Identification of a novel large multigene deletion and a frameshift indel in as the underlying cause of early-onset recessive rod-cone degeneration.

A family, with two affected identical twins with early-onset recessive inherited retinal degeneration, was analyzed to determine the underlying genetic cause of pathology. Exome sequencing revealed a rare and previously reported causative variant (c.1923_1969delinsTCTGGG; p.Asn643Glyfs*29) in the gene in the affected twins and their unaffected father. Further investigation, using genome sequencing, identified a novel ∼7.5-kb deletion (Chr 4:670,405-677,862del) encompassing the gene, part of the 5' UTR of , and a 378-bp (Chr 4:670,405-670,782) region from the 3' UTR of in the affected twins and their unaffected mother. Both variants segregated with disease in the family. Analysis of the relative expression of , in peripheral blood cells, also revealed a significantly lower level of transcript in affected siblings compared to a normal control. is associated with recessive rod-cone degeneration and autosomal dominant congenital stationary night blindness. Ophthalmic evaluation of these patients showed night blindness, fundus abnormalities, and peripheral vision loss, which are consistent with -associated recessive retinal degeneration. These findings suggest that the loss of transcript resulting from the compound heterozygous pathogenic variants is the underlying cause of recessive rod-cone degeneration in the study family.