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Fernández-Eulate G, Alfieri G, Spinazzi M, Ackermann-Bonan I, Duval F, Solé G, Caillon F, Mercier S, Pereon Y, Magot A, Pegat A, Salort-Campana E, Chabrol B, Gorokhova S, Krahn M, Biancalana V, Evangelista T, Behin A, Metay C, Stojkovic T. Phenotype variability and natural history of X-linked myopathy with excessive autophagy. J Neurol 2024; 271:4008-4018. [PMID: 38517523 DOI: 10.1007/s00415-024-12298-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/26/2024] [Accepted: 03/01/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE X-linked myopathy with excessive autophagy (XMEA) linked to the VMA21 gene leads to autophagy failure with progressive vacuolation and atrophy of skeletal muscles. Current knowledge of this rare disease is limited. Our objective was to define the clinical, radiological, and natural history of XMEA. METHODS We conducted a retrospective study collecting clinical, genetic, muscle imaging, and biopsy data of XMEA patients followed in France and reviewed the literature for additional cases. RESULTS Eighteen males had genetically confirmed XMEA in France, carrying four different VMA21 variants. Mean age at disease onset was 9.4 ± 9.9 (range 1-40) years. In 14/18 patients (77.8%), onset occurred during childhood (< 15 years); however in four patients, the disease started in adulthood. Patients had anterior and medial compartment thigh muscle weakness, distal contractures (56.3%), elevated CK levels (1287.9 ± 757.8 U/l) and autophagic vacuoles with sarcolemmal features on muscle histopathology. Muscle MRI (n = 10) showed a characteristic pattern of lower limb muscle involvement. In 11 patients, outcome measures were available for an average follow-up period of 10.6 ± 9.8 years and six of them show disease progression. Mean change of functional outcomes was 0.5 ± 1.2 points for Brooke and 2.2 ± 2.5 points for Vignos score, 7/16 patients (43.8%) needed a walking aid and 3/16 (18.8%) were wheelchair-bound (median age of 40 years old, range 39-48). The variant c.164-7 T > G was associated with a later onset of symptoms. Respiratory insufficiency was common (57.1%) but cardiac involvement rare (12.5%). INTERPRETATION XMEA has variable age of onset, but a characteristic clinical, histopathological, and muscle imaging presentation, guiding the diagnosis. Although slowly, motor disability progresses with time, and relevant genotype-phenotype correlations will help design future clinical trials.
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Affiliation(s)
- Gorka Fernández-Eulate
- Nord/Est/Ile-de-France Neuromuscular Diseases Reference Center, Institut de Myologie, Pitié-Salpêtrière Hospital, APHP, 47-83 Bd de L'Hôpital, 75013, Paris, France.
| | - Girolamo Alfieri
- Nord/Est/Ile-de-France Neuromuscular Diseases Reference Center, Institut de Myologie, Pitié-Salpêtrière Hospital, APHP, 47-83 Bd de L'Hôpital, 75013, Paris, France
- Azienda Ospedaliera Universitaria Sant'Andrea, Rome, Italy
| | - Marco Spinazzi
- Neuromuscular Diseases Reference Center, Neurology Department, CHU Angers, Angers, France
| | | | - Fanny Duval
- Neuromuscular Diseases Reference Center "AOC", Nerve-Muscle Unit, Pellegrin Hospital, CHU Bordeaux, Bordeaux, France
| | - Guilhem Solé
- Neuromuscular Diseases Reference Center "AOC", Nerve-Muscle Unit, Pellegrin Hospital, CHU Bordeaux, Bordeaux, France
| | | | - Sandra Mercier
- Medical Genetics Department, Neuromuscular Diseases Reference Center "AOC", CHU Nantes, Nantes, France
| | - Yann Pereon
- Neuromuscular Diseases Reference Center "AOC", Laboratoire d'Explorations Fonctionnelles, CHU de Nantes, FILNEMUS, Euro-NMD, Nantes, France
| | - Armelle Magot
- Neuromuscular Diseases Reference Center "AOC", Laboratoire d'Explorations Fonctionnelles, CHU de Nantes, FILNEMUS, Euro-NMD, Nantes, France
| | - Antoine Pegat
- Electroneuromyography and Neuromuscular Diseases Unit, PACA-Réunion-Rhône Alpes Neuromuscular Diseases Reference Center, Pierre Wertheimer Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Brigitte Chabrol
- Neuromuscular Diseases and ALS Reference Center, FILNEMUS, CHU La Timone, APHM, Marseille, France
| | - Svetlana Gorokhova
- Medical Genetics Department, CHU La Timone Enfants, APHM, Aix-Marseille University, Inserm, U1251-MMG, Marseille, France
| | - Martin Krahn
- Medical Genetics Department, CHU La Timone Enfants, APHM, Aix-Marseille University, Inserm, U1251-MMG, Marseille, France
| | - Valerie Biancalana
- Diagnostic Genetics Laboratory, CRU Strasbourg, Strasbourg University, Strasbourg, France
| | - Teresinha Evangelista
- Muscle Pathology Unit, Institut de Myologie, Nord/Est/Ile-de-France Neuromuscular Diseases Reference Center, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - Anthony Behin
- Nord/Est/Ile-de-France Neuromuscular Diseases Reference Center, Institut de Myologie, Pitié-Salpêtrière Hospital, APHP, 47-83 Bd de L'Hôpital, 75013, Paris, France
