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Da Silva JD, Pereira Â, Soares AR, Guimas A, Rocha S, Cardoso M, Garrido C, Soares CA, Nunes IS, Fortuna AM, Quelhas D, Figueiroa S, Ribeiro R, Santos M, Martins E, Tkachenko N. Diagnostic accuracy and the first genotype-phenotype correlation in glycogen storage disease type V. Pediatr Res 2024; 96:365-371. [PMID: 38052860 DOI: 10.1038/s41390-023-02943-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 10/20/2023] [Accepted: 11/18/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Glycogen storage disease type V (GSDV) is an autosomal recessive metabolic condition caused by pathogenic PYGM variants. This is an underdiagnosed condition as it presents with exercise intolerance in children. We reviewed the GSDV cases of a tertiary hospital center to assess diagnostic timing/accuracy, as well as potential clinical/analytical predictors of such factors. METHODS We retrospectively reviewed all GSDV cases with follow-up in both Pediatric and Adult Metabolic Diseases consultations. We included 28 cases and assessed their hospital record for clinical information. RESULTS Over 90% of our cases had late diagnoses, with more than 50% being diagnosed in adulthood despite symptom onset in preschool (very late diagnosis). Diagnostic age was lower in patients exhibiting myoglobinuria. Interestingly, patients with a positive family history of GSDV had similar rates of very late diagnoses, likely since the index case was already detected very late in life. Finally, we observe that the R50* variant is associated with increased myoglobinuria and CK elevation, in a dosage-dependent manner. CONCLUSION We concluded that GSDV is severely underdiagnosed, and that some clinical and analytical aspects of the condition can be more indicative of this diagnosis. Furthermore, we propose for the first time a genotype-phenotype correlation in GSDV. IMPACT GSDV is a pediatric-onset metabolic disorder that is mostly diagnosed late in the adult age and commonly misdiagnosed. We observed the first genotype-phenotype correlation in GSDV, regarding the common R50* variant. Awareness of GSDV for pediatricians and the overall medical community is vital.
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Affiliation(s)
- Jorge Diogo Da Silva
- Centro de Genética Médica Doutor Jacinto Magalhães (CGM), Centro Hospitalar Universitário de Santo António, Porto, Portugal.
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
- Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Biomedical Sciences Institute, Porto University, Porto, Portugal.
| | - Ângela Pereira
- Centro Materno-Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Hospital de Braga, Braga, Portugal
| | - Ana Rita Soares
- Centro de Genética Médica Doutor Jacinto Magalhães (CGM), Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Biomedical Sciences Institute, Porto University, Porto, Portugal
| | - Arlindo Guimas
- Department of Internal Medicine, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Reference Centre for Inborn Errors of Metabolism, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Sara Rocha
- Department of Internal Medicine, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Reference Centre for Inborn Errors of Metabolism, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Márcio Cardoso
- Unidade Corino de Andrade and Neurophysiology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- European Reference Network-Neuromuscular Diseases ERN-NMD, Paris, France
| | - Cristina Garrido
- Centro Materno-Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- European Reference Network-Neuromuscular Diseases ERN-NMD, Paris, France
| | - Célia Azevedo Soares
- Centro de Genética Médica Doutor Jacinto Magalhães (CGM), Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Biomedical Sciences Institute, Porto University, Porto, Portugal
- Departamento de Ciências Médicas, Universidade de Aveiro, Aveiro, Portugal
| | - Isabel Serra Nunes
- Centro de Genética Médica Doutor Jacinto Magalhães (CGM), Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Ana Maria Fortuna
- Centro de Genética Médica Doutor Jacinto Magalhães (CGM), Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Biomedical Sciences Institute, Porto University, Porto, Portugal
| | - Dulce Quelhas
- Centro de Genética Médica Doutor Jacinto Magalhães (CGM), Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Biomedical Sciences Institute, Porto University, Porto, Portugal
- Reference Centre for Inborn Errors of Metabolism, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Sónia Figueiroa
- Centro Materno-Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Rosa Ribeiro
- Department of Internal Medicine, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Reference Centre for Inborn Errors of Metabolism, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Manuela Santos
- Centro Materno-Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- European Reference Network-Neuromuscular Diseases ERN-NMD, Paris, France
| | - Esmeralda Martins
- Centro Materno-Infantil do Norte, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Reference Centre for Inborn Errors of Metabolism, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Nataliya Tkachenko
- Centro de Genética Médica Doutor Jacinto Magalhães (CGM), Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Biomedical Sciences Institute, Porto University, Porto, Portugal
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Ravaglia S, Gana S, Valente EM. Glycogen storage disease type V: a still under-recognized condition lacking definitive genotype-phenotype correlates. Pediatr Res 2024; 96:279-280. [PMID: 38514859 DOI: 10.1038/s41390-024-03149-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/19/2024] [Accepted: 03/06/2024] [Indexed: 03/23/2024]
Affiliation(s)
| | - Simone Gana
- Neurogenetics Research Center, IRCCS Fondazione Mondino, Pavia, Italy
| | - Enza Maria Valente
- Neurogenetics Research Center, IRCCS Fondazione Mondino, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
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Teles JS, Ramos CT, Almeida BM, Sousa AV. A Case Report of McArdle Disease Diagnosed Following Statin-Induced Myositis. Cureus 2023; 15:e44701. [PMID: 37809236 PMCID: PMC10552332 DOI: 10.7759/cureus.44701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
McArdle disease is a rare condition, characterized by a deficiency of phosphorylase muscle isoform, an enzyme responsible for the breaking down of glycogen, necessary for obtaining energy. Patients typically present with exercise intolerance, myalgias, fatigue, cramps, muscle stiffness, and/or weakness induced by physical activity. The diagnosis is generally established late, with a median delay of about 29 years. We present the case of a female patient with a long history of myalgias, muscle weakness, and exercise intolerance, diagnosed with McArdle disease by the age of 74, after statin-induced myopathy. We aim to review the diagnosis and treatment of this disease, as a way to raise awareness among the medical community.
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Affiliation(s)
- João S Teles
- Family Medicine, Unidade de Saúde Familiar (USF) Brás-Oleiro, Agrupamento de Centros de Saúde (ACeS) Gondomar, Porto, PRT
| | - Catarina T Ramos
- Family Medicine, Unidade de Saúde Familiar (USF) Brás-Oleiro, Agrupamento de Centros de Saúde (ACeS) Gondomar, Porto, PRT
| | - Beatriz M Almeida
- Family Medicine, Unidade de Saúde Familiar (USF) Brás-Oleiro, Agrupamento de Centros de Saúde (ACeS) Gondomar, Porto, PRT
| | - Anabela V Sousa
- Family Medicine, Unidade de Saúde Familiar (USF) Brás-Oleiro, Agrupamento de Centros de Saúde (ACeS) Gondomar, Porto, PRT
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Rhabdomyolysis Associated with Recent SARS-COV-2 Infection in a Patient with Carnitine Palmitoyltransferase II Deficiency. PRILOZI (MAKEDONSKA AKADEMIJA NA NAUKITE I UMETNOSTITE. ODDELENIE ZA MEDICINSKI NAUKI) 2022; 43:61-66. [PMID: 36473042 DOI: 10.2478/prilozi-2022-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Carnitine palmitoyltransferase II deficiency (CPT II) is an autosomal recessive inherited disorder of long-chain fatty acid oxidation in the mitochondrial matrix, resulting in an inability to utilize fat for energy in cells. The most frequent myopathic form occurs in young adults and is associated with recurrent episodes of exercise-induced rhabdomyolysis. The myopathic form is caused by the Ser113Leu mutation of the CPT II gene. Rarely, massive rhabdomyolysis could be complicated by acute kidney injury (AKI), cardiomyopathy, and respiratory insufficiency. We present a case of an 18-year old male with myalgia, muscular weakness, and dark-colored urine after prolonged exercise and a recent mildSARS-CoV-2infection. Massive rhabdomyolysis was diagnosed with markedly increased serum concentrations of myoglobin and creatine kinase, with normal kidney function. The patient experienced two similar episodes in the years 2017 and 2018, with rhabdomyolysis and AKI treated with hemodialysis. After excluding autoimmune and infectious diseases as causes of recurrent rhabdomyolysis, the patient was genetically tested and Ser113Leu mutation of the CPT II gene was confirmed. When a patient presents with myalgia and dark-colored urine triggered by minor physical activities, genetic testing for possible CPT II deficiency should be initiated. TheSARS-CoV-2infection could be a factor that triggers the occurrence of rhabdomyolysis and aggravates the severity of the attack in patients with CPT II deficiency.
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Løkken N, Revsbech KL, Jacobsen LN, Martinuzzi A, Martin MÁ, Díaz-Manera J, Dominguez-Gonzalez C, Brondani G, Musumeci O, Granata F, Stefan C, Merino-Sanchez C, Peralta CN, Khawajazada T, Alonso-Pérez J, Toscano A, Vissing J. Muscle MRI in McArdle Disease: A European Multicenter Observational Study. Neurology 2022; 99:e1664-e1675. [PMID: 35853747 DOI: 10.1212/wnl.0000000000200914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 05/16/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Glycogen storage disease type V (GSDV) or McArdle disease is a muscle glycogenosis that classically manifests with exercise intolerance and exercise-induced muscle pain. Muscle weakness and wasting may occur, but it is typically mild and described as located around the shoulder girdle in elderly patients. Paraspinal muscle involvement has received little attention in the literature. This study aimed to quantify fat replacement of paraspinal, shoulder, and lower limb muscles by magnetic resonance imaging in a European cohort of patients with GSDV. METHODS This observational study included patients with verified GSDV and healthy controls (HCs). Whole-body MRIs and clinical data were collected. The degree of muscle fat replacement was evaluated on T1-weighted images with the semiquantitative visual Mercuri scale and on Dixon images where individual muscle fat fractions (FFs) were quantitatively calculated. RESULTS MRIs and clinical data from a total of 57 patients with GSDV (age 44.3 ± 15.2 years) from 5 European centers were assessed and compared with findings in 30 HCs (age 42.4 ± 14.8 years). Patients with GSDV had significantly more fat replacement of the paraspinal muscles compared with HCs on all levels investigated, detected by both the Mercuri and the Dixon method (Dixon, paraspinal composite FF [GSDV vs HC] at the cervical level: 31.3 ± 13.1 vs 15.4 ± 7.8; thoracic level: 34.5±19.0 vs 16.9±8.6; and lumbar level: 43.9 ± 19.6 vs 21.8 ± 10.2 [p < 0.0001]). Patients with GSDV also had significantly more fat replacement of the shoulder muscles (evaluated by the Mercuri scale), along with significantly, but numerically less, fat replacement of thigh and calf muscles compared with HC (Dixon, lower limb composite FF [GSDV vs HC] at the thigh level: 12.0 ± 5.6 vs 8.8 ± 2.7 and calf level: 13.1 ± 6.7 vs 9.1 ± 2.9 [p ≤ 0.05]). DISCUSSION The primary findings are that patients with GSDV exhibit severe fat replacement of the paraspinal muscles, which can have important implications for the future management of patients with GSDV, and also significant fat replacement of shoulder girdle muscles as previously described. The clinical relevance of the discrete increases in lower limb FF is uncertain. The changes were found to be age-related in both groups, but an accelerated effect was found in GSDV, probably due to continuous muscle damage.
