Who cleans up ‘the mess’ from the cones?

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New research on the cause of blindness due to Usher syndrome

A research team led by Dr. Ronald Roepman (www.roepmanlab.com) is conducting research at Radboudumc, Netherlands, to investigate the underlying cause of vision loss in Usher syndrome. In this study, titled “Harnessing Autophagy to Combat Macular Degeneration,” they aim to gain more clarity on the death of cone cells in the retina. In a healthy eye, waste products in the retina are “cleaned up,” but in retinal diseases like Usher syndrome, this process is insufficient. The cones ultimately die because waste accumulates in harmful quantities within these cells. Thanks to the efforts of the participants in ‘Nederland wandelt voor Usher’ (Event Walks for Usher), Stichting Ushersyndroom (the Dutch Usher Syndrome Foundation) can finance a significant portion of this important research.

Crucial discovery
Hereditary blindness is a profound condition that seriously affects the lives of many patients. Researchers have been searching for effective treatments for some time, but the question of why waste products in the retina are not cleared in hereditary retinal diseases has remained unknown until now. Dr. Ronald Roepman, who collaborates in this promising project with Dr. Erik de Vrieze and Dr. Erwin van Wyk, recently made a crucial discovery that may provide an answer to this question. This could be a significant step toward a solution. Dr. Ronald Roepman says, “If you understand why the cones don’t clean up the waste, then you might be able to help them clean it up, perhaps with medication.”

Autophagy
The research focuses on understanding the mechanism of ‘autophagy’ in cone cells. Autophagy is a biological process in which certain components of a cell, such as damaged proteins or foreign particles, are broken down. Recent research data suggest that dysregulation of this process is a significant cause of cone cell death, leading to progressive vision loss in hereditary retinal disorders.

Death due to self-waste
An Usher gene contains instructions for producing a protein that keeps the light-sensitive cells in the retina – the rods and cones – healthy. Errors in this gene can lead to the protein’s malfunction and disrupt the processes. Cones produce substantial amounts of waste products, which are normally cleared through the autophagy process. If the Usher proteins are absent or not functioning properly, the cones cannot dispose of their waste products and essentially drown in their own ‘mess.’ The researchers aim to determine how the genetic defect is responsible for the malfunctioning autophagy.

Zebrafish and retinal organoids
The research team uses zebrafish as a model organism in the laboratory due to the striking similarities between their eyes and those of humans. They will compare healthy cone cells with cone cells displaying disrupted autophagy using zebrafish. Additionally, the research team will use retinal organoids, small retinas grown in the laboratory using cells from both Usher syndrome patients and people with healthy eyes. These organoids provide a valuable platform to study the autophagy mechanism in healthy and diseased cells.

Hope for finding a safe and effective treatment
Once the autophagy mechanism is understood, the research team will search for substances that can stimulate the autophagy process, thereby reducing or preventing cone cell death. With the help of a database containing thousands of substances known to stimulate or inhibit proteins, they hope to find a safe and effective treatment.

Also, for other hereditary retinal diseases
This promising research will not only contribute to detailed knowledge about autophagy and cone cell death but also offer possibilities for further treatment development. If the results of this research prove successful, this project could slow down vision deterioration and have a significant impact on the quality of life for Usher syndrome patients. Dr. Roepman says, “It could offer a solution not only for Usher syndrome but also for patients with Retinitis Pigmentosa (RP), Macular Degeneration (MD), and all other forms of hereditary retinal diseases.”

The current project has a duration of three years. Stichting Ushersyndroom plays a significant role in the research by financing a large portion of the required budget. We are not the sole financiers of this research. Thanks to the L.S.B.S. (National Foundation for the Blind and Visually Impaired) and the donors of the Oogfonds (Dutch Eye Foundation), they are co-funders for this project, providing a valuable financial contribution to make this promising research possible.

The voucher was presented during the festive day at the Railway Museum in Utrecht on Global Usher Awareness Day 2023.

You can support us through a donation. With your contribution, the Stichting Ushersyndroom can finance scientific research. Research aimed at finding a treatment for Usher syndrome, so that becoming deaf and blind can be halted!

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Every donation is valuable and brings us closer to solutions for Usher syndrome.

Restart clinical trial RNA therapy for USH2a in sight

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ProQR has announced an agreement with Laboratoires Théa to acquire Ultevursen  programs.

In August 2022 ProQR decided to focus exclusively on the development of the Axiomer® RNA editing technology platform. ProQR Therapeutics was forced to stop promising clinical trials unless they found a new strategic partner to continue.
Read about this: https://ushersyndroom.nl/klinische-trials-celeste-en-serius-worden-noodgedwongen-stopgezet/

The new partner
Laboratoires Théa (Théa) has signed an agreement with ProQR to continue the further development of the IRD Sepofurses and Ulteverses programs. Théa is European pharmaceutical company specialized in the research, development, and commercialization of eye care products. This family-owned is based in Clermont-Ferrand, France.

Within Théa, a fully dedicated team specializing in inherited retinal disorders and a new organization are currently being set up to manage these projects. More information on the next steps for these programs will be available in the coming weeks from Théa.

About Ultevursen
Ultevursen (formerly QR-421a) is a first-in-class investigational RNA therapy designed to address the underlying cause of vision loss in Usher syndrome type 2a and non-syndromic retinitis pigmentosa due to mutations in exon 13 of the USH2A gene. QR-421a is designed to restore functional usherin protein by using an exon skipping approach with the aim to stop or reverse vision loss in patients. Ultevursen is intended to be administered through intravitreal injections in the eye and has been granted orphan drug designation in the US and the European Union and received fast-track and rare pediatric disease designations from the FDA.

The transaction is expected to close in the third quarter of 2023.

