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Piga D, Rimoldi M, Magri F, Zanotti S, Napoli L, Ripolone M, Pagliarani S, Ciscato P, Velardo D, D’Amico A, Bertini E, Comi GP, Ronchi D, Corti S. Case report: A novel ACTA1 variant in a patient with nemaline rods and increased glycogen deposition. Front Neurol 2024; 15:1340693. [PMID: 38500810 PMCID: PMC10944937 DOI: 10.3389/fneur.2024.1340693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 02/22/2024] [Indexed: 03/20/2024] Open
Abstract
Background Congenital myopathies are a group of heterogeneous inherited disorders, mainly characterized by early-onset hypotonia and muscle weakness. The spectrum of clinical phenotype can be highly variable, going from very mild to severe presentations. The course also varies broadly resulting in a fatal outcome in the most severe cases but can either be benign or lead to an amelioration even in severe presentations. Muscle biopsy analysis is crucial for the identification of pathognomonic morphological features, such as core areas, nemaline bodies or rods, nuclear centralizations and congenital type 1 fibers disproportion. However, multiple abnormalities in the same muscle can be observed, making more complex the myopathological scenario. Case presentation Here, we describe an Italian newborn presenting with severe hypotonia, respiratory insufficiency, inability to suck and swallow, requiring mechanical ventilation and gastrostomy feeding. Muscle biopsy analyzed by light microscopy showed the presence of vacuoles filled with glycogen, suggesting a metabolic myopathy, but also fuchsinophilic inclusions. Ultrastructural studies confirmed the presence of normally structured glycogen, and the presence of minirods, directing the diagnostic hypothesis toward a nemaline myopathy. An expanded Next Generation Sequencing analysis targeting congenital myopathies genes revealed the presence of a novel heterozygous c.965 T > A p. (Leu322Gln) variant in the ACTA1 gene, which encodes the skeletal muscle alpha-actin. Conclusion Our case expands the repertoire of molecular and pathological features observed in actinopathies. We highlight the value of ultrastructural examination to investigate the abnormalities detected at the histological level. We also emphasized the use of expanded gene panels in the molecular analysis of neuromuscular patients, especially for those ones presenting multiple bioptic alterations.
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Affiliation(s)
- Daniela Piga
- IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | - Martina Rimoldi
- IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Neuromuscular and Rare Disease Unit, Milan, Italy
- IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Medical Genetics Unit, Milan, Italy
| | - Francesca Magri
- IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | - Simona Zanotti
- IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Neuromuscular and Rare Disease Unit, Milan, Italy
| | - Laura Napoli
- IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Neuromuscular and Rare Disease Unit, Milan, Italy
| | - Michela Ripolone
- IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Neuromuscular and Rare Disease Unit, Milan, Italy
| | - Serena Pagliarani
- IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | - Patrizia Ciscato
- IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Neuromuscular and Rare Disease Unit, Milan, Italy
| | - Daniele Velardo
- IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Neuromuscular and Rare Disease Unit, Milan, Italy
| | - Adele D’Amico
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesu’ Children’s Research Hospital, IRCCS, Rome, Italy
| | - Enrico Bertini
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesu’ Children’s Research Hospital, IRCCS, Rome, Italy
| | - Giacomo Pietro Comi
- IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
- Department of Pathophysiology and Transplantation, Dino Ferrari Center, University of Milan, Milan, Italy
| | - Dario Ronchi
- IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
- Department of Pathophysiology and Transplantation, Dino Ferrari Center, University of Milan, Milan, Italy
| | - Stefania Corti
- IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Neuromuscular and Rare Disease Unit, Milan, Italy
- Department of Pathophysiology and Transplantation, Dino Ferrari Center, University of Milan, Milan, Italy
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Nóbrega PR, de Brito de Souza JL, Maurício RB, de Paiva ARB, Dias DA, Camelo CG, Zanotelli E, Schlesinger D, Braga-Neto P, Moreno CAM. Marked neuropsychiatric involvement and dysmorphic features in nemaline myopathy. Neurol Sci 2024; 45:1225-1231. [PMID: 37851294 DOI: 10.1007/s10072-023-07128-6] [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: 04/23/2023] [Accepted: 10/08/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Inherited nemaline myopathy is one of the most common congenital myopathies. This genetically heterogeneous disease is defined by the presence of nemaline bodies in muscle biopsy. The phenotypic spectrum is wide and cognitive involvement has been reported, although not extensively evaluated. METHODS We report two nemaline myopathy patients presenting pronounced central nervous system involvement leading to functional compromise and novel facial and skeletal dysmorphic findings, possibly expanding the disease phenotype. RESULTS One patient had two likely pathogenic NEB variants, c.2943G > A and c.8889 + 1G > A, and presented cognitive impairment and dysmorphic features, and the other had one pathogenic variant in ACTA1, c.169G > C (p.Gly57Arg), presenting autism spectrum disorder and corpus callosum atrophy. Both patients had severe cognitive involvement despite milder motor dysfunction. CONCLUSION We raise the need for further studies regarding the role of thin filament proteins in the central nervous system and for a systematic cognitive assessment of congenital myopathy patients.
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Affiliation(s)
- Paulo Ribeiro Nóbrega
- Department of Neurology, Faculdade de Medicina, Universidade Federal do Ceará, R. Alexandre Baraúna, 949, Rodolfo Teófilo, Fortaleza, CE, 60430-160, Brazil.
- Department of Neurology, Faculdade de Medicina, Universidade de São Paulo (FMUSP), Av. Dr. Arnaldo, 455, Cerqueira César, Pacaembu, São Paulo, 01246-903, Brazil.
- Faculty of Medicine, Unichristus University, Rua Vereador Paulo Mamede, 131, Fortaleza, CE, 60160-196, Brazil.
