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Rathore G, Kang PB. Pediatric Neuromuscular Diseases. Pediatr Neurol 2023; 149:1-14. [PMID: 37757659 DOI: 10.1016/j.pediatrneurol.2023.08.034] [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: 03/15/2023] [Revised: 07/25/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023]
Abstract
The diagnostic and referral workflow for children with neuromuscular disorders is evolving, particularly as newborn screening programs are expanding in tandem with novel therapeutic developments. However, for the children who present with symptoms and signs of potential neuromuscular disorders, anatomic localization, guided initially by careful history and physical examination, continues to be the cardinal initial step in the diagnostic evaluation. It is important to consider whether the localization is more likely to be in the lower motor neuron, peripheral nerve, neuromuscular junction, or muscle. After that, disease etiologies can be divided broadly into inherited versus acquired categories. Considerations of localization and etiologies will help generate a differential diagnosis, which in turn will guide diagnostic testing. Once a diagnosis is made, it is important to be aware of current treatment options, as a number of new therapies for some of these disorders have been approved in recent years. Families are also increasingly interested in clinical research, which may include natural history studies and interventional clinical trials. Such research has proliferated for rare neuromuscular diseases, leading to exciting advances in diagnostic and therapeutic technologies, promising dramatic changes in the landscape of these disorders in the years to come.
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Affiliation(s)
- Geetanjali Rathore
- Division of Neurology, Department of Pediatrics, University of Nebraska College of Medicine, Omaha, Nebraska
| | - Peter B Kang
- Paul and Sheila Wellstone Muscular Dystrophy Center and Department of Neurology, University of Minnesota Medical School, Minneapolis, Minnesota; Institute for Translational Neuroscience, University of Minnesota, Minneapolis, Minnesota.
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2
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Younger DS. Childhood muscular dystrophies. HANDBOOK OF CLINICAL NEUROLOGY 2023; 195:461-496. [PMID: 37562882 DOI: 10.1016/b978-0-323-98818-6.00024-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Infancy- and childhood-onset muscular dystrophies are associated with a characteristic distribution and progression of motor dysfunction. The underlying causes of progressive childhood muscular dystrophies are heterogeneous involving diverse genetic pathways and genes that encode proteins of the plasma membrane, extracellular matrix, sarcomere, and nuclear membrane components. The prototypical clinicopathological features in an affected child may be adequate to fully distinguish it from other likely diagnoses based on four common features: (1) weakness and wasting of pelvic-femoral and scapular muscles with involvement of heart muscle; (2) elevation of serum muscle enzymes in particular serum creatine kinase; (3) necrosis and regeneration of myofibers; and (4) molecular neurogenetic assessment particularly utilizing next-generation sequencing of the genome of the likeliest candidates genes in an index case or family proband. A number of different animal models of therapeutic strategies have been developed for gene transfer therapy, but so far these techniques have not yet entered clinical practice. Treatment remains for the most part symptomatic with the goal of ameliorating locomotor and cardiorespiratory manifestations of the disease.
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Affiliation(s)
- David S Younger
- Department of Clinical Medicine and Neuroscience, CUNY School of Medicine, New York, NY, United States; Department of Medicine, Section of Internal Medicine and Neurology, White Plains Hospital, White Plains, NY, United States.
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Devkota S, Shrestha S, Gurung T, Shrestha S. Regional anesthesia as a safe option in patient with limb girdle muscular dystrophy undergoing total abdominal hysterectomy: A case report and case review. Clin Case Rep 2022; 10:e6523. [PMID: 36381058 PMCID: PMC9637942 DOI: 10.1002/ccr3.6523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/25/2022] [Accepted: 10/08/2022] [Indexed: 11/09/2022] Open
Abstract
Regional anesthesia can be a very safe option in patients with limb girdle muscular dystrophy undergoing lower abdominal surgeries as general anesthesia and volatile anesthetic agents are associated with increased risk of malignant hyperthermia and rhabdomyolysis.
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Affiliation(s)
- Sagar Devkota
- Department of Anesthesiology and Critical Care Sindhuli Hospital Sindhuli Nepal
| | | | - Tara Gurung
- Department of Anesthesiology PMWH Kathmandu Nepal
| | - Saurav Shrestha
- Department of Anesthesiology and Critical Care Nepal APF Hospital Kathmandu Nepal
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A Novel Homozygous Variant in DYSF Gene Is Associated with Autosomal Recessive Limb Girdle Muscular Dystrophy R2/2B. Int J Mol Sci 2022; 23:ijms23168932. [PMID: 36012197 PMCID: PMC9408934 DOI: 10.3390/ijms23168932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Mutations in the DYSF gene, encoding dysferlin, are responsible for Limb Girdle Muscular Dystrophy type R2/2B (LGMDR2/2B), Miyoshi myopathy (MM), and Distal Myopathy with Anterior Tibialis onset (MDAT). The size of the gene and the reported inter and intra familial phenotypic variability make early diagnosis difficult. Genetic analysis was conducted using Next Gene Sequencing (NGS), with a panel of 40 Muscular Dystrophies associated genes we designed. In the present study, we report a new missense variant c.5033G>A, p.Cys1678Tyr (NM_003494) in the exon 45 of DYSF gene related to Limb Girdle Muscular Dystrophy type R2/2B in a 57-year-old patient affected with LGMD from a consanguineous family of south Italy. Both healthy parents carried this variant in heterozygosity. Genetic analysis extended to two moderately affected sisters of the proband, showed the presence of the variant c.5033G>A in both in homozygosity. These data indicate a probable pathological role of the variant c.5033G>A never reported before in the onset of LGMDR2/2B, pointing at the NGS as powerful tool for identifying LGMD subtypes. Moreover, the collection and the networking of genetic data will increase power of genetic-molecular investigation, the management of at-risk individuals, the development of new therapeutic targets and a personalized medicine.
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Neuromuscular diseases and their cardiac manifestations under the spectrum of cardiovascular imaging. Heart Fail Rev 2022; 27:2045-2058. [PMID: 35857244 DOI: 10.1007/s10741-022-10260-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2022] [Indexed: 11/04/2022]
Abstract
Neuromuscular diseases (NMDs) include a broad spectrum of disorders that affect motor unit in every possible site, extending from the cell body of peripheral nerves to the muscle. The different lesion sites make this group of inherited disorders difficult to diagnose. Many NMDs, especially those involving skeletal muscles, can present significant cardiovascular complications, ranging from rhythm disturbances to the development of dilated or hypertrophic cardiomyopathy. Heart disease represents a major cause of morbidity and mortality among NMD patients, underlining the vital need for further familiarization with the pathogenesis and assessment of cardiac involvement. Cardiovascular imaging is the cornerstone for the evaluation of heart disorders in NMDs, with conventional echocardiography still offering a portable, affordable, and easily accessible solution. Meanwhile, newer echocardiographic techniques such as speckle tracking imaging in combination with cardiac magnetic resonance add new insights into further substrate characterization. The purpose of this review is to offer a brief presentation of the main NMDs and their cardiovascular complications, as well as the presentation of data that highlight the importance of cardiovascular imaging in early diagnosis, monitoring, and prognosis of these patients. Lastly, the authors provide a simple guide about which clinical features, imaging findings, and follow-up plan to adopt in each myopathic disorder.
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Alharbi N, Matar R, Cupler E, Al-Hindi H, Murad H, Alhomud I, Monies D, Alshehri A, Alyahya M, Meyer B, Bohlega S. Clinical, Neurophysiological, Radiological, Pathological, and Genetic Features of Dysferlinopathy in Saudi Arabia. Front Neurosci 2022; 16:815556. [PMID: 35273475 PMCID: PMC8902167 DOI: 10.3389/fnins.2022.815556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTo characterize the phenotypic, neurophysiological, radiological, pathological, and genetic profile of 33 Saudi Arabian families with dysferlinopathy.MethodsA descriptive observational study was done on a cohort of 112 Saudi Arabian families with LGMD. Screening for the Dysferlin (DYSF) gene was done in a tertiary care referral hospital in Saudi Arabia. Clinical, Neurophysiological, Radiological, Pathological, and Genetic findings in subjects with dysferlin mutation were the primary outcome variables. Statistical analysis was done by Epi-info.Results33 out of 112 families (29.46%) registered in the LGMD cohort had Dysferlinopathy. 53 subjects (28 males, 52.83%) from 33 families were followed up for various periods ranging from 1 to 28 years. The mean age of onset was 17.79 ± 3.48 years (Range 10 to 25 years). Miyoshi Myopathy phenotype was observed in 50.94% (27 out of 53), LGMDR2 phenotype in 30.19% (16 out of 53), and proximodistal phenotype in 15.09% (8 out of 53) of the subjects. Loss of ambulation was observed in 39.62% (21 out of 53 subjects). Electrophysiological, Radiological, and histopathological changes were compatible with the diagnosis. Mean serum Creatinine Kinase was 6,464.45 ± 4,149.24 with a range from 302 to 21,483 IU/L. In addition, 13 dysferlin mutations were identified two of them were compound heterozygous. One founder mutation was observed c.164_165insA in 19 unrelated families.ConclusionThe prevalence of Dysferlinopathy was 29.46% in the native Saudi LGMD cohort. It is the most prevalent subtype seconded by calpainopathy. The clinical course varied among the study subjects and was consistent with those reported from different ethnic groups. One founder mutation was identified. Initial screening of the founder mutations in new families is highly recommended.
