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Belhassen I, Laroussi S, Sakka S, Rekik S, Lahkim L, Dammak M, Authier FJ, Mhiri C. Dysferlinopathy in Tunisia: clinical spectrum, genetic background and prognostic profile. Neuromuscul Disord 2023; 33:718-727. [PMID: 37716854 DOI: 10.1016/j.nmd.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/08/2023] [Accepted: 08/13/2023] [Indexed: 09/18/2023]
Abstract
Dysferlinopathy is a rare group of hereditary muscular dystrophy with an autosomal recessive mode of inheritance caused by a mutation in the DYSF gene. It encodes for the dysferlin protein, which has a crucial role in multiple cellular processes, including muscle fiber membrane repair. This deficit has heterogeneous clinical presentations. In this study, we collected 20 Tunisian patients with a sex ratio of 1 and a median age of 50.5 years old (Interquartile range (IQR) = [36,5-54,75]). They were followed for periods ranging from 5 to 48 years. The median age at onset was 17 years old (IQR = [16,8-28,4]). Five major phenotypes were identified: Limb-girdle muscular dystrophy (LGMDR2) (35%), a proximodistal phenotype (35%), Miyoshi myopathy (10%), Distal myopathy with anterior tibial onset (DMAT) (10%), and asymptomatic HyperCKemia (10%). At the last evaluation, more than half of patients (55%) were on wheelchair. Loss of ambulation occurred generally during the fourth decade. After 20 years of disease progression, two patients with a proximodistal phenotype (10%) developed dilated cardiomyopathy and mitral valve regurgitation. Restrictive respiratory syndrome was observed in three patients (DMAT: 1 patient, proximodistal phenotype: 1 patient, LGMDR2: 1 patient). Genetic study disclosed five mutations. We observed clinical heterogeneity between families and even within the same family. Disease progression was mainly slow to intermediate regardless of the phenotype.
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Affiliation(s)
- Ikhlass Belhassen
- Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), Habib Bourguiba University Hospital, University of Sfax, Tunisia
| | - Sirine Laroussi
- Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), Habib Bourguiba University Hospital, University of Sfax, Tunisia; Department of Neurology, Habib Bourguiba University Hospital, Faculty of Medicine of Sfax, Sfax, Tunisia.
| | - Salma Sakka
- Department of Neurology, Habib Bourguiba University Hospital, Faculty of Medicine of Sfax, Sfax, Tunisia
| | - Sabrine Rekik
- Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), Habib Bourguiba University Hospital, University of Sfax, Tunisia
| | - Laila Lahkim
- Pathology Laboratory, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Mariem Dammak
- Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), Habib Bourguiba University Hospital, University of Sfax, Tunisia; Clinical Investigation Center, Habib Bourguiba University Hospital, Sfax, Tunisia; Department of Neurology, Habib Bourguiba University Hospital, Faculty of Medicine of Sfax, Sfax, Tunisia
| | | | - Chokri Mhiri
- Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), Habib Bourguiba University Hospital, University of Sfax, Tunisia; Clinical Investigation Center, Habib Bourguiba University Hospital, Sfax, Tunisia; Department of Neurology, Habib Bourguiba University Hospital, Faculty of Medicine of Sfax, Sfax, Tunisia
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Wang N, Han X, Hao S, Han J, Zhou X, Sun S, Tang J, Lu Y, Wu H, Ma S, Song X, Ji G. The clinical, myopathological, and molecular characteristics of 26 Chinese patients with dysferlinopathy: a high proportion of misdiagnosis and novel variants. BMC Neurol 2022; 22:398. [PMID: 36319958 PMCID: PMC9623978 DOI: 10.1186/s12883-022-02905-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/20/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Dysferlinopathy is an autosomal recessive muscular dystrophy caused by pathogenic variants in the dysferlin (DYSF) gene. This disease shows heterogeneous clinical phenotypes and genetic characteristics. METHODS We reviewed the clinical and pathological data as well as the molecular characteristics of 26 Chinese patients with dysferlinopathy screened by immunohistochemistry staining and pathogenic variants in DYSF genes. RESULTS Among 26 patients with dysferlinopathy, 18 patients (69.2%) presented as Limb-girdle Muscular Dystrophy Type R2 (LGMD R2), 4 (15.4%) had a phenotype of Miyoshi myopathy (MM), and 4 (15.4%) presented as asymptomatic hyperCKemia. Fifteen patients (57.7%) were originally misdiagnosed as inflammatory myopathy or other diseases. Fifteen novel variants were identified among the 40 variant sites identified in this cohort. CONCLUSION Dysferlinopathy is a clinically and genetically heterogeneous group of disorders with various phenotypes, a high proportion of novel variants, and a high rate of misdiagnosis before immunohistochemistry staining and genetic analysis.