| | - Jorge Luiz de Brito de Souza
- Center of Health Sciences, Universidade Estadual do Ceará, Av. Dr. Silas Munguba, 1700, Itaperi, Fortaleza, CE, 60714-903, Brazil
| | - Rebeca Bessa Maurício
- Center of Health Sciences, Universidade Estadual do Ceará, Av. Dr. Silas Munguba, 1700, Itaperi, Fortaleza, CE, 60714-903, Brazil
| | - Anderson Rodrigues Brandão de Paiva
- Department of Neurology, Faculdade de Medicina, Universidade de São Paulo (FMUSP), Av. Dr. Arnaldo, 455, Cerqueira César, Pacaembu, São Paulo, 01246-903, Brazil
- Mendelics Genomic Analysis, Av. Braz Leme, 1631, Casa Verde, São Paulo, SP, 02511-000, Brazil
| | - Daniel Aguiar Dias
- Department of Radiology, Faculdade de Medicina da Universidade Federal do Ceará, R. Alexandre Baraúna, 949, Rodolfo Teófilo, Fortaleza, CE, 60430-160, Brazil
| | - Clara Gontijo Camelo
- Department of Neurology, Faculdade de Medicina, Universidade de São Paulo (FMUSP), Av. Dr. Arnaldo, 455, Cerqueira César, Pacaembu, São Paulo, 01246-903, Brazil
| | - Edmar Zanotelli
- Department of Neurology, Faculdade de Medicina, Universidade de São Paulo (FMUSP), Av. Dr. Arnaldo, 455, Cerqueira César, Pacaembu, São Paulo, 01246-903, Brazil
| | - David Schlesinger
- Mendelics Genomic Analysis, Av. Braz Leme, 1631, Casa Verde, São Paulo, SP, 02511-000, Brazil
| | - Pedro Braga-Neto
- Department of Neurology, Faculdade de Medicina, Universidade Federal do Ceará, R. Alexandre Baraúna, 949, Rodolfo Teófilo, Fortaleza, CE, 60430-160, Brazil
- Center of Health Sciences, Universidade Estadual do Ceará, Av. Dr. Silas Munguba, 1700, Itaperi, Fortaleza, CE, 60714-903, Brazil
| | - Cristiane Araujo Martins Moreno
- Department of Neurology, Faculdade de Medicina, Universidade de São Paulo (FMUSP), Av. Dr. Arnaldo, 455, Cerqueira César, Pacaembu, São Paulo, 01246-903, Brazil
- Mendelics Genomic Analysis, Av. Braz Leme, 1631, Casa Verde, São Paulo, SP, 02511-000, Brazil
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Haidong L, Yin L, Ping C, Xianzhao Z, Qi Q, Xiaoli M, Zheng L, Wenhao C, Yaguang Z, Qianqian Q. Clinico-pathological and gene features of 15 nemaline myopathy patients from a single Chinese neuromuscular center. Acta Neurol Belg 2024; 124:91-99. [PMID: 37525074 PMCID: PMC10874337 DOI: 10.1007/s13760-023-02333-8] [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: 04/17/2023] [Accepted: 07/12/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Nemaline myopathy, the most common of the congenital myopathies, is caused by various genetic mutations. In this study, we attempted to investigate the clinical features, muscle pathology and genetic features of 15 patients with nemaline myopathy. RESULTS Among the 15 patients, there were 9 (60.00%) males and 6 (40.00%) females, and 9 (60.00%) of them came from three families respectively. The age of seeing a doctor ranged from 9 to 52 years old, the age of onset was from 5 to 23 years old, and the duration of disease ranged from 3 to 35 years. Ten out of the 15 patients had high arched palate and elongated face. Only one patient had mild respiratory muscle involvement and none had dysphagia. Muscle biopsies were performed in 9 out of the 15 patients. Pathologically, muscle fibers of different sizes, atrophic muscle fibers and compensatory hypertrophic fibers could be found, and occasionally degenerated and necrotic muscle fibers were observed. Different degrees of nemaline bodies aggregation could be seen in all 9 patients. The distribution of type I and type II muscle fibers were significantly abnormal in patients with nemaline myopathy caused by NEB gene, however, it was basically normal in patients with nemaline myopathy caused by TPM3 gene and ACTA1 gene. Electron microscopic analysis of 6 patients showed that nemaline bodies aggregated between myofibrils were found in 5(83.33%) cases, and most of them were located near the Z band, but no intranuclear rods were found. The gene analysis of 15 NM patients showed that three NM-related genes were harbored, including 11 (73.33%) patients with NEB, 3 (20.00%) patients with TPM3, and 1 (6.67%) patient with ACTA1, respectively. A total of 12 mutation sites were identified and included 10 (83.33%) mutations in exon and 2(16.67%) mutations in intron. CONCLUSIONS The clinical phenotype of nemaline myopathy is highly heterogeneous. Muscle pathology shows that nemaline bodies aggregation is an important feature for the diagnosis of NM. NEB is the most frequent causative gene in this cohort. The splicing mutation, c.21522 + 3A > G may be the hotspot mutation of the NEB gene in Chinese NM patients.
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Affiliation(s)
- Lv Haidong
- Department of Neurology, Jiaozuo People's Hospital of Henan Province, Henan, 454002, Henan Province, People's Republic of China
| | - Liu Yin
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, People's Republic of China
| | - Chen Ping
- Department of Neurology, Jiaozuo People's Hospital of Henan Province, Henan, 454002, Henan Province, People's Republic of China
| | - Zheng Xianzhao
- Department of Neurology, Jiaozuo People's Hospital of Henan Province, Henan, 454002, Henan Province, People's Republic of China
| | - Qian Qi
- Department of Neurology, Jiaozuo People's Hospital of Henan Province, Henan, 454002, Henan Province, People's Republic of China
| | - Ma Xiaoli
- Department of Neurology, Jiaozuo People's Hospital of Henan Province, Henan, 454002, Henan Province, People's Republic of China
| | - Lv Zheng
- Department of Neurology, Jiaozuo People's Hospital of Henan Province, Henan, 454002, Henan Province, People's Republic of China
| | - Cui Wenhao
- Department of Neurology, Jiaozuo People's Hospital of Henan Province, Henan, 454002, Henan Province, People's Republic of China
| | - Zhou Yaguang
- Department of Neurology, Jiaozuo People's Hospital of Henan Province, Henan, 454002, Henan Province, People's Republic of China
| | - Qu Qianqian
- Department of Neurology, Jiaozuo People's Hospital of Henan Province, Henan, 454002, Henan Province, People's Republic of China.
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Lehtokari VL, Sagath L, Davis M, Ho D, Kiiski K, Kettunen K, Demczko M, Stein R, Vatta M, Winder TL, Shohet A, Orenstein N, Krcho P, Bohuš P, Huovinen S, Udd B, Pelin K, Laing NG, Wallgren-Pettersson C. A recurrent ACTA1 amino acid change in mosaic form causes milder asymmetric myopathy. Neuromuscul Disord 2024; 34:32-40. [PMID: 38142473 DOI: 10.1016/j.nmd.2023.11.009] [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: 06/27/2023] [Revised: 10/25/2023] [Accepted: 11/26/2023] [Indexed: 12/26/2023]
Abstract
We describe three patients with asymmetric congenital myopathy without definite nemaline bodies and one patient with severe nemaline myopathy. In all four patients, the phenotype had been caused by pathogenic missense variants in ACTA1 leading to the same amino acid change, p.(Gly247Arg). The three patients with milder myopathy were mosaic for their variants. In contrast, in the severely affected patient, the missense variant was present in a de novo, constitutional form. The grade of mosaicism in the three mosaic patients ranged between 20 % and 40 %. We speculate that the milder clinical and histological manifestations of the same ACTA1 variant in the patients with mosaicism reflect the lower abundance of mutant actin in their muscle tissue. Similarly, the asymmetry of body growth and muscle weakness may be a consequence of the affected cells being unevenly distributed. The partial improvement in muscle strength with age in patients with mosaicism might be due to an increased proportion over time of nuclei carrying and expressing two normal alleles.