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Affiliation(s)
- Nicoline Løkken
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy.
| | - Karoline Lolk Revsbech
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
| | - Laura Nørager Jacobsen
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
| | - Andrea Martinuzzi
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
| | - Miguel Ángel Martin
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
| | - Jordi Díaz-Manera
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
| | - Cristina Dominguez-Gonzalez
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
| | - Giovanni Brondani
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
| | - Olimpia Musumeci
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
| | - Francesca Granata
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
| | - Cristina Stefan
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
| | - Concepción Merino-Sanchez
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
| | - Claudia Nuñez Peralta
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
| | - Tahmina Khawajazada
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
| | - Jorge Alonso-Pérez
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
| | - Antonio Toscano
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
| | - John Vissing
- From the Copenhagen Neuromuscular Center (N.L., K.L.R., L.N.J., T.K., J.V.), Rigshospitalet, Copenhagen University Hospital, Denmark; IRCCS (A.M., C.S.), Medea Scientific Institute, Conegliano Pieve di Soligo, Italy; Mitochondrial Diseases and Metabolic Myopathies Laboratory (M.Á.M.), Instituto de Investigación Neuromuscular Unit (C.D.-G.), and Radiology Department (C.M.-S.), Hospital 12 de Octubre (imas12); Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (M.Á.M., J.D.-M., C.D.-G., J.A.-P.), Madrid; Unitat de Malalties Neuromusculars (J.D.-M., J.A.-P.), Servei de Neurologia, Universitat Autònoma de Barcelona, and Radiology Department (C.N.P.), Hospital de la Santa Creu i Sant Pau de Barcelona, Spain; John Walton Muscular Dystrophy Research Center (J.D.-M.), Newcastle University Translational and Clinical Research Insitute, United Kingdom; Radiology Unit (G.B., A.T.), Latisana Hospital, ASL 2 Friuli Venezia Giulia; and Department of Clinical and Experimental Medicine (O.M.), Neurology and Neuromuscular Unit, and Department of Biomedical (F.G.), Dental Science and Morphological and Functional Images-Neuroradiology Unit, University of Messina, Italy
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6
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García-Consuegra I, Asensio-Peña S, Garrido-Moraga R, Pinós T, Domínguez-González C, Santalla A, Nogales-Gadea G, Serrano-Lorenzo P, Andreu AL, Arenas J, Zugaza JL, Lucia A, Martín MA. Identification of Potential Muscle Biomarkers in McArdle Disease: Insights from Muscle Proteome Analysis. Int J Mol Sci 2022; 23:4650. [PMID: 35563042 PMCID: PMC9100117 DOI: 10.3390/ijms23094650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/03/2022] [Accepted: 04/18/2022] [Indexed: 02/04/2023] Open
Abstract
Glycogen storage disease type V (GSDV, McArdle disease) is a rare genetic myopathy caused by deficiency of the muscle isoform of glycogen phosphorylase (PYGM). This results in a block in the use of muscle glycogen as an energetic substrate, with subsequent exercise intolerance. The pathobiology of GSDV is still not fully understood, especially with regard to some features such as persistent muscle damage (i.e., even without prior exercise). We aimed at identifying potential muscle protein biomarkers of GSDV by analyzing the muscle proteome and the molecular networks associated with muscle dysfunction in these patients. Muscle biopsies from eight patients and eight healthy controls showing none of the features of McArdle disease, such as frequent contractures and persistent muscle damage, were studied by quantitative protein expression using isobaric tags for relative and absolute quantitation (iTRAQ) followed by artificial neuronal networks (ANNs) and topology analysis. Protein candidate validation was performed by Western blot. Several proteins predominantly involved in the process of muscle contraction and/or calcium homeostasis, such as myosin, sarcoplasmic/endoplasmic reticulum calcium ATPase 1, tropomyosin alpha-1 chain, troponin isoforms, and alpha-actinin-3, showed significantly lower expression levels in the muscle of GSDV patients. These proteins could be potential biomarkers of the persistent muscle damage in the absence of prior exertion reported in GSDV patients. Further studies are needed to elucidate the molecular mechanisms by which PYGM controls the expression of these proteins.
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Affiliation(s)
- Inés García-Consuegra
- Mitochondrial and Neuromuscular Disorders Group, Hospital 12 de Octubre Health Research Institute (imas12), 28041 Madrid, Spain; (I.G.-C.); (S.A.-P.); (R.G.-M.); (C.D.-G.); (P.S.-L.); (J.A.); (A.L.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), 28029 Madrid, Spain;
| | - Sara Asensio-Peña
- Mitochondrial and Neuromuscular Disorders Group, Hospital 12 de Octubre Health Research Institute (imas12), 28041 Madrid, Spain; (I.G.-C.); (S.A.-P.); (R.G.-M.); (C.D.-G.); (P.S.-L.); (J.A.); (A.L.)
| | - Rocío Garrido-Moraga
- Mitochondrial and Neuromuscular Disorders Group, Hospital 12 de Octubre Health Research Institute (imas12), 28041 Madrid, Spain; (I.G.-C.); (S.A.-P.); (R.G.-M.); (C.D.-G.); (P.S.-L.); (J.A.); (A.L.)
| | - Tomàs Pinós
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), 28029 Madrid, Spain;
- Mitochondrial and Neuromuscular Disorders Unit, Vall d’Hebron Institut de Recerca, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Cristina Domínguez-González
- Mitochondrial and Neuromuscular Disorders Group, Hospital 12 de Octubre Health Research Institute (imas12), 28041 Madrid, Spain; (I.G.-C.); (S.A.-P.); (R.G.-M.); (C.D.-G.); (P.S.-L.); (J.A.); (A.L.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), 28029 Madrid, Spain;
| | - Alfredo Santalla
- Department of Computer and Sport Sciences, Universidad Pablo de Olavide, 41013 Sevilla, Spain;
| | - Gisela Nogales-Gadea
- Grup de Recerca en Malalties Neuromusculars i Neuropediàtriques, Department of Neurosciences, Institut d’Investigacio en Ciencies de la Salut Germans Trias i Pujol i Campus Can Ruti, Universitat Autònoma de Barcelona, 08916 Barcelona, Spain;
| | - Pablo Serrano-Lorenzo
- Mitochondrial and Neuromuscular Disorders Group, Hospital 12 de Octubre Health Research Institute (imas12), 28041 Madrid, Spain; (I.G.-C.); (S.A.-P.); (R.G.-M.); (C.D.-G.); (P.S.-L.); (J.A.); (A.L.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), 28029 Madrid, Spain;
| | - Antoni L. Andreu
- EATRIS, European Infrastructure for Translational Medicine, 1019 Amsterdam, The Netherlands;
| | - Joaquín Arenas
- Mitochondrial and Neuromuscular Disorders Group, Hospital 12 de Octubre Health Research Institute (imas12), 28041 Madrid, Spain; (I.G.-C.); (S.A.-P.); (R.G.-M.); (C.D.-G.); (P.S.-L.); (J.A.); (A.L.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), 28029 Madrid, Spain;
| | - José L. Zugaza
- Achucarro Basque Center for Neuroscience, Science Park of the UPV/EHU, and Department of Genetics, Physical Anthropology, and Animal Physiology, Faculty of Science and Technology, UPV/EHU, 48940 Leioa, Spain;
- IKERBASQUE, Basque Foundation for Science, Plaza Euskadi 5, 48009 Bilbao, Spain
| | - Alejandro Lucia
- Mitochondrial and Neuromuscular Disorders Group, Hospital 12 de Octubre Health Research Institute (imas12), 28041 Madrid, Spain; (I.G.-C.); (S.A.-P.); (R.G.-M.); (C.D.-G.); (P.S.-L.); (J.A.); (A.L.)
- Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
| | - Miguel A. Martín
- Mitochondrial and Neuromuscular Disorders Group, Hospital 12 de Octubre Health Research Institute (imas12), 28041 Madrid, Spain; (I.G.-C.); (S.A.-P.); (R.G.-M.); (C.D.-G.); (P.S.-L.); (J.A.); (A.L.)
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), 28029 Madrid, Spain;
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7
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Iacono S, Lupica A, Di Stefano V, Borgione E, Brighina F. A novel compound heterozygous mutation in PYGM gene associated with McArdle's disease. ACTA MYOLOGICA : MYOPATHIES AND CARDIOMYOPATHIES : OFFICIAL JOURNAL OF THE MEDITERRANEAN SOCIETY OF MYOLOGY 2022; 41:37-40. [PMID: 35465342 PMCID: PMC9004334 DOI: 10.36185/2532-1900-067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
McArdle's disease is an autosomal recessive glycogenosis due to mutation in the myophosphorylase gene (PYGM) resulting in a pure myopathy. The clinical onset typically occurs in childhood with cramps, myalgia, and intolerance to physical exercise, although late onset forms are also reported. We describe a case of a 17-year-old male complaining of cramps and myalgia following brief and intense exercise. The patient reported marked improvement in muscle fatigability few minutes after starting aerobic exercise. When he was a child, he had experienced few episodes of vomiting, nausea, and black colored urine following physical activity. Laboratory testings revealed high creatine kinase serum levels. Genetic testings for metabolic myopathies demonstrated a compound heterozygous for two PYGM mutations (p.R570Q and p.K754Nfs*49) allowing the diagnosis of McArdle's disease. To date, 183 mutations in the PYGM gene are listed in Human Gene Mutation Database Professional 2021.2, but this novel compound heterozygosis has never been reported before.
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Affiliation(s)
- Salvatore Iacono
- Section of Neurology, Department of Biomedicine, Neuroscience, and advanced Diagnostic (BiND), University of Palermo, Palermo, Italy
| | - Antonino Lupica
- Section of Neurology, Department of Biomedicine, Neuroscience, and advanced Diagnostic (BiND), University of Palermo, Palermo, Italy
| | - Vincenzo Di Stefano
- Section of Neurology, Department of Biomedicine, Neuroscience, and advanced Diagnostic (BiND), University of Palermo, Palermo, Italy
| | - Eugenia Borgione
- Unit of Neuromuscular Diseases, Oasi Research Institute-IRCCS, Troina, Italy
| | - Filippo Brighina
- Section of Neurology, Department of Biomedicine, Neuroscience, and advanced Diagnostic (BiND), University of Palermo, Palermo, Italy
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8
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Preclinical Research in McArdle Disease: A Review of Research Models and Therapeutic Strategies. Genes (Basel) 2021; 13:genes13010074. [PMID: 35052414 PMCID: PMC8774685 DOI: 10.3390/genes13010074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
McArdle disease is an autosomal recessive disorder of muscle glycogen metabolism caused by pathogenic mutations in the PYGM gene, which encodes the skeletal muscle-specific isoform of glycogen phosphorylase. Clinical symptoms are mainly characterized by transient acute “crises” of early fatigue, myalgia and contractures, which can be accompanied by rhabdomyolysis. Owing to the difficulty of performing mechanistic studies in patients that often rely on invasive techniques, preclinical models have been used for decades, thereby contributing to gain insight into the pathophysiology and pathobiology of human diseases. In the present work, we describe the existing in vitro and in vivo preclinical models for McArdle disease and review the insights these models have provided. In addition, despite presenting some differences with the typical patient’s phenotype, these models allow for a deep study of the different features of the disease while representing a necessary preclinical step to assess the efficacy and safety of possible treatments before they are tested in patients.
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Lucia A, Martinuzzi A, Nogales-Gadea G, Quinlivan R, Reason S. Clinical practice guidelines for glycogen storage disease V & VII (McArdle disease and Tarui disease) from an international study group. Neuromuscul Disord 2021; 31:1296-1310. [PMID: 34848128 DOI: 10.1016/j.nmd.2021.10.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/21/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Alejandro Lucia
- Faculty of Sports Sciences, Universidad Europea de Madrid, Spain; Centro de Investigación Biomédica en Red en Fragilidad y Envejecimiento Saludable (CIBERFES) and Research Institute of the Hospital 12 de Octubre ('imas12', PaHerg group), Madrid, Spain
| | | | - Gisela Nogales-Gadea
- Institut d'Investigació Germans Trias i Pujol, Camí de les Escoles, Barcelona, Spain
| | - Ros Quinlivan
- MRC Centre for Neuromuscular Disease, National Hospital for Neurology and Neurosurgery, London, UK
| | - Stacey Reason
- International Association for Muscle Glycogen Storage Disease, California, USA.
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Kang JH, Park JH, Park JS, Lee SK, Lee S, Baik HW. Molecular diagnosis of McArdle disease using whole-exome sequencing. Exp Ther Med 2021; 22:1029. [PMID: 34373715 PMCID: PMC8343624 DOI: 10.3892/etm.2021.10461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/28/2021] [Indexed: 12/15/2022] Open
Abstract
Whole-exome sequencing (WES) analysis has been used recently as a diagnostic tool for finding molecular defects. In the present study, researchers attempted to analyze molecular defects through WES in a 13-year-old female patient who had not been diagnosed through a conventional genetic approach. DNA was extracted and subjected to WES analysis to identify the genetic defect. A total of 106,728 exons and splicing variants were selected, and synonymous single nucleotide variants (SNVs) and general single nucleotide polymorphisms (SNPs) were filtered out. Finally, nonsynonymous SNVs (c.C415T and c.C389T) of the PYGM gene were identified in nine compound heterozygous mutations. PYGM encodes myophosphorylase and degrades glycogen in the muscle to supply energy to muscle cells. The present study revealed that the patient's father had a c.C389T mutation and the mother had a c.C415T mutation, resulting in A130V and R139W missense mutations, respectively. To the best of our knowledge, the A130V variant in PYGM has not been reported in the common variant databases. All variations of the patient's family detected using WES were verified by Sanger sequencing. Because the patient had compound heterozygous mutations in the PYGM gene, the patient was presumed to exhibit markedly decreased muscle phosphorylase activity. To assess the function of myophosphorylase, an ischemic forearm exercise test was performed. The blood ammonia level sharply increased and the lactate level maintained a flat curve shape similar to the typical pattern of McArdle disease. Therefore, the diagnosis of the patient was confirmed to be McArdle disease, a glycogen storage disease. Through WES analysis, accurate and early diagnosis could be made in the present study. This report describes a novel compound heterozygous mutation of the PYGM gene in a Korean patient.
