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Gemignani F, Percesepe A, Gualandi F, Allegri I, Bellanova MF, Nuredini A, Saccani E, Ambrosini E, Barili V, Uliana V. Charcot-Marie-Tooth Disease with Myelin Protein Zero Mutation Presenting as Painful, Predominant Small-Fiber Neuropathy. Int J Mol Sci 2024; 25:1654. [PMID: 38338934 PMCID: PMC10855578 DOI: 10.3390/ijms25031654] [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: 12/14/2023] [Revised: 01/16/2024] [Accepted: 01/20/2024] [Indexed: 02/12/2024] Open
Abstract
Charcot-Marie-Tooth disease (CMT) rarely presents with painful symptoms, which mainly occur in association with myelin protein zero (MPZ) gene mutations. We aimed to further characterize the features of painful neuropathic phenotypes in MPZ-related CMT. We report on a 58-year-old woman with a longstanding history of intermittent migrant pain and dysesthesias. Examination showed minimal clinical signs of neuropathy along with mild changes upon electroneurographic examination, consistent with an intermediate pattern, and small-fiber loss upon skin biopsy. Genetic testing identified the heterozygous variant p.Trp101Ter in MPZ. We identified another 20 CMT patients in the literature who presented with neuropathic pain as a main feature in association with MPZ mutations, mostly in the extracellular MPZ domain; the majority of these patients showed late onset (14/20), with motor-nerve-conduction velocities predominantly in the intermediate range (12/20). It is hypothesized that some MPZ mutations could manifest with, or predispose to, neuropathic pain. However, the mechanisms linking MPZ mutations and pain-generating nerve changes are unclear, as are the possible role of modifier factors. This peculiar CMT presentation may be diagnostically misleading, as it is suggestive of an acquired pain syndrome rather than of an inherited neuropathy.
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Affiliation(s)
- Franco Gemignani
- European Diagnostic Center, Polyclinic Dalla Rosa Prati, 43126 Parma, Italy
| | - Antonio Percesepe
- Medical Genetics Unit, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Medical Genetics Unit, University Hospital of Parma, 43126 Parma, Italy
| | - Francesca Gualandi
- Medical Genetics Unit, Department of Mother and Child, Sant’Anna University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Isabella Allegri
- Neurology Unit, Department of Specialized Medicine, University Hospital of Parma, 43126 Parma, Italy
| | - Maria Federica Bellanova
- Laboratory of Neuromuscular Histopathology, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Andi Nuredini
- Neurology Unit, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Elena Saccani
- Neurology Unit, Department of Specialized Medicine, University Hospital of Parma, 43126 Parma, Italy
| | - Enrico Ambrosini
- Medical Genetics Unit, University Hospital of Parma, 43126 Parma, Italy
| | - Valeria Barili
- Medical Genetics Unit, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Vera Uliana
- Medical Genetics Unit, University Hospital of Parma, 43126 Parma, Italy
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Mutation update for myelin protein zero-related neuropathies and the increasing role of variants causing a late-onset phenotype. J Neurol 2019; 266:2629-2645. [DOI: 10.1007/s00415-019-09453-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/21/2019] [Accepted: 06/26/2019] [Indexed: 01/18/2023]
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Corrado L, Magri S, Bagarotti A, Carecchio M, Piscosquito G, Pareyson D, Varrasi C, Vecchio D, Zonta A, Cantello R, Taroni F, D'Alfonso S. A novel synonymous mutation in the MPZ gene causing an aberrant splicing pattern and Charcot-Marie-Tooth disease type 1b. Neuromuscul Disord 2016; 26:516-20. [PMID: 27344971 DOI: 10.1016/j.nmd.2016.05.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/16/2016] [Accepted: 05/19/2016] [Indexed: 10/21/2022]
Abstract
Charcot-Marie-Tooth disease (CMT) is an inherited peripheral neuropathy with a heterogeneous genetic background. Here, we describe two CMT1B families with a mild sensory-motor neuropathy and a novel synonymous variant (c.309G > T, p.G103G) in exon 3 of the MPZ gene. Next generation sequencing analysis on a 94 CMT gene panel showed no mutations in other disease genes. In vitro splicing assay and mRNA expression analysis indicated that the c.309T variant enhances a cryptic donor splice site at position c.304 resulting in the markedly increased expression of the r.304_448del alternative transcript in patients' cells. This transcript is predicted to encode a truncated P0 protein (p.V102Cfs11*) lacking the transmembrane domain, thus suggesting a possible haploinsufficiency mechanism for this mutation. This is the third reported synonymous MPZ variant associated with CMT1 and affecting splicing. These data confirm the functional impact of synonymous variants on MPZ splicing and their possible role as disease-causing mutations rather than silent polymorphisms.
