- Lee, Eun-Jin;
- Chiang, Wei-Chieh Jerry;
- Kroeger, Heike;
- Bi, Chloe Xiaoke;
- Chao, Daniel L;
- Skowronska-Krawczyk, Dorota;
- Mastey, Rebecca R;
- Tsang, Stephen H;
- Chea, Leon;
- Kim, Kyle;
- Lambert, Scott R;
- Grandjean, Julia MD;
- Baumann, Britta;
- Audo, Isabelle;
- Kohl, Susanne;
- Moore, Anthony T;
- Wiseman, R Luke;
- Carroll, Joseph;
- Lin, Jonathan H
Achromatopsia (ACHM) is an autosomal recessive disease that results in severe visual loss. Symptoms of ACHM include impaired visual acuity, nystagmus, and photoaversion starting from infancy; furthermore, ACHM is associated with bilateral foveal hypoplasia and absent or severely reduced cone photoreceptor function on electroretinography. Here, we performed genetic sequencing in 3 patients from 2 families with ACHM, identifying and functionally characterizing 2 mutations in the activating transcription factor 6 (ATF6) gene. We identified a homozygous deletion covering exons 8-14 of the ATF6 gene from 2 siblings from the same family. In another patient from a different family, we identified a heterozygous deletion covering exons 2 and 3 of the ATF6 gene found in trans with a previously identified ATF6 c.970C>T (p.Arg324Cys) ACHM disease allele. Recombinant ATF6 proteins bearing these exon deletions showed markedly impaired transcriptional activity by qPCR and RNA-Seq analysis compared with WT-ATF6. Finally, RNAscope revealed that ATF6 and the related ATF6B transcripts were expressed in cones as well as in all retinal layers in normal human retina. Overall, our data identify loss-of-function ATF6 disease alleles that cause human foveal disease.