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Affiliation(s)
- Ju-Hyung Kang
- Department of Pediatrics, School of Medicine, Eulji University, Daejeon 34824, Republic of Korea
| | - Jun-Hyung Park
- Department of Biochemistry and Molecular Biology, School of Medicine, Eulji University, Daejeon 34824, Republic of Korea
| | - Jin-Soon Park
- Department of Biochemistry and Molecular Biology, School of Medicine, Eulji University, Daejeon 34824, Republic of Korea
| | - Seong-Kyu Lee
- Department of Biochemistry and Molecular Biology, School of Medicine, Eulji University, Daejeon 34824, Republic of Korea
| | - Sunghoon Lee
- Department of Research and Development Eone-Diagnomics Genome Center, Incheon 22014, Republic of Korea
| | - Haing-Woon Baik
- Department of Biochemistry and Molecular Biology, School of Medicine, Eulji University, Daejeon 34824, Republic of Korea
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Carneiro A, Viana-Gomes D, Macedo-da-Silva J, Lima GHO, Mitri S, Alves SR, Kolliari-Turner A, Zanoteli E, Neto FRDA, Palmisano G, Pesquero JB, Moreira JC, Pereira MD. Risk factors and future directions for preventing and diagnosing exertional rhabdomyolysis. Neuromuscul Disord 2021; 31:583-595. [PMID: 34193371 DOI: 10.1016/j.nmd.2021.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 12/19/2022]
Abstract
Exertional rhabdomyolysis may occur when an individual is subjected to strenuous physical exercise. It is occasionally associated with myoglobinuria (i.e. "cola-colored" urine) alongside muscle pain and weakness. The pathophysiology of exertional rhabdomyolysis involves striated muscle damage and the release of cellular components into extracellular fluid and bloodstream. This can cause acute renal failure, electrolyte abnormalities, arrhythmias and potentially death. Exertional rhabdomyolysis is observed in high-performance athletes who are subjected to intense, repetitive and/or prolonged exercise but is also observed in untrained individuals and highly trained or elite groups of military personnel. Several risk factors have been reported to increase the likelihood of the condition in athletes, including: viral infection, drug and alcohol abuse, exercise in intensely hot and humid environments, genetic polymorphisms (e.g. sickle cell trait and McArdle disease) and epigenetic modifications. This article reviews several of these risk factors and proposes screening protocols to identify individual susceptibility to exertional rhabdomyolysis as well as the relevance of proteomics for the evaluation of potential biomarkers of muscle damage.
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Affiliation(s)
- Andréia Carneiro
- Departamento de Bioquímica, Instituto de Química, Universidade Federal do Rio de Janeiro, Brazil; Departamento de Química, Diretoria de Sistemas de Armas da Marinha, Marinha do Brazil, Brazil; Departamento de Parasitologia, Universidade de São Paulo, Instituto de Ciencias Biomédicas, Brazil.
| | - Diego Viana-Gomes
- Departamento de Corridas, Universidade Federal do Rio de Janeiro, Escola de Educação Física, Brazil
| | - Janaina Macedo-da-Silva
- Departamento de Parasitologia, Universidade de São Paulo, Instituto de Ciencias Biomédicas, Brazil
| | - Giscard Humberto Oliveira Lima
- Departamento de Biofísica, Universidade Federal de São Paulo, Brazil; Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Italy
| | - Simone Mitri
- Centro de Ecologia Humana e Saúde do Trabalhador, Fundação Oswaldo Cruz, Brazil
| | | | | | - Edmar Zanoteli
- Departamento de Neurologia, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | | | - Giuseppe Palmisano
- Departamento de Parasitologia, Universidade de São Paulo, Instituto de Ciencias Biomédicas, Brazil
| | - João Bosco Pesquero
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Italy
| | | | - Marcos Dias Pereira
- Departamento de Bioquímica, Instituto de Química, Universidade Federal do Rio de Janeiro, Brazil.
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12
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Pinós T, Andreu AL, Bruno C, Hadjigeorgiou GM, Haller RG, Laforêt P, Lucía A, Martín MA, Martinuzzi A, Navarro C, Oflazer P, Pouget J, Quinlivan R, Sacconi S, Scalco RS, Toscano A, Vissing J, Vorgerd M, Wakelin A, Martí R. Creation and implementation of a European registry for patients with McArdle disease and other muscle glycogenoses (EUROMAC registry). Orphanet J Rare Dis 2020; 15:187. [PMID: 33054807 PMCID: PMC7558742 DOI: 10.1186/s13023-020-01455-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND International patient registries are of particular importance for rare disorders, as they may contribute to overcome the lack of knowledge derived from low number of patients and limited awareness of these diseases, and help to learn more about their geographical or population-based specificities, which is relevant for research purposes and for promoting better standards of care and diagnosis. Our objective was to create and implement a European registry for patients with McArdle disease and other muscle glycogenoses (EUROMAC) and to disseminate the knowledge of these disorders. RESULTS Teams from nine different countries (United Kingdom, Spain, Italy, France, Germany, Denmark, Greece, Turkey and USA) created a consortium that developed the first European registry dedicated to rare muscle glycogenoses. A work plan was implemented to design the database and platform that constitute the registry, by choosing clinical, genetics and molecular variables of interest, based on experience gained from previous national registries for similar metabolic disorders. Among dissemination activities, several teaching events were organized in different countries, especially those where the consortium considered the awareness of these diseases needs to be promoted among health professionals and patients. CONCLUSION EUROMAC represents a step forward in the knowledge of those disorders to which it is dedicated, and will have relevant clinical outcomes at the diagnostic, epidemiological, clinical and research level.
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Affiliation(s)
- Tomàs Pinós
- Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, and Research Group on Neuromuscular and Mitochondrial Diseases, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119, 08035, Barcelona, Catalonia, Spain
| | - Antoni L Andreu
- Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, and Research Group on Neuromuscular and Mitochondrial Diseases, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119, 08035, Barcelona, Catalonia, Spain
| | - Claudio Bruno
- Center of Translational and Experimental Myology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Ronald G Haller
- Neuromuscular Center, Institute for Exercise and Environmental Medicine of Texas Health Presbyterian Hospital, Dallas, TX, USA
| | - Pascal Laforêt
- Nord/Est/Ile de France Neuromuscular Reference Center, Neurology Department, Raymond-Poincaré Teaching Hospital, AP-HP, Garches, France
- INSERM U1179, END-ICAP, Paris Saclay University, Paris, France
| | - Alejandro Lucía
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
- Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, and 12 de Octubre University Hospital Research Institute, ('imas12'), Madrid, Spain
| | - Miguel A Martín
- Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, and 12 de Octubre University Hospital Research Institute, ('imas12'), Madrid, Spain
| | - Andrea Martinuzzi
- Department of Conegliano-Pieve di Soligo, IRCCS Eugenio Medea-Associazione "La Nostra Famiglia" Scientific Institute, Bosisio Parini, Italy
| | | | - Piraye Oflazer
- Department of Neurology, Neuromuscular Unit, Istanbul University, Istanbul, Turkey
| | - Jean Pouget
- Centre de Référence Maladies Neuromusculaires, Assistance Publique-Hopitaux de Marseille, Marseille, France
| | - Ros Quinlivan
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, National Hospital, London, UK
| | | | - Renata S Scalco
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, National Hospital, London, UK
| | - Antonio Toscano
- Neurology and Neuromuscular Diseases Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - John Vissing
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Matthias Vorgerd
- Heimer Institute for Muscle Research, University Hospital Bergmannsheil Bochum, Bochum, Germany
| | | | - Ramon Martí
- Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, and Research Group on Neuromuscular and Mitochondrial Diseases, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119, 08035, Barcelona, Catalonia, Spain.
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13
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Echaniz-Laguna A, Lornage X, Laforêt P, Orngreen MC, Edelweiss E, Brochier G, Bui MT, Silva-Rojas R, Birck C, Lannes B, Romero NB, Vissing J, Laporte J, Böhm J. A New Glycogen Storage Disease Caused by a Dominant PYGM Mutation. Ann Neurol 2020; 88:274-282. [PMID: 32386344 DOI: 10.1002/ana.25771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/04/2020] [Accepted: 05/04/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Glycogen storage diseases (GSDs) are severe human disorders resulting from abnormal glucose metabolism, and all previously described GSDs segregate as autosomal recessive or X-linked traits. In this study, we aimed to molecularly characterize the first family with a dominant GSD. METHODS We describe a dominant GSD family with 13 affected members presenting with adult-onset muscle weakness, and we provide clinical, metabolic, histological, and ultrastructural data. We performed exome sequencing to uncover the causative gene, and functional experiments in the cell model and on recombinant proteins to investigate the pathogenic effect of the identified mutation. RESULTS We identified a heterozygous missense mutation in PYGM segregating with the disease in the family. PYGM codes for myophosphorylase, the enzyme catalyzing the initial step of glycogen breakdown. Enzymatic tests revealed that the PYGM mutation impairs the AMP-independent myophosphorylase activity, whereas the AMP-dependent activity was preserved. Further functional investigations demonstrated an altered conformation and aggregation of mutant myophosphorylase, and the concurrent accumulation of the intermediate filament desmin in the myofibers of the patients. INTERPRETATION Overall, this study describes the first example of a dominant glycogen storage disease in humans, and elucidates the underlying pathomechanisms by deciphering the sequence of events from the PYGM mutation to the accumulation of glycogen in the muscle fibers. ANN NEUROL 2020;88:274-282.