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Affiliation(s)
- Norah Alharbi
- Department of Clinical Science, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | | | - Edward Cupler
- Department of Neuroscience, King Faisal Specialist Hospital, and Research Center, Jeddah, Saudi Arabia
| | - Hindi Al-Hindi
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hatem Murad
- Department of Neuroscience, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Iftteah Alhomud
- Department of Neuroscience, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Dorota Monies
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ali Alshehri
- Department of Neuroscience, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mossaed Alyahya
- Department of Neuroscience, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Brian Meyer
- Department of Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Saeed Bohlega
- Department of Neuroscience, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- *Correspondence: Saeed Bohlega,
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Li C, Haller G, Weihl CC. Current and Future Approaches to Classify VUSs in LGMD-Related Genes. Genes (Basel) 2022; 13:genes13020382. [PMID: 35205425 PMCID: PMC8871643 DOI: 10.3390/genes13020382] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/11/2022] [Accepted: 02/16/2022] [Indexed: 01/09/2023] Open
Abstract
Next-generation sequencing (NGS) has revealed large numbers of genetic variants in LGMD-related genes, with most of them classified as variants of uncertain significance (VUSs). VUSs are genetic changes with unknown pathological impact and present a major challenge in genetic test interpretation and disease diagnosis. Understanding the phenotypic consequences of VUSs can provide clinical guidance regarding LGMD risk and therapy. In this review, we provide a brief overview of the subtypes of LGMD, disease diagnosis, current classification systems for investigating VUSs, and a potential deep mutational scanning approach to classify VUSs in LGMD-related genes.
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Affiliation(s)
- Chengcheng Li
- Department of Neurology, Washington University School of Medicine, Saint Louis, MO 63110, USA; (C.L.); (G.H.)
| | - Gabe Haller
- Department of Neurology, Washington University School of Medicine, Saint Louis, MO 63110, USA; (C.L.); (G.H.)
- Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, MO 63110, USA
- Department of Genetics, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Conrad C. Weihl
- Department of Neurology, Washington University School of Medicine, Saint Louis, MO 63110, USA; (C.L.); (G.H.)
- Correspondence:
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8
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Rocha CT, Escolar DM. Treatment and Management of Muscular Dystrophies. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00020-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Vuillerot C. State of the art for motor function assessment tools in spinal muscular atrophy (SMA). Arch Pediatr 2021; 27:7S40-7S44. [PMID: 33357597 DOI: 10.1016/s0929-693x(20)30276-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Spinal muscular atrophy (SMA) is a progressive disease characterized by a degeneration of the spinal cord motor neurons. Many clinical trials - planned, in progress, or completed - have chosen motor function as the primary or secondary outcome because motor function assessment tools appeared to be more reliable than quantitative muscle testing in monitoring the course of the disease. Reliable, valid, and responsive outcome measures are needed to be able to capture the effectiveness of the therapeutic approach during clinical trials. Medical staff involved in neuromuscular diseases is faced with increasing pressure regarding the complex issue of choosing the right outcome measure for the objectives they have to assess. This paper provides a narrative literature review of available and validated motor function assessment tools in SMA population based on SMA subtypes, age and ambulant status. © 2020 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.
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Affiliation(s)
- C Vuillerot
- Service de Médecine Physique et Réadaptation Pédiatrique L'Escale, CHU Lyon, Université de Lyon, France; INMG, Inserm U1217, CNRS UMR5310, Université Lyon 1, Université de Lyon, Lyon, France.
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Pozsgai E, Griffin D, Potter R, Sahenk Z, Lehman K, Rodino-Klapac LR, Mendell JR. Unmet needs and evolving treatment for limb girdle muscular dystrophies. Neurodegener Dis Manag 2021; 11:411-429. [PMID: 34472379 DOI: 10.2217/nmt-2020-0066] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Limb-girdle muscular dystrophies (LGMDs) represent a major group of muscle disorders. Treatment is sorely needed and currently expanding based on safety and efficacy adopting principles of single-dosing gene therapy for monogenic autosomal recessive disorders. Gene therapy has made in-roads for LGMD and this review describes progress that has been achieved for these conditions. This review first provides a background on the definition and classification of LGMDs. The major effort focuses on progress in LGMD gene therapy, from experimental studies to clinical trials. The disorders discussed include the LGMDs where the most work has been done including calpainopathies (LGMD2A/R1), dysferlinopathies (LGMD2B/R2) and sarcoglycanopathies (LGMD2C/R5, LGMD2D/R3, LGMD2E/R4). Early success in clinical trials provides a template to move the field forward and potentially apply emerging technology like CRISPR/Cas9 that may enhance the scope and efficacy of gene therapy applied to patient care.
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Affiliation(s)
- Eric Pozsgai
- Sarepta Therapeutics, Inc., Cambridge, MA 02142, USA
| | | | | | - Zarife Sahenk
- Center for Gene Therapy, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.,Department of Pediatrics & Neurology, The Ohio State University, Columbus, OH 43210, USA
| | - Kelly Lehman
- Center for Gene Therapy, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | | | - Jerry R Mendell
- Center for Gene Therapy, The Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.,Department of Pediatrics & Neurology, The Ohio State University, Columbus, OH 43210, USA
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11
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Péladeau C, Sandhu JK. Aberrant NLRP3 Inflammasome Activation Ignites the Fire of Inflammation in Neuromuscular Diseases. Int J Mol Sci 2021; 22:ijms22116068. [PMID: 34199845 PMCID: PMC8200055 DOI: 10.3390/ijms22116068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 05/30/2021] [Accepted: 06/01/2021] [Indexed: 12/24/2022] Open
Abstract
Inflammasomes are molecular hubs that are assembled and activated by a host in response to various microbial and non-microbial stimuli and play a pivotal role in maintaining tissue homeostasis. The NLRP3 is a highly promiscuous inflammasome that is activated by a wide variety of sterile triggers, including misfolded protein aggregates, and drives chronic inflammation via caspase-1-mediated proteolytic cleavage and secretion of proinflammatory cytokines, interleukin-1β and interleukin-18. These cytokines further amplify inflammatory responses by activating various signaling cascades, leading to the recruitment of immune cells and overproduction of proinflammatory cytokines and chemokines, resulting in a vicious cycle of chronic inflammation and tissue damage. Neuromuscular diseases are a heterogeneous group of muscle disorders that involve injury or dysfunction of peripheral nerves, neuromuscular junctions and muscles. A growing body of evidence suggests that dysregulation, impairment or aberrant NLRP3 inflammasome signaling leads to the initiation and exacerbation of pathological processes associated with neuromuscular diseases. In this review, we summarize the available knowledge about the NLRP3 inflammasome in neuromuscular diseases that affect the peripheral nervous system and amyotrophic lateral sclerosis, which affects the central nervous system. In addition, we also examine whether therapeutic targeting of the NLRP3 inflammasome components is a viable approach to alleviating the detrimental phenotype of neuromuscular diseases and improving clinical outcomes.
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Affiliation(s)
- Christine Péladeau
- Human Health Therapeutics Research Centre, National Research Council Canada, 1200 Montreal Road, Ottawa, ON K1A 0R6, Canada;
| | - Jagdeep K. Sandhu
- Human Health Therapeutics Research Centre, National Research Council Canada, 1200 Montreal Road, Ottawa, ON K1A 0R6, Canada;
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada
- Correspondence: ; Tel.: +1-613-993-5304
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12
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Annexins and Membrane Repair Dysfunctions in Muscular Dystrophies. Int J Mol Sci 2021; 22:ijms22105276. [PMID: 34067866 PMCID: PMC8155887 DOI: 10.3390/ijms22105276] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022] Open
Abstract
Muscular dystrophies constitute a group of genetic disorders that cause weakness and progressive loss of skeletal muscle mass. Among them, Miyoshi muscular dystrophy 1 (MMD1), limb girdle muscular dystrophy type R2 (LGMDR2/2B), and LGMDR12 (2L) are characterized by mutation in gene encoding key membrane-repair protein, which leads to severe dysfunctions in sarcolemma repair. Cell membrane disruption is a physiological event induced by mechanical stress, such as muscle contraction and stretching. Like many eukaryotic cells, muscle fibers possess a protein machinery ensuring fast resealing of damaged plasma membrane. Members of the annexins A (ANXA) family belong to this protein machinery. ANXA are small soluble proteins, twelve in number in humans, which share the property of binding to membranes exposing negatively-charged phospholipids in the presence of calcium (Ca2+). Many ANXA have been reported to participate in membrane repair of varied cell types and species, including human skeletal muscle cells in which they may play a collective role in protection and repair of the sarcolemma. Here, we discuss the participation of ANXA in membrane repair of healthy skeletal muscle cells and how dysregulation of ANXA expression may impact the clinical severity of muscular dystrophies.
