ABSTRACT
Usher syndrome is the most common cause of “deaf/blindness” in developed countries. Its presenting symptom is hearing loss, which means that the audiologist is often the first to see a child with Usher syndrome. Due to the marked heterogeneity of hearing loss, it is often difficult to confirm a diagnosis of Usher syndrome until the onset of visual symptoms. There are three clinical types (I, II, and III) based on severity and age at onset of hearing, visual, and vestibular symptoms. However, there are at least eight molecular subtypes as defined by the specific gene involved. Molecular diagnostic techniques are available on a limited basis to assist the clinician in early confirmation of the diagnosis and in defining specific Usher syndrome genetic subtypes. Furthermore, advances in the understanding of the molecular genetics of Usher syndrome indicate that most, if not all, of the Usher genes produce proteins that work together in a molecular complex. This not only helps explain why mutations in the different genes all produce similar phenotypes, but it offers hope for therapies that may mitigate the vision and hearing losses of all the Usher syndromes. Effective therapy is the ultimate goal and progress is being made toward that objective along several fronts.
KEYWORDS
Usher syndrome - molecular diagnosis - therapy
REFERENCES
1
Kimberling W J, Moller C.
Clinical and molecular genetics of Usher syndrome.
J Am Acad Audiol.
1995;
6
63-72
2
Moller C G, Kimberling W J, Davenport S L et al..
Usher syndrome: an otoneurologic study.
Laryngoscope.
1989;
99
73-79
3
Karjalainen S, Pakarinen L, Terasvirta M, Kaariainen H, Vartiainen E.
Progressive hearing loss in Usher's syndrome.
Ann Otol Rhinol Laryngol.
1989;
98
863-866
4
Wagenaar M, van Aarem A, Huygen P, Pieke-Dahl S A, Kimberling W J, Cremers C.
Hearing impairment related to age in Usher syndrome types 1B and 2A.
Arch Otolaryngol Head Neck Surg.
1999;
125
441-445
5
Pennings R J, Huygen P L, Weston M D et al..
Pure tone hearing thresholds and speech recognition scores in Dutch patients carrying mutations in the USH2A gene.
Otol Neurotol.
2003;
24
58-63
6
Abraham F A, Cohen D, Sohmer H.
Usher's syndrome: electrophysiological tests of the visual and auditory systems.
Doc Ophthalmol.
1977;
44
435-444
7
Fishman G A.
Usher's syndrome: visual loss and variations in clinical expressivity.
Perspect Ophthalmol.
1979;
3
97-103
8
Marshall J D, Ludman M D, Shea S E et al..
Genealogy, natural history, and phenotype of Alström syndrome in a large Acadian kindred and three additional families.
Am J Med Genet.
1997;
73
150-161
9
Tranebjaerg L, Schwartz C, Eriksen H et al..
A new X-linked recessive deafness syndrome with blindness, dystonia, fractures, and mental deficiency is linked to Xq22.
J Med Genet.
1995;
32
257-263
10
Wierzbicki A S, Lloyd M D, Schofield C J, Feher M D, Gibberd F B.
Refsum's disease: a peroxisomal disorder affecting phytanic acid alpha-oxidation.
J Neurochem.
2002;
80
727-735
11 Kimberling W. Genetic hearing loss associated with eye disorders . In: Toriello HV, Reardon W, Gorlin RJ Hereditary Hearing Loss and Its Syndromes. Genetic Hearing Loss Associated with Eye Disorders. Oxford, England; Oxford University Press 2004
12
Gerber S, Bonneau D, Gilbert B et al..
USH1A: chronicle of a slow death.
Am J Hum Genet.
2006;
78
357-359
13
Weil D, Blanchard S, Kaplan J et al..
Defective myosin VIIa gene responsible for Usher syndrome type 1B.
Nature.
1995;
374
60-61
14
Bork J M, Peters L M, Riazuddin S et al..
Usher syndrome 1D and nonsyndromic autosomal recessive deafness DFNB12 are caused by allelic mutations of the novel cadherin-like gene CDH23.
Am J Hum Genet.
2001;
68
26-37
15
Ahmed Z M, Riazuddin S, Bernstein S L et al..
Mutations of the protocadherin gene PCDH15 cause Usher syndrome type 1F.
Am J Hum Genet.
2001;
69
25-34
16
Verpy E, Leibovici M, Zwaenepoel I et al..
A defect in harmonin, a PDZ domain-containing protein expressed in the inner ear sensory hair cells, underlies Usher syndrome type 1C.
Nat Genet.
2000;
26
51-55
17
Weil D, El-Amraoui A, Masmoudi S et al..
Usher syndrome type I G (USH1G) is caused by mutations in the gene encoding SANS, a protein that associates with the USH1C protein, harmonin.
Hum Mol Genet.
2003;
12
463-471
18
Eudy J D, Weston M D, Yao S et al..
Mutation of a gene encoding a protein with extracellular matrix motifs in Usher syndrome type IIa.
Science.