| | - Corinne Metay
- Cardiomyogenetics and Molecular and Cellular Myogenetics Unit, Institut de Myologie, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - Tanya Stojkovic
- Nord/Est/Ile-de-France Neuromuscular Diseases Reference Center, Institut de Myologie, Pitié-Salpêtrière Hospital, APHP, 47-83 Bd de L'Hôpital, 75013, Paris, France
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Bardhan M, Polavarapu K, Baskar D, Preethish-Kumar V, Vengalil S, Nashi S, Ganaraja VH, Sharma D, Kulanthaivelu K, Nandeesh B, Nalini A. Identification of a Novel Intronic Mutation in VMA21 Associated with a Classical Form of X-Linked Myopathy with Autophagy. Glob Med Genet 2024; 11:167-174. [PMID: 38736558 PMCID: PMC11087142 DOI: 10.1055/s-0044-1786815] [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] [Indexed: 05/14/2024] Open
Abstract
Introduction VMA21 -related myopathy is one of the rare forms of slowly progressive myopathy observed in males. Till now, there have been only a handful of reports, mainly from Europe and America, and two reports from India. Method Here, we describe a case of genetically confirmed VMA21 -associated myopathy with clinical, histopathological, and imaging features with a list of known VMA21 mutations. Results A 29-year-old man had the onset of symptoms at 18 years of age with features of proximal lower limb weakness. Muscle magnetic resonance imaging showed the preferential involvement of vasti and adductor magnus. A biopsy of the left quadriceps femoris showed features of autophagic vacuolar myopathy with vacuoles containing granular eosinophilic materials. In targeted next-generation sequencing, hemizygous mutation in the 3' splice site of intron 2 of the VMA21 gene (c.164-7 T > A) was identified and confirmed the diagnosis of X-linked myopathy with excessive autophagy. Conclusion This report expands the phenotypic and genotypic profile of VMA21 -related myopathy, with a yet unreported mutation in India.
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Affiliation(s)
- Mainak Bardhan
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Kiran Polavarapu
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, K1H 5B2, Ontario, Canada
| | - Dipti Baskar
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Veeramani Preethish-Kumar
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Valakunja H. Ganaraja
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Dinesh Sharma
- Deaprtment of Neuroradiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Karthik Kulanthaivelu
- Deaprtment of Neuroradiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - B.N. Nandeesh
- Department of Neuropathology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
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3
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Blanco-Arias P, Medina Martínez I, Arrabal Fernández L, Rivas Infante E, Salmerón Fernández MJ, González Hervás C, Azcón González de Aguilar P, Armengol L, Pedrinaci S, Perin F. Severe congenital X-linked myopathy with excessive autophagy secondary to an apparently synonymous but pathogenic novel variant. Neuromuscul Disord 2023; 33:557-561. [PMID: 37329680 DOI: 10.1016/j.nmd.2023.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 06/19/2023]
Abstract
X-linked myopathy with excessive autophagy is a rare inherited disease characterized by aberrant accumulation of autophagic vacuoles in skeletal muscle. Affected males usually show a slow progression and the heart is characteristically spared. We present four male patients from the same family with an extremely aggressive form of this disease, requiring permanent mechanical ventilation from birth. Ambulation was never achieved. Three died, one in the first hour of life, one at 7 years and one at 17 years, the last death being a consequence of heart failure. Muscle biopsy showed pathognomonic features of the disease in the 4 affected males. Genetic study found a novel synonymous variant in VMA21, c.294C>T (Gly98=). Genotyping was consistent with co-segregation with the phenotype in an X-linked recessive manner. An alteration of the normal splice pattern was confirmed by transcriptome analysis, proving that the apparently synonymous variant was the cause of this extremely severe phenotype.
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Affiliation(s)
| | | | | | - Eloy Rivas Infante
- Anatomical Pathology Department, Virgen del Rocío University Hospital, Sevilla, Spain
| | | | | | | | - Lluis Armengol
- Quantitative Genomic Medicine Laboratories SL, "qGenomics", Esplugues de Llobregat, Barcelona, Spain
| | - Susana Pedrinaci
- Genetic Department, Virgen de las Nieves and San Cecilio University Hospitals, Granada, Spain
| | - Francesca Perin
- Pediatric Cardiology Department, Hospital Universitario Virgen de las Nieves University Hospital, Granada 18014, Spain.