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Affiliation(s)
- Vilma-Lotta Lehtokari
- Folkhälsan Research Center, 00290 Helsinki, Finland; Department of Medical and Clinical Genetics, Medicum, 00014 University of Helsinki, Finland.
| | - Lydia Sagath
- Folkhälsan Research Center, 00290 Helsinki, Finland; Department of Medical and Clinical Genetics, Medicum, 00014 University of Helsinki, Finland
| | - Mark Davis
- Department of Diagnostic Genomics, PathWest Laboratory Medicine WA, Nedlands WA 6009, SA
| | - Desiree Ho
- Department of Diagnostic Genomics, PathWest Laboratory Medicine WA, Nedlands WA 6009, SA
| | - Kirsi Kiiski
- Folkhälsan Research Center, 00290 Helsinki, Finland; Laboratory of Genetics, Division of Genetics and Clinical Pharmacology, HUS Diagnostic Center, 00029 Helsinki University Hospital and 00014 University of Helsinki, Helsinki, Finland
| | - Kaisa Kettunen
- Laboratory of Genetics, Division of Genetics and Clinical Pharmacology, HUS Diagnostic Center, 00029 Helsinki University Hospital and 00014 University of Helsinki, Helsinki, Finland
| | - Matthew Demczko
- Division of Diagnostic Referral Services, Nemours Children's Hospital, Wilmington, DE 19803, United States
| | - Riki Stein
- Genetics Unit, Schneider Children's Medical Center, Petach Tikva 4920235, Israel
| | - Matteo Vatta
- Invitae Corporation, San Francisco, CA 94103, United States
| | | | - Adi Shohet
- Genetics Unit, Schneider Children's Medical Center, Petach Tikva 4920235, Israel
| | - Naama Orenstein
- Genetics Unit, Schneider Children's Medical Center, Petach Tikva 4920235, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Peter Krcho
- Department of Neonatology, Pavol Jozef Safarik University, 041 80 Košice, Slovakia
| | - Peter Bohuš
- Department of Pathology, L. Pasteur University Hospital, 040 11 Košice, Slovakia
| | - Sanna Huovinen
- Department of Pathology, Fimlab Laboratories, Tampere University Hospital, 33101 Tampere, Finland
| | - Bjarne Udd
- Folkhälsan Research Center, 00290 Helsinki, Finland; Neuromuscular Research Center, Department of Neurology, Tampere University and University Hospital, 33520 Tampere, Finland; Department of Neurology, Vaasa Central Hospital, 65130 Vaasa, Finland
| | - Katarina Pelin
- Folkhälsan Research Center, 00290 Helsinki, Finland; Molecular and Integrative Biosciences Research Programme, Faculty of Biological and Environmental Sciences, 00014 University of Helsinki, Finland
| | - Nigel G Laing
- Department of Diagnostic Genomics, PathWest Laboratory Medicine WA, Nedlands WA 6009, SA; Harry Perkins Institute of Medical Research, and University of Western Australia Centre for Medical Research, Nedlands Western Australia 6009, Australia
| | - Carina Wallgren-Pettersson
- Folkhälsan Research Center, 00290 Helsinki, Finland; Department of Medical and Clinical Genetics, Medicum, 00014 University of Helsinki, Finland
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Haghighi A, Alvandi Z, Nilipour Y, Haghighi A, Kornreich R, Nafissi S, Desnick RJ. Nemaline myopathy: reclassification of previously reported variants according to ACMG guidelines, and report of novel genetic variants. Eur J Hum Genet 2023; 31:1237-1250. [PMID: 37460656 PMCID: PMC10620380 DOI: 10.1038/s41431-023-01378-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 12/11/2022] [Accepted: 04/26/2023] [Indexed: 11/03/2023] Open
Abstract
Nemaline myopathy (NM) is a heterogeneous genetic neuromuscular disorder characterized by rod bodies in muscle fibers resulting in multiple complications due to muscle weakness. NM patients and their families could benefit from genetic analysis for early diagnosis, carrier and prenatal testing; however, clinical classification of variants is subject to change as further information becomes available. Reclassification can significantly alter the clinical management of patients and their families. We used the newly published data and ACMG/AMP guidelines to reassess NM-associated variants previously reported by clinical laboratories (ClinVar). Our analyses on rare variants that were not canonical loss-of-function (LOF) resulted in the downgrading of ~29% (28/97) of variants from pathogenic or likely-pathogenic (P/LP) to variants of uncertain significance (VUS). In addition, we analyzed the splicing effect of variants identified in NM patients by clinical laboratories or research, using an accurate in silico prediction tool that applies a deep-learning network. We identified 55 rare variants that may impact splicing (cryptic splicing). We also analyzed six new NM families and identified eight variants in NEB and ACTA1, including three novel variants: homozygous pathogenic c.164A > G (p.Tyr55Cys), and homozygous likely pathogenic c.980T > C (p.Met327Thr) in ACTA1, and heterozygous VUS c.18694-3T > G in NEB. This study demonstrates the importance of reclassifying variants to facilitate more definitive "calls" on causality or no causality in clinical genetic testing of patients with NM. Reclassification of ~150 variants is now available for improved clinical management, risk counseling and screening of NM patients.
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Affiliation(s)
- Alireza Haghighi
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
- Department of Genetics, Harvard Medical School, Boston, MA, 02115, USA.
- Howard Hughes Medical Institute, Brigham and Women's Hospital, Boston, MA, 02115, USA.
- The Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA.
| | - Zahra Alvandi
- Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA
- Vascular Biology Program, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Yalda Nilipour
- Pediatric Pathology Research Center, Research Institute for Children's Health, and Mofid Children Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirreza Haghighi
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Ruth Kornreich
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shahriar Nafissi
- Department of Neurology, Neuromuscular Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Robert J Desnick
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Mulvany-Robbins B, Putko B, Schmitt L, Oudit G, Phan C, Beecher G. Novel p.Asp27Glu ACTA1 variant features congenital myopathy with finger flexor weakness, cardiomyopathy, and cardiac conduction defects. Neuromuscul Disord 2023; 33:546-550. [PMID: 37315422 DOI: 10.1016/j.nmd.2023.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 06/16/2023]
Abstract
Pathogenic variants in the skeletal muscle α-actin 1 gene (ACTA1) cause a spectrum of myopathies with clinical and myopathological diversity. Clinical presentations occur from the prenatal period to adulthood, commonly with proximal-predominant weakness and rarely preferential distal weakness. Myopathological findings are wide-ranging, with nemaline rods being most frequent. Associated cardiomyopathy is rare and conduction defects are not reported. We describe a family with congenital myopathy with prominent finger flexor weakness and cardiomyopathy with cardiac conduction defects. The proband, a 48-year-old Caucasian male, his 73-year-old mother, 41-year-old sister, and 19-year-old nephew presented with prominent finger flexor weakness on a background of neonatal hypotonia and delayed motor milestones. All had progressive cardiomyopathy with systolic dysfunction and/or left ventricular dilation. The proband and sister had intraventricular conduction delay and left anterior fascicular block, respectively. The mother had atrial fibrillation. Muscle biopsy in the proband and sister demonstrated congenital fiber-type disproportion and rare nemaline rods in the proband. A novel dominant variant in ACTA1 (c.81C>A, p.Asp27Glu) segregated within the family. This family expands the genotypic and phenotypic spectrum of ACTA1-related myopathy, highlighting preferential finger flexor involvement with cardiomyopathy and conduction disease. We emphasize early and ongoing cardiac surveillance in ACTA1-related myopathy.
