Optic Nerve Hypoplasia (ONH) is the leading cause of childhood blindness in developed nations and its prevalence has been rising. Yet, we know little about the genetic, molecular, or cellular mechanisms underlying ONH. A previous study described ONH in a cohort of patients with mutations in CASK, an X-linked gene with established roles in neural development and synaptic function. I have demonstrated that heterozygous deletion of CASK in mice (Cask+/-) recapitulates many of the phenotypes observed in patients with CASK mutations, including ONH. This includes reduced optic nerve size, reduced numbers of retinal ganglion cells (RGCs), reduced RGC axonal diameter, and deficits in vision-related tasks. Further analysis on a homozygous partial loss of function variant (Caskfl/fl) also displayed ONH with reduced numbers of RGCs. In order to understand the mechanisms underlying CASK-associated ONH, I explored whether RGCs, the projection neurons of the retina and the cells whose axons comprise the optic nerve, generate CASK. Indeed, mRNA analysis revealed expression of CASK by a large cohort of RGCs. In order to assess whether loss of CASK from a majority of RGCs leads to ONH, I crossed a conditional allele of CASK (CASKfl/fl) with transgenic mice that express Cre Recombinase (Cre) in RGCs. Deletion of CASK from RGCs did not further alter ONH size nor RGC survival. These results demonstrate that loss of CASK signaling in this discrete neuronal populations is not sufficient to lead to further disruption in the assembly of the subcortical visual circuit, suggesting a non-cell autonomous mechanism for loss of CASK in ONH. / Doctor of Philosophy / The connection between the eye and the brain is crucial for successful vision. Impairment of this connection by either loss of the retinal neurons that project axons to the brain or damage to the nerve (optic nerve) lead to blindness. This occurs in a disease called Optic Nerve Hypoplasia (ONH), which is the leading cause of childhood blindness in developed countries. Discovering the risk factors associated with this disease and mechanisms underlying the disease can help us build tools to treat and repair the optic nerve. Previously, mutations in the CASK gene were found in patients with ONH. Here, I developed a mouse model of CASK mutations to phenocopy the human patients, and used this model to explore the development of ONH. For example, with this mouse model I described for the first time, the timeline of disease progression. Surprisingly, I also showed that loss of CASK specifically from the neurons whose axons generate the optic nerve did not lead to ONH, suggesting that ONH may develop from a failure of a network of cells, rather than just one population of cells.

Calcium/calmodulin-dependent serine protein kinase (CASK) is a membrane-associated guanylate kinase (MAGUK) family protein, which is encoded by a gene of identical name present on the X chromosome. CASK may participate in presynaptic scaffolding, gene expression regulation, and cell junction formation. CASK is essential for survival in mammals. Heterozygous mutations in the CASK gene (in females) produce X-linked intellectual disability (XLID) and mental retardation and microcephaly with pontine and cerebellar hypoplasia (MICPCH, OMIM# 300749). CASK mutations are also frequently associated with optic nerve hypoplasia (ONH) which is the most common cause of childhood blindness in developed countries. Some patients with mutations in CASK have been also diagnosed with optic nerve atrophy (ONA) and glaucoma. We have used floxed CASK (CASKfloxed), CASK heterozygous knockout (CASK(+/-)), CASK neuronal knockout (CASKNKO) and tamoxifen inducible CASK knockout (CASKiKO) mouse models to investigate the mechanism and pathology of CASK-linked ONH. Our observations indicate that ONH occurs with 100% penetrance in CASK(+/-) mice, which also displayed microcephaly and disproportionate cerebellar hypoplasia. Further, we found that CASK-linked ONH is a complex developmental neuropathology with some degenerative components. Cellular pathologies include loss of retinal ganglion cells (RGC), astrogliosis, axonopathy, and synaptopathy. The onset of ONH is late in development, observed only around the early postnatal stage in mice reaching the plateau phase by three weeks of birth. The developmental nature of the disorder is confirmed by deleting CASK after maturity since CASKiKO mice did not produce any obvious optic nerve pathology. Strikingly the CASKfloxed mice expressing ~49% level of CASK did not manifest ONH despite displaying a slightly smaller brain and cerebellar hypoplasia indicating that ONH may not simply be an extension of microcephaly. We discovered that deleting CASK in neurons produced lethality before the onset of adulthood. The CASKNKO mice exhibited delayed myelination of the optic nerve. Overall this work suggests that CASK is critical for neuronal maturation and CASK-linked ONH is a pervasive developmental disorder of the subcortical visual pathway. Finally, in a side project, I also described a new methodology of targeting neurons using receptor-mediated endocytosis which would help target retinal neurons for therapeutic purposes in the future. / Ph. D. / 7 in 10,000 children suffer from childhood blindness, for whom all the visual information from the outside world is completely blocked. Although classified as a rare disease, optic nerve hypoplasia (ONH), or the underdevelopment of optic nerve, is the leading cause of childhood blindness in developed countries, accounting for 15% of childhood blindness. Only a handful of genes have been shown to associate with ONH. The CASK gene, whose protein product calcium/calmodulin-dependent serine protein kinase (CASK) plays a role in presynaptic scaffolding, is one of them. Mutations in the CASK gene not only produce ONH, but also microcephaly and intellectual disability. Investigating the mechanism of CASK-linked ONH will provide critical data to understand the molecular basis of optic nerve formation and maturation. Here we have used the CASK heterozygous knockout mouse model to replicate the ONH and microcephaly seen in female human patients. We discovered that the onset of CASK-linked ONH corresponded to the late third trimester developmental stage in humans, thus ONH is developmental in nature. ONH pathologies include thinning of optic nerves, axonal atrophy, and synaptopathy. In contrast to the postnatal death of constitutive CASK loss of function in mice, CASK ablation in adult mice did not lead to lethality. CASK deletion also delays neuronal myelination. Overall, our results indicate that CASK is critical for postnatal maturation of the central nervous system and mutations of the CASK gene is sufficient to lead to ONH. Early intervention and proper gene therapy may treat CASK-linked ONH.