1
|
Ishizaki M, Kobayashi M, Hashimoto H, Nakamura A, Maeda Y, Ueyama H, Matsumura T. Caregiver Burden with Duchenne and Becker Muscular Dystrophy in Japan: A Clinical Observation Study. Intern Med 2024; 63:365-372. [PMID: 37344421 PMCID: PMC10901721 DOI: 10.2169/internalmedicine.9372-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/14/2023] [Indexed: 06/23/2023] Open
Abstract
Objective Skeletal muscle weakness and cardiomyopathy can be seen in carriers of dystrophinopathy. Therefore, the health management of caregivers of Duchenne/Becker muscular dystrophy (DMD/BMD) patients who are themselves carriers is an important issue. However, few studies have focused on caregivers who have dystrophin mutations. Methods In this cross-sectional study conducted at five hospitals, the daily living, situation medical treatment status, genetic testing, physical assessment, care burden, and quality of life of caregivers of DMD/BMD patients were surveyed. Results The subjects were 36 main caregivers (mean age 55.7±8.4 years old), of whom 52.8% were diagnosed as carriers, 8.3% were noncarriers, and 38.9% were not confirmed. In addition, half of the caregivers were not examined regularly at medical institutions. Of all caregivers, 54.3% had muscle or cardiac symptoms, and 75% had elevated serum creatine kinase levels. The mean Zarit Caregiver Burden Interview (ZBI) total score of current caregivers was 20.9±13.1. The frequency of a ZBI total score ≥25 was significantly higher in caregivers diagnosed as carriers than in caregivers unexamined as carriers (p=0.04). The health-related quality of life score (Short Form 36; SF-36) in caregivers was slightly lower than the Japanese standard scores in the sections of physical functioning, role limitations-physical, bodily pain, and social functioning. Conclusion Some caregivers of DMD/BMD patients can themselves have muscular or cardiac symptoms and a heavy care burden. It is therefore necessary for carrier caregivers, especially women, to undergo regular health checkups and receive appropriate health management.
Collapse
Affiliation(s)
- Masatoshi Ishizaki
- Department of Neurology, National Hospital Organization Kumamoto Saishun Medical Center, Japan
| | - Michio Kobayashi
- Department of Neurology, National Hospital Organization Akita National Hospital, Japan
| | - Hiroya Hashimoto
- Clinical Research Management Center, Nagoya City University Hospital, Japan
| | - Akinori Nakamura
- Department of Neurology, National Hospital Organization Matsumoto Medical Center, Japan
| | - Yasushi Maeda
- Department of Neurology, National Hospital Organization Kumamoto Saishun Medical Center, Japan
| | - Hidetsugu Ueyama
- Department of Neurology, National Hospital Organization Kumamoto Saishun Medical Center, Japan
| | - Tsuyoshi Matsumura
- Department of Neurology, National Hospital Organization Osaka Toneyama Medical Center, Japan
| |
Collapse
|
2
|
Ban R, Lu X, Pu C, Shi Q, Wang H, Liu H, Zhang Y. A Symptomatic Female Patient with Duchenne Muscular Dystrophy Gene Mutation Showing Rimmed Vacuole in Muscle Biopsy. Neurol India 2022; 70:2262-2264. [PMID: 36352669 DOI: 10.4103/0028-3886.359224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Rui Ban
- Department of Neurology, Chinese General PLA Hospital, Beijing; Nankai University, Nankai Qu, Tianjin, P.R. China
| | - Xianghui Lu
- Department of Neurology, Chinese General PLA Hospital, Beijing, P.R. China
| | - Chuanqiang Pu
- Department of Neurology, Chinese General PLA Hospital, Beijing, P.R. China
| | - Qiang Shi
- Department of Neurology, Chinese General PLA Hospital, Beijing, P.R. China
| | - Huifang Wang
- First Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi, P.R. China
| | - Huaxu Liu
- Department of Neurology, Chinese General PLA Hospital, Beijing, P.R. China
| | - Yutong Zhang
- Department of Neurology, Chinese General PLA Hospital, Beijing, P.R. China
| |
Collapse
|
3
|
Gruber D, Lloyd‐Puryear M, Armstrong N, Scavina M, Tavakoli NP, Brower AM, Caggana M, Chung WK. Newborn screening for Duchenne muscular dystrophy-early detection and diagnostic algorithm for female carriers of Duchenne muscular dystrophy. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2022; 190:197-205. [PMID: 36152336 PMCID: PMC9826042 DOI: 10.1002/ajmg.c.32000] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/24/2022] [Accepted: 08/27/2022] [Indexed: 01/11/2023]
Abstract