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Tariq M, Latif M, Inam M, Jan A, Bibi N, Mohamoud HSA, Ali I, Ahmad H, Khan A, Nasir J, Wadood A, Jelani M. Whole exome sequencing reveals a homozygous SGCB variant in a Pakhtun family with limb girdle muscular dystrophy (LGMDR4) phenotype. GENE REPORTS 2021. [DOI: 10.1016/j.genrep.2020.101014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mickelson JR, Minor KM, Guo LT, Friedenberg SG, Cullen JN, Ciavarella A, Hambrook LE, Brenner KM, Helmond SE, Marks SL, Shelton GD. Sarcoglycan A mutation in miniature dachshund dogs causes limb-girdle muscular dystrophy 2D. Skelet Muscle 2021; 11:2. [PMID: 33407862 PMCID: PMC7789357 DOI: 10.1186/s13395-020-00257-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/14/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND A cohort of related miniature dachshund dogs with exercise intolerance, stiff gait, dysphagia, myoglobinuria, and markedly elevated serum creatine kinase activities were identified. METHODS Muscle biopsy histopathology, immunofluorescence microscopy, and western blotting were combined to identify the specific pathologic phenotype of the myopathy, and whole genome SNP array genotype data and whole genome sequencing were combined to determine its genetic basis. RESULTS Muscle biopsies were dystrophic. Sarcoglycanopathy, a form of limb-girdle muscular dystrophy, was suspected based on immunostaining and western blotting, where α, β, and γ-sarcoglycan were all absent or reduced. Genetic mapping and whole genome sequencing identified a premature stop codon mutation in the sarcoglycan A subunit gene (SGCA). Affected dachshunds were confirmed on several continents. CONCLUSIONS This first SGCA mutation found in dogs adds to the literature of genetic bases of canine muscular dystrophies and their usefulness as comparative models of human disease.
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Affiliation(s)
- James R Mickelson
- Department of Veterinary and Biomedical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN, 55113, USA.
| | - Katie M Minor
- Department of Veterinary and Biomedical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN, 55113, USA
| | - Ling T Guo
- Department of Pathology, School of Medicine, University of California San Diego, La Jolla, CA, 92093-0709, USA
| | - Steven G Friedenberg
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN, 55113, USA
| | - Jonah N Cullen
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN, 55113, USA
| | | | | | - Karen M Brenner
- Centre for Animal Referral and Emergency, Collingwood, Victoria, Australia
| | - Sarah E Helmond
- Animal Referral Hospital, Homebush, New South Wales, Australia
| | - Stanley L Marks
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - G Diane Shelton
- Department of Pathology, School of Medicine, University of California San Diego, La Jolla, CA, 92093-0709, USA
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15
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Angelini C, Pegoraro V. Assessing diagnosis and managing respiratory and cardiac complications of sarcoglycanopathy. Expert Opin Orphan Drugs 2021. [DOI: 10.1080/21678707.2020.1865916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Corrado Angelini
- Center for Neuromuscular Diseases, IRCCS San Camillo Hospital, Venice, Italy
| | - Valentina Pegoraro
- Center for Neuromuscular Diseases, IRCCS San Camillo Hospital, Venice, Italy
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16
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Angelini C. LGMD. Identification, description and classification. ACTA MYOLOGICA : MYOPATHIES AND CARDIOMYOPATHIES : OFFICIAL JOURNAL OF THE MEDITERRANEAN SOCIETY OF MYOLOGY 2020; 39:207-217. [PMID: 33458576 PMCID: PMC7783424 DOI: 10.36185/2532-1900-024] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/19/2020] [Indexed: 11/05/2022]
Abstract
The term ‘limb girdle muscular dystrophy’ (LGMD) was first used in the seminal paper by Walton and Nattrass in 1954, were they identified LGMD as a separate clinical entity In LGMD description it is pointed out that the category of LGMD most likely comprises a heterogeneous group of disorders. After that the clinical entity was discussed but the LMGD nosography reached a permanent classification during two ENMC workshops held in 1995 and 2017, in the last one an operating definition of LGMD was agreed. This last classification included dystrophies with proximal or distal-proximal presentation with evidence at biopsy of fibre degeneration and splitting, high CK, MRI imaging consistent with degenerative changes, fibro-fatty infiltration present in individuals that reached independent walking ability. To be considered in this group at least two unrelated families should be identified. A review is done of the first genetic characterisation of a number of LGMDs during the late twentieth century and a historical summary is given regarding how these conditions were clinically described and identified, the progresses done from identification of genetic loci, to protein and gene discoveries are reported. The LGMD described on which such historical progresses were done are the recessive calpainopathy (LGMD 2A/R1), dysferlinopathy (LGMD 2B/R2), sarcoglycanopathy (LGMD 2C-2F/R3-R6) types and the dominant type due to TPNO3 variants named transportinopathy (LGMD 1F/D2). Because of new diagnostic techniques such as exome and genome sequencing, it is likely that many other subtypes of LGMD might be identified in the future, however the lesson from the past discoveries can be useful for scientists and clinicians.
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Abstract
PURPOSE OF REVIEW As a group, the limb-girdle muscular dystrophies (LGMDs) are the fourth most prevalent genetic muscle disease, yet they are still not well known or understood. This article defines and describes LGMDs, delineates a diagnostic strategy, and discusses treatment of the LGMDs. RECENT FINDINGS In 2018, the definition of the LGMDs was further refined, and a new nomenclature was proposed. Diagnosis of the LGMDs was long guided by the distinctive clinical characteristics of each particular subtype but now integrates use of genetics-with next-generation sequencing panels, exomes, and full genome analysis-early in the diagnostic assessment. Appreciation of the phenotypic diversity of each LGMD subtype continues to expand. This emphasizes the need for precision genetic diagnostics to better understand each subtype and formulate appropriate management for individual patients. Of significant relevance, the explosion of research into therapeutic options accentuates the need for accurate diagnosis, comprehensive disease characterization, and description of the natural histories of the LGMDs to move the field forward and to mitigate disease impact on patients with LGMD. SUMMARY The LGMDs are genetic muscle diseases that superficially appear similar to one another but have important differences in rates of progression and concomitant comorbidities. Definitive diagnoses are crucial to guide management and treatment now and in the future. As targeted treatments emerge, it will be important for clinicians to understand the nomenclature, diagnosis, clinical manifestations, and treatments of the LGMDs.
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Anesthetic management of a patient with limb-girdle muscular dystrophy 2B:CARE-compliant case report and literature review. BMC Anesthesiol 2019; 19:155. [PMID: 31421689 PMCID: PMC6698341 DOI: 10.1186/s12871-019-0813-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/29/2019] [Indexed: 11/24/2022] Open
Abstract
Background Limb-girdle muscular dystrophies (LGMDs) belong to few neuromuscular disorders mainly involving pelvic and shoulder girdle muscles. Also, cardiac or pulmonary complications, increased rhabdomyolysis risk when exposed to volatile anesthetics and succinylcholine may increase anesthesia related risks. However, current reports about the anesthesia management of these patients are limited. Case presentation We described our anesthetic management of a 36 years old woman with LGMD 2B receiving arthroscopic knee surgery. In consideration of the high risk of rhabdomyolysis, total intravenous anesthesia (TIVA) was selected for her surgery. Considering the unpredictable respiratory depression, opioid based patient-controlled intravenous analgesia was replaced with an intra-articular cocktail therapy consisting of 20 ml of 0.2% ropivacaine. Also, we reviewed the literatures on anesthetic management of LGMD through searching PubMed, in order to provide a comprehensive and safe guidance for the surgery. Conclusions Carefully conducted general anesthesia with TIVA technique is a good choice for LGMD patients. Neuraxial anesthesia may be used if general anesthesia needs to be avoided. To warrant safe anesthesia for surgery, any decision must be well thought out during perioperative period.
