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Cotta A, Souza LS, Carvalho E, Feitosa LN, Cunha A, Navarro MM, Valicek J, Menezes MM, Neves SVN, Xavier-Neto R, Vargas AP, Takata RI, Paim JF, Vainzof M. Central Core Disease: Facial Weakness Differentiating Biallelic from Monoallelic Forms. Genes (Basel) 2022; 13:genes13050760. [PMID: 35627144 PMCID: PMC9141459 DOI: 10.3390/genes13050760] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/20/2022] [Accepted: 04/24/2022] [Indexed: 11/18/2022] Open
Abstract
Central Core Disease (CCD) is a genetic neuromuscular disorder characterized by the presence of cores in muscle biopsy. The inheritance has been described as predominantly autosomal dominant (AD), and the disease may present as severe neonatal or mild adult forms. Here we report clinical and molecular data on a large cohort of Brazilian CCD patients, including a retrospective clinical analysis and molecular screening for RYR1 variants using Next-Generation Sequencing (NGS). We analyzed 27 patients from 19 unrelated families: four families (11 patients) with autosomal dominant inheritance (AD), two families (3 patients) with autosomal recessive (AR), and 13 sporadic cases. Biallelic RYR1 variants were found in six families (two AR and four sporadic cases) of the 14 molecularly analyzed families (~43%), suggesting a higher frequency of AR inheritance than expected. None of these cases presented a severe phenotype. Facial weakness was more common in biallelic than in monoallelic patients (p = 0.0043) and might be a marker for AR forms. NGS is highly effective for the identification of RYR1 variants in CCD patients, allowing the discovery of a higher proportion of AR cases with biallelic mutations. These data have important implications for the genetic counseling of the families.
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Affiliation(s)
- Ana Cotta
- The SARAH Network of Rehabilitation Hospitals, Av. Amazonas, 5953, Belo Horizonte 30510-000, MG, Brazil; (A.C.); (E.C.); (A.C.J.); (M.M.N.); (J.V.); (M.M.M.); (S.V.N.N.); (R.X.-N.); (A.P.V.); (R.I.T.); (J.F.P.)
| | - Lucas Santos Souza
- Human Genome and Stem Cells Research Center, Genetics and Evolutionary Biology, IBUSP, University of São Paulo, R. do Matao, 106, Cidade Universitária, Sao Paulo 05508-900, SP, Brazil; (L.S.S.); (L.N.F.)
| | - Elmano Carvalho
- The SARAH Network of Rehabilitation Hospitals, Av. Amazonas, 5953, Belo Horizonte 30510-000, MG, Brazil; (A.C.); (E.C.); (A.C.J.); (M.M.N.); (J.V.); (M.M.M.); (S.V.N.N.); (R.X.-N.); (A.P.V.); (R.I.T.); (J.F.P.)
| | - Leticia Nogueira Feitosa
- Human Genome and Stem Cells Research Center, Genetics and Evolutionary Biology, IBUSP, University of São Paulo, R. do Matao, 106, Cidade Universitária, Sao Paulo 05508-900, SP, Brazil; (L.S.S.); (L.N.F.)
| | - Antonio Cunha
- The SARAH Network of Rehabilitation Hospitals, Av. Amazonas, 5953, Belo Horizonte 30510-000, MG, Brazil; (A.C.); (E.C.); (A.C.J.); (M.M.N.); (J.V.); (M.M.M.); (S.V.N.N.); (R.X.-N.); (A.P.V.); (R.I.T.); (J.F.P.)
| | - Monica Machado Navarro
- The SARAH Network of Rehabilitation Hospitals, Av. Amazonas, 5953, Belo Horizonte 30510-000, MG, Brazil; (A.C.); (E.C.); (A.C.J.); (M.M.N.); (J.V.); (M.M.M.); (S.V.N.N.); (R.X.-N.); (A.P.V.); (R.I.T.); (J.F.P.)
