ALPK1 missense pathogenic variant in five families leads to ROSAH syndrome, an ocular multisystem autosomal dominant disorder

Lloyd B Williams, Asif Javed, Amin Sabri, Denise J Morgan, Chad D Huff, John R Grigg, Xiu Ting Heng, Alexis J Khng, Iris H I M Hollink, Margaux A Morrison, Leah A Owen, Katherine Anderson, Krista Kinard, Rebecca Greenlees, Danica Novacic, H Nida Sen, Wadih M Zein, George M Rodgers, Albert T Vitale, Neena B HaiderAxel M Hillmer, Pauline C Ng, Shankaracharya, Anson Cheng, Linda Zheng, Mark C Gillies, Marjon van Slegtenhorst, P Martin van Hagen, Tom O A R Missotten, Gary L Farley, Michael Polo, James Malatack, Julie Curtin, Frank Martin, Susan Arbuckle, Stephen I Alexander, Megan Chircop, Sonia Davila, Kathleen B Digre, Robyn V Jamieson, Margaret M DeAngelis

Research output: Contribution to journalArticleResearchpeer-review


PURPOSE: To identify the molecular cause in five unrelated families with a distinct autosomal dominant ocular systemic disorder we called ROSAH syndrome due to clinical features of retinal dystrophy, optic nerve edema, splenomegaly, anhidrosis, and migraine headache.

METHODS: Independent discovery exome and genome sequencing in families 1, 2, and 3, and confirmation in families 4 and 5. Expression of wild-type messenger RNA and protein in human and mouse tissues and cell lines. Ciliary assays in fibroblasts from affected and unaffected family members.

RESULTS: We found the heterozygous missense variant in the ɑ-kinase gene, ALPK1, (c.710C>T, [p.Thr237Met]), segregated with disease in all five families. All patients shared the ROSAH phenotype with additional low-grade ocular inflammation, pancytopenia, recurrent infections, and mild renal impairment in some. ALPK1 was notably expressed in retina, retinal pigment epithelium, and optic nerve, with immunofluorescence indicating localization to the basal body of the connecting cilium of the photoreceptors, and presence in the sweat glands. Immunocytofluorescence revealed expression at the centrioles and spindle poles during metaphase, and at the base of the primary cilium. Affected family member fibroblasts demonstrated defective ciliogenesis.

CONCLUSION: Heterozygosity for ALPK1, p.Thr237Met leads to ROSAH syndrome, an autosomal dominant ocular systemic disorder.

Original languageEnglish
Pages (from-to)2103-2115
Number of pages13
JournalGenetics in medicine : official journal of the American College of Medical Genetics
Issue number9
Publication statusPublished - Sept 2019


  • Exome/genetics
  • Female
  • Heterozygote
  • Humans
  • Hypohidrosis/genetics
  • Male
  • Migraine Disorders/genetics
  • Mutation, Missense/genetics
  • Optic Nerve/metabolism
  • Pedigree
  • Phenotype
  • Protein Kinases/genetics
  • Retina/metabolism
  • Retinal Dystrophies/genetics
  • Splenomegaly/genetics


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