- Burkard, Markus;
- Kohl, Susanne;
- Krätzig, Timm;
- Tanimoto, Naoyuki;
- Brennenstuhl, Christina;
- Bausch, Anne E;
- Junger, Katrin;
- Reuter, Peggy;
- Sothilingam, Vithiyanjali;
- Beck, Susanne C;
- Huber, Gesine;
- Ding, Xi-Qin;
- Mayer, Anja K;
- Baumann, Britta;
- Weisschuh, Nicole;
- Zobor, Ditta;
- Hahn, Gesa-Astrid;
- Kellner, Ulrich;
- Venturelli, Sascha;
- Becirovic, Elvir;
- Issa, Peter Charbel;
- Koenekoop, Robert K;
- Rudolph, Günther;
- Heckenlively, John;
- Sieving, Paul;
- Weleber, Richard G;
- Hamel, Christian;
- Zong, Xiangang;
- Biel, Martin;
- Lukowski, Robert;
- Seeliger, Matthias W;
- Michalakis, Stylianos;
- Wissinger, Bernd;
- Ruth, Peter
Mutations in CNGA3 and CNGB3, the genes encoding the subunits of the tetrameric cone photoreceptor cyclic nucleotide-gated ion channel, cause achromatopsia, a congenital retinal disorder characterized by loss of cone function. However, a small number of patients carrying the CNGB3/c.1208G>A;p.R403Q mutation present with a variable retinal phenotype ranging from complete and incomplete achromatopsia to moderate cone dysfunction or progressive cone dystrophy. By exploring a large patient cohort and published cases, we identified 16 unrelated individuals who were homozygous or (compound-)heterozygous for the CNGB3/c.1208G>A;p.R403Q mutation. In-depth genetic and clinical analysis revealed a co-occurrence of a mutant CNGA3 allele in a high proportion of these patients (10 of 16), likely contributing to the disease phenotype. To verify these findings, we generated a Cngb3R403Q/R403Q mouse model, which was crossbred with Cnga3-deficient (Cnga3-/-) mice to obtain triallelic Cnga3+/- Cngb3R403Q/R403Q mutants. As in human subjects, there was a striking genotype-phenotype correlation, since the presence of 1 Cnga3-null allele exacerbated the cone dystrophy phenotype in Cngb3R403Q/R403Q mice. These findings strongly suggest a digenic and triallelic inheritance pattern in a subset of patients with achromatopsia/severe cone dystrophy linked to the CNGB3/p.R403Q mutation, with important implications for diagnosis, prognosis, and genetic counseling.