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Affiliation(s)
- Ning Wang
- grid.452702.60000 0004 1804 3009Department of Neurology, The Second Hospital of Hebei Medical University, 050000 Shijiazhuang, Hebei People’s Republic of China ,grid.256883.20000 0004 1760 8442The Key Laboratory of Neurology (Hebei Medical University), Ministry of Education, 050000 Shijiazhuang, Hebei People’s Republic of China
| | - Xu Han
- grid.452702.60000 0004 1804 3009Department of Neurology, The Second Hospital of Hebei Medical University, 050000 Shijiazhuang, Hebei People’s Republic of China ,grid.256883.20000 0004 1760 8442The Key Laboratory of Neurology (Hebei Medical University), Ministry of Education, 050000 Shijiazhuang, Hebei People’s Republic of China
| | - Shengpu Hao
- grid.452702.60000 0004 1804 3009Department of Neurology, The Second Hospital of Hebei Medical University, 050000 Shijiazhuang, Hebei People’s Republic of China ,grid.256883.20000 0004 1760 8442The Key Laboratory of Neurology (Hebei Medical University), Ministry of Education, 050000 Shijiazhuang, Hebei People’s Republic of China
| | - Jingzhe Han
- grid.452702.60000 0004 1804 3009Department of Neurology, The Second Hospital of Hebei Medical University, 050000 Shijiazhuang, Hebei People’s Republic of China ,grid.256883.20000 0004 1760 8442The Key Laboratory of Neurology (Hebei Medical University), Ministry of Education, 050000 Shijiazhuang, Hebei People’s Republic of China
| | | | - Shuyan Sun
- grid.452702.60000 0004 1804 3009Department of Neurology, The Second Hospital of Hebei Medical University, 050000 Shijiazhuang, Hebei People’s Republic of China ,grid.256883.20000 0004 1760 8442The Key Laboratory of Neurology (Hebei Medical University), Ministry of Education, 050000 Shijiazhuang, Hebei People’s Republic of China
| | - Jin Tang
- grid.452702.60000 0004 1804 3009Department of Neurology, The Second Hospital of Hebei Medical University, 050000 Shijiazhuang, Hebei People’s Republic of China ,grid.256883.20000 0004 1760 8442The Key Laboratory of Neurology (Hebei Medical University), Ministry of Education, 050000 Shijiazhuang, Hebei People’s Republic of China
| | - Yanpeng Lu
- grid.452702.60000 0004 1804 3009Department of Neurology, The Second Hospital of Hebei Medical University, 050000 Shijiazhuang, Hebei People’s Republic of China ,grid.256883.20000 0004 1760 8442The Key Laboratory of Neurology (Hebei Medical University), Ministry of Education, 050000 Shijiazhuang, Hebei People’s Republic of China
| | - Hongran Wu
- grid.452702.60000 0004 1804 3009Department of Neurology, The Second Hospital of Hebei Medical University, 050000 Shijiazhuang, Hebei People’s Republic of China ,grid.256883.20000 0004 1760 8442The Key Laboratory of Neurology (Hebei Medical University), Ministry of Education, 050000 Shijiazhuang, Hebei People’s Republic of China
| | - Shaojuan Ma
- grid.452702.60000 0004 1804 3009Department of Neurology, The Second Hospital of Hebei Medical University, 050000 Shijiazhuang, Hebei People’s Republic of China ,grid.256883.20000 0004 1760 8442The Key Laboratory of Neurology (Hebei Medical University), Ministry of Education, 050000 Shijiazhuang, Hebei People’s Republic of China
| | - Xueqin Song
- grid.452702.60000 0004 1804 3009Department of Neurology, The Second Hospital of Hebei Medical University, 050000 Shijiazhuang, Hebei People’s Republic of China ,grid.256883.20000 0004 1760 8442The Key Laboratory of Neurology (Hebei Medical University), Ministry of Education, 050000 Shijiazhuang, Hebei People’s Republic of China
| | - Guang Ji
- grid.452702.60000 0004 1804 3009Department of Neurology, The Second Hospital of Hebei Medical University, 050000 Shijiazhuang, Hebei People’s Republic of China ,grid.256883.20000 0004 1760 8442The Key Laboratory of Neurology (Hebei Medical University), Ministry of Education, 050000 Shijiazhuang, Hebei People’s Republic of China
