region of CHST6 was amplified by polymerase chain reaction (PCR). The PCR products were analyzed by direct sequencing and restriction enzyme digestion. Enzyme-linked immunosorbent assay (ELISA) was performed to assess the presence of KS in serum from the probands of MCD-affected families participating in the study.
RESULTS. Six novel missense mutationsfour homozygous and two compound heterozygouswere identified in the CHST6 gene. The ELISA showed that the disease in all patients participating in the study was of MCD type I, including the subtype IA.
CONCLUSIONS. These novel mutations are thought to result in loss of corneal sulfotransferase function, which would account for the MCD phenotype.
| Introduction |
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MCD has been classified into three immunophenotypesI, IA, and IIbased on measurement of the serum level of sulfated keratan sulfate (KS) by enzyme-linked immunosorbent assay (ELISA)5 and an immunohistochemical evaluation of the corneal tissue.6 In MCD type I, neither the cornea nor the serum contains appreciable levels of sulfated KS, whereas in MCD type II, there is detectable KS in the cornea and serum.7 The third subtype, IA, in which sulfated KS is absent in the cornea and the serum but can be detected in the keratocytes, has been identified in subjects from Saudi Arabia.8 All three immunohistochemical subtypes have the same clinical phenotype.
Histologically, MCD is characterized by accumulation of glycosaminoglycans between the stromal lamellae, underneath the epithelium, and within the keratocytes and endothelial cells.9 10 An abnormality in the metabolism of KS has been implicated in the pathogenesis of MCD11 and has been attributed to an error in a specific sulfotransferase involved in the sulfation of KS.12 13 14
MCD types I and II had previously been linked to chromosome 16 (16q22).15 16 17 Recently, mutations in a new carbohydrate sulfotransferase gene (CHST6) encoding corneal glucosamine N-acetyl-6-sulfotransferase (C-GlcNac-6-ST) have been identified as the cause of MCD.18 A number of missense mutations were described in patients with MCD type I18 19 20 or type IA.20 In MCD type II, deletions and/or rearrangements in the upstream region of CHST618 and recently a missense mutation20 were reported.
In our study, mutation screening of CHST6 in five unrelated British families with MCD and with no clinically apparent systemic manifestations, revealed four homozygous and two compound heterozygous mutations in CHST6, all of the missense type. All the mutations involve the substitution of amino acids highly conserved across related carbohydrate sulfotransferases and/or represent the nonconservative substitution of nonpolar for polar residues and are thought to result in loss of CHST6 gene function.
| Materials and Methods |
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Mutation Detection
Genomic DNA was extracted from 10-mL blood samples obtained,
according to standard protocols, from all subjects involved in the
study. The coding region of CHST6 was amplified by
polymerase chain reaction (PCR). Each PCR was performed in a 50-µL
reaction mixture containing genomic DNA (200 ng), primers (0.4 µM
each), MgCl2 (1.52 mM), deoxynucleoside
triphosphates (dNTPs; 0.2 mM), 1x PCR buffer (containing 10 mM
Tris-HCl [pH 8.3], 50 mM KCl, and 0.1% gelatin) and Taq
polymerase (0.5 U; Bioline, UK). Amplification reactions were
performed under the following conditions: 3 minutes of denaturation at
94°C followed by 35 cycles of denaturation at 94°C for 1 minute,
annealing at 60 to 68°C for 1 minute, extension at 72°C for 1
minute, and a further extension step at 72°C for 5 minutes.
For amplification of the CHST6 coding region the following primer pairs were used: for the 5'-coding region, CK71h-intrn (5'-GCCCCTAACCGCTGCGCTCTC-3') and CK71h-R1180 (5'-GGCTTGCACACGGCCTCGCT-3') designed by Akama et al.18 For the middle coding region, two pairs of primers were designed: CK71M-F1 (5'-GACATGGACGTGTTTGATGC-3') and CK71M-R1 (5'-GCACGATGCCGTTGTCAC-3'); CK71M-F2 (5'-GCTCAACCTACGCATCGTG-3') and CK71M-R2 (5'-ATCCGTGGGTGATGTTATGG-3'); and for the 3'-coding region the following primer pair was designed: CK71L-F (5'-GAGCCGCTGGCAGAAATC-3') and CK71L-R (5'-TGCACCATGCACTCTCCTC-3'). A mismatch primer pair was also designed, sulfohin-F (5'-CTGTGCGACATGGACGAGT-3') and sulfohin-R (5'-CACCACGTGGCTGTAGGAG-3') to confirm one of the homozygous mutations (in family A, F107S) which does not alter any known restriction enzyme site. The mismatch primer created an HinfI site in conjunction with the mutation.