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Affiliation(s)
- L Corrado
- Human Genetics Laboratory, Department of Health Sciences, Amedeo Avogadro University, Via Solaroli 17, 28100 Novara, Italy; Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), Amedeo Avogadro University, Novara, Italy.
| | - S Magri
- Unit of Genetics of Neurodegenerative and Metabolic Disease, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Celoria 11, 20133 Milano, Italy
| | - A Bagarotti
- Human Genetics Laboratory, Department of Health Sciences, Amedeo Avogadro University, Via Solaroli 17, 28100 Novara, Italy
| | - M Carecchio
- Department of Neurology, Amedeo Avogadro University, Corso Mazzini 18, 28100 Novara, Italy
| | - G Piscosquito
- Unit of Clinic of Central and Peripheral Degenerative Neuropathies, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Celoria 11, 20133 Milano, Italy
| | - D Pareyson
- Unit of Clinic of Central and Peripheral Degenerative Neuropathies, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Celoria 11, 20133 Milano, Italy
| | - C Varrasi
- Department of Neurology, Amedeo Avogadro University, Corso Mazzini 18, 28100 Novara, Italy
| | - D Vecchio
- Department of Neurology, Amedeo Avogadro University, Corso Mazzini 18, 28100 Novara, Italy
| | - A Zonta
- Human Genetics Laboratory, Department of Health Sciences, Amedeo Avogadro University, Via Solaroli 17, 28100 Novara, Italy
| | - R Cantello
- Department of Neurology, Amedeo Avogadro University, Corso Mazzini 18, 28100 Novara, Italy
| | - F Taroni
- Unit of Genetics of Neurodegenerative and Metabolic Disease, Fondazione IRCCS Istituto Neurologico Carlo Besta, via Celoria 11, 20133 Milano, Italy
| | - S D'Alfonso
- Human Genetics Laboratory, Department of Health Sciences, Amedeo Avogadro University, Via Solaroli 17, 28100 Novara, Italy; Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), Amedeo Avogadro University, Novara, Italy
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Duman O, Uysal H, Skjei KL, Kizilay F, Karauzum S, Haspolat S. Sensorimotor polyneuropathy in patients with SMA type-1: Electroneuromyographic findings. Muscle Nerve 2013; 48:117-21. [DOI: 10.1002/mus.23722] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2012] [Indexed: 12/12/2022]
Affiliation(s)
- Ozgur Duman
- Akdeniz University Hospital; H Block; Department of Child Neurology; Antalya Turkey
| | - Hilmi Uysal
- Akdeniz University Hospital; Department of Neurology; Antalya Turkey
| | - Karen L. Skjei
- Children Hospital of Philadelphia; Department of Neurology; Philadelphia Pennsylvania USA
| | - Ferah Kizilay
- Akdeniz University Hospital; Department of Neurology; Antalya Turkey
| | - Sibel Karauzum
- Akdeniz University Hospital; Department of Medical Biology and Genetics; Antalya Turkey
| | - Senay Haspolat
- Akdeniz University Hospital; H Block; Department of Child Neurology; Antalya Turkey
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Dacci P, Taroni F, Bella ED, Milani M, Pareyson D, Morbin M, Lauria G. Myelin protein zero Arg36Gly mutation with very late onset and rapidly progressive painful neuropathy. J Peripher Nerv Syst 2012; 17:422-5. [DOI: 10.1111/j.1529-8027.2012.00443.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | | | | | - Michela Morbin
- Neuropathology, IRCCS Foundation; “Carlo Besta” Neurological Institute; Milan; Italy
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Marttila M, Rautenstrauss B, Huehne K, Laitinen V, Majamaa K, Kärppä M. A novel mutation of myelin protein zero associated with late-onset predominantly axonal Charcot-Marie-Tooth disease. J Neurol 2012; 259:1585-9. [PMID: 22222859 DOI: 10.1007/s00415-011-6382-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 11/14/2011] [Accepted: 11/26/2011] [Indexed: 11/28/2022]
Abstract