| | - Jaquelin Valicek
- The SARAH Network of Rehabilitation Hospitals, Av. Amazonas, 5953, Belo Horizonte 30510-000, MG, Brazil; (A.C.); (E.C.); (A.C.J.); (M.M.N.); (J.V.); (M.M.M.); (S.V.N.N.); (R.X.-N.); (A.P.V.); (R.I.T.); (J.F.P.)
| | - Miriam Melo Menezes
- The SARAH Network of Rehabilitation Hospitals, Av. Amazonas, 5953, Belo Horizonte 30510-000, MG, Brazil; (A.C.); (E.C.); (A.C.J.); (M.M.N.); (J.V.); (M.M.M.); (S.V.N.N.); (R.X.-N.); (A.P.V.); (R.I.T.); (J.F.P.)
| | - Simone Vilela Nunes Neves
- The SARAH Network of Rehabilitation Hospitals, Av. Amazonas, 5953, Belo Horizonte 30510-000, MG, Brazil; (A.C.); (E.C.); (A.C.J.); (M.M.N.); (J.V.); (M.M.M.); (S.V.N.N.); (R.X.-N.); (A.P.V.); (R.I.T.); (J.F.P.)
| | - Rafael Xavier-Neto
- The SARAH Network of Rehabilitation Hospitals, Av. Amazonas, 5953, Belo Horizonte 30510-000, MG, Brazil; (A.C.); (E.C.); (A.C.J.); (M.M.N.); (J.V.); (M.M.M.); (S.V.N.N.); (R.X.-N.); (A.P.V.); (R.I.T.); (J.F.P.)
| | - Antonio Pedro Vargas
- The SARAH Network of Rehabilitation Hospitals, Av. Amazonas, 5953, Belo Horizonte 30510-000, MG, Brazil; (A.C.); (E.C.); (A.C.J.); (M.M.N.); (J.V.); (M.M.M.); (S.V.N.N.); (R.X.-N.); (A.P.V.); (R.I.T.); (J.F.P.)
| | - Reinaldo Issao Takata
- The SARAH Network of Rehabilitation Hospitals, Av. Amazonas, 5953, Belo Horizonte 30510-000, MG, Brazil; (A.C.); (E.C.); (A.C.J.); (M.M.N.); (J.V.); (M.M.M.); (S.V.N.N.); (R.X.-N.); (A.P.V.); (R.I.T.); (J.F.P.)
| | - Julia Filardi Paim
- The SARAH Network of Rehabilitation Hospitals, Av. Amazonas, 5953, Belo Horizonte 30510-000, MG, Brazil; (A.C.); (E.C.); (A.C.J.); (M.M.N.); (J.V.); (M.M.M.); (S.V.N.N.); (R.X.-N.); (A.P.V.); (R.I.T.); (J.F.P.)
| | - Mariz Vainzof
- Human Genome and Stem Cells Research Center, Genetics and Evolutionary Biology, IBUSP, University of São Paulo, R. do Matao, 106, Cidade Universitária, Sao Paulo 05508-900, SP, Brazil; (L.S.S.); (L.N.F.)
- Correspondence:
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Galleni Leão L, Santos Souza L, Nogueira L, Pavanello RDCM, Gurgel-Giannetti J, Reed UC, Oliveira ASB, Cuperman T, Cotta A, FPaim J, Zatz M, Vainzof M. Dominant or recessive mutations in the RYR1 gene causing central core myopathy in Brazilian patients. ACTA MYOLOGICA : MYOPATHIES AND CARDIOMYOPATHIES : OFFICIAL JOURNAL OF THE MEDITERRANEAN SOCIETY OF MYOLOGY 2020; 39:274-282. [PMID: 33458582 PMCID: PMC7783440 DOI: 10.36185/2532-1900-030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 11/06/2022]
Abstract
Central Core Disease (CCD) is an inherited neuromuscular disorder characterized by the presence of cores in muscle biopsy. CCD is caused by mutations in the RYR1 gene. This gene encodes the ryanodine receptor 1, which is an intracellular calcium release channel from the sarcoplasmic reticulum to the cytosol in response to depolarization of the plasma membrane. Mutations in this gene are also associated with susceptibility to Malignant Hyperthermia (MHS). In this study, we evaluated 20 families with clinical and histological characteristics of CCD to identify primary mutations in patients, for diagnosis and genetic counseling of the families. We identified variants in the RYR1 gene in 19/20 families. The molecular pathogenicity was confirmed in 16 of them. Most of these variants (22/23) are missense and unique in the families. Two variants were recurrent in two different families. We identified six families with biallelic mutations, five compound heterozygotes with no consanguinity, and one homozygous, with consanguineous parents, resulting in 30% of cases with possible autosomal recessive inheritance. We identified seven novel variants, four of them classified as pathogenic. In one family, we identified two mutations in exon 102, segregating in cis, suggesting an additive effect of two mutations in the same allele. This work highlights the importance of using Next-Generation Sequencing technology for the molecular diagnosis of genetic diseases when a very large gene is involved, associated to a broad distribution of the mutations along it. These data also influence the prevention through adequate genetic counseling for the families and cautions against malignant hyperthermia susceptibility.