For further information or enquiries about the announcement today, please email: patientinfo@proqr.com.

The press release from ProQR can be found via this link.

Read more about RNA therapy on our Knowledge Portal:
https://ushersyndroom.nl/en/knowledge-portal/research/rna-therapy/

The very first adgrv1-zebrafish model has been presented!

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Recently, an article was published in the journal Cells about the scientific research on USH2C. Merel Stemerdink and her colleagues at the Radboudumc have developed a zebrafish model with a gene defect in adgrv1 (the gene associated with USH2C). This is the very first animal model for ADGRV1-associated retinal dysfunction, and therefore a crucial step to enable further research on therapy development for ADGRV1-related RP.

Merel Stemerdink (right) has developed the mini gene products and shows them to Ivonne Bressers (Stichting Ushersyndroom). Ivonne (left) looks at the PCR strip in her hand.

Using these fish as an animal model, Merel will also start testing the effectiveness of the ADGRV1-minigene therapy in the coming year.

The official title of the paper is ‘Generation and Characterization of a Zebrafish Model for ADGRV1-Associated Retinal Dysfunction Using CRISPR/Cas9 Genome Editing Technology’ and it has been published in a Special Issue of Cells titled ‘CRISPR-Based Genome Editing in Translational Research’.

 

READ PAPER

Read also:
How are things going with the ‘minigenes USH2c’ study?

Development of gene therapy for large USH2C gene

Two sides to the story

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When your world turns dark

Joyce de Ruiter was sixteen years old when her parents had to tell her that she’d been diagnosed with Usher syndrome: an inherited dis- order which deteriorates hearing and especially vision during life, often resulting in people becoming deaf and blind. “Finally, the puzzle pieces of hearing loss and night blindness had been named, but at the same time your whole future outlook wavers.” Joyce tells us about the impact this diagnosis had on her life and how it gradually turned into something she now draws strength and courage from.

Joyce and her brother were hearing impaired from birth and started to experience initial symptoms of night blindness around puberty, which was strange, as it didn’t run in the family. A diagnosis was lacking until her then 18-year-old brother’s vision deteriorated even further and an ophthalmologist diagnosed Usher syndrome. Joyce was diagnosed with the same disorder when she was just sixteen years old, radically changing her life and future plans. “I wanted to study, work, get married, and have a family. Would that still be possible? When I discovered the study Visual Marketing the fire started burning again, even though the name of the study didn’t sound very useful when you have a visual handicap. But I always kept making choices that made me happy and I’m convinced this enables me to do the things I want to do – despite all the limitations.”

Rushing life no longer
Joyce has worked in HR, Communications, and Events. “I crossed my own limits for too long, because I felt like I had to cram a whole life into half. After my third burnout at age 30, I was declared incapacitated, also because my vision kept deteriorating. It was another one of those moments: what can I still do, what do I want? My eyes and ears didn’t work so well anymore, but there was nothing wrong with my brain.”

INVESTING IN A POSSIBLE TREATMENT IS CHEAPER THAN LIVING WITH THE LIMITATIONS

She decides to tell her personal story in the newspaper, on radio, and on TV as an ambassador for the Dutch Usher Syndrome Foundation, in order to underline the importance of scientific research and development of treatments. This is how the speaking profession came on her path and she has been working hard on her business for 6 years, with success: “As an independent entrepreneur, I now speak at conferences and events about change and agility. Usher constantly confronts you with problems and changes that you have to learn to deal with. I link my personal story to insights in psychology about how to develop an agile mindset. With that, I try to be of value to other people. I think that is the most meaningful thing you can do in a human life.”

Tunnel vision, literally
Joyce is now 38. Her hearing loss is 70 decibels, but with advanced hearing aids she can still function reasonably well. Her vision is greatly reduced, though. “Last year I still had 18 degrees of vision, which is less than a toilet roll I can see through. My orientation on the street is becoming more and more difficult, I haven’t been able to ride a bicycle for years and I feel unsafe in crowded environments; all because of my reduced vision. This is why scientific research is so important. Investing in a possible treatment is ultimately cheaper than living with the limitations. It would be fantastic if a treatment can be found that stops the deterioration and that children do not have to experience any hearingor sight restrictions at all. Of course, we hope that all patients with Ushers syndrome will recover.

That is why the volunteers of the Usher Syndrome Foundation are putting their heart and soul into continuing to make research into a treatment such as that at the Radboud university medical center possible.”

 

 

Bringing light to the dark

From discovering the gene to, hopefully, developing a therapy which will give patients a positive outlook. Erwin Van Wijk has been involved with Usher syndrome research from start to finish, which is quite unique in this field of work as it shows how rapidly developments are following up on each other. “In the most severe form of Usher, children are born deaf and slowly start to lose their vision before puberty. We developed a genetic patch that may be able to limit the damage to vision, our data and the results of the trials look positive.”

 “The hearing problems in Usher are not easy to treat because the underlying cause already arose during development in utero”, says Erwin. “With my research group, I have focused mainly on the visual problems. These arise during life, so there are more opportunities to do something about them at an early stage. The goal of the research was therefore to slow down or even prevent the deterioration of vision. First of all, we need to know which and how genetic defects lead to problems. Mutations in the USH2A gene are the most common, so we took that gene as the primary starting point for developing a therapy.”

Restoring the function of light-sensitive cells
Usher syndrome arises from a genetic mutation which causes the loss or malfunctioning of the corresponding protein usherin. Slowly but surely, the light-sensitive cells in the eye progressively die as a result, and people become vision impaired or at a later stage even completely blind.

