Expanding the clinical and genetic spectrum of Heimler syndrome

Research output: Journal Publications and Reviews (RGC: 21, 22, 62)21_Publication in refereed journalpeer-review

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  • Feng-Juan Gao
  • Fang-Yuan Hu
  • Ping Xu
  • Yu-He Qi
  • Yong-jin Zhang
  • Fang Chen
  • Qing Chang
  • Fang Song
  • Si-Mai Shen
  • Ge-Zhi Xu
  • Ji-Hong Wu

Related Research Unit(s)


Original languageEnglish
Article number290
Number of pages12
Journal / PublicationOrphanet Journal of Rare Diseases
Online published12 Dec 2019
Publication statusPublished - 2019



Background: Heimler syndrome (HS) is a rare hereditary systemic disorder, partial clinically overlapping with Usher syndrome. So far, our knowledge of HS is very limited, many cases are misdiagnosed or may not even be diagnosed at all. This study aimed to analyze the clinical and genetic characteristics of HS, and to evaluate potential phenotype–genotype correlations. Results: Two HS cases caused by PEX1 mutations were identified, and a novel likely pathogenic mutation, PEX1 c.895_896insTATA, was found. The main ophthalmic finding of the two patients was consistent with retinitis pigmentosa accompanied by cystoid macular edema, but short axial length and hyperopia were also observed as two previously unreported ocular phenotypes. Analysis of the literature showed that of the 29 HS patients previously reported, 12 had PEX6 mutations, 10 had PEX1 mutations, two had PEX26 mutations, and the remaining patients were not genetically tested. Three novel genotype–phenotype correlations were revealed from analysis of these patients. First, most genotypes of every HS patient include at least one missense variant; second, at least one mutation in PEX1 or PEX6 gene affects the AAA-ATPase region in every HS patient with retinal dystrophy, suggesting AAA-ATPase region is a hypermutable region in patients with a retinal dystrophy; third, there are no significant differences between PEX1-, PEX6-, and PEX26-associated phenotypes. Conclusion: Next-generation sequencing is important for the diagnosis of HS. This study expands the clinical and genetic spectrum of HS, and provides additional insights into genotype–phenotype correlations, which is vital for accurate clinical practice, genetic counseling, and pathogenesis studies.

Research Area(s)

  • Heimler syndrome, Next-generation sequencing, Genetic diagnosis, PEX1, PEX6, Genotype–phenotype

Citation Format(s)

Expanding the clinical and genetic spectrum of Heimler syndrome. / Gao, Feng-Juan; Hu, Fang-Yuan; Xu, Ping; Qi, Yu-He; Li, Jian-Kang; Zhang, Yong-jin; Chen, Fang; Chang, Qing; Song, Fang; Shen, Si-Mai; Xu, Ge-Zhi; Wu, Ji-Hong.

In: Orphanet Journal of Rare Diseases, Vol. 14, 290, 2019.

Research output: Journal Publications and Reviews (RGC: 21, 22, 62)21_Publication in refereed journalpeer-review