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Affiliation(s)
- Andoni Echaniz-Laguna
- Department of Neurology, APHP, CHU de Bicêtre, Le Kremlin Bicêtre, France.,French National Reference Center for Rare Neuropathies (NNERF), Le Kremlin Bicêtre, France.,Inserm U1195 & Paris-Saclay University, Le Kremlin Bicêtre, France
| | - Xavière Lornage
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Illkirch, France.,INSERM U1258, Illkirch, France.,CNRS UMR7104, Illkirch, France.,Strasbourg University, Illkirch, France
| | - Pascal Laforêt
- Department of Neurology, Raymond Poincaré Hospital, Centre de Référence de Pathologie Neuromusculaire Nord-Est-Ile-de-France, Garches, France.,Service de Neurologie, U1179 UVSQ-INSERM Handicap Neuromusculaire: Physiologie, Biothérapie et Pharmacologie appliquées, UFR Simone Veil-Santé, Université Versailles-Saint-Quentin-en-Yvelines, Garches, France
| | - Mette C Orngreen
- Copenhagen Neuromuscular Center, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Evelina Edelweiss
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Illkirch, France.,INSERM U1258, Illkirch, France.,CNRS UMR7104, Illkirch, France.,Strasbourg University, Illkirch, France
| | - Guy Brochier
- Neuromuscular Morphology Unit, Myology Institute, GHU Pitié-Salpêtrière, Paris, France.,Centre de Référence de Pathologie Neuromusculaire Paris-Est, Institut de Myologie, GHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mai T Bui
- Neuromuscular Morphology Unit, Myology Institute, GHU Pitié-Salpêtrière, Paris, France
| | - Roberto Silva-Rojas
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Illkirch, France.,INSERM U1258, Illkirch, France.,CNRS UMR7104, Illkirch, France.,Strasbourg University, Illkirch, France
| | - Catherine Birck
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Illkirch, France.,INSERM U1258, Illkirch, France.,CNRS UMR7104, Illkirch, France.,Strasbourg University, Illkirch, France.,Structural Biology & Genomics Platform, IGBMC, Illkirch, France
| | - Béatrice Lannes
- Department of Pathology, Strasbourg University Hospital, Strasbourg, France
| | - Norma B Romero
- Neuromuscular Morphology Unit, Myology Institute, GHU Pitié-Salpêtrière, Paris, France.,Centre de Référence de Pathologie Neuromusculaire Paris-Est, Institut de Myologie, GHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université Sorbonne, UPMC Paris 06 University, Inserm UMRS974, CNRS FRE3617, Center for Research in Myology, GH Pitié-Salpêtrière, Paris, France
| | - John Vissing
- Copenhagen Neuromuscular Center, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Jocelyn Laporte
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Illkirch, France.,INSERM U1258, Illkirch, France.,CNRS UMR7104, Illkirch, France.,Strasbourg University, Illkirch, France
| | - Johann Böhm
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Illkirch, France.,INSERM U1258, Illkirch, France.,CNRS UMR7104, Illkirch, France.,Strasbourg University, Illkirch, France
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14
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Joshi PR, Zierz S. Muscle Carnitine Palmitoyltransferase II (CPT II) Deficiency: A Conceptual Approach. Molecules 2020; 25:molecules25081784. [PMID: 32295037 PMCID: PMC7221885 DOI: 10.3390/molecules25081784] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/08/2020] [Accepted: 04/11/2020] [Indexed: 11/16/2022] Open
Abstract
Carnitine palmitoyltransferase (CPT) catalyzes the transfer of long- and medium-chain fatty acids from cytoplasm into mitochondria, where oxidation of fatty acids takes place. Deficiency of CPT enzyme is associated with rare diseases of fatty acid metabolism. CPT is present in two subforms: CPT I at the outer mitochondrial membrane and carnitine palmitoyltransferase II (CPT II) inside the mitochondria. Deficiency of CPT II results in the most common inherited disorder of long-chain fatty acid oxidation affecting skeletal muscle. There is a lethal neonatal form, a severe infantile hepato-cardio-muscular form, and a rather mild myopathic form characterized by exercise-induced myalgia, weakness, and myoglobinuria. Total CPT activity (CPT I + CPT II) in muscles of CPT II-deficient patients is generally normal. Nevertheless, in some patients, not detectable to reduced total activities are also reported. CPT II protein is also shown in normal concentration in patients with normal CPT enzymatic activity. However, residual CPT II shows abnormal inhibition sensitivity towards malonyl-CoA, Triton X-100 and fatty acid metabolites in patients. Genetic studies have identified a common p.Ser113Leu mutation in the muscle form along with around 100 different rare mutations. The biochemical consequences of these mutations have been controversial. Hypotheses include lack of enzymatically active protein, partial enzyme deficiency and abnormally regulated enzyme. The recombinant enzyme experiments that we recently conducted have shown that CPT II enzyme is extremely thermoliable and is abnormally inhibited by different emulsifiers and detergents such as malonyl-CoA, palmitoyl-CoA, palmitoylcarnitine, Tween 20 and Triton X-100. Here, we present a conceptual overview on CPT II deficiency based on our own findings and on results from other studies addressing clinical, biochemical, histological, immunohistological and genetic aspects, as well as recent advancements in diagnosis and therapeutic strategies in this disorder.
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15
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Lorenzoni PJ, Werneck LC, Kay CSK, Arndt RC, Silvado CES, Scola RH. Single-centre experience on genotypic and phenotypic features of southern Brazilian patients with McArdle disease. Acta Neurol Belg 2020; 120:303-311. [PMID: 30415384 DOI: 10.1007/s13760-018-1038-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/30/2018] [Indexed: 12/20/2022]
Abstract
McArdle disease (MD) is a metabolic myopathy caused by deficiency of the myophosphorylase enzyme. The aim of our study was to analyse a series of MD patients in Brazil and the correlation between clinical findings, laboratory data, electromyography, muscle biopsy and genetic features. The PYGM gene was analysed by PCR/RLFP and Sanger sequencing. The sample included 12 patients, aged 18-57 years, from unrelated families. Exercise intolerance was present in all cases. Serum creatine kinase levels at rest were increased in all patients. Forearm ischaemic exercise testing in five patients revealed no increase in venous lactate. Needle electromyography presented 'myopathic pattern' in six patients. Muscle biopsy showed vacuolar myopathy in 10 patients and deficiency of myophosphorylase enzyme in all patients. The genetic analysis showed p.R50X as the most common mutation (allelic frequency: 56.25%), other known mutations (p.Y574X, p.G205S, p.W798R, IVS14 + 1G > A and IVS19-1G > A) and a new mutation (p.Asn168Lysfs*15) were also identified. Several features of the disorder were similar to the vast majority of patients worldwide. The genetic findings of this study revealed a range of mutations that are quite similar to the European cohort. The discovery of one novel mutation increases the genotypic heterogeneity of PYGM gene.
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Affiliation(s)
- Paulo José Lorenzoni
- Service of Neuromuscular Disorders, Division of Neurology, Department of Internal Medicine, Hospital de Clínicas, Universidade Federal do Paraná (UFPR), Curitiba, 80060-900, Brazil
| | - Lineu Cesar Werneck
- Service of Neuromuscular Disorders, Division of Neurology, Department of Internal Medicine, Hospital de Clínicas, Universidade Federal do Paraná (UFPR), Curitiba, 80060-900, Brazil
| | - Cláudia Suemi Kamoi Kay
- Service of Neuromuscular Disorders, Division of Neurology, Department of Internal Medicine, Hospital de Clínicas, Universidade Federal do Paraná (UFPR), Curitiba, 80060-900, Brazil
| | - Raquel Cristina Arndt
- Service of Neuromuscular Disorders, Division of Neurology, Department of Internal Medicine, Hospital de Clínicas, Universidade Federal do Paraná (UFPR), Curitiba, 80060-900, Brazil
| | - Carlos E S Silvado
- Service of Neuromuscular Disorders, Division of Neurology, Department of Internal Medicine, Hospital de Clínicas, Universidade Federal do Paraná (UFPR), Curitiba, 80060-900, Brazil
| | - Rosana Herminia Scola
- Service of Neuromuscular Disorders, Division of Neurology, Department of Internal Medicine, Hospital de Clínicas, Universidade Federal do Paraná (UFPR), Curitiba, 80060-900, Brazil.
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16
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Joshi PR, Deschauer M, Zierz S. McArdle Disease: Clinical, Biochemical, Histological and Molecular Genetic Analysis of 60 Patients. Biomedicines 2020; 8:biomedicines8020033. [PMID: 32075227 PMCID: PMC7168270 DOI: 10.3390/biomedicines8020033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 11/25/2022] Open
Abstract
A clinical, biochemical, histological and molecular genetic analysis of 60 McArdle patients (33 males and 27 females; mean age at diagnosis: 37 years) was performed. The objective of this study was to identify a possible genotype–phenotype correlation in McArdle disease. All patients complained of exercise-induced myalgia and fatigue; permanent weakness was present in 47% of the patients. Five percent of patients conveyed of masticatory muscle weakness. Age of onset was <15 years in 92% patients. Serum creatine kinase was elevated 5 to13-fold. Forearm ischemic test showed decreased lactate production but excessively increased ammonia upon exercise (n = 16). Muscle biopsies revealed highly reduced or missing myophosphorylase activity (n = 20) (mean: 0.17 ± 0.35 U/g tissue; normal: 12–61) and histologically, sub-sarcolemmal glycogen accumulation (n = 9). Molecular genetic analysis revealed the common p.Arg50Ter mutation in 68% of the patients. Other rather frequent mutations were p.Arg270Ter (allele frequency: 5%) followed by c.2262delA and p.Met1Val (allele frequencies: 3%). Twenty-four other rare mutations were also identified. No genotype–phenotype correlation was observed. The analysis highlights that testing of the p.Arg50Ter mutation could be performed first in molecular genetic testing of patients with exercise intolerance possibly due to McArdle disease. However, there is enormous mutation heterogeneity in McArdle disease thus sequencing of the myophosphorylase gene is needed in patients highly suspicious of McArdle disease.
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Affiliation(s)
- Pushpa Raj Joshi
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany; (M.D.); (S.Z.)
- Correspondence: ; Tel.: +49-345-557-5259
| | - Marcus Deschauer
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany; (M.D.); (S.Z.)
- Department of Neurology, School of Medicine, Technical University Munich, 81675 Munich, Germany
| | - Stephan Zierz
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany; (M.D.); (S.Z.)
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17
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McArdle Disease: New Insights into Its Underlying Molecular Mechanisms. Int J Mol Sci 2019; 20:ijms20235919. [PMID: 31775340 PMCID: PMC6929006 DOI: 10.3390/ijms20235919] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 11/14/2019] [Accepted: 11/21/2019] [Indexed: 01/05/2023] Open
Abstract
McArdle disease, also known as glycogen storage disease type V (GSDV), is characterized by exercise intolerance, the second wind phenomenon, and high serum creatine kinase activity. Here, we recapitulate PYGM mutations in the population responsible for this disease. Traditionally, McArdle disease has been considered a metabolic myopathy caused by the lack of expression of the muscle isoform of the glycogen phosphorylase (PYGM). However, recent findings challenge this view, since it has been shown that PYGM is present in other tissues than the skeletal muscle. We review the latest studies about the molecular mechanism involved in glycogen phosphorylase activity regulation. Further, we summarize the expression and functional significance of PYGM in other tissues than skeletal muscle both in health and McArdle disease. Furthermore, we examine the different animal models that have served as the knowledge base for better understanding of McArdle disease. Finally, we give an overview of the latest state-of-the-art clinical trials currently being carried out and present an updated view of the current therapies.
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18
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Santalla A, Nogales-Gadea G, Encinar AB, Vieitez I, González-Quintana A, Serrano-Lorenzo P, Consuegra IG, Asensio S, Ballester-Lopez A, Pintos-Morell G, Coll-Cantí J, Pareja-Galeano H, Díez-Bermejo J, Pérez M, Andreu AL, Pinós T, Arenas J, Martín MA, Lucia A. Genotypic and phenotypic features of all Spanish patients with McArdle disease: a 2016 update. BMC Genomics 2017; 18:819. [PMID: 29143597 PMCID: PMC5688471 DOI: 10.1186/s12864-017-4188-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We recently described the genotype/phenotype features of all Spanish patients diagnosed with McArdle disease as of January 2011 (n = 239, prevalence of ~1/167,000) (J Neurol Neurosurg Psychiatry 2012;83:322-8). Several caveats were however identified suggesting that the prevalence of the disease is actually higher. METHODS We have now updated main genotype/phenotype data, as well as potential associations within/between them, of all Spanish individuals currently diagnosed with McArdle disease (December 2016). RESULTS Ninety-four new patients (all Caucasian) have been diagnosed, yielding a prevalence of ~1/139,543 individuals. Around 55% of the mutated alleles have the commonest PYGM pathogenic mutation p.R50X, whereas p.W798R and p.G205S account for 10 and 9% of the allelic variants, respectively. Seven new mutations were identified: p.H35R, p.R70C, p.R94Q, p.L132WfsX163, p.Q176P, p.R576Q, and c.244-3_244-2CA. Almost all patients show exercise intolerance, the second wind phenomenon and high serum creatine kinase activity. There is, however, heterogeneity in clinical severity, with 8% of patients being asymptomatic during normal daily life, and 21% showing limitations during daily activities and fixed muscle weakness. A major remaining challenge is one of diagnosis, which is often delayed until the third decade of life in 72% of new patients despite the vast majority (86%) reporting symptoms before 20 years. An important development is the growing proportion of those reporting a 4-year improvement in disease severity (now 34%) and following an active lifestyle (50%). Physically active patients are more likely to report an improvement after a 4-year period in the clinical course of the disease than their inactive peers (odds ratio: 13.98; 95% confidence interval: 5.6, 34.9; p < 0.001). Peak oxygen uptake is also higher in the former (20.7 ± 6.0 vs. 16.8 ± 5.3 mL/kg/min, p = 0.0013). Finally, there is no association between PYGM genotype and phenotype manifestation of the disease. CONCLUSIONS The reported prevalence of McArdle disease grows exponentially despite frequent, long delays in genetic diagnosis, suggesting that many patients remain undiagnosed. Until a genetic cure is available (which is not predicted in the near future), current epidemiologic data support that adoption of an active lifestyle is the best medicine for these patients.