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Winckler PB, da Silva AMS, Coimbra-Neto AR, Carvalho E, Cavalcanti EBU, Sobreira CFR, Marrone CD, Machado-Costa MC, Carvalho AAS, Feio RHF, Rodrigues CL, Gonçalves MVM, Tenório RB, Mendonça RH, Cotta A, Paim JFO, Costa E Silva C, de Aquino Cruz C, Bená MI, Betancur DFA, El Husny AS, de Souza ICN, Duarte RCB, Reed UC, Chaves MLF, Zanoteli E, França MC, Saute JA. Clinicogenetic lessons from 370 patients with autosomal recessive limb-girdle muscular dystrophy. Clin Genet 2019; 96:341-353. [PMID: 31268554 DOI: 10.1111/cge.13597] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/21/2019] [Accepted: 06/30/2019] [Indexed: 12/13/2022]
Abstract
Limb-girdle muscular dystrophies (LGMD) are a group of genetically heterogeneous disorders characterized by predominantly proximal muscle weakness. We aimed to characterize epidemiological, clinical and molecular data of patients with autosomal recessive LGMD2/LGMD-R in Brazil. A multicenter historical cohort study was performed at 13 centers, in which index cases and their affected relatives' data from consecutive families with genetic or pathological diagnosis of LGMD2/LGMD-R were reviewed from July 2017 to August 2018. Survival curves to major handicap for LGMD2A/LGMD-R1-calpain3-related, LGMD2B/LGMD-R2-dysferlin-related and sarcoglycanopathies were built and progressions according to sex and genotype were estimated. In 370 patients (305 families) with LGMD2/LGMD-R, most frequent subtypes were LGMD2A/LGMD-R1-calpain3-related and LGMD2B/LGMD-R2-dysferlin-related, each representing around 30% of families. Sarcoglycanopathies were the most frequent childhood-onset subtype, representing 21% of families. Five percent of families had LGMD2G/LGMD-R7-telethonin-related, an ultra-rare subtype worldwide. Females with LGMD2B/LGMD-R2-dysferlin-related had less severe progression to handicap than males and LGMD2A/LGMD-R1-calpain3-related patients with truncating variants had earlier disease onset and more severe progression to handicap than patients without truncating variants. We have provided paramount epidemiological data of LGMD2/LGMD-R in Brazil that might help on differential diagnosis, better patient care and guiding future collaborative clinical trials and natural history studies in the field.
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Affiliation(s)
- Pablo B Winckler
- Neurology Division, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Graduate Program in Medicine, Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - André M S da Silva
- Department of Neurology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Antônio R Coimbra-Neto
- Department of Neurology, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
- Graduate Program in Medical Physiopathology, UNICAMP, Campinas, Brazil
| | - Elmano Carvalho
- Rede SARAH de Hospitais de Reabilitação, Belo Horizonte, Brazil
| | | | - Cláudia F R Sobreira
- Universidade de São Paulo, Ribeirão Preto Medical School, Department of Neurosciences, Ribeirão Preto, Brazil
| | - Carlo D Marrone
- Physiatry Division, Hospital São Lucas da Pontifícia Universidade Católica, Porto Alegre, Brazil
- Clinica Marrone, Porto Alegre, Brazil
| | | | | | - Raimunda H F Feio
- Hospital Universitário Bettina Ferro de Souza, Universidade Federal do Pará (UFPA), Belém, Brazil
| | | | | | | | - Rodrigo H Mendonça
- Department of Neurology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Ana Cotta
- Rede SARAH de Hospitais de Reabilitação, Belo Horizonte, Brazil
| | - Júlia F O Paim
- Rede SARAH de Hospitais de Reabilitação, Belo Horizonte, Brazil
| | | | - Camila de Aquino Cruz
- Universidade de São Paulo, Ribeirão Preto Medical School, Department of Neurosciences, Ribeirão Preto, Brazil
| | - Marjory I Bená
- Universidade de São Paulo, Ribeirão Preto Medical School, Department of Neurosciences, Ribeirão Preto, Brazil
| | - Daniel F A Betancur
- Physiatry Division, Hospital São Lucas da Pontifícia Universidade Católica, Porto Alegre, Brazil
| | - Antonette S El Husny
- Hospital Universitário Bettina Ferro de Souza, Universidade Federal do Pará (UFPA), Belém, Brazil
- Centro Universitário do Estado do Pará, Belém, Brazil
| | - Isabel C N de Souza
- Hospital Universitário Bettina Ferro de Souza, Universidade Federal do Pará (UFPA), Belém, Brazil
| | - Regina C B Duarte
- Hospital Ophir Loyola, Belém, Brazil
- Department of Neurology, UFPA, Belém, Brazil
| | - Umbertina C Reed
- Department of Neurology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Márcia L F Chaves
- Neurology Division, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Graduate Program in Medicine, Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Department of Internal Medicine, UFRGS, Porto Alegre, Brazil
| | - Edmar Zanoteli
- Department of Neurology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Marcondes C França
- Department of Neurology, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
- Graduate Program in Medical Physiopathology, UNICAMP, Campinas, Brazil
| | - Jonas A Saute
- Neurology Division, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Graduate Program in Medicine, Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Medical Genetics Division, HCPA, Porto Alegre, Brazil
- Department of Internal Medicine, UFRGS, Porto Alegre, Brazil
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Soni S, Hazarika A, Kumar B. Limb girdle muscle dystrophy and caesarian delivery: Anesthetic management and brief review of literature. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2018.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Sumit Soni
- Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, India
| | | | - Balbir Kumar
- Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, India
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Özyilmaz B, Kirbiyik Ö, Özdemir TR, Kaya Özer Ö, Kutbay YB, Erdogan KM, Güvenç MS, Kale MY, Gazeteci H, Kiliç B, Sertpoyraz F, Diniz G, Baydan F, Gençpinar P, Dündar NO, Yiş U. Impact of next‐generation sequencing panels in the evaluation of limb‐girdle muscular dystrophies. Ann Hum Genet 2019; 83:331-347. [DOI: 10.1111/ahg.12319] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/04/2019] [Accepted: 04/09/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Berk Özyilmaz
- Genetic Diagnosis Center, Tepecik Training and Research Hospital University of Health Sciences Izmir Turkey
- Neuromuscular Disorders Unit, Tepecik Training and Research Hospital University of Health Sciences Izmir Turkey
| | - Özgür Kirbiyik
- Genetic Diagnosis Center, Tepecik Training and Research Hospital University of Health Sciences Izmir Turkey
| | - Taha R. Özdemir
- Genetic Diagnosis Center, Tepecik Training and Research Hospital University of Health Sciences Izmir Turkey
| | - Özge Kaya Özer
- Genetic Diagnosis Center, Tepecik Training and Research Hospital University of Health Sciences Izmir Turkey
| | - Yaşar B. Kutbay
- Genetic Diagnosis Center, Tepecik Training and Research Hospital University of Health Sciences Izmir Turkey
| | - Kadri M. Erdogan
- Genetic Diagnosis Center, Tepecik Training and Research Hospital University of Health Sciences Izmir Turkey
| | - Merve Saka Güvenç
- Genetic Diagnosis Center, Tepecik Training and Research Hospital University of Health Sciences Izmir Turkey
| | - Murat Yildirim Kale
- Neuromuscular Disorders Unit, Tepecik Training and Research Hospital University of Health Sciences Izmir Turkey
| | - Hande Gazeteci
- Pediatric Neurology Cigli District Training Hospital Izmir Turkey
| | - Betül Kiliç
- Pediatric Neurology Derince Education Research Hospital Kocaeli Turkey
| | - Filiz Sertpoyraz
- Neuromuscular Disorders Unit, Tepecik Training and Research Hospital University of Health Sciences Izmir Turkey
| | - Gulden Diniz
- Department of Pathology Izmir Democracy University Izmir Turkey
| | - Figen Baydan
- Neuromuscular Disorders Unit, Tepecik Training and Research Hospital University of Health Sciences Izmir Turkey
| | - Pinar Gençpinar
- Pediatric Neurology, Faculty of Medicine Izmir Katip Celebi University Izmir Turkey
| | - Nihal Olgaç Dündar
- Pediatric Neurology, Faculty of Medicine Izmir Katip Celebi University Izmir Turkey
| | - Uluç Yiş
- Pediatric Neurology, School of Medicine Dokuz Eylül University Izmir Turkey
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Breukel A, Willmann R, Padberg G, Sterrenburg E, Meijer I. "The impact of European Neuromuscular Centre (ENMC) workshops on the neuromuscular field; 25 years on …". Neuromuscul Disord 2019; 29:330-340. [PMID: 30853171 DOI: 10.1016/j.nmd.2019.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 01/28/2019] [Indexed: 02/06/2023]
Abstract
Since 1992, the European Neuromuscular Centre facilitated workshops to bring experts in the field of neuromuscular disorders together. After organising more than 235 workshops, it is time to evaluate what impact these 25 years of ENMC workshops have had on the neuromuscular research field and on people affected by a neuromuscular condition. To measure this, workshop topics were retrospectively evaluated and bibliometric analyses on the citation scores of ENMC-derived publications were performed. In addition, a personalized survey was used to investigate the actual achievement and implementation of workshop deliverables. The evaluation of 25 years' workshop topics revealed a strong representation of muscular dystrophies, congenital and mitochondrial myopathies. The publications derived from ENMC workshops scored "high impact" as illustrated by the Mean Normalized Citation Score of 1.24. Also 16% of the ENMC papers belong to the top 10% best cited articles in the neuromuscular field. The main outcome of the personalised survey was that 90% of all workshop deliverables were started and either ongoing or completed. Of these deliverables, 78% were implemented in the field; bringing state-of-the-art knowledge and new collaborations to researchers and clinicians, improving designs of clinical trials and innovating tools to make accurate diagnoses.