1998;
280
1753-1757
19
Weston M D, Luijendijk M W, Humphrey K D, Moller C, Kimberling W J.
Mutations in the VLGR1 gene implicate G-protein signaling in the pathogenesis of Usher syndrome type II.
Am J Hum Genet.
2004;
74
357-366
20
Adato A, Vreugde S, Joensuu T et al..
USH3A transcripts encode clarin-1, a four-transmembrane-domain protein with a possible role in sensory synapses.
Eur J Hum Genet.
2002;
10
339-350
21
Petit C.
Usher syndrome: from genetics to pathogenesis.
Annu Rev Genomics Hum Genet.
2001;
2
271-297
22
Reiners J, Reidel B, El Amraoui A et al..
Differential distribution of harmonin isoforms and their possible role in Usher-1 protein complexes in mammalian photoreceptor cells.
Invest Ophthalmol Vis Sci.
2003;
44
5006-5015
23
Adato A, Michel V, Kikkawa Y et al..
Interactions in the network of Usher syndrome type 1 proteins.
Hum Mol Genet.
2005;
14
347-356
24
Reiners J, van Wijk E, Marker T et al..
Scaffold protein harmonin (USH1C) provides molecular links between Usher syndrome type 1 and type 2.
Hum Mol Genet.
2005;
14
3933-3943
25
Liu X, Udovichenko I P, Brown S D, Steel K P, Williams D S.
Myosin VIIa participates in opsin transport through the photoreceptor cilium.
J Neurosci.
1999;
19
6267-6274
26
Venkatasubbarao S.
Microarrays-status and prospects.
Trends Biotechnol.
2004;
22
630-637
27
Liu X Z, Blanton S H, Bitner-Glindzicz M et al..
Haplotype analysis of the USH1D locus and genotype-phenotype correlations.
Clin Genet.
2001;
60
58-62
28
Liu X Z, Hope C, Walsh J et al..
Mutations in the myosin VIIA gene cause a wide phenotypic spectrum, including atypical usher syndrome.
Am J Hum Genet.
1998;
63
909-912
29
Astuto L M, Bork J M, Weston M D et al..
CDH23 mutation and phenotype heterogeneity: a profile of 107 diverse families with Usher syndrome and nonsyndromic deafness.
Am J Hum Genet.
2002;
71
262-275
30
Rivolta C, Sweklo E A, Berson E L, Dryja T P.
Missense mutation in the USH2A gene: association with recessive retinitis pigmentosa without hearing loss.
Am J Hum Genet.
2000;
66
1975-1978
31
Boughman J A, Vernon M, Shaver K A.
Usher syndrome: definition and estimate of prevalence from two high-risk populations.
J Chronic Dis.
1983;
36
595-603
32
Pakarinen L, Karjalainen S, Simola K O, Laippala P, Kaitalo H.
Usher's syndrome type 3 in Finland.
Laryngoscope.
1995;
105
613-617
33
Ben Yosef T, Ness S L, Madeo A C et al..
A mutation of PCDH15 among Ashkenazi Jews with the type 1 Usher syndrome.
N Engl J Med.
2003;
348
1664-1670
34
Nuutila A.
Dystrophia retinae pigmentosa-dysacusis syndrome (DRD): a study of the Usher or Hallgren syndrome.
J Genet Hum.
1970;
18
57-58
35
Hinderlink J B, Brokx J P, Mens L H, van den Broek P.
Results from four cochlear implant patients with Usher's syndrome.
Ann Otol Rhinol Laryngol.
1994;
103(4 Pt 1)
285-293
36
Young N M, Johnson J C, Mets M B, Hain T C.
Cochlear implants in young children with Usher's syndrome.
Ann Otol Rhinol Laryngol Suppl.
1995;
166
342-345
37
Berson E L, Rosner B, Sandberg M A et al..
A randomized trial of vitamin A and vitamin E supplementation for retinitis pigmentosa.
Arch Ophthalmol.
1993;
111
761-772
38
Berson E L, Rosner B, Sandberg M A et al..
Further evaluation of docosahexaenoic acid in patients with retinitis pigmentosa receiving vitamin A treatment: subgroup analyses.
Arch Ophthalmol.
2004;
122
1306-1314
39
Chow A Y, Chow V Y, Packo K H, Pollack J S, Peyman G A, Schuchard R.
The artificial silicon retina microchip for the treatment of vision loss from retinitis pigmentosa.
Arch Ophthalmol.
2004;
122
460-469
40
Schmidt-Erfurth U.
Nutrition and retina.
Dev Ophthalmol.
2005;
38
120-147
41
Thanos C, Emerich D.
Delivery of neurotrophic factors and therapeutic proteins for retinal diseases.
Expert Opin Biol Ther.
2005;
5
1443-1452
William J KimberlingPh.D.
Center for the Study and Treatment of Usher Syndrome, Boys Town National Research Hospital and Professor of Biomedical Sciences
Creighton Medical School, Omaha, NE. 68131
Email: kimber@boystown.org