The question is: How can this disease process be stopped? Erwin: “Replacing the mutated gene was technically almost impossible because the USH2A gene is extremely large. Instead, we taped the region of the gene with the mutation with a genetic patch. As a result, a slightly shorter protein is produced, lacking the mutation. When carefully selecting the region to skip, the resulting ‘shortened protein’ could work almost as well as the original protein. In principle, this would then solve the problem. In cells we saw that the genetic patch indeed masked the region of the hereditary error. Next, we had to demonstrate that the shortened protein is also functional in the eye.”

Zebrafish as part of the solution
Erwin stumbled upon an unexpected animal to establish whether the genetic patch could preserve visual function. “Zebrafish happen to have an USH2A gene and protein that’s very similar to those of humans. If a mutation is introduced into this gene, the visual function of the zebrafish is also significantly reduced. They are an excellent model for studying USH2A-related visual dysfunction and for determining the effect of a therapeutic intervention. Indeed, visual function of USH2A mutant zebrafish treated with the genetic patch was highly improved.”

INITIAL RESULTS FROM A CLINICAL STUDY IN PATIENTS ARE HIGHLY PROMISING

 After this, the first careful steps towards the translation of the results into a use in humans could be taken. First tests in Usher patients with a mutation in the specific region of the USH2A gene showed promising outcomes, resulting in the design of a large multicenter follow-up study in which the results of the initial clinical trial will hopefully be corroborated in a large cohort of patients. If results hold up, a request for market introduction can be submitted to the American FDA and the European EMA.”

Source: PULSE Magazine #1 2022

Sleep problems Usher patient appears to be a hallmark feature of the disease

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Vision impairment is not the driver of fatigue and sleep problems

It was always thought that fatigue and sleep problems in patients with Usher syndrome are the result of increased efforts to compensate for their dual sensory impairment: limited vision combined with hearing loss. Researchers from Radboudumc show in Ophthalmology Science that this idea is incomplete. Besides severe problems with hearing and vision, sleep problems also seem to be a hallmark feature of the disease.

Patients with Usher syndrome experience major problems with vision and hearing. They are born profound deaf or hearing impaired and around puberty they also start to slowly lose their eyesight. These are the central features of the disease. The large individual differences in disease severity and progression are closely related to the underlying genetic defect and the type of Usher syndrome. “Besides hearing and vision loss, patients occasionally also encounter some other problems, like balance deficits, but these have been recognized as part of the disease,” says researcher Erwin van Wijk. “In addition, sleep problems and excessive fatigue are also regularly reported in the consulting room. The fatigue has always been regarded as a result of the dual sensory impairment that patients have to deal with. It’s generally assumed that the sleep problems often reported by patients are the result of their impaired light perception. After all, individuals with poor light perception gradually lose visual day and night rhythms, having a significant impact on their sleep quality.”

Poor sleep
Researchers at Radboudumc are in close contact with patients, mainly via the Dutch Ushersyndrome Foundation. “At one point we noticed that very many patients complained about sleep problems and fatigue”, says Van Wijk. “That intrigued us. Was perhaps something else going on than we always anticipated? Under supervision of Erik de Vrieze, Juriaan Metz, Rob Collin and myself, PhD student Jessie Hendricks started a survey to further investigate this. Fifty-six Usher syndrome type 2A (USH2A) patients and 120 healthy controls were subjected to a set of five validated questionnaires to assess sleep quality, sleep disorders, fatigue, daytime sleepiness and chronotype.” The results indicated that USH2A patients indeed experienced a strongly reduced sleep quality and that they were more often sleepy and tired during the day as compared to controls. But most strikingly, their sleep problems were not related to the severity of their visual impairment. Van Wijk: “These findings perfectly matched the reports of several parents of young USH2A patients, but that were never given a proper follow-up.”

Hallmark feature of Usher syndrome
At a first glance, it may seem only a gradual difference, but the finding is much more significant. Van Wijk: “Actually, it means that the ubiquitously reported sleep problems by USH2A patients are not primarily due to impaired light perception, but that these problems already exist in patients who still have a near normal eyesight. Sleep problems should therefore probably be considered as an additional hallmark feature of Usher syndrome, and not as a consequence of poor or deteriorating eyesight.” Of course, this conclusion based on questionnaires, needs further substantiation. This can be done, for example, through research in an existing zebrafish model for Usher syndrome. Zebrafish also have a distinct sleep pattern. Is it also disturbed? And is there evidence in the brain that Usher syndrome-associated proteins are somehow involved in regulating sleep? These research questions are currently being followed-up.

Improvement in quality of life
Van Wijk points out another aspect of the research. If sleep problems indeed turn out to be part of the disease, there might be a possibility to treat these problems. “Currently, sleep problems are not included in the daily care for Usher syndrome patients, because it is not yet being recognized as a hallmark feature of the disorder. As a result, the visit to a sleep clinic is often not reimbursed by health insurance companies. This hopefully changes based on the study published in Ophthalmology Science and the follow-up studies that are currently being conducted. Treatment of sleep problems will be a major step forward in improving the quality of life of Usher syndrome patients.”

——————————–

Paper in Ophthalmology Science: Evaluation of sleep quality and fatigue in patients with Usher syndrome type 2a – Jessie M. Hendricks, MSc, Juriaan R. Metz, Hedwig M. Velde, Jack Weeda, Franca Hartgers, Suzanne Yzer, Carel B. Hoyng, Ronald J.E. Pennings, Rob W.J. Collin, H. Myrthe Boss, Erik de Vrieze, Erwin van Wijk

Does this mutation cause blindness? It does, doesn’t, does!

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Janine Reurink ends long lasted controversy with major implications for healthcare


Initially there was no doubt a specific mutation in the USH2A gene caused the eye disease retinitis pigmentosa. Spanish research undermined that clarity and left patients in limbo. Until new research by PhD candidate Janine Reurink made it abundantly clear that the cause is indeed to be found in that USH2A gene. A textbook example of science in action.