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Pegat A, Streichenberger N, Lacoste N, Hermier M, Menassa R, Coudert L, Theuriet J, Froissart R, Terrone S, Bouhour F, Michel-Calemard L, Schaeffer L, Jacquier A. Novel Intronic Mutation in VMA21 Causing Severe Phenotype of X-Linked Myopathy with Excessive Autophagy-Case Report. Genes (Basel) 2022; 13:genes13122245. [PMID: 36553512 PMCID: PMC9777698 DOI: 10.3390/genes13122245] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/18/2022] [Accepted: 11/26/2022] [Indexed: 12/02/2022] Open
Abstract
X-linked Myopathy with Excessive Autophagy (XMEA) is a rare autophagic vacuolar myopathy caused by mutations in the Vacuolar ATPase assembly factor VMA21 gene; onset usually occurs during childhood and rarely occurs during adulthood. We described a 22-year-old patient with XMEA, whose onset was declared at 11 through gait disorder. He had severe four-limb proximal weakness and amyotrophy, and his proximal muscle MRC score was between 2 and 3/5 in four limbs; creatine kinase levels were elevated (1385 IU/L), and electroneuromyography and muscle MRI were suggestive of myopathy. Muscle biopsy showed abnormalities typical of autophagic vacuolar myopathy. We detected a hemizygous, unreported, intronic, single-nucleotide substitution c.164-20T>A (NM_001017980.4) in intron 2 of the VMA21 gene. Fibroblasts derived from this patient displayed a reduced level of VMA21 transcripts (at 40% of normal) and protein, suggesting a pathogenicity related to an alteration of the splicing efficiency associated with an intron retention. This patient with XMEA displayed a severe phenotype (rapid weakness of upper and lower limbs) due to a new intronic variant of VMA21, related to an alteration in the splicing efficiency associated with intron retention, suggesting that phenotype severity is closely related to the residual expression of the VMA21 protein.
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Affiliation(s)
- Antoine Pegat
- Service ENMG et Pathologies Neuromusculaires, Hôpital Neurologique P. Wertheimer, Hospices Civils de Lyon, 69500 Bron, France
- Pathophysiology and Genetics of Neuron and Muscle, CNRS UMR 5261, INSERM U1315, INMG, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, 69008 Lyon, France
- Correspondence: (A.P.); (A.J.)
| | - Nathalie Streichenberger
- Pathophysiology and Genetics of Neuron and Muscle, CNRS UMR 5261, INSERM U1315, INMG, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, 69008 Lyon, France
- Service d’anatomopathologie, Centre de Biologie et Pathologie Est (CBPE), Hospices Civils de Lyon, 69500 Bron, France
| | - Nicolas Lacoste
- Pathophysiology and Genetics of Neuron and Muscle, CNRS UMR 5261, INSERM U1315, INMG, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, 69008 Lyon, France
| | - Marc Hermier
- Service de Neuroradiologie, Hôpital Neurologique P. Wertheimer, Hospices Civils de Lyon, 69500 Bron, France
| | - Rita Menassa
- Pathophysiology and Genetics of Neuron and Muscle, CNRS UMR 5261, INSERM U1315, INMG, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, 69008 Lyon, France
- Service de Biochimie et Biologie Moléculaire, Centre de Biologie et Pathologie Est (CBPE), Hospices Civils de Lyon, 69500 Bron, France
| | - Laurent Coudert
- Pathophysiology and Genetics of Neuron and Muscle, CNRS UMR 5261, INSERM U1315, INMG, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, 69008 Lyon, France
| | - Julian Theuriet
- Service ENMG et Pathologies Neuromusculaires, Hôpital Neurologique P. Wertheimer, Hospices Civils de Lyon, 69500 Bron, France
- Pathophysiology and Genetics of Neuron and Muscle, CNRS UMR 5261, INSERM U1315, INMG, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, 69008 Lyon, France
| | - Roseline Froissart
- Service de Biochimie et Biologie Moléculaire, Centre de Biologie et Pathologie Est (CBPE), Hospices Civils de Lyon, 69500 Bron, France
| | - Sophie Terrone
- Pathophysiology and Genetics of Neuron and Muscle, CNRS UMR 5261, INSERM U1315, INMG, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, 69008 Lyon, France
| | - Francoise Bouhour
- Service ENMG et Pathologies Neuromusculaires, Hôpital Neurologique P. Wertheimer, Hospices Civils de Lyon, 69500 Bron, France
- Pathophysiology and Genetics of Neuron and Muscle, CNRS UMR 5261, INSERM U1315, INMG, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, 69008 Lyon, France
| | - Laurence Michel-Calemard
- Pathophysiology and Genetics of Neuron and Muscle, CNRS UMR 5261, INSERM U1315, INMG, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, 69008 Lyon, France
- Service de Biochimie et Biologie Moléculaire, Centre de Biologie et Pathologie Est (CBPE), Hospices Civils de Lyon, 69500 Bron, France
| | - Laurent Schaeffer
- Pathophysiology and Genetics of Neuron and Muscle, CNRS UMR 5261, INSERM U1315, INMG, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, 69008 Lyon, France
- Centre de Biotechnologie Cellulaire, CBC Biotec, Hospices Civils de Lyon-Groupement Est, 69500 Bron, France
| | - Arnaud Jacquier
- Pathophysiology and Genetics of Neuron and Muscle, CNRS UMR 5261, INSERM U1315, INMG, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, 69008 Lyon, France
- Centre de Biotechnologie Cellulaire, CBC Biotec, Hospices Civils de Lyon-Groupement Est, 69500 Bron, France
- Correspondence: (A.P.); (A.J.)
