Loss of function of retinol dehydrogenase 11 causes a recessive syndrome characterized by myopathy, retinal dystrophy, juvenile cataracts, and microcephaly

Purpose: Biallelic variants in RDH11, encoding retinol dehydrogenase 11, have been associated with a syndromic disorder, based on four individuals from two unrelated families. We aimed to profile the clinical variability, natural history and associated molecular spectrum of this condition. Methods: In the frame of a collaborative effort, clinical and molecular data were collected using a semi-structured survey. Structural modeling of RDH11 with NADH(P) was used to assess the functional impact of missense variants. Results: Sixteen affected individuals from nine unrelated families with biallelic RDH11 variants were assembled, frequently showing juvenile-onset progressive myopathy with vacuolar degeneration and prodromic asymptomatic hyperCKemia. Neurodevelopmental impairment, juvenile-onset cataract, and retinal dystrophy were confirmed as common features. Microcephaly and distinct craniofacial traits were also recurrent, while short stature was less frequent than previously reported. Most pathogenic variants were truncating, supporting RDH11 loss of function as the mechanism of disease. Consistently, the identified missense changes were predicted to affect RDH11 catalytic function. Conclusion: We refine the clinical and molecular spectra of RDH11-related disorder, reclassifying it as syndromic intellectual disability with muscular (juvenile myopathy) and ocular (retinal dystrophy) involvement. These insights are expected to improve diagnostic accuracy and patient care, guiding clinical evaluation and genetic counseling