We know of ten different genes that can cause Usher syndrome if they contain a mutation. Mutations in these genes eventually lead to deafness and blindness in patients with Usher syndrome. Mutations in Usher genes sometimes ‘generate’ other disorders as well. For example, a specific mutation in the Usher2A gene (USH2A) causes the eye disease retinitis pigmentosa (RP) when inherited from both father and mother. This mutation causes one spot in the USH2A protein to change the amino acid cysteine to phenylalanine, another amino acid. All this was genetically and clinically fine-tuned at the end of the last century. If you had such a specific double mutation in the USH2A gene, you didn’t have Usher syndrome but RP and the clinical problems were limited to blindness.

Smoldering controversy
Then suddenly a publication appeared about a Spanish family with RP. It wrote that researchers had found two individuals with exactly those specific USH2A mutations. But without any vision problem, which after all is an essential characteristic of RP! Erwin van Wijk, who has been researching Usher syndrome at the Radboudumc for over more than ten years: “That caused rather a lot of commotion among researchers and patients, because it meant this specific mutation could not be the cause of RP! Everyone who had previously received this diagnosis had apparently been misdiagnosed. So the real cause had to be found somewhere else in the genes.”
The publication causes many clinical genetics centers around the world to stop diagnosing RP on the basis of this USH2A mutation and all these patients should actually be re-screened. This also applies to Nijmegen. In the meantime, doubts continued. Was the screening in this Spanish family complete and reliable enough? – the results were never confirmed in any other study. Requests from different research groups to check the DNA of those families were not granted. Thus, a smoldering controversy about the value of the Spanish research ensued..

No alternatives mutations found
In recent years, Van Wijk and colleagues developed a promising therapy for a number of mutations in Usher genes. This therapy is based on a technique in which a piece of the RNA is ‘taped off’ (exon skipping). This prevents the mutation from being read and creates a protein that once again functions properly. These therapeutic ‘genetic patches’ can also be used for the specific USH2A mutation, but based on the Spanish family research the causal link with the eye disease is being questioned. As long as it’s unclear whether or not this mutation causes RP, no health insurance company will ever reimburse such a therapy. So a conclusive answer is needed. That proof was exactly what Janine Reurink set out to provide as part of her doctoral research.
Reurink: “First of all, we looked at several patients with the USH2A mutation to see if another explanation could be found for the disorder. To do this, we mapped their entire genome and examined it on all sides. The result? We did not find any alternative genetic explanation. Based on our research, the USH2A mutation remains the only possible explanation.”

Crystal clear evidence
In Nijmegen, much Usher research is done in zebrafish. This time it was also used for additional research, looking for as much evidence as possible. Reurink: “With the CRISPR/Cas9 system, a molecular scissors with which pieces of DNA can be very precisely cut away and replaced, we made a zebrafish with exactly the same mutation as in humans. Analysis of retinal cells in the eye of these fish showed that the corresponding proteins are then no longer or hardly produced. Normal production is really very thoroughly disturbed by the mutation. What’s more: as a result, other essential proteins for vision no longer end up in the right places. We also made an ERG, a kind of brain film for the eye. It demonstrated with crystal clarity that vision is really affected in zebrafish with this mutation. In short, extensive genetic bio-molecular and functional research clearly shows that the USH2A mutation is indeed the underlying cause of this form of retinitis pigmentosa. In terms of a detective novel, we now really have tracked down the culprit.”

Impact on healthcare
The research by Reurink and colleagues has been published in NPJ Genomic Medicine. For people with RP with a USH2A mutation, it’s clear now that this is the real causative, pathogenic mutation. Further search for a (non-existent) cause is no longer necessary. Meanwhile, the clinical genetics laboratories at Radboudumc have adjusted their diagnostics accordingly. Something that many more laboratories worldwide are likely to do in the near future. Moreover, patients are now eligible for therapy as soon one is available. A nice example of PhD research with impact on healthcare.

Radboudumc
Promotion Janine Reurink – USH2A-associated disease. Genetics, pathogenesis and treatment
Thursday April 6, 2023 at 12.30 pm

Two groundbreaking projects awarded

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‘Moon Rocket Grant’ awarded to two groundbreaking projects

At this moment, there is no treatment yet for Usher Syndrome, a disorder that globally 400.000 people suffer from. In order to find a treatment that can stop, slow down or even reverse the process of becoming both deaf and blind, more knowledge and research into Usher Syndrome are needed.

Therefore Stichting Ushersyndroom (The Dutch Usher Syndrome Foundation) presents the ‘Moon Rocket Grant’: € 200.000, – for research into Usher Syndrome with a maximum of € 100.000, – for each study.

The Moon Rocket Grant
Stichting Ushersyndroom has launched the Moon Rocket Grant: a large pot of money for pioneering research into (a treatment for) Usher Syndrome. The objective of the Moon Rocket Grant from the Stichting Ushersyndroom is to effectuate a moonshot formulated by us: ‘A treatment for Usher Syndrome in 2025!’ This moonshot includes all types and subtypes of Usher Syndrome.

The study proposals must fit in with one of the four core values of the ‘Moon Rocket Grant’: Treatment, Knowledge, Diagnostics and Impact.
Every study (fundamental, translational or clinical) must lead to a treatment option, more knowledge and understanding, better diagnostics and an increase of the impact for every type of Usher Syndrome.

The Medical Advisory Council extensively tested and assessed all submitted study proposals. After this first assessment there was a second round: an on-line presentation with a short interview, after which the final selection for the award was made.

The Moon Rocket Grant goes to …..

Stichting Ushersyndroom announces with pleasure that two projects are eligible for the Moon-Rocket Grant 2022.

