KIF21A

Congenital fibrosis of the extraocular muscles

At least 12 mutations in the KIF21A gene have been identified in people with congenital fibrosis of the extraocular muscles (CFEOM). These mutations cause the most common form of the disorder, CFEOM1, and are a rare cause of another form of the condition called CFEOM3. Individuals with CFEOM are unable to move their eyes normally. They have difficulty looking upward or, less commonly, side-to-side, and most also have droopy eyelids (ptosis). In addition, people with CFEOM3 can have intellectual disability or other neurological problems.

Each of the known KIF21A gene mutations changes a single protein building block (amino acid) in the KIF21A protein. Most of these changes occur in the regulatory region of the protein. These mutations alter the protein's structure, which interferes with its ability to turn itself off. As a result, the KIF21A protein is always on (constitutively active) and cannot regulate microtubule growth. Without proper control of microtubule elongation, the axons of nerves develop abnormally and do not reach the muscles they control. Nerves in the head and face (cranial nerves) that control muscles that surround the eyes (extraocular muscles) are particularly affected. Problems with cranial nerve development impair extraocular muscle function, resulting in the characteristic features of CFEOM such as restricted eye movement and droopy eyelids.