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Affiliation(s)
- Alexandra Breukel
- European Neuromuscular Centre (ENMC), Lt. Generaal van Heutszlaan 6, Baarn 3743JN, The Netherlands.
| | - Raffaella Willmann
- Schweizerische Stiftung für die Erforschung der Muskelkrankheiten (FSRMM), Cortaillod, Switzerland
| | - George Padberg
- European Neuromuscular Centre (ENMC), Lt. Generaal van Heutszlaan 6, Baarn 3743JN, The Netherlands
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Abstract
There has been an ever-expanding list of the Limb-Girdle Muscular Dystrophies (LGMD). There are currently 8 subtypes of autosomal dominant (AD) and 26 subtypes of autosomal recessive (AR) LGMD. Despite continued research efforts to conquer this group of genetic neuromuscular disease, patients continue to be treated symptomatically with the aim of prevention or addressing complications. Mouse models have been helpful in clarifying disease pathogenesis as well as strategizing pathways for treatment. Discoveries in translational research as well as molecular therapeutic approaches have kept clinicians optimistic that more promising clinical trials will lead the way to finding the cure for these devastating disorders. It is well known that the challenge for these rare diseases is the ability to assemble adequate numbers of patients for a clinically meaningful trial, but current efforts in developing patient registries have been encouraging. Natural history studies will be essential in establishing and interpreting the appropriate outcome measures for clinical trials. Nevertheless, animal studies continue to be key in providing proof of concept that will be necessary in moving research along. This review will briefly discuss each type of LGMD, highlighting their distinguishing features, then focus on research efforts that have been published in the literature for the past few years, many of which are still in the preclinical trial stage.
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Affiliation(s)
- Mary Lynn Chu
- Department of Neurology, New York University School of Medicine, New York, New York, 10016, USA.
- New York University Langone Orthopedic Hospital, 301 East 17th Street, New York, New York, 10003, USA.
| | - Ellen Moran
- Division of Clinical Genetics, Center for Children, Hassenfeld Children's Hospital at New York University Langone, New York University Langone Orthopedic Hospital, 301 East 17th Street, New York, New York, 10003, USA
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24
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Straub V, Murphy A, Udd B, Corrado A, Aymé S, Bönneman C, de Visser M, Hamosh A, Jacobs L, Khizanishvili N, Kroneman M, Laflorêt P, Murphy A, Nigro V, Rufibach L, Sarkozy A, Swanepoel S, Torrente I, Udd B, Urtizberea A, Vissing J, Walter M. 229th ENMC international workshop: Limb girdle muscular dystrophies – Nomenclature and reformed classification Naarden, the Netherlands, 17–19 March 2017. Neuromuscul Disord 2018; 28:702-710. [DOI: 10.1016/j.nmd.2018.05.007] [Citation(s) in RCA: 178] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 05/13/2018] [Accepted: 05/16/2018] [Indexed: 11/26/2022]
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25
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Molecular genetic study of Calpainopathy in Iran. Gene 2018; 677:259-265. [PMID: 30056071 DOI: 10.1016/j.gene.2018.07.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/18/2018] [Accepted: 07/26/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Calpainopathy is an autosomal recessive form of limb girdle muscular dystrophies (LGMDs) caused by mutations in the CAPN3 gene. CAPN3 is a Ca2+-dependent cystein protease consisting of 821 amino acids. LGMD is a highly heterogeneous disorder and mutation identification of this disease by Sanger sequencing of all genes is expensive and time consuming. Using autozygosity mapping is an effective approach to address this issue. METHODS We used two sets of multiplex STR (Short tandem repeat) markers linked to CAPN3, DYSF, SGCA, SGCB, SGCG, SGCD genes following sequencing of the CAPN3 gene. In silico analysis and mutation detection in one hundred ethnically matched healthy individuals were carried out to determine the pathogenicity of novel mutations. Sequence variant interpretation was performed using the American College of Medical Genetics and Genomics (ACMG) guideline. RESULTS Sixteen out of 50 families linked to the CAPN3 gene. In this study, mutations were found in 14 out of 16 families including 4 novel (c.1894A > T, c.567delG, c.2254-2256delAAC, and c.2373C > T) and 9 previously reported mutations consisting of 5 missense (c.2105C > T, c.2243G > A, c.1714C > T, c.291C > A, c.956C > T), 3 splice site (c.2380 + 2 T > G, c.946-2A > G, c.380G > A), and one indel (c.2257delinsAA) mutations. DISCUSSION The c.2105C > T was found to be the most frequent mutation in this study. The results of this study revealed that most cases with splicing, frame shift and nonsense mutations experienced more severe clinical manifestations. Nonetheless, this should be confirmed by further studies on larger sample size.
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26
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Liewluck T, Milone M. Untangling the complexity of limb-girdle muscular dystrophies. Muscle Nerve 2018; 58:167-177. [PMID: 29350766 DOI: 10.1002/mus.26077] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2018] [Indexed: 12/16/2022]
Abstract
The limb-girdle muscular dystrophies (LGMDs) are a group of genetically heterogeneous, autosomal inherited muscular dystrophies with a childhood to adult onset, manifesting with hip- and shoulder-girdle muscle weakness. When the term LGMD was first conceptualized in 1954, it was thought to be a single entity. Currently, there are 8 autosomal dominant (LGMD1A-1H) and 26 autosomal recessive (LGMD2A-2Z) variants according to the Online Mendelian Inheritance in Man database. In addition, there are other genetically identified muscular dystrophies with an LGMD phenotype not yet classified as LGMD. This highlights the entanglement of LGMDs, which represents an area in continuous expansion. Herein we aim to simplify the complexity of LGMDs by subgrouping them on the basis of the underlying defective protein and impaired function. Muscle Nerve 58: 167-177, 2018.
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Affiliation(s)
- Teerin Liewluck
- Department of Neurology, Mayo Clinic, 200 First Street SW Rochester, Minnesota, 55905, USA
| | - Margherita Milone
- Department of Neurology, Mayo Clinic, 200 First Street SW Rochester, Minnesota, 55905, USA
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Bulakh MV, Ryzhkova OP, Polyakov AV. Sarcoglycanopathies: Clinical, Molecular and Genetic Characteristics, Epidemiology, Diagnostics and Treatment Options. RUSS J GENET+ 2018. [DOI: 10.1134/s1022795418020059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Limpitikul W, Ong CS, Tomaselli GF. Neuromuscular Disease: Cardiac Manifestations and Sudden Death Risk. Card Electrophysiol Clin 2017; 9:731-747. [PMID: 29173414 DOI: 10.1016/j.ccep.2017.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Cardiovascular complications of neuromuscular diseases disproportionately affect the cardiac conduction system. Cardiomyopathy and cardiac arrhythmias produce significant morbidity and mortality. Patients with neuromuscular diseases should be carefully and frequently evaluated for the presence of bradycardia, heart block, and tachyarrhythmias. Preemptive treatment with permanent pacemakers or implanted defibrillators is appropriate in patients with conduction system disease or who are at risk for ventricular arrhythmias.
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Affiliation(s)
- Worawan Limpitikul
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Chin Siang Ong
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gordon F Tomaselli
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA.