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Affiliation(s)
- Bridget Mulvany-Robbins
- Division of Neurology, Department of Medicine, University of Alberta, 7-125 Clinical Sciences Building 11350 83rd Avenue NW, Edmonton, AB, Canada T6G 2G3
| | - Brendan Putko
- Division of Neurology, Department of Medicine, University of Alberta, 7-125 Clinical Sciences Building 11350 83rd Avenue NW, Edmonton, AB, Canada T6G 2G3
| | - Laura Schmitt
- Section of Neuropathology, Department of Laboratory Medicine and Pathology, University of Alberta, 8440 112St NW, Edmonton, AB, Canada T6G 2B7
| | - Gavin Oudit
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Health Institute, 11220 83 Ave NW, Edmonton, AB T6G 2B7
| | - Cecile Phan
- Division of Neurology, Department of Medicine, University of Alberta, 7-125 Clinical Sciences Building 11350 83rd Avenue NW, Edmonton, AB, Canada T6G 2G3
| | - Grayson Beecher
- Division of Neurology, Department of Medicine, University of Alberta, 7-125 Clinical Sciences Building 11350 83rd Avenue NW, Edmonton, AB, Canada T6G 2G3.
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Gartz M, Haberman M, Sutton J, Slick RA, Luttrell SM, Mack DL, Lawlor MW. ACTA1 H40Y mutant iPSC-derived skeletal myocytes display mitochondrial defects in an in vitro model of nemaline myopathy. Exp Cell Res 2023; 424:113507. [PMID: 36796746 PMCID: PMC9993434 DOI: 10.1016/j.yexcr.2023.113507] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023]
Abstract
Nemaline myopathies (NM) are a group of congenital myopathies that lead to muscle weakness and dysfunction. While 13 genes have been identified to cause NM, over 50% of these genetic defects are due to mutations in nebulin (NEB) and skeletal muscle actin (ACTA1), which are genes required for normal assembly and function of the thin filament. NM can be distinguished on muscle biopsies due to the presence of nemaline rods, which are thought to be aggregates of the dysfunctional protein. Mutations in ACTA1 have been associated with more severe clinical disease and muscle weakness. However, the cellular pathogenesis linking ACTA1 gene mutations to muscle weakness are unclear To evaluate cellular disease phenotypes, iPSC-derived skeletal myocytes (iSkM) harboring an ACTA1 H40Y point mutation were used to model NM in skeletal muscle. These were generated by Crispr-Cas9, and include one non-affected healthy control (C) and 2 NM iPSC clone lines, therefore representing isogenic controls. Fully differentiated iSkM were characterized to confirm myogenic status and subject to assays to evaluate nemaline rod formation, mitochondrial membrane potential, mitochondrial permeability transition pore (mPTP) formation, superoxide production, ATP/ADP/phosphate levels and lactate dehydrogenase release. C- and NM-iSkM demonstrated myogenic commitment as evidenced by mRNA expression of Pax3, Pax7, MyoD, Myf5 and Myogenin; and protein expression of Pax4, Pax7, MyoD and MF20. No nemaline rods were observed with immunofluorescent staining of NM-iSkM for ACTA1 or ACTN2, and these mRNA transcript and protein levels were comparable to C-iSkM. Mitochondrial function was altered in NM, as evidenced by decreased cellular ATP levels and altered mitochondrial membrane potential. Oxidative stress induction revealed the mitochondrial phenotype, as evidenced by collapsed mitochondrial membrane potential, early formation of the mPTP and increased superoxide production. Early mPTP formation was rescued with the addition of ATP to media. Together, these findings suggest that mitochondrial dysfunction and oxidative stress are disease phenotypes in the in vitro model of ACTA1 nemaline myopathy, and that modulation of ATP levels was sufficient to protect NM-iSkM mitochondria from stress-induced injury. Importantly, the nemaline rod phenotype was absent in our in vitro model of NM. We conclude that this in vitro model has the potential to recapitulate human NM disease phenotypes, and warrants further study.
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Affiliation(s)
- Melanie Gartz
- Department of Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA; Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Margaret Haberman
- Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI, USA; Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA; Diverge Translational Science Laboratory, Milwaukee, WI, USA
| | - Jessica Sutton
- Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI, USA; Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA; Diverge Translational Science Laboratory, Milwaukee, WI, USA
| | - Rebecca A Slick
- Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI, USA; Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Shawn M Luttrell
- Curi Bio Inc., 3000 Western Avenue, Seattle, WA, 98121, USA; Institute for Stem Cell and Regenerative Medicine, UW Medicine, Seattle, WA, USA
| | - David L Mack
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA; Institute for Stem Cell and Regenerative Medicine, UW Medicine, Seattle, WA, USA
| | - Michael W Lawlor
- Department of Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA; Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, WI, USA; Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA; Diverge Translational Science Laboratory, Milwaukee, WI, USA
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Labasse C, Brochier G, Taratuto AL, Cadot B, Rendu J, Monges S, Biancalana V, Quijano-Roy S, Bui MT, Chanut A, Madelaine A, Lacène E, Beuvin M, Amthor H, Servais L, de Feraudy Y, Erro M, Saccoliti M, Neto OA, Fauré J, Lannes B, Laugel V, Coppens S, Lubieniecki F, Bello AB, Laing N, Evangelista T, Laporte J, Böhm J, Romero NB. Severe ACTA1-related nemaline myopathy: intranuclear rods, cytoplasmic bodies, and enlarged perinuclear space as characteristic pathological features on muscle biopsies. Acta Neuropathol Commun 2022; 10:101. [PMID: 35810298 PMCID: PMC9271256 DOI: 10.1186/s40478-022-01400-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 06/19/2022] [Indexed: 11/10/2022] Open
Abstract
Nemaline myopathy (NM) is a muscle disorder with broad clinical and genetic heterogeneity. The clinical presentation of affected individuals ranges from severe perinatal muscle weakness to milder childhood-onset forms, and the disease course and prognosis depends on the gene and mutation type. To date, 14 causative genes have been identified, and ACTA1 accounts for more than half of the severe NM cases. ACTA1 encodes α-actin, one of the principal components of the contractile units in skeletal muscle. We established a homogenous cohort of ten unreported families with severe NM, and we provide clinical, genetic, histological, and ultrastructural data. The patients manifested antenatal or neonatal muscle weakness requiring permanent respiratory assistance, and most deceased within the first months of life. DNA sequencing identified known or novel ACTA1 mutations in all. Morphological analyses of the muscle biopsy specimens showed characteristic features of NM histopathology including cytoplasmic and intranuclear rods, cytoplasmic bodies, and major myofibrillar disorganization. We also detected structural anomalies of the perinuclear space, emphasizing a physiological contribution of skeletal muscle α-actin to nuclear shape. In-depth investigations of the nuclei confirmed an abnormal localization of lamin A/C, Nesprin-1, and Nesprin-2, forming the main constituents of the nuclear lamina and the LINC complex and ensuring nuclear envelope integrity. To validate the relevance of our findings, we examined muscle samples from three previously reported ACTA1 cases, and we identified the same set of structural aberrations. Moreover, we measured an increased expression of cardiac α-actin in the muscle samples from the patients with longer lifespan, indicating a potential compensatory effect. Overall, this study expands the genetic and morphological spectrum of severe ACTA1-related nemaline myopathy, improves molecular diagnosis, highlights the enlargement of the perinuclear space as an ultrastructural hallmark, and indicates a potential genotype/phenotype correlation.