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Rajeshwari M, Dhiman N, Chakrabarty B, Gulati S, Shamim U, Faruq M, Suri V, Sharma MC. X-linked Myopathy with Excessive Autophagy - A Rare Cause of Vacuolar Myopathy in Children. Neurol India 2022; 70:1643-1648. [PMID: 36076674 DOI: 10.4103/0028-3886.355110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
X-linked myopathy with excessive autophagy (XMEA) is a rare, recently characterized type of autophagic vacuolar myopathy caused by mutations in the VMA21 gene. It is characterized by slowly progressive weakness restricted to proximal limb muscles and generally has a favorable outcome. The characteristic histological and ultrastructural features distinguish this entity from other mimics, notably Danon disease. XMEA is an under recognized disease and should be considered in the differentials of slowly progressive myopathy in children. Awareness of this rare entity is also important for the pathologists in order to distinguish it from other causes of vacuolar myopathy in view of its favourable prognosis. We report the first genetically confirmed case of XMEA from India in an 8-year-old boy which was diagnosed based on the characteristic light microscopic and ultrastructural findings on muscle biopsy and subsequently confirmed by mutation analysis. The differential diagnostic considerations are also discussed.
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Affiliation(s)
- Madhu Rajeshwari
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Neena Dhiman
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Biswaroop Chakrabarty
- Department of Pediatrics (Child Neurology Division), All India Institute of Medical Sciences, New Delhi, India
| | - Sheffali Gulati
- Department of Pediatrics (Child Neurology Division), All India Institute of Medical Sciences, New Delhi, India
| | - Uzma Shamim
- Department of Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Mohammed Faruq
- Department of Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Vaishali Suri
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar Chand Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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6
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X-linked myopathy with excessive autophagy: First report of an Israeli family presenting with late onset lower limb girdle weakness. Neuromuscul Disord 2021; 31:854-858. [PMID: 34404574 DOI: 10.1016/j.nmd.2021.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 11/20/2022]
Abstract
X-linked myopathy with excessive autophagy (XMEA) is a rare disorder characterized by slow progressive muscle weakness and distinctive pathology of excessive autophagic vacuoles on muscle biopsy. Here we report on five patients, in a single family, with proximal lower limb weakness. The proband, a 25-year-old man, presented with 5 years of progressive lower limbs proximal muscle weakness. His maternal grandfather and three of his maternal male cousins had similar clinical findings and were initially suspected to have Becker muscular dystrophy. Muscle biopsy in two affected family members demonstrated autophagic myopathy, and guided the genetic investigations to the identification of a pathogenic mutation, c.272G > C in the VMA21 gene, known to cause XMEA [1]. To the best of our knowledge this is the first identified Israeli Jewish family afflicted by XMEA.
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7
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Xia Q, Huang X, Huang J, Zheng Y, March ME, Li J, Wei Y. The Role of Autophagy in Skeletal Muscle Diseases. Front Physiol 2021; 12:638983. [PMID: 33841177 PMCID: PMC8027491 DOI: 10.3389/fphys.2021.638983] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/22/2021] [Indexed: 12/13/2022] Open
Abstract
Skeletal muscle is the most abundant type of tissue in human body, being involved in diverse activities and maintaining a finely tuned metabolic balance. Autophagy, characterized by the autophagosome–lysosome system with the involvement of evolutionarily conserved autophagy-related genes, is an important catabolic process and plays an essential role in energy generation and consumption, as well as substance turnover processes in skeletal muscles. Autophagy in skeletal muscles is finely tuned under the tight regulation of diverse signaling pathways, and the autophagy pathway has cross-talk with other pathways to form feedback loops under physiological conditions and metabolic stress. Altered autophagy activity characterized by either increased formation of autophagosomes or inhibition of lysosome-autophagosome fusion can lead to pathological cascades, and mutations in autophagy genes and deregulation of autophagy pathways have been identified as one of the major causes for a variety of skeleton muscle disorders. The advancement of multi-omics techniques enables further understanding of the molecular and biochemical mechanisms underlying the role of autophagy in skeletal muscle disorders, which may yield novel therapeutic targets for these disorders.