Prof Mariya Moosajee (UCL Institute of Ophthalmology, London, UK), will receive € 100.000, – for the project:

Prof Mariya Moosajee

“Large Gene Augmentation with non-viral episomal vectors for Usher syndrome”

Use of non-viral plasmid vectors for Usher Syndrome
It is well-known that the AAV (adeno-viral virus) vector is used for gene therapy, but this vector has a limit to the size of the gene. Most Usher genes are way too large for being packed into an AAV vector. When applying gene therapy to the retina of patients using the AAV vector, sometimes thinning of the retina (also called atrophy) can develop. Therefore alternative ‘packaging’ vectors are to be found for future gene therapies for Usher Syndrome.

Prof Mariya Moosajee has in cooperation with Dr Richard Harbottle (DKFZ German Cancer Research Centre, Heidelberg) developed a DNA plasmid (USH2A-S/MAR-vector) which can hold the full-length USH2A-DNA.
The DNA plasmid has been tested in a zebrafish model as well as in patient cells taken from a skin biopsy.

Prof Mariya Moosajee will use the ‘Moon-Rocket Grant’ to test the system of DNA plasmid in an already existing rabbit model for USH2A.
If the application of this alternative gene replacement strategy turns out to be successful, this will have a great impact for all inherited retinal diseases. After this study, it may be possible to start a phase 1 clinical trial for patients and it also may offer solutions for other large Usher genes. Gene therapy making use of DNA plasmid may have additional advantages; application (several times) with a limited immune response. Prof Mariya Moosajee hopes this approach will be safer and can avoid some of the complications that are seen in the current viral gene therapy. This project will at least take 2 years and has been budgeted at over € 200.000. Moorfields Eye Charity and Cure Usher will also be contributing to this project. With the contribution of the ‘Moon Rocket Grant’ from the Stichting Ushersyndroom the budget has been covered and the study can start.

The second project to be financed by the Moon Rocket Grant is the study of Monte Westerfield (Neuroscience, university of Oregon) and Erwin van Wijk (Radboud University Medical Center, Nijmegen, the Netherlands) entitled:

Prof. Monte Westerfield and Dr. Jennifer Phillips

“Exon-skipping as a future treatment for USH1F associated retinal disease” 

In this collaborative study Monte Westerfield of the University of Oregon and Erwin van Wijk of the Radboud UMC will develop and evaluate a treatment for Usher syndrome type 1F-related retinal disease based on the exon skipping methodology.

About 20.000 people worldwide lose their eyesight as a consequence of PCDH15 mutations. This condition is named USH1F.
The PCDH15 gene codes for the protocadherin 15 protein (PCDH15 protein) and is essential for normal eyesight and hearing. The PCDH15 protein contains multiple predicted extracellular cadherin (EC) domains. Many USH1F patients have mutations in the region encoding the EC domains number 6 (EC6) and 7 (EC7), resulting in a non-functional or even absent PCDH15 protein.

The ultimate goal of the researchers is to develop a treatment that halts the progression of PCDH15-associated visual dysfunction. For this, they will adopt the principle of “exon skipping” and develop a “genetic patch” that will instruct the light-sensitive cells inside the eye to skip the region of the PCDH15 gene that codes for the EC6 and EC7 domains. In this way a somewhat shorter but hopefully still functional PCDH15 protein is produced, specifically lacking the EC6 and EC7 domains.

A pilot study exploring the therapeutic potential of “exon skipping” for USH1F was conducted some years ago. In this study the researchers targeted another domain in the protein, but this did not result in a restored function of the PCDH15 protein. With the knowledge gained in the past few years the researchers can now better predict whether or not the remaining protein after exon skipping will be functional. Based on these improved prediction tools they now opt for “skipping” the region encoding EC domains 6 and 7.
In previous studies of both Monte Westerfield and Erwin van Wijk it was shown that zebrafish are suitable animal models for this study. To obtain functional proof for the proposed concept of skipping the EC6-EC7 encoding region of PCDH15, the researchers aim to remove this part of the PCDH15 gene from the zebrafish genome and analyze whether these ‘treated’ zebrafish will have a better eyesight than the untreated mutant zebrafish with USH1F mutations.

This research project was budgeted at € 100.000, – for a period of 24 months.

The objective of Stichting Ushersyndroom is to finance scientific research that is to lead to a treatment that will show down, stop of even reverse the deterioration of hearing and eyesight. Apart from this, the foundation also (financially) supports the improvement of the quality of life, the growth of knowledge and information about Usher Syndrome and to enhance the contact between fellow-sufferers.

DONATE HERE

You can also donate directly to Stichting Ushersyndroom by using the QR code.

 

 

 

Study into the best approach of USH1B

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Stichting Ushersyndroom (Dutch Usher Syndrome Foundation) announces with pride its financing of a study that will test the best approach for USH1B (gene) therapy by making use of, among others, patient-specific cell models and a large animal model. This may take a (gene) therapy for USH1B to the pre-clinical phase. Dr. Kerstin Nagel-Wolfrum, who works at the Johannes Gutenberg University in Mainz, will lead this project.

Children suffering from Usher Syndrome type 1 (USH1) are born deaf and with a non-functioning organ of balance (the vestibular system). The first signs of loss of eyesight, such as night-blindness and a decreasing field of vision, will present themselves later in the childhood period. USH1 is most often caused by mutations in the MYO7A gene (USH1B). About 14% of all people suffering from Usher Syndrome has type 1B. The MYO7A gene is a very large gene and the Myosin protein is also called a motor protein. Is has a ‘head and a tail’ and therefore it must be replaced or processed as a whole when developing a gene therapy.

New approaches
The large size of the MYO7A gene makes classical gene therapy using an AAV vector impossible. However, new approaches, including double and triple AAV vectors, mini-genes, prime editing, translational read-through and exon skipping, are promising new alternative therapeutic strategies. Please go to the Knowledge portal for further reading.