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Affiliation(s)
- Alfredo Santalla
- Universidad Pablo de Olavide, Sevilla, Spain.,Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Gisela Nogales-Gadea
- Grup de Recerca en Malalties Neuromusculars i Neuropediatriques, Department of Neurosciences, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Camí de les Escoles, s/n 08916, (Barcelona), Badalona, Spain. .,Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.
| | - Alberto Blázquez Encinar
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Laboratorio de Enfermedades Mitocondriales y Neuromusculares, Hospital 12 de Octubre, Madrid, Spain
| | - Irene Vieitez
- Rare Diseases and Pediatric Medicine Group, Galicia Sur Health Research Institute, Complexo Hospitalario Universitario de Vigo (CHUVI), SERGAS, Vigo, Spain
| | - Adrian González-Quintana
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Pablo Serrano-Lorenzo
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Inés García Consuegra
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Laboratorio de Enfermedades Mitocondriales y Neuromusculares, Hospital 12 de Octubre, Madrid, Spain
| | - Sara Asensio
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Alfonsina Ballester-Lopez
- Grup de Recerca en Malalties Neuromusculars i Neuropediatriques, Department of Neurosciences, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Camí de les Escoles, s/n 08916, (Barcelona), Badalona, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Guillem Pintos-Morell
- Grup de Recerca en Malalties Neuromusculars i Neuropediatriques, Department of Neurosciences, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Camí de les Escoles, s/n 08916, (Barcelona), Badalona, Spain.,Servicio de Pediatría, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Jaume Coll-Cantí
- Grup de Recerca en Malalties Neuromusculars i Neuropediatriques, Department of Neurosciences, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Universitat Autònoma de Barcelona, Camí de les Escoles, s/n 08916, (Barcelona), Badalona, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Servicio de Neurología, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Helios Pareja-Galeano
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain.,Universidad Europea de Madrid, Madrid, Spain
| | - Jorge Díez-Bermejo
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain.,Universidad Europea de Madrid, Madrid, Spain
| | | | - Antoni L Andreu
- Departament de Patologia Mitocondrial i Neuromuscular, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Tomàs Pinós
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Departament de Patologia Mitocondrial i Neuromuscular, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Joaquín Arenas
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Miguel A Martín
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Laboratorio de Enfermedades Mitocondriales y Neuromusculares, Hospital 12 de Octubre, Madrid, Spain
| | - Alejandro Lucia
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain.,Universidad Europea de Madrid, Madrid, Spain
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Quinlivan R, Andreu AL, Marti R. 211th ENMC International Workshop:: Development of diagnostic criteria and management strategies for McArdle Disease and related rare glycogenolytic disorders to improve standards of care. 17-19 April 2015, Naarden, The Netherlands. Neuromuscul Disord 2017; 27:1143-1151. [PMID: 29079393 DOI: 10.1016/j.nmd.2017.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/04/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Ros Quinlivan
- MRC Centre for Neuromuscular Disease, National Hospital for Neurology and Neurosurgery, London, UK.
| | - Antoni L Andreu
- Research Group on Neuromuscular and Mitochondrial Diseases, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, CIBERER, Barcelona, Catalonia, Spain
| | - Ramon Marti
- Research Group on Neuromuscular and Mitochondrial Diseases, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, CIBERER, Barcelona, Catalonia, Spain
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20
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Myophosphorylase (PYGM) mutations determined by next generation sequencing in a cohort from Turkey with McArdle disease. Neuromuscul Disord 2017; 27:997-1008. [PMID: 28967462 DOI: 10.1016/j.nmd.2017.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/30/2017] [Accepted: 06/08/2017] [Indexed: 12/30/2022]
Abstract
This study aimed to identify PYGM mutations in patients with McArdle disease from Turkey by next generation sequencing (NGS). Genomic DNA was extracted from the blood of the McArdle patients (n = 67) and unrelated healthy volunteers (n = 53). The PYGM gene was sequenced with NGS and the observed mutations were validated by direct Sanger sequencing. A diagnostic algorithm was developed for patients with suspected McArdle disease. A total of 16 deleterious PYGM mutations were identified, of which 5 were novel, including 1 splice-site donor, 1 frame-shift, and 3 non-synonymous variants. The p.Met1Val (27-patients/11-families) was the most common PYGM mutation, followed by p.Arg576* (6/4), c.1827+7A>G (5/4), c.772+2_3delTG (5/3), p.Phe710del (4/2), p.Lys754Asnfs (2/1), and p.Arg50* (1/1). A molecular diagnostic flowchart is proposed for the McArdle patients in Turkey, covering the 6 most common PYGM mutations found in Turkey as well as the most common mutation in Europe. The diagnostic algorithm may alleviate the need for muscle biopsies in 77.6% of future patients. A prevalence of any of the mutations to a geographical region in Turkey was not identified. Furthermore, the NGS approach to sequence the entire PYGM gene was successful in detecting a common missense mutation and discovering novel mutations in this population study.
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Chen MA, Weinstein DA. Glycogen storage diseases: Diagnosis, treatment and outcome. ACTA ACUST UNITED AC 2016. [DOI: 10.3233/trd-160006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | - David A. Weinstein
- Glycogen Storage Disease Program, University of Florida College of Medicine, Gainesville, FL, USA
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22
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Park HJ, Jang H, Kim JH, Lee JH, Shin HY, Kim SM, Park KD, Yim SV, Lee JH, Choi YC. Discovery of pathogenic variants in a large Korean cohort of inherited muscular disorders. Clin Genet 2016; 91:403-410. [PMID: 27363342 DOI: 10.1111/cge.12826] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/06/2016] [Accepted: 06/17/2016] [Indexed: 01/31/2023]
Abstract
Inherited muscular disorders (IMDs) are clinically and genetically heterogeneous genetic disorders. We investigated the mutational spectrum and genotype-phenotype correlations in Korean patients with IMD. We developed a targeted panel of 69 known IMD genes and recruited a total of 209 Korean patients with IMD. Targeted capture sequencing identified 994 different variants. Among them, 98 variants were classified as pathogenic/likely pathogenic variants; 38 were novel variations. A total of 39 patients had the pathogenic/likely pathogenic variants. Among them, 75 (36%) patients were genetically confirmed, and 18 (9%) patients had one heterozygous variant of recessive myopathy. However, two genetically confirmed patients had an additional heterozygous variant of another recessive myopathy. Four patients with one heterozygous variant of a recessive myopathy showed different phenotypes, compared with the known phenotype of the identified gene. The major causative genes of Korean patients with IMDs were DMD (19 patients), COL6A1 (9), DYSF (9), GNE (7), LMNA (7), CAPN3 (6), and RYR1 (5). This study showed the mutational and clinical spectra in Korean patients with IMD and confirmed the usefulness of strategies utilizing targeted sequencing.
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Affiliation(s)
- H J Park
- Department of Neurology, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea.,Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - H Jang
- Department of Chemistry, Yonsei University, Seoul, Korea
| | - J H Kim
- Department of Clinical Pharmacology and Therapeutics, College of Medicine, Kyung Hee University, Seoul, Korea
| | - J H Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - H Y Shin
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - S M Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - K D Park
- Department of Neurology, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - S-V Yim
- Department of Clinical Pharmacology and Therapeutics, College of Medicine, Kyung Hee University, Seoul, Korea
| | - J H Lee
- Department of Clinical Pharmacology and Therapeutics, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Y-C Choi
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
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Krag TO, Pinós T, Nielsen TL, Duran J, García-Rocha M, Andreu AL, Vissing J. Differential glucose metabolism in mice and humans affected by McArdle disease. Am J Physiol Regul Integr Comp Physiol 2016; 311:R307-14. [PMID: 27280431 DOI: 10.1152/ajpregu.00489.2015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 05/27/2016] [Indexed: 11/22/2022]
Abstract
McArdle disease (muscle glycogenosis type V) is a disease caused by myophosphorylase deficiency leading to "blocked" glycogen breakdown. A significant but varying glycogen accumulation in especially distal hind limb muscles of mice affected by McArdle disease has recently been demonstrated. In this study, we investigated how myophosphorylase deficiency affects glucose metabolism in hind limb muscle of 20-wk-old McArdle mice and vastus lateralis muscles from patients with McArdle disease. Western blot analysis and activity assay demonstrated that glycogen synthase was inhibited in glycolytic muscle from McArdle mice. The level and activation of proteins involved in contraction-induced glucose transport (AMPK, GLUT4) and glycogen synthase inhibition were increased in quadriceps muscle of McArdle mice. In addition, pCaMKII in quadriceps was reduced, suggesting lower insulin-induced glucose uptake, which could lead to lower glycogen accumulation. In comparison, tibialis anterior, extensor digitorum longus, and soleus had massive glycogen accumulation, but few, if any, changes or adaptations in glucose metabolism compared with wild-type mice. The findings suggest plasticity in glycogen metabolism in the McArdle mouse that is related to myosin heavy chain type IIB content in muscles. In patients, the level of GLUT4 was vastly increased, as were hexokinase II and phosphofructokinase, and glycogen synthase was more inhibited, suggesting that patients adapt by increasing capture of glucose for direct metabolism, thereby significantly reducing glycogen buildup compared with the mouse model. Hence, the McArdle mouse may be a useful tool for further comparative studies of disease mechanism caused by myophosphorylase deficiency and basic studies of metabolic adaptation in muscle.
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Affiliation(s)
- Thomas O Krag
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark;
| | - Tomàs Pinós
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Mitochondrial Pathology and Neuromuscular Disorders Laboratory, Vall d'Hebron Research Institute, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras, Barcelona, Spain
| | - Tue L Nielsen
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jordi Duran
- Institute for Research in Biomedicine, The Barcelona Institute of Science and Technology, Barcelona, Spain; and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Barcelona, Spain
| | - Mar García-Rocha
- Institute for Research in Biomedicine, The Barcelona Institute of Science and Technology, Barcelona, Spain; and
| | - Antoni L Andreu
- Mitochondrial Pathology and Neuromuscular Disorders Laboratory, Vall d'Hebron Research Institute, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras, Barcelona, Spain
| | - John Vissing
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Petrou P, Pantzaris M, Dionysiou M, Drousiotou A, Kyriakides T. Minimally symptomatic mcardle disease, expanding the genotype-phenotype spectrum. Muscle Nerve 2015; 52:891-5. [PMID: 26032558 DOI: 10.1002/mus.24716] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2015] [Indexed: 11/07/2022]
Abstract
INTRODUCTION We report the clinical, biochemical, and molecular findings in a Cypriot family with minimally symptomatic McArdle disease. METHODS Myophosphorylase in muscle was assessed by histochemistry, quantitative spectrophotometry, and western blot analysis. Mutation identification was performed by PCR amplification of all PYGM exons, followed by bidirectional sequencing. Screening for the new mutation was performed by restriction enzyme analysis. RESULTS We found that a novel c.1151C>T transition in exon 10 of the myophosphorylase gene (PYGM) is associated with minimally symptomatic McArdle disease. Homozygous carriers displayed an ischemic exercise response characterized by a blunted increase in post-exercise blood lactate levels in conjunction with an exaggerated increase in ammonia. Myophosphorylase activity in muscle was 3.75% of normal, whereas the size and abundance of the enzyme were unaffected. CONCLUSIONS These findings expand the genotype-phenotype spectrum of McArdle disease and suggest that enzymatic activity as low as 4% may be sufficient to ameliorate the phenotype.
