OR24-1 Structure-Function Analysis of Human OTX2 Variants Defines Required Region of C-Terminus for Pituitary, Eye, and Craniofacial Development

OTX2 is a homeobox transcription factor important for eye, craniofacial and midline development. Whole gene deletions and heterozygous mutations in OTX2 cause variable anomalies with incomplete penetrance, and most cases present with craniofacial / ocular abnormalities, and hypopituitarism, including either isolated or combined pituitary hormone deficiency. Patients with variants of unknown significance in OTX2 pose a dilemma for medical diagnosis. OTX2 is highly conserved evolutionarily: variable craniofacial defects are observed in heterozygous Otx2 null mice and zebrafish with knockdown of otx2b together with other genes. Thus, mouse and zebrafish offer opportunities for functional analysis of human patient variants. A patient diagnosed with combined pituitary hormone deficiency, including deficiencies in GH, ACTH, FSH, and LH, with no obvious ocular or craniofacial abnormalities, had an intriguing, rare, likely deleterious OTX2(H230L/+) variant in a predicted protein-protein interaction domain within the C-terminus. We tested the functional significance of the variant allele. No differences in the transactivation properties were observed in cell culture transfections. To assess function in a more physiological context, we generated an Otx2 allelic series in mice using CRISPR/Cas9. This included nested C-terminal deletions, frameshifts, the OTX2(H230L/+) allele and other missense mutations. Surprisingly, all Otx2 variants after codon 220 were tolerated; no gross ocular, craniofacial, or pituitary growth insufficiency phenotypes were noted. In contrast, ocular phenotypes were 100% penetrant in Otx2(L219Pfs*17/+) mice, including unilateral or bilateral anophthalmia or microphthalmia. Given the time and cost of generating mouse models of human disease, we explored the utility of zebrafish to assess patient variants in OTX2. Although zebrafish have two otx2 genes, previous studies showed that morpholino knockdown of otx2b caused craniofacial defects that mimic those of human patients if an unrelated gene in the pathway was also knocked down. We sought to characterize the phenotypic consequences of a complete loss of function variant in zebrafish because it could offer a cleaner, more robust system for assessment of human variants than the use of multiple, gene-specific morpholinos. Zebrafish homozygous for an essential splice site mutation, otx2b(c.507-2A>C) (otx2b(hu3625)) died at 11 days post fertilization. Preliminary data suggest mutants have reduced growth hormone transcripts at day 5, and assessment of zebrafish mutant vision and eye morphology is underway. The mouse studies suggest that the patient OTX2(H230L/+) variant is likely tolerated, as are other variants and deletions C-terminal to position 220 of OTX2. Analysis of zebrafish genetic loss of function mutants suggest they offer an avenue for assessing the functional significance of human OTX2 variants.