From skin biopsy to mini-retina
With the help of a skin biopsy from a USH1B patient (fibroblast), Dr Nagel-Wolfrum can further develop these molecular cells into a retinal pigment ephithelium (RPE) and a retinal organoid (RO). The retinal pigment epithelium is found between the retina and the choroid and it clears away the waste products of the rods and cones in the retina. The retinal organoids are also called the mini-retinas.

The possibility to model retinal disorders by means of fibroblasts into mini-retinas created unprecedented opportunities in the research area.

Dr. Kerstin-Nagel-Wolfrum

Gain insights and test therapies
By making use of the ‘mini-retinas’, Dr Kerstin Nagel-Wolfrum will gain more insight into the mechanism that damages the retina and causes loss of eyesight. Apart from this, she wants to subject these retinal organoids (mini-retinas) to various therapies in order to test them for their effectiveness and functionality. Dr Nagel-Wolfrum will also test the mini-genes by conducting an AAV vector-based gene therapy.

On to the pre-clinical phase
A large animal model, a USH1B pig, has already been developed and is ready for testing possible therapies. Dr Nagel-Wolfrum will apply the therapy that the pre-study with the retinal organoids (mini-retinas) has shown to be the most effective one when doing research on the pig model. This study is called the pre-clinical phase. If this pre-clinical phase leads to positive results, this can be promising for a possible therapy for patients.

In this project Dr Kerstin Nagel-Wolfrum closely cooperates with:

  • U. Wolfrum (Institute for Molecular Physiology, JGU Mainz, Germany): USH1B pig model
  • S. Gerber (University Medical Centre Mainz, Institute of Human Genetics, Germany): Bioinformatics
  • M. Cheetham (UCL, London, United Kingdom): iPSC-RPE and iPSC-RO generation
  • V. Kalatzis (Institute for Neurosciences of Montpellier, France): iPSC-RPE and iPSC-RO generation
  • J. Gopalakrishnan (Heinrich-Heine University Düsseldorf, Germany): brain organoids

This project will have a duration of 1 year and has been budgeted at
€ 100.000, -. Stichting Ushersyndroom hopes that this study will contribute to the development of one or more effective treatments for people suffering from Usher Syndrome type 1B.

View the PowerPoint presentation about this research by Dr. Kerstin Nagel-Wolfrum

Stichting Ushersyndroom

Looking back at 2022

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One year ago the Usher Syndrome Foundation announced its reaching the milestone of 1 million euro of donations. A huge and almost magical amount of money! Thanks to the many donations, actions and events we reached this amount six years after the first start of the campaigns. This has enabled us to finance a number of scientific studies.

The special milestone of 1 million gave everyone wings. And this was shown in the year 2022!


We collected almost half a million euro of donations in one year! Thanks to all contributors and thanks to you!

Thanks to the many donations and gifts, we can finance several new (inter)national research projects.
The first 2 new studies that we will fund have already been announced at the end of December 2022. We will announce the two funded studies from the Moon Rocket Grant and another new research project in early 2023.

The start in 2022
The year started with a change in the board and expansion of the board: Diede Heijkoop took over the function of secretary from Annouk van Nunen. Johan Driessen joined the board as a member and was given the fund-raising portfolio. After a short familiarisation period the board started with the development of a Strategic Plan. Where are we now and where do we want to go? And how do we expect to get there?
We have the moonshot “A treatment for Usher Syndrome in 2025!”, but we are looking further ahead. The Stichting Ushersyndroom wants a ‘moon landing’ in 2030. After a year of interviews, away days, on-line meetings and many discussions, we are now busy developing a Strategic Plan. We will present this plan early in the year 2023.

Ivonne Bressers appointed Knight of the Order of Orange Nassau
King Willem-Alexander appointed Ivonne Bressers (56) Knight of the Order of Orange Nassau. As chairwoman and driving force behind the Stichting Ushersyndroom she is of invaluable for the Usher patients group. Mayor Marcouch presented the decoration during the rain of titles at the town hall of Arnhem.. Read more …

A visit to the researchers
The board received a progress report with respect to all ongoing studies (co-)financed by the foundation. Because of the renewal of the board and also in view of the major financial contribution that the foundation makes to scientific research, the board went to visit the researchers in the Radboudumc. The board was given a presentation and a tour for each study. Sometimes big steps are made in one year, but sometimes there also are setbacks to cope with.

Mini genes 2a: this study was patented. Researchers are talking about further cooperation with companies. Which company wants to take part in the pre-clinical phase in order to lift the study to the next level? Read more ….

Mini genes 2c: the sticking together of small coding ‘pieces’ of the gene to make a mini-gene-2c was disappointing at first, but after a few months delay and several attempts, the researcher succeeded in this! At the same time, another researcher was developing an innovative tool with which predictions can be made with the help of the computer whether a protein will or will not be functional. This made clear that the mini-genes-2c required minor adjustment. These adjustments are presently being made and will subsequently be tested. Read more …

CRUSH-study: Most CRUSH participants will be called for the very last time in the coming year. The study is heavy and burdensome for the participants. However, the analyses and results are of great value for the researchers and all people suffering from Usher Syndrome. The results will be of help in future treatments. In order to hearten the participants of the CRUSH study, they all received a small present from the foundation. The presents are handed out to the participants with each visit. Read more …

Sleep study: Many interview were held during the first year of this study. This showed that there is a clear difference between the control group and the group of people suffering from Usher Syndrome. These people had much more sleeping problems, especially with respect to sleeping on. What exactly is going on? For answering this question zebrafishes are used as animal models. We hope to know more next year. Read more …

