The combination of severe ocular and distal limb malformations is rare. Ophthalmo-acromelic syndrome (OAS; MIM 206920) is characterised by anophthalmia with lower limb oligodactyly. To date <40 cases of this autosomal recessive disorder have been reported. Genome-wide analysis of ~10,000 SNPs typed on two apparently unrelated families - comprising a total of three affected individuals, four unaffected siblings and their consanguineous parents - identified a large region of overlapping autozygosity on chromosome 14q. Adding data from a third consanguineous family gave a combined LOD score of >5 with no evidence of locus heterogeneity. Collaborative data from a further 6 individuals refined the critical interval to a 3.4 Mb region on chromosome14:69,652,605-73,059,612 Mb. To sequence all 19 known protein-coding genes in the region, the 238 exons were ranked by evolutionary sequence conservation and divided equally between the Edinburgh and Nijmegen groups. Complete sequence coverage has been obtained for 61% of the “Edinburgh” exons but no potentially causative mutations have been identified. Further mutation analysis of the OAS locus is on-going. Mice homozygous for the X-ray induced Mp mutation were reportedly anophthalmic with hind limb oligodactyly and thus represented a potential model for human OAS. This line was rederived in Edinburgh and phenotypic analysis of Mp/Mp homozygotes showed runting, malformed pinnae with microphthalmia but not anophthalmia. The apparent hind-limb oligodactyly was due to osseous syndactyly. Mp heterozygotes had milder microphthalmia and pinnae deformities, but lacked the syndactyly. In both heterozygotes and homozygotes the eye malformations were fully penetrant, pan-ocular and characterised by failure of both the ciliary apparatus and vitreous body to form and abnormal retinal lamination. Genome-wide microsatellite marker analysis showed linkage of the Mp phenotype to chromosome 18. Fbn2 mapped within the linkage interval and was a good candidate for Mp based on the finding of hind limb osseous syndactyly in Fbn2-null mice. However, Fbn2-null mice have no eye phenotype. 3’-RACE identified that Mp was as a 660 kb inversion affecting the 3’-regions of Fbn2 and the adjacent gene Isoc1. This created two aberrant reciprocal fusion transcripts: Fbn2 exons 1-63 are fused to Isoc1 exon 5; and Isoc1 exons 1-4 are fused to Fbn2 exons 64-65. This predicts nonsense-mediated decay of the Isoc1 Mp transcript and production of a truncated Fbn2 Mp protein. Ocular development was analysed in homozygote and wild type embryos to define the basis of the “worse than null phenotype” seen in Mp mice. RNA in situ hybridisations (ISH) failed to detect expression of Isoc1 in the embryonic eye. In contrast, normal expression of Fbn2 in the ciliary body and retina was consistent with the Mp phenotype. A combination of EM and immunocytochemistry showed that truncated Fbn2 (Fbn2Mp) was retained within the ER. Fbn2Mp co-localised with markers of ER stress: Grp78 expression and UPR-specific Xbp1 splicing. Signalling by Wnt2b is thought to be critical for ciliary development and Lef1, a Wnt-responsive transcription factor, showed increased and ectopic ocular expression in the region affected by ER stress. Sox2 is a direct transcriptional target of Lef1 and we observed apparent ectopic expression of Sox2 in the ciliary body. Throughout the developing retina in mutant embryos we also observed individual cells that were ectopically expressing the transcription factor Chx10 and other cells expressing the apoptotic marker Activated- Caspase-3. The apoptotic marker did not specifically co-localise with Fbn2Mp. Taken together, these findings suggest that the ocular malformations in Mp are a direct result of the ER stress induced by Fbn2Mp in a specific group of cells in the early ciliary body. The ER stress presumably halts post-translational modification of a developmentally critical signaling molecule, possibly Wnt2b, which happens to be expressed in the same cells. We have termed the resulting pathological mechanism a synodiporic effect (synodiporia = the ones walking the street together or fellow travellers). Such effects may have significant implications for human genetic disease analysis, and may provide an explanation for other “worse than null” mutations.

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