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Angelini C, Fanin M. Limb girdle muscular dystrophies: clinical-genetical diagnostic update and prospects for therapy. Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2017.1367283] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Corrado Angelini
- Department of Neurodegenerative Disorders, Neuromuscular Center, San Camillo Hospital IRCCS, Venice, Italy
| | - Marina Fanin
- Department of Neurosciences, University of Padova, Padova, Italy
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Yu M, Zheng Y, Jin S, Gang Q, Wang Q, Yu P, Lv H, Zhang W, Yuan Y, Wang Z. Mutational spectrum of Chinese LGMD patients by targeted next-generation sequencing. PLoS One 2017; 12:e0175343. [PMID: 28403181 PMCID: PMC5389788 DOI: 10.1371/journal.pone.0175343] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 03/24/2017] [Indexed: 12/21/2022] Open
Abstract
This study aimed to study the diagnostic value of targeted next-generation sequencing (NGS) in limb-girdle muscular dystrophies (LGMDs), and investigate the mutational spectrum of Chinese LGMD patients. We performed targeted NGS covering 420 genes in 180 patients who were consecutively suspected of LGMDs and underwent muscle biopsies from January 2013 to May 2015. The association between genotype and myopathological profiles was analyzed in the genetically confirmed LGMD patients. With targeted NGS, one or more rare variants were detected in 138 patients, of whom 113 had causative mutations, 10 sporadic patients had one pathogenic heterozygous mutation related to a recessive pattern of LGMDs, and 15 had variants of uncertain significance. No disease-causing mutation was found in the remaining 42 patients. Combined with the myopathological findings, we achieved a positive genetic diagnostic rate as 68.3% (123/180). Totally 105 patients were diagnosed as LGMDs with genetic basis. Among these 105 patients, the most common subtypes were LGMD2B in 52 (49.5%), LGMD2A in 26 (24.8%) and LGMD 2D in eight (7.6%), followed by LGMD1B in seven (6.7%), LGMD1E in four (3.8%), LGMD2I in three (2.9%), and LGMD2E, 2F, 2H, 2K, 2L in one patient (1.0%), respectively. Although some characteristic pathological changes may suggest certain LGMD subtypes, both heterogeneous findings in a certain subtype and overlapping presentations among different subtypes were not uncommon. The application of NGS, together with thorough clinical and myopathological evaluation, can substantially improve the molecular diagnostic rate in LGMDs. Confirming the genetic diagnosis in LGMD patients can help improve our understanding of their myopathological changes.
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Affiliation(s)
- Meng Yu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yiming Zheng
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Suqin Jin
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Qiang Gang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Qingqing Wang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Peng Yu
- Science and Technology, Precisionmdx Inc., Beijing, China
| | - He Lv
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Wei Zhang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yun Yuan
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, Beijing, China
- * E-mail:
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Solbakken G, Ørstavik K, Hagen T, Dietrichs E, Naerland T. Major involvement of trunk muscles in myotonic dystrophy type 1. Acta Neurol Scand 2016; 134:467-473. [PMID: 26984572 DOI: 10.1111/ane.12565] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The motor impairments in Myotonic Dystrophy 1 (DM1) are assumed to progress from distal toward proximal parts of the extremities in the Juvenile and Adult forms of DM1. On occasion and late in progress spine deformity is observed. In this study we have examined whether and to what extent trunk muscles are impaired in DM1, and if this impairment is correlated with the duration of the disorder, walking capacity, mobility, balance, and CTG-repeats. MATERIALS & METHODS Manual muscle testing (MMT) of skeletal muscle strength in trunk and extremities, reassessment of the mutation size, time since first symptom, the 6 min walk test (6MWT), Rivermead mobility index (RIM) and Timed up & go (TUG) were sampled in 38 adult DM1 outpatients. RESULTS We found significant impairment in trunk muscles. Trunk muscle strength decreased significantly with increasing mutation size (r = -0.64, P < 0.001). Reduced walking capacity, mobility and balance were significantly related to decreased trunk muscle strength. CONCLUSION DM1 affects trunk muscle groups. The trunk impairments seem to occur relatively early in disease progression. Awareness of trunk impairments may be of importance for everyday functioning and for understanding the risk of injuries due to falls reported among DM1 patients. It may also help in identification of DM1 patients and considered outcome measure in future clinical trials.
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Affiliation(s)
- G. Solbakken
- Department of Neurology; Drammen Hospital; Vestre Viken Health Trust; Drammen Norway
- Department of Neurology; Oslo University Hospital; Oslo Norway
| | - K. Ørstavik
- Department of Neurology; Oslo University Hospital; Oslo Norway
| | - T. Hagen
- Department of Neurology; Drammen Hospital; Vestre Viken Health Trust; Drammen Norway
| | - E. Dietrichs
- Department of Neurology; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - T. Naerland
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
- NevSom - Department of Rare Disorders and Disabilities; Oslo University Hospital; Oslo Norway
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Ramírez Botero AF, Posso Gómez LJ, Castillo A, Collado C, Fernández Pedrosa V, Rodríguez Cruz O, Lois S, Gil MT, Quiñones JA, Pachajoa H. Enfoque diagnóstico molecular utilizando secuenciación exómica en las distrofias musculares cintura-cadera. REVISTA DE LA FACULTAD DE MEDICINA 2016. [DOI: 10.15446/revfacmed.v64n1.53037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
<p>Antecedentes. La distrofia muscular cintura-cadera tipo 1B es una enfermedad con herencia autosómica dominante y secundaria a una mutación en el gen LMNA. Esta enfermedad se caracteriza por su afectación a nivel neuromuscular y cardiaco. Objetivo. Realizar diagnóstico clínico y confirmatorio molecular en una paciente con debilidad muscular proximal y sintomatología cardíaca a través de secuenciación exómica. Materiales y métodos. Se presenta el caso de una paciente de 57 años de edad con cuadro de debilidad muscular proximal progresiva principalmente en extremidades y posterior afectación cardíaca; adicionalmente, la paciente tiene múltiples familiares con la misma sintomatología. Se realizó estudio de secuenciación exómica con confirmación, por método de Sanger, de la mutación hallada y posteriormente el análisis bioinformático de esta. Resultados. La detección de la mutación R377L en el gen LMNA por secuenciación exómica con confirmación por Sanger, junto con la sintomatología clínica de la paciente y el análisis bioinformático de la mutación hallada, permitió realizar diagnóstico confirmatorio de distrofia muscular cintura-cadera tipo 1B. Conclusión. Es difícil realizar un diagnóstico clínico debido a la heterogeneidad genética del fenotipo de distrofias musculares cintura-cadera. La aproximación diagnóstica es compleja y requiere clasificar las distrofias musculares según el patrón de afectación y el patrón de herencia de la enfermedad. Adicionalmente, debido a los múltiples genes que pueden generar clínica semejante a las diferentes distrofias musculares, se recomienda realizar secuenciación exómica solicitando especial énfasis en los genes candidatos de distrofias musculares cintura-cadera.</p>
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Govindarajan R, Shepard KM, Jones LK. Diagnosis and treatment of limb-girdle and distal dystrophies: Payment policy perspectives. Neurol Clin Pract 2015; 5:454-459. [PMID: 29443172 DOI: 10.1212/cpj.0000000000000188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Limb-girdle muscular dystrophies (LGMDs) and distal dystrophies are a diverse group of genetically heterogeneous myopathies characterized by an evolving and often confusing nomenclature. Though rare as a group, they are commonly seen in neuromuscular clinics and occasionally in general neurology clinics, and are frequently a source of diagnostic dilemma. A recent evidence-based guideline by the American Academy of Neurology provides a comprehensive analysis of the clinical phenotypes, diagnostic approach, and management principles of the LGMDs and associated disorders. There remain many unanswered questions regarding the role of radiologic and genetic testing, cardiorespiratory screening, and physical therapy in managing these patients. This payment policy article suggests potential solutions to challenging coverage scenarios that result from incomplete or conflicting evidence.
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Affiliation(s)
- Raghav Govindarajan
- University of Missouri (RG), Columbia; American Academy of Neurology (KMS), Minneapolis; and Mayo Clinic (LKJ), Rochester, MN
| | - Katie M Shepard
- University of Missouri (RG), Columbia; American Academy of Neurology (KMS), Minneapolis; and Mayo Clinic (LKJ), Rochester, MN
| | - Lyell K Jones
- University of Missouri (RG), Columbia; American Academy of Neurology (KMS), Minneapolis; and Mayo Clinic (LKJ), Rochester, MN
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Identification of a Novel Mutation in the Titin Gene in a Chinese Family with Limb-Girdle Muscular Dystrophy 2J. Mol Neurobiol 2015; 53:5097-102. [DOI: 10.1007/s12035-015-9439-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 09/10/2015] [Indexed: 01/01/2023]
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Ranjan RV, Ramachandran TR, Manikandan S, John R. Limb-girdle muscular dystrophy with obesity for elective cesarean section: Anesthetic management and brief review of the literature. Anesth Essays Res 2015; 9:127-9. [PMID: 25886439 PMCID: PMC4383115 DOI: 10.4103/0259-1162.150184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Limb-girdle muscular dystrophy (LGMD) is an autosomal recessive disorder in which the pelvic or shoulder girdle musculature is predominantly or primarily involved. We report the management of a 27-year-old primigravida with LGMD associated with obesity posted for elective cesarean section. She was successfully managed with epidural anesthesia assisted with noninvasive positive pressure ventilation. She had an uncomplicated intra- and post-operative course.
