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Ben Yaou R, Yun P, Dabaj I, Norato G, Donkervoort S, Xiong H, Nascimento A, Maggi L, Sarkozy A, Monges S, Bertoli M, Komaki H, Mayer M, Mercuri E, Zanoteli E, Castiglioni C, Marini-Bettolo C, D'Amico A, Deconinck N, Desguerre I, Erazo-Torricelli R, Gurgel-Giannetti J, Ishiyama A, Kleinsteuber KS, Lagrue E, Laugel V, Mercier S, Messina S, Politano L, Ryan MM, Sabouraud P, Schara U, Siciliano G, Vercelli L, Voit T, Yoon G, Alvarez R, Muntoni F, Pierson TM, Gómez-Andrés D, Reghan Foley A, Quijano-Roy S, Bönnemann CG, Bonne G. International retrospective natural history study of LMNA-related congenital muscular dystrophy. Brain Commun 2021; 3:fcab075. [PMID: 34240052 PMCID: PMC8260964 DOI: 10.1093/braincomms/fcab075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 12/23/2020] [Accepted: 02/02/2021] [Indexed: 12/12/2022] Open
Abstract
Muscular dystrophies due to heterozygous pathogenic variants in LMNA gene cover a broad spectrum of clinical presentations and severity with an age of onset ranging from the neonatal period to adulthood. The natural history of these conditions is not well defined, particularly in patients with congenital or early onset who arguably present with the highest disease burden. Thus the definition of natural history endpoints along with clinically revelant outcome measures is essential to establishing both clinical care planning and clinical trial readiness for this patient group. We designed a large international cross-sectional retrospective natural history study of patients with genetically proven muscle laminopathy who presented with symptoms before two years of age intending to identify and characterize an optimal clinical trial cohort with pertinent motor, cardiac and respiratory endpoints. Quantitative statistics were used to evaluate associations between LMNA variants and distinct clinical events. The study included 151 patients (median age at symptom onset 0.9 years, range: 0.0–2.0). Age of onset and age of death were significantly lower in patients who never acquired independent ambulation compared to patients who achieved independent ambulation. Most of the patients acquired independent ambulation (n = 101, 66.9%), and subsequently lost this ability (n = 86; 85%). The age of ambulation acquisition (median: 1.2 years, range: 0.8–4.0) and age of ambulation loss (median: 7 years, range: 1.2–38.0) were significantly associated with the age of the first respiratory interventions and the first cardiac symptoms. Respiratory and gastrointestinal interventions occurred during first decade while cardiac interventions occurred later. Genotype–phenotype analysis showed that the most common mutation, p.Arg249Trp (20%), was significantly associated with a more severe disease course. This retrospective natural history study of early onset LMNA-related muscular dystrophy confirms the progressive nature of the disorder, initially involving motor symptoms prior to onset of other symptoms (respiratory, orthopaedic, cardiac and gastrointestinal). The study also identifies subgroups of patients with a range of long-term outcomes. Ambulatory status was an important mean of stratification along with the presence or absence of the p.Arg249Trp mutation. These categorizations will be important for future clinical trial cohorts. Finally, this study furthers our understanding of the progression of early onset LMNA-related muscular dystrophy and provides important insights into the anticipatory care needs of LMNA-related respiratory and cardiac manifestations.
