Trinucleotide repeat expansion in the transcription factor 4 (TCF4) gene leads to widespread mrna splicing changes in fuchs’ endothelial corneal dystrophy

Eric D. Wieben, Ross A. Aleff, Xiaojia Tang, Malinda L. Butz, Krishna R. Kalari, Edward W. Highsmith, Jin Jen, George Vasmatzis, Sanjay V. Patel, Leo J. Maguire, Keith H. Baratz, Michael P. Fautsch

Research output: Contribution to journalArticlepeer-review

36 Scopus citations


PURPOSE. To identify RNA missplicing events in human corneal endothelial tissue isolated from Fuchs' endothelial corneal dystrophy (FECD). METHODS. Total RNA was isolated and sequenced from corneal endothelial tissue obtained during keratoplasty from 12 patients with FECD and 4 patients undergoing keratoplasty or enucleation for other indications. The length of the trinucleotide repeat (TNR) CTG in the transcription factor 4 (TCF4) gene was determined using leukocyte-derived DNA analyzed by a combination of Southern blotting and Genescan analysis. Commercial statistical software was used to quantify expression of alternatively spliced genes. Validation of selected alternative splicing events was performed by using RT-PCR. Gene sets identified were analyzed for overrepresentation using Web-based analysis system. RESULTS. Corneal endothelial tissue from FECD patients containing a CTG TNR expansion sequence in the TCF4 gene revealed widespread changes in mRNA splicing, including a novel splicing event involving FGFR2. Differential splicing of NUMA1, PPFIBP1, MBNL1, and MBNL2 transcripts were identified in all FECD samples containing a TNR expansion. The differentially spliced genes were enriched for products that localize to the cell cortex and bind cytoskeletal and cell adhesion proteins. CONCLUSIONS. Corneal endothelium from FECD patients harbors a unique signature of missplicing events due to CTG TNR expansion in the TCF4 gene, consistent with the hypothesis that RNA toxicity contributes to the pathogenesis of FECD. Changes to the endothelial barrier function, a known event in the development of FECD, was identified as a key biological process influenced by the missplicing events.

Original languageEnglish (US)
Pages (from-to)343-352
Number of pages10
JournalInvestigative Ophthalmology and Visual Science
Issue number1
StatePublished - Jan 1 2017
Externally publishedYes


  • FECD
  • Fuchs’ dystrophy
  • Myotonic dystrophy
  • TCF4
  • Trinucleotide repeat

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience


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