Duchenne muscular dystrophy (DMD) is the most common pediatric-onset form of muscular dystrophy, occurring in 1 in 5,000 live male births. DMD is a multi-system disease resulting in muscle weakness with progressive deterioration of skeletal, heart, and smooth muscle, and learning disabilities. Pathogenic/likely pathogenic (P/LP) variants in the DMD gene, which encodes dystrophin protein, cause dystrophinopathy. All males with a P/LP variant in the X-linked DMD gene are expected to be affected. Two to 20% of female heterozygotes with a P/LP variant develop symptoms of dystrophinopathy ranging from mild muscle weakness to significant disability similar to Becker muscular dystrophy. Recently, with improvements in therapies and testing methodology, there is stronger evidence supporting newborn screening (NBS) for DMD for males and females because females may also develop symptoms. A consented pilot study to screen newborns for DMD was initiated in New York State (NYS) and conducted from 2019 to 2021. The identification of female carriers and the realization of the subsequent uncertainty of providers concerning follow-up during the pilot led to the development of algorithms for screening and diagnosis of carrier females, including both NBS and cascade molecular testing of family members.
Collapse
Affiliation(s)
- Dorota Gruber
- Department of PediatricsCohen Children's Medical Center, Northwell HealthNew Hyde ParkNew YorkUSA,Departments of Pediatrics and CardiologyDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNew YorkUSA
| | - Michele Lloyd‐Puryear
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (Retired), National Institutes of HealthBethesdaMarylandUSA
| | - Niki Armstrong
- Parent Project Muscular DystrophyWashingtonDistrict of ColumbiaUSA
| | - Mena Scavina
- Parent Project Muscular DystrophyWashingtonDistrict of ColumbiaUSA,Nemours Children's Health, DelawareWilmingtonDelawareUSA
| | - Norma P. Tavakoli
- Division of Genetics, Wadsworth CenterNew York State Department of HealthAlbanyNew YorkUSA
| | - Amy M. Brower
- American College of Medical Genetics and GenomicsBethesdaMarylandUSA
| | - Michele Caggana
- Division of Genetics, Wadsworth CenterNew York State Department of HealthAlbanyNew YorkUSA
| | - Wendy K. Chung
- Department of PediatricsColumbia University Irving Medical CenterNew YorkNew YorkUSA
| |
Collapse
|
4
|
Apkon S, Kinnett K, Cripe L, Duan D, Jackson JL, Kornegay JN, Mah ML, Nelson SF, Rao V, Scavina M, Wong BL, Flanigan KM. Parent Project Muscular Dystrophy Females with Dystrophinopathy Conference, Orlando, Florida June 26 - June 27, 2019. J Neuromuscul Dis 2021; 8:315-322. [PMID: 33361607 PMCID: PMC10497321 DOI: 10.3233/jnd-200555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Susan Apkon
- Department of Physical Medicine and Rehabilitation, University of Colorado Denver and Children’s Hospital Colorado, Aurora, CO, USA
| | - Kathi Kinnett
- Parent Project Muscular Dystrophy, Hackensack, NJ, USA
| | - Linda Cripe
- The Heart Center, Nationwide Children’s Hospital and the Ohio State University, Columbus, OH, USA
| | - Dongsheng Duan
- Department of Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, MO, USA
| | - Jamie L. Jackson
- Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children’s Hospital; Assistant Professor of Pediatrics and Psychology, The Ohio State University, Columbus, OH, USA
| | - Joe N. Kornegay
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, 4458 TAMU, College Station, TX, USA
| | - May Ling Mah
- The Heart Center, Nationwide Children’s Hospital and the Ohio State University, Columbus, OH, USA
| | - Stanley F. Nelson
- Department of Human Genetics, Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Vamshi Rao
- Department of Pediatrics, Division of Neurology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Mena Scavina
- Department of Neurology, Nemours/duPont Hospital for Children, Wilmington, DE, USA
| | - Brenda L. Wong
- Department of Pediatrics and Neurology, University of Massachusetts Medical School, Worcester, MA USA
| | - Kevin M. Flanigan
- Center for Gene Therapy, Nationwide Children’s Hospital and Departments of Pediatrics and Neurology, Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
5
|
Ban R, Lu X, Pu C, Shi Q, Wang H, Liu H, Zhang Y, Fang F. A symptomatic female patient with duchenne muscular dystrophy gene mutation showing rimmed vacuoles in muscle biopsy. Neurol India 2020; 68:518-521. [PMID: 32415039 DOI: 10.4103/0028-3886.284351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Rui Ban
- Neurological Department of the First Medical Center, Chinese PLA General Hospital; Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, P.R. China
| | - Xianghui Lu
- Geriatric Neurological Department of the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, P.R. China
| | - Chuanqiang Pu
- Neurological Department of the First Medical Center, Chinese PLA General Hospital, P.R. China
| | - Qiang Shi
- Neurological Department of the First Medical Center, Chinese PLA General Hospital, P.R. China