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Affiliation(s)
- Petros Petrou
- Department of Biochemical Genetics, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Marios Pantzaris
- Neurology Clinics A & C, The Cyprus Institute of Neurology and Genetics, P.O. Box 23462, 1683, Nicosia, Cyprus
| | - Maria Dionysiou
- Department of Biochemical Genetics, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Anthi Drousiotou
- Department of Biochemical Genetics, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Theodoros Kyriakides
- Neurology Clinics A & C, The Cyprus Institute of Neurology and Genetics, P.O. Box 23462, 1683, Nicosia, Cyprus
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Santalla A, Nogales-Gadea G, Ørtenblad N, Brull A, de Luna N, Pinós T, Lucia A. McArdle disease: a unique study model in sports medicine. Sports Med 2015; 44:1531-44. [PMID: 25028051 DOI: 10.1007/s40279-014-0223-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
McArdle disease is arguably the paradigm of exercise intolerance in humans. This disorder is caused by inherited deficiency of myophosphorylase, the enzyme isoform that initiates glycogen breakdown in skeletal muscles. Because patients are unable to obtain energy from their muscle glycogen stores, this disease provides an interesting model of study for exercise physiologists, allowing insight to be gained into the understanding of glycogen-dependent muscle functions. Of special interest in the field of muscle physiology and sports medicine are also some specific (if not unique) characteristics of this disorder, such as the so-called 'second wind' phenomenon, the frequent exercise-induced rhabdomyolysis and myoglobinuria episodes suffered by patients (with muscle damage also occurring under basal conditions), or the early appearance of fatigue and contractures, among others. In this article we review the main pathophysiological features of this disorder leading to exercise intolerance as well as the currently available therapeutic possibilities. Patients have been traditionally advised by clinicians to refrain from exercise, yet sports medicine and careful exercise prescription are their best allies at present because no effective enzyme replacement therapy is expected to be available in the near future. As of today, although unable to restore myophosphorylase deficiency, the 'simple' use of exercise as therapy seems probably more promising and practical for patients than more 'complex' medical approaches.
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Nogales-Gadea G, Brull A, Santalla A, Andreu AL, Arenas J, Martín MA, Lucia A, de Luna N, Pinós T. McArdle Disease: Update of Reported Mutations and Polymorphisms in the PYGM Gene. Hum Mutat 2015; 36:669-78. [PMID: 25914343 DOI: 10.1002/humu.22806] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 04/15/2015] [Indexed: 01/01/2023]
Abstract
McArdle disease is an autosomal-recessive disorder caused by inherited deficiency of the muscle isoform of glycogen phosphorylase (or "myophosphorylase"), which catalyzes the first step of glycogen catabolism, releasing glucose-1-phosphate from glycogen deposits. As a result, muscle metabolism is impaired, leading to different degrees of exercise intolerance. Patients range from asymptomatic to severely affected, including in some cases, limitations in activities of daily living. The PYGM gene codifies myophosphoylase and to date 147 pathogenic mutations and 39 polymorphisms have been reported. Exon 1 and 17 are mutational hot-spots in PYGM and 50% of the described mutations are missense. However, c.148C>T (commonly known as p.R50X) is the most frequent mutation in the majority of the studied populations. No genotype-phenotype correlation has been reported and no mutations have been described in the myophosphorylase domains affecting the phosphorylated Ser-15, the 280's loop, the pyridoxal 5'-phosphate, and the nucleoside inhibitor binding sites. A newly generated knock-in mouse model is now available, which renders the main clinical and molecular features of the disease. Well-established methods for diagnosing patients in laboratories around the world will shorten the frequent ∼20-year period stretching from first symptoms appearance to the genetic diagnosis.
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Affiliation(s)
- Gisela Nogales-Gadea
- Department of Neurosciences, Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol I Campus Can Ruti, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Astrid Brull
- Departament de Patologia Mitocondrial i Neuromuscular, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), , Universitat Autónoma de Barcelona, Barcelona, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Alfredo Santalla
- Universidad Pablo de Olavide, Sevilla, Spain.,Laboratorio de Enfermedades Mitocondriales y Neuromusculares, Hospital 12 de Octubre, Madrid, Spain
| | - Antoni L Andreu
- Departament de Patologia Mitocondrial i Neuromuscular, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), , Universitat Autónoma de Barcelona, Barcelona, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Joaquin Arenas
- Laboratorio de Enfermedades Mitocondriales y Neuromusculares, Hospital 12 de Octubre, Madrid, Spain.,Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Miguel A Martín
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Laboratorio de Enfermedades Mitocondriales y Neuromusculares, Hospital 12 de Octubre, Madrid, Spain.,Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Alejandro Lucia
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain.,Universidad Europea, Madrid, Spain
| | - Noemi de Luna
- Departament de Patologia Mitocondrial i Neuromuscular, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), , Universitat Autónoma de Barcelona, Barcelona, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Tomàs Pinós
- Departament de Patologia Mitocondrial i Neuromuscular, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), , Universitat Autónoma de Barcelona, Barcelona, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
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Abstract
Rhabdomyolysis is characterized by severe acute muscle injury resulting in muscle pain, weakness, and/or swelling with release of myofiber contents into the bloodstream. Symptoms develop over hours to days after an inciting factor and may be associated with dark pigmentation of the urine. Serum creatine kinase and urine myoglobin levels are markedly elevated. Clinical examination, history, laboratory studies, muscle biopsy, and genetic testing are useful tools for diagnosis of rhabdomyolysis, and they can help differentiate acquired from inherited causes of rhabdomyolysis. Acquired causes include substance abuse, medication or toxic exposures, electrolyte abnormalities, endocrine disturbances, and autoimmune myopathies. Inherited predisposition to rhabdomyolysis can occur with disorders of glycogen metabolism, fatty acid β-oxidation, and mitochondrial oxidative phosphorylation. Less common inherited causes of rhabdomyolysis include structural myopathies, channelopathies, and sickle-cell disease. This review focuses on the differentiation of acquired and inherited causes of rhabdomyolysis and proposes a practical diagnostic algorithm. Muscle Nerve 51: 793-810, 2015.
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Affiliation(s)
- Jessica R Nance
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew L Mammen
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Building 50, Room 1146, Bethesda, Maryland, 20892, USA
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28
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Abstract
Metabolic and mitochondrial myopathies encompass a heterogeneous group of disorders that result in impaired energy production in skeletal muscle. Symptoms of premature muscle fatigue, sometimes leading to myalgia, rhabdomyolysis, and myoglobinuria, typically occur with exercise that would normally depend on the defective metabolic pathway. But in another group of these disorders, the dominant muscle symptom is weakness. This article reviews the clinical features, diagnosis, and management of these diseases with emphasis on the recent literature.
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Affiliation(s)
- Lydia J Sharp
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA; Neuromuscular Center, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, 7232 Greenville Avenue, Dallas, TX 75231, USA
| | - Ronald G Haller
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA; Neuromuscular Center, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, 7232 Greenville Avenue, Dallas, TX 75231, USA; North Texas VA Medical Center, 4500 South Lancaster Road, Dallas, TX 75216, USA.
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29
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Park HJ, Shin HY, Cho YN, Kim SM, Choi YC. The significance of clinical and laboratory features in the diagnosis of glycogen storage disease type v: a case report. J Korean Med Sci 2014; 29:1021-4. [PMID: 25045239 PMCID: PMC4101771 DOI: 10.3346/jkms.2014.29.7.1021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 01/08/2014] [Indexed: 11/20/2022] Open
Abstract
Glycogen storage disease type V (GSD-V) is the most common disorder of muscle glycogenosis with characteristic clinical and laboratory findings. A 32-yr-old woman complained of exercise intolerance and myoglobulinuria since early adolescence. She reported several episodes of second-wind phenomenon. Physical examination did not show any neurological abnormality, including fixed muscle weakness or atrophy. Serum creatine kinase level was 1,161 IU/L at rest. The result of the non-ischemic forearm exercise test was compatible with GSD-V. Mutation analysis identified the compound heterozygous mutations of the PYGM, p.D510fs and p.F710del, which has not yet been reported in Korea. The present case recognizes that detail clinical and laboratory analysis is the first step in the diagnosis of GSD-V.
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Affiliation(s)
- Hyung Jun Park
- Department of Neurology, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Ha Young Shin
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Yu Na Cho
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Min Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Chul Choi
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
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30
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Gurgel-Giannetti J, Nogales-Gadea G, van der Linden H, Bellard TMR, Brasileiro Filho G, Giannetti AV, de Castro Concentino EL, Vainzof M. Clinical and molecular characterization of McArdle's disease in Brazilian patients. Neuromolecular Med 2013; 15:470-5. [PMID: 23653251 DOI: 10.1007/s12017-013-8233-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 04/26/2013] [Indexed: 11/29/2022]
Abstract
McArdle's disease, a glycogen storage disease type V, is caused by a deficiency of the enzyme myophosphorylase, encoded by the PYGM gene. Worldwide distribution of mutations has revealed interesting data about the prevalence of mutations and population migrations. Currently, more than 100 mutations in the PYGM gene have been described, with some recurrent mutations in the different populations. However, no molecular studies of McArdle's disease were reported in Brazilian patients. Here, we describe the clinical phenotype and genotype of 10 patients from 8 unrelated Brazilian families. Among the 10 patients (3 females, 7 males), eight presented with the typical phenotype, with exercise intolerance, cramps, and myalgia; one patient showed permanent muscle weakness; and one patient showed a mild phenotype. Molecular analysis identified 5 different mutations in the 8 families, both in homozygosis or compound heterozygosis state. Four of them had already been described (p.R50X, p.T692kfs30, p.K609K, and p.G455R), and one, pI513V, is a novel heterozygous mutation. The common nonsense p.R50X mutation was found in 6 of the 8 families, being therefore the commonest mutation in the Brazilian population as well. Other mutations previously reported in European patients were also found in the patients in this study, which was expected considering the European ancestry of the Brazilian population.
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Affiliation(s)
- Juliana Gurgel-Giannetti
- Department of Pediatrics, Pediatric Neurology Service, Medical School, Universidade Federal de Minas Gerais, Rua Santa Catarina, 1042 apt: 201, Belo Horizonte, MG, Brazil.
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31
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Abstract
In this review, the clinical and laboratory features of exertional rhabdomyolysis (ER) are discussed in detail, emphasizing the full clinical spectrum from physiological elevations of serum creatine kinase after exertion to life-threatening rhabdomyolysis with acute kidney injury and associated systemic complications. Laboratory markers used to diagnose both ER and rhabdomyolysis are very sensitive, but not very specific, and imperfectly distinguish "subclinical" or asymptomatic from severe, life-threatening illness. However, genetic factors, both recognized and yet to be discovered, likely influence this diverse clinical spectrum of disease and response to exercise. Genetic mutations causative for McArdle disease, carnitine palmitoyl transferase deficiency 2, myoadenylate deaminase deficiency, and malignant hyperthermia have all been associated with ER. Polymorphic variations in the myosin light chain kinase, α-actin 3, creatine kinase-muscle isoform, angiotensin I-converting enzyme, heat shock protein, and interleukin-6 genes have also been associated with either ER or exercise-induced serum creatine kinase elevations typical of ER. The prognosis for ER is significantly better than that for other etiologies of rhabdomyolysis, but the risk of recurrence after an initial episode is unknown. Guidelines for management are provided.
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32
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Haimi Cohen Y, Shalva N, Markus-Eidlitz T, Sadeh M, Dabby R, Weintraub Y, Pode-Shakked B, Zeharia A, Anikster Y. McArdle disease: a novel mutation in Jewish families from the Caucasus region. Mol Genet Metab 2012; 106:379-81. [PMID: 22608882 DOI: 10.1016/j.ymgme.2012.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 04/16/2012] [Indexed: 11/26/2022]
Abstract
McArdle disease is caused by a myophosphorylase deficiency consequent to defects in the PYGM gene. A minority of the over-133 known mutations are associated with ethnicity, occurring mainly in patients from western Europe, the United States, and Japan. We identified a novel mutation, c.632delG, in three unrelated families of Jewish descent originating from the Caucasus region. This possibly ethnicity-associated mutation can significantly facilitate the diagnosis in Jews of the Caucasus and contribute to genetic consultations.
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Affiliation(s)
- Yishai Haimi Cohen
- Day Hospitalization Unit, Schneider Children's Medical Center of Israel, Petach Tikva 49202, Israel.