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Affiliation(s)
- Qianghua Xia
- Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China
| | - Xubo Huang
- Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China
| | - Jieru Huang
- Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China
| | - Yongfeng Zheng
- Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China
| | - Michael E March
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Jin Li
- Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China
| | - Yongjie Wei
- Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China
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8
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Cannata Serio M, Graham LA, Ashikov A, Larsen LE, Raymond K, Timal S, Le Meur G, Ryan M, Czarnowska E, Jansen JC, He M, Ficicioglu C, Pichurin P, Hasadsri L, Minassian B, Rugierri A, Kalimo H, Ríos‐Ocampo WA, Gilissen C, Rodenburg R, Jonker JW, Holleboom AG, Morava E, Veltman JA, Socha P, Stevens TH, Simons M, Lefeber DJ. Mutations in the V-ATPase Assembly Factor VMA21 Cause a Congenital Disorder of Glycosylation With Autophagic Liver Disease. Hepatology 2020; 72:1968-1986. [PMID: 32145091 PMCID: PMC7483274 DOI: 10.1002/hep.31218] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 02/14/2020] [Accepted: 02/14/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Vacuolar H+-ATP complex (V-ATPase) is a multisubunit protein complex required for acidification of intracellular compartments. At least five different factors are known to be essential for its assembly in the endoplasmic reticulum (ER). Genetic defects in four of these V-ATPase assembly factors show overlapping clinical features, including steatotic liver disease and mild hypercholesterolemia. An exception is the assembly factor vacuolar ATPase assembly integral membrane protein (VMA21), whose X-linked mutations lead to autophagic myopathy. APPROACH AND RESULTS Here, we report pathogenic variants in VMA21 in male patients with abnormal protein glycosylation that result in mild cholestasis, chronic elevation of aminotransferases, elevation of (low-density lipoprotein) cholesterol and steatosis in hepatocytes. We also show that the VMA21 variants lead to V-ATPase misassembly and dysfunction. As a consequence, lysosomal acidification and degradation of phagocytosed materials are impaired, causing lipid droplet (LD) accumulation in autolysosomes. Moreover, VMA21 deficiency triggers ER stress and sequestration of unesterified cholesterol in lysosomes, thereby activating the sterol response element-binding protein-mediated cholesterol synthesis pathways. CONCLUSIONS Together, our data suggest that impaired lipophagy, ER stress, and increased cholesterol synthesis lead to LD accumulation and hepatic steatosis. V-ATPase assembly defects are thus a form of hereditary liver disease with implications for the pathogenesis of nonalcoholic fatty liver disease.
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Affiliation(s)
- Magda Cannata Serio
- Laboratory of Epithelial Biology and DiseaseImagine InstituteUniversité Paris Descartes‐Sorbonne Paris CitéParisFrance,RBIV RNA Biology of Influenza Viruses UnitInstitut PasteurCNRS, UMR3569ParisFrance
| | - Laurie A. Graham
- Department of Chemistry and BiochemistryInstitute of Molecular BiologyUniversity of OregonEugeneOR
| | - Angel Ashikov
- Department of NeurologyDonders Institute for BrainCognition and BehaviourRadboud University Medical CenterNijmegenthe Netherlands,Department of Laboratory MedicineTranslational Metabolic LaboratoryRadboud Institute for Molecular Life SciencesRadboud University Medical CenterNijmegenthe Netherlands
| | - Lars Elmann Larsen
- Department of Laboratory Medicine and PathologyMayo College of MedicineRochesterMN,Department of Chemistry and BiochemistryInstitute of Molecular BiologyUniversity of OregonEugeneOR
| | - Kimiyo Raymond
- Department of PathologyThe Children’s Memorial Health InstituteWarsawPoland
| | - Sharita Timal
- Department of NeurologyDonders Institute for BrainCognition and BehaviourRadboud University Medical CenterNijmegenthe Netherlands,Department of Laboratory MedicineTranslational Metabolic LaboratoryRadboud Institute for Molecular Life SciencesRadboud University Medical CenterNijmegenthe Netherlands
| | - Gwenn Le Meur
- Laboratory of Epithelial Biology and DiseaseImagine InstituteUniversité Paris Descartes‐Sorbonne Paris CitéParisFrance
| | - Margret Ryan
- Department of Gastroenterology and HepatologyTranslational Metabolic LaboratoryRadboud Institute for Molecular Life SciencesRadboud University Medical CenterNijmegenthe Netherlands
| | - Elzbieta Czarnowska
- Department of Pathology and Laboratory MedicineUniversity of PennsylvaniaPerelman School of MedicinePhiladelphiaPA
| | - Jos C. Jansen
- Division of Laboratory MedicineThe Children’s Hospital of PhiladelphiaPhiladelphiaPA
| | - Miao He
- Division of Human GeneticsDepartment of PediatricsThe Children’s Hospital of PhiladelphiaPhiladelphiaPA,Department of Clinical GenomicsCollege of MedicineMayo ClinicRochesterMN
| | - Can Ficicioglu
- Division of Laboratory GeneticsDepartment of Laboratory Medicine and PathologyMayo ClinicRochesterMN
| | - Pavel Pichurin
- Department of Human GeneticsRadboud Institute for Molecular Life SciencesRadboud University Medical CenterNijmegenthe Netherlands
| | - Linda Hasadsri
- Department of PediatricsRadboudumc Amalia Childrens HospitalRadboud Center for Mitochondrial MedicineNijmegenthe Netherlands
| | - Berge Minassian