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Affiliation(s)
- Rabah Ben Yaou
- Sorbonne Université, Inserm, Institut de Myologie, Centre de Recherche en Myologie, F-75013 Paris, France.,APHP-Sorbonne Université, Neuromuscular Disorders Reference Center of Nord-Est-Île de France, FILNEMUS, ERN-Euro-NMD, Service de Neuromyologie, Institute de Myologie, G.H. Pitié-Salpêtrière Paris F-75013, France
| | - Pomi Yun
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Ivana Dabaj
- APHP-Université Paris-Saclay, Neuromuscular Disorders Reference Center of Nord-Est-Île de France, FILNEMUS, ERN-Euro-NMD, Pediatric Neurology and ICU Department, DMU Santé Enfant Adolescent (SEA), Raymond Poincaré University Hospital, Garches France.,INSERM U 1245, ED497, School of Medicine, Rouen University, Rouen, France
| | - Gina Norato
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Sandra Donkervoort
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Hui Xiong
- INSERM U 1245, ED497, School of Medicine, Rouen University, Rouen, France
| | - Andrés Nascimento
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Lorenzo Maggi
- Neuromuscular Unit, Neuropaediatrics Department, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, CIBERER - ISC III, Barcelona, Spain
| | - Anna Sarkozy
- Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Instituto Neurologico Carlo Besta, Milano, Italy.,Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital Trust, London, UK
| | - Soledad Monges
- Servicio de Neurología, Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina
| | - Marta Bertoli
- Northern Genetics Service, The Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Hirofumi Komaki
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Michèle Mayer
- APHP-Sorbonne Université, Neuromuscular Disorders Reference Center of Nord-Est-Île de France, FILNEMUS, ERN-Euro-NMD, Department of Neuropediatrics, Hôpital Armand Trousseau, Paris, France
| | - Eugenio Mercuri
- Paediatric Neurology, Policlinico Gemelli, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Edmar Zanoteli
- Department of Neurology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | | | - Chiara Marini-Bettolo
- John Walton Muscular Dystrophy Research Centre, Institute of Integrated Laboratory Medicine, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Adele D'Amico
- Unit of Muscular and Neurodegenerative diseases, Department of Neurological and Psychiatric science,s Bambino Gesù Children's Hospital, Rome, Italy
| | - Nicolas Deconinck
- Paediatric Neurology Department and neuromuscular Center, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Isabelle Desguerre
- APHP-Centre - Université de Paris, Neuromuscular Disorders Reference Center of Nord-Est-Île de France, FILNEMUS, ERN-Euro-NMD, Necker-Enfants Malades Hospital, Paris, France
| | - Ricardo Erazo-Torricelli
- Neurología Pediátrica, Unidad Neuromuscular, Hospital Luis Calvo Mackenna, Clínica Alemana de Santiago, Santiago, Chile
| | - Juliana Gurgel-Giannetti
- Department of Pediatrics, Pediatric Neurology Service, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Akihiko Ishiyama
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Karin S Kleinsteuber
- Neurología Pediátrica Hospital Roberto del Río- Universidad de Chile - Clínica Las Condes Santiago, Chile
| | - Emmanuelle Lagrue
- CHRU de Tours, Université François Rabelais de Tours, INSERM U1253, Tours, France
| | - Vincent Laugel
- Department of neuropediatrics, CHU Strasbourg- Hautepierre, Strasbourg, France
| | - Sandra Mercier
- Service de Génétique médicale, INSERM, CNRS, UNIV Nantes, CHU Nantes, l'institut du Thorax, Nantes, France
| | - Sonia Messina
- Unit of Neurology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Luisa Politano
- Cardiomiology and Medical Genetics, Department of Experimental Medicine, University of Campania, Naples, Italy
| | - Monique M Ryan
- Children's Neurosciences Centre, Royal Children's Hospital, Victoria, Australia
| | - Pascal Sabouraud
- Service de Pédiatrie A, Neurologie pédiatrique, CHU de Reims, American Memorial Hospital, Reims, France
| | - Ulrike Schara
- Department of Neuropediatrics, Developmental Neurology and Social Pediatrics, Children's Hospital 1, University of Duisburg-Essen, Essen, Germany
| | - Gabriele Siciliano
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Liliana Vercelli
- Department of Neuroscience, Center for Neuromuscular Diseases, University of Turin, Turin, Italy
| | - Thomas Voit
- Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Instituto Neurologico Carlo Besta, Milano, Italy.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Grace Yoon
- Divisions of Neurology and Clinical and Metabolic Genetics, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Rachel Alvarez
- Congenital Muscle Disease International Registry (CMDIR), Cure CMD, Lakewood, CA, USA
| | - Francesco Muntoni
- Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Instituto Neurologico Carlo Besta, Milano, Italy.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Tyler M Pierson
- Departments of Pediatrics and Neurology and the Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - David Gómez-Andrés
- Pediatric Neurology (ERN-RND - EURO-NMD), Vall d'Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - A Reghan Foley
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Susana Quijano-Roy
- APHP-Université Paris-Saclay, Neuromuscular Disorders Reference Center of Nord-Est-Île de France, FILNEMUS, ERN-Euro-NMD, Pediatric Neurology and ICU Department, DMU Santé Enfant Adolescent (SEA), Raymond Poincaré University Hospital, Garches France.,INSERM U 1179, University of Versailles Saint-Quentin-en-Yvelines (UVSQ), France
| | - Carsten G Bönnemann