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Nogales-Gadea G, Pinós T, Lucia A, Arenas J, Camara Y, Brull A, de Luna N, Martín MA, Garcia-Arumí E, Martí R, Andreu AL. Knock-in mice for the R50X mutation in the PYGM gene present with McArdle disease. ACTA ACUST UNITED AC 2012; 135:2048-57. [PMID: 22730558 DOI: 10.1093/brain/aws141] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
McArdle disease (glycogenosis type V), the most common muscle glycogenosis, is a recessive disorder caused by mutations in PYGM, the gene encoding myophosphorylase. Patients with McArdle disease typically experience exercise intolerance manifested as acute crises of early fatigue and contractures, sometimes with rhabdomyolysis and myoblobinuria, triggered by static muscle contractions or dynamic exercises. Currently, there are no therapies to restore myophosphorylase activity in patients. Although two spontaneous animal models for McArdle disease have been identified (cattle and sheep), they have rendered a limited amount of information on the pathophysiology of the disorder; therefore, there have been few opportunities for experimental research in the field. We have developed a knock-in mouse model by replacing the wild-type allele of Pygm with a modified allele carrying the common human mutation, p.R50X, which is the most frequent cause of McArdle disease. Histochemical, biochemical and molecular analyses of the phenotype, as well as exercise tests, were carried out in homozygotes, carriers and wild-type mice. p.R50X/p.R50X mice showed undetectable myophosphorylase protein and activity in skeletal muscle. Histochemical and biochemical analyses revealed massive muscle glycogen accumulation in homozygotes, in contrast to heterozygotes or wild-type mice, which did not show glycogen accumulation in this tissue. Additional characterization confirmed a McArdle disease-like phenotype in p.R50X/p.R50X mice, i.e. they had hyperCKaemia and very poor exercise performance, as assessed in the wire grip and treadmill tests (6% and 5% of the wild-type values, respectively). This model represents a powerful tool for in-depth studies of the pathophysiology of McArdle disease and other neuromuscular disorders, and for exploring new therapeutic approaches for genetic disorders caused by premature stop codon mutations.
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Affiliation(s)
- Gisela Nogales-Gadea
- Laboratori de Patologia Mitocondrial i Neuromuscular, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Auto` noma deBarcelona, 08035 Barcelona, Spain
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Vieitez I, Teijeira S, Fernandez JM, San Millan B, Miranda S, Ortolano S, Louis S, Laforet P, Navarro C. Molecular and clinical study of McArdle’s disease in a cohort of 123 European patients. Identification of 20 novel mutations. Neuromuscul Disord 2011; 21:817-23. [DOI: 10.1016/j.nmd.2011.07.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 06/20/2011] [Accepted: 07/04/2011] [Indexed: 11/29/2022]
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35
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Wu Y, Weber JL, Vladutiu GD, Tarnopolsky MA. Six novel mutations in the myophosphorylase gene in patients with McArdle disease and a family with pseudo-dominant inheritance pattern. Mol Genet Metab 2011; 104:587-91. [PMID: 21880526 DOI: 10.1016/j.ymgme.2011.08.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 08/10/2011] [Indexed: 11/17/2022]
Abstract
McArdle disease is an autosomal recessive glycogenosis due to deficiency of the enzyme myophosphorylase. It results from homozygous or compound heterozygous mutations in the gene for this enzyme, PYGM. We report six novel mutations in the PYGM gene based upon sequencing data including three missense mutations (p.D51G, p.P398L, and p.N648Y), one nonsense mutation (p.Y75X), one frame-shift mutation (p.Y114SfsX181), and one amino acid deletion (p.Y53del) in six patients with McArdle disease. We also report on a Caucasian family that appeared to transmit McArdle disease in an autosomal dominant manner. In order to evaluate the potential pathogenicity of the sequence variants, we performed in silico analysis using PolyPhen-2 and SIFT BLink, along with species conservation analysis using UCSC Genome Browser. The above mutations were all predicted to be disease associated with high probability and with at least the same level of certainty as several confirmed mutations. The current data add to the list of pathogenic mutations in the PYGM gene associated with McArdle disease.
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Affiliation(s)
- Y Wu
- Department of Pediatrics, McMaster University Medical Centre, Hamilton, Ontario, Canada
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Miteff F, Potter HC, Allen J, Teoh H, Roxburgh R, Hutchinson DO. Clinical and laboratory features of patients with myophosphorylase deficiency (McArdle disease). J Clin Neurosci 2011; 18:1055-8. [PMID: 21658951 DOI: 10.1016/j.jocn.2010.12.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Revised: 12/08/2010] [Accepted: 12/11/2010] [Indexed: 11/25/2022]
Abstract
Mutations of PYGM, the gene encoding human myophosphorylase, produce a metabolic myopathy characterised by exercise intolerance and, in some patients, myoglobinuria. To illustrate the clinical and laboratory features of myophosphorylase deficiency, we describe 10 patients diagnosed in Auckland, New Zealand, between 1989 and 2009. We review the clinical, biochemical, and histologic features and the results of mutation analysis. All patients reported exercise intolerance since childhood or the teenage years, starting within minutes of moderate or intense exertion. The "second wind" phenomenon, or myoglobinuria, were each reported in about half the patients. The serum creatine kinase concentration was elevated in all patients where this had been measured. Muscle biopsies revealed subsarcolemmal vacuolation and histochemical absence of myophosphorylase. Analysis of PYGM showed mutations in all alleles, most commonly Arg49Ter or Gly204Ser. One patient harbored a novel mutation, Pro488Arg, predicted to seriously disrupt the tertiary structure of the enzyme. Myophosphorylase deficiency produces a fairly uniform set of symptoms, and consistent elevation of the serum creatine kinase concentration. The diagnosis can be confirmed in most patients by mutation analysis using a blood sample.
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Affiliation(s)
- F Miteff
- Department of Neurology, Auckland City Hospital, Auckland, New Zealand.
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Nadaj-Pakleza AA, Vincitorio CM, Laforêt P, Eymard B, Dion E, Teijeira S, Vietez I, Jeanpierre M, Navarro C, Stojkovic T. Permanent muscle weakness in MC
Ardle disease. Muscle Nerve 2009; 40:350-7. [DOI: 10.1002/mus.21351] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Vissing J, Duno M, Schwartz M, Haller RG. Splice mutations preserve myophosphorylase activity that ameliorates the phenotype in McArdle disease. Brain 2009; 132:1545-52. [PMID: 19433441 DOI: 10.1093/brain/awp065] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Over 100 mutations in the myophosphorylase gene, which cause McArdle disease, are known. All these mutations have resulted in a complete block of muscle glycogenolysis, and accordingly, no genotype-phenotype correlation has been identified in this condition. We evaluated physiologic and genetic features of two patients with a variant form of McArdle disease, associated with unusually high exercise capacity. Physiologic findings were compared to those in 47 patients with typical McArdle disease, and 17 healthy subjects. Subjects performed an ischaemic forearm exercise test to assess lactate and ammonia production. Peak oxidative capacity (VO2max) and cardiac output were determined, using cycle ergometry as the exercise modality. The two patients with atypical McArdle disease carried common mutations on one allele (R50X and G205S), and novel splice mutations in introns 3 [IVS3-26A>G (c.425-26A>G)] and 5 [IVS5-601G>A (c.856-601G>A)] on the other allele. Plasma lactate after ischaemic exercise decreased in all typical McArdle patients, but increased in the two atypical McArdle patients (10% of that in healthy subjects). Peak workload and oxidative capacity were 2-fold higher in patients with atypical McArdle disease compared to typical McArdle patients. Oxygen uptake, relative to cardiac output, was severely impaired in the 47 patients with typical McArdle disease, and partially normalized in the milder affected McArdle patients. These findings identify the first distinct genotype-phenotype relationship in McArdle disease, and indicate that minimal myophosphorylase activity ameliorates the typical McArdle disease phenotype by augmenting muscle oxidative capacity. The milder form of McArdle disease provides important clues to the level of functional myophosphorylase needed to support muscle oxidative metabolism.
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Affiliation(s)
- John Vissing
- Department of Neurology 2082, University of Copenhagen, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark.
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Duno M, Quinlivan R, Vissing J, Schwartz M. High-resolution Melting Facilitates Mutation Screening ofPYGMin Patients with McArdle Disease. Ann Hum Genet 2009; 73:292-7. [DOI: 10.1111/j.1469-1809.2009.00512.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lucia A, Nogales-Gadea G, Pérez M, Martín MA, Andreu AL, Arenas J. McArdle disease: what do neurologists need to know? ACTA ACUST UNITED AC 2008; 4:568-77. [PMID: 18833216 DOI: 10.1038/ncpneuro0913] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Accepted: 08/07/2008] [Indexed: 11/09/2022]
Abstract
McArdle disease (also known as glycogen storage disease type V) is a pure myopathy caused by an inherited deficit of myophosphorylase, the skeletal muscle isoform of the enzyme glycogen phosphorylase. The disease exhibits clinical heterogeneity, but patients typically experience exercise intolerance, that is, reversible, acute crises (early fatigue and contractures, sometimes with rhabdomyolysis and myoglobinuria) triggered by static muscle contractions (e.g. lifting weights) or dynamic exercise (e.g. climbing stairs or running). In this Review, we discuss the main features of McArdle disease, with the aim of providing neurologists with up-to-date, useful information to assist their patients. The topics covered include diagnostic tools-for example, molecular genetic diagnosis, the classic ischemic forearm test and the so-called 'second wind' phenomenon-and current therapeutic options-for example, a carbohydrate-rich diet and carbohydrate ingestion shortly before strenuous exercise, in combination with medically supervised aerobic training of low to moderate intensity.
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Affiliation(s)
- Alejandro Lucia
- Department of Physiology, Universidad Europea de Madrid, Madrid, Spain.
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Sharov VS, Galeva NA, Dremina ES, Williams TD, Schöneich C. Inactivation of rabbit muscle glycogen phosphorylase b by peroxynitrite revisited: does the nitration of Tyr613 in the allosteric inhibition site control enzymatic function? Arch Biochem Biophys 2008; 484:155-66. [PMID: 19146822 DOI: 10.1016/j.abb.2008.12.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Revised: 12/22/2008] [Accepted: 12/22/2008] [Indexed: 11/28/2022]
Abstract
There is increasing evidence that sequence-specific formation of 3-nitrotyrosine (3-NT) may cause functional changes in target proteins. Recently, the nitration of Tyr residues in glycogen phosphorylase b (Ph-b) was implicated in the age-associated decline of protein function [Sharov et al., Exp. Gerontol. 41 (2006) 407-416]; in another report, the nitration of one specific residue, Tyr613, located in the allosteric inhibition site was hypothesized as a rationale for peroxynitrite inactivation [Dairou et al., J. Mol. Biol. 372 (2007) 1009-1021]. In this study, we have optimized the analysis of in-gel Ph-b digests by high performance liquid chromatography-electro spray ionization-tandem mass spectrometry, in order to achieve a quantitative analysis of nitration of individual Tyr residues at a high coverage of Tyr-containing sequences (92%). Our data do not confirm the role of Tyr613 nitration in the control of enzymatic function. Furthermore, we show here that the enzymatic activity of Ph-b does not directly correlate with the protein nitration levels, and that the modification of Cys and, potentially, other amino acid residues can better rationalize Ph-b inactivation by peroxynitrite.
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Affiliation(s)
- Victor S Sharov
- Department of Pharmaceutical Chemistry, University of Kansas, 2095 Constant Avenue, Lawrence, KS 66047, USA
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[McArdle disease (gycogenosis type V): analysis of clinical, biological and genetic features of five French patients]. Rev Neurol (Paris) 2008; 164:912-6. [PMID: 18808785 DOI: 10.1016/j.neurol.2008.03.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2007] [Revised: 03/02/2008] [Accepted: 03/20/2008] [Indexed: 11/20/2022]
Abstract
INTRODUCTION McArdle disease (glycogenosis type V) is an autosomal recessive metabolic myopathy. Defect in glycogen breakdown is due to mutations of the gene for myophosphorylase (PYGM). Among patients of the department, we searched for correlations between disease phenotype, biochemistry analysis of muscle samples and PYGM genotype. METHODS We included five patients whose muscle biopsy showed deposits of glycogen and negative histochemical staining for myophosphorylase. RESULTS All patients exhibited exercise intolerance and high serum CK levels (mean 4400). Two of them had an acute renal insufficiency caused by rhabdomyolysis. One patient developed moderate late-onset muscle weakness of the proximal part of upper limbs. Muscle glycogen concentration was high (three times the normal). Myophosphorylase activity was undetectable in four muscle samples out of five. Two patients were homozygous and two other heterozygous for the R50X mutation of PYGM. The other one had a novel missense mutation S814N. Patients homozygous for R50X mutation had higher CK levels (8080 versus 1457, p=0.046), but disease severity and muscle glycogen concentrations were equivalent. CONCLUSIONS Our patients had typical clinical and laboratory features of McArdle disease. Diagnosis was suggested by exercise intolerance with high CK levels. The R50X mutation was the most common (60% of the mutated alleles). We found no relationship between clinical severity, PYGM genotype and biochemistry analysis of muscle samples.