- Department of PediatricsUniversity of Texas SouthwesternDallasTXUSA
| | - Alessandra Rugierri
- Department of Neuroimmunology and Neuromuscular DiseasesFondazione IRCCS Neurological Institute Carlo BestaMilanItaly,Department of Molecular and Translation MedicineUnit of Biology and Genetics, University of BresciaBresciaItaly
| | - Hannu Kalimo
- Department of Pathology, Haartman InstituteUniversity of Helsinki, FIN–00014HelsinkiFinland
| | | | | | - Richard Rodenburg
- Department of Human GeneticsDonders Centre for NeuroscienceRadboud University Medical CenterNijmegenthe Netherlands
| | - Johan W. Jonker
- Department of Laboratory Medicine and PathologyMayo College of MedicineRochesterMN
| | - Adriaan G. Holleboom
- Department of Chemistry and BiochemistryInstitute of Molecular BiologyUniversity of OregonEugeneOR
| | - Eva Morava
- Institute of Genetic MedicineInternational Centre for LifeNewcastle UniversityNewcastle upon TyneUnited Kingdom
| | - Joris A. Veltman
- Department of GastroenterologyFeeding Disorders and PediatricsChildren’s Memorial Health InstituteWarsawPoland,Section of Molecular Metabolism and NutritionDepartment of PediatricsUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | - Piotr Socha
- Department of Experimental Vascular MedicineAmsterdam University Medical CentersLocation AMCAmsterdamthe Netherlands
| | - Tom H. Stevens
- Department of Gastroenterology and HepatologyTranslational Metabolic LaboratoryRadboud Institute for Molecular Life SciencesRadboud University Medical CenterNijmegenthe Netherlands
| | - Matias Simons
- Laboratory of Epithelial Biology and DiseaseImagine InstituteUniversité Paris Descartes‐Sorbonne Paris CitéParisFrance,Institute of Human GeneticsUniversity Hospital HeidelbergHeidelbergGermany
| | - Dirk J. Lefeber
- Department of NeurologyDonders Institute for BrainCognition and BehaviourRadboud University Medical CenterNijmegenthe Netherlands,Department of Laboratory MedicineTranslational Metabolic LaboratoryRadboud Institute for Molecular Life SciencesRadboud University Medical CenterNijmegenthe Netherlands
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9
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Update Review about Metabolic Myopathies. Life (Basel) 2020; 10:life10040043. [PMID: 32316520 PMCID: PMC7235760 DOI: 10.3390/life10040043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 12/13/2022] Open
Abstract
The aim of this review is to summarize and discuss recent findings and new insights in the etiology and phenotype of metabolic myopathies. The review relies on a systematic literature review of recent publications. Metabolic myopathies are a heterogeneous group of disorders characterized by mostly inherited defects of enzymatic pathways involved in muscle cell metabolism. Metabolic myopathies present with either permanent (fixed) or episodic abnormalities, such as weakness, wasting, exercise-intolerance, myalgia, or an increase of muscle breakdown products (creatine-kinase, myoglobin) during exercise. Though limb and respiratory muscles are most frequently affected, facial, extra-ocular, and axial muscles may be occasionally also involved. Age at onset and prognosis vary considerably. There are multiple disease mechanisms and the pathophysiology is complex. Genes most recently related to metabolic myopathy include PGM1, GYG1, RBCK1, VMA21, MTO1, KARS, and ISCA2. The number of metabolic myopathies is steadily increasing. There is limited evidence from the literature that could guide diagnosis and treatment of metabolic myopathies. Treatment is limited to mainly non-invasive or invasive symptomatic measures. In conclusion, the field of metabolic myopathies is evolving with the more widespread availability and application of next generation sequencing technologies worldwide. This will broaden the knowledge about pathophysiology and putative therapeutic strategies for this group of neuromuscular disorders.
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10
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Cenacchi G, Papa V, Pegoraro V, Marozzo R, Fanin M, Angelini C. Review: Danon disease: Review of natural history and recent advances. Neuropathol Appl Neurobiol 2019; 46:303-322. [DOI: 10.1111/nan.12587] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 11/02/2019] [Indexed: 12/16/2022]
Affiliation(s)
- G. Cenacchi
- Department of Biomedical and Neuromotor Sciences “Alma Mater” University of Bologna Bologna Italy
| | - V. Papa
- Department of Biomedical and Neuromotor Sciences “Alma Mater” University of Bologna Bologna Italy
| | - V. Pegoraro
- Neurobiology Laboratory IRCCS San Camillo Hospital VeniceItaly
| | - R. Marozzo
- Neurobiology Laboratory IRCCS San Camillo Hospital VeniceItaly
| | - M. Fanin
- Department of Neurosciences University of Padova Padova Italy
| | - C. Angelini
- Neuromuscular Department IRCCS San Camillo Hospital Venice Italy
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11
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Fischer N, Preuße C, Radke J, Pehl D, Allenbach Y, Schneider U, Feist E, von Casteleyn V, Hahn K, Ruck T, Meuth SG, Goebel HH, Graf R, Mammen A, Benveniste O, Stenzel W. Sequestosome-1 (p62) expression reveals chaperone-assisted selective autophagy in immune-mediated necrotizing myopathies. Brain Pathol 2019; 30:261-271. [PMID: 31376301 PMCID: PMC8018061 DOI: 10.1111/bpa.12772] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/26/2019] [Indexed: 12/21/2022] Open
Abstract