We report a case of late-onset predominantly axonal Charcot-Marie-Tooth disease resulting from a novel mutation in the MPZ gene encoding myelin protein zero (P0). Neurological examination, electrophysiological examination and genetic testing were performed on three members of a Finnish family (family A) and one member of a German family (family B). Three other members of the Finnish family were interviewed and genetically tested. Genetic testing was also performed on 95 healthy Finnish controls. Three members in two generations of family A and the member of family B were affected with late-onset axonal more than demyelinating, motor and sensory polyneuropathy. Heterozygous c.316C>T mutation in MPZ leading to p.Arg106Cys in P0 was found in all the affected subjects, but not in the three unaffected members of the Finnish family. None of 95 healthy Finnish controls harbored the mutation. The findings of this study indicate that p.Arg106Cys allele in MPZ causes late-onset predominantly axonal sensory and motor neuropathy.
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Affiliation(s)
- Maria Marttila
- Department of Clinical Medicine, Neurology, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland
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Park EK, Chung KW, Lee KS, Lee HJ, Yun BR, Kim JN, Shin JH, Choi BO. A novel Gly137Asp MPZ mutation in a Charcot-Marie-Tooth disease type 1B family. Genes Genomics 2011. [DOI: 10.1007/s13258-011-0101-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kanwal S, Choi BO, Kim SB, Koo H, Kim JY, Hyun YS, Lee HJ, Chung KW. Wide phenotypic variations in Charcot-Marie-Tooth 1A neuropathy with rare copy number variations on 17p12. Anim Cells Syst (Seoul) 2011. [DOI: 10.1080/19768354.2011.611172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Luigetti M, Modoni A, Renna R, Silvestri G, Ricci E, Montano N, Tasca G, Papacci M, Monforte M, Conte A, Pomponi M, Sabatelli M. A case of CMT 1B due to Val 102/fs null mutation of the MPZ gene presenting as hyperCKemia. Clin Neurol Neurosurg 2010; 112:794-7. [DOI: 10.1016/j.clineuro.2010.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2009] [Revised: 04/27/2010] [Accepted: 05/02/2010] [Indexed: 10/19/2022]
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Brozková D, Mazanec R, Haberlová J, Sakmaryová I, Seeman P. Clinical and in silico evidence for and against pathogenicity of 11 new mutations in the MPZ gene. Clin Genet 2010; 78:81-7. [PMID: 20456450 DOI: 10.1111/j.1399-0004.2010.01423.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Mutations in the myelin protein zero (MPZ) gene are one of the frequent causes of Charcot-Marie-Tooth (CMT) hereditary neuropathies. Because the mutation rate of MPZ gene is rather high and some mutations are reported as polymorphisms, the proper clinical, electrophysiological examination and the segregation of the new mutation in larger families are crucial for the correct interpretation of the pathogenic or non-pathogenic character of each novel mutation. We examined 11 families with novel MPZ mutations. Eight of the mutations (L48Q, T65N, E97fs, G103W, P132T, T143R, V146G, c.645+1G>T) seem to be pathogenic on the basis of perfect segregation with the CMT phenotype and two (G213R and D246N), on the contrary, seem to be non-pathogenic/rare polymorphisms because they are present in healthy relatives. The character of the V46M mutation is difficult to interpret definitely; it may cause a sensory neuropathy or may also be a rare polymorphism. Phenotypes associated with each of the new mutations include severe hereditary motor and sensory neuropathy type III (HMSN III), and mild phenotype CMT1B presented mostly with only decreased or absent reflexes, foot deformities and mild or even absent atrophies in the lower limbs. Our report and careful family investigations with genotype-phenotype correlations should help to improve genetic counselling and correct interpretation of DNA testing results in further isolated patients or smaller families worldwide where these novel mutations might be found.