| | - Huifang Wang
- Neurological Department, First Affiliated Hospital of Shanxi Medical University, P.R. China
| | - Huaxu Liu
- Neurological Department of the First Medical Center, Chinese PLA General Hospital, P.R. China
| | - Yutong Zhang
- Neurological Department of the First Medical Center, Chinese PLA General Hospital, P.R. China
| | - Fang Fang
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, P.R. China
| |
Collapse
|
6
|
Ishizaki M, Kobayashi M, Adachi K, Matsumura T, Kimura E. Female dystrophinopathy: Review of current literature. Neuromuscul Disord 2018; 28:572-581. [PMID: 29801751 DOI: 10.1016/j.nmd.2018.04.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/10/2018] [Accepted: 04/06/2018] [Indexed: 01/16/2023]
Abstract
Skeletal muscle or cardiac symptoms are known to appear in a certain proportion of female patients carrying the dystrophin gene mutation. There is limited high-quality evidence to guide the treatment of female carriers of Duchenne muscular dystrophy/Becker muscular dystrophy (DMD/BMD). The available evidence is mainly based on expert opinions and clinical experience. To improve this situation, we reviewed 1002 reports published from 1967 to 2017 to assess the following themes: epidemiology, clinical symptoms, cardiomyopathy, burdens on parents or caregivers, pregnancy or delivery, and prognosis. We aimed to provide guidance for the provision of support, care, and education for patients, caregivers, and health care professionals. There were 271 reports before 1987, and 731 reports after 1987 when dystrophin was first recognized. In this review, we mainly selected 37 papers that were reported after 1987. In seven large research papers, the incidence of skeletal muscle damage among female carriers, including asymptomatic carriers, was reported as 2.5%-19%, and the incidence of dilated cardiomyopathy was 7.3%-16.7% for DMD and 0%-13.3% for BMD. We integrated and summarized the genetically definite manifesting carriers with skeletal muscle symptoms from 10 case series. In combined data, among 93 manifesting carriers, 16 (17.2%) presented with cardiac abnormalities. The frequency of manifesting carriers complicated by cardiomyopathy increased with age. Reports on cardiac magnetic resonance in female carriers and the burden on caregivers are increasing, whereas literatures concerning pregnancy, delivery, and prognosis in female carriers are limited. This represents a future direction for research.
Collapse
Affiliation(s)
- Masatoshi Ishizaki
- Department of Neurology, National Hospital Organization, Kumamoto Saishunso Hospital, Kumamoto, Japan.
| | - Michio Kobayashi
- Department of Neurology, National Hospital Organization, Akita National Hospital, Akita, Japan
| | - Katsuhito Adachi
- Department of Internal Medicine, National Hospital Organization, Tokushima National Hospital, Tokushima, Japan
| | - Tsuyoshi Matsumura
- Department of Neurology, National Hospital Organization, Toneyama National Hospital, Osaka, Japan
| | - En Kimura
- Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| |
Collapse
|
7
|
Finsterer J, Stöllberger C, Freudenthaler B, Simoni DD, Höftberger R, Wagner K. Muscular and cardiac manifestations in a Duchenne-carrier harboring a dystrophin deletion of exons 12-29. Intractable Rare Dis Res 2018; 7:120-125. [PMID: 29862154 PMCID: PMC5982619 DOI: 10.5582/irdr.2018.01003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Female carriers of mutations in the dystrophin gene (DMD-carriers) may manifest clinically in the skeletal muscle, the heart, or both. Cardiac involvement may manifest before, after, or together with the muscle manifestations. A 46y female developed slowly progressive weakness of the lower and upper limbs with left-sided predominance since age 26y. Muscle enzymes were repeatedly elevated and muscle biopsy showed absence of dystrophin. MLPA analysis revealed a deletion of exons 12-29. After starting steroids at age 39y, she developed palpitations and exertional dyspnoea. Cardiac MRI at age 41y revealed mildly reduced systolic function, a slightly enlarged left ventricle, mild hypokinesia of the entire myocardium, and focal, transmural late gadolinium enhancement (LGE) of the midventricular lateral wall. She did not tolerate beta-blockers but profited from ivabradine and lisinopril. In conclusion, muscle manifestations in DMD-carriers with deletions of exons 12-29 may start years before cardiac involvement becomes clinically apparent. Progressive worsening of systolic function in DMD-carriers is attributable to progressive myocardial fibrosis, as demonstrated by LGE. Steroids may trigger the development of cardiac disease in DMD-carriers.