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Affiliation(s)
- Clémence Labasse
- Myology Institute, Neuromuscular Morphology Unit, Reference Center of Neuromuscular Diseases Nord-Est-IDF, GHU Pitié-Salpêtrière, Paris, France
| | - Guy Brochier
- Myology Institute, Neuromuscular Morphology Unit, Reference Center of Neuromuscular Diseases Nord-Est-IDF, GHU Pitié-Salpêtrière, Paris, France
| | - Ana-Lia Taratuto
- Neuropathology and Neuromuscular Diseases Laboratory, Buenos Aires, Argentina
| | - Bruno Cadot
- Sorbonne Université, INSERM, Center for Research in Myology, Myology Institute, APHP, GHU Pitié-Salpêtrière, Paris, France
| | - John Rendu
- Laboratoire de Biochimie Et Génétique Moléculaire, Pôle de Biologie, CHU Grenoble Alpes, Grenoble, France.,Université Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
| | - Soledad Monges
- Servucio de Neurología Et Neuropatología, Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina
| | - Valérie Biancalana
- Institut de Génétique Et de Biologie Moléculaire Et Cellulaire (IGBMC), Inserm U 1258, CNRS UMR 7104, Université de Strasbourg, Illkirch, France.,Laboratoire de Diagnostic Génétique, Faculté de Médecine, CHRU, Strasbourg, France
| | - Susana Quijano-Roy
- APHP Université Paris-Saclay, Pediatric Neuromuscular Unit, Hôpital Universitaire Raymond-Poincaré, Université de Versailles Saint-Quentin-en-Yvelines, Garches, France
| | - Mai Thao Bui
- Myology Institute, Neuromuscular Morphology Unit, Reference Center of Neuromuscular Diseases Nord-Est-IDF, GHU Pitié-Salpêtrière, Paris, France
| | - Anaïs Chanut
- Myology Institute, Neuromuscular Morphology Unit, Reference Center of Neuromuscular Diseases Nord-Est-IDF, GHU Pitié-Salpêtrière, Paris, France
| | - Angéline Madelaine
- Myology Institute, Neuromuscular Morphology Unit, Reference Center of Neuromuscular Diseases Nord-Est-IDF, GHU Pitié-Salpêtrière, Paris, France
| | - Emmanuelle Lacène
- Myology Institute, Neuromuscular Morphology Unit, Reference Center of Neuromuscular Diseases Nord-Est-IDF, GHU Pitié-Salpêtrière, Paris, France
| | - Maud Beuvin
- Myology Institute, Neuromuscular Morphology Unit, Reference Center of Neuromuscular Diseases Nord-Est-IDF, GHU Pitié-Salpêtrière, Paris, France.,Sorbonne Université, INSERM, Center for Research in Myology, Myology Institute, APHP, GHU Pitié-Salpêtrière, Paris, France
| | - Helge Amthor
- APHP Université Paris-Saclay, Pediatric Neuromuscular Unit, Hôpital Universitaire Raymond-Poincaré, Université de Versailles Saint-Quentin-en-Yvelines, Garches, France
| | - Laurent Servais
- Centre de Références Des Maladies Neuromusculaires, Department of Paediatrics, University Hospital Liège & University of Liège, Liège, Belgium.,Department of Paediatrics, MDUK Oxford Neuromuscular Centre, University of Oxford, Oxford, UK
| | - Yvan de Feraudy
- Institut de Génétique Et de Biologie Moléculaire Et Cellulaire (IGBMC), Inserm U 1258, CNRS UMR 7104, Université de Strasbourg, Illkirch, France.,Department of Neuropediatrics, Strasbourg University Hospital, Strasbourg, France
| | - Marcela Erro
- Gutierrez Pediatric Hospital, Buenos Aires, Argentina
| | - Maria Saccoliti
- Neuropathology and Neuromuscular Diseases Laboratory, Buenos Aires, Argentina
| | - Osorio Abath Neto
- Institut de Génétique Et de Biologie Moléculaire Et Cellulaire (IGBMC), Inserm U 1258, CNRS UMR 7104, Université de Strasbourg, Illkirch, France
| | - Julien Fauré
- Laboratoire de Biochimie Et Génétique Moléculaire, Pôle de Biologie, CHU Grenoble Alpes, Grenoble, France.,Université Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
| | - Béatrice Lannes
- Department of Pathology, Strasbourg University Hospital, Strasbourg, France
| | - Vincent Laugel
- Department of Neuropediatrics, Strasbourg University Hospital, Strasbourg, France
| | - Sandra Coppens
- Center of Human Genetics, Université Libre de Bruxelles, Brussels, Belgium
| | - Fabiana Lubieniecki
- Servucio de Neurología Et Neuropatología, Hospital de Pediatría J.P. Garrahan, Buenos Aires, Argentina
| | - Ana Buj Bello
- Université Paris-Saclay, Integrare Research Unit UMR S951, Inserm, Evry, France.,Généthon, Université Evry, Evry, France
| | - Nigel Laing
- Centre for Medical Research, University of Western Australia, Harry Perkins Institute of Medical Research, Perth, Australia
| | - Teresinha Evangelista
- Myology Institute, Neuromuscular Morphology Unit, Reference Center of Neuromuscular Diseases Nord-Est-IDF, GHU Pitié-Salpêtrière, Paris, France.,Sorbonne Université, INSERM, Center for Research in Myology, Myology Institute, APHP, GHU Pitié-Salpêtrière, Paris, France
| | - Jocelyn Laporte
- Institut de Génétique Et de Biologie Moléculaire Et Cellulaire (IGBMC), Inserm U 1258, CNRS UMR 7104, Université de Strasbourg, Illkirch, France
| | - Johann Böhm
- Institut de Génétique Et de Biologie Moléculaire Et Cellulaire (IGBMC), Inserm U 1258, CNRS UMR 7104, Université de Strasbourg, Illkirch, France
| | - Norma B Romero
- Myology Institute, Neuromuscular Morphology Unit, Reference Center of Neuromuscular Diseases Nord-Est-IDF, GHU Pitié-Salpêtrière, Paris, France. .,Sorbonne Université, INSERM, Center for Research in Myology, Myology Institute, APHP, GHU Pitié-Salpêtrière, Paris, France.