For direct sequencing, PCR products were purified (Qiaquick PCR purification kit; (Qiagen, Crawley, UK) and sequenced using an automatic fluorescence DNA sequencer (ABI Prism 373A; Perkin Elmer, Foster City, CA), according to the manufacturers instructions. Nucleotide sequences were compared with the published cDNA sequence of CHST6 (GenBank accession number AF219990; GenBank is provided in the public domain by the National Center for Biotechnology Information, Bethesda, MD, and is available at http://www.ncbi.nlm.nih.gov/genbank), and mutations identified were excluded from 100 control chromosomes of white origin by restriction enzyme digestion.
Restriction Enzymes
Five enzymes were used to confirm the mutations
identified. HinfI, with recognition site 5'...
G
ANTC... 3', was used to study the
homozygous T1012C and C906T in families A and E, respectively.
ApaI, with recognition site 5'...
GGGCC
C... 3', and BstNI, with
recognition site 5'... CC
(A/T)GG... 3',
also were used to confirm the heterozygous changes C783T and T1291G in
families B and C, respectively. Similarly, DrdI, with
recognition site 5'... GACNNNN
NNGTC...
3', was used to confirm the homozygous C1309T mutation in family D. And
finally, BanII, with recognition site 5'... G (A/G) GC
(T/C)
C... 3', was used to confirm the
homozygous G905T change in family E.
The PCR products digested by HinfI, BstN I, and BanII restriction enzymes were analyzed by 6% nondenaturing polyacrylamide gel electrophoresis (Protogel; National Diagnostics, Atlanta, GA) and were visualized by staining with ethidium bromide. Products digested by ApaI and Drd I were analyzed on 3% agarose gels (Bio-Rad, Herts, UK).
Assay of Sulfated KS in Serum
Inhibition ELISA for KS detection using the monoclonal antibody
5-D-4 (ICN Biochemicals Ltd., Basingstoke, UK) was performed to assess
the presence of KS in serum obtained from the probands of MCD-affected
families participating in the study. The method was performed as
described previously,21
22
except that an antibody
(Aggrecan; Sigma Chemical Co., Poole, UK) was used to coat the
plates and 2, 2'-azino-di-[3-ethylbenzthiazoline sulfonate 6]
(ABTS; Roche Molecular Biochemicals, Lews, UK) was used as the
substrate. The plates were read at 410 nm with a reference wavelength
of 490 nm on a flow plate reader (ICN Biochemicals Ltd.). The ELISA was
sensitive to KS concentrations of 10 to 10,000 ng/mL.
| Results |
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To assess the significance of these mutations, an alignment of the
primary sequence of CHST6 with other published carbohydrate
sulfotransferases,23
24
25
26
27
a computer program for
simultaneous alignment of many nucleotide or amino acid sequences to
detect or demonstrate homology between new sequences and existing
families of sequences (Clustal W, ver. 1.7; SGI, Mountain View, CA) was
used28
(Fig. 3)
. With the exception of a P31S substitution (families B and C) that
represents a nonconservative change but occurs at a position where
residue type is not conserved across the carbohydrate
sulfotransferases, all the mutations occur at positions where the
residue type is highly conserved across all the carbohydrate
sulfotransferases. Furthermore, mutations F107S (family A), L200R
(families B and C), and P72S (family E) are all nonconservative changes
involving substitution of a nonpolar residue for a polar residue that
may affect CHST6 enzyme activity. Two of the substitutions
are conservative changes, E71D (acidic
acidic, family E) and A206V
(nonpolar
nonpolar, family D). Of these, E71D occurs in tandem with
the P72S substitution (which is more likely to be disease causing) and
thus may not itself have a major deleterious effect. It is not
immediately apparent, however, why the A206V substitution should be
disease causing, although conservative substitutions elsewhere in
CHST6 have been reported to underlie MCD type I in Icelandic
families.19
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Inhibition ELISA performed on serum from the patients with MCD showed little or no inhibition of the monoclonal antibody 5-D-4. Control experiments using increasing KS concentrations effectively inhibited 5-D-4 binding. These data from our patients are consistent with MCD type I or type IA.