Collapse
Affiliation(s)
- Josef Finsterer
- Krankenanstalt Rudolfstiftung, Vienna, Austria
- Address correspondence to:Dr. Josef Finsterer, Krankenanstalt Rudolfstiftung, Postfach 20, 1180 Vienna, Austria. E-mail:
| | - Claudia Stöllberger
- 2nd Medical Department with Cardiology and Intensive Care Medicine, Krankenanstalt Rudolfstiftung, Vienna, Austria
| | - Birgit Freudenthaler
- 2nd Medical Department with Cardiology and Intensive Care Medicine, Krankenanstalt Rudolfstiftung, Vienna, Austria
| | - Desiree De Simoni
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Romana Höftberger
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Klaus Wagner
- Institute for Human Genetics, Medical University of Graz, Graz, Austria
| |
Collapse
|
8
|
Hedberg Oldfors C, Máthé G, Thomson K, Tulinius M, Karason K, Östman-Smith I, Oldfors A. Early onset cardiomyopathy in females with Danon disease. Neuromuscul Disord 2015; 25:493-501. [PMID: 25900304 DOI: 10.1016/j.nmd.2015.03.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 03/04/2015] [Accepted: 03/11/2015] [Indexed: 11/18/2022]
Abstract
Danon disease is caused by mutations in the lysosome-associated membrane protein-2 gene, LAMP2, located on the X chromosome. Female carriers with LAMP2 mutations most often present with late onset cardiomyopathy and slow disease progress; however, there are unusual cases that emerge early and show a more severe disease course. We investigated the explanted heart and skeletal muscle biopsies in two girls, aged ten and thirteen years, who underwent cardiac transplantation because of hypertrophic cardiomyopathy secondary to LAMP2 mutations and a 41-year old female with late-onset familial LAMP2 cardiomyopathy with more typical clinical phenotype. The two girls in contrast had clinical features that mimicked severe primary hypertrophic cardiomyopathy caused by mutations in genes encoding sarcomeric proteins. Immunohistochemistry in cardiac muscles showed a remarkable pattern with lack of LAMP2 protein in large regions including thousands of cardiomyocytes that also showed myocyte hypertrophy, lysosomal enlargement and disarray. In other equally large regions there were preserved LAMP2 expression and nearly normal histology. The skeletal muscle biopsy revealed no pathological changes. An uneven distribution of LAMP2 protein may cause deleterious effects depending on which regions of the myocardium are lacking LAMP2 protein in spite of an overall moderate reduction of LAMP2 protein. This may be a more common mechanism behind early aggressive disease in females than an overall skewed X-chromosome inactivation in the tissue.