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9
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Yin X, Pu C, Wang Z, Li K, Wang H. Clinico-pathological features and mutational spectrum of 16 nemaline myopathy patients from a Chinese neuromuscular center. Acta Neurol Belg 2022; 122:631-639. [PMID: 33742414 PMCID: PMC9170660 DOI: 10.1007/s13760-020-01542-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 10/29/2020] [Indexed: 11/15/2022]
Abstract
Nemaline myopathy (NM) is a congenital myopathy of great heterogeneity, characterized by the presence of rods in the cytoplasm of muscle fibers. The samples of 16 nemaline myopathy patients diagnosed by characteristically pathological features went through whole exon sequencing. Clinico-pathological and genetic features of the cases were systematically analyzed. According to the classification of nemaline myopathy by ENMC, 8 cases are typical congenital subtype, 6 cases are childhood/juvenile onset subtype and 2 case are adult onset subtype. In histological findings, characteristic purple-colored rods are discovered under modified gömöri trichrome staining (MGT). Electron microscopy revealed the presence of high electron-dense nemaline bodies around the submucosa and the nucleus nine patients (9/16 56.3%) were detected pathogenic causative mutations, among whom mutations in the NEB gene were the most frequent (6 patients, 66.7%). KBTBD13 gene mutation was discovered in two patients and ACTA1 gene mutation was discovered in 1 patient. Nemaline myopathy is a congenital myopathy with highly clinico-pathological and genetic heterogeneity. NEB gene mutation is the most common mutation, in which splicing change c.21522 +3A > G is hotspot mutation in Chinese NM patients.
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10
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van Kleef ES, van Doorn JL, Gaytant MA, de Weerd W, Vosse BA, Wallgren-Pettersson C, van Engelen BG, Ottenheijm CA, Voermans NC, Doorduin J. Respiratory muscle function in patients with nemaline myopathy. Neuromuscul Disord 2022; 32:654-663. [DOI: 10.1016/j.nmd.2022.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 11/24/2022]
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11
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François-Heude MC, Walther-Louvier U, Espil-Taris C, Beze-Beyrie P, Rivier F, Baudou E, Uro-Coste E, Rigau V, Martin Negrier ML, Rendu J, Morales RJ, Pégeot H, Thèze C, Lacourt D, Coville AC, Cossée M, Cances C. Evaluating next-generation sequencing in neuromuscular diseases with neonatal respiratory distress. Eur J Paediatr Neurol 2021; 31:78-87. [PMID: 33667896 DOI: 10.1016/j.ejpn.2021.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/18/2020] [Accepted: 01/19/2021] [Indexed: 02/09/2023]
Abstract
With the exception of infantile spinal muscular atrophy (SMA) and congenital myotonic dystrophy 1 (DM1), congenital myopathies and muscular dystrophies with neonatal respiratory distress pose diagnostic challenges. Next-generation sequencing (NGS) provides hope for the diagnosis of these rare diseases. We evaluated the efficiency of next-generation sequencing (NGS) in ventilated newborns with peripheral hypotonia. We compared the results of our previous study in a cohort of 19 patients analysed by Sanger sequencing from 2007 to 2012, with a diagnostic yield of 26% (5/19), and those of a new retrospective study in 28 patients from 2007 to 2018 diagnosed using MyoPanel, a neuromuscular disease panel, with a diagnostic yield of 43% (12/28 patients). Pathogenic variants were found in five genes: ACTA1 (n = 4 patients), RYR1 (n = 2), CACNA1S (n = 1), NEB (n = 3), and MTM1 (n = 2). Myopanel increased the diagnosis of congenital neuromuscular diseases, but more than half the patients remained undiagnosed. Whole exome sequencing did not seem to fully respond to this diagnostic limitation. Therefore, explorations with whole genome sequencing will be the next step.
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Affiliation(s)
- Marie-Céline François-Heude
- AOC (Atlantique-Occitanie-Caraïbe) Reference Centre for Neuromuscular Disorders, Neuropaediatric Department, Toulouse University Hospital, Toulouse, France
| | - Ulrike Walther-Louvier
- AOC (Atlantique-Occitanie-Caraïbe) Reference Centre for Neuromuscular Disorders, Neuropaediatric Department, Montpellier University Hospital, Montpellier, France
| | - Caroline Espil-Taris
- AOC (Atlantique-Occitanie-Caraïbe) Reference Centre for Neuromuscular Disorders, Neuropaediatric Department, Bordeaux University Hospital, Aquitaine, France
| | | | - François Rivier
- AOC (Atlantique-Occitanie-Caraïbe) Reference Centre for Neuromuscular Disorders, Neuropaediatric Department, Montpellier University Hospital, Montpellier, France
| | - Eloise Baudou
- AOC (Atlantique-Occitanie-Caraïbe) Reference Centre for Neuromuscular Disorders, Neuropaediatric Department, Toulouse University Hospital, Toulouse, France
| | - Emmanuelle Uro-Coste
- Department of Pathology, Toulouse University Hospital, Toulouse, France; INSERM U1037, Cancer Research Centre of Toulouse (CRCT), Toulouse, France
| | - Valérie Rigau
- AOC (Atlantique-Occitanie-Caraïbe) Reference Centre for Neuromuscular Disorders, Aquitaine, France; Department of Pathology, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | | | - John Rendu
- INSERM U1216, Grenoble Alpes University Hospital, University of Grenoble Alpes, Grenoble, France
| | - Raul Juntas Morales
- Laboratory of Rare Genetic Diseases (LGMR), University of Montpellier, Montpellier, France
| | - Henri Pégeot
- Molecular Genetics Laboratory, Montpellier University Hospital Centre, Montpellier, France
| | - Corinne Thèze
- Molecular Genetics Laboratory, Montpellier University Hospital Centre, Montpellier, France
| | - Delphine Lacourt
- Molecular Genetics Laboratory, Montpellier University Hospital Centre, Montpellier, France
| | - Anne Cécile Coville
- AOC (Atlantique-Occitanie-Caraïbe) Reference Centre for Neuromuscular Disorders, Neuropaediatric Department, Toulouse University Hospital, Toulouse, France
| | - Mireille Cossée
- Laboratory of Rare Genetic Diseases (LGMR), University of Montpellier, Montpellier, France; Molecular Genetics Laboratory, Montpellier University Hospital Centre, Montpellier, France
| | - Claude Cances
- AOC (Atlantique-Occitanie-Caraïbe) Reference Centre for Neuromuscular Disorders, Neuropaediatric Department, Toulouse University Hospital, Toulouse, France.
