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Muni-Lofra R, Juanola-Mayos E, Schiava M, Moat D, Elseed M, Michel-Sodhi J, Harris E, McCallum M, Moore U, Richardson M, Trainor C, Wong K, Malinova M, Bolano-Diaz C, Keogh MJ, Ghimenton E, Verdu-Diaz J, Mayhew A, Guglieri M, Straub V, James MK, Marini-Bettolo C, Diaz-Manera J. Longitudinal Analysis of Respiratory Function of Different Types of Limb Girdle Muscular Dystrophies Reveals Independent Trajectories. Neurol Genet 2023; 9:e200084. [PMID: 37440793 PMCID: PMC10335843 DOI: 10.1212/nxg.0000000000200084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/24/2023] [Indexed: 07/15/2023]
Abstract
Background and Objectives The prevalence and progression of respiratory muscle dysfunction in patients with limb girdle muscular dystrophies (LGMDs) has been only partially described to date. Most reports include cross-sectional data on a limited number of patients making it difficult to gain a wider perspective on respiratory involvement throughout the course of the disease and to compare the most prevalent LGMD subtypes. Methods We reviewed the results of spirometry studies collected longitudinally in our cohort of patients in routine clinical visits from 2002 to 2020 along with additional clinical and genetic data. A linear mixed model was used to investigate the factors associated with the progression of respiratory dysfunction. Results We followed up 156 patients with 5 different forms of LGMDs for a median of 8 years (range 1-25 years). Of them, 53 patients had pathogenic variants in the Capn3 gene, 47 patients in the Dysf gene, 24 patients in the Fkrp gene, 19 in the Ano5 gene, and 13 in one of the sarcoglycan genes (SCG). At baseline, 58 patients (37.1%) had a forced vital capacity percentage predicted (FVCpp) below 80%, while 14 patients (8.9%) had peak cough flow (PCF) values below 270 L/min. As a subgroup, FKRP was the group with a higher number of patients having FVC <80% and/or PCF <270 L/min at initial assessment (66%). We observed a progressive decline in FVCpp and PCF measurements over time, being age, use of wheelchair, and LGMD subtype independent factors associated with this decline. Fkrp and sarcoglycan patients had a quicker decline in their FVC (Kaplan-Meier curve, F test, p < 0.001 and p = 0.02, respectively). Only 7 of the 58 patients with low FVCpp values reported symptoms of respiratory dysfunction, which are commonly reported by patients with FVCpp below 50%-60%. The number of patients ventilated increased from 2 to 8 during follow-up. Discussion Respiratory dysfunction is a frequent complication of patients with LGMDs that needs to be carefully studied and has direct implications in the care offered in daily clinics. Respiratory dysfunction is associated with disease progression because it is especially seen in patients who are full-time wheelchair users, being more frequent in patients with mutations in the Fkrp and sarcoglycan genes.
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Affiliation(s)
- Robert Muni-Lofra
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Eduard Juanola-Mayos
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Marianela Schiava
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Dionne Moat
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Maha Elseed
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Jassi Michel-Sodhi
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Elizabeth Harris
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Michelle McCallum
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Ursula Moore
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Mark Richardson
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Christina Trainor
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Karen Wong
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Monika Malinova
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Carla Bolano-Diaz
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Michael John Keogh
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Elisabetta Ghimenton
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Jose Verdu-Diaz
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Anna Mayhew
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Michela Guglieri
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Volker Straub
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Meredith K James
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Chiara Marini-Bettolo
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
| | - Jordi Diaz-Manera
- From the John Walton Muscular Dystrophy Research Centre (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Translational and Clinical Research Institute, Newcastle University, UK; Highly Specialized Service for Rare Neuromuscular Disorders (R.M.-L., M.S., D.M., M.E., J.M.-S., E.H., M. McCallum, U.M., M.R., C.T., K.W., M. Malinova, C.B.-D., M.J.K., E.G., J.V.-D., A.M., M.G., V.S., M.K.J., C.M.-B., J.D.-M.), Limb Girdle Muscular Dystrophies, Genetics Department, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, United Kingdom; and Neuromuscular Diseases Unit, Neurology Department, Hospital Germans Tries I Pujol (E.J.-M.), Badalona, Spain
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