Collapse
Affiliation(s)
| | - Gyöngyvér Máthé
- Department of Clinical Pathology and Genetics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kate Thomson
- Regional Molecular Genetics Laboratory, Churchill Hospital, Oxford, UK
| | - Mar Tulinius
- Department of Paediatrics, The Queen Silvia Children's Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kristjan Karason
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ingegerd Östman-Smith
- Department of Paediatric Cardiology, The Queen Silvia Children's Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Oldfors
- Department of Pathology, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
9
|
Affiliation(s)
- Yu Na Cho
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Chul Choi
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
10
|
Cripe LH, Tobias JD. Cardiac considerations in the operative management of the patient with Duchenne or Becker muscular dystrophy. Paediatr Anaesth 2013; 23:777-84. [PMID: 23869433 DOI: 10.1111/pan.12229] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2013] [Indexed: 12/22/2022]
Abstract
Duchenne muscular dystrophy/Becker muscular dystrophy (DMD/BMD) is a progressive multisystem neuromuscular disorder. In addition to the skeletal muscle, the myocardium in the DMD/BMD patient is dystrophin deficient which results in a progressive cardiomyopathy. The myopathic myocardium poses significant risk of increased morbidity and mortality at the time of major surgical procedures. Careful attention must be given to the DMD/BMD patient during the intraoperative and postoperative period. Anesthesia selection is critical and anesthetics should be avoided which have been shown to be harmful in this patient population. Preanesthesia assessment should include cardiac consultation and detailed preoperative evaluation. Intraoperative management needs to insure that the weakened myocardium is not compromised by physiologic changes such as hypotension or major fluid shifts. Finally, attention to the cardiac status of the patient must continue into the postoperative period. The surgical care of the DMD/BMD patient requires a multispecialty approach to insure operative success.
Collapse
Affiliation(s)
- Linda H Cripe
- The Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH 43205-2664, USA.
| | | |
Collapse
|
11
|
On the edge of noncompaction: Minimally manifesting Duchenne carrier due to the dystrophin mutation n.2867A>C. Int J Cardiol 2013. [DOI: 10.1016/j.ijcard.2012.10.075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
12
|
Findlay AR, Lewis S, Sahenk Z, Flanigan KM. Camptocormia as a late presentation in a manifesting carrier of duchenne muscular dystrophy. Muscle Nerve 2012; 47:124-7. [PMID: 23169483 DOI: 10.1002/mus.23497] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2012] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Camptocormia, or bent spine syndrome, is an abnormal posture consisting of forward flexion of the spine that disappears when a patient is supine. It is associated with a wide variety of myopathic disorders that affect paraspinal muscles, including inflammatory and inherited myopathies. METHODS We describe a woman who presented with camptocormia in her eighth decade. RESULTS Skeletal muscle biopsy showed mild nonspecific changes, but her family history was significant for a son who died of Duchenne muscular dystrophy (DMD). Genetic analysis of DMD confirmed that she was a heterozygous carrier of a mutation. CONCLUSIONS In the absence of any alternate explanation, we interpret her symptoms to be a manifestation of her DMD carrier state. To our knowledge, this represents the first reported example of camptocormia as the presenting symptom in a carrier and suggests that a manifesting carrier state should be considered in the differential diagnosis for women with unexplained camptocormia.
Collapse
Affiliation(s)
- Andrew R Findlay
- The Center for Gene Therapy, Nationwide Children's Hospital, 700 Children's Drive, Columbus, Ohio 43205, USA
| | | | | | | |
Collapse
|
13
|
Brioschi S, Gualandi F, Scotton C, Armaroli A, Bovolenta M, Falzarano MS, Sabatelli P, Selvatici R, D'Amico A, Pane M, Ricci G, Siciliano G, Tedeschi S, Pini A, Vercelli L, De Grandis D, Mercuri E, Bertini E, Merlini L, Mongini T, Ferlini A. Genetic characterization in symptomatic female DMD carriers: lack of relationship between X-inactivation, transcriptional DMD allele balancing and phenotype. BMC MEDICAL GENETICS 2012; 13:73. [PMID: 22894145 PMCID: PMC3459813 DOI: 10.1186/1471-2350-13-73] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 08/08/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although Duchenne and Becker muscular dystrophies, X-linked recessive myopathies, predominantly affect males, a clinically significant proportion of females manifesting symptoms have also been reported. They represent an heterogeneous group characterized by variable degrees of muscle weakness and/or cardiac involvement. Though preferential inactivation of the normal X chromosome has long been considered the principal mechanism behind disease manifestation in these females, supporting evidence is controversial. METHODS Eighteen females showing a mosaic pattern of dystrophin expression on muscle biopsy were recruited and classified as symptomatic (7) or asymptomatic (11), based on the presence or absence of muscle weakness. The causative DMD gene mutations were identified in all cases, and the X-inactivation pattern was assessed in muscle DNA. Transcriptional analysis in muscles was performed in all females, and relative quantification of wild-type and mutated transcripts was also performed in 9 carriers. Dystrophin protein was quantified by immunoblotting in 2 females. RESULTS The study highlighted a lack of relationship between dystrophic phenotype and X-inactivation pattern in females; skewed X-inactivation was found in 2 out of 6 symptomatic carriers and in 5 out of 11 asymptomatic carriers. All females were characterized by biallelic transcription, but no association was found between X-inactivation pattern and allele transcriptional balancing. Either a prevalence of wild-type transcript or equal proportions of wild-type and mutated RNAs was observed in both symptomatic and asymptomatic females. Moreover, very similar levels of total and wild-type transcripts were identified in the two groups of carriers. CONCLUSIONS This is the first study deeply exploring the DMD transcriptional behaviour in a cohort of female carriers. Notably, no relationship between X-inactivation pattern and transcriptional behaviour of DMD gene was observed, suggesting that the two mechanisms are regulated independently. Moreover, neither the total DMD transcript level, nor the relative proportion of the wild-type transcript do correlate with the symptomatic phenotype.
