Hereditary hearing loss is the most common sensory disorder, affecting 1 in 500 newborns. There are more than 538 million individuals with genetic hearing loss worldwide and this number is expected to grow to 1 billion over the next three decades. Currently, the only option for individuals with hearing loss is mechanical intervention such as hearing aids or cochlear implants. In the past decade, many studies have highlighted the need for personalized gene therapy or molecular intervention to treat genetic deafness. However, in order to fulfill this vision a comprehensive understanding of the intricate mutation-gene-phenotype nuances and relationships is required. Toward this goal, we unraveled novel mutation-gene-phenotype associations and mechanisms in four deafness-causing genes (CIB2, COL11A1, CEACAM16 and DFNA5), by using a combination of in-depth phenotyping, human genetics, cutting edge genomic technologies, murine mutant models, and functional assays. These novel insights revealed mutations in CIB2 do not cause Usher Syndrome, mutations in COL11A1 can cause either non-syndromic or syndromic hearing loss, CEACAM16-related deafness is due to two distinct mechanisms, loss of function and gain of function, and coding variants can influence mRNA assembly and cause DFNA5-related hearing loss. Elucidating these novel mutation-gene-phenotype relationships has improved our knowledge of the pathogenic mechanisms underlying hearing loss and provided much needed answers to individuals seeking a diagnosis for their deafness. Recognizing the complexities associated with genetic hearing loss and the challenges in interpreting the clinical significance of genetic variants, we established the first deafness-specific variant database, the Deafness Variation Database (DVD), which classifies over 876,000 variants across 152 deafness-associated genes. This breadth of data provided us with a unique opportunity to explore the molecular landscape of deafness. We show that over 96% of coding variants are rare and novel and that mutational signatures are unique to each gene and are driven by minor allele frequency thresholds, variant effect, and protein domain. The mutational landscape we define shows complex gene-specific variability, making an understanding of these nuances foundational for improved accuracy in variant interpretation. Overall the work presented in this thesis improves our understanding of deafness biology, identifies novel targets for therapeutics and enhances clinical decision-making.

No description available.

Die b -Thalassämie gehört weltweit zu den häufigsten monogenen Erbkrankheiten. Die Thalassämien treten endemisch in der Bevölkerung des Mittelmeerraumes, in Westafrika und in weiten Teilen Asiens auf. In der einheimischen Bevölkerung der Bundesrepublik Deutschland gehört die homozygote Form der b -Thalassämie zu den seltenen Erkrankungen. Häufiger ist das Auftreten der heterozygoten Form, die als Differentialdiagnose der mikrozytären, hypochromen Anämie eine besondere Rolle spielt. Blutproben von 214 deutschen Personen mit einer heterozygoten b -Thalassämie wurden mittels Allel-spezifischer Oligonukleotid-Hybridisierung, Restriktionsanalyse und direkter Sequenzierung PCR-amplifizierter DNA analysiert. Insgesamt konnten 96,3 % (206/214) der Proben molekular charakterisiert werden. Die mediterranen Mutationen stellen einen Anteil von etwa 2/3 aller identifizierten Veränderungen, häufig sind insbesondere NS 39, IVS1-110 G ® A und IVS1-1 G ® A. Das übrige Mutationsspektrum setzt sich aus sehr seltenen Mutationen (IVS1-1 G ® T, IVS1-2 T ® G, IVS1-2 T ® C, NS 15 G ® A, NS 121 G ® T, FS 8/9 +G, FS 44 -C, FS 51 -C, FS 82/83 -G, Initiations-Kodon-Mutationen ATG ® ACG/ ® GTG/ ® ATA) und einer neuen Mutation (IVS1-129 A ® G) zusammen. In 6 Fällen konnte nach vollständiger molekularer Analyse kein Gendefekt als Ursache der b -Thalassämie gefunden werden. Diese Probanden könnten b -Thalassämiedeterminanten tragen, die nicht an den b -Globingen-Komplex gekoppelt sind oder regulative Sequenzen außerhalb des b -Globingens darstellen. Die erhobenen Daten zeigen, daß der Ursprung der b -Thalassämie in der deutschen Bevölkerung in den Mittelmeerländern liegt, ein Drittel der Fälle scheint sich jedoch lokal entwickelt zu haben. / The b -thalassemia belongs to the most common monogenic disorders worldwide. Endemically in the Mediterranean population, some parts of Asia and Western Africa, b -thalassemia is a rare disease in Germany. Nevertheless, heterozygous forms of b -thalassemia minor occur more frequently in the German population and should be considered in the differential diagnosis of hypochromic anemia. To investigate the molecular biological background of b -thalassemia in Germany, 214 non-immigrant German individuals suffering from heterozygous b -thalassemia were characterized by allele-specific oligonucleotid hybridization, restriction analysis and sequencing of the b -globin gene. By these techniques, 26 different mutations were identified. Most frequently, the Mediterranean mutations NS 39, IVS1-110 G ® A, and IVS1-1 G ® A were detected. Although otherwise rare, the frameshift mutation of codon 83 (FS 83 -G) was also relatively common (5 %) in the analyzed population. Other previously described mutations (IVS1-1 G ® T, IVS1-2 T ® G, IVS1-2 T ® C, NS 15 G ® A, NS 121 G ® T, FS 8/9 +G, FS 44 -C, FS 51 -C, initiation codon mutation ATG ® ACG/ ® GTG/ ® ATA) were demonstrated in < 10 individuals. Interestingly, sequence analysis identified a novel mutation affecting position -2 of the splice acceptor site (IVS1-129 A ® G). In 6 individuals diagnosed as heterozygous b -thalassemia, a mutation of the b -globin gene could not be demonstrated. The data indicate the b -thalassemia to be introduced from the Mediterranean population into Germans in two-thirds of the cases whereas the remaining third probably is of local origin.