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Ullah MI, Ahmad A, Zarkovic M, Shah SS, Nasir A, Mahmood S, Ahmad W, Hubner CA, Hassan MJ. Novel duplication mutation of the DYSF gene in a Pakistani family with Miyoshi Myopathy. Saudi Med J 2017; 38:1190-1195. [PMID: 29209666 PMCID: PMC5787628 DOI: 10.15537/smj.2017.12.20989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To identify the underlying gene mutation in a large consanguineous Pakistani family. Methods: This is an observational descriptive study carried out at the Department of Biochemistry, Shifa International Hospital, Quaid-i-Azam University, and Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology, Islamabad, Pakistan from 2013-2016. Genomic DNA of all recruited family members was extracted and the Trusight one sequencing panel was used to assess genes associated with a neuro-muscular phenotype. Comparative modeling of mutated and wild-type protein was carried out by PyMOL tool. Results: Clinical investigations of an affected individual showed typical features of Miyoshi myopathy (MM) like elevated serum creatine kinase (CK) levels, distal muscle weakness, myopathic changes in electromyography (EMG) and muscle histopathology. Sequencing with the Ilumina Trusight one sequencing panel revealed a novel 22 nucleotide duplication (CTTCAACTTGTTTGACTCTCCT) in the DYSF gene (NM_001130987.1_c.897-918dup; p.Gly307Leufs5X), which results in a truncating frameshift mutation and perfectly segregated with the disease in this family. Protein modeling studies suggested a disruption in spatial configuration of the putative mutant protein. Conclusion: A novel duplication of 22 bases (c.897_918dup; p.Gly307Leufs5X) in the DYSF gene was identified in a family suffering from Miyoshi myopathy. Protein homology analysis proposes a disruptive impact of this mutation on protein function.
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Affiliation(s)
- Muhammad I Ullah
- Department of Biochemistry, Faculty of Biological Sciences, Quaid-i-Azam University, Lahore, Pakistan. E-mail.
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Jin SQ, Yu M, Zhang W, Lyu H, Yuan Y, Wang ZX. Dysferlin Gene Mutation Spectrum in a Large Cohort of Chinese Patients with Dysferlinopathy. Chin Med J (Engl) 2017; 129:2287-93. [PMID: 27647186 PMCID: PMC5040013 DOI: 10.4103/0366-6999.190671] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Dysferlinopathy is caused by mutations in the dysferlin (DYSF) gene. Here, we described the genetic features of a large cohort of Chinese patients with this disease. METHODS Eighty-nine index patients were included in the study. DYSF gene analysis was performed by Sanger sequencing in 41 patients and targeted next generation sequencing (NGS) in 48 patients. Multiplex ligation-dependent probe amplification (MLPA) was performed to detect exon duplication/deletion in patients with only one pathogenic mutation. RESULTS Among the 89 index patients, 79 patients were demonstrated to carry two disease-causing (73 cases) or possibly disease-causing mutations (6 cases), including 26 patients with homozygous mutations. We identified 105 different mutations, including 59 novel ones. Notably, in 13 patients in whom only one pathogenic mutation was initially found by Sanger sequencing or NGS, 3 were further identified to carry exon deletions by MLPA. The mutations identified in this study appeared to cluster in the N-terminal region. Mutation types included missense mutations (30.06%), nonsense mutations (17.18%), frameshift mutations (30.67%), in-frame deletions (2.45%), intronic mutations (17.79%), and exonic rearrangement (1.84%). No genotype-phenotype correlation was identified. CONCLUSIONS DYSF mutations in Chinese patients clustered in the N-terminal region of the gene. Exonic rearrangements were found in 23% of patients with only one pathogenic mutation identified by Sanger sequencing or NGS. The novel mutations found in this study greatly expanded the mutational spectrum of dysferlinopathy.
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Affiliation(s)
- Su-Qin Jin
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Meng Yu
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Wei Zhang
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - He Lyu
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Yun Yuan
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Zhao-Xia Wang
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
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