Collapse
Affiliation(s)
- Simona Brioschi
- Section of Medical Genetics, Department of Experimental and Diagnostic Medicine, University of Ferrara, Ferrara, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Soltanzadeh P, Friez MJ, Dunn D, von Niederhausern A, Gurvich OL, Swoboda KJ, Sampson JB, Pestronk A, Connolly AM, Florence JM, Finkel RS, Bönnemann CG, Medne L, Mendell JR, Mathews KD, Wong BL, Sussman MD, Zonana J, Kovak K, Gospe SM, Gappmaier E, Taylor LE, Howard MT, Weiss RB, Flanigan KM. Clinical and genetic characterization of manifesting carriers of DMD mutations. Neuromuscul Disord 2010; 20:499-504. [PMID: 20630757 DOI: 10.1016/j.nmd.2010.05.010] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2009] [Revised: 04/30/2010] [Accepted: 05/18/2010] [Indexed: 10/19/2022]
Abstract
Manifesting carriers of DMD gene mutations may present diagnostic challenges, particularly in the absence of a family history of dystrophinopathy. We review the clinical and genetic features in 15 manifesting carriers identified among 860 subjects within the United Dystrophinopathy Project, a large clinical dystrophinopathy cohort whose members undergo comprehensive DMD mutation analysis. We defined manifesting carriers as females with significant weakness, excluding those with only myalgias/cramps. DNA extracted from peripheral blood was used to study X-chromosome inactivation patterns. Among these manifesting carriers, age at symptom onset ranged from 2 to 47 years. Seven had no family history and eight had male relatives with Duchenne muscular dystrophy (DMD). Clinical severity among the manifesting carriers varied from a DMD-like progression to a very mild Becker muscular dystrophy-like phenotype. Eight had exonic deletions or duplications and six had point mutations. One patient had two mutations (an exonic deletion and a splice site mutation), consistent with a heterozygous compound state. The X-chromosome inactivation pattern was skewed toward non-random in four out of seven informative deletions or duplications but was random in all cases with nonsense mutations. We present the results of DMD mutation analysis in this manifesting carrier cohort, including the first example of a presumably compound heterozygous DMD mutation. Our results demonstrate that improved molecular diagnostic methods facilitate the identification of DMD mutations in manifesting carriers, and confirm the heterogeneity of mutational mechanisms as well as the wide spectrum of phenotypes.
Collapse
Affiliation(s)
- Payam Soltanzadeh
- Department of Human Genetics, University of Utah, Salt Lake City, UT, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Kesari A, Neel R, Wagoner L, Harmon B, Spurney C, Hoffman EP. Somatic mosaicism for Duchenne dystrophy: evidence for genetic normalization mitigating muscle symptoms. Am J Med Genet A 2009; 149A:1499-503. [PMID: 19530190 PMCID: PMC2729699 DOI: 10.1002/ajmg.a.32891] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We describe a young adult male presenting with cardiac failure necessitating cardiac transplantation 7 months after presentation. Skeletal muscle biopsy showed mosaic immunostaining for dystrophin. DNA studies showed somatic mosaicism for a nonsense mutation in the dystrophin gene (Arg2905X). The frequency of normal versus mutant genes were determined in blood/DNA (50:50), muscle/DNA (80:20) and muscle/mRNA (90:10). These data are consistent with genetic normalization processes that may biochemically rescue skeletal muscle in male somatic mosaic patients mitigating muscle symptoms (gradual loss of dystrophin-negative skeletal muscle tissue replaced by dystrophin-positive stem cells). To our knowledge, this is only the second reported case of a clinically ascertained patient showing somatic mosaicism for Duchenne muscular dystrophy (DMD). We hypothesize that many somatic mosaic males for DMD exist, yet they are not detected clinically due to genetic normalization. Somatic mosaicism for DMD should be considered in acute heart failure with dilated cardiomyopathy, as genetic normalization in heart is unlikely to occur.