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Nogales-Gadea G, Rubio JC, Fernandez-Cadenas I, Garcia-Consuegra I, Lucia A, Cabello A, Garcia-Arumi E, Arenas J, Andreu AL, Martín MA. Expression of the muscle glycogen phosphorylase gene in patients with McArdle disease: the role of nonsense-mediated mRNA decay. Hum Mutat 2008; 29:277-83. [PMID: 17994553 DOI: 10.1002/humu.20649] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Nearly 35% of all mutations identified in the muscle glycogen phosphorylase gene (PYGM) in patients with McArdle disease result in premature termination codons (PTCs), particularly the p.R50X mutation. The latter accounts for more than 50% of the mutated alleles in most Caucasian patient populations. Mutations resulting in PTC could trigger the degradation of mRNA through a mechanism known as nonsense mediated decay (NMD). To investigate if NMD affects the levels of transcripts containing PYGM mutations, 28 Spanish patients with McArdle disease, harboring 17 different mutations with PTCs in 77% of their alleles, were studied. Transcripts levels of PYGM were measured and sequenced. We assessed that 92% of patients showed NMD. The most frequent mutation (p.R50X) elicited decay in all the genotypes tested. Other PTC producing mutations resulting in NMD were: p.L5VfsX22, p.Q73HfsX7, p.E125X, p.N134KfsX161, p.W388SfsX34, p.R491AfsX7, and p.D534VfsX5. Located in the last exon, the mutation p.E797VfsX19 was not affected by NMD. Missense mutations did not appear to be affected by NMD. In the cDNA sequences they appeared as homozygous, despite being heterozygous in the genomic DNA sequences. Exceptions to the rules governing NMD were found in the mutations p.A704 V and p.K754NfsX49.
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Affiliation(s)
- Gisela Nogales-Gadea
- Departament de Patologia Mitocondrial i Neuromuscular, Institut de Recerca, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Martinuzzi A, Liava A, Trevisi E, Frare M, Tonon C, Malucelli E, Manners D, Kemp GJ, Testa C, Barbiroli B, Lodi R. Randomized, placebo-controlled, double-blind pilot trial of ramipril in McArdle's disease. Muscle Nerve 2008; 37:350-7. [DOI: 10.1002/mus.20937] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Beauchamp NJ, Taybert J, Champion MP, Layet V, Heinz-Erian P, Dalton A, Tanner MS, Pronicka E, Sharrard MJ. High frequency of missense mutations in glycogen storage disease type VI. J Inherit Metab Dis 2007; 30:722-34. [PMID: 17705025 DOI: 10.1007/s10545-007-0499-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2006] [Revised: 05/11/2007] [Accepted: 06/11/2007] [Indexed: 11/24/2022]
Abstract
Deficiency of liver glycogen phosphorylase in glycogen storage disease (GSD) type VI results in a reduced ability to mobilize glucose from glycogen. Six mutations of the PYGL gene, which encodes the liver isoform of the enzyme, have been identified in the literature. We have characterized eight patients from seven families with GSD type VI and identified 11 novel PYGL gene defects. The majority of the mutations were missense, resulting in the substitution of highly conserved residues. These could be grouped into those that were predicted to affect substrate binding (p.V456M, p.E673K, p.S675L, p.S675T), pyridoxal phosphate binding (p.R491C, p.K681T), or activation of glycogen phosphorylase (p.Q13P) or that had an unknown effect (p.N632I and p.D634H). Two mutations were predicted to result in null alleles, p.R399X and [c.1964_1969inv6;c.1969+1_+4delGTAC]. Only 7 of the 23 (30%) reported PYGL alleles carry nonsense, splice site or frameshift mutations compared to 68-80% of affected alleles of the highly homologous muscle glycogen phosphorylase gene, PYGM, that underlie McArdle disease. There was heterogeneity in the clinical symptoms observed in affected individuals. These varied from hepatomegaly and subclinical hypoglycaemia, to severe hepatomegaly with recurrent severe hypoglycaemia and postprandial lactic acidosis. We conclude that deficiency of liver glycogen phosphorylase is predominantly the result of missense mutations affecting enzyme activity. There are no common mutations and the severity of clinical symptoms varies significantly.
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Affiliation(s)
- N J Beauchamp
- Academic Unit of Child Health, University of Sheffield, Stephenson Wing, Sheffield Children's NHS Trust, Western Bank, Sheffield, S10 2TH, UK.
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Maté-Muñoz JL, Moran M, Pérez M, Chamorro-Viña C, Gómez-Gallego F, Santiago C, Chicharro L, Foster C, Nogales-Gadea G, Rubio JC, Andreu AL, Martín MA, Arenas J, Lucia A. Favorable responses to acute and chronic exercise in McArdle patients. Clin J Sport Med 2007; 17:297-303. [PMID: 17620784 DOI: 10.1097/jsm.0b013e3180f6168c] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study reports acute exercise responses in a large (N = 46) series of patients with McArdle disease and responses to exercise training in a smaller (n = 9) set of patients. DESIGN Patients were studied during both incremental and steady-state cycle ergometer exercise, using cardiopulmonary testing, and the patients were compared with age- and gender-matched controls. SETTING The study was performed in a university setting (clinical exercise physiology laboratory). PARTICIPANTS The 46 patients showed common features of McArdle disease. They were definitively diagnosed by histochemistry, biochemistry, and/or molecular genetic analysis. The 46 controls were healthy, sedentary individuals. INTERVENTION Nine patients were studied before and after an 8-month supervised aerobic exercise training program (including five weekly sessions of walking and/or cycling exercise with a duration no greater than 60 minutes). MAIN OUTCOME MEASUREMENTS The main indicators of exercise capacity that we measured were peak power output, peak oxygen uptake (VO2peak), and ventilatory threshold (VT). RESULTS Exercise capacity (peak power output, 35% control; VO2peak, 44% control; VT, 66% control) was markedly depressed in the patients. The patients who trained improved peak power output (25%), VO2peak (44%), and VT (27%), with no evidence of negative outcomes from training. Although not achieving normal values, the response to training put the patients into the lower limit of normal controls. CONCLUSIONS Under carefully controlled conditions, patients with McArdle disease may perform acute exercise safely, and they may respond favorably to training. This may offer an additional therapeutic option to help normalize the lifestyles of these patients.
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Rubio JC, Gómez-Gallego F, Santiago C, García-Consuegra I, Pérez M, Barriopedro MI, Andreu AL, Martín MA, Arenas J, Lucia A. Genotype modulators of clinical severity in McArdle disease. Neurosci Lett 2007; 422:217-22. [PMID: 17630210 DOI: 10.1016/j.neulet.2007.06.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Revised: 06/11/2007] [Accepted: 06/14/2007] [Indexed: 01/05/2023]
Abstract
The phenotypic manifestation of McArdle disease varies considerably from one individual to the next. The purpose of this study was to assess the possible association between the clinical severity of the disease, and each of the genotypes PYGM (R50X), ACE (I/D), AMPD1 (Q12X), PPARGC1A (G482S) and ACTN3 (R577X). We also assessed links between clinical disease severity and other potential phenotype modulators such as age or gender. McArdle disease was diagnosed in 99 patients of Spanish origin (60 male, 39 female; age range 8-81 years) by identifying the two mutant alleles of the PYGM gene. Disease severity was assessed using the grading scheme previously reported by Martinuzzi et al. [A. Martinuzzi, E. Sartori, M. Fanin, et al., Phenotype modulators in myophosphorylase deficiency, Ann. Neurol. 53 (2003) 497-502]. Significant correlation was observed (exact two-sided P<0.0001) between the number of D alleles of the ACE gene and the disease severity score. Rank-order correlation coefficients were 0.296 (95% CI: 0.169, 0.423) (Kendall's tau) and 0.345 (95% CI: 0.204, 0.486) (Somer's D). No significant relationships were detected between clinical severity and the remaining genotypes examined. Finally, disease severity was significantly worse in women with the disease. Our findings indicate that both ACE genotype and gender contribute to how McArdle disease manifests in an individual patient. The role of other candidate genes remains to be elucidated.
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Affiliation(s)
- Juan C Rubio
- Centro de Investigación, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
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Lucia A, Gómez-Gallego F, Santiago C, Pérez M, Maté-Muñoz JL, Chamorro-Viña C, Nogales-Gadea G, Foster C, Rubio JC, Andreu AL, Martín MA, Arenas J. The 577X allele of the ACTN3 gene is associated with improved exercise capacity in women with McArdle's disease. Neuromuscul Disord 2007; 17:603-10. [PMID: 17560787 DOI: 10.1016/j.nmd.2007.04.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2006] [Revised: 03/01/2007] [Accepted: 04/26/2007] [Indexed: 11/20/2022]
Abstract
We assessed the possible association existing between alpha-actinin-3 (ACTN3) R577X genotypes and the capacity for performing aerobic exercise in McArdle's patients. Forty adult McArdle's disease patients and forty healthy, age and gender-matched sedentary controls (21 men, 19 women in both groups) performed a graded test until exhaustion and a constant-load test on a cycle-ergometer to determine clinically relevant indices of exercise capacity as peak oxygen uptake (VO(2peak)) and the ventilatory threshold (VT). In the group of diseased women, carriers of the X allele had a higher (P<0.01) VO(2peak) (15.0+/-1.2 ml/kg/min) and a higher (P<0.05) oxygen uptake (VO(2)) at the VT (11.2+/-1 ml/kg/min) than R/R homozygotes (VO(2peak): 9.6+/-0.5 ml/kg/min; VO(2) at the VT: 8.2+/-0.7 ml/kg/min). No differences were found in male patients. In women with McArdle's disease, ACTN3 genotypes might partly explain the large individual variability that exists in the phenotypic manifestation of this disorder.
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Deschauer M, Morgenroth A, Joshi PR, Gläser D, Chinnery PF, Aasly J, Schreiber H, Knape M, Zierz S, Vorgerd M. Analysis of spectrum and frequencies of mutations in McArdle disease. Identification of 13 novel mutations. J Neurol 2007; 254:797-802. [PMID: 17404776 DOI: 10.1007/s00415-006-0447-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Revised: 10/02/2006] [Accepted: 10/19/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND McArdle disease, a common metabolic myopathy with autosomal recessive inheritance, is caused by a frequent R50X mutation and many rare mutations in the myophosphorylase gene. OBJECTIVES To identify spectrum and frequencies of myophosphorylase gene mutations in a large cohort of patients with McArdle disease, to discuss diagnostic implications, and to analyse genotype-phenotype relationship. METHODS Molecular genetic analysis of 56 index patients with muscle biopsy-proven myophosphorylase deficiency from Germany (n = 35), UK (n = 13), and several other countries (n = 8) was performed using direct sequencing. RESULTS Allele frequency of the R50X mutation was 58%, and 71% of the patients carried this mutation at least on one allele. We detected 26 other less common mutations, 13 of which are novel: G157V, R161C, Q337R, E384K, S450L, G486D, R570W, K575E, IVS6-2A>T, IVS10+1G>A, R650X, c.1354insC, c.1155_1156delGG. There was no genotype-phenotype correlation with respect to age of onset and severity. R270X was the most frequent mutation among the less common mutations reaching an allele frequency of 5% followed by R94W and G686R representing a frequency of 4% each. CONCLUSIONS The study further extends the genetic heterogeneity of myophosphorylase gene mutations showing no mutational hotspot and no genotype-phenotype correlation. Most novel missense mutations were located in secondary structures or active sites of the enzyme. Some of the less common mutations are recurrent with different frequencies within Europe. Ethnic origin and frequency of less common mutations must be considered to establish efficient strategies in molecular genetic testing. Performing molecular testing can avoid muscle biopsy.
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Affiliation(s)
- M Deschauer
- Klinik und Poliklinik für Neurologie, Martin-Luther Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06097 Halle/Saale, Germany.
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Abstract
This review highlights recent advances in our understanding of McArdle's disease, including the mechanisms involved in the regulation of the clinical phenotype. The latest molecular genetic studies have demonstrated the genetic heterogeneity of the disorder, with more than 65 mutations identified to date. There is not a specific treatment for McArdle's disease, but some nutritional treatments in combination with aerobic conditioning could improve the quality of life in most patients.
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Affiliation(s)
- G Nogales-Gadea
- Dept Patologia Mitocondrial i Neuromuscular, Centre d'Investigacions en Bioguimica y Bioloqía Molecular, Institut de Recera Vall d'Hebron, Barcelona, Spain
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