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Affiliation(s)
- R V Ranjan
- Department of Anaesthesiology and Critical Care, PIMS, Pondicherry, India
| | - T R Ramachandran
- Department of Anaesthesiology and Critical Care, PIMS, Pondicherry, India
| | - S Manikandan
- Department of Anaesthesiology and Critical Care, PIMS, Pondicherry, India
| | - Roshan John
- Department of Anaesthesiology and Critical Care, PIMS, Pondicherry, India
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Abstract
A collection of more than 30 genetic muscle diseases that share certain key features, limb-girdle muscular dystrophies are characterized by progressive weakness and muscle atrophy of the hips, shoulders, and proximal extremity muscles with postnatal onset. This article discusses clinical, laboratory, and histologic features of the 6 most prevalent limb-girdle dystrophies. In this large group of disorders, certain distinctive features often can guide clinicians to a correct diagnosis.
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England JD. Making sense of the muscular dystrophies: diagnosis and treatment guideline for limb-girdle muscular dystrophy. Muscle Nerve 2014; 50:721-2. [PMID: 25219766 DOI: 10.1002/mus.24459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 09/03/2014] [Accepted: 09/10/2014] [Indexed: 11/07/2022]
Affiliation(s)
- John D England
- Department of Neurology, School of Medicine, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, New Orleans, Louisiana, 70112, USA
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Narayanaswami P, Weiss M, Selcen D, David W, Raynor E, Carter G, Wicklund M, Barohn RJ, Ensrud E, Griggs RC, Gronseth G, Amato AA. Evidence-based guideline summary: diagnosis and treatment of limb-girdle and distal dystrophies: report of the guideline development subcommittee of the American Academy of Neurology and the practice issues review panel of the American Association of Neuromuscular & Electrodiagnostic Medicine. Neurology 2014; 83:1453-63. [PMID: 25313375 DOI: 10.1212/wnl.0000000000000892] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To review the current evidence and make practice recommendations regarding the diagnosis and treatment of limb-girdle muscular dystrophies (LGMDs). METHODS Systematic review and practice recommendation development using the American Academy of Neurology guideline development process. RESULTS Most LGMDs are rare, with estimated prevalences ranging from 0.07 per 100,000 to 0.43 per 100,000. The frequency of some muscular dystrophies varies based on the ethnic background of the population studied. Some LGMD subtypes have distinguishing features, including pattern of muscle involvement, cardiac abnormalities, extramuscular involvement, and muscle biopsy findings. The few published therapeutic trials were not designed to establish clinical efficacy of any treatment. PRINCIPAL RECOMMENDATIONS For patients with suspected muscular dystrophy, clinicians should use a clinical approach to guide genetic diagnosis based on clinical phenotype, inheritance pattern, and associated manifestations (Level B). Clinicians should refer newly diagnosed patients with an LGMD subtype and high risk of cardiac complications for cardiology evaluation even if they are asymptomatic from a cardiac standpoint (Level B). In patients with LGMD with a known high risk of respiratory failure, clinicians should obtain periodic pulmonary function testing (Level B). Clinicians should refer patients with muscular dystrophy to a clinic that has access to multiple specialties designed specifically to care for patients with neuromuscular disorders (Level B). Clinicians should not offer patients with LGMD gene therapy, myoblast transplantation, neutralizing antibody to myostatin, or growth hormone outside of a research study designed to determine efficacy and safety of the treatment (Level R). Detailed results and recommendations are available on the Neurology® Web site at Neurology.org.
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Affiliation(s)
- Pushpa Narayanaswami
- From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Michael Weiss
- From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Duygu Selcen
- From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - William David
- From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Elizabeth Raynor
- From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Gregory Carter
- From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Matthew Wicklund
- From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Richard J Barohn
- From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Erik Ensrud
- From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Robert C Griggs
- From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Gary Gronseth
- From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Anthony A Amato
- From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA
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El Kerch F, Ratbi I, Sbiti A, Laarabi FZ, Barkat A, Sefiani A. Carrier frequency of the c.525delT mutation in the SGCG gene and estimated prevalence of limb girdle muscular dystrophy type 2C among the Moroccan population. Genet Test Mol Biomarkers 2014; 18:253-6. [PMID: 24552312 DOI: 10.1089/gtmb.2013.0326] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Autosomal recessive limb-girdle muscular dystrophies (AR-LGMDs) are characterized by clinical and genetic heterogeneity. LGMD type 2C, or γ-sarcoglycanopathy, is the most frequent in North African populations as a result of the founder c.525delT mutation in the SGCG gene. Its epidemiology is poorly known in Morocco, and its prevalence among the Moroccan population has never been evaluated. This study screened 26 patients with a LGMD2C and 45 patients with an AR-LGMD phenotype for the c.525delT mutation. DNA extracted from umbilical cord blood samples of 250 newborns was tested for the same mutation. Molecular epidemiologic methods were used to calculate the frequency of heterozygotes for this mutation in Moroccan newborns and to estimate the prevalence of LGMD2C in the Moroccan population. The carrier frequency was estimated to be 1/250, which would imply that the prevalence of LGMD2C would be approximately 1/20,492 considering the effect of consanguinity. The homozygous c.525delT mutation was found in 65% of all patients with AR-LGMDs. These findings suggest that AR-LGMDs are prevalent in the Moroccan population and LGMD2C is one of the most common forms. This information might be useful for the development of diagnostic strategies on a large scale for better management of patients with AR-LGMD and genetic counseling of families.
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Affiliation(s)
- Fatiha El Kerch
- 1 Département de Génétique Médicale, Institut National d'Hygiène , Rabat, Morocco
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Neuromuscular disease: muscle. Curr Opin Neurol 2013; 26:516-8. [PMID: 23995280 DOI: 10.1097/wco.0b013e328365048d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Herson S, Hentati F, Rigolet A, Behin A, Romero NB, Leturcq F, Laforêt P, Maisonobe T, Amouri R, Haddad H, Audit M, Montus M, Masurier C, Gjata B, Georger C, Cheraï M, Carlier P, Hogrel JY, Herson A, Allenbach Y, Lemoine FM, Klatzmann D, Sweeney HL, Mulligan RC, Eymard B, Caizergues D, Voït T, Benveniste O. A phase I trial of adeno-associated virus serotype 1-γ-sarcoglycan gene therapy for limb girdle muscular dystrophy type 2C. ACTA ACUST UNITED AC 2012; 135:483-92. [PMID: 22240777 DOI: 10.1093/brain/awr342] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
γ-Sarcoglycanopathy or limb girdle muscular dystrophy type 2C is an untreatable disease caused by autosomal recessively inherited mutations of the γ-sarcoglycan gene. Nine non-ambulatory patients (two males, seven females, mean age 27 years; range 16-38 years) with del525T homozygous mutation of the γ-sarcoglycan gene and no γ-sarcoglycan immunostaining on muscle biopsy were divided into three equal groups to receive three escalating doses of an adeno-associated virus serotype 1 vector expressing the human γ-sarcoglycan gene under the control of the desmin promoter, by local injection into the extensor carpi radialis muscle. The first group received a single injection of 3 × 10(9) viral genomes in 100 µl, the second group received a single injection of 1.5 × 10(10) viral genomes in 100 µl, and the third group received three simultaneous 100-µl injections at the same site, delivering a total dose of 4.5 × 10(10) viral genomes. No serious adverse effects occurred during 6 months of follow-up. All nine patients became adeno-associated virus serotype 1 seropositive and one developed a cytotoxic response to the adeno-associated virus serotype 1 capsid. Thirty days later, immunohistochemical analysis of injected-muscle biopsy specimens showed γ-sarcoglycan expression in all three patients who received the highest dose (4.7-10.5% positively stained fibres), while real-time polymerase chain reaction detected γ-sarcoglycan messenger RNA. In one patient, γ-sarcoglycan protein was detected by western blot. For two other patients who received the low and intermediate doses, discrete levels of γ-sarcoglycan expression (<1% positively stained fibres) were also detectable. Expression of γ-sarcoglycan protein can be induced in patients with limb girdle muscular dystrophy type 2C by adeno-associated virus serotype 1 gene transfer, with no serious adverse effects.
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Affiliation(s)
- Serge Herson
- Service de Médecine Interne 1, Groupe Hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris Cedex 13, France
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Rosales XQ, al-Dahhak R, Tsao CY. Childhood onset of limb-girdle muscular dystrophy. Pediatr Neurol 2012; 46:13-23. [PMID: 22196486 DOI: 10.1016/j.pediatrneurol.2011.08.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 08/25/2011] [Indexed: 01/16/2023]
Abstract
Limb-girdle muscular dystrophies comprise a rare heterogeneous group of genetic muscular dystrophies, involving 15 autosomal recessive subtypes and seven autosomal dominant subtypes. Autosomal recessive dystrophy is far more common than autosomal dominant dystrophy. Typical clinical features include progressive limb muscle weakness and atrophy (proximal greater than distal), varying from very mild to severe. Significant overlap of clinical phenotypes, with genetic and clinical heterogeneity, constitutes the rule for this group of diseases. Muscle biopsies are useful for histopathologic and immunolabeling studies, and DNA analysis is the gold standard to establish the specific form of muscular dystrophy. A definitive diagnosis among various subtypes is challenging, and the data presented here provide neuromuscular clinicians with additional information to help attain that goal.