Collapse
Affiliation(s)
- Akanchha Kesari
- Research Center for Genetic Medicine, Children's National Medical Center, Washington, District of Columbia 20010, USA
| | | | | | | | | | | |
Collapse
|
16
|
Ross LF. Screening for conditions that do not meet the Wilson and Jungner criteria: the case of Duchenne muscular dystrophy. Am J Med Genet A 2009; 140:914-22. [PMID: 16528755 DOI: 10.1002/ajmg.a.31165] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this manuscript, I examine four overlapping policy and ethical issues regarding screening newborns (and infants) for Duchenne muscular dystrophy (DMD). First, what are the risks and benefits of expanding newborn screening (NBS) to include DMD? Second, if NBS were to expand to include DMD, should it require informed consent? Third, should NBS for DMD be limited to boys? Why or why not? Fourth, when is the ideal timing for screening (prenatal, newborn, or later in infancy) and what factors influence this determination? I argue that decisions about when, how, and whom to test reflect a tension between maximizing uptake and diagnosis versus maximizing autonomy and choice with respect to genetic information. I conclude that screening for DMD is a valid moral option, but not as part of the mandatory NBS population program. Rather, I propose that screening for DMD should be offered only on a voluntary basis beyond the newborn period. I support offering this screening to families of young boys and girls to ensure that all children and their families can benefit from early diagnosis and its reproductive implications. A rigorous consent process will be necessary to ensure that the decision whether or not to test is a voluntary and informed choice.
Collapse
Affiliation(s)
- Lainie Friedman Ross
- Department of Pediatrics, Section of General Pediatrics, University of Chicago, Illinois 60637, USA.
| |
Collapse
|
17
|
Walcher T, Kunze M, Steinbach P, Sperfeld AD, Burgstahler C, Hombach V, Torzewski J. Cardiac involvement in a female carrier of Duchenne muscular dystrophy. Int J Cardiol 2008; 138:302-5. [PMID: 18706718 DOI: 10.1016/j.ijcard.2008.06.084] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Accepted: 06/28/2008] [Indexed: 11/26/2022]
Abstract
A 42 year-old female carrier of Duchenne muscular dystrophy (DMD) was referred with suspected subacute myocarditis and non-sustained ventricular tachycardia. Echochardiography and cardiac catheterization revealed severely reduced left ventricular function (LVF). Coronary artery disease was excluded. Cardiac magnetic resonance imaging showed transmural, intramural and subepicardial late gadolinium enhancement. Myocardial biopsy excluded viral infection and showed severe myopathic changes with abnormal expression of dystrophin and utrophin. Moleculargenetic analysis of the DMD gene revealed frameshift duplication of exon 2. The patient received conventional heart failure therapy, implantable cardioverter/defibrillator-implantation and prednisolone to attenuate cardiac degradation. 6 months later she had improved clinically though LVF was still severely reduced.
Collapse
|
18
|
Schmidt GN, Burmeister MA, Lilje C, Wappler F, Bischoff P. Acute heart failure during spinal surgery in a boy with Duchenne muscular dystrophy. Br J Anaesth 2003; 90:800-4. [PMID: 12765898 DOI: 10.1093/bja/aeg116] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Patients with Duchenne muscular dystrophy (DMD) are at high risk of perioperative complications. DMD may be accompanied by heart failure resulting from dystrophic involvement of the myocardium, which can be subclinical in the early stages of the disease. This case demonstrates that a normal preoperative ECG and echocardiograph cannot exclude the development of heart failure during anaesthesia in DMD patients undergoing major surgery.