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12
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Pavlek LR, Barber MM. Case 2: A Profoundly Hypotonic Premature Infant. Neoreviews 2020; 21:e831-e833. [PMID: 33262210 DOI: 10.1542/neo.21-12-e831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Leeann R Pavlek
- Division of Neonatology, Nationwide Children's Hospital, Columbus, OH.,Department of Pediatrics, The Ohio State University, Columbus, OH
| | - Maria M Barber
- Division of Neonatology, Avera McKennan Hospital University Health Center, Sioux Falls, SD.,Department of Pediatrics, Sanford School of Medicine, Sioux Falls, SD
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13
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Garibaldi M, Fattori F, Pennisi EM, Merlonghi G, Fionda L, Vanoli F, Leonardi L, Bucci E, Morino S, Micaloni A, Tartaglione T, Uijterwijk B, Zierikzee M, Ottenheijm C, Bertini ES, Stoppacciaro A, Raffa S, Salvetti M, Antonini G. Novel ACTA1 mutation causes late-presenting nemaline myopathy with unusual dark cores. Neuromuscul Disord 2020; 31:139-148. [PMID: 33384202 DOI: 10.1016/j.nmd.2020.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 11/19/2020] [Accepted: 11/25/2020] [Indexed: 12/24/2022]
Abstract
ACTA1 gene encodes the skeletal muscle alpha-actin, the core of thin filaments of the sarcomere. ACTA1 mutations are responsible of several muscle disorders including nemaline, cores, actin aggregate myopathies and fiber-type disproportion. We report clinical, muscle imaging, histopatological and genetic data of an Italian family carrying a novel ACTA1 mutation. All affected members showed a late-presenting, diffuse muscle weakness with sternocleidomastoideus and temporalis atrophy. Mild dysmorphic features were also detected. The most affected muscles by muscle MRI were rectus abdominis, gluteus minimus, vastus intermedius and both gastrocnemii. Muscle biopsy showed the presence of nemaline bodies with several unusual dark areas at Gomori Trichrome, corresponding to unstructured cores with abundant electrodense material by electron microscopy. The molecular analysis revealed missense variant c.148G>A; p.(Gly50Ser) in the exon 3 of ACTA1, segregating with affected members in the family. We performed a functional essay of fibre contractility showing a higher pCa50 (a measure of the calcium sensitivity of force) of type 1 fibers compared to control subjects' type 1 muscle fibers. Our findings expand the clinico-pathological spectrum of ACTA1-related congenital myopathies and the genetic spectrum of core-rod myopathies.
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Affiliation(s)
- Matteo Garibaldi
- Neuromuscular and Rare Disease Centre, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), SAPIENZA University of Rome, Sant'Andrea Hospital, Rome, Italy.
| | - Fabiana Fattori
- Unit of Neuromuscular and Neurodegenerative Disorders, Laboratory of Molecular Medicine, Bambino Gesù Children's Research Hospital, Rome, Italy
| | - Elena Maria Pennisi
- Unit of Neuromuscular Disorders, Neurology, San Filippo Neri Hospital, Rome, Italy
| | - Gioia Merlonghi
- Neuromuscular and Rare Disease Centre, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), SAPIENZA University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Laura Fionda
- Neuromuscular and Rare Disease Centre, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), SAPIENZA University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Fiammetta Vanoli
- Neuromuscular and Rare Disease Centre, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), SAPIENZA University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Luca Leonardi
- Neuromuscular and Rare Disease Centre, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), SAPIENZA University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Elisabetta Bucci
- Neuromuscular and Rare Disease Centre, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), SAPIENZA University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Stefania Morino
- Neuromuscular and Rare Disease Centre, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), SAPIENZA University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Andrea Micaloni
- Laboratory of Ultrastructural pathology, Department of Clinical and Molecular Medicine, SAPIENZA University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Tommaso Tartaglione
- Department of Radiology, Istituto Dermopatico dell'Immacolata, IRCCS, Rome, Italy
| | - Bas Uijterwijk
- Department of Physiology, Amsterdam UMC (location VUmc), Amsterdam, Netherlands
| | - Martijn Zierikzee
- Department of Physiology, Amsterdam UMC (location VUmc), Amsterdam, Netherlands
| | - Coen Ottenheijm
- Department of Physiology, Amsterdam UMC (location VUmc), Amsterdam, Netherlands
| | - Enrico Silvio Bertini
- Unit of Neuromuscular and Neurodegenerative Disorders, Laboratory of Molecular Medicine, Bambino Gesù Children's Research Hospital, Rome, Italy
| | - Antonella Stoppacciaro
- Unit of Pathology, Department of Clinical and Molecular Medicine, SAPIENZA University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Salvatore Raffa
- Laboratory of Ultrastructural pathology, Department of Clinical and Molecular Medicine, SAPIENZA University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Marco Salvetti
- Neuromuscular and Rare Disease Centre, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), SAPIENZA University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Giovanni Antonini
- Neuromuscular and Rare Disease Centre, Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), SAPIENZA University of Rome, Sant'Andrea Hospital, Rome, Italy
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14
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Abstract
PURPOSE OF REVIEW Congenital muscular dystrophies and congenital myopathies are a heterogeneous group of disorders resulting in hypotonia, muscle weakness, and dystrophic or myopathic features on muscle biopsy. This article summarizes the clinical and genetic aspects of these disorders. RECENT FINDINGS Historically, diagnoses of congenital muscular dystrophy and congenital myopathy have been made by clinical features and histopathology; however, recent advances in genetics have changed diagnostic practice by relying more heavily on genetic findings. This article reviews the clinical and genetic features of the most common congenital muscular dystrophies including laminin subunit alpha 2 (LAMA2)-related (merosin deficient), collagen VI-related, and α-dystroglycan-related congenital muscular dystrophies and reviews the most common congenital myopathies including nemaline rod, core, and centronuclear myopathies. With the increasing accessibility of genetic testing, the number of genes found to be associated with these disorders has increased dramatically. A wide spectrum of severity and onset (from birth to adulthood) exist across all subtypes. Progression and other features are variable depending on the subtype and severity of the specific genetic mutation. SUMMARY Congenital muscular dystrophy and congenital myopathy are increasingly recognized disorders. A growing appreciation for the breadth of phenotypic variability and overlap between established subtypes has challenged long-standing phenotypic and histopathologic classifications of these disorders but has driven a greater understanding of pathogenesis and opened the door to the development of novel treatments.