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Affiliation(s)
- Leonardo Galleni Leão
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
| | - Lucas Santos Souza
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
| | - Letícia Nogueira
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
| | | | - Juliana Gurgel-Giannetti
- Depart of Pediatrics, Medical School of Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Umbertina C Reed
- Department of Neurology, Medical School of the University of Sao Paulo, São Paulo, Brazil
| | - Acary S B Oliveira
- Department of Neurology and Neurosurgery, Division of Neuromuscular Disorders, Federal University of São Paulo (Unifesp), São Paulo SP, Brazil
| | - Thais Cuperman
- Department of Neurology and Neurosurgery, Division of Neuromuscular Disorders, Federal University of São Paulo (Unifesp), São Paulo SP, Brazil
| | - Ana Cotta
- Department of Pathology SARAH Network of Rehabilitation Hospitals, Belo Horizonte, MG, Brazil
| | - Julia FPaim
- Department of Pathology SARAH Network of Rehabilitation Hospitals, Belo Horizonte, MG, Brazil
| | - Mayana Zatz
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
| | - Mariz Vainzof
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, Brazil
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Samões R, Oliveira J, Taipa R, Coelho T, Cardoso M, Gonçalves A, Santos R, Melo Pires M, Santos M. RYR1-Related Myopathies: Clinical, Histopathologic and Genetic Heterogeneity Among 17 Patients from a Portuguese Tertiary Centre. J Neuromuscul Dis 2018; 4:67-76. [PMID: 28269792 DOI: 10.3233/jnd-160199] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pathogenic variants in ryanodine receptor type 1 (RYR1) gene are an important cause of congenital myopathy. The clinical, histopathologic and genetic spectrum is wide. OBJECTIVE Review a group of the patients diagnosed with ryanodinopathy in a tertiary centre from North Portugal, as an attempt to define some phenotypical patterns that may help guiding future diagnosis. METHODS Patients were identified from the database of the reference centre for Neuromuscular Disorders in North Portugal. Their data (clinical, histological and genetic) was retrospectively accessed. RESULTS Seventeen RYR1-related patients (including 4 familial cases) were identified. They were divided in groups according to three distinctive clinical characteristics: extraocular muscle (EOM) weakness (N = 6), disproportionate axial muscle weakness (N = 2) and joint laxity (N = 5). The fourth phenotype includes patients with mild tetraparesis and no distinctive clinical features (N = 4). Four different histopathological patterns were found: centronuclear (N = 5), central core (N = 4), type 1 fibres predominance (N = 4) and congenital fibre type disproportion (N = 1) myopathies. Each index case, except two patients, had a different RYR1 variant. Four new genetic variants were identified. All centronuclear myopathies were associated with autosomal recessive inheritance and EOM weakness. All central core myopathies were caused by pathogenic variants in hotspot 3 with autosomal dominant inheritance. Three genetic variants were reported to be associated to malignant hyperthermia susceptibility. CONCLUSIONS Distinctive clinical features were recognized as diagnostically relevant: extraocular muscle weakness (and centronuclear pattern on muscle biopsy), severe axial weakness disproportionate to the ambulatory state and mild tetraparesis associated with (proximal) joint laxity. There was a striking genetic heterogeneity, including four new RYR1 variants.