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Affiliation(s)
- Xiomara Q Rosales
- Neuromuscular Division, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
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Vanhoutte EK, Faber CG, van Nes SI, Jacobs BC, van Doorn PA, van Koningsveld R, Cornblath DR, van der Kooi AJ, Cats EA, van den Berg LH, Notermans NC, van der Pol WL, Hermans MCE, van der Beek NAME, Gorson KC, Eurelings M, Engelsman J, Boot H, Meijer RJ, Lauria G, Tennant A, Merkies ISJ. Modifying the Medical Research Council grading system through Rasch analyses. ACTA ACUST UNITED AC 2011; 135:1639-49. [PMID: 22189568 PMCID: PMC3338921 DOI: 10.1093/brain/awr318] [Citation(s) in RCA: 149] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The Medical Research Council grading system has served through decades for the evaluation of muscle strength and has been recognized as a cardinal feature of daily neurological, rehabilitation and general medicine examination of patients, despite being respectfully criticized due to the unequal width of its response options. No study has systematically examined, through modern psychometric approach, whether physicians are able to properly use the Medical Research Council grades. The objectives of this study were: (i) to investigate physicians’ ability to discriminate among the Medical Research Council categories in patients with different neuromuscular disorders and with various degrees of weakness through thresholds examination using Rasch analysis as a modern psychometric method; (ii) to examine possible factors influencing physicians’ ability to apply the Medical Research Council categories through differential item function analyses; and (iii) to examine whether the widely used Medical Research Council 12 muscles sum score in patients with Guillain–Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy would meet Rasch model's expectations. A total of 1065 patients were included from nine cohorts with the following diseases: Guillain–Barré syndrome (n = 480); myotonic dystrophy type-1 (n = 169); chronic inflammatory demyelinating polyradiculoneuropathy (n = 139); limb-girdle muscular dystrophy (n = 105); multifocal motor neuropathy (n = 102); Pompe's disease (n = 62) and monoclonal gammopathy of undetermined related polyneuropathy (n = 8). Medical Research Council data of 72 muscles were collected. Rasch analyses were performed on Medical Research Council data for each cohort separately and after pooling data at the muscle level to increase category frequencies, and on the Medical Research Council sum score in patients with Guillain–Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy. Disordered thresholds were demonstrated in 74–79% of the muscles examined, indicating physicians’ inability to discriminate between most Medical Research Council categories. Factors such as physicians’ experience or illness type did not influence these findings. Thresholds were restored after rescoring the Medical Research Council grades from six to four options (0, paralysis; 1, severe weakness; 2, slight weakness; 3, normal strength). The Medical Research Council sum score acceptably fulfilled Rasch model expectations after rescoring the response options and creating subsets to resolve local dependency and item bias on diagnosis. In conclusion, a modified, Rasch-built four response category Medical Research Council grading system is proposed, resolving clinicians’ inability to differentiate among its original response categories and improving clinical applicability. A modified Medical Research Council sum score at the interval level is presented and is recommended for future studies in Guillain–Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy.
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Benveniste O, Romero NB. Myositis or dystrophy? Traps and pitfalls. Presse Med 2011; 40:e249-55. [DOI: 10.1016/j.lpm.2010.11.023] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 11/15/2010] [Accepted: 11/16/2010] [Indexed: 01/25/2023] Open
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Abstract
The so-called sarcoglycanopathies form a subgroup of four genetically closely related autosomal recessive limb-girdle muscular dystrophies (LGMD2C-F) caused by mutations of the α-, β-, γ-, and δ-sarcoglycan genes. All four sarcoglycans are glycosylated transmembrane proteins and form a tetrameric complex that is part of dystrophin-associated proteins. The clinical phenotype associated with sarcoglycanopathies is characterized by a slowly progressive proximal muscle weakness with onset during childhood in most cases. The disease course is often similar but more variable than X-linked Duchenne muscular dystrophy. Diagnosis is usually based on muscle biopsy findings that confirm dystrophic changes and deficiency of one or more sarcoglycan proteins. Genetic testing is used to confirm the diagnosis. A number of different animal models have been developed to study the function of sarcoglycans and to develop specific therapeutic strategies such as gene transfer, but so far none of these techniques has entered clinical practice. Therefore, treatment is symptomatic and aims at amelioration of locomotor, respiratory, and cardiac manifestations of the disease.
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Affiliation(s)
- Janbernd Kirschner
- Division of Neuropediatrics and Muscle Disorders, University Medical Center Freiburg, Freiburg, Germany.
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Miopatie dei cingoli. Neurologia 2011. [DOI: 10.1016/s1634-7072(11)70573-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Mutation in exon 1f of PLEC, leading to disruption of plectin isoform 1f, causes autosomal-recessive limb-girdle muscular dystrophy. Am J Hum Genet 2010; 87:834-41. [PMID: 21109228 DOI: 10.1016/j.ajhg.2010.10.017] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 10/12/2010] [Accepted: 10/18/2010] [Indexed: 01/02/2023] Open
Abstract
Limb-girdle muscular dystrophy (LGMD) is a genetically heterogeneous group of inherited muscular disorders manifesting symmetric, proximal, and slowly progressive muscle weakness. Using Affymetrix 250K SNP Array genotyping and homozygosity mapping, we mapped an autosomal-recessive LGMD phenotype to the telomeric portion of chromosome 8q in a consanguineous Turkish family with three affected individuals. DNA sequence analysis of PLEC identified a homozygous c.1_9del mutation containing an initiation codon in exon 1f, which is an isoform-specific sequence of plectin isoform 1f. The same homozygous mutation was also detected in two additional families during the analysis of 72 independent LGMD2-affected families. Moreover, we showed that the expression of PLEC was reduced in the patient's muscle and that there was almost no expression for plectin 1f mRNA as a result of the mutation. In addition to dystrophic changes in muscle, ultrastructural alterations, such as membrane duplications, an enlarged space between the membrane and sarcomere, and misalignment of Z-disks, were observed by transmission electron microscopy. Unlike the control skeletal muscle, no sarcolemmal staining of plectin was detected in the patient's muscle. We conclude that as a result of plectin 1f deficiency, the linkage between the sarcolemma and sarcomere is broken, which could affect the structural organization of the myofiber. Our data show that one of the isoforms of plectin plays a key role in skeletal muscle function and that disruption of the plectin 1f can cause the LGMD2 phenotype without any dermatologic component as was previously reported with mutations in constant exons of PLEC.
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Perez F, Vital A, Martin-Negrier ML, Ferrer X, Sole G. Diagnostic des dystrophies musculaires progressives des ceintures de type 2A ou calpaïnopathies : étude des patients du centre de référence des maladies neuromusculaires de Bordeaux (France). Rev Neurol (Paris) 2010; 166:502-8. [DOI: 10.1016/j.neurol.2009.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2009] [Revised: 09/18/2009] [Accepted: 10/28/2009] [Indexed: 11/26/2022]
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Navarro C, Teijeira S. Molecular diagnosis of muscular dystrophies, focused on limb girdle muscular dystrophies. ACTA ACUST UNITED AC 2009; 3:631-47. [PMID: 23496048 DOI: 10.1517/17530050903313988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Muscular dystrophies include a spectrum of muscle disorders, some of which are phenotypically well characterized. The identification of dystrophin as the causative factor in Duchenne muscular dystrophy has led to the development of molecular genetics and has facilitated the division of muscular dystrophies into distinct groups, among which are the 'limb girdle muscular dystrophies'. OBJECTIVES This article reviews the methodology to be used in the diagnosis of muscular dystrophies, focused on the groups of limb girdle muscular dystrophies, and the development of new strategies to reach a final molecular diagnosis. METHOD A literature review (Medline) from 1985 to the present. CONCLUSION Immunohistochemistry and western blotting analyses of the proteins involved in the various forms of muscular dystrophies have permitted a refined pathological approach necessary to conduct genetic studies and to offer appropriate genetic counseling. The application of molecular medicine in genetic muscular dystrophies also brings great hope to the therapeutic management of these patients.
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Affiliation(s)
- Carmen Navarro
- University Hospital of Vigo, Department of Pathology and Neuropathology, Meixoeiro, s/n, 36200 Vigo - Pontevedra, Spain +34 986 81 11 11 ext. 211661 ; +34 986 27 64 16 ;
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