Collapse
Affiliation(s)
- G N Schmidt
- Department of Anaesthesiology, University Hospital Eppendorf, Hamburg, Germany.
| | | | | | | | | |
Collapse
|
19
|
Lu S, Hoey A. Age- and sex-associated changes in cardiac beta(1)-adrenoceptors from the muscular dystrophy (mdx) mouse. J Mol Cell Cardiol 2000; 32:1661-8. [PMID: 10966828 DOI: 10.1006/jmcc.2000.1200] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Variations in beta(1)-adrenoceptor function due to age or sex were examined in the mouse model of Duchenne muscular dystrophy. Positive chronotropic and inotropic responses to (-)-isoprenaline and antagonist effects of CGP20712A were determined in isolated right and left atria from young (12 week) and old (12 month) male and old (12 month) female mdx mice and their age- and sex-matched C57BL/10ScSn (C57) mice. There was no difference in efficacy to (-)-isoprenaline when expressed as an increase in the rate of contraction or force of contraction as a percentage of Ca(2+)-induced increase respectively in right or left atria from age- and sex-matched mdx and C57. Old mdx males showed a decreased sensitivity to (-)-isoprenaline (P<0.05) and a reduced affinity to CGP 20712A (P<0.05) in both right and left atria compared with old C57 males. These same changes were also observed in left atria between old and young mdx males. A reduced efficacy to (-)-isoprenaline was also evident when young and old mdx males were compared. In contrast, in old females, mdx showed an increased affinity to CGP20712A in left and right atria (P<0.05), and an enhanced sensitivity to (-)-isoprenaline in right atria. Finally, in left atria, the maximum Ca(2+)-induced increase in force of contraction was lower in all mdx compared to their age- and sex-matched C57 (P<0.05). In conclusion, age- and sex-associated changes in beta(1)-adrenoceptor function and responses to calcium were demonstrated in cardiac muscle from mdx mice, with a marked deterioration in beta(1)-adrenoceptor function occurring with aging in male mdx being particularly evident.
Collapse
Affiliation(s)
- S Lu
- Department of Biological and Physical Sciences, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
| | | |
Collapse
|
20
|
Posada Rodríguez IJ, Gutiérrez-Rivas E, Cabello A. [Cardiac involvement in neuromuscular diseases]. Rev Esp Cardiol 1997; 50:882-901. [PMID: 9470454 DOI: 10.1016/s0300-8932(97)74695-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Many neuromuscular disorders involve the heart, occasionally with overt clinical disease. Muscular dystrophies (dystrophinopathies, limb girdle muscular dystrophy, Emery-Dreifuss muscular dystrophy, Steinert's myotonic dystrophy), congenital myopathies, inflammatory myopathies and metabolic diseases (glycogenosis, periodic paralysis, mitochondrial diseases) may produce dilated or hypertrophic cardiomyopathy and heart rhythm or conduction disturbances. Furthermore the heart is commonly involved in some hereditary and degenerative diseases (Friedreich's ataxia and Kugelberg-Welander syndrome) and acquired (Guillain-Barré syndrome) or inherited (Refsum's disease and Charcot-Marie-Tooth syndrome) polyneuropathies. A cardiologist's high clinical suspicion and a simple but systematic skeletal muscle and peripheral nerve investigation, including muscle enzymes quantification, neurophysiological study and muscle biopsy, are necessary for an accurate diagnosis. In selected patients, more sophisticated biochemical and genetic analysis will be necessary. In most cases, endomyocardial biopsy is not essential for the diagnosis.
Collapse
MESH Headings
- Adolescent
- Adult
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/etiology
- Cardiomyopathy, Dilated/diagnosis
- Cardiomyopathy, Dilated/etiology
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/etiology
- Charcot-Marie-Tooth Disease/complications
- Child
- Child, Preschool
- Echocardiography
- Electrocardiography
- Glycogen Storage Disease/complications
- Glycogen Storage Disease/diagnosis
- Heart Diseases/diagnosis
- Heart Diseases/etiology
- Humans
- Infant
- Infant, Newborn
- Male
- Middle Aged
- Mitochondrial Myopathies/complications
- Mitochondrial Myopathies/diagnosis
- Muscular Atrophy/complications
- Muscular Atrophy/diagnosis
- Muscular Dystrophies/complications
- Muscular Dystrophies/diagnosis
- Myopathies, Nemaline/complications
- Myopathies, Nemaline/diagnosis
- Neuromuscular Diseases/complications
- Neuromuscular Diseases/diagnosis
- Neuromuscular Diseases/metabolism
- Paralyses, Familial Periodic/complications
- Paralyses, Familial Periodic/diagnosis
- Polyradiculoneuropathy/complications
- Polyradiculoneuropathy/diagnosis
- Refsum Disease/complications
- Refsum Disease/diagnosis
Collapse
|