A novel founder variant in BEST1 gene causing autosomal recessive bestrophinopathy

Abstract Background Autosomal recessive bestrophinopathy (ARB) is a rare retinal dystrophy caused by homozygous or compound heterozygous null variants in the BEST1 gene. Clinically, ARB presents with variable features including central visual impairment, global photoreceptor dysfunction (as indicate...

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Main Authors: Nagham Maher Elbagoury, Caroline Atef Tawfik, Asmaa Fawzy Abdel-Aleem, Heba Mahmoud Fathy, Dina Nabil Baddar, Mona Lotfi Essawi
Format: Article
Language:English
Published: BMC 2025-05-01
Series:Orphanet Journal of Rare Diseases
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Online Access:https://doi.org/10.1186/s13023-025-03813-1
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author Nagham Maher Elbagoury
Caroline Atef Tawfik
Asmaa Fawzy Abdel-Aleem
Heba Mahmoud Fathy
Dina Nabil Baddar
Mona Lotfi Essawi
author_facet Nagham Maher Elbagoury
Caroline Atef Tawfik
Asmaa Fawzy Abdel-Aleem
Heba Mahmoud Fathy
Dina Nabil Baddar
Mona Lotfi Essawi
author_sort Nagham Maher Elbagoury
collection DOAJ
description Abstract Background Autosomal recessive bestrophinopathy (ARB) is a rare retinal dystrophy caused by homozygous or compound heterozygous null variants in the BEST1 gene. Clinically, ARB presents with variable features including central visual impairment, global photoreceptor dysfunction (as indicated by abnormal full-field ERG), and a significantly reduced electro-oculogram (EOG) light rise, a hallmark of bestrophinopathy. Fundus examination reveals widespread retinal pigment epithelial (RPE) disturbance, vitelliform deposits in the posterior pole (more clearly visualized with fundus autofluorescence), and macular fluid accumulation. Angle-closure glaucoma, secondary to anterior chamber dysgenesis, is a potential complication. This work aims at documenting the founder effect of a novel variant in the BEST1 gene causing autosomal recessive bestrophinopathy and determining its variable clinical features. Methods Twelve members of nine unrelated, consanguineous Egyptian families with a history of impaired central vision underwent comprehensive ophthalmological examination, fundus color photography, fundus autofluorescence (FAF), spectral-domain optical coherence tomography (SD-OCT) of the macula, and electrophysiological studies. Variant screening of coding exons of the BEST1 gene and some flanking regions was performed using the Sanger sequencing technique. The pathogenicity of the variants was tested using different in silico functional analysis tools. Results The clinical examination and investigations confirmed the ARB phenotype. All twelve patients exhibited (c.365 G > C, p. Arg122Pro) a novel BEST1 gene variant in a homozygous form. On top of the classical retinal phenotype of ARB, some patients had other ocular associations: four patients were found to have angle-closure glaucoma, one patient had associated corneal dystrophy, one developed a macular hole, and one patient developed uveitis. Conclusion The identification of the same, novel homozygous BEST1 missense variant in twelve patients from nine unrelated, consanguineous families of Egyptian origin, suggests a founder effect. Angle-closure glaucoma was the most commonly associated ocular abnormality (30%). Our finding expands the molecular spectrum of ARB-associated variants, and identification of this founder variant can simplify genetic testing in the presence of limited resources and lead to better counseling.