USHIII: The ‘USHIII Initiative’ spent a large part of the past year on going through all procedures for an application with the FDA in order to be able to start the trial. Preparations are being made. The commitment of Dr Ronald Pennings and Dr Suzanne Yzer is mainly focused on the natural development study and based on data from the past that are already available in existing medical files. Read more …

Mini retinas 2a: The progress report was received. Early next year, a delegation of the board and the Medical Advisory Council will visit the LUMC where the study is conducted. This study was started at the end of last year. Read more …

Discovery of a new type of Usher Syndrome: type 4
The Radboud UMC has proven the existence of another type of Usher Syndrome. People diagnosed for type 4 are born with good hearing and eyesight, but these will both gradually decrease as the patient gets older (from the age of 17). Read more …

Global Usher Awareness Day 2022
Every year on the third Saturday of September, we celebrate ‘Global Usher Awareness Day’. On this day, which falls on the same day as the autumn equinox, the sun is directly above the equator and the day and the night have the same length. Following the autumn equinox, there will be less light every day; days get shorter and nights get longer.

Usher? So what!
Especially for the Global Usher Awareness Day the Usher Syndrome Foundation published a video podcast series with Joyce de Ruiter and Femke Krijger, in which they talk about their ‘USH-life’.

Joyce is ambassador of the Usher Syndrome Foundation, author and professional speaker. She published, among others, the book ‘Niet horen, niet zien, niet zwijgen’ (not hear, not see and not keep silent). Femke is shiatsu therapist and inspirational speaker and she recently published her book ‘De evenwichtskunstenaar’ (The balance artist). This podcast series consists of 7 episodes, each covering a new subject. Watch and listen (CC English) ….

How do they do that?
On our socials in the section ‘Hoe doen zij dat?’ (how do they do that?) random Ushers and/or their parents are asked five pressing questions. These are question that everyone can answer. The inspiring and motivating stories were put together in this on-line magazine especially for the celebration of Global Usher Awareness Day ’22. Read magazine {Dutch} …

Let USH Talk
On October 15, the Stichting Ushersyndroom organized the first edition of Let USH Talk, a series of interactive online events about (living with) Usher Syndrome. In the first edition, Dr. Ronald Pennings and Dr. Suzanne Yzer talks about the diagnosis interview together with the other guests and the online audience. Afterwards, the participants could meet and talk digitally in the online breakout rooms.

The 2nd edition is planned for February 4, with the theme “Loss & Resilience” and will include Prof. dr. Dr. Em. Manu Keirse join the chair of the day Wendelien Wouters. Joyce de Ruiter and Lotte Driessen (both live with Usher syndrome) will join the table. Read and watch (Video CC English) …

Long-awaited patients’ brochure finally available
The brochure: ‘Ushersyndroom’ (Usher Syndrome) will be available as from mid October in the webshop of the Usher Syndrome Foundation. The production of the patients’ brochure was an extensive process; from writing, selecting pictures and photos to design development. With the launch of the patients’ brochure a long-cherished wish of the foundation came true. The brochure is intended for everyone who has been diagnosed for Usher Syndrome, but in particular also for their family and social surroundings or people who are otherwise interested in Usher Syndrome. Read moren (Temporarily only available in Dutch) ….

Usher4Usher
Sometimes you want to come into contact with fellow-sufferers or parents of ‘Usher’ children. The request are diverse, from teenagers to adults and parents who sometimes also want to physically meet people. Usher4Usher mediates in these contacts. Mail to: contactgroep@ushersyndroom.nl

Tears as a source of information?
Can tears provide information that may be important for better diagnostics and monitoring in future treatments of USH1b patients?
In the pilot study “Investigating the exosome content as a novel marker for Usher syndrome 1b” Dr Irene Vazquez Dominguez, working at the Radboud UMC, will study tears. She hopes to find any indications that tears can be a source of information and may contribute to a better prediction of the development of Usher Syndrome type 1b.
This study will be financed by the Stichting Ushersyndroom with co-financing from Usher Syndrome Ireland  Read more ….

Reggeborgh supports Stichting Ushersyndroom en Radboudumc
Reggeborgh supports the 4-year study ‘Development of Exon Excision Therapy’ by Dr. Erwin van Wijk and dr. Erik de Vrieze at Radboudumc. In this research, the aim is to permanently remove specific exons in which patients have hereditary mutations from the DNA of the photoreceptors in the retina and/or the hair cells of the inner ear using the CRISPR/Cas9 gene editing technique. The aim of this strategy is, with a single treatment, to stop the deterioration of vision (and in time hopefully also of hearing) in larger groups of patients who have mutations in these exons of the USH2A gene.
An incredibly important and hopeful research!
We would like to thank Reggeborgh for making this research possible! Read more ….

Moon Rocket Grant
The Stichting Ushersyndroom presented the ‘Moon Rocket Grant’ early in the year 2020: researcher from all over the world could submit study proposals and had the chance of receiving a subsidy of € 100,000.-. The foundation made 2 x € 100,000.- available for this ‘Moon Rocket Grant’.

The foundation was able to present this Grant thanks to the many donations. The Grant was internationally appreciated and the applications included various Usher genes and Usher Syndrome types.
The foundation will announce which researchers will receive a subsidy of €100,000.- for their study proposals early in the year 2023. Read more ….

The Medical Advisory Council
Other than former years, last year was a busy year for the Medical Advisory Council. The members of the Medical Advisory Council had to assess several study proposals that the Usher Syndrome Foundation received from Uitzicht. Apart from this, the Medical Advisory Council set up the entire Moon Rocket Grant and they designed the application form. The Medical Advisory Council also studied and assessed all applications for the Moon Rocket Grant.
Willem Quite will terminate his function as member of the Medical Advisory Council by the end of this year. After 6 full years of intense involvement he will leave the Medical Advisory Council and Donna Debets will take his place.