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Affiliation(s)
- D Brozková
- DNA Laboratory, Department of Child Neurology, Charles University 2nd Medical School and University Hospital Motol, V Uvalu 84, Prague, Czech Republic.
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Schneider-Gold C, Kötting J, Epplen JT, Gold R, Gerding WM. Unusual Charcot-Marie-Tooth phenotype due to a mutation within the intracellular domain of myelin protein zero. Muscle Nerve 2010; 41:550-4. [DOI: 10.1002/mus.21523] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Mazzeo A, Muglia M, Rodolico C, Toscano A, Patitucci A, Quattrone A, Messina C, Vita G. Charcot-Marie-Tooth disease type 1B: marked phenotypic variation of the Ser78Leu mutation in five Italian families. Acta Neurol Scand 2008; 118:328-32. [PMID: 18422810 DOI: 10.1111/j.1600-0404.2008.01021.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe clinical, electrophysiological and genetic data of five unrelated Sicilian pedigrees harbouring a heterozygous Ser78Leu mutation in the myelin protein zero (MPZ) extracellular domain. MATERIALS AND METHODS Clinical, electrophysiological and genetic findings of 16 patients were reported. Polymorphic markers flanking the coding sequence of MPZ gene were also analysed. RESULTS A wide range of age at onset was observed in families 1 and 3, with a clinical heterogeneity, in terms of severity of the disease, within the same family (families 1 and 3), and among families. A markedly unsteady gait was a distinctive feature of many members of family 1. All patients in family 2 complained of severe cramps and painful paresthesia. Molecular genetic analysis showed that all affected subjects shared a common haplotype at three microsatellite loci D1S2858, D1S2624 and D1S484. CONCLUSIONS Our study provides further evidence that phenotypic features of MPZ mutations can vary within and among different families. High frequency of Ser78Leu mutation in Sicily as well as the results of haplotype analyses suggest that the mutation may have been inherited from a common ancestor.
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Affiliation(s)
- A Mazzeo
- Department of Neurosciences, Psychiatry and Anaesthesiology University of Messina, Messina, Italy.
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Smith CA, Chetlin RD, Gutmann L, Yeater RA, Alway SE. Effects of exercise and creatine on myosin heavy chain isoform composition in patients with Charcot-Marie-Tooth disease. Muscle Nerve 2006; 34:586-94. [PMID: 16881064 DOI: 10.1002/mus.20621] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
It is not known whether myosin heavy chain (MHC) content changes in response to exercise training or creatine supplementation in subjects with Charcot-Marie-Tooth disease (CMT). Based on previous data, we hypothesized that resistance exercise and creatine would increase the percentage of type I MHC composition in the vastus lateralis muscle and that myosin isoform changes would correlate with improved chair rise-time in CMT subjects. To test this hypothesis, 18 CMT subjects were randomly assigned to either a placebo or creatine group. All subjects performed a 12-week, home-based, moderate-intensity resistance training program. Chair rise-time was measured before and after the training program. Muscle biopsies were obtained from the vastus lateralis before and after the 12-week program. Gel electrophoresis showed a significant decrease (approximately 30%) in MHC type I in CMT subjects given creatine supplementation when compared with placebo. There was a nonsignificant increase in both MHC type IIa (approximately 23%) and MHC type IIx (approximately 7%) in CMT subjects given creatine. Reduced MHC type I content and increased MHC type IIa content correlated with faster chair rise-times (i.e., improved muscle performance). The training-induced change in MHC IIa content was inversely correlated with chair rise-time in CMT subjects given creatine. When the two subject groups were combined, there was a linear, negative relationship between the change in MHC type IIa content and chair rise-time after training and a positive relationship between the training-induced change in MHC type I content and chair rise-time. These data suggest that improved function (chair rise-time) was associated with a lower level of MHC type I and increased MHC type IIa composition. Furthermore, the data are consistent with the hypothesis that creatine supplementation alters MHC composition in CMT patients undergoing resistance training and that MHC changes associated with creatine supplementation can improve muscle function.