Diffuse myofiber necrosis in the context of inflammatory myopathy is the hallmark of immune‐mediated necrotizing myopathy (IMNM). We have previously shown that skeletal muscle fibers of IMNM patients may display nonrimmed vacuoles and sarcoplasmic irregularities. The dysfunctional chaperone activity has been linked to the defective assembly of skeletal muscle proteins and their degradation via lysosomes, autophagy and the proteasomal machinery. This study was undertaken to highlight a chaperone‐assisted selective autophagy (CASA) pathway, functionally involved in protein homeostasis, cell stress and the immune response in skeletal muscle of IMNM patients. Skeletal muscle biopsies from 54 IMNM patients were analyzed by immunostaining, as well as by qPCR. Eight biopsies of sIBM patients served as pathological controls, and eight biopsies of nondisease control subjects were included. Alteration of autophagy was detectable in all IMNM biopsy samples highlighted via a diffuse sarcoplasmic staining pattern by p62 and LC3 independent of vacuoles. This pattern was at variance with the coarse focal staining pattern mostly confined to rimmed vacuoles in sIBM. Colocalization of p62 with the chaperone proteins HSP70 and αB‐crystalline points to the specific targeting of misfolded proteins to the CASA machinery. Bcl2‐associated athanogene 3 (BAG3) positivity of these fibers emphasizes the selectivity of autophagy processes and these fibers also express MHC class I sarcolemma. Expression of genes involved in autophagy and endoplasmic reticulum (ER) stress pathways studied here is significantly upregulated in IMNM. We highlight that vacuoles without sarcolemmal features may arise in IMNM muscle biopsies, and they must not be confounded with sIBM‐specific vacuoles. Further, we show the activation of selective autophagy and emphasize the role of chaperones in this context. CASA occurs in IMNM muscle, and specific molecular pathways of autophagy differ from the ones in sIBM, with p62 as a unique identifier of this process.
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Affiliation(s)
- Norina Fischer
- Department of Neuropathology, Charité - Universitätsmedizin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Corinna Preuße
- Department of Neuropathology, Charité - Universitätsmedizin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Josefine Radke
- Department of Neuropathology, Charité - Universitätsmedizin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Debora Pehl
- Oxford University Hospitals Foundation Trust, Neuropathology & Ocular Pathology Department, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Yves Allenbach
- Assistance Public-Hôpitaux de Paris, Sorbonne-Université, INSERM, UMR974, Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Paris, France
| | - Udo Schneider
- Department of Rheumatology, Charité - Universitätsmedizin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Eugen Feist
- Department of Rheumatology, Charité - Universitätsmedizin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Vincent von Casteleyn
- Department of Rheumatology, Charité - Universitätsmedizin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Katrin Hahn
- Department of Neurology, Charité - Universitätsmedizin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Tobias Ruck
- Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Münster, Germany
| | - Sven G Meuth
- Department of Neurology with Institute for Translational Neurology, University Hospital Münster, Münster, Germany
| | - Hans-Hilmar Goebel
- Department of Neuropathology, Charité - Universitätsmedizin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Rose Graf
- National Institutes of Health, 9000 Rockville Pike, Building 50, Room 1505, Bethesda, MD, 20892, USA
| | - Andrew Mammen
- National Institutes of Health, 9000 Rockville Pike, Building 50, Room 1505, Bethesda, MD, 20892, USA
| | - Olivier Benveniste
- Assistance Public-Hôpitaux de Paris, Sorbonne-Université, INSERM, UMR974, Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, Paris, France
| | - Werner Stenzel
- Department of Neuropathology, Charité - Universitätsmedizin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany.,Leibniz ScienceCampus Chronic Inflammation, Berlin, Germany
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12
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Congenital autophagic vacuolar myopathy is allelic to X-linked myopathy with excessive autophagy. Neurology 2019; 93:371. [DOI: 10.1212/wnl.0000000000007478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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13
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Konialis C, Assimakopoulos E, Hagnefelt B, Karapanou S, Sotiriadis A, Pangalos C. Prenatal diagnosis of X-linked myopathy associated with a VMA21 gene mutation afforded through a novel targeted exome sequencing strategy applied in fetuses with abnormal ultrasound findings. Clin Case Rep 2017; 5:308-311. [PMID: 28265396 PMCID: PMC5331204 DOI: 10.1002/ccr3.822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/13/2016] [Accepted: 12/25/2016] [Indexed: 01/23/2023] Open
Abstract
Fetal malformations detected through routine prenatal ultrasound examination comprise a heterogeneous group potentially associated with genetic disorders where the underlying cause is difficult to establish. We present the prenatal diagnosis of a rare X‐linked myopathy involving a new VMA21 gene mutation, detected through a novel prenatal exome sequencing‐based approach.
