Autosomal recessive retinitis pigmentosa (arRP) is characterized by considerable allelic and nonallelic heterogeneity. Mutations have been described in the rhodopsin gene (RHO), the genes encoding the α and β subunits of rod phosphodiesterase (PDEA and PDEB) and the gene encoding the α subunit of the cGMP-gated channel (CNCG). In addition, linkage studies in single extended pedigrees have defined two new arRP loci, at 1q and 6p. In order to identify the disease gene in a Spanish consanguineous arRP family, a linkage analysis was undertaken. After testing 102 polymorphic markers, a significant positive lod score (Ζ max =3.64 at θ=0) was obtained with marker D1S188 at 1p13-p21, the same region where the Stargardt and fundus flavimaculatus (FFM) loci were previously defined. Exhaustive ophthalmologic examination of the patients clearly distinguished the disease from the Stargardt and FFM phenotypes, and revealed an atypical form of arRP with choroidal atrophy as a distinctive feature.
3Retinitis pigmentosa is a clinically and genetically heterogeneous group of retinal degenerations characterized by progressive loss of night and peripheral vision and, eventually, severe visual loss (9). As is the case of the autosomal dominant (adRP) and the X-linked (xlRP) forms of the disease, autosomal recessive retinitis pigmentosa (arRP) is characterized by allelic and nonallelic heterogeneity. Mutations cosegregating with the disease have been described in the rhodopsin gene (RHO) (15,24), the genes encoding the α and β subunits of rod phosphodiesterase (PDEA and PDEB, respectively) (3,10,21,28, 29) and the gene encoding the α subunit of the cGMP-gated channel (CNCG) (6). In addition, genetic linkage studies in single extended pedigrees have identified two new arRP loci, at 1q (18, 30) and 6p (14).Among the Spanish population, 39% of the RP pedigrees show an autosomal recessive pattern of inheritance (arRP) (2). Here we report the case of a Spanish consanguineous arRP family (M-33) with six out of seven sibs affected (Fig.1). Ophthalmologic examination of both parents revealed no manifestation of RP; the father (who died aged 72), showed no symptoms other than glaucoma, whereas the mother (aged 82) is totally asymptomatic. This fact, together with the consanguinity (second-cousin marriage), indicate an autosomal recessive pattern of inheritance. Clinical evaluation of the affected members suggested an aggressive form of the disease, with night blindness as the first symptom appearing in the first decade of life (mean age of onset, 8 years), followed by a decrease in visual acuity, starting at 14 years of age. Fundus examination and fluorescein angiographies (Fig.2) of the affected sibs in the fourth decade of life revealed papillary pallor, attenuated vessels, peripheral scattered pigmentation, bone spicule-like pigmentation reaching some areas of the macula and severe atrophy of the retinal pigment epithelium (RPE). At present, the older sibs show a complete scotoma while the youngest (around 45 years of age) still ...