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spelling doaj-art-b0602d6531b544de90db32d4faf62c5f2025-08-20T02:29:27ZengBMCOrphanet Journal of Rare Diseases1750-11722025-05-0120111110.1186/s13023-025-03813-1A novel founder variant in BEST1 gene causing autosomal recessive bestrophinopathyNagham Maher Elbagoury0Caroline Atef Tawfik1Asmaa Fawzy Abdel-Aleem2Heba Mahmoud Fathy3Dina Nabil Baddar4Mona Lotfi Essawi5Department of Medical Molecular Genetics, Human Genetics and Genome Research Institute, National Research CentreDepartment of Ophthalmology, Ain Shams UniversityDepartment of Medical Molecular Genetics, Human Genetics and Genome Research Institute, National Research CentreDepartment of Medical Molecular Genetics, Human Genetics and Genome Research Institute, National Research CentreWatany Eye HospitalDepartment of Medical Molecular Genetics, Human Genetics and Genome Research Institute, National Research CentreAbstract Background Autosomal recessive bestrophinopathy (ARB) is a rare retinal dystrophy caused by homozygous or compound heterozygous null variants in the BEST1 gene. Clinically, ARB presents with variable features including central visual impairment, global photoreceptor dysfunction (as indicated by abnormal full-field ERG), and a significantly reduced electro-oculogram (EOG) light rise, a hallmark of bestrophinopathy. Fundus examination reveals widespread retinal pigment epithelial (RPE) disturbance, vitelliform deposits in the posterior pole (more clearly visualized with fundus autofluorescence), and macular fluid accumulation. Angle-closure glaucoma, secondary to anterior chamber dysgenesis, is a potential complication. This work aims at documenting the founder effect of a novel variant in the BEST1 gene causing autosomal recessive bestrophinopathy and determining its variable clinical features. Methods Twelve members of nine unrelated, consanguineous Egyptian families with a history of impaired central vision underwent comprehensive ophthalmological examination, fundus color photography, fundus autofluorescence (FAF), spectral-domain optical coherence tomography (SD-OCT) of the macula, and electrophysiological studies. Variant screening of coding exons of the BEST1 gene and some flanking regions was performed using the Sanger sequencing technique. The pathogenicity of the variants was tested using different in silico functional analysis tools. Results The clinical examination and investigations confirmed the ARB phenotype. All twelve patients exhibited (c.365 G > C, p. Arg122Pro) a novel BEST1 gene variant in a homozygous form. On top of the classical retinal phenotype of ARB, some patients had other ocular associations: four patients were found to have angle-closure glaucoma, one patient had associated corneal dystrophy, one developed a macular hole, and one patient developed uveitis. Conclusion The identification of the same, novel homozygous BEST1 missense variant in twelve patients from nine unrelated, consanguineous families of Egyptian origin, suggests a founder effect. Angle-closure glaucoma was the most commonly associated ocular abnormality (30%). Our finding expands the molecular spectrum of ARB-associated variants, and identification of this founder variant can simplify genetic testing in the presence of limited resources and lead to better counseling.https://doi.org/10.1186/s13023-025-03813-1AfricaAutosomal recessive bestrophinopathyBEST1 geneEgyptFounder effectMissense variant
spellingShingle Nagham Maher Elbagoury
Caroline Atef Tawfik
Asmaa Fawzy Abdel-Aleem
Heba Mahmoud Fathy
Dina Nabil Baddar
Mona Lotfi Essawi
A novel founder variant in BEST1 gene causing autosomal recessive bestrophinopathy
Orphanet Journal of Rare Diseases
Africa
Autosomal recessive bestrophinopathy
BEST1 gene
Egypt
Founder effect
Missense variant
title A novel founder variant in BEST1 gene causing autosomal recessive bestrophinopathy
title_full A novel founder variant in BEST1 gene causing autosomal recessive bestrophinopathy
title_fullStr A novel founder variant in BEST1 gene causing autosomal recessive bestrophinopathy
title_full_unstemmed A novel founder variant in BEST1 gene causing autosomal recessive bestrophinopathy
title_short A novel founder variant in BEST1 gene causing autosomal recessive bestrophinopathy
title_sort novel founder variant in best1 gene causing autosomal recessive bestrophinopathy
topic Africa
Autosomal recessive bestrophinopathy
BEST1 gene
Egypt
Founder effect
Missense variant
url https://doi.org/10.1186/s13023-025-03813-1
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