A book, a TedTalk and interviews in newspapers and magazines
Femke Krijger wrote her first book: De Evenwichtskunstenaar (The balance artist). Joyce de Ruiter held her first TedTalk and many people suffering from Usher Syndrome were interviewed for newspapers and magazines.

Run, cycle, walk, collect returnable bottles and crotchet oven cloths
This year was filled with wonderful actions and initiatives! For example, over 100 people joined in the Run4Usher during the Zandvoort Circuit Run. Tim Schroeder made his gigantic cycling trip to Alicante and will make a gigantic cycling trip again in 2023. Wilte Jager cycled the 11-city race in 24 hours with his tandem buddy. The first edition of NL wandelt voor Usher (The Dutch walking for Usher) turned out to be a huge success. The Run4Usher during the 7 Hills Run was a feast of unity and the gallery of the many bottle deposit actions is growing steadily. On WhyDonate we see a number of other wonderful actions that were organised for the Usher Syndrome Foundation in the past year: Billie for Usher, Crosse for Josse, Tennis tournament and clinic HOT in Nieuw and also Team Lente took up a sportive challenge.

Really great actions were organised for the foundation on the action platform Support & Donate as well: The A-team took action for the Usher Syndrome Foundation and Tim van der Avoird did his most heavy sportive challenge ever.

There also were runs during the Marathon of Rotterdam  and the Wateringse Veldloopfestijn and in Breda, the 40 kilometres of the Canal Run were run by the famous ’40 of Breda’.

Social media, website and mailbox
Apart from all the above-mentioned actions, other individual actions were organised and money was donated. People knew how to reach us through website, mail or other social media channels. Thank you very much!

 

The objective of the Stichting Ushersyndroom is to finance scientific research that is to lead to a treatment that will show down, stop of even reverse the deterioration of hearing and eyesight. Apart from this, the foundation also (financially) supports the improvement of the quality of life, the growth of knowledge and information about Usher Syndrome and to enhance the contact between fellow-sufferers.

DONATE HERE

You can also donate directly to Stichting Ushersyndroom by using the QR code.

 

 

 

Tears as a source of information?

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Stichting Ushersyndroom and Usher Syndrome Ireland

finance research into USH1b

Can tears provide information that may be important for improving diagnostics and monitoring in future treatments of USH1b patients? In the pilot study “Investigating the exosome content as a novel marker for Usher syndrome 1b” Dr. Irene Vázquez Domínguez, who is working at the Radboudumc (Nijmegen, the Netherlands), will investigate tears. By doing this, she wants to assess whether there is any indications on tears that can be employed as a source of information and therefore may contribute to not only increase the current knowledge of the disease but also to allow better prediction of the development of Usher Syndrome type 1b.

This study will be mainly financed by the Usher Syndrome Foundation and partially co-financed by Usher Syndrome Ireland. If this study produces any positive results, the study of tears may lead to new strategies in USH research.

Tears
Tears are human body fluids. Tears are rich of proteins, lipoproteins and exosomes. Exosomes are small bladders which contain a wide range of molecules inside like RNA molecules. Thanks to that, exosomes are important for the communication between cells. In addition, they can be isolated from tears, which allow the study of their content.
As tears can be collected in a non-invasive way (without entering the body) from patients, they allow for easy and patient-friendly isolation of exosomes.

New biomarker for research
Biomarkers are measurable indicators that may indicate that someone is ill, predict how serious the illness will be or show whether a treatment is effective or not.

By making use of tears, the researcher Dr. Irene Vázquez Domínguez wants to find out whether biomarkers can be found that may be used to improve the diagnostics and to better predict the development of Usher Syndrome type 1b. In the long term, point-of-care tests could be developed on the basis of these biomarkers. Point-of-care tests offer care professionals the possibility to start, monitor or adjust a future development.

The MYO7A geneWe know that more than 10 genes are involved in Usher Syndrome.
This new study is focused on one of these genes, being the MYO7A gene. This gene is responsible for the production of a specific protein: Myosin, which keeps the photoreceptors (the rods and cones) of the retina alive.

Some children having mutations in the MYO7A gene do not develop retinitis pigmentosa in their childhood and puberty beside their hereditary deafness. Here we speak of non-syndromic deafness 

How can this be explained and/or predicted? The answer to this question may lead to better diagnostics. Sometimes it is really difficult for the parents to cope with the uncertainty whether or not their child will develop retinitis pigmentosa (RP).

Increasing the present knowledge about the MYO7A gene is necessary for finding new biomarkers that can be used for making the diagnosis and for predicting the development. At the same time, this knowledge can also be used in monitoring after a treatment.

Isolation of exosomes
Usher Syndrome falls within the group of Retinal Dystrophy diseases (RDs). The deterioration of the eyesight is caused by the dying of retinal cells, such as the light-sensitive photoreceptors and/or the retinal pigment epithelium (RPE).
Within the retina RPE cells are responsible for the majority of the production of exosomes. Previous studies indicated that tears may be rich of RPE exosomes.

The goal of the study is to isolate exosomes from tears as well as from RPE cells. Then, the content of both will be studied. First, the control group will be compared with the material from USH1b patients. Then the information from tear derived exosomes and RPE derived exosomes will be also compared to assess if, as it was suggested before, they provide the same information. If this turns out to be successful, this study will show that exosomes can be used as a means to develop new strategies in USH research.
Finally, this study will also show whether tears can be a source for research. This would help to find an easy and patient-friendly way to isolate exosomes.

This one year study was budgeted at  € 75.000, -.
Stichting Ushersyndroom (Dutch Usher syndrome Foundation) will finance this study with co-financing from Usher Syndrome Ireland.

 

Watch the powerpoint presentation by
Dr. Irene Vázquez Domínguez