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Affiliation(s)
- Christopher Konialis
- InterGenetics - Diagnostic Genetics Centre Athens 11526 Greece; Genomis Ltd, Lynton House London WC1H 9BQ UK
| | - Efstratios Assimakopoulos
- 2nd Department of Obstetrics and Gynecology Ippokrateion General Hospital Aristotle University of Thessaloniki Thessaloniki Greece
| | - Birgitta Hagnefelt
- InterGenetics - Diagnostic Genetics Centre Athens 11526 Greece; Genomis Ltd, Lynton House London WC1H 9BQ UK
| | | | - Alexandros Sotiriadis
- 2nd Department of Obstetrics and Gynecology Ippokrateion General Hospital Aristotle University of Thessaloniki Thessaloniki Greece
| | - Constantinos Pangalos
- InterGenetics - Diagnostic Genetics Centre Athens 11526 Greece; Genomis Ltd, Lynton House London WC1H 9BQ UK
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14
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Munteanu I, Kalimo H, Saraste A, Nishino I, Minassian BA. Cardiac autophagic vacuolation in severe X-linked myopathy with excessive autophagy. Neuromuscul Disord 2017; 27:185-187. [DOI: 10.1016/j.nmd.2016.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 08/19/2016] [Accepted: 10/17/2016] [Indexed: 12/24/2022]
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15
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Ackerley CA, Cooper MA, Munoz DG, Minassian BA. Fatal hepatic failure and pontine and extrapontine myelinolysis in XMEA. Neurology 2016; 87:1417-9. [PMID: 27566744 DOI: 10.1212/wnl.0000000000003155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 06/09/2016] [Indexed: 11/15/2022] Open
Affiliation(s)
- Cameron A Ackerley
- From the Division of Pathology (C.A.A.), Department of Pathology and Laboratory Medicine, The Hospital for Sick Children, Toronto; Division of Gastroenterology (M.A.C.), Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto; Division of Pathology (D.G.M.), Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital and University of Toronto; and Division of Neurology (B.A.M.), Department of Paediatrics and Program in Genetics and Genome Biology, The Hospital for Sick Children, and the Institute of Medical Science, University of Toronto, Canada
| | - Mary Anne Cooper
- From the Division of Pathology (C.A.A.), Department of Pathology and Laboratory Medicine, The Hospital for Sick Children, Toronto; Division of Gastroenterology (M.A.C.), Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto; Division of Pathology (D.G.M.), Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital and University of Toronto; and Division of Neurology (B.A.M.), Department of Paediatrics and Program in Genetics and Genome Biology, The Hospital for Sick Children, and the Institute of Medical Science, University of Toronto, Canada
| | - David G Munoz
- From the Division of Pathology (C.A.A.), Department of Pathology and Laboratory Medicine, The Hospital for Sick Children, Toronto; Division of Gastroenterology (M.A.C.), Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto; Division of Pathology (D.G.M.), Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital and University of Toronto; and Division of Neurology (B.A.M.), Department of Paediatrics and Program in Genetics and Genome Biology, The Hospital for Sick Children, and the Institute of Medical Science, University of Toronto, Canada
| | - Berge A Minassian
- From the Division of Pathology (C.A.A.), Department of Pathology and Laboratory Medicine, The Hospital for Sick Children, Toronto; Division of Gastroenterology (M.A.C.), Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto; Division of Pathology (D.G.M.), Department of Laboratory Medicine and Pathobiology, St. Michael's Hospital and University of Toronto; and Division of Neurology (B.A.M.), Department of Paediatrics and Program in Genetics and Genome Biology, The Hospital for Sick Children, and the Institute of Medical Science, University of Toronto, Canada.
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16
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Dowling JJ, Moore SA, Kalimo H, Minassian BA. X-linked myopathy with excessive autophagy: a failure of self-eating. Acta Neuropathol 2015; 129:383-90. [PMID: 25644398 DOI: 10.1007/s00401-015-1393-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 01/22/2015] [Indexed: 12/15/2022]
Abstract
Autophagic vacuolar myopathies (AVMs) are a group of disorders united by shared histopathological features on muscle biopsy that include the aberrant accumulation of autophagic vacuoles. The classic conditions that compose the AVMs include Pompe Disease, Danon Disease and X-linked myopathy with excessive autophagy (XMEA). Other disorders, including acquired myopathies like chloroquine toxicity, also have features of an autophagic myopathy. This review is focused on XMEA, a myopathy with onset of slowly progressive proximal weakness and elevated serum creatine kinase (2× to 20× normal) typically in the first decade of life. However, both late-adult onset and severe, sometimes lethal, neonatal cases also occur. Skeletal muscle pathology is characterized by numerous cytoplasmic autophagic vacuoles, complex muscle fiber splitting with internalization of capillaries, and complement C5b-9 deposition within vacuoles and along the sarcolemma. The autophagic vacuoles have sarcolemmal features. Mutations in the VMA21 gene at Xq28 cause XMEA by reducing the activity of lysosomal hydrolases. The VMA21 protein regulates the assembly of the V-ATPase required to acidify the lysosome. Increased lysosomal pH and poor degradation of cellular debris may secondarily induce autophagy, the net effect being accumulation of autophagolysosomes. The relationship of XMEA to other lysosomal disorders of muscle and potential therapeutic interventions for XMEA are discussed.
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Affiliation(s)
- James J Dowling
- Division of Neurology and Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON, M5G 0A4, Canada,
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