This 2008 Human Mutation paper reports full-length USH2A sequencing (exons 1-73) in 118 unrelated Scandinavian USH2 families (Denmark 48, Norway 23, Sweden 47), a landmark for its era because most prior studies screened only exons 1-21, leaving 45-61% of solved patients with an unidentified second allele .
Of 122 sequence alterations (73 new), 57 were predicted pathogenic (23 nonsense, 18 missense, 15 rearrangements, 1 splice-site), 7 of uncertain pathogenicity, and 58 benign. USH2A mutations were found in 89/118 families (75.4%), with two alleles identified in 79 (88.8% of solved cases). Notably, 31 of 36 novel mutations lay in exons 22-73, specific to the long usherin isoform, confirming that long-isoform analysis was the key to solving unsolved cases. USH3A mutations explained 5/118 families (4.2%), underscoring clinical mimicry between USH2 and USH3 .
c.2299delG (p.E767fs) accounted for 30.6% of all disease alleles overall and 47.5% of Danish alleles, consistent with the authors' prior finding of a common ancestral origin . Conversely, 56.1% of pathogenic variants were private (single families), and the Scandinavian long-isoform mutation spectrum showed only modest overlap with Spanish and French cohorts .
The paper's central strength is methodological: demonstrating that exons 22-73 harbored the missing alleles, and that two long-isoform truncating or truncating+missense combinations alone produce classic USH2 without extra-renal/cardiac symptoms β an observation later validated by genotype-phenotype work showing two truncating mutations cause more severe hearing impairment and by p.W3955X-specific RNA base-editing therapeutic efforts .
Limitations the authors partially acknowledged: conventional PCR sequencing missed large deletions (two were found only because homozygous), deep-intronic variants such as c.7595-2144A>G were undetectable by exon-focused methods , and missense classification relied on absence from ~100-200 control chromosomes plus cross-species conservation rather than functional assays β a standard of its time but now superseded by comprehensive variant databases. The 10 unsolved heterozygous families and 24 mutation-negative families are honestly reported, though the binomial argument that most true USH2A patients were identified is an inference, not direct evidence. Swedish families had a notably higher unsolved rate (32.6% vs ~15%), which the authors attribute to other loci but do not resolve. Six authors lack full names in the record, limiting attribution. Overall, a rigorous, high-impact population genetics study whose allele-frequency data still inform diagnostic panels today .
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