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Affiliation(s)
- Raquel Samões
- Department of Neurology, Centro Hospitalar do Porto, Porto, Portugal
| | - Jorge Oliveira
- Unidade de Genética Molecular, Centro de Genética Médica, Centro Hospitalar do Porto, Porto, Portugal.,Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - Ricardo Taipa
- Neuropathology Unit, Centro Hospitalar do Porto, Porto, Portugal
| | - Teresa Coelho
- Department of Neurophysiology and Neuromuscular Disorders Outpatient Clinic, Centro Hospitalar do Porto, Porto, Portugal
| | - Márcio Cardoso
- Department of Neurophysiology and Neuromuscular Disorders Outpatient Clinic, Centro Hospitalar do Porto, Porto, Portugal
| | - Ana Gonçalves
- Unidade de Genética Molecular, Centro de Genética Médica, Centro Hospitalar do Porto, Porto, Portugal.,Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - Rosário Santos
- Unidade de Genética Molecular, Centro de Genética Médica, Centro Hospitalar do Porto, Porto, Portugal.,Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal.,UCIBIO/REQUIMTE, Departamento de Ciências Biológicas, Laboratório de Bioquímica, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
| | | | - Manuela Santos
- Neuromuscular Disorders Outpatient Clinic and Department of Neuropaediatrics, Centro Hospitalar do Porto, Porto, Portugal
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Rocha J, Taipa R, Melo Pires M, Oliveira J, Santos R, Santos M. Ryanodine myopathies without central cores--clinical, histopathologic, and genetic description of three cases. Pediatr Neurol 2014; 51:275-8. [PMID: 24950660 DOI: 10.1016/j.pediatrneurol.2014.04.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 04/18/2014] [Accepted: 04/24/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Mutations in ryanodine receptor 1 gene (RYR1) are frequent causes of myopathies. They classically present with central core disease; however, clinical variability and histopathologic overlap are being increasingly recognized. PATIENTS Patient 1 is a 15-year-old girl with mild proximal, four-limb weakness from age 5, presenting with a progressive scoliosis starting at age 10. Patient 2 is an 18-year-old girl with progressively worsening muscle hypotrophy and mild proximal, four-limb weakness. She developed a rapidly progressive scoliosis from age 11 and needed surgical treatment at age 14 years. Patient 3 is an 11-year-old boy with moderate proximal limb weakness and progressive neck flexor weakness, first noticed at age 2. Muscle biopsies revealed type 1 fiber predominance (Patients 1 and 2) or abnormal type 1 fiber uniformity (Patient 3). Different RYR1 variants were identified in all patients. In Patients 1 and 3, these changes were validated as being pathogenic. CONCLUSIONS These patients illustrate early-onset, progressive myopathies with predominant axial involvement. Histopathologic findings were abnormal but not specific for a diagnosis, particularly central core myopathy. Genetic testing helped broaden the range of phenotypes included in the RYR1-related myopathies. Our patients reinforce the need to recognize the broad histopathologic variability of RYR1-related myopathies and sometimes lack of pathognomonic findings that may reduce the diagnostic threshold of this disease. We suggest that the predominance of type 1 fibers and involvement of axial muscles may be an important element to consider the RYR1 gene as candidate.
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Affiliation(s)
- João Rocha
- Department of Neurology, Hospital de Braga, Braga, Portugal.
| | - Ricardo Taipa
- Neuropathology Unit, Centro Hospitalar do Porto, Porto, Portugal
| | | | - Jorge Oliveira
- Molecular Genetics Unit, Centro de Genética Médica Dr. Jacinto Magalhães, Centro Hospitalar do Porto, Porto, Portugal
| | - Rosário Santos
- Molecular Genetics Unit, Centro de Genética Médica Dr. Jacinto Magalhães, Centro Hospitalar do Porto, Porto, Portugal
| | - Manuela Santos
- Neuromuscular Diseases Unit, Department of Pediatric Neurology, Centro Hospitalar do Porto, Porto, Portugal
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