| Discussion |
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KS proteoglycans (lumican, keratocan, and mimecan) are present in the cornea as the major class of proteoglycans and are thought to play an important role in corneal transparency.31 32 33 The sulfate group of KS appears to be crucial for its biological function, because the degree of sulfation of KS increases during corneal development34 35 and the synthesis of unsulfated KS is observed in the corneas of patients with MCD.36 37 In view of the autosomal recessive inheritance of the condition, MCD probably results from a deficiency in sulfotransferase specific for proper sulfation of KS.10
We have identified six novel missense mutations in the probands from all families participating in this study. The mutations were detected by direct sequencing of CHST6 PCR products. Using restriction enzyme analysis, we were able to confirm the mutations in the probands and exclude them from unaffected family members and 50 normal individuals. To measure levels of sulfated KS in the serum of our patients with MCD, ELISA was performed and revealed barely detectable levels in all patients, confirming that disease in our patients was of MCD type I or IA.
All mutations detected occur at positions in the protein where the residue type is highly conserved across carbohydrate sulfotransferases and/or involve nonconservative substitutions of nonpolar residues for polar residue. One possible exception is E71D (family E) but this occurs as part of a double, homozygous substitution with P72S. It seems unlikely that E71D on its own would result in absence of protein function, because it entitles a replacement of an amino acid with another that is chemically similar. Two mutations occur in the 3'-PB domain, an essential part of the active site responsible for PAPS binding. Of these, L200R involves a nonconservative substitution of a polar for a nonpolar residue at a site that is completely conserved across carbohydrate sulfotransferases. The A206V substitution, although representing a conservative change at a position that is not so highly conserved across carbohydrate sulfotransferases, is nonetheless predicted to result in a structural change at a highly sensitive region of the protein and, when modeled on the crystal structure of mouse estrogen sulfotransferase, result in nonfunctionality due to structural constraints (data not shown).
It has recently been shown that there is a decrease in the activity of N-acetylglucosamine-6-sulfotransferase (GlcNAc6ST) in the cornea of patients with MCD and that this results in the formation of poorly or nonsulfated KS and causes corneal opacity.38 More recently, it has been reported that mouse intestinal GlcNac6-O-ST (mIGn6ST) has the same activity as human corneal GlcNac6-O-ST (C-GlcNA6ST) suggesting that mIGn6ST is the orthologue of human C-GlcNA6ST and functions as a sulfotransferase to produce KS in the cornea. Moreover, the amino acid substitutions in human C-GlcNA6ST resulting from missense mutations in CHST6 found in patients with MCD abolished the sulfotransferase activity by functional inactivation rather than protein degradation or mislocalization.39
The homozygous mutations detected in our patients infers an essential role of C-GlcNA6ST, the CHST6 protein product, in the production of normally functioning KS, whereas its inactivation is responsible for the MCD phenotype. Furthermore, the heterozygous changes identified affected both alleles in two families, suggesting that these compound heterozygous mutations could also result in the MCD phenotype.
We conclude that mutated carbohydrate sulfotransferase could result in loss of function of the sulfotransferase enzyme required for proper sulfation of KS, an essential element for corneal transparency, leading to the MCD phenotype.
| Acknowledgements |
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| Footnotes |
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Submitted for publication June 14, 2001; revised September 7, 2001; accepted October 2, 2001.
Commercial relationships policy: N
The publication costs of this article were defrayed in part by page
charge payment. This article must therefore be marked
"advertisement" in accordance with 18 U.S.C.
1734
solely to indicate this fact.
Corresponding author: Mohamed F. El-Ashry, Department of Molecular Genetics, Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK; m_el_ashry{at}hotmail.com
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