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Affiliation(s)
- Cheryl A Smith
- Laboratory of Muscle Biology and Sarcopenia, Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, West Virginia 26506, USA
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Kilfoyle DH, Dyck PJ, Wu Y, Litchy WJ, Klein DM, Dyck PJB, Kumar N, Cunningham JM, Klein CJ. Myelin protein zero mutation His39Pro: hereditary motor and sensory neuropathy with variable onset, hearing loss, restless legs and multiple sclerosis. J Neurol Neurosurg Psychiatry 2006; 77:963-6. [PMID: 16844954 PMCID: PMC2077629 DOI: 10.1136/jnnp.2006.090076] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Mutations of myelin protein zero (MPZ) may cause inherited neuropathy with variable expression. OBJECTIVE To report phenotypic variability in a large American kindred with MPZ mutation His39Pro. PATIENTS Genetic testing was performed on 77 family members and 200 controls. Clinical and electrophysiological field study assessments were available for review in 47 family members. RESULTS His39Pro was found in all 10 individuals prospectively identified with neuropathy. 200 normal controls were without mutation. Symptoms of neuropathy began in adulthood and were slowly progressive except for one acute-onset painful sensory neuropathy. Associated features included premature hearing loss (n = 7), nocturnal restless leg symptoms (n = 8) and multiple sclerosis in one. CONCLUSIONS MPZ mutation His39Pro may be associated with acute-onset neuropathy, early-onset hearing loss and restless legs. The relationship with multiple sclerosis in the proband remains uncertain.
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Affiliation(s)
- D H Kilfoyle
- Peripheral Nerve Group, Department of Neurology, Mayo Clinic, Genotyping Shared Resource Center of Advanced Genomic Technology Center, Rochester, Minnesota 55905, USA
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Burns TM, Phillips LH, Dimberg EL, Vaught BK, Klein CJ. Novel myelin protein zero mutation (Arg36Trp) in a patient with acute onset painful neuropathy. Neuromuscul Disord 2006; 16:308-10. [PMID: 16616847 DOI: 10.1016/j.nmd.2006.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2005] [Revised: 02/07/2006] [Accepted: 02/17/2006] [Indexed: 11/19/2022]
Abstract
We present a patient with acute onset painful polyneuropathy found to have a novel MPZ mutation (Arg36Trp). The Arg36Trp mutation described in this report occurs at a putative adhesion interface. An alternative explanation for his polyneuropathy was not found and his mother was identified to have polyneuropathy and carry the same mutation. Two hundred normal controls were without this base alteration. The temporal profile of the index case may provide further indirect evidence suggesting an immune mechanism contributing to the pathogenesis of some cases of MPZ mutations. We predict that other rapid symptom onset polyneuropathies will be found to have direct genetic susceptibility.
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Affiliation(s)
- Ted M Burns
- Department of Neurology, University of Virginia, Hospital Drive, McKim Hall, P.O. Box 800394, Charlottesville, VA 22908, USA.
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