- Neuromuscular and Neurogenetic Disorders of Childhood Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Gisèle Bonne
- Sorbonne Université, Inserm, Institut de Myologie, Centre de Recherche en Myologie, F-75013 Paris, France.,APHP-Sorbonne Université, Neuromuscular Disorders Reference Center of Nord-Est-Île de France, FILNEMUS France, ERN-Euro-NMD, Paris, France
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Pasqualin LMA, Reed UC, Costa TVMM, Quedas E, Albuquerque MAV, Resende MBD, Rutkowski A, Chadi G, Zanoteli E. Congenital muscular dystrophy with dropped head linked to the LMNA gene in a Brazilian cohort. Pediatr Neurol 2014; 50:400-6. [PMID: 24508248 DOI: 10.1016/j.pediatrneurol.2013.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 11/11/2013] [Accepted: 11/13/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Congenital muscular dystrophy is a clinically and genetically heterogeneous group of myopathies. Congenital muscular dystrophy related to lamin A/C is rare and characterized by early-onset hypotonia with axial muscle weakness typically presenting with a loss in motor acquisitions within the first year of life and a dropped-head phenotype. METHODS Here we report the clinical and histological characteristics of four unrelated Brazilian patients with dropped-head syndrome and mutations in the LMNA gene. RESULTS All patients had previously described mutations (p.E358K, p.R249W, and p.N39S) and showed pronounced cervical muscle weakness, elevation of serum creatine kinase, dystrophic pattern on muscle biopsy, and respiratory insufficiency requiring ventilatory support. Three of the patients manifested cardiac arrhythmias, and one demonstrated a neuropathic pattern on nerve conduction study. CONCLUSION Although lamin A/C--related congenital muscular dystrophy is a clinically distinct and recognizable phenotype, genotype/phenotype correlation, ability to anticipate onset of respiratory and cardiac involvement, and need for nutritional support remain difficult.
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Affiliation(s)
- Lívia M A Pasqualin
- Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Umbertina C Reed
- Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Thais V M M Costa
- Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Elisângela Quedas
- Department of Endocrinology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Marco A V Albuquerque
- Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Maria B D Resende
- Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Gerson Chadi
- Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Edmar Zanoteli
- Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil.
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Bönnemann CG, Wang CH, Quijano-Roy S, Deconinck N, Bertini E, Ferreiro A, Muntoni F, Sewry C, Béroud C, Mathews KD, Moore SA, Bellini J, Rutkowski A, North KN. Diagnostic approach to the congenital muscular dystrophies. Neuromuscul Disord 2014; 24:289-311. [PMID: 24581957 PMCID: PMC5258110 DOI: 10.1016/j.nmd.2013.12.011] [Citation(s) in RCA: 206] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 12/23/2013] [Accepted: 12/31/2013] [Indexed: 12/14/2022]
Abstract
Congenital muscular dystrophies (CMDs) are early onset disorders of muscle with histological features suggesting a dystrophic process. The congenital muscular dystrophies as a group encompass great clinical and genetic heterogeneity so that achieving an accurate genetic diagnosis has become increasingly challenging, even in the age of next generation sequencing. In this document we review the diagnostic features, differential diagnostic considerations and available diagnostic tools for the various CMD subtypes and provide a systematic guide to the use of these resources for achieving an accurate molecular diagnosis. An International Committee on the Standard of Care for Congenital Muscular Dystrophies composed of experts on various aspects relevant to the CMDs performed a review of the available literature as well as of the unpublished expertise represented by the members of the committee and their contacts. This process was refined by two rounds of online surveys and followed by a three-day meeting at which the conclusions were presented and further refined. The combined consensus summarized in this document allows the physician to recognize the presence of a CMD in a child with weakness based on history, clinical examination, muscle biopsy results, and imaging. It will be helpful in suspecting a specific CMD subtype in order to prioritize testing to arrive at a final genetic diagnosis.
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Affiliation(s)
- Carsten G Bönnemann
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States.
| | - Ching H Wang
- Driscoll Children's Hospital, Corpus Christi, TX, United States
| | - Susana Quijano-Roy
- Hôpital Raymond Poincaré, Garches, and UFR des sciences de la santé Simone Veil (UVSQ), France
| | - Nicolas Deconinck
- Hôpital Universitaire des Enfants Reine Fabiola, Brussels and Ghent University Hospital, Ghent, Belgium
| | | | - Ana Ferreiro
- UMR787 INSERM/UPMC and Reference Center for Neuromuscular Disorders, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Francesco Muntoni
- Dubowitz Neuromuscular Centre, UCL Institute of Child Health, London, United Kingdom
| | - Caroline Sewry
- Dubowitz Neuromuscular Centre, UCL Institute of Child Health, London, United Kingdom
| | - Christophe Béroud
- INSERM U827, Laboratoire de Génétique Moleculaire, Montpellier, France
| | | | | | - Jonathan Bellini
- Stanford University School of Medicine, Stanford, CA, United States
| | | | - Kathryn N North
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
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