El establecimiento de correlaciones entre fenotipo y genotipo es uno de los principales objetivos de la genética. La obtención de un diagnóstico ajustado facilita el manejo clínico del paciente, así como poder ofrecer un correcto consejo genético, con asesoramiento reproductivo a las familias de pacientes con enfermedades genéticas. La identificación de genes asociados a patología desde alteraciones citogenéticas asociadas a fenotipo es uno de los métodos de clonación posicional. En este trabajo nos hemos basado en dos tipos de modelos de anomalías citogenéticas: balanceadas y no balanceadas (translocaciones y cromosomas marcadores). Hemos caracterizado las alteraciones citogenéticas de cinco pacientes de cada modelo con fenotipos diversos, empleando una combinación de técnicas citogenéticas y moleculares, con el objetivo de proponer genes candidatos asociados a cada fenotipo. / One of the main objectives of Genetics is the establishment of phenotype-genotype correlations. A correct diagnosis facilitates the clinical management of the patient and the possibility to offer a genetic counselling, with reproductive assessment to the families with a patient with a genetic disease. The identification of genes associated to pathology from cytogenetic alterations associated to phenotype is one of the methods of positional cloning. In this work we have based in two different models of cytogenetic alterations: balanced and unbalanced anomalies (translocations and marker chromosomes). We have characterized five patients of each group with different phenotypes, using a combination of cytogenetic and molecular techniques, with the objective of establish candidate genes associated to disease.

The primary focus of this diploma thesis is on marker chromosomes and phenotypically similar human karyotype polymorphisms, variants of short acrocentric arms in particular. The first half provides a very useful review of literature concerning different aspects of both sSMC and human polymorphisms such as their origin, inheritance, associated phenotype, formation and molecular cytogenetic methods that are applied in the process of identification of these aberrations. The methodical emphasis is on FISH and its modifications (e.g. M-FISH, acro M FISH, cen M-FISH) as well as on the CGH methods. The main objective was to test the above-mentioned methods and state their limitations and applications. Thus, in the other half we provide evaluations of commonly used methods and introduce new strategies that could be implemented to make the identification of these additional chromosomes or satellite translocations more effective. All the conclusions are based on the analysis of 7 patients with sSMC and 4 patients with variants involving acrocentric NOR regions. The results of our thorough research into their karyotypes have been compared with similar findings in the literature. Last but not least, we tried to establish a link between observed abnormalities and the type of a chromosomal aberration at hand.

Autosomal recessive polycystic kidney disease (ARPKD) is a rare severe inherited disease manifested by cystic renal disease, congenital hepatic fibrosis and dilatatation of bile ducts. The spectrum of clinical manifestations is very wide and variable, depends on the age at which the disease was manifested. In severe forms of the disease, it is possible to detect the first symptoms prenatally around the 20th week of pregnancy due to increased echogenic kidneys and the presence of oligohydramnios. The causal gene of this disease is thePKHD1 gene with protein product fibrocystin that is most likely contributing on maintaining the intracellular concentration of Ca2+ cations. The exact phatophysiology mechanism of ARPKD remains unknown. Phenotypic manifestations of this disease may overlap with mutations associated with other genes. One of the genes mimicking the ARPKD phenotype is the HNF1B gene. Mutations associated with HNF1B gene are the most common monogenic cause of developmental kidney abnormalities. HNF1B is a tissue-specific transcription factor that regulates the expression of PKHD1. In experimental part I worked on genetic analysis of the HNF1B gene in 28 patients who have not been confirmed ARPKD diagnosis by detection of 2 PKHD1 mutations. For the purposes of mutational screening, I used...