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15
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Wang Q, Hu Z, Chang X, Yu M, Xie Z, Lv H, Zhang W, Xiong H, Yuan Y, Wang Z. Mutational and clinical spectrum in a cohort of Chinese patients with hereditary nemaline myopathy. Clin Genet 2020; 97:878-889. [PMID: 32222963 DOI: 10.1111/cge.13745] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/23/2020] [Accepted: 03/23/2020] [Indexed: 12/12/2022]
Abstract
Hereditary nemaline myopathy (NM) is one of the most common congenital myopathies with the histopathological findings of nemaline bodies. We used targeted next-generation sequencing to identify causative mutations in 48 NM patients with confirmed myopathological diagnosis, analyze the mutational spectrum and phenotypic features. Furthermore, reverse transcription polymerase chain reaction (RT-PCR) was used to confirm the pathogenic effect of one nebulin (NEB) splicing variant. The results showed that variants were found in five NM-associated genes, including NEB, actin alpha 1 (ACTA1), troponin T1, Kelch repeat and BTB domain-containing 13, and cofilin-2, in 34 (73.9%), 7 (15.2%), 3 (6.5%), 1 (2.2%), and 1 (2.2%) patients, respectively, in a total of 46/48 (95.8%) NM patients. Of the total 64 variants identified, 51 were novel variants including 26 pathogenic, 1 probably pathogenic, and 24 variant of uncertain significance (VUS). Notably, one NEB splicing mutation, c.21417+3A>G causing exon 144 splicing (NM_001164508.1), as confirmed by RT-PCR, was found in 52.9% (18 patients) of NEB variant-carrying patients. Typical congenital NM, the most common clinical subtype (60.4%), was associated with five NM genes. We concluded that hereditary NM showed a highly variable genetic spectrum. NEB was the most frequent causative gene in this Chinese cohort, followed by ACTA1. We found a hotspot splicing mutation in NEB among Chinese cohort.
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Affiliation(s)
- Qi Wang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Zhenxian Hu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Xingzhi Chang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Meng Yu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Zhiying Xie
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - He Lv
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Wei Zhang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Hui Xiong
- Department of Pediatrics, 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
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16
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Yokoi T, Sei K, Enomoto Y, Naruto T, Kurosawa K. Somatic mosaicism of a heterogeneous mutation of ACTA1 in nemaline myopathy. Pediatr Int 2019; 61:1169-1171. [PMID: 31724238 DOI: 10.1111/ped.13962] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 05/27/2019] [Accepted: 07/05/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Takayuki Yokoi
- Department of Pediatrics, Jikei University School of Medicine, Tokyo, Japan.,Division of Medical Genetics, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
| | - Kenshi Sei
- Division of Neurology, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
| | - Yumi Enomoto
- Clinical Research Institute, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
| | - Takuya Naruto
- Pediatrics and Developmental Biology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Kenji Kurosawa
- Division of Medical Genetics, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
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17
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Sewry CA, Laitila JM, Wallgren-Pettersson C. Nemaline myopathies: a current view. J Muscle Res Cell Motil 2019; 40:111-126. [PMID: 31228046 PMCID: PMC6726674 DOI: 10.1007/s10974-019-09519-9] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 05/29/2019] [Indexed: 12/13/2022]
Abstract
Nemaline myopathies are a heterogenous group of congenital myopathies caused by de novo, dominantly or recessively inherited mutations in at least twelve genes. The genes encoding skeletal α-actin (ACTA1) and nebulin (NEB) are the commonest genetic cause. Most patients have congenital onset characterized by muscle weakness and hypotonia, but the spectrum of clinical phenotypes is broad, ranging from severe neonatal presentations to onset of a milder disorder in childhood. Most patients with adult onset have an autoimmune-related myopathy with a progressive course. The wide application of massively parallel sequencing methods is increasing the number of known causative genes and broadening the range of clinical phenotypes. Nemaline myopathies are identified by the presence of structures that are rod-like or ovoid in shape with electron microscopy, and with light microscopy stain red with the modified Gömöri trichrome technique. These rods or nemaline bodies are derived from Z lines (also known as Z discs or Z disks) and have a similar lattice structure and protein content. Their shape in patients with mutations in KLHL40 and LMOD3 is distinctive and can be useful for diagnosis. The number and distribution of nemaline bodies varies between fibres and different muscles but does not correlate with severity or prognosis. Additional pathological features such as caps, cores and fibre type disproportion are associated with the same genes as those known to cause the presence of rods. Animal models are advancing the understanding of the effects of various mutations in different genes and paving the way for the development of therapies, which at present only manage symptoms and are aimed at maintaining muscle strength, joint mobility, ambulation, respiration and independence in the activities of daily living.
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Affiliation(s)
- Caroline A Sewry
- Dubowitz Neuromuscular Centre, UCL Institute of Child Health and Great Ormond Street Hospital, 30 Guilford Street, London, WC1N 1EH, UK. .,Wolfson Centre of Inherited Neuromuscular Disorders, RJAH Orthopaedic Hospital, Oswestry, SY10 7AG, UK.
| | - Jenni M Laitila
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Department of Medical and Clinical Genetics, Medicum, University of Helsinki, Helsinki, Finland
| | - Carina Wallgren-Pettersson
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Department of Medical and Clinical Genetics, Medicum, University of Helsinki, Helsinki, Finland
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Lehtokari VL, Gardberg M, Pelin K, Wallgren-Pettersson C. Clinically variable nemaline myopathy in a three-generation family caused by mutation of the skeletal muscle alpha-actin gene. Neuromuscul Disord 2018; 28:323-326. [PMID: 29433794 DOI: 10.1016/j.nmd.2017.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/11/2017] [Accepted: 12/18/2017] [Indexed: 11/28/2022]
Abstract
We present here a Finnish nemaline myopathy family with a dominant mutation in the skeletal muscle α-actin gene, p.(Glu85Lys), segregating in three generations. The index patient, a 5-year-old boy, had the typical form of nemaline myopathy with congenital muscle weakness and motor milestones delayed but reached, while his mother never had sought medical attention for her very mild muscle weakness, and his maternal grandmother had been misdiagnosed as having myotonic dystrophy. This illustrates the clinical variability in nemaline myopathy.
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Affiliation(s)
- Vilma-Lotta Lehtokari
- The Folkhälsan Institute of Genetics and the Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland.
| | - Maria Gardberg
- Department of Pathology, Turku University Hospital and University of Turku, Turku, Finland
| | - Katarina Pelin
- The Folkhälsan Institute of Genetics and the Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland; Department of Biosciences, Division of Genetics, University of Helsinki, Helsinki, Finland
| | - Carina Wallgren-Pettersson
- The Folkhälsan Institute of Genetics and the Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
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